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The Client with Urinary Tract Health ProblemsThe Client with Cancer of the Bladder■ The Client with Renal Calculi■ The Client with Acute Renal Failure■ The Client with Urinary Tract Infection■ The Client with Pyelonephritis■ The Client with Chronic Renal Failure■ The Client with Urinary Incontinence■ Managing Care Quality and Safety■ Answers, Rationales, and Test Taking StrategiesThe Client with Cancer of theBladder1. A client has undergone a cystectomy andan ileal conduit diversion. What should the nurseincorporate into the discharge instructions? Selectall that apply.■ 1. Drink at least 3,000 mL of fl uid each day.■ 2. Minimize daily activities.■ 3. Keep urine alkaline to prevent urinary tractinfections.■ 4. Avoid odor-producing foods, such as onions,fi sh, eggs, and cheese.■ 5. Wear snug clothing over the stoma to encourageurine fl ow into the drainage bag.2. A nurse is caring for a client with an ilealconduit. When assessing the stoma, which of thefollowing outcomes are undesirable? Select all thatapply.■ 1. Dermatitis.■ 2. Bleeding.■ 3. Fungal infection.■ 4. Flow of adhesive solvent into the stoma.■ 5. Partial obstruction of the stoma from skincement.3. The nurse should assess the client with bladdercancer for which of the following?■ 1. Suprapubic pain.■ 2. Dysuria.■ 3. Painless hematuria.■ 4. Urine retention.4. A client is to have a cystoscopy to rule outcancer of the bladder. Which of the following indicatethat the client has developed a complicationafter the cystoscopy?■ 1. Dizziness.■ 2. Chills.■ 3. Pink-tinged urine.■ 4. Bladder spasms.5. If the client develops lower abdominal painafter a cystoscopy, the nurse should instruct the clientto do which of the following?■ 1. Apply an ice pack to the pubic area.■ 2. Massage the abdomen gently.■ 3. Ambulate as much as possible.■ 4. Sit in a tub of warm water.6. A client who has been diagnosed withbladder cancer is scheduled for an ileal conduit.Preoperatively, the nurse reinforces the client’sunderstanding of the surgical procedure by explainingthat an ileal conduit:■ 1. Is a temporary procedure that can be reversedlater.■ 2. Diverts urine into the sigmoid colon, where itis expelled through the rectum.■ 3. Conveys urine from the ureters to a stomaopening on the abdomen.■ 4. Creates an opening in the bladder that allowsurine to drain into an external pouch.7. After surgery for an ileal conduit, the nurseshould closely assess the client for the occurrenceof which of the following complications related topelvic surgery?■ 1. Peritonitis.■ 2. Thrombophlebitis.■ 3. Ascites.■ 4. Inguinal hernia.■ The Client with Cancer of the Bladder■ The Client with Renal Calculi■ The Client with Acute Renal Failure■ The Client with Urinary Tract Infection■ The Client with Pyelonephritis■ The Client with Chronic Renal Failure■ The Client with Urinary Incontinence■ Managing Care Quality and Safety■ Answers, Rationales, and Test Taking StrategiesThe Client with Urinary Tract Health9 Problems TEST502 The Nursing Care of Adults with Medical and Surgical Health Problems8. The nurse is assessing the urine of a clientwho has had an ileal conduit and notes that theurine is yellow with a moderate amount of mucus.Based on the data, the nurse should?■ 1. Change the appliance bag.■ 2. Notify the physician.■ 3. Obtain a urine specimen for culture.■ 4. Encourage a high fl uid intake.9. When teaching the client to care for an ilealconduit, the nurse instructs the client to empty theappliance frequently. Which of the following indicatethat the client is following instructions?■ 1. The skin around the stoma is red.■ 2. The urine is a deep yellow.■ 3. There is no odor present.■ 4. The seal around the stoma is intact.10. The nurse should teach the client with anileal conduit to prevent urine leakage when changingthe appliance by using which of the followingprocedures?■ 1. Insert a gauze wick into the stoma.■ 2. Close the opening temporarily with a cellophaneseal.■ 3. Suction the stoma before changing the appliance.■ 4. Avoid oral fl uids for several hours beforechanging the appliance.11. The client with an ileal conduit will be usinga reusable appliance at home. The nurse shouldteach the client to clean the appliance routinelywith which product?■ 1. Baking soda.■ 2. Soap.■ 3. Hydrogen peroxide.■ 4. Alcohol.12. The nurse is evaluating the discharge teachingfor a client who has an ileal conduit. Which ofthe following statements indicates that the client hascorrectly understood the teaching? Select all thatapply.■ 1. “If I limit my fl uid intake, I will not have toempty my ostomy pouch as often.”■ 2. “I can place an aspirin tablet in my pouch todecrease odor.”■ 3. “I can usually keep my ostomy pouch on for 3to 7 days before changing it.”■ 4. “I must use a skin barrier to protect my skinfrom urine.”■ 5. “I should empty my ostomy pouch of urinewhen it is full.”13. A client has an ileal conduit. Which of thefollowing solutions will be useful to help controlodor in the urine collecting bag after it has beencleaned?■ 1. Salt water.■ 2. Vinegar.■ 3. Ammonia.■ 4. Bleach.14. A female client who has a urinary diversiontells the nurse, “This urinary pouch is embarrassing.Everyone will know that I’m not normal. I don’tsee how I can go out in public anymore.” The mostappropriate nursing diagnosis for this client is:■ 1. Anxiety related to the presence of a urinarydiversion.■ 2. Defi cient knowledge about how to care for theurinary diversion.■ 3. Low self-esteem related to feelings of worthlessness.■ 4. Disturbed body image related to creation of aurinary diversion.15. The nurse teaches the client with a urinarydiversion to attach the appliance to a standard urinecollection bag at night. The most important reasonfor doing this is to prevent:■ 1. Urine refl ux into the stoma.■ 2. Appliance separation.■ 3. Urine leakage.■ 4. The need to restrict fl uids.16. The nurse teaches the client with an ilealconduit measures to prevent a urinary tract infection.Which of the following measures would bemost effective?■ 1. Avoid people with respiratory tract infections.■ 2. Maintain a daily fl uid intake of 2,000 to 3,000mL.■ 3. Use sterile technique to change the appliance.■ 4. Irrigate the stoma daily.17. The nurse evaluates the effectiveness of theclient’s postoperative plan of care. Which of the followingwould be an expected outcome for a clientwith an ileal conduit?■ 1. The client verbalizes the understanding thathis physical activity must be curtailed.■ 2. The client states that he will place an aspirinin the drainage pouch to help control odor.■ 3. The client demonstrates how to catheterizethe stoma.■ 4. The client states that he will empty the drainagepouch frequently throughout the day.The Client with Urinary Tract Health Problems 50318. A nurse is planning care for a client whounderwent a percutaneous needle biopsy of the kidney.What should the nurse plan to do immediatelyafter the biopsy? Select all that apply.■ 1. Assess the biopsy site.■ 2. Take vital signs every hour.■ 3. Assess urine for hematuria.■ 4. Place the client in a prone position.■ 5. Assess the client for chest pain.The Client with Renal Calculi19. A client has renal colic due to renal lithiasis.What is the nurse’s fi rst priority in managing carefor this client?■ 1. Do not allow the client to ingest fl uids.■ 2. Encourage the client to drink at least 500 mLof water each hour.■ 3. Request the central supply department tosend supplies for straining urine.■ 4. Administer an opioid analgesic as prescribed.20. A client is admitted to the hospital with adiagnosis of renal calculi. The client is experiencingsevere fl ank pain and nausea; the temperature is100.6° F (38.1° C). Which of the following would bea priority outcome for this client?■ 1. Prevention of urinary tract complications.■ 2. Alleviation of nausea.■ 3. Alleviation of pain.■ 4. Maintenance of fl uid and electrolyte balance.21. The client is scheduled to have a kidney, ureter,and bladder (KUB) radiograph. To prepare theclient for this procedure, the nurse should explainto the client that:■ 1. Fluid and food will be withheld the morningof the examination.■ 2. A tranquilizer will be given before the examination.■ 3. An enema will be given before the examination.■ 4. No special preparation is required for theexamination.22. In addition to nausea and severe fl ank pain, afemale client with renal calculi has pain in the groinand bladder. The nurse should assess the client furtherfor signs of:■ 1. Nephritis.■ 2. Referred pain.■ 3. Urine retention.■ 4. Additional stone formation.23. Which of the following nursing interventionsis likely to provide the most relief from the painassociated with renal colic?■ 1. Applying moist heat to the fl ank area.■ 2. Administering meperidine (Demerol).■ 3. Encouraging high fl uid intake.■ 4. Maintaining complete bed rest.24. A client who has been diagnosed with renalcalculi reports that the pain is intermittent and lesscolicky. Which of the following nursing actions ismost important at this time?■ 1. Report hematuria to the physician.■ 2. Strain the urine carefully.■ 3. Administer meperidine (Demerol) every3 hours.■ 4. Apply warm compresses to the fl ank area.25. The client is scheduled for an intravenouspyelogram (IVP) to determine the location of therenal calculi. Which of the following measureswould be most important for the nurse to include inpretest preparation?■ 1. Ensuring adequate fl uid intake on the day ofthe test.■ 2. Preparing the client for the possibility of bladderspasms during the test.■ 3. Checking the client’s history for allergy toiodine.■ 4. Determining when the client last had a bowelmovement.26. After an intravenous pyelogram (IVP), thenurse should anticipate incorporating which of thefollowing measures into the client’s plan of care?■ 1. Maintaining bed rest.■ 2. Encouraging adequate fl uid intake.■ 3. Assessing for hematuria.■ 4. Administering a laxative.27. A client has a ureteral catheter in place afterrenal surgery. A priority nursing action for care ofthe ureteral catheter would be to:■ 1. Irrigate the catheter with 30 mL of normalsaline every 8 hours.■ 2. Ensure that the catheter is draining freely.■ 3. Clamp the catheter every 2 hours for 30 minutes.