Nokea
The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal?
- A. The client will have a blood pressure within normal limits.
- B. The client will show no protein in the urine.
- C. The client will maintain normal renal function.
- D. The client will have clear lung sounds.
Correct Answer: C
Rationale: Maintaining normal renal function is the ultimate long-term goal for acute glomerulonephritis, as it indicates resolution of renal damage. Normal BP and no proteinuria are intermediate goals, and clear lung sounds are unrelated.
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Which nursing intervention is most helpful in assisting the client undergoing hemodialysis to cope with the client and the patient to the patient?
- A. Giving the client literature to read about renal failure
- B. Advising the client's spouse to cook the client's favorite dishes
- C. Keeping the client informed of the latest research findings
- D. Exploring with the client how this disorder has affected life
Correct Answer: D
Rationale: Exploring the impact of the disorder on the client's life fosters emotional coping and supports psychosocial adjustment.
Which statement indicates discharge teaching has been effective for the client who is postoperative TURP?
- A. I will call the surgeon if I experience any difficulty urinating.'
- B. I will take my Proscar daily, the same as before my surgery.'
- C. I will continue restricting my oral fluid intake.'
- D. I will take my pain medication routinely even if I do not hurt.'
Correct Answer: A
Rationale: Difficulty urinating post-TURP may indicate obstruction or complications, requiring prompt reporting. Proscar is typically discontinued post-TURP, fluid restriction is unnecessary, and routine pain meds are not advised.
Which statements made by the client's spouse most closely correlate with the diagnosis of acute glomerulonephritis? Select all that apply.
- A. My spouse's face looks rather puffy lately.
- B. Recently my spouse has been quite forgetful.
- C. My spouse has been salting food heavily.
- D. My spouse has been eating very well.
- E. My spouse hasn't been eating very well.
- F. My spouse gets up at night to use the bathroom.
Correct Answer: A,F
Rationale: Facial puffiness and nocturia are symptoms of glomerulonephritis, reflecting fluid retention and impaired kidney function.
When applying an external catheter to a male client, which action by the nurse is correct?
- A. I think the nurse is correct applying the catheter.
- B. Measure the length and circumference of the penis.
- C. Leave space between the end of the penis and the catheter's drainage end.
- D. Retract the foreskin before rolling the catheter sheath over the penis.
Correct Answer: C
Rationale: Leaving space between the penis and the catheter's drainage end prevents pressure and irritation, ensuring proper function and comfort.
The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first?
- A. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%.
- B. The client who does not have a palpable thrill or auscultated bruit.
- C. The client who is complaining of being exhausted and is sleeping.
- D. The client who did not take antihypertensive medication this morning.
Correct Answer: B
Rationale: Absence of a thrill or bruit indicates a non-functioning dialysis access (e.g., AV fistula), which is critical for dialysis and requires immediate assessment to prevent treatment delays or complications. Anemia, exhaustion, or missed medication are less urgent.