Page 1890 - Saunders Comprehensive Review For NCLEX-RN

646. Answer: 1

Rationale: The nurse assesses the patency of the fistula by palpating for the
presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit
indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a
normal observation but are not indicative of fistula patency. Although the presence
of a radial pulse in the left wrist and capillary refill less than 3 seconds in the
nailbeds of the fingers on the left hand indicate adequate circulation to the hand,
they do not assess fistula patency.
Test-Taking Strategy: Eliminate options 2 and 4 first because they are comparable
or alike, and assess for adequate circulation in the distal portion of the extremity
(not the fistula). Enlarged blood vessels occur when the fistula is created. Select
option 1, because a thrill indicates blood flow and patency of the fistula.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Adult Health: Renal and Urinary
Health Problem: Adult Health: Renal and Urinary: Chronic kidney disease
Priority Concepts: Clinical Judgment; Clotting
Reference: Ignatavicius, Workman, Rebar (2018), p. 1415.

647. Answer: 4

Rationale: Urethritis in the male client often results from chlamydial infection and
is characterized by dysuria, which is accompanied by a clear to mucopurulent
discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are
done for both and include culture and rapid assays. Hematuria is not associated with
urethritis. Proteinuria is associated with kidney dysfunction.
Test-Taking Strategy: Focus on the subject, manifestations of urethritis. Recalling
that urethritis generally is accompanied by dysuria in the male client will assist you
in eliminating options 1 and 3. Knowing that the problem originates in the urethra,
not the kidneys, will assist you in eliminating option 2, because proteinuria indicates
a problem with kidney function.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Adult Health: Renal and Urinary
Health Problem: Adult Health: Renal and Urinary: Inflammation/Infections
Priority Concepts: Infection; Sexuality
Reference: Ignatavicius, Workman, Rebar (2018), pp. 1359-1361.

648. Answer: 3

Rationale: Typical signs and symptoms of epididymitis include scrotal pain and
edema, which often are accompanied by fever, nausea and vomiting, and chills.
Epididymitis most often is caused by infection, although sometimes it can be caused
by trauma. The remaining options do not present all of the accurate manifestations.

1890