Med Surg Chapter 6

Front 1

The nurse collects a urine specimen from a client for a culture and sensitivity analysis. Which of the following is the correct care of the specimen?

a) Send the specimen with the next pickup.

b) Promptly send the specimen to the laboratory.

c) Send the specimen the next time a nursing assistant is available.

d) Store the specimen in the refrigerator until it can be sent to the laboratory.

Back 1

b

Front 2

Which of the following abnormal blood values would not be improved by dialysis treatment?

a) Decreased hemoglobin concentration.

b) Hyperkalemia.

c) Elevated serum creatinine level.

d) Hypernatremia.

Back 2

a

Front 3

A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed?

a) Inform the client's sexual contacts of their possible exposure to chlamydia.

b) Inform the health department that this client contracted an STD.

c) Do nothing because the client's sexual habits place him at risk for contracting other STDs.

d) Educate the client about why it's important to inform sexual contacts so they can receive treatment.

Back 3

d

Front 4

The nurse teaches the client how to recognize signs and symptoms of infection in the shunt by telling the client to assess the shunt each day for:

a) Coolness of the involved extremity.

b) Swelling at the shunt site.

c) Sluggish capillary refill time.

d) Absence of a bruit.

Back 4

b

Front 5

The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to:

a) Maintain catheter patency.

b) Reduce incisional bleeding.

c) Perform activities of daily living.

d) Recognize signs of prostate cancer.

Back 5

a

Front 6

A client is scheduled to undergo transurethral resection of the prostate. The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should assess the client for:

a) Seizures.

b) Renal shutdown.

c) Respiratory paralysis.

d) Cardiac arrest.

Back 6

c

Front 7

A male client complains of impotence. The nurse examines the client's medication regimen and is aware that a contributing factor to impotence could be:

a) Nonsteroidal anti-inflammatory drugs.

b) Aspirin.

c) Antihypertensives.

d) Anticoagulants.

Back 7

c

Front 8

The client asks the nurse, "Is it really possible to lead a normal life with an ileostomy?" Which action by the nurse would be the most effective to address this question?

a) Notify the surgeon of the client's question.

b) Tell the client to worry about those concerns after surgery.

c) Arrange for a person with an ostomy to visit the client preoperatively.

d) Have the client talk with a member of the clergy about these concerns.

Back 8

c

Front 9

The nurse gives a pamphlet that describes Kegel exercises to a client with stress incontinence. Which of the following statements indicates to the nurse that the client has understood the instructions contained in the pamphlet?

a) ”It will probably take a year before the exercises are effective.”

b) ”I can do these exercises sitting up, lying down, or standing.”

c) ”I should perform these exercises every evening.”

d) ”I need to tighten my abdominal muscles to do these exercises correctly.”

Back 9

b

Front 10

A 28-year-old male is diagnosed with acute epididymitis. The nurse should assess the client for:

a) Foul-smelling urine.

b) Burning and pain on urination.

c) Foul-smelling ejaculate.

d) Severe tenderness and swelling in the scrotum.

Back 10

d

Front 11

The client is on a fluid restriction of 500 ml/day plus replacement for urine output. Because the client’s 24-hour urine output yesterday was 150 ml, the total fluid allotment for the next 24 hours is 650 ml. How should the nurses distribute this fluid over the next 24 hours?


a) Supplemented with gelatin and ice cream.

b) Given with meals, divided equally between breakfast and lunch.

c) Given in its entirety in the morning to minimize the client’s thirst during the rest of the 24 hour period.

d) Given in small amounts throughout each shift.

Back 11

d

Front 12

A nursing assistant tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that isn't possible because he has a catheter in place that is draining well." Which of the following responses would be most appropriate for the nurse to make?

a) "The urge to void is usually created by the large catheter, and he may be having some bladder spasms."

b) "His catheter is probably plugged. I'll irrigate it in a few minutes."

c) "That's a common complaint after prostate surgery. The client only imagines the urge to void."

d) "I think he may be somewhat confused."

