Reviewer
RESPIRATORY SYSTEM
1. Betty is a 9-year-old girl diagnosed with
cystic fibrosis. Which of the following must
Nurse Archie keep in mind when developing a
care plan for the child?
A. Pulmonary secretions are abnormally thick.
B. Elevated levels of potassium are found in the
sweat.
C. CF is an autosomal dominant hereditary
disorder.
D. Obstruction of the endocrine glands occurs.
2. Veronica’s parents were told that their
daughter needs ribavirin (Virazole). This drug is
used to treat which of the following?
A. Cystic fibrosis
B. Otitis media
C. Respiratory syncytial virus (RSV)
D. Bronchitis
3. Beta-adrenergic agonists such
as albuterol are given to Reggie, a child
with asthma. Such drugs are administered
primarily to do which of the following?
A. Dilate the bronchioles
B. Reduce secondary infections
C. Decrease postnasal drip
D. Reduce airway inflammation
4. Alice is rushed to the emergency
department during an acute, severe prolonged
asthma attack and is unresponsive to usual
treatment. The condition is referred to as
which of the following?
A. Status asthmaticus
B. Reactive airway disease
C. Intrinsic asthma
D. Extrinsic asthma
5. Which of the following infants is least
probable to develop sudden infant death
syndrome (SIDS)?
A. Baby Angela who was premature
B. A sibling of Baby Angie who died of SIDS
C. Baby Gabriel with prenatal drug exposure
D. Baby Gabby who sleeps on his back
6. Fred is a 12-year-old boy diagnosed with
pneumococcal pneumonia. Which of the
following would Nurse Nica expect to assess?
A. Mild cough
B. Slight fever
C. Chest pain
D. Bulging fontanel
7. Baby Melody is a neonate who has a very
low-birth-weight. Nurse Josie carefully
monitors inspiratory pressure and oxygen (O2)
concentration to prevent which of the
following?
A. Meconium aspiration syndrome
B. Bronchopulmonary dysplasia (BPD)
C. Respiratory syncytial virus (RSV)
D. Respiratory distress syndrome (RDS)
8. Archie who weighs 44 lb has been given an
order for amoxicillin 500 mg b.i.d. The drug text
notes that the daily dose of amoxicillin is 50
mg/kg/day in two divided doses. What dose in
milligrams is safest for this child?
A. 1000 mg
B. 750 mg
C. 500 mg
D. 250 mg
9. The Andrews family has been taking good
care of their youngest, Archie, who was
diagnosed with asthma. Which of the following
statements indicate a need for further home
care teaching?
A. “He should increase his fluid intake regularly
to thin secretions.”
B. “We’ll make sure that he avoids exercise to
prevent attacks.”
C. “He is to use his bronchodilator inhaler
before the steroid inhaler.”
D. “We need to identify what things trigger his
attacks.”
10. Which of the following instructions should
Nurse Cheryl include in her teaching plan for
the parents of Reggie with otitis media?
A. Placing the child in the supine position to
bottle-feed
B. Giving prescribed amoxicillin (Amoxil) on an
empty stomach
C. Cleaning the inside of the ear canals with
cotton swabs
D. Avoiding contact with people who have
upper respiratory tract infections
11. Immunization of children
with Haemophilus influenzae type B (Hib)
vaccine decreases the incidence of which of
the following conditions?
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A. Bronchiolitis
B. Laryngotracheobronchitis (LTB)
C. Epiglottitis
D. Pneumonia
12. Which of the following respiratory
conditions is always considered a medical
emergency?
A. Asthma
B. Cystic fibrosis (CF)
C. Epiglottiditis
D. Laryngotracheobronchitis (LTB)
13. When assessing a child’s cultural
background, the nurse in charge should keep in
mind that:
A. Heritage dictates a group’s shared values
B. Physical characteristics mark the child as part
of a particular culture
C. Cultural background usually has little bearing
on a family’s health practices
D. Behavioral patterns are passed from one
generation to the next
14. Which of the following is the best method
for performing a physical examination on a
toddler
A. From head to toe
B. Distally to proximally
C. From abdomen to toes, the to head
D. From least to most intrusive
15. Nurse Veronica is teaching a group of
parents about otitis media. When discussing
why children are predisposed to this disorder,
the nurse should mention the significance of
which anatomical feature?
A. Nasopharynx
B. Eustachian tubes
C. External ear canal
D. Tympanic membrane
Answers and Rationale
1. Answer: A. Pulmonary secretions are
abnormally thick.
A: CF is identified by abnormally thick
pulmonary secretions.
B: Diagnosis of CF is based on elevated chloride
levels detected in sweat.
C: It is a chronic, inherited disorder, particularly
an autosomal recessive hereditary
disorder concerning the exocrine, not endocrine
glands.
D: The thick mucus blocks the exocrine glands.
2. Answer: C. Respiratory syncytial virus (RSV)
C: Ribavirin is an antiviral medication used for
treating RSV infection and for children with RSV
who are compromised (such as children with
bronchopulmonary dysplasia or heart disease).
A,B,D: The drug is not used to treat bronchiolitis,
otitis media, or CF.
3. Answer: A. Dilate the bronchioles
A: Beta-adrenergic agonists, such as albuterol,
are highly effective bronchodilators and are
used to dilate the narrow airways associated
with asthma.
B: Antibiotics are used to prevent secondary
infection.
C: Decongestants may be given to decrease
postnasal drip.
D: Corticosteroids may be used for their anti-
inflammatory effect.
4. Answer: A. Status asthmaticus
A: Status asthmaticus is an acute, prolonged,
severe asthma attack that is unresponsive to
usual treatment. Typically, the child requires
hospitalization.
B: Reactive airway disease is another general
term for asthma.
C: Intrinsic is a term used to denote internal
precipitating factors, such as viruses.
D: Extrinsic is a term used to denote external
precipitating factors, such as allergens.
5. Answer: D. Baby Gabby who sleeps on his
back
D: Infants who sleep on their back are least
likely to develop SIDS. However, SIDS has been
associated with infants who sleep on their
abdomens.
A,B,C: Being premature, having a sibling who
died of SIDS, and being prenatally exposed to
drugs all place the infant at high risk for
developing SIDS.
6. Answer: C. Chest pain
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C: Older children with pneumococcal
pneumonia may complain of chest pain.
A,B: A mild cough and slight fever are
commonly assessed with viral pneumonia.
D: A bulging fontanel may be seen in infants
with meningitis or increased intracranial
pressure.
7. Answer: B. Bronchopulmonary dysplasia
(BPD)
B: Close monitoring of inspiratory pressure and
O2 concentration is necessary to prevent BPD,
which is related to the use of high inspiratory
pressures and O2concentrations especially in
very low-birth-weight and extremely low-birth-
weight neonates with lung disorders.
A: Meconium aspiration syndrome is a respiratory
disorder created by the aspiration of meconium
in perinatal period.
C: RSV is a group of viruses that cause
respiratory tract infections, such as bronchiolitis
and pneumonia.
D: RDS, a disorder caused by lack of surfactant,
usually is found in premature neonates.
8. Answer: C. 500 mg
C: First, calculate the child’s weight in kg: 44/2.2
= 20 kg. Then calculate the appropriate daily
dose according to the drug text: 50 mg/kg/day =
50 mg x 20 kg = 1,000 mg/day. the abbreviation
b.i.d. means twice daily; therefore 1,000 divided
by 2 equals 500 mg.
9. Answer: B. “We’ll make sure that he avoids
exercise to prevent attacks.”
B: Additional teaching is needed if the family
states that the child with asthma should avoid
exercise to prevent attacks. Children with
asthma should be encouraged to exercise as
tolerated.
A,C,D: Identifying triggers, using a
bronchodilator inhaler before a steroid inhaler,
and increasing fluid intake are appropriate
measures to be included in a home care
teaching program for the child with asthma and
his family.
10. Answer: D. Avoiding contact with people
who have upper respiratory tract infections
D: Otitis media is commonly precipitated by an
upper respiratory tract infection. Therefore,
children prone to otitis should avoid people
known to have an upper respiratory tract
infection.
A: A bottle-fed child should be fed in an upright
position because feeding the child in the supine
position may actually precipitate otitis by
allowing the formula to pool in the pharyngeal
cavity.
B: Amoxicillin, when prescribed, should be given
with food to prevent stomach upset.
C: Cotton swabs can cause injuries such as
tympanic perforation. They may be used to
clean the outer ear, but they should never be
inserted into the ear canal.
11. Answer: C. Epiglottitis
C: Epiglottitis is a bacterial infection of
the epiglottis primarily caused by Hib.
Administration of the vaccine has decreased the
incidence of epiglottitis.
A: Bronchiolitis is usually caused by Respiratory
Syncytial Virus (RSV).
B: Acute LTB is of viral origin.
D: The most common bacterial organisms
causing pneumonia in children are
pneumococci, streptococci, and staphylococci.
12. Answer: C. Epiglottiditis
C: Epiglottiditis, acute and severe inflammation
of the epiglottis, is always considered an acute
medical emergency because it can lead to
acute, life-threatening airway obstruction.
A: Asthma is a chronic disease; however, status
asthmaticus and acute attacks require prompt
treatment.
B: CF is a chronic disease and is not considered
an emergency.
D: Acute LTB requires close observation for
airway obstruction, but this condition is not
always an emergency.
13. Answer: D. Behavioral patterns are passed
from one generation to the next
D: A family’s behavioral patterns and values are
passed from one generation to the next.
A: Although heritage plays a role in culture, it
does not dictate a group’s shared values and its
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effect on culture is weaker than that of tracheostomy tube, the nurse initially should
behavioral patterns. plug the opening in the tube for:

B: Physical characteristics do not indicate a A. 15 to 60 seconds.

child’s culture. B. 5 to 20 minutes.
C. 30 to 40 minutes.
C: Cultural background commonly plays a major
D. 45 to 60 minutes.
role in determining a family’s health practices.
4. Gina, a home health nurse is visiting a home
14. Answer: Answer: D. From least to most care client with advanced lung cancer. Upon
intrusive assessing the client, the nurse discovers
D: When examining a toddler or any small child, wheezing, bradycardia, and a respiratory rate
the best way to perform the exam is from least of 10 breaths/minute. These signs are
to most intrusive. associated with which condition?

A: Starting at the head or abdomen is intrusive A. Hypoxia

and should be avoided. B. Delirium
C. Hyperventilation
B: Proceeding from distal to proximal is D. Semiconsciousness
inappropriate at any age.
5. A male client with Guillain-Barré syndrome
15. Answer: B. Eustachian tubes develops respiratory acidosis as a result of
reduced alveolar ventilation. Which
B: In a child, Eustachian tubes are short and lie
combination of arterial blood gas (ABG) values
in a horizontal plane, promoting entry of
confirms respiratory acidosis?
nasopharyngeal secretions into the tubes and
thus setting the stage for otitis media. A. pH, 5.0; PaCO2 30 mm Hg
B. pH, 7.40; PaCO2 35 mm Hg
A,C,D: The nasopharynx, tympanic membrane,
C. pH, 7.35; PaCO2 40 mm Hg
external ear canal have no unusual features that
D. pH, 7.25; PaCO2 50 mm Hg
would predispose a child to otitis media.
6. A female client with interstitial lung disease
is prescribed prednisone (Deltasone) to control
1. The nurse is caring for a male client with a inflammation. During client teaching, the nurse
chest tube. If the chest drainage system is stresses the importance of taking prednisone
accidentally disconnected, what should the exactly as prescribed and cautions against
nurse plan to do? discontinuing the drug abruptly. A client who
discontinues prednisone abruptly may
A. Place the end of the chest tube in a experience:
container of sterile saline.
B. Apply an occlusive dressing and notify A. hyperglycemia and glycosuria.
the physician. B. acute adrenocortical insufficiency.
C. Clamp the chest tube immediately. C. GI bleeding.
D. Secure the chest tube with tape. D. restlessness and seizures.

2. A male elderly client is admitted to an acute

care facility with influenza. The nurse monitors
7. A male client is admitted to the health care
the client closely for complications. What is the
facility for treatment of chronic obstructive
most common complication of influenza?
pulmonary disease. Which nursing diagnosis is
A. Septicemia most important for this client?
B. Pneumonia
A. Activity intolerance related to fatigue
C. Meningitis
B. Anxiety related to actual threat to
D. Pulmonary edema
health status
3. A female client has a tracheostomy but C. Risk for infection related to retained
doesn’t require continuous mechanical secretions
ventilation. When weaning the client from the D. Impaired gas exchange related to
airflow obstruction
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8. A male client abruptly sits up in bed, reports 13. The amount of air inspired and expired
having difficulty breathing and has an arterial with each breath is called:
oxygen saturation of 88%. Which mode of
oxygen delivery would most likely reverse the A. tidal volume.
B. residual volume.
manifestations?
C. vital capacity.
A. Simple mask D. dead-space volume.
B. Non-rebreather mask
C. Face tent 14. A male client with pneumonia develops
respiratory failure and has a partial pressure of
D. Nasal cannula
arterial oxygen of 55 mm Hg. He’s placed on
9. A male adult client with cystic fibrosis is mechanical ventilation with a fraction of
admitted to an acute care facility with an acute inspired oxygen (FIO2) of 0.9. The nursing goal
respiratory infection. Prescribed respiratory should be to reduce the FIO2 to no greater
treatment includes chest physiotherapy. When than:
should the nurse perform this procedure?
A. 0.21
A. Immediately before a meal B. 0.35
B. At least 2 hours after a meal C. 0.5
C. When bronchospasms occur D. 0.7
D. When secretions have mobilized
15. Nurse Mickey is administering a purified
10. On arrival at the intensive care unit, a protein derivative (PPD) test to a homeless
critically ill female client suffers respiratory client. Which of the following statements
arrest and is placed on mechanical ventilation. concerning PPD testing is true?
The physician orders pulse oximetry to
monitor the client’s arterial oxygen saturation A. A positive reaction indicates that the
(SaO2) noninvasively. Which vital sign client has active tuberculosis (TB).
B. A positive reaction indicates that the
abnormality may alter pulse oximetry values?
client has been exposed to the disease.
A. Fever C. A negative reaction always excludes the
B. Tachypnea diagnosis of TB.
C. Tachycardia D. The PPD can be read within 12 hours
D. Hypotension after the injection.

11. The nurse is caring for a male client who 16. Nurse Murphy administers albuterol
recently underwent a tracheostomy. The first (Proventil), as prescribed, to a client with
priority when caring for a client with a emphysema. Which finding indicates that the
tracheostomy is: drug is producing a therapeutic effect?

