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MS |! 2 |! Quiz |! 7 |! with |! precise |! detailed |!
solutions
A |! nurse |! is |! assessing |! a |! patient |! with |! renal |! impairment. |! Which |! facial |! characteristic |! is |! a |! sign |! of |! fluid |! retention? a. |! Broken |! blood |! vessels |! around |! the |! nose |! b. |! Periorbital |! edema |! c. |! Rash |! on |! cheeks |! and |! neck |! d. |! Facial |! twitching |! - |! Correct |! answer |! ✔ANS: |! B |! Periorbital |! edema |! is |! a |! sign |! of |! fluid |! retention. |! Because |! the |! patient |! with |! renal |! impairment |! has |! generalized |! edema, |! this |! facial |! feature |! is |! extremely |! significant |! in |! assessing |! edema. What |! laboratory |! value |! change |! should |! indicate |! to |! a |! nurse |! that |! a |! patient |! with |! renal |! failure |! has |! entered |! the |! oliguric |! stage? |! a. |! Blood |! urea |! nitrogen |! (BUN) |! level |! rises. |! b. |! Serum |! calcium |! increases. |! c. |! Blood |! volume |! decreases. |! d. |! Urine |! osmolality |! increases |! - |! Correct |! answer |! ✔ANS: |! A |!
In |! the |! oliguric |! stage |! of |! renal |! failure, |! the |! urine |! output |! decreases |! to |! less |! than |! 400 |! mL/day; |! the |! BUN, |! creatinine, |! and |! potassium |! increase; |! and |! the |! serum |! calcium |! decreases. |! The |! patient |! becomes |! hypervolemic |! as |! the |! urine |! osmolality |! increases. What |! should |! nursing |! care |! focus |! on |! when |! caring |! for |! a |! patient |! with |! a |! ureteral |! catheter |! in |! place |! after |! the |! removal |! of |! a |! kidney |! stone? |! a. |! Irrigating |! the |! catheter |! regularly |! b. |! Assessing |! for |! patency |! c. |! Including |! ureteral |! output |! with |! the |! bladder |! output |! d. |! Early |! ambulation |! - |! Correct |! answer |! ✔ANS: |! B |! Patency |! of |! the |! ureteral |! catheter |! is |! essential |! to |! prevent |! injury |! to |! the |! kidney. |! The |! patient |! is |! on |! bed |! rest |! until |! the |! ureteral |! catheter |! is |! removed. |! The |! output |! from |! the |! ureteral |! catheter |! is |! measured |! and |! recorded |! separately, |! and |! irrigation, |! if |! performed, |! is |! not |! done |! on |! a |! regular |! schedule |! and |! is |! not |! more |! than |! 5 |! mL. What |! is |! true |! about |! the |! urine |! osmolality |! when |! the |! kidney |! is |! adequately |! functioning? |! a. |! Equal |! to |! the |! osmolality |! of |! the |! serum |! b. |! Approximately |! half |! of |! the |! serum |! c. |! In |! a |! ratio |! of |! 10:1 |! with |! the |! serum |! d. |! Equal |! to |! the |! excretion |! of |! urea |! - |! Correct |! answer |! ✔ANS: |! A |!
The |! bowel |! is |! manipulated |! during |! urinary |! diversion |! surgeries |! and |! frequently |! leads |! to |! the patient |! with |! a |! paralytic |! ileus. A |! nurse |! is |! performing |! frequent |! catheterizations |! for |! residual |! urine. |! What |! causes |! the |! greatest |! concern |! for |! the |! nurse? a. |! Introduction |! of |! pathogens |! into |! the |! bladder |! b. |! Frequent |! genital |! exposure |! of |! the |! patient |! c. |! Presence |! of |! the |! indwelling |! catheter |! d. |! Causing |! urethral |! erosion |! - |! Correct |! answer |! ✔ANS: |! A |! The |! frequency |! of |! introducing |! a |! catheter |! into |! the |! bladder |! offers |! a |! very |! real |! risk |! of |! infection. A |! patient |! has |! a |! nephrostomy |! tube |! that |! has |! been |! inserted |! because |! of |! an |! obstruction |! in |! the |! ureter. |! What |! special |! precautions |! in |! the |! care |! of |! the |! nephrostomy |! tube |! should |! the |! nurse |! implement? |! a. |! Clamping |! every |! 2 |! hours |! to |! allow |! expansion |! of |! the |! kidney |! pelvis |! b. |! Instilling |! no |! more |! than |! 50 |! mL |! of |! sterile |! water |! if |! sterile |! irrigations |! are |! ordered |! c. |! Being |! certain |! the |! tube |! is |! connected, |! not |! kinked, |! or |! not |! clamped |! to |! ensure |! that |! it |! continually |! drains |! d. |! Leaving |! the |! nephrostomy |! site |! open |! to |! air |! - |! Correct |! answer |! ✔ANS: |! C
