Chapter: 16, 15, 14
The nurse is reviewing the purpose of insulin with a patient newly diagnosed with type 2 diabetes mellitus. What will the nurse teach the patient about the function of insulin in the body? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. It moves glucose from the blood into the body cells to be used as fuel. 2. It stimulates the liver to store extra glucose. 3. It is used to create energy. 4. It helps to bind oxygen to the blood. 5. It aids in the digestion of protein.
Correct Answer: 1,2
A critically ill patient is being evaluated for acute kidney injury. The nurse expects that which laboratory tests will be prescribed for this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Urinalysis 2. Blood-urea-nitrogen level 3. Serum creatinine 4. Arterial blood gases 5. Hemoglobin and hematocrit levels
Correct Answer: 1,2,3
A patient with acute kidney injury is prescribed intermittent hemodialysis three times a week for 4 hours each session. The nurse will plan interventions to address what problems that can occur between sessions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Fluid overload 2. Waste accumulation 3. Electrolyte imbalances 4. Hypotension 5. Infection
Correct Answer: 1,2,3
A patient with an acute kidney injury is prescribed intravenous calcium for a potassium level of 6.8 mEq/L. What actions will the nurse make when providing this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Administer the medication IV push over 2 minutes. 2. Observe for electrocardiogram rhythm changes in 1 to 3 minutes after administering the medication. 3. Monitor for ongoing effects to last 30 to 60 minutes. 4. Discontinue the medication if tachycardia occurs. 5. Observe for a urine output increase within 10 minutes after administering this medication.
Correct Answer: 1,2,3
The nurse identifies that a patient with type 2 diabetes mellitus is at risk for developing hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which health problems did the nurse identify in the patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Patient recovering from surgery 2. Patient prescribed prednisone 3. Patient receiving antibiotics for a skin infection 4. Patient receiving NSAIDs 5. Patient receiving enteral supplements
Correct Answer: 1,2,3
The nurse is caring for a patient during continuous renal replacement therapy. What interventions would the nurse perform at this time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Monitor vital signs every half hour. 2. Administer replacement fluid as determined by the hourly fluid balance goal. 3. Assess partial thromboplastin time every 1 to 2 hours. 4. Warm the dialysate to body temperature. 5. Inspect the dialysate return.
Correct Answer: 1,2,3
The nurse is planning to instruct a patient with type 1 diabetes mellitus on ways to prevent the onset of diabetic ketoacidosis (DKA). What will the nurse assess prior to teaching this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Ability to self-administer insulin 2. Performance of blood glucose testing 3. Current adjustments to diet during exercise 4. Frequency of eye examinations 5. Daily foot inspections
Correct Answer: 1,2,3
The nurse suspects that a patient with acute kidney injury will not be prescribed peritoneal dialysis because: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Peritoneal dialysis takes too much time to remove body wastes. 2. The excess fluid in the peritoneum can negatively impact the patient's breathing. 3. There are poorer outcomes from using peritoneal dialysis. 4. The patient has hypertension. 5. The patient has a potassium level of 5.5 mEq/L
Correct Answer: 1,2,3
A patient is experiencing prerenal failure secondary to hypovolemia. The nurse reviewing the patient's laboratory work and vascular pressures would expect to see which results? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Creatinine clearance of 50 mL/min/1.73m2 2. Low CVP or PAWP pressures 3. BUN of 65 mg/dL 4. Serum creatinine of 3 mg/dL 5. Urine with granular casts and sediment
Correct Answer: 1,2,3,4
The nurse is preparing an infusion of norepinephrine for a patient with acute kidney injury. What are the nurse's responsibilities when providing this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Monitor the blood pressure every 2 to 5 minutes. 2. Monitor changes in MAP. 3. Monitor heart rate and pattern. 4. Infuse through the central line. 5. Infuse through a hand vein.
Correct Answer: 1,2,3,4
The nurse, preparing instruction for a patient recovering from a critical illness, will include ways to prevent the onset of type 2 diabetes. What caused the nurse to provide this patient teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Patient is obese. 2. Patients triglyceride level is elevated. 3. Patient is 55 years old. 4. Patient has high blood pressure. 5. Patient is Caucasian.
Correct Answer: 1,2,3,4
To assist with the common complication of hypotension for the patient undergoing continuous renal replacement therapies, the nurse could implement which actions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Infuse 0.9% sodium chloride boluses. 2. Administer mannitol. 3. Decrease the rate of ultrafiltration on the dialyzer. 4. Administer albumin. 5. Place the patient in a high-Fowler's position.