A. helping him communicate. A. Respiratory rate of 22 breaths/minute

B. keeping his airway patent. B. Dilated and reactive pupils
C. encouraging him to perform activities of C. Urine output of 40 ml/hour
daily living. D. Heart rate of 100 beats/minute
D. preventing him from developing an
infection. 17. What is the normal pH range for arterial
blood?
12. For a male client with chronic obstructive
pulmonary disease, which nursing intervention A. 7 to 7.49
B. 7.35 to 7.45
would help maintain a patent airway?
C. 7.50 to 7.60
A. Restricting fluid intake to 1,000 ml/day D. 7.55 to 7.65
B. Enforcing absolute bed rest
C. Teaching the client how to perform 18. Before weaning a male client from a
ventilator, which assessment parameter is
controlled coughing
D. Administering prescribed sedatives most important for the nurse to review?
regularly and in large amounts
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A. Fluid intake for the last 24 hours
B. Baseline arterial blood gas (ABG) levels
C. Prior outcomes of weaning
D. Electrocardiogram (ECG) results
19. Which of the following would be most
appropriate for a male client with an arterial
blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg,
O2 saturation 96%, HCO3 24 mEq/L, and PaO2
94 mm Hg?
A. Administer a prescribed decongestant.
B. Instruct the client to breathe into a
paper bag.
C. Offer the client fluids frequently.
D. Administer prescribed supplemental
oxygen.
20. A female client is receiving supplemental
oxygen. When determining the effectiveness
of oxygen therapy, which arterial blood gas
value is most important?
A. pH
B. Bicarbonate (HCO3–)
C. Partial pressure of arterial oxygen
(PaO2)
D. Partial pressure of arterial carbon
dioxide (PaCO2)
21. Nurse Julia is caring for a client who has a
tracheostomy and temperature of 103° F (39.4°
C). Which of the following interventions will
most likely lower the client’s arterial blood
oxygen saturation?
A. Endotracheal suctioning
B. Encouragement of coughing
C. Use of cooling blanket
D. Incentive spirometry
22. For a male client who has a chest tube
connected to a closed water-seal drainage
system, the nurse should include which action
in the plan of care?
A. Measuring and documenting the
drainage in the collection chamber
B. Maintaining continuous bubbling in the
water-seal chamber
C. Keeping the collection chamber at chest
level
D. Stripping the chest tube every hour
23. Nurse Eve formulates a nursing diagnosis of
Activity intolerance related to inadequate
oxygenation and dyspnea for a client with
chronic bronchitis. To minimize this problem,
the nurse instructs the client to avoid
conditions that increase oxygen demands.
Such conditions include:
A. drinking more than 1,500 ml of fluid
daily.
B. being overweight.
C. eating a high-protein snack at bedtime.
D. eating more than three large meals a
day.
24. A black male client with asthma seeks
emergency care for acute respiratory distress.
Because of this client’s dark skin, the nurse
should assess for cyanosis by inspecting the:
A. lips.
B. mucous membranes.
C. nail beds.
D. earlobes.
25. A female client with asthma is receiving a
theophylline preparation to promote
bronchodilation. Because of the risk of drug
toxicity, the nurse must monitor the client’s
serum theophylline level closely. The nurse
knows that the therapeutic theophylline
concentration falls within which range?
A. 1 to 2 mcg/ml
B. 2 to 5 mcg/ml
C. 5 to 10 mcg/ml
D. 10 to 20 mcg/ml
26. A male client is to receive I.V. vancomycin
(Vancocin). When preparing to administer this
drug, the nurse should keep in mind that:
A. vancomycin should be infused over 60
to 90 minutes in a large volume of fluid.
B. vancomycin may cause irreversible
neutropenia.
C. vancomycin should be administered
rapidly in a large volume of fluid.
D. vancomycin should be administered
over 1 to 2 minutes as an I.V. bolus.
27. Before seeing a newly assigned female
client with respiratory alkalosis, the nurse
quickly reviews the client’s medical history.
Which condition is a predisposing factor for
respiratory alkalosis?
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A. Myasthenia gravis
B. Type 1 diabetes mellitus
C. Extreme anxiety
D. Narcotic overdose
28. At 11 p.m., a male client is admitted to the
emergency department. He has a respiratory
rate of 44 breaths/minute. He’s anxious, and
wheezes are audible. The client is immediately
given oxygen by face mask and
methylprednisolone (Depo-medrol) I.V. At
11:30 p.m., the client’s arterial blood oxygen
saturation is 86% and he’s still wheezing. The
nurse should plan to administer:
A. alprazolam (Xanax).
B. propranolol (Inderal)
C. morphine.
D. albuterol (Proventil)
29. Pulmonary disease (COPD), which nursing
action best promotes adequate gas exchange?
A. Encouraging the client to drink three
glasses of fluid daily
B. Keeping the client in semi-Fowler’s
position
C. Using a high-flow Venturi mask to
deliver oxygen as prescribed
D. Administering a sedative as prescribed
30. Nurse Joana is teaching a client with
emphysema how to perform pursed-lip
breathing. The client asks the nurse to explain
the purpose of this breathing technique. Which
explanation should the nurse provide?
A. It helps prevent early airway collapse.
B. It increases inspiratory muscle strength
C. It decreases use of accessory breathing
muscles.
D. It prolongs the inspiratory phase of
respiration.
Answers and Rationales
Answer A. If a chest drainage system is
disconnected, the nurse may place the end of
the chest tube in a container of sterile saline or
water to prevent air from entering the chest
tube, thereby preventing negative respiratory
pressure. The nurse should apply an occlusive
dressing if the chest tube is pulled out — not if
the system is disconnected. The nurse shouldn’t
clamp the chest tube because clamping
increases the risk of tension pneumothorax. The
nurse should tape the chest tube securely to
prevent it from being disconnected, rather than
taping it after it has been disconnected.
Answer B. Pneumonia is the most common
complication of influenza. It may be either
primary influenza viral pneumonia or
pneumonia secondary to a bacterial infection.
Other complications of influenza include
myositis, exacerbation of chronic obstructive
pulmonary disease, and Reye’s syndrome.
Myocarditis, pericarditis, transverse myelitis,
and encephalitis are rare complications of
influenza. Although septicemia may arise when
any infection becomes overwhelming, it rarely
results from influenza. Meningitis and
pulmonary edema aren’t associated with
influenza.
Answer B. Initially, the nurse should plug the
opening in the tracheostomy tube for 5 to 20
minutes, and then gradually lengthen this
interval according to the client’s respiratory
status. A client who doesn’t require continuous
mechanical ventilation already is breathing
without assistance, at least for short periods;
therefore, plugging the opening of the tube for
only 15 to 60 seconds wouldn’t be long enough
to reveal the client’s true tolerance to the
procedure. Plugging the opening for more than
20 minutes would increase the risk of acute
respiratory distress because the client requires
an adjustment period to start breathing
normally.
Answer A. As the respiratory center in the brain
becomes depressed, hypoxia occurs, producing
wheezing, bradycardia, and a decreased
respiratory rate. Delirium is a state of mental
confusion characterized by disorientation to
time and place. Hyperventilation (respiratory
rate greater than that metabolically necessary
for gas exchange) is marked by an increased
respiratory rate or tidal volume, or both.
Semiconsciousness is a state of impaired
consciousness characterized by limited motor
and verbal responses and decreased
orientation.
Answer D. In respiratory acidosis, ABG analysis
reveals an arterial pH below 7.35 and partial
pressure of arterial carbon dioxide (PaCO2)
above 45 mm Hg. Therefore, the combination of
a pH value of 7.25 and a PaCO2 value of 50 mm
Hg confirms respiratory acidosis. A pH value of
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5.0 with a PaCO2 value of 30 mm Hg indicates
respiratory alkalosis. Options B and C represent
normal ABG values, reflecting normal gas
exchange in the lungs.
Answer B. Administration of a corticosteroid
such as prednisone suppresses the body’s
natural cortisol secretion, which may take
weeks or months to normalize after drug
discontinuation. Abruptly discontinuing such
therapy may cause the serum cortisol level to
drop low enough to trigger acute adrenocortical
insufficiency. Hyperglycemia, glycosuria, GI
bleeding, restlessness, and seizures are
common adverse effects of corticosteroid
therapy, not its sudden cessation.
Answer D. A patent airway and an adequate
breathing pattern are the top priority for any
client, making impaired gas exchange related to
airflow obstruction the most important nursing
diagnosis. The other options also may apply to
this client but are less important.
Answer B. A non-rebreather mask can deliver
levels of the fraction of inspired oxygen (FIO2)
as high as 100%. Other modes — simple mask,
face tent and nasal cannula — deliver lower
levels of FIO2.
Answer B. The nurse should perform chest
physiotherapy at least 2 hours after a meal to
reduce the risk of vomiting and aspiration.
Performing it immediately before a meal may
tire the client and impair the ability to eat.
Percussion and vibration, components of chest
physiotherapy, may worsen bronchospasms;
therefore, the procedure is contraindicated in
clients with bronchospasms. Secretions that
have mobilized (especially when suction
equipment isn’t available) are a
contraindication for postural drainage, another
component of chest physiotherapy.
Answer D. Hypotension, hypothermia, and
vasoconstriction may alter pulse oximetry
values by reducing arterial blood flow. Likewise,
movement of the finger to which the oximeter
is applied may interfere with interpretation of
SaO2. All of these conditions limit the
usefulness of pulse oximetry. Fever, tachypnea,
and tachycardia don’t affect pulse oximetry
values directly.
Answer B. Maintaining a patent airway is the
most basic and critical human need. All other
interventions are important to the client’s well-
being but not as important as having sufficient
oxygen to breathe.
Answer C. Controlled coughing helps maintain a
patent airway by helping to mobilize and
remove secretions. A moderate fluid intake
(usually 2 L or more daily) and moderate activity
help liquefy and mobilize secretions. Bed rest
and sedatives may limit the client’s ability to
maintain a patent airway, causing a high risk of
infection from pooled secretions.
Answer A. Tidal volume is the amount of air
inspired and expired with each breath. Residual
volume is the amount of air remaining in the
lungs after forcibly exhaling. Vital capacity is the
maximum amount of air that can be moved out
of the lungs after maximal inspiration and
expiration. Dead-space volume is the amount of
air remaining in the upper airways that never
reaches the alveoli. In pathologic conditions,
dead space may also exist in the lower airways.
Answer C. An FO2 greater than 0.5 for as little
as 16 to 24 hours can be toxic and can lead to
decreased gas diffusion and surfactant activity.
The ideal oxygen source is room air F IO 2 0.18
to 0.21.
Answer B. A positive reaction means the client
has been exposed to TB; it isn’t conclusive of
the presence of active disease. A positive
reaction consists of palpable swelling and
induration of 5 to 15 mm. It can be read 48 to
72 hours after the injection. In clients with
positive reactions, further studies are usually
done to rule out active disease. In
immunosuppressed clients, a negative reaction
doesn’t exclude the presence of active disease.
Answer A. In a client with emphysema,
albuterol is used as a bronchodilator. A
respiratory rate of 22 breaths/minute indicates
that the drug has achieved its therapeutic effect
because fewer respirations are required to
achieve oxygenation. Albuterol has no effect on
pupil reaction or urine output. It may cause a
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change in the heart rate, but this is an adverse,
not therapeutic, effect.
Answer B. A pH less than 7.35 is indicative of
acidosis; a pH above 7.45 indicates alkalosis.
Answer B.
Before weaning a client from mechanical
ventilation, it’s most important to have baseline
ABG levels. During the weaning process, ABG
levels will be checked to assess how the client is
tolerating the procedure. Other assessment
parameters are less critical. Measuring fluid
volume intake and output is always important
when a client is being mechanically ventilated.
Prior attempts at weaning and ECG results are
documented on the client’s record, and the
nurse can refer to them before the weaning
process begins.
Answer B. The ABG results reveal respiratory
alkalosis. The best intervention to raise the
PaCO2 level would be to have the client breathe
into a paper bag. All of the other options —
such as administering a decongestant, offering
fluids frequently, and administering
supplemental oxygen — wouldn’t raise the
lowered PaCO2 level.
Answer C. The most significant and direct
indicator of the effectiveness of oxygen therapy
is the PaO2 value. Based on the PaO2 value, the
nurse may adjust the type of oxygen delivery
(cannula, venturi mask, or mechanical
ventilator), flow rate, and oxygen percentage.
The other options reflect the client’s ventilation
status, not oxygenation.
Answer A. Endotracheal suctioning removes
secretions as well as gases from the airway and
lowers the arterial oxygen saturation (SaO2)
level. Coughing and incentive spirometry
improves oxygenation and should raise or
maintain oxygen saturation. Because of
superficial vasoconstriction, using a cooling
blanket can lower peripheral oxygen saturation
readings, but SaO2 levels wouldn’t be affected.
Answer A. The nurse should measure and
document the amount of chest tube drainage
regularly to detect abnormal drainage patterns,
such as may occur with a hemorrhage (if
excessive) or a blockage (if decreased).
Continuous bubbling in the water-seal chamber
indicates a leak in the closed chest drainage
system, which must be corrected. The nurse
should keep the collection chamber below chest
level to allow fluids to drain into it. The nurse
should not strip chest tubes because doing so
may traumatize the tissue or dislodge the tube.
Answer B. Conditions that increase oxygen
demands include obesity, smoking, exposure to
temperature extremes, and stress. A client with
chronic bronchitis should drink at least 2,000 ml
of fluid daily to thin mucus secretions;
restricting fluid intake may be harmful. The
nurse should encourage the client to eat a high-
protein snack at bedtime because protein
digestion produces an amino acid with sedating
effects that may ease the insomnia associated
with chronic bronchitis. Eating more than three
large meals a day may cause fullness, making
breathing uncomfortable and difficult; however,
it doesn’t increase oxygen demands. To help
maintain adequate nutritional intake, the client
with chronic bronchitis should eat small,
frequent meals (up to six a day).
Answer B. Skin color doesn’t affect the mucous
membranes. The lips, nail beds, and earlobes
are less reliable indicators of cyanosis because
they’re affected by skin color.
Answer D. The therapeutic serum theophylline
concentration ranges from 10 to 20 mcg/ml.
Values below 10 mcg/ml aren’t therapeutic.
Answer A. To avoid a hypotensive reaction from
rapid I.V. administration, the nurse should
infuse vancomycin slowly, over 60 to 90
minutes, in a large volume of fluid. Although
neutropenia may occur in approximately 5% to
10% of clients receiving vancomycin, this
adverse effect reverses rapidly when the drug is
discontinued.
Answer C. Extreme anxiety may lead to
respiratory alkalosis by causing
hyperventilation, which results in excessive
carbon dioxide (CO2) loss. Other conditions that
may set the stage for respiratory alkalosis
include fever, heart failure, and injury to the
brain’s respiratory center, overventilation with
a mechanical ventilator, pulmonary embolism,
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and early salicylate intoxication. Type 1 diabetes
mellitus may lead to diabetic ketoacidosis; the
deep, rapid respirations occurring in this
disorder (Kussmaul’s respirations) don’t cause
excessive CO2 loss. Myasthenia gravis and
narcotic overdose suppress the respiratory
drive, causing CO2 retention, not CO2 loss; this
may lead to respiratory acidosis, not alkalosis.
Answer D. The client is hypoxemic because of
bronchoconstriction as evidenced by wheezes
and a subnormal arterial oxygen saturation
level. The client’s greatest need is
bronchodilation, which can be accomplished by
administering bronchodilators. Albuterol is a
beta2 adrenergic agonist, which causes dilation
of the bronchioles. It’s given by nebulization or
metered-dose inhalation and may be given as
often as every 30 to 60 minutes until relief is
accomplished. Alprazolam is an anxiolytic and
central nervous system depressant, which could
suppress the client’s breathing. Propranolol is
contraindicated in a client who’s wheezing
because it’s a beta2 adrenergic antagonist.
Morphine is a respiratory center depressant and
is contraindicated in this situation.
Answer C. The client with COPD retains carbon
dioxide, which inhibits stimulation of breathing
by the medullary center in the brain. As a result,
low oxygen levels in the blood stimulate
respiration, and administering unspecified,
unmonitored amounts of oxygen may depress
ventilation. To promote adequate gas exchange,
the nurse should use a Venturi mask to deliver a
specified, controlled amount of oxygen
consistently and accurately. Drinking three
glasses of fluid daily wouldn’t affect gas
exchange or be sufficient to liquefy secretions,
which are common in COPD. Clients with COPD
and respiratory distress should be placed in high
Fowler’s position and shouldn’t receive
sedatives or other drugs that may further
depress the respiratory center.
Answer A. Pursed-lip breathing helps prevent
early airway collapse. Learning this technique
helps the client control respiration during
periods of excitement, anxiety, exercise, and
respiratory distress. To increase inspiratory
muscle strength and endurance, the client may
need to learn inspiratory resistive breathing. To
decrease accessory muscle use and thus reduce
the work of breathing, the client may need to
learn diaphragmatic (abdominal) breathing. In
pursed-lip breathing, the client mimics a normal
inspiratory-expiratory (I:E) ratio of 1:2. (A client
with emphysema may have an I:E ratio as high
as 1:4.)
1. Dr. Jones prescribes albuterol sulfate
(Proventil) for a patient with newly
diagnose asthma. When teaching the patient
about this drug, the nurse should explain that
it may cause:
A. Nasal congestion
B. Nervousness
C. Lethargy
D. Hyperkalemia
2. Miriam, a college student with
acute rhinitis sees the campus nurse because of
excessive nasal drainage. The nurse asks the
patient about the color of the drainage. In
acute rhinitis, nasal drainage normally is:
A. Yellow
B. Green
C. Clear
D. Gray
3. A male adult patient hospitalized for
treatment of a pulmonary embolism develops
respiratory alkalosis. Which clinical findings
commonly accompany respiratory alkalosis?
A. Nausea or vomiting
B. Abdominal pain or diarrhea
C. Hallucinations or tinnitus
D. Lightheadedness or paresthesia
4. Before administering ephedrine, Nurse Tony
assesses the patient’s history. Because of
ephedrine’s central nervous system (CNS)
effects, it is not recommended for:
A. Patients with an acute asthma attack
B. Patients with narcolepsy
C. Patients under age 6
D. Elderly patients
5. A female patient suffers adult respiratory
distress syndrome as a consequence of shock.
The patient’s condition deteriorates rapidly,
and endotracheal intubation and mechanical
ventilation are initiated. When the high-
pressure alarm on the mechanical ventilator,
alarm sounds, the nurse starts to check for the
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cause. Which condition triggers the high-
pressure alarm?
A. Kinking of the ventilator tubing
B. A disconnected ventilator tube
C. An endotracheal cuff leak
D. A change in the oxygen concentration
without resetting the oxygen level alarm
6. A male adult patient on mechanical
ventilation is receiving pancuronium bromide
(Pavulon), 0.01 mg/kg I.V. as needed. Which
assessment finding indicates that the patient
needs another pancuronium dose?
A. Leg movement
B. Finger movement
C. Lip movement
D. Fighting the ventilator
7. On auscultation, which finding suggests a
right pneumothorax?
A. Bilateral inspiratory and expiratory crackles
B. Absence of breaths sound in the right thorax
C. Inspiratory wheezes in the right thorax
D. Bilateral pleural friction rub.
8. Rhea, confused and short breath, is brought
to the emergency department by a family
member. The medical history reveals chronic
bronchitis and hypertension. To learn more
about the current respiratory problem, the
doctor orders a chest x-ray and
arterial blood gas (ABG) analysis. When
reviewing the ABG report, the nurses sees
many abbreviations. What does a lowercase
“a” in ABG value present?
A. Acid-base balance
B. Arterial Blood
C. Arterial oxygen saturation
D. Alveoli
9. A male patient is admitted to the healthcare
facility for treatment of chronic obstructive
pulmonary disease. Which nursing diagnosis is
most important for this patient?
A. Activity intolerance related to fatigue
B. Anxiety related to actual threat to health
status
C. Risk for infection related to retained secretions
D. Impaired gas exchange related to airflow
obstruction
10. Nurse Ruth assessing a patient for tracheal
displacement should know that the trachea will
deviate toward the:
A. Contralateral side in a simple pneumothorax
B. Affected side in a hemothorax
C. Affected side in a tension pneumothorax
D. Contralateral side in hemothorax
11. After undergoing a left pneumonectomy, a
female patient has a chest tube in place for
drainage. When caring for this patient, the
nurse must:
A. Monitor fluctuations in the water-seal
chamber
B. Clamp the chest tube once every shift
C. Encourage coughing and deep breathing
D. Milk the chest tube every 2 hours
12. When caring for a male patient who has
just had a total laryngectomy, the nurse should
plan to:
A. Encourage oral feeding as soon as possible
B. Develop an alternative communication
method
C. Keep the tracheostomy cuff fully inflated
D. Keep the patient flat in bed
13. A male patient has a sucking stab wound to
the chest. Which action should the nurse take
first?
A. Drawing blood for a hematocrit
and hemoglobin level
B. Applying a dressing over the wound and
taping it on three sides
C. Preparing a chest tube insertion tray
D. Preparing to start an I.V. line
14. For a patient with advanced chronic
obstructive pulmonary disease (COPD), which
nursing action best promotes adequate gas
exchange?
A. Encouraging the patient to drink three
glasses of fluid daily
B. Keeping the patient in semi-Fowler’s position
C. Using a high-flow venture mask to deliver
oxygen as prescribe
D. Administering a sedative, as prescribe
15. A male patient’s X-ray result reveals
bilateral white-outs, indicating adult
respiratory distress syndrome (ARDS). This
syndrome results from:
A. Cardiogenic pulmonary edema
B. Respiratory alkalosis
C. Increased pulmonary capillary permeability
D. Renal failure
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16. For a female patient with chronic
obstructive pulmonary disease, which nursing
intervention would help maintain a patent
airway?
A. Restricting fluid intake to 1,000 ml per day
B. Enforcing absolute bed rest
C. Teaching the patient how to perform
controlled coughing
D. Administering prescribe sedatives regularly
and in large amounts
17. Nurse Lei caring for a client with a
pneumothorax and who has had a chest tube
inserted notes continues gentle bubbling in the
suction control chamber. What action is
appropriate?
A. Do nothing, because this is an expected
finding
B. Immediately clamp the chest tube and notify
the physician
C. Check for an air leak because the bubbling
should be intermittent
D. Increase the suction pressure so that the
bubbling becomes vigorous
18. Nurse Maureen has assisted a physician
with the insertion of a chest tube. The nurse
monitors the client and notes fluctuation of
the fluid level in the water seal chamber after
the tube is inserted. Based on this assessment,
which action would be appropriate?
A. Inform the physician
B. Continue to monitor the client
C. Reinforce the occlusive dressing
D. Encourage the client to deep breathe
19. Nurse Reynolds caring for a client with a
chest tube turns the client to the side, and the
chest tube accidentally disconnects. The initial
nursing action is to:
A. Call the physician
B. Place the tube in bottle of sterile water
C. Immediately replace the chest tube system
D. Place a sterile dressing over the
disconnection site
20. A nurse is assisting a physician with the
removal of a chest tube. The nurse should
instruct the client to:
A. Exhale slowly
B. Stay very still
C. Inhale and exhale quickly
D. Perform the Valsalva maneuver
21. While changing the tapes on
a tracheostomy tube, the male client coughs
and tube is dislodged. The initial nursing action
is to:
A. Call the physician to reinsert the tube
B. Grasp the retention sutures to spread the
opening
C. Call the respiratory therapy department to
reinsert the tracheotomy
D. Cover the tracheostomy site with a sterile
dressing to prevent infection
22. Nurse Oliver is caring for a client
immediately after removal of the endotracheal
tube. The nurse reports which of the following
signs immediately if experienced by the client?
A. Stridor
B. Occasional pink-tinged sputum
C. A few basilar lung crackles on the right
D. Respiratory rate 24 breaths/min
23. An emergency room nurse is assessing a
male client who has sustained a blunt injury to
the chest wall. Which of these signs would
indicate the presence of a pneumothorax in
this client?
A. A low respiratory rate
B. Diminished breath sounds
C. The presence of a barrel chest
D. A sucking sound at the site of injury
24. Nurse Reese is caring for a client
hospitalized with acute exacerbation of chronic
obstructive pulmonary disease. Which of the
following would the nurse expect to note on
assessment of this client?
A. Hypocapnia
B. A hyperinflated chest noted on the chest x-
ray
C. Increased oxygen saturation with exercise
D. A widened diaphragm noted on the chest x-
ray
25. An oxygen delivery system is prescribed for
a male client with chronic obstructive pulmonary
disease to deliver a precise oxygen
concentration. Which of the following types of
oxygen delivery systems would the nurse
anticipate to be prescribed?
A. Face tent
B. Venturi mask
C. Aerosol mask
D. Tracheostomy collar
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26. Blessy, a community health nurse is
conducting an educational session with
community members regarding tuberculosis.
The nurse tells the group that one of the first
symptoms associated with tuberculosis is:
A. Dyspnea
B. Chest pain
C. A bloody, productive cough
D. A cough with the expectoration of mucoid
sputum
27. A nurse performs an admission assessment
on a female client with a diagnosis of
tuberculosis. The nurse reviews the result of
which diagnosis test that will confirm this
diagnosis?
A. Bronchoscopy
B. Sputum culture
C. Chest x-ray
D. Tuberculin skin test
28. A nurse is caring for a male client
with emphysema who is receiving oxygen. The
nurse assesses the oxygen flow rate to ensure
that it does not exceed:
A. 1 L/min
B. 2 L/min
C. 6 L/min
D. 10 L/min
29. A nurse instructs a female client to use the
pursed-lip method of breathing and the client
asks the nurse about the purpose of this type
of breathing. The nurse responds, knowing
that the primary purpose of pursed-lip
breathing is to:
A. Promote oxygen intake
B. Strengthen the diaphragm
C. Strengthen the intercostal muscles
D. Promote carbon dioxide elimination
30. A nurse is caring for a male client with
acute respiratory distress syndrome. Which of
the following would the nurse expect to note
in the client?
A. Pallor
B. Low arterial PaO2
C. Elevated arterial PaO2
D. Decreased respiratory rate
31. A nurse is preparing to obtain a sputum
specimen from a male client. Which of the
following nursing actions will facilitate
obtaining the specimen?
A. Limiting fluid
B. Having the client take deep breaths
C. Asking the client to spit into the collection
container
D. Asking the client to obtain the specimen after
eating
32. Nurse Joy is caring for a client after a
bronchoscopy and biopsy. Which of the
following signs, if noticed in the client, should
be reported immediately to the physician?
A. Dry cough
B. Hematuria
C. Bronchospasm
D. Blood-streaked sputum
33. A nurse is suctioning fluids from a male
client via a tracheostomy tube. When
suctioning, the nurse must limit the suctioning
time to a maximum of:
A. 1 minute
B. 5 seconds
C. 10 seconds
D. 30 seconds
34. A nurse is suctioning fluids from a female
client through an endotracheal tube. During
the suctioning procedure, the nurse notes on
the monitor that the heart rate is decreasing.
Which if the following is the appropriate
nursing intervention?
A. Continue to suction
B. Notify the physician immediately
C. Stop the procedure and reoxygenate the
client
D. Ensure that the suction is limited to 15
seconds
35. A male adult client is suspected of having a
pulmonary embolus. A nurse assesses the
client, knowing that which of the following is a
common clinical manifestation of pulmonary
embolism?
A. Dyspnea
B. Bradypnea
C. Bradycardia
D. Decreased respirations
36. A slightly obese female client with a history
of allergy-induced asthma, hypertension, and
mitral valve prolapse is admitted to an acute
care facility for elective surgery. The nurse
obtains a complete history and performs a
thorough physical examination, paying special
attention to the cardiovascular and respiratory
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systems. When percussing the client’s chest
wall, the nurse expects to elicit:
A. Resonant sounds.
B. Hyperresonant sounds.
C. Dull sounds.
D. Flat sounds.
37. A male client who weighs 175 lb (79.4 kg) is
receiving aminophylline (Aminophyllin) (400
mg in 500 ml) at 50 ml/hour. The theophylline
level is reported as 6 mcg/ml. The nurse calls
the physician who instructs the nurse to
change the dosage to 0.45 mg/kg/hour. The
nurse should:
A. Question the order because it’s too low.
B. Question the order because it’s too high.
C. Set the pump at 45 ml/hour.
D. Stop the infusion and have the laboratory
repeat the theophylline measurement.
38. The nurse is teaching a male client with
chronic bronchitis about breathing exercises.
Which of the following should the nurse
include in the teaching?
A. Make inhalation longer than exhalation.
B. Exhale through an open mouth.
C. Use diaphragmatic breathing.
D. Use chest breathing.
39. Which phrase is used to describe the
volume of air inspired and expired with a
normal breath?
A. Total lung capacity
B. Forced vital capacity
C. Tidal volume
D. Residual volume
40. A male client abruptly sits up in bed,
reports having difficulty breathing and has an
arterial oxygen saturation of 88%. Which mode
of oxygen delivery would most likely reverse
the manifestations?
A. Simple mask
B. Non-rebreather mask
C. Face tent
D. Nasal cannula
41. A female client must take streptomycin for
tuberculosis. Before therapy begins, the nurse
should instruct the client to notify the
physician if which health concern occurs?
A. Impaired color discrimination
B. Increased urinary frequency
C. Decreased hearing acuity
D. Increased appetite
42. A male client is asking the nurse a question
regarding the Mantoux test for tuberculosis.
The nurse should base her response on the fact
that the:
A. Area of redness is measured in 3 days and
determines whether tuberculosis is present.
B. Skin test doesn’t differentiate between active
and dormant tuberculosis infection.
C. Presence of a wheal at the injection site in 2
days indicates active tuberculosis.
D. Test stimulates a reddened response in some
clients and requires a second test in 3 months.
43. A female adult client has a tracheostomy
but doesn’t require continuous mechanical
ventilation. When weaning the client from the
tracheostomy tube, the nurse initially should
plug the opening in the tube for:
A. 15 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes.
44. Nurse Oliver observes constant bubbling in
the water-seal chamber of a closed chest