■ 4. Ensure that the catheter drains at least 30 mL/hour.28. Which of the following interventions wouldbe the most appropriate for preventing the developmentof a paralytic ileus in a client who has undergonerenal surgery?■ 1. Encourage the client to ambulate every 2 to 4hours.■ 2. Offer 3 to 4 oz of a carbonated beverage periodically.■ 3. Encourage use of a stool softener.■ 4. Continue I.V. fl uid therapy.29. The nurse is conducting a postoperativeassessment of a client on the fi rst day after renal surgery.Which of the following fi ndings would be mostimportant for the nurse to report to the physician?■ 1. Temperature, 99.8° F (37.7° C).■ 2. Urine output, 20 mL/hour.■ 3. Absence of bowel sounds.■ 4. A 2″?× 2″?area of serosanguineous drainage onthe fl ank dressing.30. A client with a history of renal calculi formationis being discharged after surgery to removethe calculus. What instructions should the nurseinclude in the client’s discharge teaching plan?■ 1. Increase daily fl uid intake to at least 2 to 3 L.■ 2. Strain urine at home regularly.■ 3. Eliminate dairy products from the diet.■ 4. Follow measures to alkalinize the urine.31. Because a client’s renal stone was found tobe composed of uric acid, a low-purine, alkaline-ashdiet was ordered. Incorporation of which of the followingfood items into the home diet would indicatethat the client understands the necessary dietmodifi cations?■ 1. Milk, apples, tomatoes, and corn.■ 2. Eggs, spinach, dried peas, and gravy.■ 3. Salmon, chicken, caviar, and asparagus.■ 4. Grapes, corn, cereals, and liver.32. Allopurinol (Zyloprim), 200 mg/day, isprescribed for the client with renal calculi to takeat home. The nurse should teach the client aboutwhich of the following adverse effects of this medication?■ 1. Retinopathy.■ 2. Maculopapular rash.■ 3. Nasal congestion.■ 4. Dizziness.33. A client has been prescribed allopurinol(Zyloprim) for renal calculi that are caused by highuric acid levels. Which of the following indicate theclient is experiencing adverse effect(s) of this drug?Select all that apply.■ 1. Nausea.■ 2. Rash.■ 3. Constipation.■ 4. Flushed skin.■ 5. Bone marrow depression.34. The nurse is reviewing laboratory reports fora client who is taking allopurinol (Zyloprim). Whichof the following indicate that the drug has had atherapeutic effect?■ 1. Decreased urine alkaline phosphatase level.■ 2. Increased urine calcium excretion.■ 3. Increased serum calcium level.■ 4. Decreased serum uric acid level.The Client with Acute RenalFailure35. A client is to receive peritoneal dialysis. Toprepare for the procedure, the nurse should?■ 1. Assess the dialysis access for a bruit andthrill.■ 2. Insert an indwelling urinary catheter anddrain all urine from the bladder.■ 3. Ask the client to turn toward the left side.■ 4. Warm the solution in the warmer.36. A client has been admitted with acute renalfailure. What should the nurse do? Select all thatapply.■ 1. Elevate the head of the bed 30 to 45 degrees.■ 2. Take vital signs.■ 3. Establish an I.V. access site.■ 4. Call the admitting physician for orders.■ 5. Contact the hemodialysis unit.37. Which of the following is the most commoninitial manifestation of acute renal failure?■ 1. Dysuria.■ 2. Anuria.■ 3. Hematuria.■ 4. Oliguria.38. A client developed shock after a severemyocardial infarction and has now developed acuterenal failure. The client’s family asks the nurse whythe client has developed acute renal failure. Thenurse should base the response on the knowledgethat there was:■ 1. A decrease in the blood fl ow through the kidneys.■ 2. An obstruction of urine fl ow from the kidneys.■ 3. A blood clot formed in the kidneys.■ 4. Structural damage to the kidney resulting inacute tubular necrosis.39. The client’s blood urea nitrogen (BUN) concentrationis elevated in acute renal failure. What isthe likely cause of this fi nding?■ 1. Fluid retention.■ 2. Hemolysis of red blood cells.■ 3. Below-normal metabolic rate.■ 4. Reduced renal blood fl ow.40. The client’s serum potassium level is elevatedin acute renal failure, and the nurse administerssodium polystyrene sulfonate (Kayexalate). Thisdrug acts to:■ 1. Increase potassium excretion from the colon.■ 2. Release hydrogen ions for sodium ions.■ 3. Increase calcium absorption in the colon.■ 4. Exchange sodium for potassium ions in the colon.41. A client with acute renal failure has anincrease in the serum potassium level. The nurseshould monitor the client for:■ 1. Cardiac arrest.■ 2. Pulmonary edema.■ 3. Circulatory collapse.■ 4. Hemorrhage.42. A high-carbohydrate, low-protein diet is prescribedfor the client with acute renal failure. Theintended outcome of this diet is to:■ 1. Act as a diuretic.■ 2. Reduce demands on the liver.■ 3. Help maintain urine acidity.■ 4. Prevent the development of ketosis.43. The client with acute renal failure asks thenurse for a snack. Because the client’s potassiumlevel is elevated, which of the following snacks ismost appropriate?■ 1. A gelatin dessert.■ 2. Yogurt.■ 3. An orange.■ 4. Peanuts.44. In the oliguric phase of acute renal failure,the nurse should assess the client for:■ 1. Pulmonary edema.■ 2. Metabolic alkalosis.■ 3. Hypotension.■ 4. Hypokalemia.45. The client in acute renal failure has anexternal cannula inserted in the forearm for hemodialysis.Which of the following nursing measures isappropriate for the care of this client?■ 1. Use the unaffected arm for blood pressuremeasurements.■ 2. Draw blood from the cannula for routine laboratorywork.■ 3. Percuss the cannula for bruits each shift.■ 4. Inject heparin into the cannula each shift.46. The nurse initiates the client’s fi rst hemodialysistreatment. The client develops a headache,confusion, and nausea. The nurse should assess theclient further for:■ 1. Disequilibrium syndrome.■ 2. Myocardial infarction.■ 3. Air embolism.■ 4. Peritonitis.47. During dialysis, the client has disequilibriumsyndrome. The nurse should fi rst?■ 1. Administer oxygen per nasal cannula.■ 2. Slow the rate of dialysis.■ 3. Reassure the client that the symptoms arenormal.■ 4. Place the client in Trendelenburg’s position.48. The client receives heparin while receivinghemodialysis. The nurse explains the rationalesupporting anticoagulation by making which of thefollowing statements?■ 1. “Regional anticoagulation is achieved byputting heparin in the dialysis machine andprotamine sulfate, which reverses the anticoagulation,in the client.”■ 2. “You will receive warfarin sodium (Coumadin)to maintain anticoagulation betweentreatments.”■ 3. “Heparin does not enter the body, so there isno risk of bleeding.”■ 4. “Clotting time is seriously prolonged for severalhours after each treatment.”49. Which of the following abnormal blood valueswould not be improved by dialysis treatment?■ 1. Elevated serum creatinine level.■ 2. Hyperkalemia.■ 3. Decreased hemoglobin concentration.■ 4. Hypernatremia.50. The nurse teaches the client how to recognizesigns and symptoms of infection in the shuntby telling the client to assess the shunt each day for:■ 1. Absence of a bruit.■ 2. Sluggish capillary refi ll time.■ 3. Coolness of the involved extremity.■ 4. Swelling at the shunt site.51. The client with acute renal failure is recoveringand asks the nurse, “Will my kidneys ever functionnormally again?” The nurse’s response is basedon knowledge that the client’s renal status will mostlikely:■ 1. Continue to improve over a period of weeks.■ 2. Result in the need for permanent hemodialysis.■ 3. Improve only if the client receives a renaltransplant.■ 4. Result in end-stage renal failure.The Client with Urinary TractInfection52. The nurse is teaching an 80-year-old clientwith a urinary tract infection about the importanceof increasing fl uids in the diet. Which of the followingputs this client at a risk for not obtaining suffi -cient fl uids?■ 1. Diminished liver function.■ 2. Increased production of antidiuretic hormone.■ 3. Decreased production of aldosterone.■ 4. Decreased ability to detect thirst.53. A client with a urinary tract infection is totake nitrofurantoin (Macrodantin) four times eachday. The client asks the nurse, “What should I do if Iforget a dose?” What should the nurse tell the client?■ 1. “You can wait and take the next dose when itis due.”■ 2. “Double the amount prescribed with yournext dose.”■ 3. “Take the prescribed dose as soon as youremember it, and if it is very close to the timefor the next dose, delay that next dose.”■ 4. “Take a lot of water with a double amount ofyour prescribed dose.”54. A nurse is assessing a client with a urinarytract infection who takes an antihypertensive drug.The nurse reviews the client’s urinalysis results (seechart). The nurse should:■ 1. Encourage the client to increase fl uid intake.■ 2. Withhold the next dose of antihypertensivemedication.■ 3. Restrict the client’s sodium intake.■ 4. Encourage the client to eat at least half of abanana per day.Laboratory ResultsTest ResultpH 6.8Red blood cells 3 per high power fi eldColor YellowSpecifi c gravity 1.03055. A client has nephropathy. The physicianorders that a 24-hour urine collection be done forcreatinine clearance. Which of the following actionsis necessary to ensure proper collection of thespecimen?■ 1. Collect the urine in a preservative-free containerand keep it on ice.■ 2. Inform the client to discard the last voidedspecimen at the conclusion of urine collection.■ 3. Ask the client what his weight is beforebeginning the collection of urine.■ 4. Request an order for insertion of an indwellingurinary catheter.56. A client who weighs 207 lb is to receive 1.5mg/kg of gentamicin sulfate (Garamycin) I.V. threetimes each day. How many milligrams of medicationshould the nurse administer for each dose? Roundto the nearest whole number.__________________ mg.57. A 24-year-old female client comes to anambulatory care clinic in moderate distress with aprobable diagnosis of acute cystitis. When obtainingthe client’s history, the nurse should ask the client ifshe has had:■ 1. Fever and chills.■ 2. Frequency and burning on urination.■ 3. Flank pain and nausea.■ 4. Hematuria.58. The client asks the nurse, “How did I get thisurinary tract infection?” The nurse should explainthat in most instances, cystitis is caused by:■ 1. Congenital strictures in the urethra.■ 2. An infection elsewhere in the body.■ 3. Urinary stasis in the urinary bladder.■ 4. An ascending infection from the urethra.59. The client, who is a newlywed, is afraid todiscuss her diagnosis of cystitis with her husband.Which would be the nurse’s best approach?