Because |! of |! the |! small |! capacity |! of |! the |! renal |! pelvis, |! drainage |! must |! be |! continuous; |! otherwise, |! the urine |! may |! back |! up |! and |! destroy |! the |! kidney. Which |! statement |! by |! a |! patient |! on |! dialysis, |! taking |! gentamicin |! (Garamycin), |! should |! cause |! the |! nurse |! the |! most |! concern? |! a. |! "I |! have |! a |! horrible |! headache." |! b. |! "Speak |! up! |! I |! can't |! hear |! you." |! c. |! "I've |! had |! diarrhea |! once |! or |! twice |! today." |! d. |! "I'm |! thirsty. |! I |! can't |! get |! enough |! water." |! - |! Correct |! answer |! ✔ANS: |! B |! Garamycin |! is |! ototoxic. |! Indication |! of |! hearing |! impairment |! suggests |! drug |! toxicity. Erythropoietin |! is |! a |! hormone |! produced |! by |! the |! kidney. |! What |! will |! a |! deficiency |! of |! erythropoietin |! in |! a |! patient |! in |! chronic |! renal |! failure |! result |! in? |! a. |! Diminished |! immunologic |! function |! with |! fewer |! white |! blood |! cells |! b. |! Elevated |! lipid |! levels |! in |! the |! bloodstream, |! contributing |! to |! accelerated |! atherosclerosis |! c. |! Anemia |! as |! a |! result |! of |! the |! diminished |! number |! of |! red |! blood |! cells |! being |! produced |! d. |! Hypertension |! as |! a |! result |! of |! the |! increased, |! concentrated |! blood |! volume |! - |! Correct |! answer |! ✔ANS: |! C |!
e. |! Keep |! the |! drainage |! system |! open |! - |! Correct |! answer |! ✔ANS: |! A, |! B, |! D |! Keeping |! the |! bag |! below |! the |! level |! of |! the |! bed, |! providing |! perineal |! care |! twice |! daily, |! and |! using |! Standard |! Precautions |! will |! assist |! in |! decreasing |! infection |! risk. |! Tubing |! is |! only |! flushed |! with |! a |! physician's |! order |! if |! required. |! The |! drainage |! system |! should |! be |! closed. A |! nurse |! reads |! the |! serum |! calcium |! laboratory |! report |! of |! a |! patient |! as |! 4.2 |! mEq/L. |! Which |! symptoms |! should |! the |! nurse |! anticipate |! that |! the |! patient |! might |! exhibit? |! (Select |! all |! that |! apply.) |! a. |! Irritability |! b. |! Tingling |! sensations |! in |! limbs |! c. |! Tetany |! d. |! Nausea |! e. |! Visual |! disturbances |! - |! Correct |! answer |! ✔ANS: |! A, |! B, |! C Symptoms |! of |! hypocalcemia |! include |! irritability, |! tingling |! sensations, |! tetany, |! muscle |! twitching, and |! muscle |! contractions. A |! patient |! comes |! to |! the |! medical |! clinic |! with |! complaints |! of |! urgency, |! frequency, |! pain |! in |! the |! area |! of |! the |! symphysis |! pubis, |! and |! dark |! cloudy |! urine. |! What |! should |! the |! nurse |! suspect |! that |! this |! patient |! has? |! a. |! Urinary |! calculi, |! probably |! located |! in |! the |! ureter |! b. |! Kidney |! infection, |! most |! likely |! pyelonephritis |!
c. |! Cystitis, |! probably |! from |! bacterial |! contamination |! d. |! Interstitial |! cystitis |! (although |! rare |! in |! a |! male |! patient) |! - |! Correct |! answer |! ✔ANS: |! C |! Cystitis |! causes |! urgency, |! dysuria, |! and |! pain |! behind |! the |! symphysis |! pubis. |! Cystitis |! is |! usually |! caused |! by |! bacterial |! infection. A |! patient |! who |! has |! cystitis |! has |! been |! told |! to |! drink |! at |! least |! 30 |! mL |! for |! each |! kilogram |! of |! body |! weight. |! Her |! weight |! is |! 154 |! lb. |! How |! many |! mL/day |! should |! the |! nurse |! instruct |! the |! patient |! to |! drink? |! a. |! 1500 |! b. |! 2100 |! c. |! 2700 |! d. |! 3100 |! - |! Correct |! answer |! ✔ANS: |! B |! 154 |! lb |! ÷ |! 2.2 |! lb/kg |! = |! 70 |! kg; |! 70 |! kg |! 30 |! mL |! = |! 2100 |! mL. A |! home |! health |! patient |! diagnosed |! with |! cystitis |! has |! been |! prescribed |! the |! medication |! phenazopyridine |! (Pyridium). |! When |! providing |! patient |! teaching, |! what |! should |! the |! nurse |! caution |! the |! patient |! about? |! a. |! Staying |! out |! of |! the |! heat |! b. |! Nausea |! c. |! Staining |! of |! clothing |!