Back 12

A

Front 13

A client who had a transurethral resection of the prostate (TURP) 1 day earlier has a three-way Foley catheter inserted for continuous bladder irrigation. Which of the following statements best explains why continuous irrigation is used after TURP?

a) To prevent bladder distention.

b) To keep the catheter free from clot obstruction.

c) To instill antibiotics into the bladder.

d) To control bleeding in the bladder.

Back 13

b

Front 14

A client is to receive peritoneal dialysis. To prepare for the procedure, the nurse should?

a) Ask the client to turn toward the left side.

b) Assess the dialysis access for a bruit and thrill.

c) Insert an indwelling urinary catheter and drain all urine from the bladder.

d) Warm the solution in the warmer.

Back 14

d

Front 15

If the client develops lower abdominal pain after a cystoscopy, the nurse should instruct the client to do which of the following?

a) Massage the abdomen gently.

b) Ambulate as much as possible.

c) Sit in a tub of warm water.

d) Apply an ice pack to the pubic area.

Back 15

c

Front 16

The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which one of the following strategies would be most useful?

a) Suggest using alternative forms of sexual expression and intimacy.

b) Help the client to accept that sexual activity will be decreased.

c) Tell the client to plan rest periods after sexual activity.

d) Suggest that the client avoid sexual activity to prevent embarrassment.

Back 16

A

Front 17

A woman in menopause is a good candidate for hormone replacement therapy (HRT) if she:

a) Has a family history of breast cancer.

b) Has severe hot flashes.

c) Had breast cancer a year ago.

d) Had an estrogen-dependent dysplasia.

Back 17

b

Front 18

Which client is at highest risk for developing a hospital-acquired infection?

a) A client with an indwelling urinary catheter

b) A client who's taking prednisone (Deltasone)

c) A client with Crohn's disease

d) A client with a laceration to the left hand

Back 18

A

Front 19

The client is taking sildenafil (Viagra) PO for erectile dysfunction. The nurse should instruct the client about which of the following?

a) Sildenafil (Viagra) offers protection against some sexually transmitted diseases (STDs).

b) The health care provider should be notified promptly if the client experiences sudden or diminished vision.

c) Sildenafil (Viagra) may be taken more than one time per day.

d) Sildenafil (Viagra) does not require sexual stimulation to work.

Back 19

b

Front 20

During hospitalization, a 10-year-old child with acute poststreptococcal glomerulonephritis and oliguria asks for food from home. After teaching the mother and child about diet, the nurse determines that the teaching had been effective when the mother brings in which food?

a) Ice cream sundae.

b) Pizza and cola.

c) Strawberries and kiwi.

d) Hamburger and fries.

Back 20

c

Front 21

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl. The most therapeutic pharmacologic intervention would be to administer:

a) filgrastim (Neupogen).

b) enoxaparin (Lovenox).

c) epoetin alfa (Epogen).

d) ferrous sulfate (Feratab).

Back 21

c

Front 22

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

a) Uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%

b) Increased serum levels of potassium, magnesium, and calcium

c) Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl

d) Increased pH with decreased hydrogen ions

Back 22

c

Front 23

A nurse is admitting an older female client to the gynecology surgical unit. When the nurse asks the client what medication she is taking at home, the client responds that she is taking a little red pill in the morning and a white capsule at night for her blood pressure. What action by the nurse is focused on safe, effective care of this client?

a) Show pictures to the client from the Physician's Desk Reference to identify the medications.

b) Ask a family member to bring the medications from home in the original vials for proper identification and administration times.

c) Consult the previous medical record from 2 years ago and notify the physician regarding medications that must be ordered.

d) Consult the pharmacist regarding identification of the medications.

Back 23

b

Front 24

Urinary tract infection (UTI) is a potential problem after spinal cord injury. To prevent an UTI, the nurse should encourage the client to:

a) Wash hands frequently.

b) Add extra protein to the daily diet.

c) Drink at least 2,000 ml of fluid daily.

d) Drink a glass of citrus fruit juice at every meal.