■ 1. Arrange a meeting with the client, her husband,the physician, and the nurse.■ 2. Insist that the client talk with her husbandbecause good communication is necessary fora successful marriage.■ 3. Talk fi rst with the husband alone and thenwith both of them together to share the husband’sreactions.■ 4. Spend time with the client addressing herconcerns and then stay with her while shetalks with her husband.60. The nurse teaches a female client who hascystitis methods to relieve her discomfort untilthe antibiotic takes effect. Which of the followingresponses by the client would indicate that sheunderstands the nurse’s instructions?■ 1. “I will place ice packs on my perineum.”■ 2. “I will take hot tub baths.”■ 3. “I will drink a cup of warm tea every hour.”■ 4. “I will void every 5 to 6 hours.”61. The client with cystitis is given a prescriptionfor phenazopyridine hydrochloride (Pyridium).The nurse should teach the client that this drug isused to treat urinary tract infections by:■ 1. Releasing formaldehyde and providing bacteriostaticaction.■ 2. Potentiating the action of the antibiotic.■ 3. Providing an analgesic effect on the bladdermucosa.■ 4. Preventing the the crystallization that can occur with sulfa drugs.62. When teaching the client with a urinary tractinfection about taking phenazopyridine hydrochloride(Pyridium), the nurse should tell the client toexpect:■ 1. Bright orange-red urine.■ 2. Incontinence.■ 3. Constipation.■ 4. Slight drowsiness.63. A client has been prescribed nitrofurantoin(Macrodantin) for treatment of a lower urinarytract infection. Which of the following instructionsshould the nurse include when teaching the clienthow to take this medication? Select all that apply.■ 1. “Take the medication on an empty stomach.”■ 2. “Your urine may become brown in color.”■ 3. “Increase your fl uid intake.”■ 4. “Take the medication until your symptomssubside.”■ 5. “Take the medication with an antacid todecrease gastrointestinal distress.”64. Nitrofurantoin (Macrodantin), 75 mg fourtimes per day, has been prescribed for a client with alower urinary tract infection. The medication comesin an oral suspension of 25 mg/5 mL. How manymilliliters should the nurse administer for eachdose?________________________ mL.65. Which of the following statements by theclient would indicate that she is at high risk for arecurrence of cystitis?■ 1. “I can usually go 8 to 10 hours without needingto empty my bladder.”■ 2. “I take a tub bath every evening.”■ 3. “I wipe from front to back after voiding.”■ 4. “I drink a lot of water during the day.”66. To prevent recurrence of cystitis, the nurseshould plan to encourage the female client toinclude which of the following measures in herdaily routine?■ 1. Wearing cotton underpants.■ 2. Increasing citrus juice intake.■ 3. Douching regularly with 0.25% acetic acid.■ 4. Using vaginal sprays.67. The nurse explains to the client the importanceof drinking large quantities of fl uid to preventcystitis. The nurse should tell the client to drink:■ 1. Twice as much fl uid as usual.■ 2. At least 1 quart more than usual.■ 3. A lot of water, juice, and other fl uids throughoutthe day.■ 4. At least 3,000 mL of fl uids daily.The Client with Pyelonephritis68. A client is diagnosed with acute pyelonephritis.Which of the following instructions shouldthe nurse provide to the client about managing thedisease?■ 1. “Urinate frequently because the bacteria thatcause acute pyelonephritis reach the kidneysby means of an infection that progressesupward from lower in the urinary tract.”■ 2. “Taking frequent bubble baths will decreasethe likelihood of further episodes of pyelonephritis.”■ 3. “You should take antibiotics for the rest ofyour life to prevent urinary tract infections.”■ 4. “By decreasing your fl uid intake, you willdecrease the need for frequent urination andthe irritating effect of urine in your ureter.”69. Which of the following symptoms wouldmost likely indicate that the client has pyelonephritis?■ 1. Ascites.■ 2. Costovertebral angle (CVA) tenderness.■ 3. Polyuria.■ 4. Nausea and vomiting.70. Which of the following factors would put theclient at increased risk for pyelonephritis?■ 1. History of hypertension.■ 2. Intake of large quantities of cranberry juice.■ 3. Fluid intake of 2,000 mL/day.■ 4. History of diabetes mellitus.71. To assess the client’s rental stauts, the nurseshould monitor which of the following laboratorytests? Select all that apply.■ 1. Serum sodium■ 2. Potassium levels.■ 3. Arterial blood gases■ 4. Hemoglobin.■ 5. Serum blood urea nitrogen■ 6. Creatinine levels.■ 7. Urinalysis.72. The client with pyelonephritis asks thenurse, “How will I know whether the antibioticsare effectively treating my infection?” The nurse’smost appropriate response would be which of thefollowing?■ 1. “After you take the antibiotics for 2 weeks,you’ll not have any infection.”■ 2. “Your health care provider can tell by thecolor and odor of your urine.”■ 3. “Your health care provider will take a urineculture.”■ 4. “When your symptoms disappear, you’llknow that your infection is gone.”73. The client with acute pyelonephritis wants toknow the possibility of developing chronic pyelonephritis.The nurse’s response is based on knowledgethat which of the following disorders most commonlyleads to chronic pyelonephritis?■ 1. Acute pyelonephritis.■ 2. Recurrent urinary tract infections.■ 3. Acute renal failure.■ 4. Glomerulonephritis.The Client with ChronicRenal Failure74. The nurse assesses the client who haschronic renal failure and notes the following: cracklesin the lung bases, elevated blood pressure, andweight gain of 2 lb in 1 day. Based on these data,which of the following nursing diagnoses is appropriate?■ 1. Excess fl uid volume related to the kidney’sinability to maintain fl uid balance.■ 2. Ineffective breathing pattern related to fl uidin the lungs.■ 3. Ineffective tissue perfusion related to interruptedarterial blood fl ow.■ 4. Ineffective therapeutic regimen managementrelated to lack of knowledge abouttherapy.75. What is the primary disadvantage of usingperitoneal dialysis for long-term management ofchronic renal failure?■ 1. The danger of hemorrhage is high.■ 2. It cannot correct severe imbalances.■ 3. It is a time-consuming method of treatment.■ 4. The risk of contracting hepatitis is high.76. A client with chronic renal failure whoreceives hemodialysis three times a week is experiencingsevere nausea. What should the nurse advisethe client to do to manage the nausea? Select all thatapply.■ 1. Drink fl uids before eating solid foods.■ 2. Have limited amounts of fl uids only whenthirsty.■ 3. Limit activity.■ 4. Keep all dialysis appointments.■ 5. Eat smaller, more frequent meals.77. The dialysis solution is warmed before use inperitoneal dialysis primarily to:■ 1. Encourage the removal of serum urea.■ 2. Force potassium back into the cells.■ 3. Add extra warmth to the body.■ 4. Promote abdominal muscle relaxation.78. Which of the following assessments wouldbe most appropriate for the nurse to make whilethe dialysis solution is dwelling within the client’sabdomen?■ 1. Assess for urticaria.■ 2. Observe respiratory status.■ 3. Check capillary refi ll time.■ 4. Monitor electrolyte status.79. During the client’s dialysis, the nurseobserves that the solution draining from the abdomenis consistently blood-tinged. The client hasa permanent peritoneal catheter in place. Whichinterpretation of this observation would be correct?■ 1. Bleeding is expected with a permanent peritonealcatheter.■ 2. Bleeding indicates abdominal blood vesseldamage.■ 3. Bleeding can indicate kidney damage.■ 4. Bleeding is caused by too-rapid infusion ofthe dialysate.80. During dialysis, the nurse observes that thefl ow of dialysate stops before all the solution hasdrained out. The nurse should:■ 1. Have the client sit in a chair.■ 2. Turn the client from side to side.■ 3. Reposition the peritoneal catheter.■ 4. Have the client walk.81. Which of the following nursing interventionsshould be included in the client’s plan of care duringdialysis therapy?■ 1. Limit the client’s visitors.■ 2. Monitor the client’s blood pressure.■ 3. Pad the side rails of the bed.■ 4. Keep the client on nothing-by-mouth (NPO)status.82. The client performs his own peritoneal dialysis.What should the nurse teach the client aboutpreventing peritonitis? Select all that apply.■ 1. Broad-spectrum antibiotics may be administeredto prevent infection.■ 2. Antibiotics may be added to the dialysate totreat peritonitis.■ 3. Clean technique is permissible for preventionof peritonitis.■ 4. Peritonitis is characterized by cloudydialysate drainage and abdominal discomfort.■ 5. Peritonitis is the most common and seriouscomplication of peritoneal dialysis.83. After completion of peritoneal dialysis, thenurse should expect the client to exhibit which ofthe following characteristics?■ 1. Hematuria.■ 2. Weight loss.■ 3. Hypertension.■ 4. Increased urine output.84. Aluminum hydroxide gel (Amphojel) isprescribed for the client with chronic renal failureto take at home. What is the expected outcome ofgiving this drug?■ 1. Relieving the pain of gastric hyperacidity.■ 2. Preventimg Curling’s stress ulcers.■ 3. Binding phosphate in the intestine.■ 4. Reversing metabolic acidosis.85. The nurse teaches the client with chronicrenal failure when to take aluminum hydroxide gel(Amphojel). Which of the following statements wouldindicate that the client understands the teaching?■ 1. “I’ll take it every 4 hours around the clock.”■ 2. “I’ll take it between meals and at bedtime.”■ 3. “I’ll take it when I have a sour stomach.”■ 4. “I’ll take it with meals and bedtime snacks.”86. The client with chronic renal failure tellsthe nurse he takes magnesium hydroxide (milk ofmagnesia) at home for constipation. The nurse suggeststhat the client switch to psyllium hydrophilicmucilloid (Metamucil) because:■ 1. Milk of magnesia can cause magnesiumintoxication.■ 2. Milk of magnesia is too harsh on the bowel.■ 3. Metamucil is more palatable.■ 4. Milk of magnesia is high in sodium.87. The nurse is determining which teachingapproaches for the client with chronic renal failureand uremia would be most appropriate. The nurseshould:■ 1. Provide all needed teaching in one extendedsession.