drainage system. What should the nurse
conclude?
A. The system is functioning normally
B. The client has a pneumothorax.
C. The system has an air leak.
D. The chest tube is obstructed.
45. A black client with asthma seeks
emergency care for acute respiratory distress.
Because of this client’s dark skin, the nurse
should assess for cyanosis by inspecting the:
A. Lips.
B. Mucous membranes.
C. Nail beds.
D. Earlobes.
46. For a male client with an endotracheal (ET)
tube, which nursing action is most essential?
A. Auscultating the lungs for bilateral breath
sounds
B. Turning the client from side to side every 2
hours
C. Monitoring serial blood gas values every 4
hours
D. Providing frequent oral hygiene
Reviewer
47. The nurse assesses a male client’s
respiratory status. Which observation indicates
that the client is experiencing difficulty
breathing?
A. Diaphragmatic breathing
B. Use of accessory muscles
C. Pursed-lip breathing
D. Controlled breathing
48. A female client is undergoing a complete
physical examination as a requirement for
college. When checking the client’s respiratory
status, the nurse observes respiratory
excursion to help assess:
A. Lung vibrations.
B. Vocal sounds.
C. Breath sounds.
D. Chest movements.
49. A male client comes to the emergency
department complaining of sudden onset
of diarrhea, anorexia, malaise, cough,
headache, and recurrent chills. Based on the
client’s history and physical findings, the
physician suspects legionnaires’ disease. While
awaiting diagnostic test results, the client is
admitted to the facility and started
on antibiotic therapy. What is the drug of
choice for treating legionnaires’ disease?
A. Erythromycin (Erythrocin)
B. Rifampin (Rifadin)
C. Amantadine (Symmetrel)
D. Amphotericin B (Fungizone)
50. A male client with chronic obstructive
pulmonary disease (COPD) is recovering from
a myocardial infarction. Because the client is
extremely weak and can’t produce an effective
cough, the nurse should monitor closely for:
A. Pleural effusion.
B. Pulmonary edema.
C. Atelectasis.
D. Oxygen toxicity.
51. The nurse in charge is teaching a client with
emphysema how to perform pursed-lip
breathing. The client asks the nurse to explain
the purpose of this breathing technique. Which
explanation should the nurse provide?
A. It helps prevent early airway collapse.
B. It increases inspiratory muscle strength.
C. It decreases use of accessory breathing
muscles.
D. It prolongs the inspiratory phase of
respiration.
52. After receiving an oral dose of codeine for
an intractable cough, the male client asks the
nurse, “How long will it take for this drug to
work?” How should the nurse respond?
A. In 30 minutes
B. In 1 hour
C. In 2.5 hours
D. In 4 hours
53. A male client suffers adult respiratory
distress syndrome as a consequence of shock.
The client’s condition deteriorates rapidly, and
endotracheal (ET) intubation and mechanical
ventilation are initiated. When the high-
pressure alarm on the mechanical ventilator
sounds, the nurse starts to check for the cause.
Which condition triggers the high-pressure
alarm?
A. Kinking of the ventilator tubing
B. A disconnected ventilator tube
C. An ET cuff leak
D. A change in the oxygen concentration
without resetting the oxygen level alarm
54. A female client with chronic obstructive
pulmonary disease (COPD) takes anhydrous
theophylline, 200 mg P.O. every 8 hours.
During a routine clinic visit, the client asks the
nurse how the drug works. What is the
mechanism of action of anhydrous
theophylline in treating a nonreversible
obstructive airway disease such as COPD?
A. It makes the central respiratory center more
sensitive to carbon dioxide and stimulates the
respiratory drive.
B. It inhibits the enzyme phosphodiesterase,
decreasing degradation of cyclic adenosine
monophosphate, a bronchodilator.
C. It stimulates adenosine receptors, causing
bronchodilation.
D. It alters diaphragm movement, increasing
chest expansion and enhancing the lung’s
capacity for gas exchange.
55. A male client with
pneumococcal pneumonia is admitted to an
acute care facility. The client in the next room
is being treated for mycoplasmal pneumonia.
Despite the different causes of the various
types of pneumonia, all of them share which
feature?
Reviewer
A. Inflamed lung tissue
B. Sudden onset
C. Responsiveness to penicillin.
D. Elevated white blood cell (WBC) count
56. A client with Guillain-Barré
syndrome develops respiratory acidosis as a
result of reduced alveolar ventilation. Which
combination of arterial blood gas (ABG) values
confirms respiratory acidosis?
A. pH, 5.0; PaCO2 30 mm Hg
B. pH, 7.40; PaCO2 35 mm Hg
C. pH, 7.35; PaCO2 40 mm Hg
D. pH, 7.25; PaCO2 50 mm Hg
57. A male client admitted to an acute care
facility with pneumonia is receiving
supplemental oxygen, 2 L/minute via nasal
cannula. The client’s history includes chronic
obstructive pulmonary disease (COPD)
and coronary artery disease. Because of these
history findings, the nurse closely monitors the
oxygen flow and the client’s respiratory status.
Which complication may arise if the client
receives a high oxygen concentration?
A. Apnea
B. Anginal pain
C. Respiratory alkalosis
D. Metabolic acidosis
58. At 11 p.m., a male client is admitted to the
emergency department. He has a respiratory
rate of 44 breaths/minute. He’s anxious, and
wheezes are audible. The client is immediately
given oxygen by face mask
and methylprednisolone (Depo-medrol) I.V. At
11:30 p.m., the client’s arterial blood oxygen
saturation is 86% and he’s still wheezing. The
nurse should plan to administer:
A. Alprazolam (Xanax).
B. Propranolol (Inderal)
C. Morphine.
D. Albuterol (Proventil).
59. After undergoing a thoracotomy, a male
client is receiving epidural analgesia. Which
assessment finding indicates that the client has
developed the most serious complication of
epidural analgesia?
A. Heightened alertness
B. Increased heart rate
C. Numbness and tingling of the extremities
D. Respiratory depression
60. The nurse in charge formulates a nursing
diagnosis of Activity intolerance related to
inadequate oxygenation and dyspnea for a
client with chronic bronchitis. To minimize this
problem, the nurse instructs the client to avoid
conditions that increase oxygen demands.
Such conditions include:
A. Drinking more than 1,500 ml of fluid daily.
B. Being overweight.
C. Eating a high-protein snack at bedtime.
D. Eating more than three large meals a day.
Answers and Rationale
1. Answer: B. Nervousness
Albuterol may cause nervousness. The inhaled
form of the drug may cause dryness and
irritation of the nose and throat, not nasal
congestion; insomnia, not lethargy;
and hypokalemia (with high doses),
not hyperkalemia. Other adverse effects of
albuterol include tremor, dizziness, headache,
tachycardia, palpitations, hypertension,
heartburn, nausea, vomiting and muscle
cramps.
2. Answer: C. Clear
Normally, nasal drainage in acute rhinitis is
clear. Yellow or green drainage indicates spread
of the infection to the sinuses. Gray drainage
may indicate a secondary infection.
3. Answer: D. Lightheadedness or paresthesia
The patient with respiratory alkalosis may
complain of lightheadedness or paresthesia
(numbness and tingling in the arms and legs).
Nausea, vomiting, abdominal pain, and diarrhea
may accompany respiratory acidosis.
Hallucinations and tinnitus rare are associated
with respiratory alkalosis or any other acid-base
imbalance.
4. Answer: D. Elderly patients
Ephedrine is not recommended for elderly
patients, who are particularly susceptible to
CNS reactions (such as confusion and anxiety)
and to cardiovascular reactions (such as
increased systolic blood pressure, coldness in the
extremities, and anginal pain). Ephedrine is
used for its bronchodilator effects with acute
and chronic asthma and occasionally for its CNS
stimulant actions for narcolepsy. It can be
administered to children age 2 and older.
Reviewer
5. Answer: A. Kinking of the ventilator tubing
Conditions that trigger the high-pressure alarm
include kinking of the ventilator tubing,
bronchospasm or pulmonary embolus, mucus
plugging, water in the tube, coughing or biting
on endotracheal tube, and the patient’s being
out of breathing rhythm with the ventilator. A
disconnected ventilator tube or an
endotracheal cuff leak would trigger the low
pressure alarm. Changing the oxygen
concentration without resetting the oxygen
level alarm would trigger the oxygen alarm.
6. Answer: D. Fighting the ventilator
Pancuronium, a nondepolarizing blocking agent,
is used for muscle relaxation and paralysis. It
assists mechanical ventilation by promoting
endotracheal intubation and paralyzing the
patient so that the mechanical ventilator can do
its work. Fighting the ventilator is a sign that the
patient needs another pancuronium dose. The
nurse should administer 0.01 to 0.02 mg/kg I.V.
every 20 to 60 minutes. Movement of the legs,
or lips has no effect on the ventilator and
therefore is not used to determine the need for
another dose.
7. Answer: B. Absence of breaths sound in the
right thorax
In pneumothorax, the alveoli are deflated and
no air exchange occurs in the lungs. Therefore,
breath sounds in the affected lung field are
absent. None of the other options are
associated with pneumothorax. Bilateral
crackles may result from pulmonary congestion,
inspiratory wheezes may signal asthma, and a
pleural friction rub may indicate pleural
inflammation.
8. Answer: B. Arterial Blood
A lowercase “a” in an ABG value represents
arterial blood. For instance, the abbreviation
PaO2 refers to the partial pressure of oxygen in
arterial blood. The pH value reflects the acid-
base balance in arterial blood. Sa02 indicates
arterial oxygen saturation. An uppercase “A”
represents alveolar conditions: for example,
PA02 indicates the partial pressure of oxygen in
the alveoli.
9. Answer: D. Impaired gas exchange related to
airflow obstruction
A patient airway and an adequate breathing
pattern are the top priority for any patient,
making “impaired gas exchange related to
airflow obstruction” the most important nursing
diagnosis. The other options also may apply to
this patient but less important.
10. Answer: D. Contralateral side in
hemothorax
The trachea will shift according to the pressure
gradients within the thoracic cavity. In tension
pneumothorax and hemothorax, accumulation
of air or fluid causes a shift away from the
injured side. If there is no significant air or fluid
accumulation, the trachea will not shift.
Tracheal deviation toward the contralateral side
in simple pneumothorax is seen when the
thoracic contents shift in response to the
release of normal thoracic pressure gradients
on the injured side.
11. Answer: C. Encourage coughing and deep
breathing
When caring for a patient who is recovering
from a pneumonectomy, the nurse should
encourage coughing and deep breathing to
prevent pneumonia in the unaffected lung.
Because the lung has been removed, the water-
seal chamber should display no fluctuations.
Reinflation is not the purpose of chest tube.
Chest tube milking is controversial and should
be done only to remove blood clots that
obstruct the flow of drainage.
12. Answer: B. Develop an alternative
communication method
A patient with a laryngectomy cannot speak, yet
still needs to communicate. Therefore, the
nurse should plan to develop an alternative
communication method. After a laryngectomy,
edema interferes with the ability to swallow
and necessitates tube (enteral) feedings. To
prevent injury to the tracheal mucosa, the nurse
should deflate the tracheostomy cuff or use the
minimal leak technique. To decrease edema,
the nurse should place the patient in semi-
Fowler’s position.
13. Answer: B. Applying a dressing over the
wound and taping it on three sides
The nurse immediately should apply a dressing
over the stab wound and tape it on three sides
to allow air to escape and to prevent tension
pneumothorax (which is more life-threatening
than an open chest wound). Only after covering
and taping the wound should the nurse draw
Reviewer
blood for laboratory tests, assist with chest tube
insertion, and start an I.V. line.
14. Answer: C. Using a high-flow venture mask
to deliver oxygen as prescribe
The patient with COPD retains carbon dioxide,
which inhibits stimulation of breathing by the
medullary center in the brain. As a result, low
oxygen levels in the blood stimulate respiration,
and administering unspecified, unmonitored
amounts of oxygen may depress ventilation. To
promote adequate gas exchange, the nurse
should use a Venturi mask to deliver a specified,
controlled amount of oxygen consistently and
accurately. Drinking three glasses of fluid daily
would not affect gas exchange or be sufficient
to liquefy secretions, which are common in
COPD. Patients with COPD and respiratory
distress should be places in high-Fowler’s
position and should not receive sedatives or
other drugs that may further depress the
respiratory center.
15. Answer: C. Increased pulmonary capillary
permeability
ARDS results from increased pulmonary
capillary permeability, which leads to
noncardiogenic pulmonary edema.
In cardiogenic pulmonary edema, pulmonary
congestion occurs secondary to heart failure. In
the initial stage of ARDS, respiratory alkalosis
may arise secondary to hyperventilation;
however, it does not cause ARDS. Renal failure
does not cause ARDS, either.
16. Answer: C. Teaching the patient how to
perform controlled coughing
Controlled coughing helps maintain a patent
airway by helping to mobilize and remove
secretions. A moderate fluid intake (usually 2 L
or more daily) and moderate activity help
liquefy and mobilize secretions. Bed rest and
sedatives may limit the patient’s ability to
maintain a patent airway, causing a high risk for
infection from pooled secretions.
17. Answer: A. Do nothing, because this is an
expected finding
Continuous gentle bubbling should be noted in
the suction control chamber. Option b is
incorrect. Chest tubes should only be clamped
to check for an air leak or when changing
drainage devices (according to agency policy).
Option c is incorrect. Bubbling should be
continuous and not intermittent. Option d is
incorrect because bubbling should be gentle.
Increasing the suction pressure only increases
the rate of evaporation of water in the drainage
system.
18. Answer: B. Continue to monitor the client
The presence of fluctuation of the fluid level in
the water seal chamber indicates a patent
drainage system. With normal breathing, the
water level rises with inspiration and falls
with expiration. Fluctuation stops if the tube is
obstructed, if a dependent loop exists, if the
suction is not working properly, or if the lung
has reexpanded. Options A, C, and D are
incorrect.
19. Answer: B. Place the tube in bottle of
sterile water
If the chest drainage system is disconnected,
the end of the tube is placed in a bottle of
sterile water held below the level of the chest.
The system is replaced if it breaks or cracks or if
the collection chamber is full. Placing a sterile
dressing over the disconnection site will not
prevent complications resulting from the
disconnection. The physician may need to be
notified, but this is not the initial action.
20. Answer: D. Perform the Valsalva maneuver
When the chest tube is removed, the client is
asked to perform the Valsalva maneuver (take a
deep breath, exhale, and bear down). The tube
is quickly withdrawn, and an airtight dressing is
taped in place. An alternative instruction is to
ask the client to take a deep breath and hold
the breath while the tube is removed. Options
A, B, and C are incorrect client instructions.
21. Answer: B. Grasp the retention sutures to
spread the opening
If the tube is dislodged accidentally, the initial
nursing action is to grasp the retention sutures
and spread the opening. If agency policy
permits, the nurse then attempts immediately
to replace the tube. Covering the tracheostomy
site will block the airway. Options A and C will
delay treatment in this emergency situation.
22. Answer: A. Stridor
The nurse reports stridor to the physician
immediately. This is a high-pitched, coarse
sound that is heard with the stethoscope over
the trachea. Stridor indicates airway edema and
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places the client at risk for airway obstruction.
Options B, C, and D are not signs that require
immediate notification of the physician.
23. Answer: B. Diminished breath sounds
This client has sustained a blunt or a closed
chest injury. Basic symptoms of a closed
pneumothorax are shortness of breath and
chest pain. A larger pneumothorax may cause
tachypnea, cyanosis, diminished breath sounds,
and subcutaneous emphysema.
Hyperresonance also may occur on the affected
side. A sucking sound at the site of injury would
be noted with an open chest injury.
24. Answer: B. A hyperinflated chest noted on
the chest x-ray
Clinical manifestations of chronic obstructive
pulmonary disease (COPD) include hypoxemia,
hypercapnia, dyspnea on exertion and at rest,
oxygen desaturation with exercise, and the use
of accessory muscles of respiration. Chest x-rays
reveal a hyperinflated chest and a flattened
diaphragm if the disease is advanced.
25. Answer: B. Venturi mask
The Venturi mask delivers the most accurate
oxygen concentration. It is the best oxygen
delivery system for the client with chronic
airflow limitation because it delivers a precise
oxygen concentration. The face tent, aerosol
mask, and tracheostomy collar are also high-
flow oxygen delivery systems but most often
are used to administer high humidity.
26. Answer: D. A cough with the expectoration
of mucoid sputum
One of the first pulmonary symptoms is a slight
cough with the expectoration of mucoid
sputum. Options A, B, and C are late symptoms
and signify cavitation and extensive lung
involvement.
27. Answer: B. Sputum culture
Tuberculosis is definitively diagnosed through
culture and isolation of Mycobacterium
tuberculosis. A presumptive diagnosis is made
based on a tuberculin skin test, a sputum smear
that is positive for acid-fast bacteria, a chest x-
ray, and histological evidence of granulomatous
disease on biopsy.
28. Answer: B. 2 L/min
Oxygen is used cautiously and should not
exceed 2 L/min. Because of the long-standing
hypercapnia that occurs in emphysema, the
respiratory drive is triggered by low oxygen
levels rather than increased carbon dioxide
levels, as is the case in a normal respiratory
system.
29. Answer: D. Promote carbon dioxide
elimination
Pursed-lip breathing facilitates maximal
expiration for clients with obstructive lung
disease. This type of breathing allows better
expiration by increasing airway pressure that
keeps air passages open during exhalation.
Options A, B, and C are not the purposes of this
type of breathing.
30. Answer: B. Low arterial PaO2
The earliest clinical sign of acute respiratory
distress syndrome is an increased respiratory
rate. Breathing becomes labored, and the client
may exhibit air hunger, retractions, and
cyanosis. Arterial blood gas analysis reveals
increasing hypoxemia, with a PaO2 lower than
60 mm Hg.
31. Answer: B. Having the client take deep
breaths
To obtain a sputum specimen, the client should
rinse the mouth to reduce contamination,
breathe deeply, and then cough into a sputum
specimen container. The client should be
encouraged to cough and not spit so as to
obtain sputum. Sputum can be thinned by fluids
or by a respiratory treatment such as inhalation
of nebulized saline or water. The optimal time
to obtain a specimen is on arising in the
morning.
32. Answer: C. Bronchospasm
If a biopsy was performed during a
bronchoscopy, blood-streaked sputum is
expected for several hours. Frank blood
indicates hemorrhage. A dry cough may be
expected. The client should be assessed for
signs of complications, which would include
cyanosis, dyspnea, stridor, bronchospasm,
hemoptysis, hypotension, tachycardia, and
dysrhythmias. Hematuria is unrelated to this
procedure.
33. Answer: C. 10 seconds
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Hypoxemia can be caused by prolonged
suctioning, which stimulates the pacemaker cells
in the heart. A vasovagal response may occur,
causing bradycardia. The nurse must
preoxygenate the client before suctioning and
limit the suctioning pass to 10 seconds.
34. Answer: C. Stop the procedure and
reoxygenate the client
During suctioning, the nurse should monitor the
client closely for side effects, including
hypoxemia, cardiac irregularities such as a
decrease in heart rate resulting from vagal
stimulation, mucosal trauma, hypotension, and
paroxysmal coughing. If side effects develop,
especially cardiac irregularities, the procedure is
stopped and the client is reoxygenated.
35. Answer: A. Dyspnea
The common clinical manifestations of
pulmonary embolism are tachypnea,
tachycardia, dyspnea, and chest pain.
36. Answer: A. Resonant sounds.
When percussing the chest wall, the nurse
expects to elicit resonant sounds — low-
pitched, hollow sounds heard over normal lung
tissue. Hyperresonant sounds indicate increased
air in the lungs or pleural space; they’re louder
and lower pitched than resonant sounds.
Although hyperresonant sounds occur in such
disorders as emphysema and pneumothorax,
they may be normal in children and very thin
adults. Dull sounds, normally heard only over
the liver and heart, may occur over dense lung
tissue, such as from consolidation or a tumor.
Dull sounds are thudlike and of medium pitch.
Flat sounds, soft and high-pitched, are heard
over airless tissue and can be replicated by
percussing the thigh or a bony structure.
37. Answer: A. Question the order because it’s
too low.
A therapeutic theophylline level is 10 to 20
mcg/ml. The client is currently receiving 0.5
mg/kg/hour of aminophylline. Because the
client’s theophylline level is sub-therapeutic,
reducing the dose (which is what the physician’s
order would do) would be inappropriate.
Therefore, the nurse should question the order.
38. Answer: C. Use diaphragmatic breathing.
In chronic bronchitis the diaphragm is flat and
weak. Diaphragmatic breathing helps to
strengthen the diaphragm and maximizes
ventilation. Exhalation should be longer than
inhalation to prevent collapse of the bronchioles.
The client with chronic bronchitis should exhale
through pursed lips to prolong exhalation, keep
the bronchioles from collapsing, and prevent air
trapping. Diaphragmatic breathing — not chest
breathing — increases lung expansion.
39. Answer: C. Tidal volume
Tidal volume refers to the volume of air inspired
and expired with a normal breath. Total lung
capacity is the maximal amount of air the lungs
and respiratory passages can hold after a forced
inspiration. Forced vital capacity is the vital
capacity performed with a maximally forced
expiration. Residual volume is the maximal
amount of air left in the lung after a maximal
expiration.
40. Answer: B. Non-rebreather mask
A non-rebreather mask can deliver levels of the
fraction of inspired oxygen (FIO2) as high as
100%. Other modes — simple mask, face tent,
and nasal cannula — deliver lower levels of
FIO2.
41. Answer: C. Decreased hearing acuity
Decreased hearing acuity indicates ototoxicity, a
serious adverse effect of streptomycin therapy.
The client should notify the physician
immediately if it occurs so that streptomycin
can be discontinued and an alternative drug can
be prescribed. The other options aren’t
associated with streptomycin. Impaired color
discrimination indicates color blindness;
increased urinary frequency and increased
appetite accompany diabetes mellitus.
42. Answer: B. Skin test doesn’t differentiate
between active and dormant tuberculosis
infection.
The Mantoux test doesn’t differentiate between
active and dormant infections. If a positive
reaction occurs, a sputum smear and culture as
well as a chest X-ray are necessary to provide
more information. Although the area of redness
is measured in 3 days, a second test may be
needed; neither test indicates that tuberculosis
is active. In the Mantoux test, an induration 5 to
9 mm in diameter indicates a borderline
reaction; a larger induration indicates a positive
reaction. The presence of a wheal within 2 days
doesn’t indicate active tuberculosis.
Reviewer
43. Answer: B. B. 5 to 20 minutes.
Initially, the nurse should plug the opening in
the tracheostomy tube for 5 to 20 minutes,
then gradually lengthen this interval according
to the client’s respiratory status. A client who
doesn’t require continuous mechanical
ventilation already is breathing without
assistance, at least for short periods; therefore,
plugging the opening of the tube for only 15 to
60 seconds wouldn’t be long enough to reveal
the client’s true tolerance to the procedure.
Plugging the opening for more than 20 minutes
would increase the risk of acute respiratory
distress because the client requires an
adjustment period to start breathing normally.
44. Answer: C. The system has an air leak.
Constant bubbling in the chamber indicates an
air leak and requires immediate intervention.
The client with a pneumothorax will have
intermittent bubbling in the water-seal
chamber. Clients without a pneumothorax
should have no evidence of bubbling in the
chamber. If the tube is obstructed, the nurse
should notice that the fluid has stopped
fluctuating in the water-seal chamber.
45. Answer: B. Mucous membranes.
Skin color doesn’t affect the mucous
membranes. The lips, nail beds, and earlobes
are less reliable indicators of cyanosis because
they’re affected by skin color.
46. Answer: A. Auscultating the lungs for
bilateral breath sounds
For a client with an ET tube, the most important
nursing action is auscultating the lungs regularly
for bilateral breath sounds to ensure proper
tube placement and effective oxygen delivery.
Although the other options are appropriate for
this client, they’re secondary to ensuring
adequate oxygenation.
47. Answer: B. Use of accessory muscles
The use of accessory muscles for respiration
indicates the client is having difficulty breathing.
Diaphragmatic and pursed-lip breathing are two
controlled breathing techniques that help the
client conserve energy.
48. Answer: D. Chest movements.
The nurse observes respiratory excursion to
help assess chest movements. Normally,
thoracic expansion is symmetrical; unequal
expansion may indicate pleural effusion,
atelectasis, pulmonary embolus, or a rib
or sternum fracture. The nurse assesses vocal
sounds to evaluate air flow when checking for
tactile fremitus; after asking the client to say
“99,” the nurse palpates the vibrations
transmitted from the bronchopulmonary
system along the solid surfaces of the chest wall
to the nurse’s palms. The nurse assesses breath
sounds during auscultation.
49. Answer: A. Erythromycin (Erythrocin)
Erythromycin is the drug of choice for treating
legionnaires’ disease. Rifampin may be added to
the regimen if erythromycin alone is ineffective;
however, it isn’t administered first. Amantadine,
an antiviral agent, and amphotericin B,
an antifungal agent, are ineffective against
legionnaires’ disease, which is caused by
bacterial infection.
50. Answer: C. Atelectasis.
In a client with COPD, an ineffective cough
impedes secretion removal. This, in turn, causes
mucus plugging, which leads to localized airway
obstruction — a known cause of atelectasis. An
ineffective cough doesn’t cause pleural effusion
(fluid accumulation in the pleural space).
Pulmonary edema usually results from left-
sided heart failure, not an ineffective cough.
Although many noncardiac conditions may
cause pulmonary edema, an ineffective cough
isn’t one of them. Oxygen toxicity results from
prolonged administration of high oxygen
concentrations, not an ineffective cough.
51. Answer: A. It helps prevent early airway
collapse.
Pursed-lip breathing helps prevent early airway
collapse. Learning this technique helps the
client control respiration during periods of
excitement, anxiety, exercise, and respiratory
distress. To increase inspiratory muscle strength
and endurance, the client may need to learn
inspiratory resistive breathing. To decrease
accessory muscle use and thus reduce the work
of breathing, the client may need to learn
diaphragmatic (abdominal) breathing. In
pursed-lip breathing, the client mimics a normal
inspiratory-expiratory (I:E) ratio of 1:2. (A client
with emphysema may have an I:E ratio as high
as 1:4.)
52. Answer: A. In 30 minutes
Reviewer
Codeine’s onset of action is 30 minutes. Its peak
concentration occurs in about 1 hour; its half-
life, in 2.5 hours; and its duration of action is 4
to 6 hours.
53. Answer: A. Kinking of the ventilator tubing
Conditions that trigger the high-pressure alarm
include kinking of the ventilator tubing,
bronchospasm or pulmonary embolus, mucus
plugging, water in the tube, coughing or biting
on the ET tube, and the client’s being out of
breathing rhythm with the ventilator. A
disconnected ventilator tube or an ET cuff leak
would trigger the low-pressure alarm. Changing
the oxygen concentration without resetting the
oxygen level alarm would trigger the oxygen
alarm.
54. Answer: A. It makes the central respiratory
center more sensitive to carbon dioxide and
stimulates the respiratory drive.
Anhydrous theophylline and other
methylxanthine agents make the central
respiratory center more sensitive to CO2 and
stimulate the respiratory drive. Inhibition of
phosphodiesterase is the drug’s mechanism of
action in treating asthma and other reversible
obstructive airway diseases — not COPD.
Methylxanthine agents inhibit rather than
stimulate adenosine receptors. Although these
agents reduce diaphragmatic fatigue in clients
with chronic bronchitis or emphysema, they
don’t alter diaphragm movement to increase
chest expansion and enhance gas exchange.
55. Answer: A. Inflamed lung tissue
The common feature of all types of pneumonia
is an inflammatory pulmonary response to the
offending organism or agent. Although most
types of pneumonia have a sudden onset, a few
(such as anaerobic bacterial pneumonia and
mycoplasmal pneumonia) have an insidious
onset. Antibiotic therapy is the primary
treatment for most types of pneumonia;
however, the antibiotic must be specific for the
causative agent, which may not be responsive
to penicillin. A few types of pneumonia, such as
viral pneumonia, aren’t treated with antibiotics.
Although pneumonia usually causes an elevated
WBC count, some types, such as mycoplasmal
pneumonia, don’t.
56. Answer: D. pH, 7.25; PaCO2 50 mm Hg
In respiratory acidosis, ABG analysis reveals an
arterial pH below 7.35 and partial pressure of
arterial carbon dioxide (PaCO2) above 45 mm
Hg. Therefore, the combination of a pH value of
7.25 and a PaCO2 value of 50 mm Hg confirms
respiratory acidosis. A pH value of 5.0 with a
PaCO2 value of 30 mm Hg indicates respiratory
alkalosis. Options B and C represent normal
ABG values, reflecting normal gas exchange in
the lungs.
57. Answer: A. Apnea
Hypoxia is the main breathing stimulus for a
client with COPD. Excessive oxygen
administration may lead to apnea by removing
that stimulus. Anginal pain results from a
reduced myocardial oxygen supply. A client with
COPD may have anginal pain from generalized
vasoconstriction secondary to hypoxia;
however, administering oxygen at any
concentration dilates blood vessels, easing
anginal pain. Respiratory alkalosis results from
alveolar hyperventilation, not excessive oxygen
administration. In a client with COPD, high
oxygen concentrations decrease the ventilatory
drive, leading to respiratory acidosis, not
alkalosis. High oxygen concentrations don’t
cause metabolic acidosis.
58. Answer: D. Albuterol (Proventil).
The client is hypoxemic because of
bronchoconstriction as evidenced by wheezes
and a subnormal arterial oxygen saturation
level. The client’s greatest need is
bronchodilation, which can be accomplished by
administering bronchodilators. Albuterol is a
beta2 adrenergic agonist, which causes dilation
of the bronchioles. It’s given by nebulization or
metered-dose inhalation and may be given as
often as every 30 to 60 minutes until relief is
accomplished. Alprazolam is an anxiolytic and
central nervous system depressant, which could
suppress the client’s breathing. Propranolol is
contraindicated in a client who’s wheezing
because it’s a beta2 adrenergic antagonist.
Morphine is a respiratory center depressant and
is contraindicated in this situation.
59. Answer: D. Respiratory depression
Respiratory depression is the most serious
complication of epidural analgesia. Other
potential complications include hypotension,
decreased sensation and movement of the
extremities, allergic reactions,
and urine retention. Typically, epidural analgesia
Reviewer

