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MEDICAL-SURGICAL NURSING

1. In counseling a client with ulcerative colitis for 25 years 6. The nurse explains to a client with Crohn’s disease who
about health plans, the nurse would include the advice that is recovering from a fourth bowel resection that because of
the client should the multiple resections, the client may develop
A. Avoid red meat A. malabsorption syndrome

C. peritonitis
C. obtain genetic counseling B. ulcerative colitis
B. reduce physical exercise

D. Schedule regular proctoscopic exams D. chronic constipation

2. The out-patient clinic nurse is caring for a 66-year-old 7. Which nursing observation would suggest that a client
woman with insulin-dependent diabetes mellitus (IDDM). has developed an Addisonian crisis?
Because the client is unwilling to perform blood glucose A. Muscular weakness and fatigue.
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 C. Dark pigmentation of the skin.
clients to perform. B. Restlessness and rapid, weak pulse.
C. urine testing for glucose provides false-positive
readings.
D. determination of the color on a reagent strip varies from
person to person. D. Gastrointestinal disturbances and anorexia

3. The Clinical instructor is supervising a student nurse 8. Which information should the nurse recognize as being
administering an enema to a patient. During the the MOST pertinent to the diagnosis of cholecystitis?
administration, it is MOST important for the Student nurse A. Flatulence.
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.
C. Right upper abdominal pain.
4. Which of the following types of foods should the nurse B. Nausea and vomiting.
encourage in the diet of a client with hypoparathyroidism?
A. High in phosphorus.

D. Dyspepsia.
C. Low in sodium. 9. The nurse recognizes that the teaching about the
B. High in calcium. 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. Low in potassium. D. “My symptoms with the disease will come and go”

5. The nurse suggests that the client not eat or drink 10. The nurse should caution the client with
anything just before going to bed. The appropriateness of hypothyroidism to avoid
this comment is based on which of these understandings A. warm environmental temperatures.
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 C. increased physical exercise.
stomach is empty. B. narcotic sedatives.
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.
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-


D. a diet high in fiber. old woman seen in the clinic. The nurse would expect the
client to exhibit which of the following symptoms?
11. The nurse would explain to the diabetic client that the A. Lethargy in the early morning.
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 C. Weight loss of 10 lb in 3 weeks.
eye. B. Sensitivity to cold.
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 D. Reduced deep tendon reflexes.
before the test.”
B. “I will need to use laxatives and enemas to clean out my 18. The nurse planning to irrigate a nasogastric (NG) tube
bowel before this test.” prepares to use
C. “I’m not sure if I can drink the 2 quarts of water I need A. half-strength peroxide.
the day before the test.” C. normal saline.
D. “I will be prepared for the barium enema when I get to
the hospital for the test.” B. sterile water.
D. tap water.
13. The nurse knows that Cortisol is responsible for
A. preparing the body for "flight or fight." 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
C. converting proteins and fat into glucose. A. darker and more pigmented.
B. regulating the calcium metabolism.

D. enhancing musculoskeletal activity. C. puffy and scaly.


B. ruddy and oily.
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.

D. pale and dry.


C. feed the infant regular formula.
B. make the infant NPO for three hours. 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
D. maintain the infant NPO for six hours. A. absent NG tube drainage.
C. mild diarrhea.
15. In preparing a teaching plan regarding colostomy B. increase in gastric pH.
irrigations, the nurse should include which of the D. decreased abdominal rigidity.
following?
A. The colostomy needs to be irrigated at the same time 21. Which of the following nursing actions has the
every day. HIGHEST priority in caring for the client with
B. Irrigate the colostomy after meals to increase peristalsis. hypoparathyroidism?
C. Insert the catheter about ten inches into the stoma. A. Develop a teaching plan.
D. The solution should be very warm to increase dilation B. Plan measures to deal with cardiac dysrhythmias.
and flow. C. Take measures to prevent a respiratory infection.
D. Assess laboratory results.
16. A 34-year-old man comes to the clinic for the results of
a glycosylated hemoglobin assay (HbA1c). Which 22. For a client with cirrhosis who had 1000 ml of ascitic
statement, if made by the client to the nurse, indicates an fluid removed during a peritoneal tap 20 minutes ago, the
understanding of this procedure? intervention that would have priority is
A. "This test is performed by sticking my finger and A. frequently monitoring vital signs.
measuring the results." C. administering pain medications.
B. "This test needs to be performed in the morning before I B. assessing for deep tendon reflex.
eat D. assisting with ambulation.
breakfast."
C. "This test indicates how well my blood sugar has been
23. The nurse should anticipate the client with a gastric of the following?
ulcer to have pain A. Pattern of alternating diarrhea and constipation.
A. two to three hours after a meal. 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