Correct Answer: 1,2,3,4
When creating the care plan for a patient in the critical care unit, the nurse includes checking capillary blood glucose levels every morning. Even though the patient does not have diabetes, checking the blood glucose levels daily and maintaining them at normal levels will: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Prevent inflammation 2. Improve immunity 3. Improve lipid levels 4. Protect endothelial tissue 5. Improve oxygenation
Correct Answer: 1,2,3,4
While recovering from injuries obtained in a motor vehicle crash, a patient with type 1 diabetes mellitus begins to demonstrate signs of developing diabetic ketoacidosis (DKA). What findings would suggest to the nurse that the patient was developing DKA? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Abdominal pain 2. Nausea and vomiting 3. Deep rapid respirations 4. Ketones in the urine 5. Capillary refill 5 seconds
Correct Answer: 1,2,3,4
A nurse caring for a patient with diabetic ketoacidosis (DKA) would evaluate the patient carefully for which potential complications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Myocardial infarction 2. Acute respiratory distress syndrome 3. Pulmonary embolism 4. Pneumonia 5. Cerebral edema
Correct Answer: 1,2,3,5
When planning care for a patient in diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS), which goals would be included in the plan of care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Stabilize blood glucose levels to within normal limits. 2. Increase understanding of self-management to prevent future episodes. 3. Reestablish fluid balance through rehydration. 4. Restore A1C blood levels to at or above 8%. 5. Effectively treat the precipitating cause for DKA or HHNS.
Correct Answer: 1,2,3,5
While reviewing a patient's medication record, the critical care nurse would be concerned about which drugs that have been implicated in the development of renal failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Cyclosporine 2. Contrast media 3. Aminoglycosides 4. Antiseizure medications 5. Nonsteroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: 1,2,3,5
A patient with type 1 diabetes who is ill is seeking advice from the nurse. The nurse would highly encourage the patient to seek medical attention if the patient states: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I have had diarrhea for more than a day. 2. My mouth feels very dry from the flu. 3. I have had ketones in my urine for more than 4 hours. 4. I have had a fever of 99 degrees all day. 5. I have been vomiting all night.
Correct Answer: 1,2,5
The nurse will review a critically ill patient's history for which causes of intrinsic renal failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Contrast media given intravenously during diagnostic imaging 2. Prescribed levothyroxine (Synthroid) following thyroidectomy 3. Acyclovir (Zovorax) prescribed for treatment of genital herpes 4. Receiving prophylactic chemotherapy after surgery for cancer 5. History of using high-dose NSAIDs for rheumatoid arthritis
Correct Answer: 1,3,5
The nurse is calculating the distribution restricted fluids for a patient with acute kidney injury. The patient had a urine output of 200 mL the previous day. What amount of fluid is the patient permitted during the night? Standard Text: Record your answer rounding to the nearest whole number.
Correct Answer: 100
A patient is admitted with diabetic ketoacidosis. The nurse realizes that which problem caused the cascade to diabetic ketoacidosis (DKA) to occur? 1. Ketosis 2. Insulin deficiency 3. Hypoglycemia 4. Dehydration
Correct Answer: 2
For which order would the nurse seek clarification regarding a patient with decreased renal perfusion and lowered glomerular filtration rate? 1. Administer acetylcysteine prior to an intravenous pyelogram procedure. 2. Infuse vancomycin 1,500 mg IV every 12 hours. 3. Check a peak and trough level with every third dose of IV clindamycin. 4. Give furosemide 10 mg by mouth daily.
