Nokea
The nurse is precepting a new graduate who will be caring for a client with bacterial cystitis. Which of the following statements by the new graduate requires follow-up?
- A. The client should be counseled to increase their fluid intake.'
- B. A 24-hour urine sample will be needed to confirm the diagnosis.'
- C. Risk factors include frequent intercourse and douching.'
- D. Cranberry concentrate may be used to prevent future infections.'
Correct Answer: B
Rationale: A 24-hour urine sample is not typically required for bacterial cystitis diagnosis, which relies on urinalysis or culture.
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The nurse is caring for an assigned client. Which prescription requires clarification with the primary healthcare provider (PHCP) based on the laboratory data?
- A. furosemide
- B. vancomycin
- C. ibuprofen
- D. citalopram
- E. enalapril
Correct Answer: C
Rationale: Ibuprofen can worsen renal function in kidney injury, requiring clarification.
The following scenario applies to the next 6 items.
The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 2 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.
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.
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)]
The nurse focuses on the client's serum sodium level and recognizes which conditions may cause hyponatremia or hypernatremia. For each condition below, click to specify if it causes hyponatremia or hypernatremia.
- A. syndrome of inappropriate antidiuretic hormone (SIADH)
- B. diabetes insipidus (DI)
- C. adrenal insufficiency
- D. Cushing's syndrome
Correct Answer: A: Hyponatremia, B: Hypernatremia, C: Hyponatremia, D: Hypernatremia
Rationale: SIADH and adrenal insufficiency cause hyponatremia via water retention or sodium loss. DI and Cushing's syndrome cause hypernatremia via water loss or sodium retention.
The nurse is administering phosphate excreting medications to a client with hypocalcemia. The reason for administering this medication is because
- A. as phosphorus exits the body so does calcium.
- B. calcium is managed by the excretion of phosphorus.
- C. when serum phosphorus decreases, serum calcium increases.
- D. phosphorus must be above 4.5 mg/dL (1.45 mmol/L) [3.0-4.5 mg/dL,0.81-1.58 mmol/L] before calcium can increase.
Correct Answer: C
Rationale: Phosphate-excreting medications reduce serum phosphorus levels, which inversely increases serum calcium levels due to the physiological relationship between phosphorus and calcium. Options A, B, and D are incorrect as they misrepresent this relationship.
The nurse cares for a client diagnosed with end-stage renal disease who just returned from initial hemodialysis. Which of the following assessment findings is of the highest concern?
- A. Headache and nausea
- B. Scant blood on the AV fistula
- C. Potassium 3.7 mEq/L (mmol/L) [3.5-5.0 mEq/L, mmol/L]
- D. Hemoglobin 8.8 g/dL [Male: 14-18 g/dL; Female: 12-16 g/dL, Female 115-155 g/L Male 125-170 g/L]
Correct Answer: A
Rationale: Headache and nausea may indicate dialysis disequilibrium syndrome, a serious complication requiring immediate attention.
The nurse is assessing a client receiving peritoneal dialysis. Which laboratory result should immediately be reported to the primary healthcare provider (PHCP)?
- A. WBC 19,000 mm3 [5,000-10,000 mm3]
- B. Hemoglobin 9 g/dL [Male: 14-18 g/dL (140-180 g/L) Female: 12-16 g/dL (120-160 g/L)]
- C. Calcium 8.6 mg/dL [9.0-10.5 mg/dL]
- D. Serum pH 7.33 [7.35-7.45]
Correct Answer: A
Rationale: Elevated WBC (19,000 mm3) suggests infection, a serious complication in peritoneal dialysis.