C. relieved by ingestion of food. diagnosis of Cushing's syndrome. Which of the following
B. at night. 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. one-half to one hour after a meal.
D. Irritability, moon face, and dry skin.
24. The laboratory value that would necessitate notification
of the client’s physician before liver biopsy is 31. Which observation indicates to the nurse that the client
a. platelets 50,000/mm3. c. partial needs further teaching before he can administer his own
thromboplastin time 15 seconds. insulin?
b. hemoglobin 12 g/dl. A. The client draws up his regular insulin first, then the
d. indirect bilirubin 0.2 mg/100 ml. NPH.
B. The client gently rotates the insulin bottle before
25. Which of the following assessment findings should the withdrawing the dose.
nurse recognize as pertinent to a diagnosis of Cushing's C. The client rotates injection sites following the guide on
syndrome? his printed diagram.
A. Low blood pressure and weight loss. D. The client administers the insulin while it is still cold
B. Thin extremities with easy bruising. from the refrigerator.
C. Decreased urinary output and decreased serum
potassium. 32. The nurse is caring for a client admitted with acute
D. Tachycardia with complaints of night sweats. hypoparathyroidism. It is MOST important for the nurse to
have which of the following items available?
26. A patient with type I diabetes mellitus (IDDM) asks the A. Tracheostomy set.
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. IV monitor.
C. "Human insulin prevents the development of long-term B. Cardiac monitor.
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) D. Heating pad.
tube before beginning a tube feeding for a client. Which of
the following results would indicate to the nurse that the 33. During evaluation, a client presents with coarse, dry,
tube feeding can begin? brittle hair and elevated blood pressure. When evaluating
A. A small amount of white mucus is aspirated from the the client’s head and neck area, the nurse would look
NG tube. specifically for
B. The pH of the contents removed from the NG tube is 3. a. bulging eyes.
C. No bubbles are seen when the nurse inverts the NG tube c. clear nasal drainage.
in water. b. cataracts.
D. The client says he can feel the NG tube in the back of d. dental caries.
his throat.
34. The nurse is caring for a client who is receiving a tube
28. A 46-year-old man with newly diagnosed diabetes feeding around the clock. Which of the following nursing
mellitus says to the nurse, "I know that I have to take good actions is MOST appropriate?
care of my feet. When I buy new shoes, is there anything A. Rinse the bag and change the formula every four hours.
special I should do?" Which of the following responses by B. Rinse the bag and change the formula every shift.
the nurse is BEST? C. Change the bag and formula every shift.
A. "It is best to buy new shoes in the morning." D. Rinse the bag and change the formula every two hours.
B. "Have each foot measured every time you buy new
shoes." 35. A 25-year-old primigravida with type I diabetes
C. "Buy shoes one half size larger than your foot size so the mellitus is reviewing her insulin regimen with the nurse.
fit is roomy." The nurse explains to the client that her insulin needs will
D. "Buy vinyl shoes because they won't lose their shape A. increase during pregnancy and decrease after delivery.
easily." B. decrease during pregnancy and increase after delivery.
C. increase during pregnancy and remain increased after
29. A client is admitted with irritable bowel syndrome. The delivery.
nurse would anticipate the client's history to reflect which D. decrease during pregnancy and fluctuate after delivery.
b. skin breakdown.
36. A client asks what the difference is between his gastric d.urinary tract infection.
ulcer and his friend's duodenal ulcer. The nurse's response
should be based on which of the following statements? 42. A client with a peptic ulcer had a partial gastrectomy
A. "Gastric ulcers have an increased association with and vagotomy (Billroth I). In planning the discharge
clients who experience increased psychological pressures." teaching, the client should be cautioned by the nurse about
B. "The pain of a duodenal ulcer usually occurs two to four which of the following?
hours after meals." A. Sit up for at least 30 minutes after eating.
C. "Clients with gastric ulcers often gain weight, as food B. Avoid fluids between meals.
alleviates the pain." C. Increase the intake of high-carbohydrate foods.
D. "Antacids such as Maalox are seldom prescribed for D. Avoid eating large meals that are high in simple sugars
clients with duodenal ulcers. " and liquids.