causes central nervous system depression A. Respiratory alkalosis

(indicated by drowsiness) as well as a decreased B. Respiratory acidosis
heart rate and blood pressure. C. Metabolic acidosis
D. Metabolic alkalosis
60. Answer: B. Being overweight.
4. Which of the following information
Conditions that increase oxygen demands
corresponds with a negative TB test?
include obesity, smoking, exposure to
temperature extremes, and stress. A client with A. 0-4 mm induration at 48 hours
chronic bronchitis should drink at least 2,000 ml B. 0-5 mm induration at 48 hours
of fluid daily to thin mucus secretions; C. 0-6 mm induration at 48 hours
restricting fluid intake may be harmful. The D. 0-7 mm induration at 48 hours
nurse should encourage the client to eat a high-
protein snack at bedtime because protein 5. Which of the following is the most common
digestion produces an amino acid with sedating type of lung cancer?
effects that may ease the insomnia associated A. Large cell
with chronic bronchitis. Eating more than three B. Adenocarcinoma
large meals a day may cause fullness, making C. Oat cell
breathing uncomfortable and difficult; however, D. Squamous cell
it doesn’t increase oxygen demands. To help
maintain adequate nutritional intake, the client 6. What cell type secrets surfactant?
with chronic bronchitis should eat small,
A. Plasma cell
frequent meals (up to six a day).
B. Type I alveolar cell
C. Type II alveolar cell
D. Type III alveolar cell
1 Which of the following conditions correlate
with the following information: 7. Which of the following pulmonary term
correlates with the definition: noted
i. High pH obstruction of the trachea or larynx.
ii. High HCO3
iii. High BE A. Rhonchi
iv. Neutral pCO2 B. Stridor
A. Respiratory alkalosis
C. Wheezes
B. Respiratory acidosis
D. Vesicular
C. Metabolic acidosis
D. Metabolic alkalosis 8. Normal values for pCO2 are considered:

2. Which of the following conditions A. 20-40 mm Hg

correlate with the following information: B. 25-30 mm Hg
C. 30-40 mm Hg
 High pH
D. 35-45 mm Hg
 Neutral HCO3
 Neutral BE 9. Normal values for HCO3 are considered:
 Low pCO2
A. 15-30 mEq/L
B. 20-35 mEq/L
A. Respiratory alkalosis
C. 22-26 mEq/L
B. Respiratory acidosis
D. 24-29 mEq/L
C. Metabolic acidosis
D. Metabolic alkalosis 10. Pneumoncystis carinii infections are
commonly treated with which of the following
3. Which of the following conditions correlate
medications?
with the following information:
A. Pentamidine
 Low pH
B. Allopurinol
 Low HCO3
C. Iorazepam
 Low BE
D. Chlorpropamide
 Neutral pCO2
Reviewer

11. Which of the following is not generally 18. Which of the following matches the
caused by COPD? definition: The volume of air that can be inhaled
following exhalation of tidal volume?
A. Pneumonia
B. Right sided heart failure A. Expiratory reserve volume
C. Headaches B. Inspiratory capacity
D. Cor pulmonale C. Inspiratory reserve volume
D. Vital capacity
12. Which of the following is not considered a
COPD related disease? 19. Which of the following matches the
definition: The maximum volume of air that can
A. Bronchiectasis
be exhaled after taking the deepest breath
B. Bronchial asthma possible?
C. Bronchitis
D. Bronchial hypotension A. Expiratory reserve volume
B. Inspiratory capacity
13. Which of the following pulmonary term C. Inspiratory reserve volume
correlates with the definition: bronchospasm of
D. Vital capacity
the bronchial walls?
20. The respiratory center is located in the ____
A. Wheezes and ______.
B. Rhonchi
C. Stridor A. Midbrain and pons
D. Pleural Rub B. Pons and Medulla oblongata
C. Midbrain and Medulla oblongata
14. Which of the following is considered an D. Pons and Hypothalamus
expectorant?
Answers
A. Acetylcysteine
B. Guaifenesin 1. Metabolic alkalosis
C. Theophylline 2. Respiratory alkalosis
D. Epinephrine HCL 3. Metabolic acidosis
4. 0-4 mm induration at 48 hours
15. Which of the following is considered a 5. Squamous cell
bronchodilator? 6. Type II alveolar cell
A. Acetylcysteine 7. Stridor
B. Guaifenesin 8. 35-45 mm Hg
C. Theophylline 9. 22-26 mEq/L
D. Epinephrine HCL 10. Pentamidine
11. Headaches
16. Which of the following is considered a 12. Bronchial hypotension
xanthine? 13. Wheezes
14. Guaifenesin
A. Acetylcysteine
15. Epinephrine HCL
B. Guaifenesin
16. Theophylline
C. Theophylline
17. Acetylcysteine
D. Epinephrine HCL
18. Inspiratory capacity
17. Which of the following is considered a 19. Vital capacity
mucolytic? 20. Pons and Medulla oblongata

A. Acetylcysteine
B. Guaifenesin
URINARY SYSTEM
C. Theophylline
D. Epinephrine HCL 1. Which of the following symptoms do you
expect to see in a patient diagnosed with acute
pyelonephritis?
Reviewer
1. Jaundice and flank pain
2. Costovertebral angle tenderness and chills
3. Burning sensation on urination
4. Polyuria and nocturia
2. You have a patient that might have a urinary
tract infection (UTI). Which statement by the
patient suggests that a UTI is likely?
1. “I pee a lot.”
2. “It burns when I pee.”
3. “I go hours without the urge to pee.”
4. “My pee smells sweet.”
3. Which instructions do you include in the
teaching care plan for a patient
with cystitis receiving phenazopyridine
(Pyridium).
1. If the urine turns orange-red, call the doctor.
2. Take phenazopyridine just before urination to
relieve pain.
3. Once painful urination is relieved, discontinue
prescribed antibiotics.
4. After painful urination is relieved, stop taking
phenazopyridine.
4. Which patient is at greatest risk for
developing a urinary tract infection (UTI)?
1. A 35 y.o. woman with a fractured wrist
2. A 20 y.o. woman with asthma
3. A 50 y.o. postmenopausal woman
4. A 28 y.o. with angina
5. You have a patient that is receiving
peritoneal dialysis. What should you do when
you notice the return fluid is slowly draining?
1. Check for kinks in the outflow tubing.
2. Raise the drainage bag above the level of the
abdomen.
3. Place the patient in a
reverse Trendelenburg position.
4. Ask the patient to cough.
6. What is the appropriate infusion time for
the dialysate in your 38 y.o. patient with
chronic renal failure?
1. 15 minutes
2. 30 minutes
3. 1 hour
4. 2 to 3 hours
7. A 30 y.o. female patient is undergoing
hemodialysis with an internal arteriovenous
fistula in place. What do you do to prevent
complications associated with this device?
1. Insert I.V. lines above the fistula.
2. Avoid taking blood pressures in the arm with
the fistula.
3. Palpate pulses above the fistula.
4. Report a bruit or thrill over the fistula to the
doctor.
8. Your patient becomes restless and tells you
she has a headache and feels nauseous during
hemodialysis. Which complication do you
suspect?
1. Infection
2. Disequilibrium syndrome
3. Air embolus
4. Acute hemolysis
9. Your patient is complaining
of muscle cramps while undergoing
hemodialysis. Which intervention is effective
in relieving muscle cramps?
1. Increase the rate of dialysis
2. Infuse normal saline solution
3. Administer a 5% dextrose solution
4. Encourage active ROM exercises
10. Your patient with chronic renal failure
reports pruritus. Which instruction should you
include in this patient’s teaching plan?
1. Rub the skin vigorously with a towel
2. Take frequent baths
3. Apply alcohol-based emollients to the skin
4. Keep fingernails short and clean
11. Which intervention do you plan to include
with a patient who has renal calculi?
1. Maintain bed rest
2. Increase dietary purines
3. Restrict fluids
4. Strain all urine
12. An 18 y.o. student is admitted with dark
urine, fever, and flank pain and is diagnosed
with acute glomerulonephritis. Which would
most likely be in this student’s health history?
1. Renal calculi
2. Renal trauma
3. Recent sore throat
4. Family history of acute glomerulonephritis
13. Which drug is indicated for pain related to
acute renal calculi?
1. Narcotic analgesics
2. Nonsteroidal anti-inflammatory drugs
(NSAIDS)
Reviewer

3. Muscle relaxants 3. Excretory urography

4. Salicylates 4. Prostate-specific antigen

14. Which of the following causes the majority 21. A 22 y.o. patient with diabetic nephropathy
of UTI’s in hospitalized patients? says, “I have two kidneys and I’m still young. If
I stick to my insulin schedule, I don’t have to
1. Lack of fluid intake worry about kidney damage, right?” Which of
2. Inadequate perineal care the following statements is the best response?
3. Invasive procedures
4. Immunosuppression 1. “You have little to worry about as long as
your kidneys keep making urine.”
15. Clinical manifestations of acute
2. “You should talk to your doctor because
glomerulonephritis include which of the statistics show that you’re being unrealistic.”
following? 3. “You would be correct if your diabetes could
1. Chills and flank pain be managed with insulin.”
2. Oliguria and generalized edema 4. “Even with insulin, kidney damage is still a
3. Hematuria and proteinuria concern.”
4. Dysuria and hypotension 22. A patient diagnosed with sepsis from a UTI
16. You expect a patient in the oliguric phase is being discharged. What do you plan to
of renal failure to have a 24 hour urine output include in her discharge teaching?
less than: 1. Take cool baths
1. 200ml 2. Avoid tampon use
2. 400ml 3. Avoid sexual activity
3. 800ml 4. Drink 8 to 10 eight-oz glasses of water daily
4. 1000ml 23. You’re planning your medication teaching
17. The most common early sign of kidney for your patient with a UTI prescribed
disease is: phenazopyridine (Pyridium). What do you
include?
1. Sodium retention
2. Elevated BUN level 1. “Your urine might turn bright orange.”
3. Development of metabolic acidosis 2. “You need to take this antibiotic for 7 days.”
4. Inability to dilute or concentrate urine 3. “Take this drug between meals and at
bedtime.”
18. A patient is experiencing which type 4. “Don’t take this drug if you’re allergic
of incontinence if she experiences leaking to penicillin.”
urine when she coughs, sneezes, or lifts heavy
objects? 24. Which finding leads you to suspect acute
glomerulonephritis in your 32 y.o. patient?
1. Overflow
2. Reflex 1. Dysuria, frequency, and urgency
3. Stress 2. Back pain, nausea, and vomiting
4. Urge 3. Hypertension, oliguria, and fatigue
4. Fever, chills, and right upper quadrant pain
19. Immediately post-op after a radiating to the back
prostatectomy, which complications requires
priority assessment of your patient? 25. What is the priority nursing diagnosis with
your patient diagnosed with end-stage renal
1. Pneumonia disease?
2. Hemorrhage
3. Urine retention 1. Activity intolerance
4. Deep vein thrombosis 2. Fluid volume excess
3. Knowledge deficit
20. The most indicative test for 4. Pain
prostate cancer is:

