Medical Surgical Nursing

MEDICAL-SURGICAL NURSING Name:___________________________________________________________________ Date:____________ 1. In counseling a client with ulcerative colitis for 25 years about health plans, the nurse would include the advice that the client should A. Avoid red meat C. obtain genetic counseling B. reduce physical exercise D. Schedule regular proctoscopic exams 2. The out-patient clinic nurse is caring for a 66-year-old woman with insulin-dependent diabetes mellitus (IDDM). Because the client is unwilling to perform blood glucose monitoring, she tests her urine for sugar and acetone. The nurse knows that blood glucose monitoring is preferred over urine testing for glucose because A. the renal threshold for glucose is elevated in the elderly. B. blood glucose monitoring is easier and less costly for clients to perform. C. urine testing for glucose provides false-positive readings. D. determination of the color on a reagent strip varies from person to person. 3. The Clinical instructor is supervising a student nurse administering an enema to a patient. During the administration, it is MOST important for the Student nurse to take which of the following actions? A. Place the solution 20 inches above the anus. B. Adjust the temperature of the solution. C. Insert the tube six inches. D. Position the patient left side-lying (Sim's) with knee flexed. 4. Which of the following types of foods should the nurse encourage in the diet of a client with hypoparathyroidism? A. High in phosphorus. C. Low in sodium. B. High in calcium. D. Low in potassium. 5. The nurse suggests that the client not eat or drink anything just before going to bed. The appropriateness of this comment is based on which of these understandings about GERD? A. The client is less likely to awaken during the night with heartburn if the stomach is empty. B. Early-morning vomiting will be less of a problem if the stomach is empty. C. Drinking or eating before lying down causes decreased respirations due to increased pressure on the lungs. D. The client may develop fluid overload if fluids are taken just before going to bed. 6. The nurse explains to a client with Crohn’s disease who is recovering from a fourth bowel resection that because of the multiple resections, the client may develop A. malabsorption syndrome C. peritonitis B. ulcerative colitis D. chronic constipation 7. Which nursing observation would suggest that a client has developed an Addisonian crisis? A. Muscular weakness and fatigue. C. Dark pigmentation of the skin. B. Restlessness and rapid, weak pulse. D. Gastrointestinal disturbances and anorexia 8. Which information should the nurse recognize as being the MOST pertinent to the diagnosis of cholecystitis? A. Flatulence. C. Right upper abdominal pain. B. Nausea and vomiting. D. Dyspepsia. 9. The nurse recognizes that the teaching about the pathophysiology of ulcerative colitis needs reinforcement when the 13 year old client says A. “ulcerative colitis involves contiguous areas of bowel” B. “I will grow out of my disease” C. “I know that physical exertion and fatigue can bring on an attack” D. “My symptoms with the disease will come and go” 10. The nurse should caution the client with hypothyroidism to avoid A. warm environmental temperatures. C. increased physical exercise. B. narcotic sedatives. D. a diet high in fiber.