d. |! Recent |! wound |! infection |! - |! Correct |! answer |! ✔ANS: |! B |! The |! cause |! is |! an |! upper |! respiratory |! infection |! caused |! by |! a |! beta-hemolytic |! Streptococcus. A |! nurse |! is |! caring |! for |! a |! patient |! with |! acute |! glomerulonephritis. |! What |! should |! the |! nurse |! be |! aware |! that |! the |! inflammation |! of |! the |! capillary |! loops |! in |! the |! glomeruli |! will |! lead |! to? |! a. |! Moderate |! to |! high |! blood |! pressure |! b. |! Low |! blood |! volume |! with |! polyuria |! c. |! Irritability |! and |! hyperactivity |! d. |! Low |! levels |! of |! BUN |! and |! creatinine |! - |! Correct |! answer |! ✔ANS: |! A |! The |! inflammatory |! process |! in |! the |! glomeruli |! decreases |! the |! filtration |! rate, |! and |! the |! blood |! volume |! increases, |! raising |! the |! patient's |! blood |! pressure. A |! 16-year-old |! patient |! with |! acute |! glomerulonephritis |! complains |! of |! boredom |! with |! bed |! rest |! and |! asks |! when |! he |! can |! become |! more |! active. |! He |! asks, |! "What |! has |! to |! happen |! for |! me |! to |! get |! off |! of |! bed |! rest?" |! What |! is |! the |! most |! accurate |! statement |! by |! the |! nurse? |! a. |! Dialysis |! starts. |! b. |! The |! antibiotic |! protocol |! is |! completed. |! c. |! Potassium |! levels |! are |! normal. |! d. |! Blood |! pressure |! drops |! to |! normal |! levels. |! - |! Correct |! answer |! ✔ANS: |! D |!
Bed |! rest, |! when |! ordered, |! is |! for |! the |! protection |! of |! the |! patient |! because |! of |! high |! blood |! pressure. |! Bed |! rest |! will |! continue |! until |! the |! treatment |! causes |! diuresis |! and |! a |! drop |! in |! the |! blood |! pressure. What |! discharge |! teaching |! is |! appropriate |! for |! the |! nurse |! to |! provide |! to |! a |! patient |! who |! has |! had |! a |! lithotripsy? |! a. |! Check |! for |! edema |! of |! the |! legs |! and |! ankles. |! b. |! Watch |! for |! stone |! debris |! in |! the |! urine |! in |! 1 |! to |! 4 |! weeks. |! c. |! Decrease |! fluid |! intake |! to |! 1000 |! mL/day. |! d. |! Remain |! on |! restricted |! activity |! for |! a |! week. |! - |! Correct |! answer |! ✔ANS: |! B |! The |! stones |! that |! have |! shattered |! with |! the |! sound |! waves |! will |! show |! up |! as |! debris |! in |! 1 |! to |! 4 |! weeks. |! Fluid |! intake |! is |! encouraged, |! and |! activity |! is |! resumed |! the |! next |! day. |! Edema |! is |! not |! a |! concern. Which |! outcome |! is |! most |! necessary |! for |! a |! patient |! diagnosed |! with |! renal |! calculi? |! a. |! Patient |! states |! an |! awareness |! of |! signs |! and |! symptoms |! of |! kidney |! stones |! and |! knows |! where |! to |! find |! pain |! relief. |! b. |! Patient |! will |! measure |! intake |! and |! output |! so |! that |! they |! will |! be |! approximately |! equal. |! c. |! Patient |! will |! avoid |! infections |! and |! situations |! that |! would |! increase |! stress. |!