■ 2. Validate the client’s understanding of thematerial frequently.■ 3. Conduct a one-on-one session with the client.■ 4. Use videotapes to reinforce the material asneeded.88. The nurse is instructing the client withchronic renal failure to maintain adequate nutritionalintake. Which of the following diets would bemost appropriate?■ 1. High-carbohydrate, high-protein.■ 2. High-calcium, high-potassium, high-protein.■ 3. Low-protein, low-sodium, low-potassium.■ 4. Low-protein, high-potassium.89. The nurse is discussing concerns about sexualactivity with a client with chronic renal failure.Which one of the following strategies would be mostuseful?■ 1. Help the client to accept that sexual activitywill be decreased.■ 2. Suggest using alternative forms of sexualexpression and intimacy.■ 3. Tell the client to plan rest periods after sexualactivity.■ 4. Suggest that the client avoid sexual activity toprevent embarrassment.90. A client with chronic renal failure has askedto be evaluated for a home continuous ambulatoryperitoneal dialysis (CAPD) program. The nurseshould explain that the major advantage of thisapproach is that it:■ 1. Is relatively low in cost.■ 2. Allows the client to be more independent.■ 3. Is faster and more effi cient than standardperitoneal dialysis.■ 4. Has fewer potential complications than standardperitoneal dialysis.91. The client asks about diet changes whenusing continuous ambulatory peritoneal dialysis(CAPD). Which of the following would be thenurse’s best response?■ 1. “Diet restrictions are more rigid with CAPDbecause standard peritoneal dialysis is a moreeffective technique.”■ 2. “Diet restrictions are the same for both CAPDand standard peritoneal dialysis.”■ 3. “Diet restrictions with CAPD are fewer thanwith standard peritoneal dialysis becausedialysis is constant.”■ 4. “Diet restrictions with CAPD are fewer thanwith standard peritoneal dialysis becauseCAPD works more quickly.”92. A client is receiving continous ambulatoryperitoneal dialysis (CAPD). The nurse should assessthe client for which of the following signs of peritonealinfection?■ 1. Cloudy dialysate fl uid.■ 2. Swelling in the legs.■ 3. Poor drainage of the dialysate fl uid.■ 4. Redness at the catheter insertion site.The Client with Urinary Incontinence93. What should the nurse teach the client to doto prevent stress incontinence? Select all that apply.■ 1. Use techniques that strengthen the sphincterand structural supports of the bladder, suchas Kegel exercises.■ 2. Avoid dietary irritants (e.g., caffeine, alcoholicbeverages).■ 3. Not to laugh when in social gatherings.■ 4. Carry an extra incontinence pad when awayfrom home.■ 5. Obtain a fl uid intake of 500 mL/day.94. A client has stress incontinence. Which ofthe following data from the client’s history contributesto the client’s incontinence?■ 1. The client’s intake of 2 to 3 L of fl uid per day.■ 2. The client’s history of three full-term pregnancies.■ 3. The client’s age of 45 years.■ 4. The client’s history of competitive swimming.95. The primary goal of nursing care for a clientwith stress incontinence is to:■ 1. Help the client adjust to the frequent episodesof incontinence.■ 2. Eliminate all episodes of incontinence.■ 3. Prevent the development of urinary tractinfections.■ 4. Decrease the number of incontinence episodes.96. The nurse is developing a teaching plan for aclient with stress incontinence. Which of the followinginstructions should be included?■ 1. Avoid activities that are stressful and upsetting.■ 2. Avoid caffeine and alcohol.■ 3. Do not wear a girdle.■ 4. Limit physical exertion.97. A client has urge incontinence. When obtainingthe health history, the nurse should ask if theclient has:■ 1. Inability to empty the bladder.■ 2. Loss of urine when coughing.■ 3. Involuntary urination with minimal warning.■ 4. Frequent dribbling of urine.98. Which of the following interventions wouldbe most appropriate for a client who has urge incontinence?■ 1. Have the client urinate on a timed schedule.■ 2. Provide a bedside commode.■ 3. Administer prophylactic antibiotics.■ 4. Teach the client intermittent self-catheterizationtechnique.Managing Care Quality and Safety99. A client is scheduled for an intravenouspyelogram (IVP). The evening before the procedure,the nurse learns that the client has a sensitivity toshellfi sh. The nurse should:■ 1. Administer a cathartic to the client to emptythe colon.■ 2. Administer an antifl atulent to the client torelieve gas.■ 3. Keep the client on nothing-by-mouth (NPO)status.■ 4. Cancel the IVP and notify the physician.100. The nurse fi nds a container with the client’surine specimen sitting on a counter in the bathroom.The client states that the specimen has been sitting inthe bathroom for at least 2 hours. The nurse should:■ 1. Discard the urine and obtain a new specimen.■ 2. Send the urine to the laboratory as quickly aspossible.■ 3. Add fresh urine to the collected specimenand send the specimen to the laboratory.■ 4. Refrigerate the specimen until it can be transportedto the laboratory.101. A client with early acute renal failure hasanemia, tachycardia, hypotension, and shortness ofbreath. The physician has ordered 2 units of packedred blood cells (RBCs). Prior to initiating the bloodtransfusion the nurse should determine if? Select allthat apply.■ 1. there is an I.V. access with the appropriate tubingand normal saline as the priming solution■ 2. there is a signed informed consent for transfusiontherapy■ 3. blood typing and cross-matching is documentedin the medical record?■ 4. the vital signs have been taken and documentedin accordance with facility policy andprocedure?■ 5. there is the second unit of blood in the medicationroom?■ 6. the client has an identifi cation bracelet andred blood band?102. The nurse is instructing the unlicensed nursingpersonnel (UAP) about the correct technique forobtaining a clean-catch urine culture from a femaleclient. Which of the following statements indicatesthat the assistant has understood the instructions?■ 1. “I will have the client completely empty herbladder into the specimen cup.”■ 2. “I will need to catheterize the client to get theurine specimen.”■ 3. “I will ask the client to clean her labia, voidinto the toilet, and then into the specimen cup.”■ 4. “I will obtain the specimen in the afternoonafter the client has had plenty of fl uids.”Answers, Rationales, and TestTaking StrategiesThe answers and rationales for each question followbelow, along with keys ( ) to the client need(CN) and cognitive level (CL) for each question. Usethese keys to further develop your test-taking skills.For additional information about test-taking skillsand strategies for answering questions, refer to pages10–21, and pages 25–26 in Part 1 of this book.The Client with Cancer of theBladder1. 1, 4. An adequate fl uid intake aids in theprevention of urinary calculi and infection. Odorproducingfoods can produce offensive odors thatmay impact the client’s lifestyle and relationships.Lack of activity leads to urinary stasis, which promotesurinary calculi development and infection. Acidic urine helps prevent urinary tract infections.Tight clothing over the stoma obstructs blood circulationand urine fl : Reduction of risk potential;CL: Synthesize2. 1, 2, 3. Dermatitis with alkaline encrustationsmay occur when alkaline urine comes in contactwith exposed skin. Yeast infections (or fungal infections)are another common peristomal skin problem.If the stoma is irritated from rubbing, there will bebleeding. The nurse and client should avoid irritatingthe stoma. Adhesive solvent is used on a gauzepad to remove old adhesive and would not contactthe stoma directly. Only a minimal amount of skincement is applied to the faceplate and skin to securethe appliance over the stoma, so obstruction of thestoma by the cement would not be : Physiological adaptation;CL: Evaluate3. 3. Painless hematuria is the most commonclinical fi nding in bladder cancer. Other symptomsinclude urinary frequency, dysuria, and urinaryurgency, but these are not as common as hematuria.Suprapubic pain and urine retention do not occur inbladder : Physiological adaptation;CL: Analyze4. 2. Chills could indicate the onset of acuteinfection that can progress to septic shock. Dizzinesswould not be an anticipated symptom after acystoscopy. Pink-tinged urine and bladder spasmsare common after : Reduction of risk potential;CL: Analyze5. 4. Lower abdominal pain after a cystoscopyis frequently caused by bladder spasms. Warm watercan help relax muscles. Ice is not effective in relievingspasms. Massage and ambulation may increasebladder : Basic care and comfort;CL: Synthesize6. 3. An ileal conduit is a permanent urinarydiversion in which a portion of the ileum is surgicallyresected and one end of the segment is closed.The ureters are surgically attached to this segmentof the ileum, and the open end of the ileumis brought to the skin surface on the abdomen toform the stoma. The client must wear a pouch tocollect the urine that continually fl ows through theconduit. The bladder is removed during the surgicalprocedure and the ileal conduit is not reversible.Diversion of urine to the sigmoid colon iscalled a ureteroileosigmoidostomy. An opening in the bladder that allows urine to drain externally iscalled a : Reduction of risk potential;CL: Apply7. 2. After pelvic surgery, there is an increasedchance of thrombophlebitis owing to the pelvicmanipulation that can interfere with circulationand promote venous stasis. Peritonitis is a potentialcomplication of any abdominal surgery, not just pelvicsurgery. Ascites is most frequently an indicationof liver disease. Inguinal hernia may be caused byan increase in intra-abdominal pressure or a congenitalweakness of the abdominal wall; ventral herniaoccurs at the site of a previous abdominal : Reduction of risk potential;CL: Analyze8. 4. Mucus is secreted by the intestinal segmentused to create the conduit and is a normaloccurrence. The client should be encouraged tomaintain a large fl uid intake to help fl ush the mucusout of the conduit. Because mucus in the urine isexpected, it is not necessary to change the appliancebag or to notify the physician. The mucus is not anindication of an infection, so a urine culture is : Reduction of risk potential;CL: Synthesize9. 