11. The nurse would explain to the diabetic client that the decreased vision he has experienced is due to which of the following? A. Bleeding into the inner ocular chamber of the eye. B. Gradual separation of the retina from the base of the eye. C. An increase in the size of the vessels in the back of the eye. D. Gradual destruction and degeneration of the retina. 12. A client who is scheduled for a barium enema indicates that she understands the nurse’s preprocedure instructions when she says A. “I will need to eat a high-fiber diet during the 2 days before the test.” B. “I will need to use laxatives and enemas to clean out my bowel before this test.” C. “I’m not sure if I can drink the 2 quarts of water I need the day before the test.” D. “I will be prepared for the barium enema when I get to the hospital for the test.” 13. The nurse knows that Cortisol is responsible for A. preparing the body for "flight or fight." C. converting proteins and fat into glucose. B. regulating the calcium metabolism. D. enhancing musculoskeletal activity. 14. The nurse is caring for a three-month-old infant that is scheduled for a barium swallow in the morning. Prior to the procedure, the MOST appropriate nursing action would be to A. offer the infant only clear liquids. C. feed the infant regular formula. B. make the infant NPO for three hours. D. maintain the infant NPO for six hours. 15. In preparing a teaching plan regarding colostomy irrigations, the nurse should include which of the following? A. The colostomy needs to be irrigated at the same time every day. B. Irrigate the colostomy after meals to increase peristalsis. C. Insert the catheter about ten inches into the stoma. D. The solution should be very warm to increase dilation and flow. 16. A 34-year-old man comes to the clinic for the results of a glycosylated hemoglobin assay (HbA1c). Which statement, if made by the client to the nurse, indicates an understanding of this procedure? A. "This test is performed by sticking my finger and measuring the results." B. "This test needs to be performed in the morning before I eat breakfast." C. "This test indicates how well my blood sugar has been controlled the past 6-8 weeks." D. "I must follow my diet carefully for several days before the test." 17. The physician diagnoses Graves' disease for a 28-year-old woman seen in the clinic. The nurse would expect the client to exhibit which of the following symptoms? A. Lethargy in the early morning. C. Weight loss of 10 lb in 3 weeks. B. Sensitivity to cold. D. Reduced deep tendon reflexes. 18. The nurse planning to irrigate a nasogastric (NG) tube prepares to use A. half-strength peroxide. C. normal saline. B. sterile water. D. tap water. 19. A 23-year-old man with Addison's disease comes to the health clinic. The nurse should expect the client to report that his skin has become A. darker and more pigmented. C. puffy and scaly. B. ruddy and oily. D. pale and dry. 20.The nurse administers alternating doses of two antacids into the NG tube of a client with a duodenal ulcer. The finding that best indicates that this drug regimen has been successful is A. absent NG tube drainage. C. mild diarrhea. B. increase in gastric pH. D. decreased abdominal rigidity. 21. Which of the following nursing actions has the HIGHEST priority in caring for the client with hypoparathyroidism? A. Develop a teaching plan. B. Plan measures to deal with cardiac dysrhythmias. C. Take measures to prevent a respiratory infection. D. Assess laboratory results.

22. For a client with cirrhosis who had 1000 ml of ascitic fluid removed during a peritoneal tap 20 minutes ago, the intervention that would have priority is A. frequently monitoring vital signs. C. administering pain medications. B. assessing for deep tendon reflex. D. assisting with ambulation. 23. The nurse should anticipate the client with a gastric ulcer to have pain A. two to three hours after a meal. C. relieved by ingestion of food. B. at night. D. one-half to one hour after a meal. 24. The laboratory value that would necessitate notification of the client’s physician before liver biopsy is a. platelets 50,000/mm3. c. partial thromboplastin time 15 seconds. b. hemoglobin 12 g/dl. d. indirect bilirubin 0.2 mg/100 ml. 25. Which of the following assessment findings should the nurse recognize as pertinent to a diagnosis of Cushing's syndrome? A. Low blood pressure and weight loss. B. Thin extremities with easy bruising. C. Decreased urinary output and decreased serum potassium. D. Tachycardia with complaints of night sweats. 26. A patient with type I diabetes mellitus (IDDM) asks the nurse why the doctor ordered human insulin instead of beef or pork insulin. Which of the following responses by the nurse is BEST? A. "Human insulin is less likely to cause you to have a localized allergic reaction to the injection." B. "Human insulin will cause you to experience fewer problems with hypoglycemia or hyperglycemia." C. "Human insulin prevents the development of long-term damage to the eyes and kidneys." D. "Human insulin does not cause the formation of antibodies because the protein structure is identical to your own." 27. The nurse checks for placement of a nasogastric (NG) tube before beginning a tube feeding for a client. Which of the following results would indicate to the nurse that the tube feeding can begin? A. A small amount of white mucus is aspirated from the NG tube. B. The pH of the contents removed from the NG tube is 3. C. No bubbles are seen when the nurse inverts the NG tube in water. D. The client says he can feel the NG tube in the back of his throat. 28. A 46-year-old man with newly diagnosed diabetes mellitus says to the nurse, "I know that I have to take good care of my feet. When I buy new shoes, is there anything special I should do?" Which of the following responses by the nurse is BEST? A. "It is best to buy new shoes in the morning." B. "Have each foot measured every time you buy new shoes." C. "Buy shoes one half size larger than your foot size so the fit is roomy." D. "Buy vinyl shoes because they won't lose their shape easily." 29. A client is admitted with irritable bowel syndrome. The nurse would anticipate the client's history to reflect which of the following? A. Pattern of alternating diarrhea and constipation. B. Chronic diarrhea stools occurring 10-12 times per day. C. Diarrhea and vomiting with severe abdominal distention. D. Bloody stools with increased cramping after eating. 30. A client is admitted for a series of tests to verify the diagnosis of Cushing's syndrome. Which of the following assessment findings, if observed by the nurse, would support this diagnosis? A. Buffalo hump, hyperglycemia, and hypernatremia. C. Lethargy, weight gain, and intolerance to cold. B. Nervousness, tachycardia, and intolerance to heat. D. Irritability, moon face, and dry skin. 31. Which observation indicates to the nurse that the client needs further teaching before he can administer his own insulin?