1. A thorough digital rectal examination

2. Magnetic resonance imaging (MRI)
Reviewer
26. A patient with ESRD has an arteriovenous
fistula in the left arm for hemodialysis. Which
intervention do you include in his plan of care?
1. Apply pressure to the needle site upon
discontinuing hemodialysis
2. Keep the head of the bed elevated 45
degrees
3. Place the left arm on an arm board for at
least 30 minutes
4. Keep the left arm dry
27. Your 60 y.o. patient with pyelonephritis
and possible septicemia has had five UTIs over
the past two years. She is fatigued from lack of
sleep, has lost weight, and urinates frequently
even in the night. Her labs show: sodium, 154
mEq/L; osmolarity 340 mOsm/L; glucose, 127
mg/dl; and potassium, 3.9 mEq/L. Which
nursing diagnosis is priority?
1. Fluid volume deficit related to osmotic
diuresis induced by hyponatremia
2. Fluid volume deficit related to inability to
conserve water
3. Altered nutrition: Less than body
requirements related to hypermetabolic state
4. Altered nutrition: Less than body
requirements related to catabolic effects of
insulin deficiency
28. Which sign indicated the second phase
of acute renal failure?
1. Daily doubling of urine output (4 to 5 L/day)
2. Urine output less than 400 ml/day
3. Urine output less than 100 ml/day
4. Stabilization of renal function
29. Your patient had surgery to form an
arteriovenous fistula for hemodialysis. Which
information is important for providing care for
the patient?
1. The patient shouldn’t feel pain during
initiation of dialysis
2. The patient feels best immediately after the
dialysis treatment
3. Using a stethoscope for auscultating the
fistula is contraindicated
4. Taking a blood pressure reading on the
affected arm can cause clotting of the fistula
30. A patient with diabetes mellitus and renal
failure begins hemodialysis. Which diet is best
on days between dialysis treatments?
1. Low-protein diet with unlimited amounts of
water
2. Low-protein diet with a prescribed amount of
water
3. No protein in the diet and use of a salt
substitute
4. No restrictions
31. After the first hemodialysis treatment, your
patient develops a headache, hypertension,
restlessness, mental confusion, nausea, and
vomiting. Which condition is indicated?
1. Disequilibrium syndrome
2. Respiratory distress
3. Hypervolemia
4. Peritonitis
32. Which action is most important during
bladder training in a patient with a neurogenic
bladder?
1. Encourage the use of an indwelling urinary
catheter
2. Set up specific times to empty the bladder
3. Encourage Kegel exercises
4. Force fluids
33. A patient with diabetes has had many renal
calculi over the past 20 years and now has
chronic renal failure. Which substance must be
reduced in this patient’s diet?
1. Carbohydrates
2. Fats
3. Protein
4. Vitamin C
34. What is the best way to check for patency
of the arteriovenous fistula for hemodialysis?
1. Pinch the fistula and note the speed of filling
on release
2. Use a needle and syringe to aspirate blood
from the fistula
3. Check for capillary refill of the nail beds on
that extremity
4. Palpate the fistula throughout its length to
assess for a thrill
35. You have a paraplegic patient with renal
calculi. Which factor contributes to the
development of calculi?
1. Increased calcium loss from the bones
2. Decreased kidney function
3. Decreased calcium intake
4. High fluid intake
Reviewer
36. What is the most important nursing
diagnosis for a patient in end-stage renal
disease?
1. Risk for injury
2. Fluid volume excess
3. Altered nutrition: less than body
requirements
4. Activity intolerance
37. Frequent PVCs are noted on the cardiac
monitor of a patient with end-stage renal
disease. The priority intervention is:
1. Call the doctor immediately
2. Give the patient IV lidocaine (Xylocaine)
3. Prepare to defibrillate the patient
4. Check the patient’s latest potassium level
38. A patient who received a kidney transplant
returns for a follow-up visit to the outpatient
clinic and reports a lump in her breast.
Transplant recipients are:
1. At increased risk for cancer due to
immunosuppression caused
by cyclosporine (Neoral)
2. Consumed with fear after the life-threatening
experience of having a transplant
3. At increased risk for tumors because of the
kidney transplant
4. At decreased risk for cancer, so the lump is
most likely benign
39. You’re developing a care plan with the
nursing diagnosis risk for infection for your
patient that received a kidney transplant. A
goal for this patient is to:
1. Remain afebrile and have negative cultures
2. Resume normal fluid intake within 2 to 3 days
3. Resume the patient’s normal job within 2 to 3
weeks
4. Try to discontinue cyclosporine (Neoral) as
quickly as possible
40. You suspect kidney transplant rejection
when the patient shows which symptoms?
1. Pain in the incision, general malaise,
and hypotension
2. Pain in the incision, general malaise,
and depression
3. Fever, weight gain, and diminished urine
output
4. Diminished urine output and hypotension
41. Your patient returns from the operating
room after abdominal aortic aneurysm repair.
Which symptom is a sign of acute renal failure?
1. Anuria
2. Diarrhea
3. Oliguria
4. Vomiting
42. Which cause of hypertension is the most
common in acute renal failure?
1. Pulmonary edema
2. Hypervolemia
3. Hypovolemia
4. Anemia
43. A patient returns from surgery with an
indwelling urinary catheter in place and empty.
Six hours later, the volume is 120ml. The
drainage system has no obstructions. Which
intervention has priority?
1. Give a 500 ml bolus of isotonic saline
2. Evaluate the patient’s circulation and vital
signs
3. Flush the urinary catheter with sterile water
or saline
4. Place the patient in the shock position, and
notify the surgeon
44. You’re preparing for
urinary catheterization of a trauma patient and
you observe bleeding at the urethral meatus.
Which action has priority?
1. Irrigate and clean the meatus before
catheterization
2. Check the discharge for occult blood before
catheterization
3. Heavily lubricate the catheter
before insertion
4. Delay catheterization and notify the doctor
45. What change indicates recovery in a
patient with nephritic syndrome?
1. Disappearance of protein from the urine
2. Decrease in blood pressure to normal
3. Increase in serum lipid levels
4. Gain in body weight
46. Which statement correctly distinguishes
renal failure from prerenal failure?
1. With prerenal failure, vasoactive substances
such as dopamine (Intropin) increase blood
pressure
2. With prerenal failure, there is less response
Reviewer
to such diuretics as furosemide (Lasix)
3. With prerenal failure, an IV isotonic saline
infusion increases urine output
4. With prerenal failure, hemodialysis reduces
the BUN level
47. Which criterion is required before a patient
can be considered for continuous peritoneal
dialysis?
1. The patient must be hemodynamically stable
2. The vascular access must have healed
3. The patient must be in a home setting
4. Hemodialysis must have failed
48. Polystyrene sulfonate (Kayexalate) is used
in renal failure to:
1. Correct acidosis
2. Reduce serum phosphate levels
3. Exchange potassium for sodium
4. Prevent constipation from sorbitol use
49. Your patient has complaints of severe
right-sided flank pain, nausea, vomiting and
restlessness. He appears slightly pale and is
diaphoretic. Vital signs are BP 140/90 mmHg,
Pulse 118 beats/min., respirations 33
breaths/minute, and temperature, 98.0F.
Which subjective data supports a diagnosis of
renal calculi?
1. Pain radiating to the right upper quadrant
2. History of mild flu symptoms last week
3. Dark-colored coffee-ground emesis
4. Dark, scanty urine output
50. Immunosuppression following Kidney
transplantation is continued:
1. For life
2. 24 hours after transplantation
3. A week after transplantation
4. Until the kidney is not anymore rejected
Answers and Rationale
1. Answer: 2. Costovertebral angle tenderness
and chills
Costovertebral angle tenderness, flank pain,
and chills are symptoms of acute pyelonephritis.
Option A: Jaundice
indicates gallbladder or liver obstruction.
Option C: A burning sensation on urination is a
sign of lower urinary tract infection.
2. Answer: 2. “It burns when I pee.”
A common symptom of a UTI is dysuria. A
patient with a UTI often reports frequent
voiding of small amounts and the urgency to
void.
Option D: Urine that smells sweet is often
associated with diabetic ketoacidosis.
3. Answer: 4. After painful urination is
relieved, stop taking phenazopyridine.
Pyridium is taken to relieve dysuria because is
provides an analgesic and anesthetic effect on
the urinary tract mucosa. The patient can stop
taking it after the dysuria is relieved.
Option A: The urine may temporarily turn red or
orange due to the dye in the drug.
Option B: The drug isn’t taken before voiding,
and is usually taken 3 times a day for 2 days.
4. Answer: 3. A 50 y.o. postmenopausal
woman
Women are more prone to UTI’s
after menopause due to
reduced estrogen levels. Reduced estrogen
levels lead to reduced levels of
vaginal Lactobacilli bacteria, which protect
against infection.
Options B, C, and D: Angina, asthma and
fractures don’t increase the risk of UTI.
5. Answer: 1. Check for kinks in the outflow
tubing.
Tubing problems are a common cause of
outflow difficulties, check the tubing for kinks
and ensure that all clamps are open. Other
measures include having the patient change
positions (moving side to side or sitting up),
applying gentle pressure over the abdomen, or
having a bowel movement.
6. Answer: 1. 15 minutes
Dialysate should be infused quickly. The
dialysate should be infused over 15 minutes or
less when performing peritoneal dialysis. The
fluid exchange takes place over a period ranging
from 30 minutes to several hours.
7. Answer: 2. Avoid taking blood pressures in
the arm with the fistula.
Reviewer
Don’t take blood pressure readings in the arm
with the fistula because the compression could
damage the fistula.
Option A: IV lines shouldn’t be inserted in the
arm used for hemodialysis.
Option C: Palpate pulses below the fistula.
Option D: Lack of bruit or thrill should be
reported to the doctor.
8. Answer: 2. Disequilibrium syndrome
Disequilibrium syndrome is caused by a rapid
reduction in urea, sodium, and other solutes
from the blood. This can lead to cerebral edema
and increased intracranial pressure (ICP). Signs
and symptoms include headache, nausea,
restlessness, vomiting, confusion, twitching, and
seizures.
9. Answer: 2. Infuse normal saline solution
Treatment includes administering normal saline
or hypertonic normal saline solution because
muscle cramps can occur when the sodium and
water are removed to quickly during dialysis.
Reducing the rate of dialysis, not increasing it,
may alleviate muscle cramps.
10. Answer: 4. Keep fingernails short and clean
Calcium-phosphate deposits in the skin may
cause pruritus. Scratching leads to excoriation
and breaks in the skin that increase the
patient’s risk of infection. Keeping fingernails
short and clean helps reduce the risk of
infection.
11. Answer: 4. Strain all urine
All urine should be strained through gauze or a
urine strainer to catch stones that are passed.
The stones are then analyzed for composition.
Option A: Ambulation may help the movement
of the stone down the urinary tract.
Option C: Encourage fluid to help flush the
stones out.
12. Answer: 3. Recent sore throat
The most common form of acute
glomerulonephritis is caused by group A beta-
hemolytic streptococcal infection elsewhere in
the body.
13. Answer: 1. Narcotic analgesics
Narcotic analgesics are usually needed to
relieve the severe pain of renal calculi.
Options B and D: NSAIDS and salicylates are
used for their anti-inflammatory and antipyretic
properties and to treat less severe pain.
Option C: Muscle relaxants are typically used to
treat skeletal muscle spasms.
14. Answer: 3. Invasive procedures
Invasive procedures such as catheterization can
introduce bacteria into the urinary tract. A lack
of fluid intake could cause concentration of
urine, but wouldn’t necessarily cause infection.
15. Answer: 3. Hematuria and proteinuria
Hematuria and proteinuria indicate acute
glomerulonephritis. These finding result from
increased permeability of the glomerular
membrane due to the antigen-antibody
reaction. Generalized edema is seen most often
in nephrosis.
16. Answer: 2. 400ml
Oliguria is defined as urine output of less than
400ml/24hours.
17. Answer: 2. Elevated BUN level
Increased BUN is usually an early indicator of
decreased renal function.
18. Answer: 3. Stress
Stress incontinence is an involuntary loss of a
small amount of urine due to sudden increased
intra-abdominal pressure, such as with
coughing or sneezing.
19. Answer: 2. Hemorrhage
Hemorrhage is a potential complication.
Option A: Pneumonia may occur if the patient
doesn’t cough and deep breathe.
Option C: Urine retention isn’t a problem soon
after surgery because a catheter is in place.
Option D: Thrombosis may occur later if the
patient doesn’t ambulate.
20. Answer: 4. Prostate-specific antigen
An elevated prostate-specific antigen level
indicates prostate cancer, but it can be falsely
elevated if done after the prostate gland is
manipulated.
Reviewer
Option A: A digital rectal examination should be
done as part of the yearly screening, and then
the antigen test is done if the digital exam
suggests cancer.
Option B: MRI is used in staging the cancer.
21. Answer: 4. “Even with insulin, kidney
damage is still a concern.”
Kidney damage is still a concern. Microvascular
changes occur in both of the patient’s kidneys
as a complication of the diabetes. Diabetic
nephropathy is the leading cause of end-stage
renal disease. The kidneys continue to produce
urine until the end stage. Nephropathy occurs
even with insulin management.
22. Answer: 4. Drink 8 to 10 eight-oz glasses of
water daily
Drinking 2-3L of water daily inhibits bacterial
growth in the bladder and helps flush the
bacteria from the bladder. The patient should
be instructed to void after sexual activity.
23. Answer: 1. “Your urine might turn bright
orange.”
The drug turns the urine orange. It may be
prescribed for longer than 7 days and is usually
ordered three times a day after meals.
Phenazopyridine is an azo (nitrogenous)
analgesic; not an antibiotic.
24. Answer: 3. Hypertension, oliguria, and
fatigue
Mild to moderate HTN may result from sodium
or water retention and inappropriate renin
release from the kidneys. Oliguria and fatigue
also may be seen. Other signs are proteinuria
and azotemia.
25. Answer: 2. Fluid volume excess
Fluid volume excess because the kidneys aren’t
removing fluid and wastes. The other diagnoses
may apply, but they don’t take priority.
26. Answer: 1. Apply pressure to the needle
site upon discontinuing hemodialysis
Apply pressure when discontinuing
hemodialysis and after removing the
venipuncture needle until all the bleeding has
stopped. Bleeding may continue for 10 minutes
in some patients.
27. Answer: 2. Fluid volume deficit related to
inability to conserve water
28. Answer: 1. Daily doubling of urine output
(4 to 5 L/day)
Daily doubling of the urine output indicates that
the nephrons are healing. This means the
patient is passing into the second phase
(dieresis) of acute renal failure.
29. Answer: 4. Taking a blood pressure reading
on the affected arm can cause clotting of the
fistula Pressure on the fistula or the extremity
can decrease blood flow and precipitate
clotting, so avoid taking blood pressure on the
affected arm.
30. Answer: 2. Low-protein diet with a
prescribed amount of water
The patient should follow a low-protein diet
with a prescribed amount of water. The patient
requires some protein to meet metabolic needs.
Option C: Salt substitutes shouldn’t be used
without a doctor’s order because it may contain
potassium, which could make the patient
hyperkalemic. Option D: Fluid and
protein restrictions are needed.
31. Answer: 1. Disequilibrium syndrome
Disequilibrium occurs when excess solutes are
cleared from the blood more rapidly than they
can diffuse from the body’s cells into the
vascular system.
32. Answer: 2. Set up specific times to empty
the bladder
Instruct the patient with neurogenic bladder to
write down his voiding pattern and empty the
bladder at the same times each day.
33. Answer: 3. Protein
Because of damage to the nephrons, the kidney
can’t excrete all the metabolic wastes of
protein, so this patient’s protein intake must be
restricted.
Options A, B, and D: A higher intake of carbs,
fats, and vitamin supplements is needed to
ensure the growth and maintenance of the
patient’s tissues.
34. Answer: 4. Palpate the fistula throughout
its length to assess for a thrill
The vibration or thrill felt during palpation
ensures that the fistula has the desired
turbulent blood flow. Pinching the fistula could
cause damage. Aspirating blood is a needless
invasive procedure.
Reviewer
35. Answer: 1. Increased calcium loss from the
bones
Bones lose calcium when a patient can no
longer bear weight. The calcium lost from bones
form calculi, a concentration of mineral salts
also known as a stone, in the renal system.
36. Answer: 2. Fluid volume excess
Kidneys are unable to rid the body of excess
fluids which results in fluid volume excess
during ESRD.
37. Answer: 4. Check the patient’s latest
potassium level
The patient with ESRD may develop arrhythmias
caused by hypokalemia.
Option A: Call the doctor after checking the
patient’s potassium values.
Option B: Lidocaine may be ordered if the PVCs
are frequent and the patient is symptomatic.
38. Answer: 1. At increased risk for cancer due
to immunosuppression caused by cyclosporine
(Neoral)
Cyclosporine suppresses the immune response
to prevent rejection of the transplanted kidney.
The use of cyclosporine places the patient at
risk for tumors.
39. Answer: 1. Remain afebrile and have
negative cultures
The immunosuppressive activity of cyclosporine
places the patient at risk for infection, and
steroids can mask the signs of infection. The
patient may not be able to resume normal fluid
intake or return to work for an extended period
of time and the patient may need cyclosporine
therapy for life.
40. Answer: 3. Fever, weight gain, and
diminished urine output
Symptoms of rejection include fever, rapid
weight gain, hypertension, pain over the graft
site, peripheral edema, and diminished urine
output.
41. Answer: 3. Oliguria
Urine output less than 50ml in 24 hours signifies
oliguria, an early sign of renal failure. Anuria is
uncommon except in obstructive renal
disorders.
42. Answer: 2. Hypervolemia
Acute renal failure causes hypervolemia as a
result of overexpansion of extracellular
fluid and plasma volume with the
hypersecretion of renin. Therefore,
hypervolemia causes hypertension.
43. Answer: 2. Evaluate the patient’s
circulation and vital signs
A total UO of 120ml is too low. Assess the
patient’s circulation and hemodynamic stability
for signs of hypovolemia. A fluid bolus may be
required, but only after further nursing
assessment and a doctor’s order.
44. Answer: 4. Delay catheterization and notify
the doctor
Bleeding at the urethral meatus is evidence that
the urethra is injured. Because catheterization
can cause further harm, consult with the
doctor.
45. Answer: 1. Disappearance of protein from
the urine
With nephrotic syndrome, the glomerular
basement membrane of the kidney becomes
more porous, leading to loss of protein in the
urine. As the patient recovers, less protein is
found in the urine.
46. Answer: 3. With prerenal failure, an IV
isotonic saline infusion increases urine output
Prerenal failure is caused by such conditions as
hypovolemia that impairs kidney perfusion;
giving isotonic fluids improves urine output.
Vasoactive substances can increase blood
pressure in both conditions.
47. Answer: 1. The patient must be
hemodynamically stable
Hemodynamic stability must be established
before continuous peritoneal dialysis can be
started.
48. Answer: 3. Exchange potassium for sodium
In renal failure, patients become hyperkalemic
because they can’t excrete potassium in the
urine. Polystyrene sulfonate acts to excrete
potassium by pulling potassium into the bowels
and exchanging it for sodium.
49. Answer: 4. Dark, scanty urine output
Reviewer
Patients with renal calculi commonly have blood
in the urine caused by the stone’s passage
through the urinary tract. The urine appears
dark, tests positive for blood, and is typically
scant.
50. Answer: 1. For life.
1. A client is complaining of severe flank and
abdominal pain. A flat plate of the abdomen
shows urolithiasis. Which of the following
interventions is important?
1. Strain all urine
2. Limit fluid intake
3. Enforce strict bed rest
4. Encourage a high calcium diet
2. A client is receiving a radiation implant for
the treatment of bladder cancer. Which of the
following interventions is appropriate?
1. Flush all urine down the toilet
2. Restrict the client’s fluid intake
3. Place the client in a semi-private room
4. Monitor the client for signs and symptoms
of cystitis
3. A client has just received a renal transplant
and has started cyclosporine therapy to
prevent graft rejection. Which of the following
conditions is a major complication of this drug
therapy?
1. Depression
2. Hemorrhage
3. Infection
4. Peptic ulcer disease
4. A client received a kidney transplant 2
months ago. He’s admitted to the hospital with
the diagnosis of acute rejection. Which of the
following assessment findings would be
expected?
1. Hypotension
2. Normal body temperature
3. Decreased WBC count
4. Elevated BUN and creatinine levels
5. The client is to undergo kidney
transplantation with a living donor. Which of
the following preoperative assessments is
important?
1. Urine output
2. Signs of graft rejection
3. Signs and symptoms of rejection
4. Client’s support system and understanding of
lifestyle changes.
6. A client had a transurethral prostatectomy
for benign prostatic hypertrophy. He’s
currently being treated with a continuous
bladder irrigation and is complaining of an
increase in severity of bladder spasms. Which
of the interventions should be done first?
1. Administer an oral analgesic
2. Stop the irrigation and call the physician
3. Administer a belladonna
and opium suppository as ordered by the
physician.
4. Check for the presence of clots, and make
sure the catheter is draining properly.
7. A client is admitted with a diagnosis of
hydronephrosis secondary to calculi. The
calculi have been removed and post
obstructive diuresis is occurring. Which of the
following interventions should be done?
1. Take vital signs every 8 hours
2. Weigh the client every other day
3. Assess for urine output every shift
4. Monitor the client’s electrolyte levels.
8. A client has passed a renal calculus. The
nurse sends the specimen to the laboratory so
it can be analyzed for which of the following
factors?
1. Antibodies
2. Type of infection
3. Composition of calculus
4. Size and number of calculi
9. Which of the following symptoms indicate
acute rejection of a transplanted kidney?
1. Edema, Nausea
2. Fever, Anorexia
3. Weight gain, pain at graft site
4. Increased WBC count, pain with voiding
10. Adverse reactions of prednisone therapy
include which of the following conditions?
1. Acne and bleeding gums
2. Sodium retention and constipation
3. Mood swings and increased temperature
4. Increased blood glucose levels and decreased
wound healing.
11. The nurse suspects that a client with
polyuria is experiencing water diuresis. Which
laboratory value suggests water diuresis?
Reviewer
1. High urine specific gravity
2. High urine osmolarity
3. Normal to low urine specific gravity
4. Elevated urine pH
12. A client is diagnosed with prostate cancer.
Which test is used to monitor progression of
this disease?
1. Serum creatinine
2. Complete blood cell count (CBC)
3. Prostate-specific antigen (PSA)
4. Serum potassium
13. A 27-year old client, who became
paraplegic after a swimming accident, is
experiencing autonomic dysreflexia. Which
condition is the most common cause of
autonomic dysreflexia?
1. Upper respiratory infection
2. Incontinence
3. Bladder distention
4. Diarrhea
14. When providing discharge teaching for a
client with uric acid calculi, the nurse should an
instruction to avoid which type of diet?
1. Low-calcium
2. Low-oxalate
3. High-oxalate
4. High-purine
15. The client with urolithiasis has a history of
chronic urinary tract infections. The nurse
concludes that this client most likely has which
of the following types of urinary stones?
1. Calcium oxalate
2. Uric acid
3. Struvite
4. Cystine
16. The nurse is receiving in transfer from the
postanesthesia care unit a client who has had a
percutaneous ultrasonic lithotripsy for
calculuses in the renal pelvis. The nurse
anticipates that the client’s care will
involve monitoring which of the following?
1. Suprapubic tube
2. Urethral stent
3. Nephrostomy tube
4. Jackson-Pratt drain
17. The client is admitted to the ER following a
MVA. The client was wearing a lap seat belt
when the accident occurred. The client
has hematuria and lower abdominal pain. To
determine further whether the pain is due to
bladder trauma, the nurse asks the client if the
pain is referred to which of the following
areas?
1. Shoulder
2. Umbilicus
3. Costovertebral angle
4. Hip
18. The client complains of fever, perineal
pain, and urinary urgency, frequency,
and dysuria. To assess whether the client’s
problem is related to bacterial prostatitis, the
nurse would look at the results of the prostate
examination, which should reveal that the
prostate gland is:
1. Tender, indurated, and warm to the touch
2. Soft and swollen
3. Tender and edematous with ecchymosis
4. Reddened, swollen, and boggy.
19. The nurse is taking the history of a client
who has had benign prostatic hyperplasia in
the past. To determine whether the client
currently is experiencing difficulty, the nurse
asks the client about the presence of which of
the following early symptoms?
1. Urge incontinence
2. Nocturia
3. Decreased force in the stream of urine
4. Urinary retention
20. The client who has a cold is seen in the
emergency room with inability to void.
Because the client has a history of BPH, the
nurse determines that the client should be
questioned about the use of which of the
following medications?
1. Diuretics
2. Antibiotics
3. Antitussives
4. Decongestants
21. The nurse is preparing to care for the client
following a renal scan. Which of the following
would the nurse include in the plan of care?
1. Place the client on radiation precautions for
18 hours
2. Save all urine in a radiation safe container for
18 hours
3. Limit contact with the client to 20 minutes
per hour.
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4. No special precautions except to wear gloves
if in contact with the client’s urine.
22. The client passes a urinary stone, and lab
analysis of the stone indicates that it is
composed of calcium oxalate. Based on this
analysis, which of the following would the
nurse specifically include in the dietary
instructions?
1. Increase intake of meat, fish, plums, and
cranberries
2. Avoid citrus fruits and citrus juices
3. Avoid green, leafy vegetables such as
spinach.
4. Increase intake of dairy products.
23. The client returns to the nursing unit
following a pyelolithotomy for removal of a
kidney stone. A Penrose drain is in place.
Which of the following would the nurse
include in the client’s postoperative care?
1. Sterile irrigation of the Penrose drain
2. Frequent dressing changes around the
Penrose drain
3. Weighing the dressings
4. Maintaining the client’s position on the
affected side
24. The nurse is caring for a client following a
kidney transplant. The client develops oliguria.
Which of the following would the nurse
anticipate to be prescribed as the treatment of
oliguria?
1. Encourage fluid intake
2. Administration of diuretics
3. Irrigation of Foley catheter
4. Restricting fluids
25. A week after kidney transplantation the
client develops a temperature of 101,
the blood pressure is elevated, and the kidney
is tender. The X-ray results the transplanted
kidney is enlarged. Based on these assessment
findings, the nurse would suspect which of the
following?
1. Acute rejection
2. Chronic rejection
3. Kidney infection
4. Kidney obstruction
26. The client with BPH undergoes a
transurethral resection of the prostate.
Postoperatively, the client is receiving
continuous bladder irrigations. The nurse
assesses the client for signs of transurethral
resection syndrome. Which of the following
assessment data would indicate the onset of
this syndrome?
1. Bradycardia and confusion
2. Tachycardia and diarrhea
3. Decreased urinary output and bladder
spasms
4. Increased urinary output and anemia
27. The client is admitted to the hospital with
BPH, and a transurethral resection of the
prostate is performed. Four hours
after surgery the nurse takes the client’s VS
and empties the urinary drainage bag. Which
of the following assessment findings would
indicate the need to notify the physician?
1. Red bloody urine
2. Urinary output of 200 ml greater than intake
3. Blood pressure of 100/50 and pulse 130.
4. Pain related to bladder spasms.
28. Which of the following symptoms is the
most common clinical finding associated with
bladder cancer?
1. Suprapubic pain
2. Dysuria
3. Painless hematuria
4. Urinary retention
29. A client who has been diagnosed with
bladder cancer is scheduled for an ileal
conduit. Preoperatively, the nurse reinforces
the client’s understanding of the surgical
procedure by explaining that an ileal conduit:
1. Is a temporary procedure that can be
reversed later.
2. Diverts urine into the sigmoid colon, where it
is expelled through the rectum.
3. Conveys urine from the ureters to a stoma
opening in the abdomen.
4. Creates an opening in the bladder that allows
urine to drain into an external pouch.
30. After surgery for an ileal conduit, the nurse
should closely evaluate the client for the
occurrence of which of the following
complications related to pelvic surgery?
1. Peritonitis
2. Thrombophlebitis
3. Ascites
4. Inguinal hernia
31. The nurse is assessing the urine of a client
who has had an ileal conduit and notes that
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the urine is yellow with a moderate amount of
mucus. Based on the assessment data, which
of the following nursing interventions would
be most appropriate at this time?
1. Change the appliance bag
2. Notify the physician
3. Obtain a urine specimen for culture
4. Encourage a high fluid intake
32. When teaching the client to care for an
ileal conduit, the nurse instructs the client to
empty the appliance frequently, primarily to
prevent which of the following problems?
1. Rupture of the ileal conduit
2. Interruption of urine production
3. Development of odor
4. Separation of the appliance from the skin
33. The client with an ileal conduit will be using
a reusable appliance at home. The nurse
should teach the client to clean the appliance
routinely with what product?
1. Baking soda
2. Soap
3. Hydrogen peroxide
4. Alcohol
34. The nurse is evaluating the discharge
teaching for a client who has an ileal conduit.
Which of the following statements indicates
that the client has correctly understood the
teaching? Select all that apply.
1. “If I limit my fluid intake I will not have to
empty my ostomy pouch as often.”
2. “I can place an aspirin tablet in my pouch to
decrease odor.”
3. “I can usually keep my ostomy pouch on for 3
to 7 days before changing it.”
4. “I must use a skin barrier to protect my skin
from urine.”
5. “I should empty my ostomy pouch of urine
when it is full.”
35. A female client with a urinary diversion
tells the nurse, “This urinary pouch is
embarrassing. Everyone will know that I’m not
normal. I don’t see how I can go out in public
anymore.” The most appropriate nursing
diagnosis for this patient is:
1. Anxiety related to the presence of urinary
diversion.
2. Deficient Knowledge about how to care for
the urinary diversion.
3. Low Self-Esteem related to feelings of
worthlessness
4. Disturbed Body Image related to creation of a
