The healthcare provider prescribes a 24-hour urine specimen to be collected for creatinine clearance. The client is eager to go home and tells the nurse that the first sample was put in the urinal 2 hours ago. Which action should the nurse implement?

Start collecting the specimen with the next void.

Begin the collection the next day.

Observe the sample for sediment.

Empty the sample into the 24-hour container.

Answer and Explanation

The Correct Answer is A

The correct answer is A. Start collecting the specimen with the next void.

Choice A reason: The 4-hour urine collection for creatinine clearance should start with an empty bladder. The first urine of the day is discarded and the time is noted. All subsequent urine for the next 4 hours, including the first urine the following day, should be collected. If the first sample was put in the urinal hours ago and was not collected, the nurse should start collecting the specimen with the next void.

Choice B reason: Beginning the collection the next day would delay the test and may not be necessary. The test should ideally start after the first urine of the day is discarded.

Choice C reason: Observing the sample for sediment is not typically part of the procedure for a 4-hour urine collection for creatinine clearance. The focus is on collecting all urine for a specified period, not on the physical characteristics of the sample.

Choice D reason: Emptying the sample into the 4-hour container would be incorrect if the sample was the first urine of the day, which should be discarded. The collection should start with the next void.

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Correct Answer is B

Explanation

Choice A reason: Assessing the position of the mask on the client's face is not the priority action. The mask may be well-fitted, but the oxygen delivery may be compromised by the faulty connection of the flowmeter.

Choice B reason: Releasing and reinserting the flowmeter in the wall outlet is the best action as it may correct the problem of the loose or misaligned connection. The nurse should ensure that the flowmeter is securely attached and that the oxygen is flowing properly.

Choice C reason: Attaching the flowmeter to a humidification canister is not necessary for oxygen delivery per mask. Humidification is usually added for high-flow oxygen devices such as nasal cannula or face tent.

Choice D reason: Adjusting the flow rate to the prescribed liters per minute is not the appropriate action. The flow rate may be correct, but the oxygen delivery may be impaired by the hissing sound indicating a leak or obstruction.

A. To avoid pain-causing activity. B. To take analgesics as prescribed. C. To show evidence of incision healing. D. To ambulate without discomfort.

Correct Answer is D

Explanation

Choice A reason: To avoid pain-causing activity is not the best outcome statement for the nurse to include in this client's plan of care. It does not address the problem of activity intolerance, but rather reinforces the client's refusal to ambulate. It may also delay the client's recovery and increase the risk of complications.

Choice B reason: To take analgesics as prescribed is a relevant outcome statement for the nurse to include in this client's plan of care, but not the best one. It may help to reduce the client's pain and improve his comfort, but it does not directly measure the client's activity tolerance or mobility.

Choice C reason: To show evidence of incision healing is an important outcome statement for the nurse to include in this client's plan of care, but not the best one. It indicates the client's progress and recovery from surgery, but it does not reflect the client's activity intolerance or pain level.

Choice D reason: To ambulate without discomfort is the best outcome statement for the nurse to include in this client's plan of care. It addresses the problem of activity intolerance related to pain, and the goal of increasing the client's mobility and function. It also implies that the client's pain is well-managed and his incision is healing.

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The healthcare provider prescribes a 24-hour urine specimen to be collected for creatinine clearance. The client is eager to go home and tells the nurse that the first sample was put in the urinal 2 hours ago. Which action should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When initiating oxygen per mask to a client who is short of breath, the nurse hears a loud hissing sound after inserting the flowmeter into the wall outlet. Which should the nurse do next?

Correct Answer is B

Explanation

Correct Answer is D

Explanation

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