<P>

<Q>When
<TYPE>single</TYPE>
caring for a client diagnosed with end-stage renal failure, which of the
<MC1>Increased
<MC2>Restricted
<MC3>Increased
<MC4>Restricted
<F>Rationale:
<CORRECT>2</CORRECT>
following diets With
protein,
potassium
protein,
phosphorus
should
end-stage
the
decreased
increased
andand
nurse
sodium</MC3>
renal
magnesium</MC4>
recommend?</Q>
carbohydrates</MC1>
carbohydrates</MC2>
disease, the kidneys have difficulty excretin
g protein, and the build-up of toxins in the system causes systemic problems. Cl
ients must usually restrict dietary protein while increasing carbohydrate intake
to meet energy needs and prevent tissue breakdown (option 2). Since option 2 is
correct, option 1 is incorrect because it is the opposite. Potassium, sodium, a
nd phosphorus (options 3 and 4) are restricted in clients with end-stage renal d
Cognitive
isease.
Client
Integrated
Content
Strategy:
Need:
Area:
Level:
Acute
Process:
Physiological
Foundational
illness
Application
Nursing
increases
Integrity:
Sciences:
Process:metabolic
Implementation
Nutrition
Physiological
demand andAdaptation
therefore requires an inc
reased need for calories so eliminate any distracter that decreases calories or
carbohydrates.
Reference: LeMone,
Decrease
P., &any Burke,
element
K. (2008).
that increases
<i>Medical-surgical
the strain onnursing:
the kidneys.
Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. client
<Q>The
<TYPE>single</TYPE>
<P>
</P> 918-919.</F>
diagnosed with cystitis is given a prescription for phenazopyridin
e (Pyridium).
<MC1>Eases
<MC2>Eliminates
<MC3>Eases
<MC4>Should
<F>Rationale:
<CORRECT>1</CORRECT>
discomfort
urinary
beThe
taken
urinary
nurse
pain
tract
after
ofexperienced
explains
bacteria.</MC2>
thesexual
spasms.</MC3>
bladder
tointercourse.</MC4>
with
the
mucosa.</MC1>
client that
cystitis maythis
be relieved
medication:</Q>
by an analgesic
such as phenazopyridine that soothes the bladder mucosa (option 1). Antibiotic
therapy (option 2) eliminates bacterial growth that causes a UTI. Hyoscyamine is
an antispasmodic used to treat bladder spasm (option 3). Clients who develop ch
ronic cystitis are usually prescribed a dose of an antibiotic or antiseptic to b
e takenNeed:
Cognitive
Client
Integrated
Content
Strategy:immediately
Area:
Level:
This
Process:
Physiological
Pharmacology
item
Application
after intercourse
Teaching/Learning
requires Integrity:
knowledgePharmacological
(option
of what4).cystitisandisParenteral
and the mechanism
Therapiesof
action of phenazopyridine. Note that the drug in the question does not have any
of the typical prefixes or suffixes found in the various classes of antibiotics,
suggesting this drug is not an antimicrobial. Use nursing knowledge and the pro
cess of elimination
Reference: LeMone, P.,to &makeBurke,
a selection.
K. (2008). <i>Medical-surgical nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. nurse
<Q>The
<TYPE>single</TYPE>
<P>
</P> 850-851.</F>
is caring for a client who has developed urinary incontinence. Duri
ng the intake assessment, the nurse performs an assessment of cognitive function
ing. When questioned by the family, the nurse explains that this assessment will
<MC1>Stress
<MC2>Overflow
<MC3>Functional
<MC4>Mixed
<F>Rationale:
<CORRECT>3</CORRECT>
help to determine
incontinence.</MC4>
incontinence.</MC1>
incontinence.</MC2>
Functional
incontinence.</MC3>
whetherincontinence
the client (option
has:</Q>3) is usually associated with impa
ired cognitive functioning as that seen with dementia. Stress incontinence (opti
on 1) is usually associated with coughing or sneezing or loss of estrogen postme
nopause. Overflow incontinence (option 2) occurs when the bladder becomes overdi
stended and urine leaks out to prevent rupture of the bladder. Mixed incontinenc
e (option
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
4)Process:
Level:
Identify
isAdult
Physiological
aApplication
combination
the
Nursing
Health:
typesIntegrity:
Process:
Renal
ofofurinary
stress
andAssessment
Physiological
Genitourinary
and urge incontinence.
incontinence Adaptation
and compare them to the sce
nario identified
Reference: LeMone,inP.,
the&question.