urinary diversion.
36. The nurse teaches the client with a urinary
diversion to attach the appliance to a standard
urine collection bag at night. The most
important reason for doing this is to prevent:
1. Urine reflux into the stoma
2. Appliance separation
3. Urine leakage
4. The need to restrict fluids
37. The nurse teaches the client with an ileal
conduit measures to prevent a UTI. Which of
the following measures would be most
effective?
1. Avoid people with respiratory tract infections
2. Maintain a daily fluid intake of 2,000 to 3,000
ml
3. Use sterile technique to change the appliance
4. Irrigate the stoma daily.
38. A client who has been diagnosed with
calculi reports that the pain is intermittent and
less colicky. Which of the following nursing
actions is most important at this time?
1. Report hematuria to the physician
2. Strain the urine carefully
3. Administer meperidine (Demerol) every 3
hours
4. Apply warm compresses to the flank area
39. A client has a ureteral catheter in place
after renal surgery. A priority nursing action
for care of the ureteral catheter would be to:
1. Irrigate the catheter with 30 ml of normal
saline every 8 hours
2. Ensure that the catheter is draining freely
3. Clamp the catheter every 2 hours for 30
minutes.
4. Ensure that the catheter drains at least 30 ml
an hour
40. Which of the following interventions would
be most appropriate for preventing the
development of a paralytic ileus in a client who
has undergone renal surgery?
1. Encourage the client to ambulate every 2 to 4
hours
2. Offer 3 to 4 ounces of a carbonated beverage
periodically.
3. Encourage use of a stool softener
4. Continue intravenous fluid therapy
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41. The nurse is conducting a postoperative
assessment of a client on the first day after
renal surgery. Which of the following findings
would be most important for the nurse to
report to the physician?
1. Temperature, 99.8
2. Urine output, 20 ml/hour
3. Absence of bowel sounds
4. A 2×2 inch area of serous sanguineous
drainage on the flank dressing.
42. Because a client’s renal stone was found to
be composed to uric acid, a low-purine,
alkaline ash diet was ordered. Incorporation of
which of the following food items into the
home diet would indicate that the client
understands the necessary diet modifications?
1. Milk, apples, tomatoes, and corn
2. Eggs, spinach, dried peas, and gravy.
3. Salmon, chicken, caviar, and asparagus
4. Grapes, corn, cereals, and liver.
43. Allopurinol (Zyloprim), 200 mg/day, is
prescribed for the client with renal calculi to
take home. The nurse should teach the client
about which of the following side effects of
this medication?
1. Retinopathy
2. Maculopapular rash
3. Nasal congestion
4. Dizziness
44. The client has a clinic appointment
scheduled 10 days after discharge. Which
laboratory finding at that time would indicate
that allopurinol (Zyloprim) has had a
therapeutic effect?
1. Decreased urinary alkaline phosphatase level
2. Increased urinary calcium excretion
3. Increased serum calcium level
4. Decreased serum uric acid level
45. When developing a plan of care for the
client with stress incontinence, the nurse
should take into consideration that stress
incontinence is best defined as the involuntary
loss of urine associated with:
1. A strong urge to urinate
2. Overdistention of the bladder
3. Activities that increase abdominal pressure
4. Obstruction of the urethra
46. Which of the following assessment data
would most likely be related to a client’s
current complaint of stress incontinence?
1. The client’s intake of 2 to 3 L of fluid per day.
2. The client’s history of three full-term
pregnancies
3. The client’s age of 45 years
4. The client’s history of competitive swimming
47. The nurse is developing a teaching plan for
a client with stress incontinence. Which of the
following instructions should be included?
1. Avoid activities that are stressful and
upsetting
2. Avoid caffeine and alcohol
3. Do not wear a girdle
4. Limit physical exertion
48. A client has urge incontinence. Which of
the following signs and symptoms would the
nurse expect to find in this client?
1. Inability to empty the bladder
2. Loss of urine when coughing
3. Involuntary urination with minimal warning
4. Frequent dribbling of urine
49. A 72-year old male client is brought to the
emergency room by his son. The client is
extremely uncomfortable and has been unable
to void for the past 12 hours. He has known for
some time that he has an enlarged prostate
but has wanted to avoid surgery. The best
method for the nurse to use when assessing
for bladder distention in a male client is to
check for:
1. A rounded swelling above the pubis.
2. Dullness in the lower left quadrant
3. Rebound tenderness below the symphysis
4. Urine discharge from the urethral meatus
50. During a client’s urinary
bladder catheterization, the bladder is emptied
gradually. The best rationale for the
nurse’s action is that completely emptying an
overdistended bladder at one time tends to
cause:
1. Renal failure
2. Abdominal cramping
3. Possible shock
4. Atrophy of bladder musculature
51. The primary reason for taping an
indwelling catheter laterally to the thigh of a
male client is to:
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1. Eliminate pressure at the penoscrotal angle
2. Prevent the catheter from kinking in the
urethra
3. Prevent accidental catheter removal
4. Allow the client to turn without kinking the
catheter
52. The primary function of the prostate gland
is:
1. To store underdeveloped sperm before
ejaculation
2. To regulate the acidity and alkalinity of the
environment for proper sperm development.
3. To produce a secretion that aids in the
nourishment and passage of sperm
4. To secrete a hormone that stimulates the
production and maturation of sperm
53. The nurse is reviewing a medication history
of a client with BPH. Which medication should
be recognized as likely to aggravate BPH?
1. Metformin (Glucophage)
2. Buspirone (BuSpar)
3. Inhaled ipratropium (Atrovent)
4. Ophthalmic timolol (Timoptic)
54. A client is scheduled to undergo a
transurethral resection of the prostate gland
(TURP). The procedure is to be done under
spinal anesthesia. Postoperatively, the nurse
should be particularly alert for early signs of:
1. Convulsions
2. Cardiac arrest
3. Renal shutdown
4. Respiratory paralysis
55. A client with BPH is being treated
with terazosin (Hytrin) 2 mg at bedtime. The
nurse should monitor the client’s:
1. Urinary nitrites
2. White blood cell count
3. Blood pressure
4. Pulse
56. A client underwent a TURP, and a large
three-way catheter was inserted into the
bladder with continuous bladder irrigation. In
which of the following circumstances would
the nurse increase the flow rate of the
continuous bladder irrigation?
1. When the drainage is continuous but slow
2. When the drainage appears cloudy and dark
yellow
3. When the drainage becomes bright red
4. When there is no drainage of urine and
irrigating solution
57. A priority nursing diagnosis for the client
who is being discharged t home 3 days after a
TURP would be:
1. Deficient fluid volume
2. Imbalanced Nutrition: Less than Body
Requirements
3. Impaired Tissue Integrity
4. Ineffective Airway Clearance
58. If a client’s prostate enlargement is caused
by a malignancy, which of the following blood
examinations should the nurse anticipate to
assess whether metastasis has occurred?
1. Serum creatinine level
2. Serum acid phosphatase level
3. Total nonprotein nitrogen level
4. Endogenous creatinine clearance time
59. Steroids, if used following kidney
transplantation would cause which of the
following side effects?
1. Alopecia
2. Increase Cholesterol Level
3. Orthostatic Hypotension
4. Increase Blood Glucose Level
60. Mr. Roberto was readmitted to the
hospital with acute graft rejection. Which of
the following assessment finding would be
expected?
1. Hypotension
2. Normal Body Temperature
3. Decreased WBC
4. Elevated BUN and Creatinine
Answers and Rationale
1. Answer: 1. Strain all urine
Urine should be strained for calculi and sent to
the lab for analysis.
Option B: Fluid intake of three (3) to four (4) L is
encouraged to flush the urinary tract and
prevent further calculi formation.
Option C: Ambulation is encouraged to help
pass the calculi through gravity.
Option D: A low-calcium diet is recommended
to help prevent the formation of calcium calculi.
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2. Answer: 4. Monitor the client for signs and
symptoms of cystitis
Cystitis is the most common adverse reaction of
clients undergoing radiation therapy; symptoms
include dysuria, frequency, urgency, and
nocturia. Clients with radiation implants require
a private room. Urine of clients with radiation
implants for bladder cancer should be sent to
the radioisotopes lab for monitoring. It is
recommended that fluid intake be increased.
3. Answer: 3. Infection
Infection is the major complication to watch for
in clients on cyclosporine therapy because it’s
an immunosuppressive drug.
Option A: Depression may occur
posttransplantation but not because of
cyclosporine.
Option B: Hemorrhage is a complication
associated with anticoagulant therapy.
Option D: Peptic ulcer disease is a complication
of steroid therapy.
4. Answer: 4. Elevated BUN and creatinine
levels
In a client with acute renal graft rejection,
evidence of deteriorating renal function is
expected.
Option A: The client would most likely have
acute hypertension.
Options B and C: The nurse would see elevated
WBC counts and fever because the body is
recognizing the graft as foreign and is
attempting to fight it.
5. Answer: 4. Client’s support system and
understanding of lifestyle changes.
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, it’s 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, it’s most important
postoperatively due to the immunosuppressant
therapy. Rejection can occur postoperatively.
6. Answer: 4. Check for the presence of clots,
and make sure the catheter is draining
properly.
Blood clots and blocked outflow if the urine can
increase spasms.
Option A: Oral analgesics should be given if the
spasms are unrelieved by the belladonna and
opium suppository.
Option B: The irrigation shouldn’t be stopped as
long as the catheter is draining because clots
will form.
Option C: A belladonna and opium suppository
should be given to relieve spasms but only after
assessment of the drainage.
7. Answer: 4. Monitor the client’s electrolyte
levels.
Postobstructive diuresis seen in hydronephrosis
can cause electrolyte imbalances; lab values
must be checked so electrolytes can be replaced
as needed.
Option A: VS should initially be taken every 30
minutes for the first 4 hours and then every 2
hours.
Option B: The client’s weight should be taken
daily to assess fluid status more closely.
Option C: Urine output needs to be assessed
hourly.
8. Answer: 3. Composition of calculus
The calculus should be analyzed for the
composition to determine appropriate
interventions such as dietary restrictions.
Options A and D: The size and number of calculi
aren’t relevant, and they don’t contain
antibodies.
Option B: Calculi don’t result in infections.
9. Answer: 3. Weight gain, pain at graft site
Pain at the graft site and weight gain indicates
the transplanted kidney isn’t functioning and
possibly is being rejected. Transplant clients
usually have edema, anorexia, fever, and
nausea before transplantation, so those
symptoms may not indicate rejection.
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10. Answer: 4. Increased blood glucose levels
and decreased wound healing.
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 don’t affect
thermoregulation, bleeding tendencies, or
constipation.
Options A, B, and C: Steroids don’t affect
thermoregulation, bleeding tendencies, or
constipation.
11. Answer: 3. Normal to low urine specific
gravity
Water diuresis causes low urine specific gravity,
low urine osmolarity, and a normal to elevated
serum sodium level.
Option A: High specific gravity
indicates dehydration. Hypernatremia signals
acidosis and shock.
Option D: Elevated urine pH can result
from potassium deficiency, a high-protein diet,
or uncontrolled diabetes.
12. Answer: 3. Prostate-specific antigen (PSA)
The PSA test is used to monitor prostate cancer
progression; higher PSA levels indicate a
greater tumor burden.
Option A: Serum creatinine levels may suggest
blockage from an enlarged prostate.
Option B: CBC is used to diagnose anemia and
polycythemia.
Option D: Serum potassium levels
identify hypokalemia and hyperkalemia.
13. Answer: 3. Bladder distention
Autonomic dysreflexia is a potentially life-
threatening complication of spinal cord injury,
occurring from obstruction of the urinary
system or bowel.
Option A: An URI could obstruct the respiratory
system, but not the urinary or bowel system.
Options B and D: Incontinence and diarrhea
don’t result in obstruction of the urinary system
or bowel, respectively.
14. Answer: 4. High-purine
To control uric acid calculi, the client should
follow a low-purine diet, which excludes high-
purine foods such as organ meats.
Option A: A low-calcium diet decreases the risk
for oxalate renal calculi.
Options B and C: 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. Answer: 3. Struvite
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.
Option A: Calcium oxalate stones result from
increased calcium intake or conditions that raise
serum calcium concentrations.
Option B: Uric acid stones occur in clients with
gout.
Option D: Cystine stones are rare and occur in
clients with a genetic defect that results in
decreased renal absorption of the amino acid
cystine.
16. Answer: 3. Nephrostomy tube
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. Answer: 1. Shoulder
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.
Options B, C, and D: Bladder injury pain do not
radiate to the umbilicus, CV angle, or hip.
18. Answer: 1. Tender, indurated, and warm to
the touch
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).
Reviewer
19. Answer: 3. Decreased force in the stream
of urine
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. Answer: 4. Decongestants
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. Answer: 4. No special precautions except to
wear gloves if in contact with the client’s urine.
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. Answer: 3. Avoid green, leafy vegetables
such as spinach.
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. Answer: 2. Frequent dressing changes
around the Penrose drain
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.
Option A: A Penrose drain is not irrigated.
Option C: Weighing the dressings is not
necessary.
Option D: Placing the client on the affected side
will prevent a free flow of urine through the
drain.
24. Answer: 2. Administration of diuretics
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.
Options A and D: Fluid intake would not be
encouraged or restricted.
Option C: Irrigation of the Foley catheter will
not assist in alleviating this oliguria.
25. Answer: 1. Acute rejection
Acute rejection most often occurs in the first
two (2) weeks after transplant. Clinical
manifestations include fever, malaise, elevated
WBC count, acute hypertension, graft
tenderness, and manifestations of deteriorating
renal function.
Option B: Chronic rejection occurs gradually
during a period of months to years.
Options C and D: Although kidney infection or
obstruction can occur, the symptoms presented
in the question do not relate specifically to
these disorders.
26. Answer: 1. Bradycardia and confusion
Transurethral resection syndrome is caused by
increased absorption of nonelectrolyte
irrigating fluid used during surgery. The client
may show signs of cerebral edema and
increased intracranial pressure such as
increased blood pressure, bradycardia,
confusion, disorientation, muscle twitching,
visual disturbances, and nausea and vomiting.
27. Answer: 3. Blood pressure of 100/50 and
pulse 130.
A rapid pulse with a low blood pressure is a
potential sign of excessive blood loss. The
physician should be notified.
Option A: Frank bleeding (arterial or venous)
may occur during the first few days after
surgery.
Option B: Some hematuria is usual for several
days after surgery. A urinary output of 200 ml of
greater than intake is adequate.
Options D: Bladder spasms are expected to
occur after surgery.
28. Answer: 3. Painless hematuria
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Painless hematuria is the most common clinical
finding in bladder cancer. Other symptoms
include frequency, dysuria, and urgency, but
these are not as common as the hematuria.
Options A and D: Suprapubic pain and urinary
retention do not occur in bladder cancer.
29. Answer: 3. Conveys urine from the ureters
to a stoma opening in the abdomen.
An ileal conduit is a permanent urinary
diversion in which a portion of the ileum is
surgically resected and one end of the segment
is closed. The ureters are surgically attached to
this segment of the ileum, and the open end of
the ileum is brought to the skin surface on the
abdomen to form the stoma. The client must
wear a pouch to collect the urine that
continually flows through the conduit. The
bladder is removed during the surgical
procedure and the ileal conduit is not
reversible.
Option B: Diversion of the urine to the sigmoid
colon is called a ureter ileosigmoidostomy.
Option D: An opening in the bladder that allows
urine to drain externally is called a cystostomy.
30. Answer: 2. Thrombophlebitis
After pelvic surgery, there is an increased
chance of thrombophlebitis owing to the pelvic
manipulation that can interfere with circulation
and promote venous stasis.
Option A: Peritonitis is a potential complication
of any abdominal surgery, not just pelvic
surgery.
Option C: Ascites is most frequently an
indication of liver disease.
Option D: Inguinal hernia may be caused by an
increase in abdominal pressure or a congenital
weakness of the abdominal wall; a ventral
hernia occurs at the site of a previous
abdominal surgery.
31. Answer: 4. Encourage a high fluid intake
Mucus is secreted by the intestinal segment
used to create the conduit and is a normal
occurrence. The client should be encouraged to
maintain a large fluid intake to help flush the
mucus out of the conduit.
Option A: Because mucus in the urine is
expected, it is not necessary to change the
appliance bag or notify the physician.
Option C: The mucus is not an indication of an
infection, so a urine culture is not necessary.
32. Answer: 4. Separation of the appliance
from the skin
If the appliance becomes too full, it is likely to
pull away from the skin completely or to leak
urine onto the skin. A full appliance will not
rupture the ileal conduit or interrupt urine
production. Odor formation has numerous
causes.
33. Answer: 2. Soap
A reusable appliance should be routinely
cleaned with soap and water.
34. Answers: 3, 4. “I can usually keep my
ostomy pouch on for 3 to 7 days before
changing it.” and “I must use a skin barrier to
protect my skin from urine.”
The client with an ileal conduit must learn self-
care activities related to the care of the stoma
and ostomy appliances. The client should be
taught to increase fluid intake to about 3,000 ml
per day and should not limit intake. The ostomy
appliance should be changed approximately
every 3 to 7 days and whenever a leak develops.
A skin barrier is essential to protecting the skin
from the irritation of the urine.
Option A: Adequate fluid intake helps to flush
mucus from the ileal conduit.
Option B: An aspirin should not be used as a
method of odor control because it can be an
irritant to the stoma and lead to ulceration.
Option E: The ostomy pouch should be emptied
when it is one-third to one-half full to prevent
the weight from pulling the appliance away
from the skin.
35. Answer: 4. Disturbed Body Image related
to the creation of a urinary diversion.
It is normal for clients to express fears and
concerns about the body changes associated
with a urinary diversion. Allowing the client
time to verbalize concerns in a supportive
environment and suggest that she discuss these
concerns with people who have successfully
adjusted to ostomy surgery can help her begin
coping with these changes in a positive manner.
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Options A and C: Although the client may be
anxious about this situation and self-esteem
may be diminished, the underlying problem is a
disturbance in body image.
Option B: There are no data to support a
diagnosis of Deficient Knowledge.
36. Answer: 1. Urine reflux into the stoma
The most important reason for attaching the
appliance to a standard urine collection bag at
night is to prevent reflux into the stoma and
ureters, which can result in infection.
Options B and C: Use of a standard collection
bag also keeps the appliance from separating
from the skin and helps prevent urine leakage
from an overly full bag, but the primary purpose
is to prevent reflux of urine.
Option D: A client with a urinary diversion
should drink 2000-3000 ml of fluid each day; it
would be inappropriate to suggest decreasing
fluid intake.
37. Answer: 2. Maintain a daily fluid intake of
2,000 to 3,000 ml
Maintaining a fluid intake of 2,000 to 3,000
ml/day is likely to be effective in preventing UTI.
A high fluid intake results in high urine output,
which prevents urinary stasis and bacterial
growth.
Option A: Avoiding people with respiratory tract
infections will not prevent urinary tract
infections.
Option C: Clean, not sterile, technique is used to
change the appliance.
Option D: An ileal conduit stoma is not irrigated.
38. Answer: 2. Strain the urine carefully
Intermittent pain that is less colicky indicates
that the calculi may be moving along the urinary
tract. Fluids should be encouraged to promote
movement, and the urine should be strained to
detect the passage of the stone.
Option A: Hematuria is to be expected from the
irritation of the stone.
Option C: Analgesics should be administered
when the client needs them, not routinely.
Option D: Moist heat to the flank area is helpful
when renal colic occurs, but it is less necessary
as pain is lessened.
39. Answer: 2. Ensure that the catheter is
draining freely
The ureteral catheter should drain freely
without bleeding at the site.
Option A: The catheter is rarely irrigated, and
any irrigation would be done by the physician.
Option C: The catheter is never clamped.
Option D: The client’s total urine output
(ureteral catheter plus voiding or Foley catheter
output) should be 30 ml/hour.
40. Answer: 1. Encourage the client to
ambulate every two (2) to four (4) hours
Ambulation stimulates peristalsis. A client with
paralytic ileus is kept NPO until peristalsis
returns.
Option C: A stool softener will not stimulate
peristalsis.
Option D: Intravenous fluid infusion is a routine
postoperative order that does not have any
effect on preventing paralytic ileus.
41. Answer: 2. Urine output, 20 ml/hour
The decrease in urinary output may indicate
inadequate renal perfusion and should be
reported immediately. Urine output of 30
ml/hour or greater is considered acceptable.
Option A: A slight elevation in temperature is
expected after surgery.
Option C: Peristalsis returns gradually, usually
the second or third day after surgery. Bowel
sounds will be absent until then.
Option D: A small amount of serous
sanguineous drainage is to be expected.
42. Answer: 1. Milk, apples, tomatoes, and
corn
Because a high-purine diet contributes to the
formation of uric acid, a low-purine diet is
advocated. An alkaline ash diet is also
advocated because uric acid crystals are more
likely to develop in acid urine. Foods that may
be eaten as desired in a low-purine diet include
milk, all fruits, tomatoes, cereals, and corn.
Food allowed on an alkaline ash diet include
milk, fruits (except cranberries, plums, and
prunes), and vegetables (especially legumes and
green vegetables). Gravy, chicken, and liver are
high in purine.
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43. Answer: 2. Maculopapular rash
Allopurinol is used to treat renal calculi
composed of uric acid. Side effects of
allopurinol include drowsiness, maculopapular
rash, anemia, abdominal pain, nausea,
vomiting, and bone marrow depression. Clients
should be instructed to report skin rashes and
any unusual bleeding or bruising.
Options A, C, and D: Retinopathy, nasal
congestion, and dizziness are not side effects of
allopurinol.
44. Answer: 4. Decreased serum uric acid level
By inhibiting uric acid synthesis, allopurinol
decreases its excretion. The drug’s effectiveness
is assessed by evaluating for a decreased serum
uric acid concentration.
Options A, B, and C: Allopurinol does not alter
the level of alkaline phosphatase, not does it
affect urinary calcium excretion or the serum
calcium level.
45. Answer: 3. Activities that increase
abdominal pressure
Stress incontinence is the involuntary loss of
urine during such activities as coughing,
sneezing, laughing, or physical exertion. These
activities increase abdominal and detrusor
pressure.
Option A: A strong urge to urinate is associated
with urge incontinence.
Option B: Overdistention of the bladder can
lead to overflow incontinence.
Option D: Obstruction of the urethra can lead to
urinary retention.
46. Answer: 2. The client’s history of three full-
term pregnancies
The history of three pregnancies is most likely
the cause of the client’s current episodes of
stress incontinence. The client’s fluid intake,
age, or history of swimming would not create
an increase in intra-abdominal pressure.
47. Answer: 2. Avoid caffeine and alcohol
Client’s with stress incontinence are
encouraged to avoid substances such as
caffeine and alcohol which are bladder irritants.
Option A: Emotional stressors do not cause
stress incontinence. It is caused most commonly
be relaxed pelvic musculature.
Option C: Wearing Girdles is not
contraindicated.
Option D: Although clients may be inclined to
limit physical exertion to avoid incontinence
episodes; they should be encouraged to seek
treatment instead of limiting their activities.
48. Answer: 3. Involuntary urination with
minimal warning
A characteristic of urge incontinence is
involuntary urination with little or no warning.
Option A: The inability to empty the bladder is
urinary retention. Option B: Loss of urine when
coughing occurs with stress incontinence.
Option D: Frequent dribbling of urine is
common in male clients after some types of
prostate surgery or may occur in women after
the development of
Option A: The inability to empty the bladder is
urinary retention.
Option B: Loss of urine when coughing occurs
with stress incontinence.
Option D: Frequent dribbling of urine is
common in male clients after some types of
prostate surgery or may occur in women after
the development of a vesicovaginal or
ureterovaginal fistula.
49. Answer: 1. A rounded swelling above the
pubis.
The best way to assess for a distended bladder
in either a male or female client is to check for a
rounded swelling above the pubis. The swelling
represents the distended bladder rising above
the pubis into the abdominal cavity.
Option B: Dullness does not indicate a
distended bladder.
Option C: The client might experience
tenderness or pressure above the symphysis.
Option D: No urine discharge is expected; the
urine flow is blocked by the enlarged prostate.
50. Answer: 3. Possible shock
Rapid emptying of an overdistended bladder
may cause hypotension and shock due to the
sudden change of pressure within the
abdominal viscera. Previously, removing no
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more than 1,000 ml at one time was the
standard of practice, but this is no longer
thought to be necessary as long as the
overdistended bladder is emptied slowly.
51. Answer: 1. Eliminate pressure at the
penoscrotal angle
The primary reason for taping an indwelling
catheter to a male client soothe penis is held in
a lateral position to prevent pressure at the
penoscrotal angle. Prolonged pressure at the
penoscrotal angle can cause a
ureterocutaneous fistula.
52. Answer: 3. To produce a secretion that aids
in the nourishment and passage of sperm
The prostate gland is located below the bladder
and surrounds the urethra. It serves one
primary purpose: to produce a secretion that
aids in the nourishment and passage of sperm.
53. Answer: 3. Inhaled ipratropium (Atrovent)
Atrovent is a bronchodilator, and its
anticholinergic effects can aggravate urinary
retention.
Options A and B: Glucophage and BuSpar do not
affect the urinary system.
Option D: Timolol does not have a systemic
effect.
54. Answer: 4. Respiratory paralysis
If paralysis of vasomotor nerves in the
upper spinal cord occurs when spinal anesthesia
is used, the client is likely to develop respiratory
paralysis. Artificial ventilation is required until
the effects of the anesthesia subside.
Options A, B, and C: Convulsions, cardiac arrest,
and renal shutdown are not likely results of
spinal anesthesia.
55. Answer: 3. Blood pressure
Terazosin (Hytrin) is an antihypertensive drug
that is also used in the treatment of BPH. Blood
pressure must be monitored to ensure that the
client does not develop hypotension, syncope,
or postural hypotension. The client should be
instructed to change positions slowly.
Options A, B, and D: Urinary nitrites, white
blood cell count, and pulse rate are not affected
by terazosin.
56. Answer: 3. When the drainage becomes
bright red
The decision made by the surgeon to insert a
catheter after a TURP or prostatectomy
depends on the amount of bleeding that is
expected after the procedure. During
continuous bladder irrigation after a TURP or
prostatectomy, the rate at which the solution
enters the bladder should be increased when
the drainage becomes brighter red. The color
indicates the presence of blood. Increasing the
flow of irrigating solution helps flush the
catheter well so clots do not plug it.
Option B: There would be no reason to increase
the flow rate when the return is continuous or
when the return appears cloudy and dark
yellow.
Option D: Increasing the flow would be
contraindicated when there is no return of
urine and irrigating solution.
57. Answer: 1. Deficient fluid volume
Deficient Fluid Volume is a priority diagnosis
because the client needs to drink a large
amount of fluid to keep the urine clear. The
urine should be almost without color. About
two (2) weeks after a TURP, when desiccated
tissue is sloughed out, a secondary hemorrhage
could occur. The client should be instructed to
call the surgeon or go to the ED if at any time
the urine turns bright red.
Option B: The client is not specifically at risk for
nutritional problems after a TURP. The client is
not specifically at risk for nutritional problems
after a TURP.
Option C: The client is not specifically at risk for
impaired tissue integrity because there is no
external incision.
Option D: The client is not specifically at risk for
airway problems because the procedure is done
after spinal anesthesia.
58. Answer: 2. Serum acid phosphatase level
The most specific examination to determine
whether a malignancy extends outside of the
prostatic capsule is a study of the serum acid
phosphatase level. The level increases when a
malignancy has metastasized. The prostate-
specific antigen (PSA) determination and a
digital rectal examination are done when
screening for prostate cancer. Serum creatinine
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level, total nonprotein nitrogen level, and
endogenous creatinine clearance time give
information about kidney function, not
Options A, C, and D: Serum creatinine level,
total nonprotein nitrogen level, and
endogenous creatinine clearance time give
information about kidney function, not prostate
malignancy.
59. Answer: 4. Increased Blood Glucose Level.
60. Answer: 4. Elevated BUN and Creatinine.
1. Dialysis allows for the exchange of particles
across a semipermeable membrane by which
of the following actions?
1. Osmosis and diffusion
