The nurse is caring for a client with polycystic kidney disease (PKD). Which of the following would indicate the client is achieving treatment goals?
- A. Blood Pressure 128/63 mmHg
- B. Creatinine 2.3 mg/dL [0.6-1.2 mg/dL (53-106 mmol/L)]
- C. Proteinuria 2+
- D. Sodium 132 mEq/L [136-145 mEq/L (mmol/L)]
Correct Answer: A
Rationale: Controlled blood pressure (128/63 mmHg) indicates effective PKD management, as hypertension is a common complication.
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When assessing for dehydration, the nurse should observe for which of the following?
- A. Headache and increased urinary output
- B. Weight gain and edema
- C. Hypertension and decreased urinary output
- D. Hypotension, headache, and dry mucous membranes
Correct Answer: D
Rationale: Dehydration causes hypotension, headache, and dry mucous membranes due to fluid loss.
The nurse is providing discharge instructions to a client prescribed phenazopyridine. Which of the following instructions should the nurse include?
- A. The amount of urine you void will increase
- B. Your urine will turn orange in color
- C. You may notice that your urine is malodorous
- D. Concentrated urine is an expected finding
Correct Answer: B
Rationale: Phenazopyridine causes orange-colored urine, a common side effect to inform clients about.
Which of the following signs and symptoms may lead the nurse to suspect hypovolemia? Select all that apply.
- A. Decreased skin turgor
- B. Increased urine output
- C. Dry mucous membranes
- D. Weight gain
- E. Low blood pressure
Correct Answer: A,C,E
Rationale: Hypovolemia causes decreased skin turgor, dry mucous membranes, and low blood pressure due to reduced fluid volume.
The nurse is caring for a client with a phosphorus level of 5.3 mg/dL (1.71 mmol/L) [normal range: 3.0-4.5 mg/dL (0.97-1.45 mmol/L)]. The nurse identifies which of the following as possible causes of this condition? Select all that apply.
- A. tumor lysis syndrome
- B. hypoparathyroidism
- C. hypercalcemia
- D. renal failure
- E. anorexia
Correct Answer: A,B,D
Rationale: Tumor lysis syndrome, hypoparathyroidism, and renal failure cause hyperphosphatemia by increasing phosphate release or reducing excretion.
The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 4 of 6
History and Physical
A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.
Laboratory Results
• Hemoglobin 14 g/dL [14-18 g/dL (140–180 g/L)]
• Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
• White Blood Cell 11,000 mm3 [5-10 mm3]
• Platelet Count 140,000 mm3 [150-400 mm3 (150–400 × 109/L)]
• Glucose 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)]
• Sodium 116 mEq/L [136–145 mEq/L (mmol/L)]
• Potassium 3.3 mEq/L [3.5–5.0 mEq/L (mmol/L)]
• Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285–295 mmol/kg)]
Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8° F (36.6° C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
0850: Verbal order was received from physician to insert indwelling urethral catheter.
0910: Urinary catheter inserted with sterile technique. 40 mL of dark yellow urine returned.
The physician diagnoses the client with syndrome of inappropriate antidiuretic hormone. The nurse updates the nurses' notes. For each potential order, click to specify whether the potential order is indicated or not indicated for the client.
- A. thiazide diuretic
- B. continuous cardiac monitoring
- C. seizure precautions
- D. intravenous hypotonic fluids
- E. urology consultation
- F. desmopressin {DDAVP}
Correct Answer: A: Not indicated, B: Indicated, C: Indicated, D: Not indicated, E: Not indicated, F: Not indicated
Rationale: Thiazide diuretics, hypotonic fluids, and desmopressin worsen SIADH. Cardiac monitoring and seizure precautions are indicated due to hyponatremia risks.
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