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If this client shares cultural characteristics of other Native Americans, which findings in the cultural assessment should be included in the client's care plan? Select all that apply.
- A. Native Americans may hesitate to share personal information with strangers.
- B. Questions regarding health history may be interpreted as prying.
- C. Native Americans value listening skills.
- D. Touching on the head is considered offensive.
- E. Native Americans pattern their lifestyle according to 'clock time.'
- F. Direct eye contact should be used when addressing the client or family.
Correct Answer: A,B,C
Rationale: These cultural characteristics reflect common Native American values and should guide culturally sensitive care.
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The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse?
- A. The blood urea nitrogen is 15 mg/dL.
- B. The creatinine level is 1.2 mg/dL.
- C. The glomerular filtration rate is 40 mL/min.
- D. The 24-hour creatinine clearance is 100 mL/min.
Correct Answer: C
Rationale: A GFR of 40 mL/min indicates significant renal impairment, suggesting worsening chronic glomerulonephritis. Normal BUN (15 mg/dL), creatinine (1.2 mg/dL), and creatinine clearance (100 mL/min) do not reflect deterioration.
To avoid erroneous test results caused by the manipulation of the prostate, the nurse should be included in diagnostic test before the client's rectal examination?
- A. Kidneys, ureters, bladder X-ray
- B. Needle biopsy of the prostate gland
- C. Prostate specific antigen (PSA) test
- D. Transrectal ultrasound examination
Correct Answer: C
Rationale: The PSA test should be done before rectal examination, as manipulation can elevate PSA levels, leading to false results.
The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure?
- A. Ask if the client is allergic to shellfish or iodine.
- B. Keep the client NPO eight (8) hours prior to the ultrasound.
- C. Ensure the client has a signed informed consent form.
- D. Explain the test is noninvasive and there is no discomfort.
Correct Answer: D
Rationale: Renal ultrasound is noninvasive, painless, and requires minimal preparation. Explaining this reduces anxiety. No contrast (iodine) is used, NPO is unnecessary, and informed consent is not typically required.
The client returned from surgery after having a TURP and has a P 110, R 24, BP 90/40, and cool and clammy skin. Which interventions should the nurse implement? Select all that apply.
- A. Assess the urine in the continuous irrigation drainage bag.
- B. Decrease the irrigation fluid in the continuous irrigation catheter.
- C. Lower the head of the bed while raising the foot of the bed.
- D. Contact the surgeon to give an update on the client’s condition.
- E. Check the client’s postoperative creatinine and BUN.
Correct Answer: A,C,D
Rationale: Tachycardia, hypotension, and clammy skin suggest hypovolemic shock, likely from bleeding. Assess urine for blood, use Trendelenburg to improve perfusion, and notify the surgeon. Decreasing irrigation may worsen clotting, and lab checks are less urgent.
Which finding provides the best evidence that peritoneal dialysis is achieving a therapeutic effect?
- A. Urine output increases.
- B. Appetite improves.
- C. Red blood cell count is lower.
Correct Answer: B
Rationale: Improved appetite indicates reduced uremia, a sign that dialysis is effectively removing toxins.