A. The client draws up his regular insulin first, then the NPH. B. The client gently rotates the insulin bottle before withdrawing the dose. C. The client rotates injection sites following the guide on his printed diagram. D. The client administers the insulin while it is still cold from the refrigerator. 32. The nurse is caring for a client admitted with acute hypoparathyroidism. important for the nurse to have which of the following items available? A. Tracheostomy set. C. IV monitor. B. Cardiac monitor. D. Heating pad.

It is MOST

33. During evaluation, a client presents with coarse, dry, brittle hair and elevated blood pressure. When evaluating the client’s head and neck area, the nurse would look specifically for a. bulging eyes. c. clear nasal drainage. b. cataracts. d. dental caries. 34. The nurse is caring for a client who is receiving a tube feeding around the clock. Which of the following nursing actions is MOST appropriate? A. Rinse the bag and change the formula every four hours. B. Rinse the bag and change the formula every shift. C. Change the bag and formula every shift. D. Rinse the bag and change the formula every two hours. 35. A 25-year-old primigravida with type I diabetes mellitus is reviewing her insulin regimen with the nurse. The nurse explains to the client that her insulin needs will A. increase during pregnancy and decrease after delivery. B. decrease during pregnancy and increase after delivery. C. increase during pregnancy and remain increased after delivery. D. decrease during pregnancy and fluctuate after delivery. 36. A client asks what the difference is between his gastric ulcer and his friend's duodenal ulcer. The nurse's response should be based on which of the following statements? A. "Gastric ulcers have an increased association with clients who experience increased psychological pressures." B. "The pain of a duodenal ulcer usually occurs two to four hours after meals." C. "Clients with gastric ulcers often gain weight, as food alleviates the pain." D. "Antacids such as Maalox are seldom prescribed for clients with duodenal ulcers. " 37. A client was admitted for regulation of her insulin dosage. The client takes 15 units of Humulin insulin at 8 AM every day. At 4 PM, which of the following nursing observations would indicate a complication from the insulin? A. Acetone odor to the breath, polyuria, and flushed skin. B. Irritability, tachycardia, and diaphoresis. C. Headache, nervousness, and polydipsia. D. Tenseness, tachycardia, and anorexia. 38. A patient is admitted to the surgical unit with a diagnosis of rule out intestinal obstruction. The nurse is preparing to insert a NG tube as ordered. In which of the following positions would it be BEST for the nurse to place this patient during the procedure? A. Head of bed elevated 30º - 45º. C. Side-lying with head elevated 15º. B. Head of bed elevated 60º - 90º. D. Lying flat with head turned to the left side. 39. A client received six units of regular insulin three hours ago. The nurse would be MOST concerned if which of the following was observed? A. Kussmaul respirations and diaphoresis. C. Diaphoresis and trembling. B. Anorexia and lethargy. D. Headache and polyuria. 40. The home health care nurse is caring for a 30-year-old woman with type I diabetes mellitus. The client has been maintained on a regimen of NPH and regular insulin and a 1,800-calorie diabetic diet with normal blood sugar levels. Morning self-monitoring blood sugar (SMBG) readings the past two days were 205 mg/dL and 233 mg/dL. The nurse expects the physician to A. reduce the client's diet to 1,500 calorie ADA. B. order 3 additional units of NPH insulin at 10 PM. C. order an additional 10 units of regular insulin at 8 PM.

