NUR 2244 Pre-lecture Quiz on Renal and Endocrine System, Quizzes of Nursing

Download NUR 2244 Pre-lecture Quiz on Renal and Endocrine System and more Quizzes Nursing in PDF only on Docsity! NUR 2244 Pre-lecture Quiz on Renal and Endocrine System Renal System 1. After having transurethral resection of the prostate (TURP), a Mr. Locke returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client’s catheter is occluded? a. The urine in the drainage bag appears red to pink. b. The client reports bladder spasms and the urge to void. c. The normal saline irrigant is infusing at a rate of 50 drops/minute. d. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned. Rationale: Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency. 2. Nurse Myrna is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to: a. initiate a stream of urine. b. breathe deeply. c. turn to the side. d. hold the labia or shaft of penis. Rationale: When inserting a urinary catheter, facilitate insertion by asking the client to breathe deeply. Doing this will relax the urinary sphincter. Initiating a stream of urine isn't recommended during catheter insertion. Turning to the side or holding the labia or penis won't ease insertion, and doing so may contaminate the sterile field. 3. A female adult client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a. Blood urea nitrogen (BUN) level of 22 mg/dl b. Serum creatinine level of 1.2 mg/dl c. Serum creatinine level of 1.2 mg/dl d. Urine output of 400 ml/24 hours Rationale: ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is demonstrated by a urine output of 400 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder. 4. A 55-year old client with benign prostatic hyperplasia doesn’t respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, nurse Gail asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? a. Transurethral resection of the prostate (TURP) b. Suprapubic prostatectomy c. Retropubic prostatectomy d. Transurethral laser incision of the prostate Rationale: TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; they all require an incision. 5. A female client with suspected renal dysfunction is scheduled for excretory urography. Nurse July reviews the history for conditions that may warrant changes in client preparation. Normally, a client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding would call for the client to be well hydrated instead? a. Cystic fibrosis b. Multiple myeloma c. Gout d. Myasthenia gravis Rationale: Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don't necessitate changes in client preparation for excretory urography. 6. Nurse Kim is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence? a. Encouraging intake of at least 2 L of fluid daily b. Giving the client a glass of soda before bedtime c. Taking the client to the bathroom twice per day d. Consulting with a dietitian Rationale: By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence. 7. When examining a female client’s genitourinary system, nurse Sally assesses for tenderness at the costovertebral angle by placing the left hand over this area and striking it with the right fist. Normally, this percussion technique produces which sound? a. A flat sound b. A dull sound c. Hyperresonance d. Tympany Rationale: Percussion over the costovertebral angle normally produces a dull, thudding sound, which is soft to moderately loud with a moderate pitch and duration. This sound occurs over less dense, mostly fluid-filled matter, such as the kidneys, liver, and spleen. In contrast, a flat sound occurs over highly dense matter such as muscle; hyperresonance occurs over the air-filled, appropriate? a. Tell the client to try to urinate around the catheter to remove blood clots. b. Restrict fluids to prevent the client’s bladder from becoming distended. c. Prepare to remove the catheter. d. Use aseptic technique when irrigating the catheter. Rationale: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. Encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is only removed with a physician's order. 16. A female client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim- sulfamethoxazole). Nurse Don should provide which medication instruction? a. “Take the medication with food.” b. “Drink at least eight 8-oz glasses of fluid daily.” c. “Avoid taking antacids during co-trimoxazole therapy.” d. “Don’t be afraid to go out in the sun.” Rationale: When receiving a sulfonamide such as co-trimoxazole, the client should drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy. 17. A male client is admitted for treatment of glomerulonephritis. On initial assessment, Nurse Rose detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include: a. generalized edema, especially of the face and periorbital area. b. green-tinged urine. c. moderate to severe hypotension. d. polyuria. Rationale: Generalized edema, especially of the face and periorbital area, is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain. 18. A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans? a. Cottage cheese–like discharge b. Yellow-green discharge c. Gray-white discharge d. Discharge with a fishy odor Rationale: The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis. 19. A 24-year old female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. b. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. d. The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex. Rationale: Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx. 20. Nurse Vic is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract infection (UTI)? a. Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg b. Limiting fluid intake to 1 L/day c. Encouraging the client to use a feminine deodorant after bathing d. Encouraging the client to douche once a day after removal of the indwelling urinary catheter Rationale: Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx. 21. Nurse Eve is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence? a. Encouraging intake of at least 2 L of fluid daily b. Giving the client a glass of soda before bedtime c. Taking the client to the bathroom twice per day d. Consulting with a dietitian Rationale: By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence. 22. A female client with an indwelling urinary catheter is suspected of having a urinary tract infection. Nurse Angel should collect a urine specimen for culture and sensitivity by: a. disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container. b. wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle. c. draining urine from the drainage bag into a sterile container. d. clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine. Rationale: Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Tubing shouldn't be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Urine in urine drainage bags may not be fresh and may contain bacteria, giving false test results. When there is no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect. 23. Nurse Grace is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? a. Rashes on the palms of the hands and soles of the feet b. Cauliflower-like warts on the penis c. Painful red papules on the shaft of the penis d. Foul-smelling discharge from the penis Rationale: Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes. 24. Nurse Ethel is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client: a. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. b. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. c. retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn’t necessary to reduce the potassium level. d. retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn’t necessary to reduce the potassium level. Rationale: Kayexalate is a sodium exchange resin. Thus the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention. 25. When caring for a male client with acute renal failure (ARF), Nurse Fatima expects to adjust the dosage or dosing schedule of certain drugs. Which of the following drugs would not require such adjustment? a. acetaminophen (Tylenol) c. Hypoglycemia d. Hyperthyroidism Rationale: Agitation, irritability, poor memory, loss of appetite, and neglect of one’s appearance may signal depression, which is common in clients with Cushing’s syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing’s syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite. 8. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a. Tetany b. Hemorrhage c. Thyroid storm d. Laryngeal nerve damage Rationale: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction. 9. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? a. Primary hypothyroidism b. Graves’ disease c. Thyrotoxicosis d. Euthyroidism Rationale: Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism. It is contraindicated in Graves’ disease and thyrotoxicosis because these conditions are forms of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function, wouldn’t require any thyroid preparation. 10. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? a. Tetanic contractions b. Neck vein distention c. Weight loss d. Polyuria Rationale: SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn’t associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria). 11. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer: a. phentolamine (Regitine). b. methyldopa (Aldomet). c. mannitol (Osmitrol). d. felodipine (Plendil). Rationale: Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic blocking agent given by I.V. bolus or drip, antagonizes the body’s response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn’t effective in treating hypertensive emergencies. Mannitol, a diuretic, isn’t used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn’t reduce blood pressure quickly enough to correct hypertensive crisis. 12. A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client’s hypertension is caused by excessive hormone secretion from which of the following glands? a. Adrenal cortex b. Pancreas c. Adrenal medulla d. Parathyroid Rationale: Excessive secretion of aldosterone in the adrenal cortex is responsible for the client’s hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone. 13. Nurse Troy is aware that the most appropriate for a client with Addison’s disease? a. Risk for infection b. Excessive fluid volume c. Urinary retention d. Hypothermia Rationale: Addison’s disease decreases the production of all adrenal hormones, compromising the body’s normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison’s disease include Deficient fluid volume and Hyperthermia. Urinary retention isn’t appropriate because Addison’s disease causes polyuria. 14. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching when the client states: a. “If I have hypoglycemia, I should eat some sugar, not dextrose.” b. “The drug makes my pancreas release more insulin.” c. “I should never take insulin while I’m taking this drug.” d. “It’s best if I take the drug with the first bite of a meal.” Rationale: Acarbose delays glucose absorption, so the client should take an oral form of dextrose rather than a product containing table sugar when treating hypoglycemia. The alpha-glucosidase inhibitors work by delaying the carbohydrate digestion and glucose absorption. It’s safe to be on a regimen that includes insulin and an alpha-glucosidase inhibitor. The client should take the drug at the start of a meal, not 30 minutes to an hour before. 15. A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? a. “You must lie flat for 24 hours after surgery.” b. “You must avoid coughing, sneezing, and blowing your nose.” c. “You must restrict your fluid intake.” d. “You must report ringing in your ears immediately.” Rationale: After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy. 16. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? a. “Be sure to take glipizide 30 minutes before meals.” b. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.” c. “You won’t need to check your blood glucose level after you start taking glipizide.” d. “Take glipizide after a meal to prevent heartburn.” Rationale: The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The drug doesn’t cause hyponatremia and therefore doesn’t necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy. 17. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? a. They contain exudate and provide a moist wound environment. b. They protect the wound from mechanical trauma and promote healing. c. They debride the wound and promote healing by secondary intention. d. They prevent the entrance of microorganisms and minimize wound discomfort.