Nursing Elites

1. After a urography, a client is instructed by a nurse. Which instruction should the nurse include in this client’s discharge teaching?

• A. Avoid direct contact with your urine for 24 hours until the dye clears.
• B. You may experience dribbling of urine for several weeks post-procedure.
• C. Drink at least 3 liters of fluids today to assist in dye elimination.
• D. Your skin may turn slightly yellow from the dye used in this procedure.

Correct answer: C

Rationale: It is important for the client to increase fluid intake to aid in the rapid elimination of the potentially nephrotoxic dye used in urography. This instruction will help prevent any adverse effects related to the dye. Choices A, B, and D are incorrect because the dye used in urography is not radioactive, so there is no need to avoid direct contact with urine, urine dribbling is not a common post-procedure occurrence, and the dye should not cause the client's skin to change color.

2. A patient has begun taking spironolactone (Aldactone) in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to

• A. not take a potassium supplement daily.
• B. recognize that abdominal cramping is a common side effect.
• C. report decreased urine output to the provider.
• D. take these medications in the morning.

Correct answer: C

Rationale: When combining a potassium-sparing diuretic like spironolactone with a thiazide diuretic, there is an increased risk of hyperkalemia, especially in patients with poor renal function. Therefore, the patient should be educated to report any decrease in urine output, which could indicate a potential issue with kidney function. Choice A is incorrect because taking additional potassium supplements can further increase the risk of hyperkalemia. Choice B is incorrect as abdominal cramping is not a common side effect of spironolactone. Choice D is incorrect because the timing of medication administration is not directly related to the addition of spironolactone and thiazide diuretic; there is no specific recommendation to take these medications only at bedtime.

3. A client is recovering after a nephrostomy tube was placed 6 hours ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour. Which action should the nurse take?

• A. Document the finding in the client’s record.
• B. Evaluate the tube as working in the hand-off report.
• C. Clamp the tube in preparation for removing it.
• D. Assess the client’s abdomen and vital signs.

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to assess the client’s abdomen and vital signs. The nephrostomy tube should have a consistent amount of drainage, and a decrease may indicate obstruction. Before notifying the provider, the nurse must assess the client for pain, distention, and changes in vital signs. This assessment is crucial to gather essential information to report accurately. Documenting the finding without further assessment may delay necessary intervention. Evaluating the tube as working in the hand-off report or clamping the tube prematurely are not appropriate actions and could lead to complications if there is an obstruction.

4. After a renal biopsy, which intervention should the nurse include in the post-procedure plan of care?

• A. Restricting fluid intake for the first 24 hours
• B. Periodically testing the urine for occult blood
• C. Avoiding the administration of opioid analgesics
• D. Having the client ambulate in the room and hall for short distances

Correct answer: B

Rationale: After a renal biopsy, it is essential to maintain bed rest and frequently assess the client's vital signs and the puncture site. The nurse should test the urine periodically for occult blood to detect any bleeding, which could be a complication of the procedure. Restricting fluid intake for the first 24 hours is not necessary after a renal biopsy and could potentially lead to dehydration. Avoiding the administration of opioid analgesics is not a standard intervention post-renal biopsy unless contraindicated for a specific reason. Having the client ambulate in the room and hall for short distances is generally not recommended immediately after a renal biopsy due to the need for bed rest to prevent complications.

5. The nurse is caring for a patient who is ordered to receive PO trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 QID to treat a urinary tract infection caused by E. coli. The nurse will contact the provider to clarify the correct

• A. dose.
• B. drug.
• C. frequency.
• D. route.

Correct answer: C

Rationale: The correct answer is 'frequency.' Trimethoprim-sulfamethoxazole (TMP-SMX) is typically prescribed to be taken twice daily, not four times a day (QID). The dose, drug, and route are already specified in the order, so the nurse should contact the provider to clarify the frequency of administration to ensure optimal treatment for the urinary tract infection caused by E. coli. Choosing 'dose' is incorrect because the dose of 160/800 is already provided in the order. 'Drug' is incorrect because the medication Trimethoprim-sulfamethoxazole (TMP-SMX) is explicitly stated in the prescription. 'Route' is incorrect as PO (by mouth) is also clearly indicated in the prescription.

Similar Questions