Burke, K. (2008). <i>Medical-surgical nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. nurse
<Q>The
<TYPE>single</TYPE>
<P>
</P> 874-875.</F>
is caring for an elderly male who reports difficulty starting urina
tion and voiding several times during the night. The nurse suspects that this cl
ient has:</Q>prostatic
<MC1>Benign
<MC2>Urinary
<MC3>Urethral
<F>Rationale:
<CORRECT>1</CORRECT>
<MC4>Urethritis.</MC4>
tract
strictures.</MC3>
Benigninfection.</MC2>
prostatic
hyperplasia hyperplasia
(BPH).</MC1>
(BPH) partially obstructs the neck of
the bladder, making voiding difficult. Clients with BPH have difficulty startin
g the urinary stream and frequently feel an urge to void because of incomplete b
ladder emptying. A urinary tract infection (option 2) presents with urgency and
frequency but does not affect the ability to start a urinary stream. Urethral st
rictures (option 3) are usually related to trauma or sexually transmitted diseas
es. Urethritis (option 4) is similar to a urinary tract infection with symptoms
of burning
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
Level:
The
orPhysiological
Process:
difficulty
Adult
client's
Analysis
Nursing
Health:
agewith
Integrity:
and
Process:
Renal
urination
gender
andAssessment
Physiological
Genitourinary
help
or focus
discharge
theAdaptation
from the meatus.
selection of the correct re
sponse. Eliminate
Reference: LeMone,theP.,distracters
& Burke, K.that (2008).
are <i>Medical-surgical
nongender and age related.
nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. nurse
<Q>The
<TYPE>fill</TYPE>
<P>
</P> 1778-1779.</F>
is caring for a client diagnosed with acute renal failure following
surgery to repair a ruptured diverticulum. The client has a past medical histor
y of heart failure and is receiving peritoneal dialysis (PD) to manage fluid and
renal status. The client is receiving IV fluids at a rate of 125 mL/hr. From 07
:00 too 11:00, the client's urine output was 150 mL, Salem sump drainage was 250
mL, and peritoneal dialysis balance is -475. In calculating the client's 4-hour
intake and output totals, what is the client's total net fluid loss in mL consi
dering all forms
<F>Rationale:
<CORRECT>["375"]</CORRECT>
Nondialysis
of intakeintakeand output?
includesProvide
all IVa and
numerical
oral fluids
response.</Q>
(although this
client has only IV fluids ordered); this total is 500 mL. Nondialysis output inc
ludes urine and Salem sump drainage, which totals 400 mL. The dialysis fluid los
s is 475 mL, after totaling the hourly dialysis balances. The total output (400
+ 475) is 875 mL. After subtracting total intake (500 mL) from the output, the c
lient'sNeed:
Cognitive
Client
Integrated
Content
Strategy:netCalculate
Area:
Level:
Process:
fluid
Physiological
Adult
Analysis
loss
Nursing
Health:
the for
intake
the
Integrity:
Process:
Renal
4-hour
and and
output
Implementation
period
Basic
Genitourinary
separately.
Care
is 375
andmL.
Comfort
Then to obtain the total f
luid balance,Berman,
References: subtract
A.,theSnyder,
totalS.,
intake
Kozier,
fromB.,
the&total
Erb, G.
output.
