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The nurse is caring for clients on a renal surgery unit. After the afternoon report, which client should the nurse assess first?
- A. The male client who just returned from a CT scan who states he left his glasses in the x-ray department.
- B. The client who is one (1) day postoperative and has a moderate amount of serous drainage on the dressing.
- C. The client who is scheduled for surgery in the morning and wants an explanation of the operative procedure before signing the permit.
- D. The client who had ileal conduit surgery this morning and has not had any drainage in the drainage bag.
Correct Answer: D
Rationale: No drainage in the ileal conduit bag post-surgery suggests obstruction or complications, risking urine backup and renal damage. This is critical. Lost glasses, serous drainage, and surgical education are less urgent.
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The nurse is caring for a client diagnosed with rule-out nephrotic syndrome. Which intervention should be included in the plan of care?
- A. Monitor the urine for bright-red bleeding.
- B. Evaluate the calorie count of the 500-mg protein diet.
- C. Assess the client’s sacrum for dependent edema.
- D. Monitor for a high serum albumin level.
Correct Answer: C
Rationale: Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema, often dependent (e.g., in the sacrum in bedridden clients). Assessing for dependent edema is a key intervention to monitor disease progression or response to treatment. Bright-red bleeding is not typical, a 500-mg protein diet is incorrect, and high serum albumin is not expected.
The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first?
- A. Start an IV with a 20-gauge catheter.
- B. Initiate antibiotic therapy IVPB.
- C. Collect a urine specimen for culture.
- D. Change the indwelling catheter.
Correct Answer: C
Rationale: Symptoms suggest a catheter-associated UTI. Collecting a urine culture first identifies the causative organism, guiding antibiotic therapy. Starting an IV, antibiotics, or changing the catheter are secondary to obtaining a diagnostic sample.
The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client?
- A. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH.
- B. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis.
- C. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate.
- D. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.
Correct Answer: C
Rationale: In CKD, the kidneys fail to excrete acids (via ammonia) and reabsorb bicarbonate, leading to metabolic acidosis. Increased acid excretion would raise pH, RBC lifespan affects anemia, and vomiting causes alkalosis, not acidosis.
If the client makes the following statements, which information is most important to report to the physician before the client undergoes an intravenous pyelography (IVP)?
- A. The barium they give me to drink causes me to have concentration.
- B. I have a low tolerance for pain during procedures.
- C. I had a reaction when my gallbladder was X-rayed before.
- D. I get claustrophobic when I am put into that big round machine.
Correct Answer: C
Rationale: A previous reaction to a contrast dye, as implied by the gallbladder X-ray reaction, indicates a potential allergy risk, which must be reported before IVP.
After the TURP, which assessment finding would the nurse expect to observe during the immediate postoperative period?
- A. Light pink to clear urine
- B. Second sediments in urine
- C. Decreased volume of urine
- D. Grossly bloody urine
Correct Answer: D
Rationale: Grossly bloody urine is expected immediately after TURP due to surgical trauma to the prostate.