When caring for a male client with acute renal failure (ARF), Nurse Fatrishia expects to adjust the dosage or dosing schedule of certain drugs. Which of the following drugs would not require such adjustment?
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Solution
acetaminophen (Tylenol)
Because acetaminophen is metabolized in the liver, its dosage and dosing schedule need not be adjusted for a client with ARF.
Options B and D: In contrast, the dosages and schedules for gentamicin and ticarcillin, which are metabolized and excreted by the kidney, should be adjusted.
Option C: Because cyclosporine may cause nephrotoxicity, the nurse must monitor both the dosage and blood drug level in a client receiving this drug.
Nurse Erica is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client:
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Solution
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.
Kayexalate is a sodium exchange resin. Thus the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention.
Nurse Grace is assessing a male client diagnosed with gonorrheA. Which symptom most likely prompted the client to seek medical attention?
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Solution
Foul-smelling discharge from the penis
Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination.
Option A: Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis.
Option B: Cauliflower-like warts on the penis are a sign of human papillomavirus.
Option C: Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.
A female client with an indwelling urinary catheter is suspected of having a urinary tract infection. Nurse Angel should collect a urine specimen for culture and sensitivity by:
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Solution
wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle.
Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Option A: Tubing shouldn’t be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Option C: Urine in urine drainage bags may not be fresh and may contain bacteria, giving false test results. Option D: When there is no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect.
Nurse Eve is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence?
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Solution
Encouraging intake of at least 2 L of fluid daily
By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the client’s bladder, thereby promoting bladder retraining by stimulating the urge to void.
Option B: The nurse shouldn’t give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent.
Option C: The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient.
Option D: Consultation with a dietitian won’t address the problem of urinary incontinence.
Nurse Vic is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract infection (UTI)?
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Solution
Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg
Maintaining a closed indwelling urinary catheter system helps prevent introduction of bacteria; securing the catheter to the client’s leg also decreases the risk of infection by helping to prevent urethral trauma.
Option B: To flush bacteria from the urinary tract, the nurse should encourage the client to drink at least 10 glasses of fluid daily, if possible.
Options C and D: Douching and feminine deodorants may irritate the urinary tract and should be discouraged.
A 24-year old female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?
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Solution
This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Option B: Because condylomata
Option B: Because condylomata acuminata is a virus, there is no permanent cure.
Option C: Because condylomata acuminata can occur on the vulva, a condom won’t protect sexual partners.
Option D: HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.
A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?
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Solution
Cottage cheese–like discharge
The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese.
Option B: Yellow-green discharge is a sign of Trichomonas vaginalis.
Options C and D: Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis.
A male client is admitted for treatment of glomerulonephritis. On initial assessment, Nurse Miley detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:
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Solution
Generalized edema, especially of the face and periorbital area.
Generalized edema, especially of the face and periorbital area, is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.
A female client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-sulfamethoxazole). Nurse Dolly should provide which medication instruction?
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Solution
“Drink at least eight 8-oz glasses of fluid daily.”
When receiving a sulfonamide such as co-trimoxazole, the client should drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits.
Option A: For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals.
Option C: No evidence indicates that antacids interfere with the effects of sulfonamides.
Option D: To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.