Back 24

c

Front 25

A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for:

a) Circulatory collapse.

b) Hemorrhage.

c) Cardiac arrest.

d) Pulmonary edema.

Back 25

c

Front 26

A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which of the following client statements indicates effective teaching?

a) "Both of my ovaries will be removed during the tubal ligation procedure."

b) "Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%."

c) "My fallopian tubes will be tied off through a small abdominal incision."

d) "After this procedure, I must abstain from intercourse for at least 3 weeks."

Back 26

c

Front 27

The nurse is teaching an 80-year-old client with a urinary tract infection about the importance of increasing fluids in the diet. Which of the following puts this client at a risk for not obtaining sufficient fluids?

a) Increased production of antidiuretic hormone.

b) Decreased production of aldosterone.

c) Diminished liver function.

d) Decreased ability to detect thirst.

Back 27

d

Front 28

The nurse is developing a community health education program about sexually transmitted diseases. Which information about women who acquire gonorrhea should be included?

a) Women are more reluctant than men to seek medical treatment.

b) Gonorrhea is not easily transmitted to women who are menopausal.

c) Women with gonorrhea are usually asymptomatic.

d) Gonorrhea is usually a mild disease for women.

Back 28

c

Front 29

The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent:

a) Appliance separation.

b) Urine leakage.

c) Urine reflux into the stoma.

d) The need to restrict fluids.

Back 29

c

Front 30

A client admitted to the unit with a diagnosis of end-stage renal disease is scheduled to undergo hemodialysis. He voices anxiety over shunt placement and management of care at home. A nurse initiates a referral to which members of the interdisciplinary team?

a) Home health nurse, nutritionist, and social worker

b) Physical and occupational therapist, dietitian, and home health aide

c) Dialysis nurse, physician, and family

d) Physician, physical therapist, and family

Back 30

a

Front 31

Which of the following factors would put the client at increased risk for pyelonephritis?

a) History of diabetes mellitus.

b) History of hypertension.

c) Intake of large quantities of cranberry juice.

d) Fluid intake of 2,000 ml/day

Back 31

a

Front 32

The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink:

a) At least 1 quart more than usual.

b) Twice as much fluid as usual.

c) At least 3,000 ml of fluids daily.

d) A lot of water, juice, and other fluids throughout the day.

Back 32

c

Front 33

A 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, the nurse 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) Transurethral laser incision of the prostate

c) Retropubic prostatectomy

d) Suprapubic prostatectomy

Back 33

a

Front 34

Which of the following is an initial clinical manifestation of gonorrhea in men?

a) Urethral discharge

b) Scrotal pain.

c) Impotence.

d) Penile lesion

Back 34

a

Front 35

The client asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that in most instances, cystitis is caused by:

a) Urinary stasis in the urinary bladder.

b) Congenital strictures in the urethra.

c) An infection elsewhere in the body.

d) An ascending infection from the urethra.

Back 35

d

Front 36

Eight hours after surgery for an abdominal hysterectomy client has not voided and says to the nurse, “I don’t think I can urinate.” The nurse should first:

a) Assess the client’s bladder.

b) Inform the surgeon of the client’s status.

c) Increase the client’s fluid intake.

d) Administer pain medication.

Back 36

a

Front 37

A client has nephropathy. The physician orders that a 24-hour urine collection be done for creatinine clearance. Which of the following actions is necessary to ensure proper collection of the specimen?

a) Collect the urine in a preservative-free container and keep it on ice.

b) Inform the client to discard the last voided specimen at the conclusion of urine collection.

c) Ask the client what his weight is before beginning the collection of urine.

d) Request an order for insertion of an indwelling urinary catheter.