D. eliminate the client's bedtime snack. 41.In a client with Graves’ disease receiving radioiodine, the nurse would monitor for the common treatment complication of a. hypothyroidism. c. pulmonary emboli. b. skin breakdown. d.urinary tract infection. 42. A client with a peptic ulcer had a partial gastrectomy and vagotomy (Billroth I). In planning the discharge teaching, the client should be cautioned by the nurse about which of the following? A. Sit up for at least 30 minutes after eating. B. Avoid fluids between meals. C. Increase the intake of high-carbohydrate foods. D. Avoid eating large meals that are high in simple sugars and liquids. 43. The nurse should explain to a client that tolbutamide (Orinase) is effective for diabetics who A. can no longer produce any insulin. C. are unable to administer their injections. B. produce minimal amounts of insulin. D. have a sustained decreased blood glucose. 44. A client with newly diagnosed type I diabetes mellitus is being seen by the home health nurse. The physician orders include: 1,200-calorie ADA diet, 15 units of NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the client at 5 PM, the nurse observes the man performing a blood sugar analysis. The result is 50 mg/dL. The nurse would expect the client to be A. confused with cold, clammy skin and a pulse of 110. B. lethargic with hot dry skin and rapid, deep respirations. C. alert and cooperative with a BP of 130/80 and respirations of 12. D. short of breath, with distended neck veins and a bounding pulse of 96. 45. In making emergency equipment available at the bedside of a client who has undergone subtotal thyroidectomy, the nurse would include A. an electrocardiogram (ECG) monitor. C. an intra-aortic balloon pump. B. a defibrillator. D. a tracheostomy set. 46.The nurse teaching a type 2 diabetic client how to manage the disease while on a prescribed diet and taking an oral antidiabetic agent would recognize that the client has an accurate understanding of diabetes management when the client states A. “I must exercise at least 1 hour daily to help bring down my sugar.” B. “I’m really happy I can take insulin pills; it’s much easier than an injection.” C. “I must decrease my total daily fat intake to less than 45% of my total calories.” D. “I can use oral medications for my diabetes as long as my pancreas can still produce insulin.” 47. The physician orders ranitidine hydrochloride (Zantac) 150 mg PO qd for a client. The nurse should advise the client the BEST time to take this medication is A. before breakfast. C. with food. B. with dinner. D. at hs. 48. The nurse is performing discharge teaching for a client with Addison's disease. MOST important for the nurse instruct the client about A. signs and symptoms of infection. C. seizure precautions. B. fluid and electrolyte balance. D. steroid replacement.

It is

49. A 38-year-old woman is returned to her room after a subtotal thyroidectomy for treatment of hyperthyroidism. Which of the following, if found by the nurse at the patient's bedside, is nonessential? A. Potassium chloride for IV administration. C. Tracheostomy set-up. B. Calcium gluconate for IV administration. D. Suction equipment. 50. The nurse knows that the client with drug-induced Cushing's syndrome should FIRST be instructed about A. compression fractures from increased calcium excretion. B. decreased resistance to stress.

C. the schedule for gradual withdrawal of the drug. D. changes in secondary sex characteristics. 51. The client is exhibiting symptoms of myxedema. The nursing assessment should reveal A. increased pulse rate. C. fine tremors. B. decreased temperature. D. increased radioactive iodine uptake level.

52. The physician orders sucralfate (Carafate) 1 g PO bid for a 56-year-old woman taking digoxin (Lanoxin) 0.25 mg qd. The woman asks the nurse if she can take both pills together with her breakfast so she doesn't forget to take them. The nurse should advise the woman to A. take the Carafate and Lanoxin before breakfast. B. take the Lanoxin 1 hour before breakfast and the Carafate 1 hour after breakfast. C. take the Carafate 1 hour before breakfast and the Lanoxin 1 hour after breakfast. D. take the Carafate and the Lanoxin after breakfast. 53. The nurse should assess a client with a history of hypothyroidism for the metabolic condition of a. goiter. c. Hashimoto’s thyroiditis. b. Graves’ disease.

d. Myxedema.

