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C.

Infections is the major complication to watch for in clients on cyclosporine therapy because its an
immunosuppressive drug. Depression may occur posttransplantation but not because of
cyclosporine. Hemorrhage is a complication associated with anticoagulant therapy. Peptic ulcer
disease is a complication of steroid therapy.

4. D. In a client with acute renal graft rejection, evidence of deteriorating renal function is expected.
The nurse would see elevated WBC counts and fever because the body is recognizing the graft as
foreign and is attempting to fight it. The client would most likely have acute hypertension.

5. D. The client undergoing a renal transplantation will need vigilant follow-up care and must adhere
to the medical regimen. The client is most likely anuric or oliguric preoperatively, but
postoperatively will require close monitoring of urine output to make sure the transplanted kidney is
functioning optimally. While the client will always need to be monitored for signs and symptoms of
infection, its most important post-op will require close monitoring of urine output to make sure the
transplanted kidney is functioning optimally. While the client will always need to be monitored for
signs and symptoms of infection, its most important postoperatively due to the immunosuppressant
therapy. Rejection can occur postoperatively.

6. D. Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldnt be
stopped as long as the catheter is draining because clots will form. A belladonna and opium
suppository should be given to relieve spasms but only after assessment of the drainage. Oral
analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.

7. D. Postobstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values
must be checked so electrolytes can be replaced as needed. VS should initially be taken every 30
minutes for the first 4 hours and then every 2 hours. Urine output needs to be assessed hourly. The
clients weight should be taken daily to assess fluid status more closely.

8. C. The calculus should be analyzed for composition to determine appropriate interventions such
as dietary restrictions. Calculi dont result in infections. The size and number of calculi arent
relevant, and they dont contain antibodies.

9. C. Pain at the graft site and weight gain indicates the transplanted kidney isnt functioning and
possibly is being rejected. Transplant clients usually have edema, anorexia, fever, and nausea before
transplantation, so those symptoms may not indicate rejection.

10. D. Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and
borderline diabetes. Steroids also contribute to poor wound healing and may cause acne, mood
swings, and sodium and water retention. Steroids dont affect thermoregulation, bleeding
tendencies, or constipation.

11. C. Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to
elevated serum sodium level. High specific gravity indicates dehydration. Hypernatremia signals
acidosis and shock. Elevated urine pH can result from potassium deficiency, a high-protein diet, or
uncontrolled diabetes.

12. C. The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a
greater tumor burden. Serum creatinine levels may suggest blockage from an enlarged prostate. CBC
is used to diagnose anemia and polycythemia. Serum potassium levels identify hypokalemia and
hyperkalemia.
13. C. Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury,
occurring from obstruction of the urinary system or bowel. Incontinence and diarrhea dont result in
obstruction of the urinary system or bowel, respectively. An URI could obstruct the respiratory
system, but not the urinary or bowel system.

14. D. To control uric acid calculi, the client should follow a low-purine diet, which excludes high-
purine foods such as organ meats. A low-calcium diet decreases the risk for oxalate renal calculi.
Oxalate is an essential amino acid and must be included in the diet. A low-oxalate diet is used to
control calcium or oxalate calculi.

15. C. Struvite stones commonly are referred to as infection stones because they form in urine that is
alkaline and rich in ammonia, such as with a urinary tract infection. Calcium oxalate stones result
from increased calcium intake or conditions that raise serum calcium concentrations. Uric acid
stones occur in clients with gout. Cystine stones are rare and occur in clients with a genetic defect
that results in decreased renal absorption of the amino acid cystine.

16. C. A nephrostomy tube is put in place after a percutaneous ultrasonic lithotripsy to treat
calculuses in the renal pelvis. The client may also have a foley catheter to drain urine produced by
the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to
detect elimination of the calculus fragments.

17. A. Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of
the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip.

18. A. The client with prostatitis has a prostate gland that is swollen and tender but that is also warm
to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low
back pain, and signs of urinary tract infection (which often accompany the disorder).

19. C. Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak
and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and
nocturia. If untreated, complete obstruction and urinary retention can occur.

20. D. In the client with BPH, episodes of urinary retention can be triggered by certain medications,
such as decongestants, anticholinergics, and antidepressants. The client should be questioned about
the use of these medications if the client has urinary retention. Retention can also be precipitated by
other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.