2. Passage of fluid toward a solution with a
lower solute concentration
3. Allowing the passage of blood cells and
protein molecules through it.
4. Passage of solute particles toward a solution
with a higher concentration.
2. A client is diagnosed with chronic renal
failure and told she must start hemodialysis.
Client teaching would include which of the
following instructions?
1. Follow a high potassium diet
2. Strictly follow the hemodialysis schedule
3. There will be a few changes in your lifestyle.
4. Use alcohol on the skin and clean it due
to integumentary changes.
3. A client is undergoing peritoneal dialysis.
The dialysate dwell time is completed, and the
dwell clamp is opened to allow the dialysate to
drain. The nurse notes that the drainage has
stopped and only 500 ml has drained; the
amount the dialysate instilled was 1,500 ml.
Which of the following interventions would be
done first?
1. Change the client’s position.
2. Call the physician.
3. Check the catheter for kinks or obstruction.
4. Clamp the catheter and instill more dialysate
at the next exchange time.
4. A client receiving hemodialysis treatment
arrives at the hospital with a blood pressure of
200/100, a heart rate of 110, and a respiratory
rate of 36. Oxygen saturation on room air is
89%. He complains of shortness of breath, and
+2 pedal edema is noted. His last hemodialysis
treatment was yesterday. Which of the
following interventions should be done first?
1. Administer oxygen
2. Elevate the foot of the bed
3. Restrict the client’s fluids
4. Prepare the client for hemodialysis.
5. A client has a history of chronic renal failure
and received hemodialysis treatments three
times per week through an arteriovenous (AV)
fistula in the left arm. Which of the following
interventions is included in this client’s plan of
care?
1. Keep the AV fistula site dry.
2. Keep the AV fistula wrapped in gauze.
3. Take the blood pressure in the left arm
4. Assess the AV fistula for a bruit and thrill
6. Which of the following factors causes the
nausea associated with renal failure?
1. Oliguria
2. Gastric ulcers
3. Electrolyte imbalances
4. Accumulation of waste products
7. Which of the following clients is at greatest
risk for developing acute renal failure?
1. A dialysis client who gets influenza
2. A teenager who has an appendectomy
3. A pregnant woman who has a
fractured femur
4. A client with diabetes who has a
heart catheterization
8. In a client in renal failure, which assessment
finding may indicate hypocalcemia?
1. Headache
2. Serum calcium level of 5 mEq/L
3. Increased blood coagulation
4. Diarrhea
9. A nurse is assessing the patency of an
arteriovenous fistula in the left arm of a client
who is receiving hemodialysis for the
treatment of chronic renal failure. Which
finding indicates that the fistula is patent?
1. Absence of bruit on auscultation of the
fistula.
2. Palpation of a thrill over the fistula
3. Presence of a radial pulse in the left wrist
4. Capillary refill time less than 3 seconds in
the nail beds of the fingers on the left hand.
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10. The client with chronic renal failure is at
risk of developing dementia related to
excessive absorption of aluminum. The nurse
teaches that this is the reason that the client is
being prescribed which of the following
phosphate binding agents?
1. Alu-cap (aluminum hydroxide)
2. Tums (calcium carbonate)
3. Amphojel (aluminum hydroxide)
4. Basaljel (aluminum hydroxide)
11. The client newly diagnosed with chronic
renal failure recently has begun hemodialysis.
Knowing that the client is at risk for
disequilibrium syndrome, the nurse assesses
the client during dialysis for:
1. Hypertension, tachycardia, and fever
2. Hypotension, bradycardia, and hypothermia
3. restlessness, irritability, and generalized
weakness
4. Headache, deteriorating level of
consciousness, and twitching.
12. A client with chronic renal failure has
completed a hemodialysis treatment. The
nurse would use which of the following
standard indicators to evaluate the client’s
status after dialysis?
1. Potassium level and weight
2. BUN and creatinine levels
3. VS and BUN
4. VS and weight.
13. The hemodialysis client with a left arm
fistula is at risk for steal syndrome. The nurse
assesses this client for which of the following
clinical manifestations?
1. Warmth, redness, and pain in the left hand.
2. Pallor, diminished pulse, and pain in the left
hand.
3. Edema and reddish discoloration of the left
arm
4. Aching pain, pallor, and edema in the left
arm.
14. A client is admitted to the hospital and has
a diagnosis of early stage chronic renal failure.
Which of the following would the nurse expect
to note on assessment of the client?
1. Polyuria
2. Polydipsia
3. Oliguria
4. Anuria
15. The client with chronic renal failure returns
to the nursing unit following a hemodialysis
treatment. On assessment the nurse notes that
the client’s temperature is 100.2. Which of the
following is the most appropriate nursing
action?
1. Encourage fluids
2. Notify the physician
3. Monitor the site of the shunt for infection
4. Continue to monitor vital signs
16. The nurse is performing an assessment on
a client who has returned from the dialysis unit
following hemodialysis. The client is
complaining of a headache and nausea and is
extremely restless. Which of the following is
the most appropriate nursing action?
1. Notify the physician
2. Monitor the client
3. Elevate the head of the bed
4. Medicate the client for nausea
17. The nurse is assisting a client on a low-
potassium diet to select food items from the
menu. Which of the following food items, if
selected by the client, would indicate an
understanding of this dietary restriction?
1. Cantaloupe
2. Spinach
3. Lima beans
4. Strawberries
18. The nurse is reviewing a list of components
contained in the peritoneal dialysis solution
with the client. The client asks the nurse about
the purpose of the glucose contained in the
solution. The nurse bases the response
knowing that the glucose:
1. Prevents excess glucose from being removed
from the client.
2. Decreases risk of peritonitis.
3. Prevents disequilibrium syndrome
4. Increased osmotic pressure to produce
ultrafiltration.
19. The nurse is preparing to care for a client
receiving peritoneal dialysis. Which of the
following would be included in the nursing
plan of care to prevent the major complication
associated with peritoneal dialysis?
1. Monitor the client’s level of consciousness
2. Maintain strict aseptic technique
3. Add heparin to the dialysate solution
4. Change the catheter site dressing daily
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20. A client newly diagnosed with renal failure
is receiving peritoneal dialysis. During the
infusion of the dialysate the client complains
of abdominal pain. Which action by the nurse
is most appropriate?
1. Slow the infusion
2. Decrease the amount to be infused
3. Explain that the pain will subside after the
first few exchanges
4. Stop the dialysis
21. The nurse is instructing a client
with diabetes mellitus about peritoneal
dialysis. The nurse tells the client that it is
important to maintain the dwell time for the
dialysis at the prescribed time because of the
risk of:
1. Infection
2. Hyperglycemia
3. Fluid overload
4. Disequilibrium syndrome
22. The client with acute renal failure has a
serum potassium level of 5.8 mEq/L. The nurse
would plan which of the following as a priority
action?
1. Allow an extra 500 ml of fluid intake to dilute
the electrolyte concentration.
2. Encourage increased vegetables in the diet
3. Place the client on a cardiac monitor
4. Check the sodium level
23. The client with chronic renal failure who is
scheduled for hemodialysis this morning is due
to receive a daily dose of enalapril (Vasotec).
The nurse should plan to administer this
medication:
1. Just before dialysis
2. During dialysis
3. On return from dialysis
4. The day after dialysis
24. The client with chronic renal failure has an
indwelling catheter for peritoneal dialysis in
the abdomen. The client spills water on the
catheter dressing while bathing. The nurse
should immediately:
1. Reinforce the dressing
2. Change the dressing
3. Flush the peritoneal dialysis catheter
4. Scrub the catheter with povidone-iodine
25. The client being hemodialyzed suddenly
becomes short of breath and complains
of chest pain. The client is tachycardic, pale,
and anxious. The nurse suspects air embolism.
The nurse should:
1. Continue the dialysis at a slower rate after
checking the lines for air
2. Discontinue dialysis and notify the physician
3. Monitor vital signs every 15 minutes for the
next hour
4. Bolus the client with 500 ml of normal
saline to break up the air embolism.
26. The nurse has completed client teaching
with the hemodialysis client about self-
monitoring between hemodialysis treatments.
The nurse determines that the client best
understands the information given if the client
states to record the daily:
1. Pulse and respiratory rate
2. Intake, output, and weight
3. BUN and creatinine levels
4. Activity log
27. The client with an arteriovenous shunt in
place for hemodialysis is at risk for bleeding.
The nurse would do which of the following as a
priority action to prevent this complication
from occurring?
1. Check the results of the PT time as they are
ordered.
2. Observe the site once per shift
3. Check the shunt for the presence of a bruit
and thrill
4. Ensure that small clamps are attached to the
AV shunt dressing.
28. The nurse is monitoring a client receiving
peritoneal dialysis and nurse notes that a
client’s outflow is less than the inflow. Select
actions that the nurse should take.
1. Place the client in good body alignment
2. Check the level of the drainage bag
3. Contact the physician
4. Check the peritoneal dialysis system for kinks
5. Reposition the client to his or her side.
29. The nurse assesses the client who has
chronic renal failure and notes the following:
crackles in the lung bases, elevated blood
pressure, and weight gain of 2 pounds in one
day. Based on these data, which of the
following nursing diagnoses is appropriate?
1. Excess fluid volume related to the kidney’s
inability to maintain fluid balance.
2. Increased cardiac output related to fluid
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overload.
3. Ineffective tissue perfusion related to
interrupted arterial blood flow.
4. Ineffective Therapeutic Regimen
Management related to lack of knowledge
about therapy.
30. The nurse is caring for a hospitalized client
who has chronic renal failure. Which of the
following nursing diagnoses are most
appropriate for this client? Select all that
apply.
1. Excess Fluid Volume
2. Imbalanced Nutrition; Less than Body
Requirements
3. Activity Intolerance
4. Impaired Gas Exchange
5. Pain.
31. What is the primary disadvantage of using
peritoneal dialysis for long-term management
of chronic renal failure?
1. The danger of hemorrhage is high.
2. It cannot correct severe imbalances.
3. It is a time consuming method of treatment.
4. The risk of contracting hepatitis is high.
32. The dialysis solution is warmed before use
in peritoneal dialysis primarily to:
1. Encourage the removal of serum urea.
2. Force potassium back into the cells.
3. Add extra warmth into the body.
4. Promote abdominal muscle relaxation.
33. During the client’s dialysis, the nurse
observes that the solution draining from the
abdomen is consistently blood tinged. The
client has a permanent peritoneal catheter in
place. Which interpretation of this observation
would be correct?
1. Bleeding is expected with a permanent
peritoneal catheter
2. Bleeding indicates abdominal blood vessel
damage
3. Bleeding can indicate kidney damage.
4. Bleeding is caused by too-rapid infusion of
the dialysate.
34. Which of the following nursing
interventions should be included in the client’s
care plan during dialysis therapy?
1. Limit the client’s visitors
2. Monitor the client’s blood pressure
3. Pad the side rails of the bed
4. Keep the client NPO.
35. Aluminum hydroxide gel (Amphojel) is
prescribed for the client with chronic renal
failure to take at home. What is the purpose of
giving this drug to a client with chronic renal
failure?
1. To relieve the pain of gastric hyperacidity
2. To prevent Curling’s stress ulcers
3. To bind phosphorus in the intestine
4. To reverse metabolic acidosis.
36. The nurse teaches the client with chronic
renal failure when to take the aluminum
hydroxide gel. Which of the following
statements would indicate that the client
understands the teaching?
1. “I’ll take it every four (4) hours around the
clock.”
2. “I’ll take it between meals and at bedtime.”
3. “I’ll take it when I have a sour stomach.”
4. “I’ll take it with meals and bedtime snacks.”
37. The client with chronic renal failure tells
the nurse he takes magnesium hydroxide (milk
of magnesia) at home for constipation. The
nurse suggests that the client switch to
psyllium hydrophilic mucilloid (Metamucil)
because:
1. MOM can cause magnesium toxicity
2. MOM is too harsh on the bowel
3. Metamucil is more palatable
4. MOM is high in sodium
38. In planning teaching strategies for the
client with chronic renal failure, the nurse
must keep in mind the neurologic impact of
uremia. Which teaching strategy would be
most appropriate?
1. Providing all needed teaching in one
extended session.
2. Validating frequently the client’s
understanding of the material.
3. Conducting a one-on-one session with the
client.
4. Using videotapes to reinforce the material as
needed.
39. The nurse helps the client with chronic
renal failure develop a home diet plan with the
goal of helping the client maintain adequate
nutritional intake. Which of the following diets
would be most appropriate for a client with
chronic renal failure?
Reviewer
1. High carbohydrate, high protein
2. High calcium, high potassium, high protein
3. Low protein, low sodium, low potassium
4. Low protein, high potassium
40. A client with chronic renal failure has asked
to be evaluated for a home continuous
ambulatory peritoneal dialysis (CAPD)
program. The nurse should explain that the
major advantage of this approach is that it:
1. Is relatively low in cost
2. Allows the client to be more independent
3. Is faster and more efficient than standard
peritoneal dialysis
4. Has fewer potential complications than
standard peritoneal dialysis
41. The client asks whether her diet would
change on CAPD. Which of the following would
be the nurse’s best response?
1. “Diet restrictions are more rigid with CAPD
because standard peritoneal dialysis is a more
effective technique.”
2. “Diet restrictions are the same for both CAPD
and standard peritoneal dialysis.”
3. “Diet restrictions with CAPD are fewer than
with standard peritoneal dialysis because
dialysis is constant.”
4. “Diet restrictions with CAPD are fewer than
with standard peritoneal dialysis because CAPD
works more quickly.”
42. Which of the following is the most
significant sign of peritoneal infection?
1. Cloudy dialysate fluid
2. Swelling in the legs
3. Poor drainage of the dialysate fluid
4. Redness at the catheter insertion site
43. The main indicator of the need for
hemodialysis is:
1. Ascites
2. Acidosis
3. Hypertension
4. Hyperkalemia
44. To gain access to the vein and artery, an AV
shunt was used for Mr. Roberto. The most
serious problem with regards to the AV shunt
is:
1. Septicemia
2. Clot formation
3. Exsanguination
4. Vessel sclerosis
45. When caring for Mr. Roberto’s AV shunt on
his right arm, you should:
1. Cover the entire cannula with an elastic
bandage
2. Notify the physician if a bruit and thrill are
present
3. User surgical aseptic technique when giving
shunt care
4. Take the blood pressure on the right arm
instead
Answers and Rationale
1. Answer: 1. Osmosis and diffusion
Osmosis allows for the removal of fluid from the
blood by allowing it to pass through the
semipermeable membrane to an area of high
concentrate (dialysate), and diffusion allows for
passage of particles (electrolytes, urea, and
creatinine) from an area of higher
concentration to an area of lower
concentration.
Option B: Fluid passes to an area with a higher
solute concentration.
Option C: The pores of a semipermeable
membrane are small, thus preventing the flow
of blood cells and protein molecules through it.
2. Answer: 2. Strictly follow the hemodialysis
schedule
To prevent life-threatening complications, the
client must follow the dialysis schedule.
Option A: The client should follow a low-
potassium diet because potassium levels
increase in chronic renal failure.
Option C: The client should know hemodialysis
is time-consuming and will definitely cause a
change in current lifestyle.
Option D: Alcohol would further dry the client’s
skin more than it already is.
3. Answer: 3. Check the catheter for kinks or
obstruction.
The first intervention should be to check for
kinks and obstructions because that could be
preventing drainage. After checking for kinks,
have the client change position to promote
drainage. Don’t give the next scheduled
exchange until the dialysate is drained because
abdominal distention will occur, unless the
output is within parameters set by the
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physician. If unable to get more output despite
checking for kinks and changing the client’s
position, the nurse should then call the
physician to determine the proper intervention.
4. Answer: 1. Administer oxygen
Airway and oxygenation are always the first
priority. Because the client is complaining of
shortness of breath and his oxygen saturation is
only 89%, the nurse needs to try to increase his
levels by administering oxygen.
Option B: The foot of the bed may be elevated
to reduce edema, but this isn’t the priority.
Options C and D: The client is in pulmonary
edema from fluid overload and will need to be
dialyzed and have his fluids restricted, but the
first interventions should be aimed at the
immediate treatment of hypoxia.
5. Answer: 4. Assess the AV fistula for a bruit
and thrill
Assessment of the AV fistula for bruit and thrill
is important because, if not present, it indicates
a non-functioning fistula.
Option A: When not being dialyzed, the AV
fistula site may get wet.
Option B: Immediately after a dialysis
treatment, the access site is covered with
adhesive bandages.
Option C: No blood pressures or venipunctures
should be taken in the arm with the AV fistula.
6. Answer: 4. Accumulation of waste products
Although clients with renal failure can develop
stress ulcers, the nausea is usually related to
the poisons of metabolic wastes that
accumulate when the kidneys are unable to
eliminate them.
Options A and C: The client has electrolyte
imbalances and oliguria, but these don’t directly
cause nausea.
7. Answer: 4. A client with diabetes who has a
heart catheterization
Clients with diabetes are prone to renal
insufficiency and renal failure. The contrast
used for heart catheterization must be
eliminated by the kidneys, which further
stresses them and may produce acute renal
failure. A dialysis client already has end-stage
renal disease and wouldn’t develop acute renal
failure.
Options B and C: A teenager who has an
appendectomy and a pregnant woman with a
fractured femur isn’t at increased risk for renal
failure.
8. Answer: 4. Diarrhea
In renal failure, calcium absorption from the
intestine declines, leading to increased smooth
muscle contractions, causing diarrhea.
Option A: CNS changes in renal failure rarely
include headache.
Option B: A serum calcium level of 5 mEq/L
indicates hypercalcemia.
Option C: As renal failure progresses, bleeding
tendencies increase.
9. Answer: 2. Palpation of a thrill over the
fistula
The nurse assesses the patency of the fistula by
palpating for the presence of a thrill or
auscultating for a bruit.
Option A: The presence of a thrill and bruit
indicate patency of the fistula.
Options C and D: Although the presence of a
radial pulse in the left wrist and capillary refill
time less than 3 seconds in the nail beds of the
fingers on the left hand are normal findings;
they do not assess fistula patency.
10. Answer: 2. Tums (calcium carbonate)
Phosphate binding agents that contain
aluminum include Alu-caps, Basaljel, and
Amphojel. These products are made from
aluminum hydroxide. Tums are made from
calcium carbonate and also bind phosphorus.
Tums are prescribed to avoid the occurrence of
dementia related to high intake of aluminum.
Phosphate binding agents are needed by the
client in renal failure because the kidneys
cannot eliminate phosphorus.
11. Answer: 4. Headache, deteriorating level of
consciousness and twitching.
Disequilibrium syndrome is characterized by
headache, mental confusion, decreasing level of
consciousness, nausea, and vomiting, twitching,
and possible seizure activity. Disequilibrium
syndrome is caused by rapid removal of solutes
from the body during hemodialysis. At the same
time, the blood-brain barrier interferes with the
efficient removal of wastes from brain tissue. As
a result, water goes into cerebral cells because
of the osmotic gradient, causing brain swelling
and onset of symptoms. The syndrome most
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often occurs in clients who are new to dialysis
and is prevented by dialyzing for shorter times
or at reduced blood flow rates.
12. Answer: 4. VS and weight.
Following dialysis, the client’s vital signs are
monitored to determine whether the client is
remaining hemodynamically stable. Weight is
measured and compared with the client’s
predialysis weight to determine the
effectiveness of fluid extraction.
Options A, B, and C: Laboratory studies are
done as per protocol but are not necessarily
done after the hemodialysis treatment has
ended.
13. Answer: 2. Pallor, diminished pulse, and
pain in the left hand.
Steal syndrome results from vascular
insufficiency after the creation of a fistula. The
client exhibits pallor and a diminished pulse
distal to the fistula. The client also complains of
pain distal to the fistula, which is due to tissue
ischemia.
Option A: Warmth, redness, and pain more
likely would characterize a problem with
infection.
14. Answer: 1. Polyuria
Polyuria occurs early in chronic renal failure and
if untreated can cause severe dehydration.
Polyuria progresses to anuria, and the client
loses all normal functions of the kidney.
Options B, C, and D: Oliguria and anuria are not
early signs, and polydipsia is unrelated to
chronic renal failure.
15. Answer: 4. Continue to monitor vital signs
The client may have an elevated temperature
following dialysis because the dialysis machine
warms the blood slightly. If the temperature is
elevated excessively and remains
elevated, sepsis would be suspected, and a
blood sample would be obtained as prescribed
for culture and sensitivity purposes.
16. Answer: 1. Notify the physician
Disequilibrium syndrome may be due to the
rapid decrease in BUN levels during dialysis.
These changes can cause cerebral edema that
leads to increased intracranial pressure. The
client is exhibiting early signs of disequilibrium
syndrome and appropriate treatments with
anticonvulsant medications
and barbiturates may be necessary to prevent a
life-threatening situation. The physician must be
notified.
17. Answer: 3. Lima beans
Lima beans (1/3 c) averages three (3) mEq per
serving.
Option A: Cantaloupe (1/4 small)
Option B: Spinach (1/2 cooked)
Option D: Strawberries (1 ¼ cups) are high
potassium foods and average 7 mEq per
serving.
18. Answer: 4. Increases osmotic pressure to
produce ultrafiltration.
Increasing the glucose concentration makes the
solution increasingly more hypertonic. The
more hypertonic the solution, the greater the
osmotic pressure for ultrafiltration and thus the
greater amount of fluid removed from the client
during an exchange.
19. Answer: 2. Maintain strict aseptic
technique
The major complication of peritoneal dialysis
is peritonitis. Strict aseptic technique is required
in caring for the client receiving this treatment.
Although option D may assist in preventing
infection, this option relates to an external site.
20. Answer: 3. Explain that the pain will
subside after the first few exchanges
Pain during the inflow of dialysate is common
during the first few exchanges because of
peritoneal irritation; however, the pain usually
disappears after 1 to 2 weeks of treatment. The
infusion amount should not be decreased, and
the infusion should not be slowed or stopped.
21. Answer: 2. Hyperglycemia
An extended dwell time increases the risk of
hyperglycemia in the client with diabetes
mellitus as a result of absorption of glucose
from the dialysate and electrolyte changes.
Diabetic clients may require extra insulin when
receiving peritoneal dialysis.
22. Answer: 3. Place the client on a cardiac
monitor
The client with hyperkalemia is at risk for
developing cardiac dysrhythmias and cardiac
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arrest. Because of this, the client should be
placed on a cardiac monitor.
Option A: Fluid intake is not increased because
it contributes to fluid overload and would not
affect the serum potassium level significantly.
Option B: Vegetables are a natural source of
potassium in the diet, and their use would not
be increased.
Option D: The nurse may also assess the sodium
level because sodium is another electrolyte
commonly measured with the potassium level.
However, this is not a priority action at this
time.
23. Answer: 3. On return from dialysis
Antihypertensive medications such as enalapril
are given to the client following hemodialysis.
This prevents the client from becoming
hypotensive during dialysis and also from
having the medication removed from the
bloodstream by dialysis. No rationale exists for
waiting a full day to resume the medication.
This would lead to ineffective control of the
blood pressure.
24. Answer: 2. Change the dressing
Clients with peritoneal dialysis catheters are at
high risk for infection. A dressing that is wet is a
conduit for bacteria for bacteria to reach the
catheter insertion site. The nurse assures that
the dressing is kept dry at all times.
Option A: Reinforcing the dressing is not a safe
practice to prevent infection in this
circumstance.
Option C: Flushing the catheter is not indicated.
Option D: Scrubbing the catheter with
povidone-iodine is done at the time of
connection or disconnecting of peritoneal
dialysis.
25. Answer: 2. Discontinue dialysis and notify
the physician
If the client experiences air embolus during
hemodialysis, the nurse should terminate
dialysis immediately, notify the physician, and
administer oxygen as needed.
26. Answer: 2. Intake, output, and weight
The client on hemodialysis should monitor fluid
status between hemodialysis treatments by
recording intake and output and measuring
weight daily. Ideally, the hemodialysis client
should not gain more than 0.5 kg of weight per
day.
27. Answer: 4. Ensure that small clamps are
attached to the AV shunt dressing.
An AV shunt is a less common form of access
site but carries a risk of bleeding when it is used
because two ends of an external cannula are
tunneled subcutaneously into an artery and a
vein and the ends of the cannula are joined. If
accidental connection occurs, the client could
lose blood rapidly. For this reason, small clamps
are attached to the dressing that covers the
insertion site to use if needed.
Option B: The shunt site should be assessed at
least every four hours.
28. Answer: 1, 2, 4, 5.
If outflow drainage is inadequate, the nurse
attempts to stimulate outflow by changing the
client’s position. Turning the client to the other
side or making sure that the client is in good
body alignment may assist with outflow
drainage. The drainage bag needs to be lower
than the client’s abdomen to enhance gravity
drainage. The connecting tubing and the
peritoneal dialysis system is also checked for
kinks or twisting and the clamps on the system
are checked to ensure that they are open. There
is no reason to contact the physician.
29. Answer: 1. Excess fluid volume related to
the kidney’s inability to maintain fluid balance.
Crackles in the lungs, weight gain, and elevated
blood pressure are indicators of excess fluid
volume, a common complication in chronic
renal failure. The client’s fluid status should be
monitored carefully for imbalances on an
ongoing basis.
30. Answer: 1, 2, 3.
Appropriate nursing diagnoses for clients with
chronic renal failure include excess fluid volume
related to fluid and sodium retention;
imbalanced nutrition, less than body
requirements related to anorexia, nausea, and
vomiting; and activity intolerance related
to fatigue.
Options D and E: The nursing diagnoses of
impaired gas exchange and pain are not
commonly related to the chronic renal failure.
Reviewer
31. Answer: 3. It is a time-consuming method
of treatment.
The disadvantages of peritoneal dialysis in the
long-term management of chronic renal failure
is that requires large blocks of time.
Options A and D: The risk of hemorrhage or
hepatitis is not high with PD.
Option B: PD is effective in maintaining a client’s
fluid and electrolyte balance.
32. Answer: 1. Encourage the removal of
serum urea.
The main reason for warming the peritoneal
dialysis solution is that the warm solution helps
dilate peritoneal vessels, which increases urea
clearance.
Options B and D: The warmed solution does not
force potassium into the cells or promote
abdominal muscle relaxation.
Option C: Warmed dialyzing solution also
contributes to client comfort by preventing
chilly sensations, but this is a secondary reason
for warming the solution.
33. Answer: 2. Bleeding indicates abdominal
blood vessel damage
Because the client has a permanent catheter in
place, blood tinged drainage should not occur.
Persistent blood tinged drainage could indicate
damage to the abdominal vessels, and the
physician should be notified.
Option C: The bleeding is originating in the
peritoneal cavity, not the kidneys.
Option D: Too rapid infusion of the dialysate can
cause pain.
34. Answer: 2. Monitor the client’s blood
pressure
Because hypotension is a complication of
peritoneal dialysis, the nurse records intake,
and output, monitors VS, and observes the
client’s behavior.
Option A: The nurse also encourages visiting
and other diversional activities.
Options C and D: A client on PD does not need
to be placed in bed with padded side rails or
kept NPO.
35. Answer: 3. To bind phosphorus in the
intestine
A client in renal failure develops
hyperphosphatemia that causes a
corresponding excretion of the body’s calcium
stores, leading to renal osteodystrophy. To
decrease this loss, aluminum hydroxide gel is
prescribed to bind phosphates in the intestine
and facilitate their excretion.
Option A: Gastric hyperacidity is not necessarily
a problem associated with chronic renal failure.
Options B and D: Antacids will not prevent
Curling’s stress ulcers and do not affect
metabolic acidosis.
36. Answer: 4. “I’ll take it with meals and
bedtime snacks.”
Aluminum hydroxide gel is administered to bind
the phosphates in ingested foods and must be
given with or immediately after meals and
snacks.
Option A: There is no need for the client to take
it on a 24-hour schedule.
Options B and C: It is not administered to treat
hyperacidity in clients with CRF and therefore is
not prescribed between meals.
37. Answer: 1. MOM can cause magnesium
toxicity
Magnesium is normally excreted by the kidneys.
When the kidneys fail, magnesium can
accumulate and cause severe neurologic
problems.
Option B: MOM is harsher than Metamucil, but
magnesium toxicity is a more serious problem.
Option C: A client may find both MOM and
Metamucil unpalatable.
Option D: MOM is not high in sodium.
38. Answer: 2. Validating frequently the
client’s understanding of the material.
Uremia can cause decreased alertness, so the
nurse needs to validate the client’s
comprehension frequently.
Option A: Because the client’s ability to
concentrate is limited, short lesions are most
effective.
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Option C: If family members are present at the