Back 37

a

Front 38

The correct procedure for collecting a urine specimen from an indwelling catheter is to:

a) Disconnect the drainage tube from the collecting bag and allow urine to flow from the tubing into the specimen container.

b) Disconnect the drainage tube from the indwelling catheter and allow urine to flow from the tubing into the specimen container.

c) Open the spigot on the collecting bag and allow urine to empty into the specimen container.

d) Remove urine from the drainage tube with a sterile needle and syringe and place urine from the syringe into the specimen container.

Back 38

d

Front 39

A nurse is caring for a client diagnosed with ovarian cancer. Diagnostic testing reveals that the cancer has spread outside the pelvis. The client has previously undergone a right oophorectomy and received chemotherapy. The client now wants palliative care instead of aggressive therapy. The nurse determines that the care plan's priority nursing diagnosis should be:

a) Noncompliance

b) Acute pain

c) Ineffective breast-feeding

d) Impaired home maintenance

Back 39

b

Front 40

A client was treated for a streptococcal throat infection 2 weeks ago. The client now has been diagnosed with acute poststreptococcal glomerulonephritis. The client asks the nurse how he could have prevented this condition. What should the nurse tell the client?

a) "You may continue to utilize the previously prescribed antibiotics until they are gone."

b) "As long as you do not have a fever, it is sufficient to gargle daily with an antibacterial mouthwash."

c) "See your physician for an early diagnosis and treatment of a sore throat."

d) "Unscented bar soap may be used in showers."

Back 40

c

Front 41

Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis?

a) "I can usually go 8 to 10 hours without needing to empty my bladder."

b) "I wipe from front to back after voiding."

c) "I take a tub bath every evening."

d) "I drink a lot of water during the day."

Back 41

a

Front 42

The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which of the following measures would be most important for the nurse to include in pretest preparation?

a) Preparing the client for the possibility of bladder spasms during the test.

b) Checking the client's history for allergy to iodine.

c) Determining when the client last had a bowel movement.

d) Ensuring adequate fluid intake on the day of the test.

Back 42

b

Front 43

The nurse is instructing a nursing assistant to collect a urine specimen from an indwelling catheter. Which of the following statements indicates that the assistant understands the instructions?

a) "I will get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container.”

b) ”I should collect urine from the catheter drainage bag at the end of the shift and place it in the specimen container.”

c) ”I will empty the catheter drainage bag, have the client drink some water, and an hour later collect the urine that drains into the bag.”

d) The client reports bladder spasms and the urge to void.

Back 43

a

Front 44

The nurse is teaching a 17-year-old girl who has a severe gonorrheal infection. The nurse realizes that the girl understands the implications of her disease when she tells the nurse:

a) "Once I'm treated, I'll have immunity."

b) "I won't have any more problems once I learn to protect myself."

c) "I could have trouble getting pregnant."

d) "My partner doesn't need treatment."

Back 44

c

Front 45

During dialysis, the client has disequilibrium syndrome. The nurse should first?

a) Reassure the client that the symptoms are normal.

b) Administer oxygen per nasal cannula.

c) Place the client in Trendelenburg's position.

d) Slow the rate of dialysis.

Back 45

d

Front 46

The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 lb in 1 day. Based on these data, which of the following nursing diagnoses is appropriate?

a) Excess fluid volume related to the kidney's inability to maintain fluid balance.

b) Ineffective tissue perfusion related to interrupted arterial blood flow.

c) Ineffective therapeutic regimen management related to lack of knowledge about therapy.

d) Ineffective breathing pattern related to fluid in the lungs.

Back 46

a

Front 47

A female client with gonorrhea informs the nurse that she has had sexual intercourse with her boyfriend and asks the nurse, "Would he have any symptoms?" The nurse responds that in men the symptoms of gonorrhea include:

a) Scrotal swelling.

b) Dysuria.

c) Urine retention.

d) Impotence.

Back 47

b

Front 48

The most significant sign of acute renal failure is:

a) Elevated body temperature.

b) Decreased urine output.

c) Increased urine specific gravity.

d) Increased blood pressure.

d)

Back 48

b