4. If the appliance becomes too full, it islikely to pull away from the skin completely or toleak urine onto the skin; thus if the seal is intact, theclient is emptying the appliance regularly. The skinaround the seal should not be red or irritated, whichcould indicate a leak. There will likely be an odorfrom the urine. Deep yellow urine indicates that theclient should be increasing fl uid : Physiological adaptation;CL: Evaluate10. 1. Inserting a gauze wick into the stoma helpsprevent urine leakage when changing the appliance.The stoma should not be sealed or suctioned. Oralfl uids do not need to be : Physiological adaptation;CL: Synthesize11. 2. A reusable appliance should be routinelycleaned with soap and : Physiological adaptation; CL: Apply12. 3, 4. The client with an ileal conduit mustlearn self-care activities related to care of the stomaand ostomy appliances. The client should be taughtto increase fl uid intake to about 3,000 mL/day andshould not limit intake. Adequate fl uid intake helpsto fl ush mucus from the ileal conduit. The ostomyappliance should be changed approximately every3 to 7 days and whenever a leak develops. A skinbarrier is essential to protecting the skin from theirritation of the urine. An aspirin should not be usedas a method of odor control because it can be an irritantto the stoma and lead to ulceration. The ostomypouch should be emptied when it is one-third toone-half full to prevent the weight of the urine frompulling the appliance away from the : Reduction of risk potential;CL: Evaluate13. 2. A distilled vinegar solution acts as agood deodorizing agent after an appliance has beencleaned well with soap and water. If the clientprefers, a commercial deodorizer may be used. Saltsolution does not deodorize. Ammonia and bleachingagents may damage the : Basic care and comfort; CL: Apply14. 4. It is normal for clients to express fearsand concerns about the body changes associatedwith a urinary diversion. Allowing the client timeto verbalize concerns in a supportive environmentand suggesting that she discuss these concerns withpeople who have successfully adjusted to ostomysurgery can help her begin coping with thesechanges in a positive manner. Although the clientmay be anxious about this situation and self-esteemmay be diminished, the underlying problem is adisturbance in body image. There are no data to supporta diagnosis of Defi cient : Psychosocial adaptation;CL: Analyze15. 1. The most important reason for attachingthe appliance to a standard urine collection bag atnight is to prevent urine refl ux into the stoma andureters, which can result in infection. Use of a standardcollection bag also keeps the appliance fromseparating from the skin and helps prevent urineleakage from an overly full bag, but the primarypurpose is to prevent refl ux of urine. A client with aurinary diversion should drink 2,000 to 3,000 mL offl uid each day; it would be inappropriate to suggestdecreasing fl uid : Physiological adaptation; CL: Apply16. 2. Maintaining a fl uid intake of 2,000 to 3,000mL/day is likely to be most effective in preventingurinary tract infection. A high fl uid intake results inhigh urine output, which prevents urinary stasis andbacterial growth. Avoiding people with respiratorytract infections will not prevent urinary tract infections.Clean, not sterile, technique is used to changethe appliance. An ileal conduit stoma is not : Physiological adaptation;CL: Synthesize17. 4. It is important that the client empty thedrainage pouch throughout the day to decrease therisk of leakage. The client does not normally needto curtail physical activity. Aspirin should neverbe placed in a pouch because aspirin can irritate orulcerate the stoma. The client does not catheterizean ileal conduit : Physiological adaptation;CL: Evaluate18. 1, 3, 4. The nurse should assess the biopsysite for bleeding and hematoma formation. The clientshould remain prone for 8 to 24 hours after thebiopsy. A pressure dressing will aid in blood coagulation.Vital signs assessment should be taken every5 to 15 minutes for the fi rst hour and then less oftenif the client is stable. The urine does not need to becollected and kept on ice. The nurse should collectserial urine specimens to assess for hematuria. Arenal biopsy does not put the client at increased riskfor chest : Reduction of risk potential;CL: SynthesizeThe Client with Renal Calculi19. 4. If infection or blockage caused by calculi ispresent, a client can experience sudden severe painin the fl ank area, known as renal colic. Pain from akidney stone is considered an emergency situationand requires analgesic intervention. Withholdingfl uids will make urine more concentrated and stonesmore diffi cult to pass naturally. Forcing large quantitiesof fl uid may cause hydronephrosis if urine isprevented from fl owing past calculi. Straining urinefor small stones is important, but does not take priorityover pain : Management of care; CL: Synthesize20. 3. The priority nursing goal for this clientis to alleviate the pain, which can be excruciating.Prevention of urinary tract complications andalleviation of nausea are appropriate throughout theclient’s hospitalization, but relief of the severe painis a priority. The client is at little risk for fl uid andelectrolyte : Physiological adaptation;CL: Synthesize21. 4. A KUB radiographic examination ordinarilyrequires no preparation. It is usually done whilethe client lies supine and does not involve the useof radiopaque : Reduction of risk potential;22. 2. The pain associated with renal colic dueto calculi is commonly referred to the groin andbladder in female clients and to the testicles inmale clients. Nausea, vomiting, abdominal cramping,and diarrhea may also be present. Nephritis orurine retention is an unlikely cause of the referredpain. The type of pain described in this situation isunlikely to be caused by additional stone : Physiological adaptation;CL: Analyze23. 2. During episodes of renal colic, the painis excruciating. It is necessary to administer opioidanalgesics to control the pain. Application of heat,encouraging high fl uid intake, and limitation ofactivity are important interventions, but they willnot relieve the renal colic : Reduction of risk potential;CL: Synthesize24. 2. Intermittent pain that is less colickyindicates that the calculi may be moving along theurinary tract. Fluids should be encouraged to promotemovement, and the urine should be strainedto detect passage of the stone. Hematuria is to beexpected from the irritation of the stone. Analgesicsshould be administered when the client needs them,not routinely. Moist heat to the fl ank area is helpfulwhen renal colic occurs, but it is less necessary aspain is : Physiological adaptation;CL: Synthesize25. 3. A client scheduled for an IVP should beassessed for allergies to iodine and shellfi sh. Clientswith such allergies may be allergic to the IVPdye and be at risk for an anaphylactic reaction.Adequate fl uid intake is important after the examination.Bladder spasms are not common during anIVP. Bowel preparation is important before an IVPto allow visualization of the ureters and bladder, butchecking for allergies is most : Reduction of risk potential;CL: Synthesize26. 2. After an IVP, the nurse should encouragefl uids to decrease the risk of renal complicationscaused by the contrast agent. There is no need toplace the client on bed rest or administer a laxative.An IVP would not cause : Reduction of risk potential;CL: Synthesize27. 2. The ureteral catheter should drain freelywithout bleeding at the site. The catheter is rarelyirrigated, and any irrigation would be done by thephysician. The catheter is never clamped. Theclient’s total urine output (ureteral catheter plus voiding or indwelling urinary catheter output)should be 30 mL/: Reduction of risk potential;CL: Synthesize28. 1. Ambulation stimulates peristalsis. A clientwith paralytic ileus is kept on nothing-by-mouthstatus until peristalsis returns. Carbonated beverageswill increase gas and distention but will not stimulateperistalsis. A stool softener will not stimulateperistalsis. I.V. fl uid infusion is a routine postoperativeorder that does not have any effect on preventingparalytic : Physiological adaptation;CL: Synthesize29. 2. The decrease in urine output may refl ectinadequate renal perfusion and should be reportedimmediately. Urine output of 30 mL/hour or greateris considered acceptable. A slight elevation in temperatureis expected after surgery. Peristalsis returnsgradually, usually the second or third day aftersurgery. Bowel sounds will be absent until then. Asmall amount of serosanguineous drainage is to : Physiological adaptation;CL: Analyze30. 1. A high daily fl uid intake is essential for allclients who are at risk for calculi formation becauseit prevents urinary stasis and concentration, whichcan cause crystallization. Depending on the compositionof the stone, the client also may be instructedto institute specifi c dietary measures aimed atpreventing stone formation. Clients may need tolimit purine, calcium, or oxalate. Urine may need tobe either alkaline or acid. There is no need to strainurine : Basic care and comfort;CL: Synthesize31. 1. Because a high-purine diet contributesto the formation of uric acid, a low-purine diet isadvocated. An alkaline-ash diet is also advocatedbecause uric acid crystals are more likely to developin acid urine. Foods that may be eaten as desired ina low-purine diet include milk, all fruits, tomatoes,cereals, and corn. Foods allowed on an alkaline-ashdiet include milk, fruits (except cranberries, plums,and prunes), and vegetables (especially legumes andgreen vegetables). Gravy, chicken, and liver are highin : Basic care and comfort;CL: Evaluate32. 2. Allopurinol (Zyloprim) is used to treatrenal calculi composed of uric acid. Adverse effectsof allopurinol include drowsiness, maculopapularrash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should beinstructed to report rashes and unusual bleeding orbruising. Retinopathy, nasal congestion, and dizzinessare not adverse effects of : Pharmacological and parenteraltherapies; CL: Synthesize33. 1, 2, 5. Common adverse effects ofallopurinol (Zyloprim) include gastrointestinaldistress, such as anorexia, nausea, vomiting, anddiarrhea. A rash is another potential adverse effect.A potentially life-threatening adverse effect is bonemarrow depression. Constipation and fl ushed skinare not associated with this : Pharmacological and parenteraltherapies; CL: Analyze34. 