sessions, they can reinforce the material.

Option D: Written materials that the client can

review are superior to videotapes, because the
clients may not be able to maintain alertness
during the viewing of the videotape.

39. Answer: 3. Low protein, low sodium, low

Option A: CAPD is costly and must be done

daily.

Option D: Side effects and complications are

similar to those of standard peritoneal dialysis.

41. Answer: 3. “Diet restrictions with CAPD are

fewer than with standard peritoneal dialysis
because dialysis is constant.”

Dietary restrictions with CAPD are fewer than

those with standard peritoneal dialysis because
dialysis is constant, not intermittent. The
constant slow diffusion of CAPD helps prevent
accumulation of toxins and allows for a more
liberal diet. CAPD does not work more quickly,
but more consistently. Both types of peritoneal
dialysis are effective.

42. Answer: 1. Cloudy dialysate fluid

Cloudy drainage indicates bacterial activity in

the peritoneum. Other signs and symptoms of
infection are fever, hyperactive bowel sounds,
and abdominal pain.

Option B: Swollen legs may be indicative

of congestive heart failure.

Option C: Poor drainage of dialysate fluid is

probably the result of a kinked catheter.

Option D: Redness at the insertion site indicates

local infection, not peritonitis. However, a local
infection that is left untreated can progress to
the peritoneum.

43. Answer: 4. Hyperkalemia

44. Answer: 3. Exsanguination

45. Answer: 3. User surgical aseptic technique

when giving shunt care