(2008). <i>Fundamental
s of nursing: Concepts, process, and practice</i> (8th ed.). Upper Saddle River,
<Q>Which
<TYPE>single</TYPE>
<P>
</P>
NJ: Pearson
of the Education,
followingpp.nursing
1447-1448.</F>
actions is most appropriate when caring for a
client with a nursing diagnosis of excess fluid volume related to renal insuffic
<MC1>Teaching Clients
iency?</Q>
<MC2>Administering
<MC3>Assessing
<MC4>Observing
<F>Rationale:
<CORRECT>1</CORRECT>
clients
and signs
for vitamin
documenting
about
with ofexcess
Dhypocalcemia</MC4>
sodium
supplements</MC2>
client's
fluid
content
energy
volumeof foods</MC1>
level</MC3>
need to have restrictions in sodi
um intake (option 1) because of the relationship of water and sodium. Elevated s
erum sodium will cause water to be retained. The client should avoid foods that
are high in sodium such as cured meats, preserved foods, and canned goods. Vitam
in D (option 2) and hypocalcemia (option 4) bear no relationship with fluid volu
me overload. Clients with an excess fluid volume may have decreased energy level
s, but Need:
Cognitive
Client
Integrated
Content
Strategy:
this
Area:
Level:
The
Process:
isHealth
Adult
relationship
notApplication
directly
Maintenance
Nursing
Health: between
related
Process:
Renal andand
fluid
toImplementation
Promotion
Genitourinary
decreasing
balance and thesodium
amountisoffundamental
fluid retention.
to an
swering this item. Recall that "water wants to follow salt" to help you choose c
Reference: LeMone, P., & Burke, K. (2008). <i>Medical-surgical nursing: Critical
orrectly.
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. nurse
<Q>The
<TYPE>single</TYPE>
<P>
</P> 210-211.</F>
is caring for a client with recurrent cystitis. Which of the follow
ing instructions
<MC1>Limit
<MC2>There
<MC3>Void
<MC4>Daily
<F>Rationale:
<CORRECT>3</CORRECT>
atcranberry
fluid
is least
Anoclient
should
daily
relationship
every
juice
intake
with
befour
included
has
frequent
tobeen
between
hours
decrease
prior
even
proven
cystitis
sexual
ifthe
totothe
discharge?</Q>
intercourse
urge
decrease
must
urgevoid
toisvoid.</MC1>
the
absent.</MC3>
whenever
andnumber
cystitis.</MC2>
the
of urge
UTIs.</MC4>
occurs
and at least every 4 hours (option 3). Cranberry juice (option 4) is used to de
crease the incidence of urinary tract infections (UTIs) but its effectiveness ha
s not been empirically proven. There is a direct relationship between the develo
pment of a UTI and sexual intercourse (option 2) in many women. Increasing the f
luid intake to 2 to 3 L per day helps to flush the bladder, while limiting fluid
s shouldNeed:
Cognitive
Client
Integrated
Content
Strategy:Area:
beThe
Level:
Process:
avoided
Physiological
Adult
possible
Application
(option
Nursing
Health:
mechanisms
Integrity:
1). for
Process:
Renal andImplementation
Physiological
Genitourinary
bacterial migration
Adaptation
up the urethra are exp
lored in this item as well as interventions to flush the bacteria out. Select th
e distracterLeMone,
Reference: that meets
P., &both Burke,criteria.