37. A client was admitted for regulation of her insulin 43. The nurse should explain to a client that tolbutamide
dosage. The client takes 15 units of Humulin insulin at 8 (Orinase) is effective for diabetics who
AM every day. At 4 PM, which of the following nursing A. can no longer produce any insulin.
observations would indicate a complication from the
insulin?
A. Acetone odor to the breath, polyuria, and flushed skin.
B. Irritability, tachycardia, and diaphoresis. C. are unable to administer their injections.
C. Headache, nervousness, and polydipsia. B. produce minimal amounts of insulin.
D. Tenseness, tachycardia, and anorexia.

38. A patient is admitted to the surgical unit with a D. have a sustained decreased blood glucose.
diagnosis of rule out intestinal obstruction. The nurse is
preparing to insert a NG tube as ordered. In which of the 44. A client with newly diagnosed type I diabetes mellitus
following positions would it be BEST for the nurse to place is being seen by the home health nurse. The physician
this patient during the procedure? orders include: 1,200-calorie ADA diet, 15 units of NPH
A. Head of bed elevated 30º - 45º. 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.
C. Side-lying with head elevated 15º. B. lethargic with hot dry skin and rapid, deep respirations.
B. Head of bed elevated 60º - 90º. 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
D. Lying flat with head turned to the left side. 96.
39. A client received six units of regular insulin three hours 45. In making emergency equipment available at the
ago. The nurse would be MOST concerned if which of the bedside of a client who has undergone subtotal
following was observed? thyroidectomy, the nurse would include
A. Kussmaul respirations and diaphoresis. A. an electrocardiogram (ECG) monitor.
C. an intra-aortic balloon pump.
B. a defibrillator.
C. Diaphoresis and trembling. D. a tracheostomy set.
B. Anorexia and lethargy.
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
D. Headache and polyuria. down my sugar.”
B. “I’m really happy I can take insulin pills; it’s much
40. The home health care nurse is caring for a 30-year-old easier than an injection.”
woman with type I diabetes mellitus. The client has been C. “I must decrease my total daily fat intake to less than
maintained on a regimen of NPH and regular insulin and a 45% of my total calories.”
1,800-calorie diabetic diet with normal blood sugar levels. D. “I can use oral medications for my diabetes as long as
Morning self-monitoring blood sugar (SMBG) readings the my pancreas can still produce insulin.”
past two days were 205 mg/dL and 233 mg/dL. The nurse
expects the physician to 47. The physician orders ranitidine hydrochloride (Zantac)
A. reduce the client's diet to 1,500 calorie ADA. 150 mg PO qd for a client. The nurse should advise the
B. order 3 additional units of NPH insulin at 10 PM. client the BEST time to take this medication is
C. order an additional 10 units of regular insulin at 8 PM. A. before breakfast.
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. C. with food.
B. with dinner.
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. at hs. d. Myxedema.
48. The nurse is performing discharge teaching for a client 54. An adult client has regular insulin ordered before
with Addison's disease. It is MOST important for the nurse breakfast. The nurse notes that the client's blood glucose
instruct the client about level is 68 mg/dL, and the client is nauseated. Which of the
A. signs and symptoms of infection. following actions should the nurse take?
A. Immediately give the client orange juice to drink.
B. Administer the insulin on time.
C. seizure precautions. C. Withhold the insulin and notify the physician.
B. fluid and electrolyte balance. 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
D. steroid replacement. require an intervention by the nurse?
A. Places the end of the NG tube in a cup of water and
49. A 38-year-old woman is returned to her room after a watches for bubble formation.
subtotal thyroidectomy for treatment of hyperthyroidism. B. Checks the pH of the contents aspirated from the NG
Which of the following, if found by the nurse at the tube.
patient's bedside, is nonessential? C. Positions a stethoscope on the upper abdomen and
A. Potassium chloride for IV administration. listens as air is introduced into the NG tube.
D. Uses a large barreled syringe to aspirate for stomach
contents.

