Module 3 Week 9 Renal, Hematological, Oncological Exam V1

A 55-year-old female client is admitted with complaints of fatigue, dark-colored urine, and mild lower abdominal discomfort. A urinalysis is ordered. Laboratory Results: Color: Dark amber Odor: Strong ammonia-like smell pH: 5.0 Osmolality: 1100 mOsm/kg Specific gravity: 1.035 Glucose: Negative Ketones: Negative Protein: 1+ Bilirubin: Positive Casts: Positive Bacteria: 50,000/mL Hemoglobin: Negative Myoglobin: Negative Culture for organisms: Pending Based on the urinalysis findings, which abnormalities should the nurse report to the provider? Select all that apply. Specific gravity of 1.035. Urine pH of 5.0. Positive bilirubin. Positive protein. Presence of casts. Bacteria count of 50,000/mL. Negative glucose and ketones.

A 62-year-old client is admitted to the hospital following abdominal surgery complicated by blood loss. On postoperative day 2, the client has a urine output of 250 mL over 24 hours. Laboratory results show elevated BUN and creatinine, metabolic acidosis, and hyperkalemia. The nurse notes edema, crackles in the lungs, and confusion. The provider suspects acute kidney injury (AKI). Which phase of acute kidney injury is this client most likely experiencing, and what nursing actions are appropriate at this stage?. Onset phase; begin increasing oral fluid intake and monitor for dehydration. Oliguric phase; restrict fluid intake and monitor for signs of fluid overload. Diuretic phase; hold IV fluids and encourage protein-rich diet. Recovery phase; discharge planning and promote mobility to regain strength.

The nurse is caring for a 68-year-old client with a diagnosis of acute kidney injury in the oliguric phase. The ECG monitor shows peaked T waves and a widening QRS complex, which the nurse notes while completing the assessment. Urine output: 200 mL in 24 hours Blood pressure: 158/92 mm Hg Serum potassium: 6.4 mEq/L Heart rate: 108 bpm, irregular Reports nausea and generalized muscle weakness Which action should the nurse take first?. Notify the health care provider of the urine output. Administer a prescribed antiemetic for nausea. Administer a prescribed dose of calcium gluconate IV. Restrict dietary potassium intake.

The nurse is reviewing a list of medications for a hospitalized client who has a history of chronic kidney disease. Which of the following medications should the nurse identify as potentially nephrotoxic and report to the provider? Select all that apply. Gentamicin. Amphotericin B. Ibuprofen. Cisplatin. Acetaminophen. Metoprolol. Lead exposure (history of occupational exposure).

The nurse is caring for a 72-year-old client with stage 4 chronic kidney disease who reports shortness of breath when lying flat and mild chest discomfort, along with nausea, fatigue, hypertension, and swelling in both lower extremities. Which action should the nurse take first?. Place the client in high Fowler's position. Notify the provider of the elevated BUN and creatinine levels. Administer the prescribed oral antihypertensive medication. Administer sodium polystyrene sulfonate (Kayexalate) as prescribed.

The nurse is caring for a 68-year-old client with end-stage renal disease who is receiving scheduled hemodialysis. The client presents with stable vital signs and is alert and oriented. Which of the following nursing interventions are appropriate in the plan of care? Select all that apply. Monitor the client's vital signs before, during, and after dialysis. Administer antihypertensive medications prior to dialysis. Assess for fluid overload before and fluid deficit after dialysis. Encourage the client to eat before or during dialysis if tolerated. Monitor the access site for patency and signs of bleeding. Administer water-soluble vitamins before dialysis. Notify the provider if the client's temperature elevates excessively during dialysis.

Scenario: The nurse is teaching a postmenopausal client during an annual wellness exam how to perform a breast self-examination (BSE) at home. The nurse provides the following instructions. Identify whether each instruction is appropriate or not appropriate based on recommended guidelines. Use the pads of the second, third, and fourth fingers to examine the breast. Use only one hand to examine both breasts simultaneously for symmetry. Examine the breast in the shower using small circular motions in an up-and- down pattern. Check for breast changes only by looking in the mirror with arms at your side. While lying down, place a towel under one shoulder and hand behind the head to examine. Use the palms of the hands to feel for lumps or thickening. Observe for dimpling or changes while pressing hands firmly on hips to engage pectorals.

The nurse is caring for a client receiving chemotherapy for acute leukemia who presents with nausea, muscle cramps, and weakness. Laboratory results are: potassium 6.4 mEq/L (6.4 mmol/L), phosphate 6.0 mg/dL, calcium 7.1 mg/dL, and uric acid 10.8 mg/dL. Which of the following actions should the nurse take first?. Administer sodium polystyrene sulfonate (Kayexalate) as prescribed. Administer calcium gluconate IV as prescribed. Encourage oral fluids and monitor intake and output. Notify the healthcare provider of the client's symptoms and lab results.

The nurse is caring for a client who is two days post-kidney transplant. The client is receiving immunosuppressive therapy and is being monitored closely for signs of complications. Which of the following assessment findings should the nurse report to the provider? Select all that apply. Blood pressure of 148/92 mm Hg. Temperature of 101.1°F (38.4℃). Mild pain at the surgical site. Urine output of 20 mL/hour. Serum creatinine of 3.2 mg/dL. Weight gain of 2 kg in 24 hours.

The nurse is caring for a client who is 1 hour postoperative following a tracheostomy. Which of the following findings requires the nurse's immediate intervention?. Small amount of serosanguinous drainage at the stoma site. Respiratory rate of 24 breaths per minute. Audible gurgling sounds with decreased oxygen saturation. Cuff pressure of 18 mm Hg on the tracheostomy tube.