4. By inhibiting uric acid synthesis,allopurinol (Zyloprim) decreases its excretion.The drug’s effectiveness is assessed by evaluatingfor a decreased serum uric acid concentration.Allopurinol does not alter the level of alkaline phosphatase,nor does it affect urine calcium excretion orthe serum calcium : Pharmacological and parenteraltherapies; CL: EvaluateThe Client with Acute Renal Failure35. 4. Solution for peritoneal dialysis should bewarmed to body temperature in a warmer or witha heating pad; do not use the microwave. Colddialysate increases discomfort. Assessment for abruit and thrill is necessary with hemodialysiswhen the client has a fi stula, graft, or shunt. Anindwelling urinary catheter is not required for thisprocedure. The nurse should position the client in asupine or low Fowler’s : Reduction of risk potential;CL: Synthesize36. 1, 2, 3, 4. Elevation of the head of the bedwill promote ease of breathing. Respiratory manifestationsof acute renal failure include shortnessof breath, orthopnea, crackles, and the potential forpulmonary edema. Therefore, priority is placed onfacilitation of respiration. The nurse should assessthe vital signs because the pulse and respirationswill be elevated. Establishing a site for I.V. therapywill become important because fl uids will be administeredI.V. in addition to orally. The physician willneed to be contacted for further orders; there is noneed to contact the hemodialysis : Physiological adaptation;CL: Synthesize37. 4. Oliguria is the most common initial symptomof acute renal failure. Anuria is rarely the initialsymptom. Dysuria and hematuria are not associatedwith acute renal : Physiological adaptation;CL: Analyze38. 1. There are three categories of acute renalfailure: prerenal, intrarenal, and postrenal. Causesof prerenal failure occur outside the kidney andinclude poor perfusion and decreased circulatingvolume resulting from such factors as trauma, septicshock, impaired cardiac function, and dehydration.In this case of severe myocardial infarction, therewas a decrease in perfusion of the kidneys causedby impaired cardiac function. An obstructionwithin the urinary tract, such as from kidney stones,tumors, or benign prostatic hypertrophy, is calledpostrenal failure. Structural damage to the kidneyresulting from acute tubular necrosis is calledintrarenal failure. It is caused by such conditionsas hypersensitivity (allergic disorders), renal vesselobstruction, and nephrotoxic : Physiological adaptation; CL: Apply39. 4. Urea, an end product of protein metabolism,is excreted by the kidneys. Impairment inrenal function caused by reduced renal blood fl owresults in an increase in the plasma urea level. Fluidretention, hemolysis of red blood cells, and loweredmetabolic rate do not cause an elevated BUN : Reduction of risk potential;CL: Analyze40. 4. Polystyrene sulfonate, a cation-exchangeresin, causes the body to excrete potassium throughthe gastrointestinal tract. In the intestines, particularlythe colon, the sodium of the resin is partiallyreplaced by potassium. The potassium is theneliminated when the resin is eliminated with feces.Although the result is to increase potassium excretion,the specifi c method of action is the exchangeof sodium ions for potassium ions. Polystyrenesulfonate does not release hydrogen ions or increasecalcium : Pharmacological and parenteraltherapies; CL: Apply41. 1. Hyperkalemia places the client at riskfor serious cardiac arrhythmias and cardiac arrest.Therefore, the nurse should carefully monitor theclient for cardiac arrhythmias and be prepared totreat cardiac arrest when caring for a client withhyperkalemia. Increased potassium levels do notresult in pulmonary edema, circulatory collapse, : Pharmacological and parenteraltherapies; CL: Analyze42. 4. High-carbohydrate foods meet the body’scaloric needs during acute renal failure. Proteinis limited because its breakdown may result inaccumulation of toxic waste products. The maingoal of nutritional therapy in acute renal failureis to decrease protein catabolism. Protein catabolismcauses increased levels of urea, phosphate,and potassium. Carbohydrates provide energy anddecrease the need for protein breakdown. They donot have a diuretic effect. Some specifi c carbohydratesinfl uence urine pH, but this is not the reasonfor encouraging a high-carbohydrate, low-proteindiet. There is no need to reduce demands on theliver through dietary manipulation in acute : Basic care and comfort; CL: Apply43. 1. Gelatin desserts contain little or no potassiumand can be served to a client on a potassiumrestricteddiet. Foods high in potassium includebran and whole grains; most dried, raw, and frozenfruits and vegetables; most milk and milk products;chocolate, nuts, raisins, coconut, and strong : Basic care and comfort; CL: Apply44. 1. Pulmonary edema can develop duringthe oliguric phase of acute renal failure because ofdecreased urine output and fl uid retention. Metabolicacidosis develops because the kidneys cannotexcrete hydrogen ions, and bicarbonate is used tobuffer the hydrogen. Hypertension may develop as aresult of fl uid retention. Hyperkalemia develops asthe kidneys lose the ability to excrete : Physiological adaptation;CL: Analyze45. 1. The unaffected arm should be used forblood pressure measurement. The external cannulamust be handled carefully and protected fromdamage and disruption. In addition, a tourniquetor clamps should be kept at the bedside becausedislodgment of the cannula would cause arterialhemorrhage. The arm with the cannula is not usedfor blood pressure measurement, I.V. therapy, orvenipuncture. Patency is assessed by auscultatingfor bruits every shift. Heparin is not injected intothe cannula to maintain patency. Because it is partof the general circulation, the cannula cannot : Reduction of risk potential;CL:Synthesize46. 1. Common symptoms of disequilibrium syndromeinclude headache, nausea and vomiting, confusion,and even seizures. Disequilibrium syndrometypically occurs near the end or after the completionof hemodialysis treatment. It is the result of rapid changes in solute composition and osmolality of theextracellular fl uid. These symptoms are not relatedto cardiac function, air embolism, or : Reduction of risk potential;CL: Analyze47. 2. If disequilibrium syndrome occurs duringdialysis, the most appropriate intervention is toslow the rate of dialysis. The syndrome is believedto result from too-rapid removal of urea and excesselectrolytes from the blood; this causes transientcerebral edema, which produces the symptoms.Administration of oxygen and position changes donot affect the symptoms. It would not be appropriateto reassure the client that the symptoms are : Reduction of risk potential;CL: Synthesize48. 1. Regional anticoagulation can be achievedby infusing heparin in the dialyzer and protaminesulfate, its antagonist, in the client. Warfarin sodium(Coumadin) is not used in dialysis treatment. Thereis some risk of bleeding; however, clotting time ismonitored carefully. The client’s clotting time willnot be seriously affected, although some reboundeffect may : Pharmacological and parenteraltherapies; CL: Apply49. 3. Dialysis has no effect on anemia. Becausesome red blood cells are injured during the procedure,dialysis aggravates a low hemoglobin concentration.Dialysis will clear metabolic waste productsfrom the body and correct electrolyte : Reduction of risk potential;CL: Apply50. 4. Signs and symptoms of an external accessshunt infection include redness, tenderness, swelling,and drainage from around the shunt site. Theabsence of a bruit indicates closing of the shunt.Sluggish capillary refi ll time and coolness of theextremity indicate decreased blood fl ow to : Reduction of risk potential;CL: Analyze51. 1. The kidneys have a remarkable ability torecover from serious insult. Recovery may take 3 to12 months. The client should be taught how to recognizethe signs and symptoms of decreasing renalfunction and to notify the physician if such problemsoccur. In a client who is recovering from acuterenal failure, there is no need for renal transplantationor permanent hemodialysis. Chronic renalfailure develops before end-stage renal : Physiological adaptation; CL: ApplyThe Client with UrinaryTract Infection52. 4. The sensation of thirst diminishes in thosegreater than 60 years of age; hence, fl uid intake isdecreased and dissolved particles in the extracellularfl uid compartment become more concentrated.There is no change in liver function in older adults,nor is there a reduction of ADH and aldosterone as anormal part of : Physiological adaptation;CL: Apply53. 3. Antibiotics have the maximum effect whena blood level of the medication is maintained. However,because nitrofurantoin (Macrodantin) is readilyabsorbed from the gastrointestinal tract and isprimarily excreted in urine, toxicity may develop bydoubling the dose. The client should not skip a doseif she realizes that she has missed one. Additionalfl uids, especially water, should be encouraged, butnot forced to promote elimination of the antibioticfrom the body. Adequate fl uid intake aids in theprevention of urinary tract infections, in addition toan acidic : Pharmacological and parenteraltherapies; CL: Synthesize54. 1. The client’s urine specifi c gravity is elevated.Specifi c gravity is a refl ection of the concentratingability of the kidneys. This level indicatesthat the urine is concentrated. By increasing fl uidintake, the urine will become more dilute. Antihypertensivesdo not make urine more concentratedunless there is a diuretic component within them.The nurse should not hold a dose of antihypertensivemedication. Sodium tends to pull water withit; by restricting sodium, less water, not more, willbe present. Bananas do not aid in the dilution : Reduction of risk potential;CL: Synthesize55. 1. All urine for creatinine clearance determinationmust be saved in a container with nopreservatives and refrigerated or kept on ice. Thefi rst urine voided at the beginning of the collectionis discarded, not the last. A self-report of weightmay not be accurate. It is not necessary to have anindwelling urinary catheter inserted for urine : Reduction of risk potential;CL: Apply56. 