C. Tracheostomy set-up. 56. The nurse is caring for a client with Cushing's
B. Calcium gluconate for IV administration. 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.
D. Suction equipment. C. Teach the client signs and symptoms of hyperglycemia.
D. Instigate measures to prevent fluid overload.
50. The nurse knows that the client with drug-induced
Cushing's syndrome should FIRST be instructed about 57. The nurse caring for a female client who had a total
A. compression fractures from increased calcium excretion. thyroidectomy 2 days ago would know to assess for tetany
B. decreased resistance to stress. if:
C. the schedule for gradual withdrawal of the drug. a. the assessment indicates decreasing diastolic blood
D. changes in secondary sex characteristics. pressure.
b. the client reports that her mouth has an odd sensation.
51. The client is exhibiting symptoms of myxedema. The c. the client reports a loss of appetite.
nursing assessment should reveal d. the client reports increased thirst.
A. increased pulse rate.
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. fine tremors. c. not administer fluids with meals.
B. decreased temperature. 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?
D. increased radioactive iodine uptake level. 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.
52. The physician orders sucralfate (Carafate) 1 g PO bid
for a 56-year-old woman taking digoxin (Lanoxin) 0.25 mg 60. The nurse caring for a client with hyperparathyroidism
qd. The woman asks the nurse if she can take both pills should assign priority to
together with her breakfast so she doesn't forget to take A. coughing hourly.
them. The nurse should advise the woman to C. preventing falls.
A. take the Carafate and Lanoxin before breakfast. B. encouraging exercise.
B. take the Lanoxin 1 hour before breakfast and the D. averting infection.
Carafate 1 hour after breakfast.
C. take the Carafate 1 hour before breakfast and the 61.In a client with Addisonian crisis, assessment would
Lanoxin 1 hour after breakfast. indicate that the drug Kayexalate is not effective when the
D. take the Carafate and the Lanoxin after breakfast. nurses assesses the clinical manifestation of
A. decreasing blood pressure. colostomy; all previous activities may be resumed.
C. low back pain.
B. rapid or erratic pulse. 68. A client with diabetes who has properly learned the
D. pedal edema. principles of foot care would be most likely to say
62. The nurse caring for a client with a history of a. “I should wear nice, tight shoes for firm support.”
experiencing the Somogyi effect would monitor the client’s b. “A mirror will be very helpful so I can look at all parts of
blood sugar level between my feet each day.”
a. 2 AM and 7 AM. c. “I should limit walking barefoot to a half hour a day.”
c. 12 AM and 6 AM. d. “The best method of testing bath temperature is with the
b. 10 AM and 3 PM. toes.”
d. 5 AM and 12 NN.
69. The nurse teaching a type 2 diabetic client how to
63. A 45-year-old client with newly diagnosed IDDM manage the disease while on a prescribed diet and taking an
(insulin-dependent diabetes mellitus) is being seen by the oral antidiabetic agent would recognize that the client has
home health nurse. The client's orders include 1,800-calorie an accurate understanding of diabetes management when
ADA diet, 15 units NPH insulin before breakfast, and the client states
check blood sugar qid. When the nurse visits the client at 5 A. “I must exercise at least 1 hour daily to help bring down
PM, the client has not eaten since noon and has just my sugar.”
returned from jogging. The client's vital signs are: BP B. “I’m really happy I can take insulin pills; it’s much
110/80, pulse 120, and respirations 18, temperature 36.8 º easier than an injection.”
C. The nurse would expect his blood sugar reading to be C. “I must decrease my total daily fat intake to less than
A. 250 mg/dL. 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
C. 90 mg/dL. A. prone with her head turned to the side.
B. 160 mg/dL. 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. The nurse should report which of the
following assessments to the physician?
D. 50 mg/dL. A. Anxiety with extreme nervousness.
64. The nurse would instruct a client who is on a rowing
team to avoid injecting insulin in his arms on rowing C. Cool, clammy skin.
practice days because B. Slow, sluggish pulse.
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. D. Husky, slow speech.