Correct Answer: 2
The critical care nurse is providing a training session on the principles of renal replacement therapies. When discussing how solutes move across a semipermeable membrane from a higher to lower concentration, the nurse is describing: 1. Ultrafiltration 2. Diffusion 3. Active transport 4. Osmosis
Correct Answer: 2
The intensive care nurse is reviewing a patient's chart to find the most accurate indicator of fluid volume status, which is: 1. Intake and output 2. Daily weights 3. Hematocrit level 4. Systolic blood pressure
Correct Answer: 2
The nurse believes a patient is experiencing prerenal dysfunction and not intrinsic renal failure because of which laboratory finding? 1. Urine osmolality of 200 mOsm/L 2. Urine osmolality of 550 mOsm/L 3. Urine sodium greater than 40 mmol/L 4. Presence of granular casts and sediment
Correct Answer: 2
The nurse is caring for a patient in DKA with serum sodium of 130 and serum glucose of 600. After calculating the corrected serum sodium (CSS) [CSS = Serum Na+ + {[(Serum glucose (mg/dL) 100)/100] 1.6}], which intravenous fluid would the nurse plan to provide this patient? 1. D5 NS 2. 0.45 NS 3. 0.9 NS 4. Lactated Ringers (LR)
Correct Answer: 2
The nurse is caring for a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). The nurse realizes that this health problem could develop because of: 1. Certain antibiotics that can induce HHNS in those with type 2 diabetes 2. Poor compliance to medical therapy 3. Skipping meals, especially during illness 4. Taking too much insulin during illness
Correct Answer: 2
The nurse is comparing diabetic ketoacidosis (DKA) to hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What does the nurse identify as the main difference between the two disorders? 1. DKA and HHNS are caused by too much insulin in the body. 2. No insulin is present in DKA, whereas some insulin is present in HHNS. 3. DKA results in metabolic acidosis; HHNS results in metabolic alkalosis. 4. Dehydration is greater or more severe in DKA than in HHNS.
Correct Answer: 2
The nurse would identify which nursing diagnosis for the patient experiencing dialysis disequilibrium syndrome? 1. Infection 2. Altered thought processes 3. Fluid volume deficit 4. Anxiety
Correct Answer: 2
The typical dietary plan for a patient with acute kidney injury would focus on provision of: 1. High fat, low protein 2. High carbohydrate, low protein 3. High protein, low sodium 4. High calorie, low carbohydrate
Correct Answer: 2
What will the nurse do when caring for a patient with an atrioventricular fistula in the forearm for hemodialysis? 1. Percuss the fistula for presence of a bruit each shift 2. Take the blood pressure in the unaffected arm 3. Position the patient so there is pressure on the access area 4. Flush the fistula with heparin every shift
Correct Answer: 2
Which type of insulin would the nurse administer for an intravenous bolus and continuous infusion to regulate a patients blood glucose levels? 1. Lantus 2. Regular 3. Lente 4. NPH
Correct Answer: 2
Why would the nurse implement seizure precautions in a patient with diabetic ketoacidosis (DKA)? The patient may be at risk for seizures because: 1. Potassium shifts may cause cerebral ischemia. 2. Intracellular fluid shifts may cause cerebral edema. 3. High blood glucose levels overstimulate brain cells. 4. Drugs used to treat the DKA have a side effect of seizures.
Correct Answer: 2
Which medications contribute to hyperglycemia in the patient with diabetes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Digoxin (Lanoxin) 2. Calcium channel blockers such as nifedipine 3. Sympathomimetics such as dopamine 4. Glucocorticoids such as dexamethasone 5. Thiazide diuretics such as hydrochlorothiazide/HCTZ
Correct Answer: 2,3,4,5
A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes. What is the best explanation for a high glucose in a patient without diabetes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The physiologic stress of a large meal plus a myocardial infarction causes hyperglycemia. 2. Insulin resistance is caused by pro-inflammatory factors. 3. Insulin resistance is caused by beta blockers and nitroglycerin, which are commonly used to treat myocardial infarction. 4. Myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state. 5. Glucagon, cortisol, and epinephrine cause hyperglycemia.
Correct Answer: 2,4,5
A nurse plans to administer to a patient a fluid challenge for the purpose of establishing normal renal perfusion. What does this treatment involve? 1. Infusing 250 mL of 0.9% sodium chloride over 1 hour 2. Administering albumin intravenously, followed by furosemide 3. Infusing 500 mL of normal saline over a 30-minute period 4. Giving twice the amount of IV fluid each hour compared to urinary output
Correct Answer: 3
A patient has been placed on a 1,000-mL fluid restriction over 24 hours. Choose the plan that reflects how the critical care nurse would divide this amount of fluid. 1. 350 mL for dayshift, 325 mL for evening shift, and 325 mL for nightshift 2. 400 mL for dayshift, 400 mL for evening shift, and 200 mL for nightshift 3. 500 mL for dayshift, 325 mL for evening shift, and 125 mL for nightshift 4. 600 mL for dayshift, 200 mL for evening shift, and 200 mL for nightshift
Correct Answer: 3
A patient with acute kidney injury is disappointed that hemodialysis, instead of peritoneal dialysis, is planned for treatment. After teaching about the two types of dialysis, the nurse determines that further instruction is needed when the patient makes which statement about the disadvantages of peritoneal dialysis? 1. "It's not speedy enough to remove the wastes." 2. "It may worsen my breathing problems." 3. "It cannot be used for older patients like me." 4. "It's not nearly as efficient as hemodialysis."