141 mg1 221kg lb1kg:2.2lb= kg:207lb2.2lb kg=1kg 207lbkg=kg 207?????.XXXlblbkg1.5mg 94.1=141.15=141mg.94 112 294 1..X ??.?CN: Pharmacological and parenteraltherapies; CL: Apply57. 2. The classic symptoms of cystitis are severeburning on urination, urgency, and frequent urination.Systemic symptoms, such as fever and nauseaand vomiting, are more likely to accompany pyelonephritisthan cystitis. Hematuria may occur, but itis not as common as frequency and : Physiological adaptation;CL: Analyze58. 4. Although various conditions may resultin cystitis, the most common cause is an ascendinginfection from the urethra. Strictures and urineretention can lead to infections, but these are not themost common cause. Systemic infections are rarelycauses of : Physiological adaptation; CL: Apply59. 4. As newlyweds, the client and her husbandneed to develop a strong communication base. Thenurse can facilitate communication by preparing andsupporting the client. Given the situation, an interdisciplinaryconference is inappropriate and wouldnot promote intimacy for the client and her husband.Insisting that the client talk with her husband is notaddressing her fears. Being present allows the nurseto facilitate the discussion of a diffi cult topic. Havingthe nurse speak fi rst with the husband alone shiftsresponsibility away from the : Psychosocial adaptation;CL: Synthesize60. 2. Hot tub baths promote relaxation and helprelieve urgency, discomfort, and spasm. Applyingheat to the perineum is more helpful than coldbecause heat reduces infl ammation. Althoughliberal fl uid intake should be encouraged, caffeinatedbeverages, such as tea, coffee, and cola, canbe irritating to the bladder and should be avoided.Voiding at least every 2 to 3 hours should be encouragedbecause it reduces urinary : Basic care and comfort; CL: Evaluate61. 3. Phenazopyridine hydrochloride (Pyridium)is a urinary analgesic that works directly onthe bladder mucosa to relieve the distressing symptomsof dysuria. Phenazopyridine does not have abacteriostatic effect. It does not potentiate antibioticsor prevent : Pharmacological and parenteraltherapies; CL: Apply62. 1. The client should be told thatphenazopyridine hydrochloride (Pyridium) turnsthe urine a bright orange-red, which may stainunderwear. It can be frightening for a client to seeorange-red urine without having been forewarned.Other common adverse effects associated withphenazopyridine include headaches, gastrointestinaldisturbances, and rash. Phenazopyridine doesnot cause incontinence, constipation, or : Pharmacological and parenteraltherapies; CL: Apply63. 2, 3. Clients who are taking nitrofurantoin(Macrodantin) should be instructed to take themedication with meals and to increase their fl uidintake to minimize gastrointestinal distress. Theurine may become brown in color. Although thischange is harmless, clients need to be prepared forthis color change. The client should be instructed totake the full prescription and not to stop taking thedrug because symptoms have subsided. The medicationshould not be taken with antacids as this mayinterfere with the drug’s : Pharmacological and parenteraltherapies; CL: Synthesize64. 15 mLThe following formula is used to calculate the correctdosage:25 mg/5 mL = 75 mg/X mLX = 15 : Pharmacological and parenteraltherapies; CL: Apply65. 1. Stasis of urine in the bladder is one of thechief causes of bladder infection, and a client whovoids infrequently is at greater risk for reinfection.A tub bath does not promote urinary tract infectionsas long as the client avoids harsh soaps and bubblebaths. Scrupulous hygiene and liberal fl uid intake(unless contraindicated) are excellent preventivemeasures, but the client also should be taught tovoid every 2 to 3 hours during the : Reduction of risk potential;CL: Analyze66. 1. A woman can adopt several healthpromotionmeasures to prevent the recurrence of cystitis, including avoiding too-tight pants, noncottonunderpants, and irritating substances, such asbubble baths and vaginal soaps and sprays. Increasingcitrus juice intake can be a bladder irritant.Regular douching is not recommended; it can alterthe pH of the vagina, increasing the risk of : Health promotion and maintenance;CL: Synthesize67. 4. Instructions should be as specifi c as possible,and the nurse should avoid general statementssuch as “a lot.” A specifi c goal is most useful. Amix of fl uids will increase the likelihood of clientcompliance. It may not be suffi cient to tell the clientto drink twice as much as or 1 quart more than sheusually drinks if her intake was inadequate to : Basic care and comfort; CL: ApplyThe Client with Pyelonephritis68. 1. Pyelonephritis usually begins with colonizationand infection of the lower urinary tract viathe ascending urethral route, and the client shouldhave an adequate intake of fl uids to promote thefl using action of urination. Bubble baths and limitingfl uid intake increase the risk of developing aurinary tract infection. Antibiotics should be usedon a short-term basis because the risk of antibioticresistance may lead to breakthrough infections withincreasingly virulent : Health promotion and maintenance;CL: Synthesize69. 2. Common symptoms of pyelonephritisinclude CVA tenderness, burning on urination, urinaryurgency or frequency, chills, fever, and fatigue.Ascites, polyuria, and nausea and vomiting are notindicative of : Physiological adaptation;CL: Analyze70. 4. A client with a history of diabetes mellitus,urinary tract infections, or renal calculi is atincreased risk for pyelonephritis. Others at high riskinclude pregnant women and people with structuralalterations of the urinary tract. A history of hypertensionmay put the client at risk for kidney damage,but not kidney infection. Intake of large quantities ofcranberry juice and a fl uid intake of 2,000 mL/dayare not risk factors for : Reduction of risk potential;CL: Analyze71. 5, 6. Serum BUN and creatinine are thetests most commonly used to assess renal function,with creatinine being the most reliable indicator.Nonrenal factors may affect BUN levels as well asserum sodium and potassium levels. Arterial bloodgases and hemoglobin are not used to assess renalstatus. Urinalysis is a general screening : Physiological adaptation;CL: Analyze72. 3. Antibiotics are usually prescribed for a2- to 4-week period. A urine culture is needed toevaluate the effectiveness of antibiotic therapy.Urine must be examined microscopically to adequatelydetermine the presence of bacteria; lookingat the color of the urine or checking the odor is notsuffi cient. Symptoms usually disappear 48 to 72hours after antibiotic therapy is started, but antibioticsmay need to continue for up to 4 : Pharmacological and parenteraltherapies; CL: Evaluate73. 2. Chronic pyelonephritis is most commonlythe result of recurrent urinary tract infections.Chronic pyelonephritis can lead to chronic renalfailure. Single cases of acute pyelonephritis rarelycause chronic pyelonephritis. Acute renal failure isnot a cause of chronic pyelonephritis. Glomerulonephritisis an immunologic disorder, not an : Physiological adaptation; CL: ApplyThe Client with Chronic Renal Failure74. 1. Crackles in the lungs, weight gain, and elevatedblood pressure are indicators of excess fl uidvolume, a common complication in chronic renalfailure. The client’s fl uid status should be monitoredcarefully for imbalances on an ongoing basis.Although the client has ineffective breathing, theprimary cause is related to the renal failure. Thereare no data to suggest ineffective tissue perfusion orlack of : Physiological adaptation;CL: Analyze75. 3. A disadvantage of peritoneal dialysis inlong-term management of chronic renal failure isthat it requires large blocks of time. The risk ofhemorrhage or hepatitis is not high with peritonealdialysis. Peritoneal dialysis is effective in maintaininga client’s fl uid and electrolyte : Reduction of risk potential;CL: Apply76. 2, 4, 5. To manage nausea, the nurse canadvise the client to drink limited amounts of fl uidonly when thirsty, eat food before drinking fl uids toalleviate dry mouth, encourage strict follow-up for blood work, dialysis, and health care provider visits.Smaller, more frequent meals may help to reducenausea and facilitate medication taking. The clientshould be as active as possible to avoid immobilizationbecause it increases bone demineralization. Theclient should also maintain the dialysis schedulebecause the dialysis will remove wastes that cancontribute to : Physiological adaptation;CL: Synthesize77. 1. The main reason for warming the peritonealdialysis solution is that the warm solutionhelps dilate peritoneal vessels, which increases ureaclearance. Warmed dialyzing solution also contributesto client comfort by preventing chilly sensations,but this is a secondary reason for warming thesolution. The warmed solution does not force potassiuminto the cells or promote abdominal : Reduction of risk potential;CL: Apply78. 2. During dwell time, the dialysis solutionis allowed to remain in the peritoneal cavity for thetime ordered by the physician (usually 20 to 45 minutes).During this time, the nurse should monitorthe client’s respiratory status because the pressureof the dialysis solution on the diaphragm can createrespiratory distress. The dialysis solution would notcause urticaria or affect circulation to the fi ngers.The client’s laboratory values are obtained beforebeginning treatment and are monitored every 4 to8 hours during the treatment, not just during thedwell : Reduction of risk potential;CL: Analyze79. 2. Because the client has a permanent catheterin place, blood-tinged drainage should not occur.Persistent blood-tinged drainage could indicatedamage to the abdominal vessels, and the physicianshould be notifi ed. The bleeding is originatingin the peritoneal cavity, not the kidneys. Too-rapidinfusion of the dialysate can cause pain, not : Reduction of risk potential;CL: Analyze80. 2. Fluid return with peritoneal dialysis isaccomplished by gravity fl ow. Actions that enhancegravity fl ow include turning the client from side toside, raising the head of the bed, and gently massagingthe abdomen. The client is usually confi ned toa recumbent position during the dialysis. The nurseshould not attempt to reposition the : Reduction of risk potential;CL: Synthesize81. 