65. In a client who needs fluid replacement therapy for


DKA, the nurse would evaluate the best indicator of 72. The physician orders cholestyramine (Questran) 4 g PO
dehydration as qid for a 40-year-old client. The medication is provided in
A. intake and output. single-dose 4-g packets. The client asks the office nurse
C. skin turgor. how to take the medication. The nurse should instruct the
B. weight deviation from baseline. client to
D. dryness of tongue and mucous membranes. A. sprinkle the powder on a beverage, stir, and drink
immediately.
66. The nurse suspects hypoglycemia in a client with B. sprinkle the powder on food and eat slowly.
diabetes who is difficult to arouse. To reverse this C. add water to make a paste and eat, followed by 8 oz of
condition, the nurse knows that the best therapy would be water.
A. graham crackers. D. sprinkle the powder on a beverage, let it stand a few
C. 4 teaspoons granulated sugar. minutes, and
B. orange juice.
D. glucagon. then stir and drink.

67. A client had surgery for cancer of the colon, and a 73. The nurse is caring for a two-month-old infant. A pH
colostomy was performed. Prior to discharge, the client probe test indicates that the infant has reflux. Which
states that he will no longer be able to swim. The nurse's nursing action is MOST appropriate?
response would be based on which of the following? A. Hold the next feeding.
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 C. Maintain a normal feeding schedule.
B. Teach the mother CPR.
go into water only up to that area.
D. There are no restrictions on the activity of a client with a
A. common duct obstruction.
C. spasm of the biliary tree.
B. perforation of the gallbladder.
D. infarct of the hepatic vein.

D. Elevate the head of the bed. 80. A client returned to the nursing unit after
cholecystectomy with common bile duct exploration has
74. The nurse providing education to a client newly bile leaking from around the wound. The most appropriate
diagnosed with diabetes mellitus about an exercise program nursing intervention at this time would be to
would remind the client to A. assess the client further, asking about pain.
A. reduce fluid intake before exercising. B. reassure the client that this is normal and reinforce the
C. refrain from eating until 30 minutes after dressing.
exercising. C. monitor the client for elevations in blood pressure and
B. ensure that blood sugar level is above 100. pulse.
D. set exercise periods for different times during the D. encourage the client to change position in bed.
day.
81.For a client with a history of recurrent UTI who is
75. The nurse is teaching a client with newly diagnosed prescribed an acid-ash diet, the nurse would advise the
diabetes mellitus how to treat hypoglycemia at home. The client to include
nurse should instruct the client to do which of the following a. carbonated beverages.
actions if symptoms of hypoglycemia are experienced? c. alcohol.
A. Eat a candy bar. b. coffee.
B. Drink 1/2-cup fruit juice followed by a protein snack. d. cranberry juice.
C. Inject 10 units of Humulin R.
D. Inject glucagon. 82. The nurse teaching self-catheterization technique
should include the importance of:
76. The nurse caring for a client admitted for treatment of a. sterile technique.
diabetic ketoacidosis (DKA) assesses Kussmaul’s b. drinking at least 500 ml of fluid within 2 hours of
respirations, which are catheterization.
A. rapid and short. c. using the Credé maneuver before catheterization.
C. irregular and gasping. d. catheterizing every 3 to 4 hours.
B. slow and shallow.
D. fast and deep. 83. During a bladder training program for a client with
spinal cord injury using intermittent catheterization, the
77. Following treatment for Addison's disease in a seven- client suddenly complains of a throbbing headache. Noting
year-old patient, the nurse plans for the client's discharge. that the client’s blood pressure is elevated, the nurse
The mother asks how long her daughter must continue initially would
receiving replacement therapy. The nurse's response should a. place the client flat in bed.
be c. notify the physician immediately.
A. "For approximately six months." b. catheterize the client.
d. Limit fluids for the remainder of the day.