The nurse is caring for an adult client admitted with a vaso-occlusive sickle cell crisis. Evaluate each intervention below and determine whether it is appropriate or inappropriate for managing a vaso-occlusive crisis. Apply cool compresses to painful joints. Administer IV fluids as prescribed. Encourage ambulation every hour. Keep the client on bedrest during periods of severe pain. Administer prescribed opioid analgesics. Limit fluid intake to prevent fluid overload. Administer aspirin for mild joint discomfort. Apply ice packs to reduce localized swelling.

The nurse is teaching the family of a client with a recent total laryngectomy and permanent tracheostomy about home care. Which of the following statements reflect appropriate understanding? Select all that apply. We will ensure the client wears a stoma guard when going outside to prevent dust from entering. We will keep the tracheostomy stoma covered with a scarf at all times to avoid infections. We will clean the stoma and change the dressing using clean technique. We will avoid using aerosol sprays, powders, and perfumes near the stoma. We will place a shower shield on the client to prevent water from entering the airway. We will encourage the client to swim regularly to improve cardiovascular health.

A 50-year-old client presents to the outpatient clinic for an annual wellness exam. The nurse is reviewing the client's health history and notes the following recent changes: Chronic indigestion for the past 3 months A sore on the lip that has not healed in 4 weeks Frequent hoarseness and coughing for the past 2 months Occasional fatigue with a recent hemoglobin of 10.2 g/dL Based on the client's reported findings, which symptoms are recognized as early warning signs of cancer? Select 3 answers that apply. Chronic indigestion. Sore on the lip that does not heal. Occasional fatigue. Persistent hoarseness and cough. Hemoglobin level of 10.2 g/dL. Mild joint pain in the morning. Occasional dizziness when standing. Short-term memory lapses.

The nurse is caring for a client with a sealed radiation implant for treatment of cervical cancer. The nurse is orienting a student nurse to the precautions necessary for safe client care. Which of the following actions by the student nurse requires intervention? Select all that apply. Wears a dosimeter film badge while caring for the client. Spends 45 minutes at the bedside organizing supplies and assisting with hygiene. Touches the radiation implant directly to adjust its position in bed. Requests a pregnant nurse to take over care during lunch break. Leaves the door to the client's room partially open during care. Places a radiation precaution sign on the client's door. Allow the client's 10-year-old son to visit for 10 minutes at the bedside.

A 54-year-old client arrives at the emergency department with complaints of sudden, severe left-sided flank pain radiating to the groin, nausea, and visible hematuria. The nurse notes the client is diaphoretic and reports difficulty urinating. The client has a history of frequent kidney stones and hyperparathyroidism. The provider orders IV fluids, pain medication, and a CT scan of the abdomen and pelvis. Which nursing intervention takes priority at this time?. Provide a warm compress to the flank area to ease muscle tension. Administer the prescribed IV fluids at 150 mL/hr. Monitor the client's temperature. Administer prescribed analgesia to control acute pain.

A 55-year-old postmenopausal client comes to the clinic for a routine check-up. The nurse is providing education about breast cancer screening and symptoms that warrant further evaluation. Which of the following findings should the nurse identify as potential warning signs of breast cancer? Select all that apply. Painless, fixed, irregular mass detected on breast self-exam (BSE). Slight asymmetry between breasts. Clear nipple discharge. Dimpling of the skin over the breast. Peau d'orange appearance of the breast skin. Absence of palpable lymph nodes in the axilla. Nipple elevation or retraction.

The nurse is caring for a 45-year-old adult client with newly diagnosed iron-deficiency anemia who reports fatigue and dizziness. The client's vital signs are: BP 92/58 mm Hg, HR 110 bpm, RR 20, SpO2 95% on room air. Lab results reveal hemoglobin 6.9 g/dL (69 g/L), hematocrit 21%. Which of the following nursing actions is the priority?. Prepare the client for blood transfusion per standing order. Educate the client about iron-rich food sources. Reassess the client's blood pressure in 30 minutes. Administer oral iron supplementation.

The nurse is caring for a client with a history of small-cell lung carcinoma who recently completed radiation therapy. The client is alert but appears anxious and reports tightness in the chest and difficulty buttoning their shirt due to swelling. On assessment, the nurse notes periorbital edema and distended neck veins. Vital signs: BP 132/78, HR 94, RR 26, SpO2 90% on room air. Which action should the nurse take first?. Administer oxygen via non-rebreather mask. Elevate the head of the bed to high Fowler's position. Notify the healthcare provider of the client's condition. Prepare the client for emergency imaging studies.

The nurse is caring for a client with a small-cell lung tumor who was recently diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The client is increasingly confused and complains of headaches and muscle cramps. The most recent lab results show: sodium 119 mEq/L (119 mmol/L), serum osmolality 260 mOsm/kg, and urine specific gravity 1.035. Which action should the nurse take first?. Place the client on seizure precautions. Restrict the client's fluid intake to 800 mL/day. Notify the healthcare provider of the sodium level. Administer prescribed hypertonic saline.

The nurse is working on a medical-surgical unit and receives report on the following four clients. Which client should the nurse assess first?. A client with multiple myeloma who reports lower back pain and fatigue. A client with iron-deficiency anemia who has a hemoglobin level of 7.4 g/dL and is scheduled for discharge in the afternoon. A client with metastatic lung cancer who is receiving chemotherapy and reports new onset of facial swelling and tightness around the collar. A client with sickle cell anemia who reports joint pain rated 8/10 and is awaiting a dose of opioid analgesic.