21. D. No specific precautions are necessary following a renal scan. Urination into a commode is
acceptable without risk from the small amount of radioactive material to be excreted. The nurse
wears gloves to maintain body secretion precautions.

22. C. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are
rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.

23. B. Frequent dressing changes around the Penrose drain is required to protect the skin against
breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed
over the drain to protect the skin. A Penrose drain is not irrigated. Weighing the dressings is not
necessary. Placing the client on the affected side will prevent a free flow of urine through the drain.

24. B. To increase urinary output, diuretics and osmotic agents are considered. The client should be
monitored closely because fluid overload can cause hypertension, congestive heart failure, and
pulmonary edema. Fluid intake would not be encouraged or restricted. Irrigation of the foley
catheter will not assist in allievating this oliguria.
25. A. Acute rejection most often occurs in the first 2 weeks after transplant. Clinical manifestations
include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and
manifestations of deteriorating renal function. Chronic rejection occurs gradually during a period of
months to years. Although kidney infection or obstruction can occur, the symptoms presented in the
question do not relate specifically to these disorders.

. B. Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis
is a direct result of plaque formation in the artery. Hardened vessels cant dilate properly and,
therefore, constrict blood flow.

2. D. A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals


pericardial tamponade, a complication of CABG surgery. Left-sided heart failure can cause pulsus
alternans (pulse amplitude alternation from beat to beat, with a regular rhythm). Aortic
regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic peak).
Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure).

3. C. Check with Dani if you have issues with this problem.

4. C. The pulmonary artery pressures are used to assess the hearts ability to receive and pump
blood. The pulmonary capillary wedge pressure reflects the left ventricle end-diastolic pressure and
guides the physician in determining fluid management for the client. The degree of coronary artery
stenosis is assessed during a cardiac catherization. The peripheral arterial pressure is assessed with
an arterial line.

5. A. In an immobilized client, calcium leaves the bone and concentrates in the ECF fluid. When a
large amount of calcium passes through the kidneys, calcium can precipitate and form calculi.
Nursing interventions that help prevent calculi include ensuring a liberal fluid intake (unless
contraindicated). A diet rich in acid should be provided to keep the urine acidic, which increases the
solubility of calcium. Preventing constipation is not associated with excessive calcium excretion.
Limiting foods rich in calcium, such as dairy products, will help on preventing renal calculi.

6. A. An expected outcome of surgery is warmth, redness, and edema in the surgical extremity
because of increased blood flow.

7. A. Temperatures of 102*F or greater lead to an increased metabolism and cardiac workload.

8. C. Blood samples from the right atrium, right ventricle, and pulmonary artery would all be about
the same with regard to oxygen concentration. Such blood contains slightly less oxygen than does
systemic arterial blood.

9. D. The catheter is placed in the pulmonary artery. Information regarding left ventricular function
is obtained when the catheter balloon is inflated.

10. D. The client is up more at home, so dependent edema usually increases. Serosanguineous
drainage may persist after discharge.

11. B. While the balloon must be inflated to measure the capillary wedge pressure, leaving the
balloon inflated will interfere with blood flow to the lung. Bearing down will increase intrathoracic
pressure and alter the reading. While a supine position is preferred; it is not essential. Agency
protocols relative to flushing of unused ports must be followed.
12. C. Checking capillary refill provides data about current perfusion of the extremity. While the
presence and quality of the pedal pulse provide data about peripheral circulation, it is not necessary
to count the rate.

13. A. C. E. Blood in the pericardial sac compresses the heart so the ventricles cannot fill; this leads
to a rapid thready pulse. Tamponade causes hypotension and a narrowed pulse pressure. As the
tamponade increases, pressure on the heart interferes with the ejection of blood from the left
ventricle, resulting in an increased pressure in the right side of the heart and the systemic
circulation. As the heart because more inefficient, there is a decrease in kidney perfusion and
therefore urine output. The increased venous pressure caused JVD.

14. A. If dopamine as a positive effect, it will cause vasoconstriction peripherally, but increase renal
perfusion and the blood pressure will rise. The cardiac index will also rise and the PCWP should
decrease.

15. B. All of the clients symptoms are found in both cardiac tamponade and hypovolemic shock
except the increase in urinary output.

1.
D

2.
D

3.
B

4.
C

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C

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C

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D
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D

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C

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B

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A

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