84. The nurse reinforces explanations that the procedure for


lithotripsy involves
C. "Until she reaches puberty." a. surgical removal of stones.
B. "For approximately one year." 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


D. "For the rest of her life." should include
a. encouraging fluid intake up to 4000 ml/day.
78. The nurse is caring for a 74-year-old man with type I b. collecting a 24-hour urine specimen for calcium.
diabetes. The client is scheduled for cataract surgery under c. maintaining bed rest.
general anesthesia at 9 AM. The man usually receives 30 d. checking for abdominal distention.
units of NPH and 10 units of regular insulin each morning
at 7 AM. At 7 AM the morning of surgery, the nurse 86. To determine if a client has an initial manifestation
would expect to take which of the following actions? typically seen in clients with bladder neoplasm, the nurse
A. hold the morning dose of NPH and regular insulin and would ask
monitor the blood glucose. a. “Have you noticed any blood in your urine?”
B. give half the morning dose of NPH insulin along with b. “Do you produce larger amounts of urine than you have
the regular insulin and monitor the blood glucose when the in the past?”
client returns from surgery. c. “Do you have pain when you urinate?”
C. give the full dose of NPH and regular insulin and d. “Have you noticed that you seem to urinate much more
monitor the blood glucose every 2 to 4 hours. frequently than you used to?”
D. give the full dose of regular insulin but hold the NPH
insulin and monitor the blood glucose until the client goes 87. For a client experiencing urinary incontinence, in the
to surgery initial plan of care the nurse would include
a. limiting fluid intake.
79. A client with a history of cholelithiasis presents at the c. encouraging the client to void frequently.
hospital with nausea and vomiting, abdominal pain, and b. using adult diapers to prevent accidents.
jaundice. The nurse would assume that the precipitating d. teaching Kegel exercises.
physiologic event was
88. The nurse warns a client with insulin-dependent b. oliguria.
diabetes mellitus (IDDM) who has developed proteinuria d. High fever.
that this finding is significant because
a. renal failure will most likely develop in 5 to 10 years. 95. The nurse explains that the type of antibiotic prescribed
b. it indicates that the client’s diabetes is uncontrolled. for clients that is least likely to cause nephrotoxicity is
c. renal failure will result if diabetes is not well controlled. a. A cephalosporin.
d. insulin requirements should be lowered. c. A penicillin.
b. an aminoglycoside.
89. In the nursing care plan for a client with acute d. A sulfonamide.
pyelonephritis, the nurse would include teaching the client
to 96. In the client with pyelonephritis, the nurse would take
a. drink 4000 ml of fluid daily. special care to monitor
c. complete the entire course of antibiotics. a. oxygen saturation.
b. maintain complete bed rest. c. respiratory rate.
d. withhold any antihypertensive medications ordered. b. pulse rate.
d. blood pressure.
90. When obtaining the history of a client with acute
glomerulonephritis, the nurse should be sure to ask about 97. As part of the care plan for a client with pyelonephritis,
a. recent urinary tract infections. the nurse should
c. a history of long-term analgesic use. a. encourage increased activity.
b. recent respiratory infections. c. assess for manifestations of fluid overload.
d. a history of hypertension. b. increase fluid intake to 3 to 4 L/day.
d. watch for early manifestations of anaphylaxis.
91. The teaching plan for a client with nephrotic syndrome
should include 98. The nurse explains that the type of renal tumor
a. diligent skin care. occurring primarily in childhood is
b. discussion about a low-protein diet. a. transitional cell.
c. explanation of the need to complete antibiotic therapy. c. adenocarcinoma.
d. the importance of maintaining fluid restriction. b. squamous cell.
d. nephroblastoma.
92. Nursing care for the client with glomerulonephritis
should include 99. Assessing the urinalysis of a woman in the eighth
a. increasing fluid intake. month of pregnancy who was injured in an automobile
c. encouraging ambulation, as tolerated. accident, the nurse would recognize as abnormality the
b. maintaining isolation precautions. finding of
d. maintaining a high-calorie, low-protein diet. a. proteinuria.
c. pyuria.
93. In the care plan for a client after nephrectomy, the nurse b. decreased specific gravity.
would include an intervention for d. casts.
a. maintaining patency of wound drains.
c. maintaining adequate hydration. 100. For a client after nephrectomy and based on the
b. promoting effective breathing patterns. location of the incision, the nurse would formulate the
d. encouraging ambulation. nursing diagnosis of
a. Risk for Injury: Postoperative Complications related to
surgical procedure.
94. A client with a renal abscess would exhibit b. Acute Pain related to surgery.
a. hypertension. c. Anxiety related to long-term outcome.
c. bacteria in the urine. d. Risk for Impaired Skin Integrity related to immobility.