54. An adult client has regular insulin ordered before breakfast. The nurse notes that the client's blood glucose level is 68 mg/dL, and the client is nauseated. Which of the following actions should the nurse take? A. Immediately give the client orange juice to drink. B. Administer the insulin on time. C. Withhold the insulin and notify the physician. D. Return the breakfast tray to the kitchen. 55. The nurse observes a student nurse checking the placement of a nasogastric (NG) tube. Which of the following actions, if performed by the student nurse, would require an intervention by the nurse? A. Places the end of the NG tube in a cup of water and watches for bubble formation. B. Checks the pH of the contents aspirated from the NG tube. C. Positions a stethoscope on the upper abdomen and listens as air is introduced into the NG tube. D. Uses a large barreled syringe to aspirate for stomach contents. 56. The nurse is caring for a client with Cushing's syndrome. Which of the following nursing actions would be of HIGHEST priority? A. Implement measures to prevent skin breakdown. B. Plan measures to prevent infections. C. Teach the client signs and symptoms of hyperglycemia. D. Instigate measures to prevent fluid overload. 57. The nurse caring for a female client who had a total thyroidectomy 2 days ago would know to assess for tetany if: a. the assessment indicates decreasing diastolic blood pressure. b. the client reports that her mouth has an odd sensation. c. the client reports a loss of appetite. d. the client reports increased thirst. 58. The nursing diagnosis Impaired Urinary Elimination has been assigned to the client with hyperparathryoidism. To address this diagnosis, the nurse would a. encourage the client to start and stop the urine stream. b. force fluids. c. not administer fluids with meals. d. withhold acidic juices in the diet. 59. The nurse is preparing a 56-year-old woman for a paracentesis. It is MOST important for the nurse to take which of the following actions? A. Keep the woman NPO 12 hours before the procedure.

B. Have the woman void just before the procedure. C. Initiate a bowel preparation program 24 hours before the procedure. D. Place the woman supine during the procedure. 60. The nurse caring for a client with hyperparathyroidism should assign priority to A. coughing hourly. C. preventing falls. B. encouraging exercise. D. averting infection. 61.In a client with Addisonian crisis, assessment would indicate that the drug Kayexalate is not effective when the nurses assesses the clinical manifestation of A. decreasing blood pressure. C. low back pain. B. rapid or erratic pulse. D. pedal edema. 62. The nurse caring for a client with a history of experiencing the Somogyi effect would monitor the client’s blood sugar level between a. 2 AM and 7 AM. c. 12 AM and 6 AM. b. 10 AM and 3 PM. d. 5 AM and 12 NN. 63. A 45-year-old client with newly diagnosed IDDM (insulin-dependent diabetes mellitus) is being seen by the home health nurse. The client's orders include 1,800-calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the client at 5 PM, the client has not eaten since noon and has just returned from jogging. The client's vital signs are: BP 110/80, pulse 120, and respirations 18, temperature 36.8 º C. The nurse would expect his blood sugar reading to be A. 250 mg/dL. C. 90 mg/dL. B. 160 mg/dL. D. 50 mg/dL. 64. The nurse would instruct a client who is on a rowing team to avoid injecting insulin in his arms on rowing practice days because A. the arms have increased muscle mass. C. increased circulation in the arms will dilute the insulin. B. the arms will become painful. D. exercise increases the absorption rate of insulin. 65. In a client who needs fluid replacement therapy for DKA, the nurse would evaluate the best indicator of dehydration as A. intake and output. C. skin turgor. B. weight deviation from baseline. D. dryness of tongue and mucous membranes. 66. The nurse suspects hypoglycemia in a client with diabetes who is difficult to arouse. To reverse this condition, the nurse knows that the best therapy would be A. graham crackers. C. 4 teaspoons granulated sugar. B. orange juice. D. glucagon. 67. A client had surgery for cancer of the colon, and a colostomy was performed. Prior to discharge, the client states that he will no longer be able to swim. The nurse's response would be based on which of the following? A. Swimming is not recommended; the client should begin looking for other areas of interest. B. Swimming is not restricted if the client wears a watertight dressing over the stoma. C. The client cannot go into water that is over the stoma area; he can go into water only up to that area. D. There are no restrictions on the activity of a client with a colostomy; all previous activities may be resumed. 68. A client with diabetes who has properly learned the principles of foot care would be most likely to say a. “I should wear nice, tight shoes for firm support.” b. “A mirror will be very helpful so I can look at all parts of my feet each day.” c. “I should limit walking barefoot to a half hour a day.” d. “The best method of testing bath temperature is with the toes.” 69. The nurse teaching a type 2 diabetic client how to manage the disease while on a prescribed diet and taking an oral antidiabetic agent would recognize that the client has an accurate understanding of diabetes management when the client states A. “I must exercise at least 1 hour daily to help bring down my sugar.” B. “I’m really happy I can take insulin pills; it’s much easier than an injection.” C. “I must decrease my total daily fat intake to less than 45% of my total calories.”