Correct Answer: 3
An older patient being treated for pneumonia has signs of metabolic syndrome but denies the presence of diabetes. Serum glucose is 220 mg/dL and the hemoglobin A1C is 5%. What can be induced from these findings? 1. The nurse should anticipate discharge teaching related to insulin to manage blood sugars at home. 2. The nurse anticipates that the doctor will diagnose the patient with type 1 diabetes. 3. The nurse would anticipate treatment with sliding scale insulin even though diabetes is not yet evident. 4. The nurse anticipates that the doctor will diagnose the patient with type 2 diabetes.
Correct Answer: 3
The certified diabetes educator (CDE) has encouraged a patient with metabolic syndrome who experienced hyperglycemia during hospitalization to attend outpatient diabetes education classes. The patient asks why the classes are needed if diabetes is not a health problem. What is the nurses best response? 1. The certified diabetes educator (CDE) saw that you had high blood sugars while in the ICU. I will let her know that you are not diabetic. 2. You will learn about healthy diet, weight management, and exercise. This knowledge can delay the onset of type 2 diabetes. 3. If you maintain a healthy diet, correct weight, and exercise you can delay the onset of type 2 diabetes. 4. The class is only for those with diabetes. If you become diabetic you may attend the class.
Correct Answer: 3
The nurse is explaining the pathophysiology of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which statement will the nurse include when teaching? HHNS: 1. Is accompanied by severe metabolic acidosis 2. Results in cellular overhydration and interstitial space dehydration 3. Causes severe dehydration from very high osmolarity 4. Causes a severe decline in glucose production, resulting in increased metabolic rates to burn fat for energy
Correct Answer: 3
The nurse monitors the blood glucose levels of a patient being treated with insulin for diabetic ketoacidosis to ensure glucose levels decline at the rate of 50-70 mg/dL/hour because: 1. When blood glucose drops rapidly fluids shift out of the cell, which increases dehydration, causing severe hypovolemic shock. 2. When blood glucose drops rapidly severe damage to the brain results from metabolic alkalosis. 3. A rapid drop in blood glucose can result in hypokalemia, causing life-threatening arrhythmias. 4. A rapid drop in blood glucose can result in formation of thromboses as a result of dehydration.
Correct Answer: 3
The nurse preparing to administer peritoneal dialysis would have which responsibility in contrast to hemodialysis? 1. Knowing the patient's dry weight prior to beginning 2. Monitoring for changes in vital signs 3. Inspecting the tunneled catheter for infection 4. Suggesting a low-Fowler's position for comfort
Correct Answer: 3
To test for a positive Trousseau's sign indicating hypocalcemia, the nurse would need which piece of equipment? 1. Percussion hammer 2. Penlight 3. Blood pressure cuff 4. Doppler
Correct Answer: 3
Using evidence based practice interventions for a patient with acute kidney injury, the nurse is aware that the best approach for fluid volume excess management is: 1. A sodium-restricted diet 2. Diuretics 3. Fluid restriction 4. Plasmapheresis
Correct Answer: 3
What would the best nutritional goal for the patient with acute kidney injury? 1. Weight will increase by 3 pounds in a month 2. Patient eats over 50% of all meals 3. Albumin level will rise from 2.6 g/dL 4. Total protein level will increase to 10 g/dL
Correct Answer: 3
What would the nurse assess before beginning insulin therapy in a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1. Sodium level (Na+) 2. Previous history of cardiac dysrhythmias 3. Potassium level (K+) 4. Arterial blood gas results
Correct Answer: 3
When calculating the initial rate of an insulin infusion as treatment for diabetic ketoacidosis in a patient weighing 80 kg, the nurse would expect to administer insulin at what rate? 1. 120 units per hour 2. 80 units per hour 3. 8 units per hour 4. 12 units per hour
Correct Answer: 3
A patient with diabetes has a serum osmolarity level of 325 mmol/L. What is the correct interpretation and action for the nurse to take based on this result? 1. The result is somewhat high but no immediate action is necessary. 2. The result is very low and the physician should be notified of the result. 3. The result is somewhat low but no immediate action is necessary. 4. The result is very high and the physician should be notified of the result.