c. |! Increases |! the |! appetite |! d. |! Corrects |! the |! pH |! of |! the |! bowel |! - |! Correct |! answer |! ✔ANS: |! B |! Amphojel |! binds |! phosphorus, |! which |! increases |! the |! serum |! calcium |! level |! and |! decreases |! hypocalcemia. Which |! statement |! by |! a |! patient |! on |! dialysis, |! taking |! gentamicin |! (Garamycin), |! should |! cause |! the |! nurse |! the |! most |! concern? |! a. |! "I |! have |! a |! horrible |! headache." b. |! "Speak |! up! |! I |! can't |! hear |! you." |! c. |! "I've |! had |! diarrhea |! once |! or |! twice |! today." |! d. |! "I'm |! thirsty. |! I |! can't |! get |! enough |! water. |! - |! Correct |! answer |! ✔ANS: |! B |! Garamycin |! is |! ototoxic. |! Indication |! of |! hearing |! impairment |! suggests |! drug |! toxicity. A |! family |! member |! of |! a |! patient |! who |! has |! returned |! to |! the |! special |! unit |! after |! renal |! transplantation |! is |! alarmed |! by |! blood |! in |! the |! urine |! of |! the |! patient. |! What |! is |! the |! nurse's |! best |! explanation |! when |! explaining |! the |! reason |! for |! hematuria |! in |! this |! patient? |! a. |! "It |! is |! related |! to |! the |! immunosuppressant |! drugs |! taken |! before |! transplantation." |! b. |! "It |! is |! a |! normal |! postoperative |! expectation." |! c. |! "It |! is |! caused |! by |! dye |! injected |! during |! surgery." |!
d. |! "It |! is |! caused |! by |! a |! small |! vessel |! that |! may |! be |! bleeding |! but |! will |! coagulate |! as |! urine |! flow |! increases." |! - |! Correct |! answer |! ✔ANS: |! B |! Blood |! in |! the |! urine |! is |! an |! expected |! postoperative |! expectation |! and |! will |! gradually |! clear |! up. A |! 10-year-old |! boy |! tells |! a |! nurse |! that |! he |! wants |! to |! give |! his |! kidney |! to |! his |! grandfather. |! How |! many |! years |! of |! age |! should |! the |! nurse |! explain |! that |! kidney |! donors |! must |! be? a. |! At |! least |! 14 |! years |! old |! b. |! At |! least |! 16 |! years |! old |! c. |! At |! least |! 18 |! years |! old |! d. |! At |! least |! 21 |! years |! old |! - |! Correct |! answer |! ✔ANS: |! C |! The |! donor |! must |! be |! at |! least |! 18 |! years |! old, |! have |! no |! systemic |! disease, |! and |! have |! normal |! renal |! function. A |! patient |! with |! chronic |! renal |! failure |! is |! to |! begin |! renal |! dialysis |! treatment |! and |! asks |! for |! advice |! about |! which |! type |! of |! dialysis |! would |! be |! best. |! The |! patient |! is |! considering |! peritoneal |! dialysis |! because |! it |! is |! less |! expensive |! and |! has |! fewer |! dietary |! and |! fluid |! restrictions. |! What |! is |! the |! most |! accurate |! information |! for |! the |! nurse |! to |! provide |! about |! peritoneal |! dialysis? |! a. |! It |! has |! literally |! no |! drawbacks. |!
a. |! Retroperitoneal |! bleeding |! and |! bruising |! over |! the |! flank |! b. |! Hematuria |! with |! abdominal |! bruising |! c. |! Distended |! bladder |! with |! painful |! urination |! d. |! Bladder |! spasms |! on |! palpation |! of |! abdomen |! - |! Correct |! answer |! ✔ANS: |! A |! The |! Grey |! Turner |! sign |! is |! bruising |! over |! the |! flank |! and |! retroperitoneal |! bleeding. |! This |! is |! observed |! in |! blunt |! trauma |! to |! the |! kidney. A |! female |! patient |! reports |! very |! painful |! urethritis. |! What |! should |! the |! home |! health |! care |! nurse |! question |! the |! patient |! about |! the |! use |! of? |! (Select |! all |! that |! apply.) |! a. |! Bubble |! bath |! b. |! Vitamin |! preparations |! c. |! Herbal |! remedies |! d. |! Vaginal |! sprays |! e. |! Exercise |! machines |! - |! Correct |! answer |! ✔ANS: |! A, |! D |! Bath |! additives |! and |! vaginal |! sprays |! are |! causative |! for |! urethritis. |! Vitamins, |! herbal |! preparations, |! and |! exercise |! machinery |! are |! noncontributory. The |! major |! risk |! of |! peritoneal |! dialysis |! is |! ______. |! - |! Correct |! answer |! ✔ANS: |! peritonitis |!
Peritonitis |! is |! the |! major |! risk |! of |! peritoneal |! dialysis A |! nurse |! is |! aware |! that |! if |! a |! ureter |! is |! blocked |! by |! a |! kidney |! stone, |! the |! urine |! backs |! up |! into |! the |! kidney, |! causing |! ______. |! - |! Correct |! answer |! ✔ANS: |! hydronephrosis |! Hydronephrosis |! results |! when |! a |! ureter |! is |! obstructed |! and |! urine |! backs |! up |! into |! the |! pelvis |! of |! the |! kidney. |! If |! unrelieved, |! this |! condition |! will |! require |! the |! removal |! of |! the |! kidney.
