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In evaluating multiple clients with UTIs, the clinic nurse should identify which client to be at least risk for developing a UTI?
- A. A client with urethral mucosa damage
- B. A client with an altered mental condition
- C. A client with an altered metabolic state
- D. An immunocompromised client
Correct Answer: C
Rationale: An altered metabolic state, without specific risk factors like diabetes, poses the least risk for UTIs compared to mucosal damage, mental status changes, or immunosuppression.
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The nurse writes the client problem of 'fluid volume excess' (FVE). Which intervention should be included in the plan of care?
- A. Change the IV fluid from 0.9% NS to D5W.
- B. Restrict the sodium in the client’s diet.
- C. Monitor blood glucose levels.
- D. Prepare the client for hemodialysis.
Correct Answer: B
Rationale: Restricting sodium reduces fluid retention in FVE, as sodium promotes water reabsorption. D5W provides free water, worsening FVE; glucose monitoring is unrelated; and hemodialysis is reserved for severe cases.
The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level?
- A. Erythropoietin.
- B. Calcium gluconate.
- C. Regular insulin.
- D. Osmotic diuretic.
Correct Answer: C
Rationale: Regular insulin, often given with glucose, drives potassium into cells, temporarily lowering serum potassium levels in hyperkalemia. Calcium gluconate stabilizes cardiac membranes, erythropoietin treats anemia, and osmotic diuretics are not used for hyperkalemia.
Which symptom indicative of renal failure would the nurse expect to note when assessing this client?
- A. Anemia
- B. Hypotension
- C. Weight loss
- D. Fever
Correct Answer: A
Rationale: Anemia is a common symptom of renal failure due to decreased erythropoietin production by the kidneys.
After the cystoscopy, which urinary symptom can the nurse expect the client to report?
- A. A sense of urgency
- B. No urinary output
- C. A strong urinary odor
- D. A large volume of urine output
Correct Answer: A
Rationale: A sense of urgency is common after cystoscopy due to urethral irritation from the procedure.
If the client asks the nurse to outline the benefits of the cystoscopy procedure, which ones should the nurse list as possible? Select all that apply.
- A. Involves visual examination of the internal structure of the kidney
- B. Helps identify the sources of hematuria, incontinence, and urine retention
- C. Allows for collection of tissue samples, cell washings, and urine samples
- D. Requires no sedation because it is painless
- E. Allows the nurse to visualize the internal structure
- F. Requires no surgical incision because the scope is introduced into the urethra
Correct Answer: B,C,F
Rationale: Cystoscopy identifies causes of urinary symptoms, allows sample collection, and is minimally invasive via the urethra.