K. (2008). <i>Medical-surgical nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp.client
<Q>A
<TYPE>single</TYPE>
<P>
</P> 852-854.</F>
has undergone creation of an ileal conduit. Which of the following i
nstructions to the client about urostomy care would be appropriate to include in
<MC1>Cut
the teaching
the faceplate
plan?</Q>of the appliance so that the opening is slightly smaller
than the stoma.</MC1>
<MC2>Plan
<MC3>Limit
<MC4>Cleansetofluids
do appliance
the skin
to minimize
aroundchanges
the
odorstoma
just
fromusing
before
urinegentle
bedtime.</MC2>
breakdown
soaptoandammonia.</MC3>
water, rinse and dr
y well.</MC4> Peristomal skin (option 4) should be cleansed with each appliance
<F>Rationale:
<CORRECT>4</CORRECT>
change using a gentle soap and water, and then should be rinsed and dried thorou
ghly. The client should change the appliance early in the morning (option 2), wh
en urine production is slowest from lack of fluid intake during sleep. The openi
ng of the appliance should be cut no larger than 3 mm greater than the opening o
f the stoma (option 1). An opening smaller than the stoma could decrease circula
tion to the stoma, causing ischemia. Fluids should be encouraged (option 3) to m
aintain proper fluid and electrolyte balance and to dilute the urine and decreas
e the odor.
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
Level:
This
Process:
Health
Adult
item
Application
Promotion
Nursing
Health:
is relatedProcess:
Renal
and
to the
Maintenance
and Planning
Genitourinary
selection of the appropriate interventions
. Select theLeMone,
Reference: distracter
P., &that Burke,doesK.not
(2008).
pose <i>Medical-surgical
a risk to the skin ornursing:
the stoma.
Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp.client
<Q>A
<TYPE>single</TYPE>
<P>
</P> 864-865.</F>
seen in the Emergency Department reports painful urination, frequenc
y, and urgency.
<MC1>Renal
<MC4>Polycystic
<MC3>Glomerulonephritis</MC3>
<MC2>Cystitis</MC2>
<F>Rationale:
<CORRECT>2</CORRECT>
calculi</MC1>
Painful
Which urination,
kidney ofdisease</MC4>
the following
frequency,
conditions
and urgency
would are
the common
nurse suspect?</Q>
signs of cyst
itis, or bladder infection (option 2). Renal calculi or stones (option 1) presen
t with flank pain that progresses toward the groin as the stone migrates downwar
d. Glomerulonephritis (option 3) frequently presents with hematuria. Polycystic
kidney Need:
Cognitive
Client
Integrated
Content
Strategy:
disease
Area:
Level:
AsProcess:
Physiological
you
Adult
(option
Analysis
readNursing
Health:
each
4) frequently
Integrity:
distracter,
Process:
Renal andAssessment
presents
Physiological
Genitourinary
identifywith theflank
Adaptation
major pain
clinical
and hypertension.
signs of that
Reference:
disorder. LeMone,
Compare P.,the &signsBurke,youK.identified,
(2008). <i>Medical-surgical
with those providednursing:
in the Critical
stem.
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp.client
<Q>A
<TYPE>single</TYPE>
<P>
</P> 852-854.</F>
underwent cystectomy for cancer of the bladder and had a Kock pouch
created for urinary diversion. The home care nurse would follow up with the clie
nt about which
<MC1>Application
<MC2>Technique
<MC3>Proper
<MC4>Foods
<F>Rationale:
<CORRECT>2</CORRECT>
that
administration
Afor
ofKock
must
and
the
catheterizing
care
be
pouch
following
restricted
ofis
ofexternal
aprophylactic
instructions
continent
theinKock
pouch</MC1>
the pouch</MC2>
diet</MC4>
internal
antibiotics</MC3>
for self-care?</Q>
ileal reservoir, eliminating
the need for an external pouch (option 1). The nurse needs to instruct the clien
t about the technique for catheterizing the pouch to empty the urine (option 2).
Antibiotics are not required unless an infection (option 3) is present and diet
ary restrictions
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
Level:
Eliminate
Process:
Physiological
Adult
areany
Application
Nursing
Health:
unnecessary
distracter
Integrity:
Process:
Renal (option
and
that
Implementation
Physiological
Genitourinary
is4).unrelatedAdaptation
to the removal of the bladd
er and creation of a urinary diversion. Then differentiate internal from externa
l procedures.
Reference: LeMone, P., & Burke, K. (2008). <i>Medical-surgical nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. 789, 865.</F>
</P>