2. Because hypotension is a complicationassociated with peritoneal dialysis, the nurserecords intake and output, monitors vital signs,and observes the client’s behavior. The nurse alsoencourages visiting and other diversional activities.A client on peritoneal dialysis does not need to beplaced in a bed with padded side rails or kept onNPO : Reduction of risk potential;CL: Synthesize82. 1, 2, 4, 5. Broad-spectrum antibiotics may beadministered to prevent infection when a peritonealcatheter is inserted for peritoneal dialysis. If peritonitisis present, antibiotics may be added to thedialysate. Aseptic technique is imperative. Peritonitis,the most common and serious complicationof peritoneal dialysis, is characterized by cloudydialysate drainage, diffuse abdominal pain, andrebound : Safety and infection control;CL: Synthesize83. 2. Weight loss is expected because of theremoval of fl uid. The client’s weight before andafter dialysis is one measure of the effectiveness oftreatment. Blood pressure usually decreases becauseof the removal of fl uid. Hematuria would not occurafter completion of peritoneal dialysis. Dialysis onlyminimally affects the damaged kidneys’ ability tomanufacture : Reduction of risk potential;CL: Evaluate84. 3. A client in renal failure develops hyperphosphatemiathat causes a corresponding excretionof the body’s calcium stores, leading to renalosteodystrophy. To decrease this loss, aluminumhydroxide gel is prescribed to bind phosphates inthe intestine and facilitate their excretion. Gastrichyperacidity is not necessarily a problem associatedwith chronic renal failure. Antacids will not preventCurling’s stress ulcers and do not affect : Pharmacological and parenteraltherapies; CL: Evaluate85. 4. Aluminum hydroxide gel (Amphojel) isadministered to bind the phosphates in ingestedfoods and must be given with or immediately aftermeals and snacks. There is no need for the clientto take it on a 24-hour schedule. It is not administeredto treat hyperacidity in clients with chronicrenal failure and therefore is not prescribed : Pharmacological and parenteraltherapies; CL: Evaluate86. 1. Magnesium is normally excreted by thekidneys. When the kidneys fail, magnesium canaccumulate and cause severe neurologic problems.Milk of magnesia is harsher than Metamucil, butmagnesium toxicity is a more serious problem. Aclient may fi nd both milk of magnesia and Metamucilunpalatable. Milk of magnesia is not high : Pharmacological and parenteraltherapies; CL: Apply87. 2. Uremia can cause decreased alertness, sothe nurse needs to validate the client’s comprehensionfrequently. Because the client’s ability to concentrateis limited, short lessons are most effective.If family members are present at the sessions, theycan reinforce the material. Written materials that theclient can review are superior to videotapes becauseclients may not be able to maintain alertness duringthe viewing of the : Physiological adaptation;CL: Synthesize88. 3. Dietary management for clients withchronic renal failure is usually designed to restrictprotein, sodium, and potassium intake. Proteinintake is reduced because the kidney can no longerexcrete the byproducts of protein metabolism. Thedegree of dietary restriction depends on the degreeof renal impairment. The client should also receivea high-carbohydrate diet along with appropriatevitamin and mineral supplements. Calcium requirementsremain 1,000 to 2,000 mg/: Basic care and comfort;CL: Synthesize89. 2. Altered sexual functioning commonlyoccurs in chronic renal failure and can stress marriagesand relationships. Altered sexual functioningcan be caused by decreased hormone levels,anemia, peripheral neuropathy, or medication. Theclient should not decrease or avoid sexual activitybut instead should modify it. The client should restbefore sexual : Psychosocial adaptation;CL: Synthesize90. 2. The major benefi t of CAPD is that itfrees the client from daily dependence on dialysiscenters, health care personnel, and machines forlife-sustaining treatment. This independence is avaluable outcome for some people. CAPD is costlyand must be done daily. Adverse effects and complicationsare similar to those of standard peritonealdialysis. Peritoneal dialysis usually takes less timebut cannot be done at : Reduction of risk potential;CL: Apply91. 3. Dietary restrictions with CAPD are fewerthan those with standard peritoneal dialysis becausedialysis is constant, not intermittent. The constantslow diffusion of CAPD helps prevent accumulationof toxins and allows for a more liberal diet. CAPDdoes not work more quickly, but more consistently.Both types of peritoneal dialysis are : Basic care and comfort;CL: Synthesize92. 1. Cloudy drainage indicates bacterial activityin the peritoneum. Other signs and symptoms ofinfection are fever, hyperactive bowel sounds, andabdominal pain. Swollen legs may indicate heartfailure. Poor drainage of dialysate fl uid is probablythe result of a kinked catheter. Redness at the insertionsite indicates local infection, not peritonitis.However, a local infection that is left untreated canprogress to the : Reduction of risk potential;CL: AnalyzeThe Client with Urinary Incontinence93. 1, 2. Laughing may be a part of one’s socialization,so it should not be discouraged. In non-restrictedclients, a fl uid intake of at least 2 to 3 L/dayis encouraged; clients with stress incontinence mayreduce their fl uid intake to avoid incontinence atthe risk of developing dehydration and urinary tractinfections. Establishing a voiding schedule wouldbe more effective in the prevention of stress incontinencerather than carrying incontinence pads.Dietary irritants and natural diuretics, such as caffeineand alcoholic beverages, may increase stressincontinence. Kegel exercises strengthen the sphincterand structural supports of the : Health promotion and maintenance;CL: Synthesize94. 2. The history of three pregnancies is mostlikely the cause of the client’s current episodes ofstress incontinence. The client’s fl uid intake, age, orhistory of swimming would not create an increase inintra-abdominal : Reduction of risk potential;CL: Analyze95. 4. The primary goal of nursing care is todecrease the number of incontinence episodesand the amount of urine expressed in an episode.Behavioral interventions (e.g., diet and exercise)and medications are the nonsurgical managementmethods used to treat stress incontinence. Withoutsurgical intervention, it may not be possible toeliminate all episodes of incontinence. Helping theclient adjust to the incontinence is not treating theproblem. Clients with stress incontinence are notprone to the development of urinary tract : Physiological adaptation;CL: Synthesize96. 2. Clients with stress incontinence areencouraged to avoid substances, such as caffeineand alcohol, that are bladder irritants. Emotionalstressors do not cause stress incontinence. It is mostcommonly caused by relaxed pelvic musculature.Wearing girdles is not contraindicated. Althoughclients may want to limit physical exertion to avoidincontinence episodes, they should be encouragedto seek treatment instead of limiting their : Reduction of risk potential;CL: Create97. 3. A characteristic of urge incontinence isinvoluntary urination with little or no warning. Theinability to empty the bladder is urine retention.Loss of urine when coughing occurs with stressincontinence. Frequent dribbling of urine is commonin male clients after some types of prostate surgeryor may occur in women after the developmentof a vesicovaginal or urethrovaginal fi : Physiological adaptation;CL: Analyze98. 1. Instructing the client to void at regularlyscheduled intervals can help decrease the frequencyof incontinence episodes. Providing a bedside commodedoes not decrease the number of incontinenceepisodes and does not help the client who leads anactive lifestyle. Infections are not a common causeof urge incontinence, so antibiotics are not an appropriatetreatment. Intermittent self-catheterization isappropriate for overfl ow or refl ux incontinence, butnot urge incontinence, because it does not treat theunderlying : Physiological adaptation;CL: SynthesizeManaging Care Quality and Safety99. 4. Sensitivity to shellfi sh or iodine may causean anaphylactic reaction to the contrast material,which contains iodine. Administering a catharticor antifl atulent will not prevent an anaphylacticreaction to the contrast material. Keeping a client onNPO status for 8 hours before the procedure is partof the usual preparation for such a procedure to preventaspiration of food or fl uids if the client vomitswhen lying on the X-ray table.100. 1. The appropriate action would be to discardthe specimen and obtain a new one. Urine that isallowed to stand at room temperature will becomealkaline, with multiplying bacteria. The specimenshould be examined within 1 hour after : Reduction of risk potential;CL: Synthesize101. 1, 2, 3, 4, 6. Before ordering and administeringpacked RBCs, the nurse should assess the I.V.site to make sure it has an 18G to 20G Angiocath.The nurse should also ensure that normal salinesolution is used to prime the tubing to preventRBCs from adhering to the tubing. The client mustindicate informed consent for the procedure bysigning the consent form. The client’s blood mustbe typed to determine ABO blood typing and Rhfactor and ensure that the client receives compatibleblood. Cross-matching is done to detect the presenceof recipient antibodies to the donor’s minorantigens. Vital signs provide a baseline reference forcontinuous monitoring throughout the transfusion.An identifi cation bracelet and red blood band areessential for client identifi cation 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 minutesof the time that the RBC unit is checked out of theblood bank. Thus, no blood should be kept in themedication room before : Safety and infection control;CL: Synthesize102. 3. The correct technique for a clean-catchurine culture specimen is to have the female clientclean the labia from front to back, void into the toilet,and then void into the cup. The client does notneed to fully empty her bladder into the cup. It isnot necessary to catheterize the client to obtain thespecimen. The fi rst voided specimen of the day hasthe highest bacterial : Basic care and comfort;CL: Evaluate ................
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