D. “I can use oral medications for my diabetes as long as my pancreas can still produce insulin.” 70. The nurse is preparing a 50-year-old client for a liver biopsy. The nurse should position the client A. prone with her head turned to the side. B. on her right side with her head slightly elevated. C. supine with her arms raised over her head. D. on her left side with the bed flat. 71. The nurse is obtaining a history on a client with hyperthyroidism. report which of the following assessments to the physician? A. Anxiety with extreme nervousness. C. Cool, clammy skin. B. Slow, sluggish pulse. D. Husky, slow speech.

The nurse should

72. The physician orders cholestyramine (Questran) 4 g PO qid for a 40-year-old client. The medication is provided in single-dose 4-g packets. The client asks the office nurse how to take the medication. The nurse should instruct the client to A. sprinkle the powder on a beverage, stir, and drink immediately. B. sprinkle the powder on food and eat slowly. C. add water to make a paste and eat, followed by 8 oz of water. D. sprinkle the powder on a beverage, let it stand a few minutes, and then stir and drink. 73. The nurse is caring for a two-month-old infant. A pH probe test indicates that the infant has reflux. Which nursing action is MOST appropriate? A. Hold the next feeding. C. Maintain a normal feeding schedule. B. Teach the mother CPR. D. Elevate the head of the bed. 74. The nurse providing education to a client newly diagnosed with diabetes mellitus about an exercise program would remind the client to A. reduce fluid intake before exercising. C. refrain from eating until 30 minutes after exercising. B. ensure that blood sugar level is above 100. D. set exercise periods for different times during the day. 75. The nurse is teaching a client with newly diagnosed diabetes mellitus how to treat hypoglycemia at home. The nurse should instruct the client to do which of the following actions if symptoms of hypoglycemia are experienced? A. Eat a candy bar. B. Drink 1/2-cup fruit juice followed by a protein snack. C. Inject 10 units of Humulin R. D. Inject glucagon. 76. The nurse caring for a client admitted for treatment of diabetic ketoacidosis (DKA) assesses Kussmaul’s respirations, which are A. rapid and short. C. irregular and gasping. B. slow and shallow. D. fast and deep. 77. Following treatment for Addison's disease in a seven-year-old patient, the nurse plans for the client's discharge. The mother asks how long her daughter must continue receiving replacement therapy. The nurse's response should be A. "For approximately six months." C. "Until she reaches puberty." B. "For approximately one year." D. "For the rest of her life." 78. The nurse is caring for a 74-year-old man with type I diabetes. The client is scheduled for cataract surgery under general anesthesia at 9 AM. The man usually receives 30 units of NPH and 10 units of regular insulin each morning at 7 AM. At 7 AM the morning of surgery, the nurse would expect to take which of the following actions? A. hold the morning dose of NPH and regular insulin and monitor the blood glucose. B. give half the morning dose of NPH insulin along with the regular insulin and monitor the blood glucose when the client returns from surgery. C. give the full dose of NPH and regular insulin and monitor the blood glucose every 2 to 4 hours. D. give the full dose of regular insulin but hold the NPH insulin and monitor the blood glucose until the client goes to surgery

79. A client with a history of cholelithiasis presents at the hospital with nausea and vomiting, abdominal pain, and jaundice. The nurse would assume that the precipitating physiologic event was A. common duct obstruction. C. spasm of the biliary tree. B. perforation of the gallbladder. D. infarct of the hepatic vein. 80. A client returned to the nursing unit after cholecystectomy with common bile duct exploration has bile leaking from around the wound. The most appropriate nursing intervention at this time would be to A. assess the client further, asking about pain. B. reassure the client that this is normal and reinforce the dressing. C. monitor the client for elevations in blood pressure and pulse. D. encourage the client to change position in bed. 81.For a client with a history of recurrent UTI who is prescribed an acid-ash diet, the nurse would advise the client to include a. carbonated beverages. c. alcohol. b. coffee. d. cranberry juice. 82. The nurse teaching self-catheterization technique should include the importance of: a. sterile technique. b. drinking at least 500 ml of fluid within 2 hours of catheterization. c. using the Credé maneuver before catheterization. d. catheterizing every 3 to 4 hours. 83. During a bladder training program for a client with spinal cord injury using intermittent catheterization, the client suddenly complains of a throbbing headache. Noting that the client’s blood pressure is elevated, the nurse initially would a. place the client flat in bed. c. notify the physician immediately. b. catheterize the client. d. Limit fluids for the remainder of the day. 84. The nurse reinforces explanations that the procedure for lithotripsy involves a. surgical removal of stones. c. fragmenting of stones by electrical charge. b. capturing of stones via a scope. d. dissolution of stones with medication. .

85. Nursing care for a client with urinary bladder calculi should include a. encouraging fluid intake up to 4000 ml/day. b. collecting a 24-hour urine specimen for calcium. c. maintaining bed rest. d. checking for abdominal distention. 86. To determine if a client has an initial manifestation typically seen in clients with bladder neoplasm, the nurse would ask a. “Have you noticed any blood in your urine?” b. “Do you produce larger amounts of urine than you have in the past?” c. “Do you have pain when you urinate?” d. “Have you noticed that you seem to urinate much more frequently than you used to?” 87. For a client experiencing urinary incontinence, in the initial plan of care the nurse would include a. limiting fluid intake. c. encouraging the client to void frequently. b. using adult diapers to prevent accidents. d. teaching Kegel exercises. 88. The nurse warns a client with insulin-dependent diabetes mellitus (IDDM) who has developed proteinuria that this finding is significant because a. renal failure will most likely develop in 5 to 10 years. b. it indicates that the client’s diabetes is uncontrolled. c. renal failure will result if diabetes is not well controlled. d. insulin requirements should be lowered. 89. In the nursing care plan for a client with acute pyelonephritis, the nurse would include teaching the client to a. drink 4000 ml of fluid daily. c. complete the entire course of antibiotics. b. maintain complete bed rest. d. withhold any antihypertensive medications ordered.

90. When obtaining the history of a client with acute glomerulonephritis, the nurse should be sure to ask about a. recent urinary tract infections. c. a history of long-term analgesic use. b. recent respiratory infections. d. a history of hypertension. 91. The teaching plan for a client with nephrotic syndrome should include a. diligent skin care. b. discussion about a low-protein diet. c. explanation of the need to complete antibiotic therapy. d. the importance of maintaining fluid restriction. 92. Nursing care for the client with glomerulonephritis should include a. increasing fluid intake. c. encouraging ambulation, as tolerated. b. maintaining isolation precautions. d. maintaining a high-calorie, low-protein diet. 93. In the care plan for a client after nephrectomy, the nurse would include an intervention for a. maintaining patency of wound drains. c. maintaining adequate hydration. b. promoting effective breathing patterns. d. encouraging ambulation. 94. A client with a renal abscess would exhibit a. hypertension. c. bacteria in the urine. b. oliguria. d. High fever. 95. The nurse explains that the type of antibiotic prescribed for clients that is least likely to cause nephrotoxicity is a. A cephalosporin. c. A penicillin. b. an aminoglycoside. d. A sulfonamide. 96. In the client with pyelonephritis, the nurse would take special care to monitor a. oxygen saturation. c. respiratory rate. b. pulse rate. d. blood pressure. 97. As part of the care plan for a client with pyelonephritis, the nurse should a. encourage increased activity. c. assess for manifestations of fluid overload. b. increase fluid intake to 3 to 4 L/day. d. watch for early manifestations of anaphylaxis. 98. The nurse explains that the type of renal tumor occurring primarily in childhood is a. transitional cell. c. adenocarcinoma. b. squamous cell. d. nephroblastoma. 99. Assessing the urinalysis of a woman in the eighth month of pregnancy who was injured in an automobile accident, the nurse would recognize as abnormality the finding of a. proteinuria. c. pyuria. b. decreased specific gravity. d. casts. 100. For a client after nephrectomy and based on the location of the incision, the nurse would formulate the nursing diagnosis of a. Risk for Injury: Postoperative Complications related to surgical procedure. b. Acute Pain related to surgery. c. Anxiety related to long-term outcome. d. Risk for Impaired Skin Integrity related to immobility.