Correct Answer: 4
A patient, admitted with cellulitis, has hemoglobin A1C level that revealed the patients average blood sugars prior to admission were 300 mg/dL. The patient has been started on insulin in addition to oral diabetes medications. Which teaching point is essential for this patient to understand before discharge? It will be important for you to: 1. Decrease your weight in order to decrease your hemoglobin A1C. 2. Eat for 60 minutes each morning after taking your insulin. 3. Change the types of carbohydrates you eat to complex carbohydrates. 4. Use the glucose meter to check your blood sugars before you take your insulin.
Correct Answer: 4
Of the following patients in an intensive care unit, the nurse identifies which patient as being at highest risk for the development of acute kidney injury with a prerenal cause? A patient who is: 1. Experiencing acute status asthmaticus 2. Being treated for hypertension following a cerebral vascular accident 3. In skeletal traction following a motor vehicle accident 4. Post-operative from a ruptured abdominal aortic aneurysm
Correct Answer: 4
The intensive care nurse explains to a patient with acute kidney injury that the most effective method for reducing hyperkalemia is the use of: 1. Insulin plus glucose 2. Inhaled beta agonists 3. Sodium bicarbonate 4. Hemodialysis
Correct Answer: 4
The nurse, caring for a patient weighing 80 kg, is preparing an initial dose of insulin as beginning treatment for diabetic ketoacidosis. What are the appropriate dose and route for the nurse administer the insulin? 1. 8 units IV 2. 8 units subcutaneous 3. 12 units subcutaneous 4. 12 units IV
Correct Answer: 4
What would the critical care nurse expect to find if administering a fluid challenge to an 80-year-old patient had the intended effect? 1. A systolic blood pressure of 120 mm Hg or less 2. Heart rate remaining steady at 60 to 70 beats per minute 3. Skin turgor showing improvement within 24 hours 4. A MAP of 70 mm Hg or higher
Correct Answer: 4
Which patient situation would increase the risk for developing dialysis disequilibrium syndrome? 1. Peritoneal dialysis provided in a home environment 2. Patient who received an ACE inhibitor prior to hemodialysis 3. A known history of long-term substance abuse 4. Patient undergoing first hemodialysis treatment
Correct Answer: 4
A patient has started taking corticosteroids for immune suppression following transplantation. What should the nurse teach the patient about this medication?
Select all that apply. 2. Increased thirst and urination may occur, but should be reported immediately. 3. Your face may have a full or round appearance after taking this medication. 5. Mood swings are common when taking this medication. Correct Answer: 2,3,5
A patient recovering from a liver transplant is at risk for malnutrition. What would the nurse include when planning care for this patient?
Select all that apply. 1. Consult with a dietician to plan for adequate energy from carbohydrates or fats. 2. Provide nutritional supplements enterally. Correct Answer: 1,2
The nurse should suspect that a patient recovering from a liver transplant is experiencing acute rejection if what is found during assessment?
Select all that apply. 1. Malaise and fatigue 2. Swollen and tender graft site 3. Colorless bile 4. Tea-colored urine Correct Answer: 1,2,3,4
A patient recovering from a kidney transplant is prescribed tacrolimus (Prograf). What actions will the nurse take when providing this medication to the patient?
Select all that apply. 1. Provide the medication orally. 2. Provide the medication in the morning before breakfast. 3. Monitor blood pressure. 4. Assess capillary blood glucose level daily. Correct Answer: 1,2,3,4
A patient in the intensive care unit is having brainstem reflexes assessed to validate brain death. What assessment findings would validate the diagnosis of brain death?
Select all that apply. 1. Pupils do not respond to light or accommodation 2. Absent corneal reflex 3. No cough reflex to bronchial suctioning Correct Answer: 1,2,3
The nurse is caring for an organ donor patient who has been diagnosed as brain dead. What will the nurse do to ensure stability of the patient's body temperature?
Select all that apply. 1. Set the room temperature to 90 degrees Fahrenheit. 2. Administer warm intravenous fluids. 3. Apply warming blankets to the patient. Correct Answer: 1,2,3
The mother of a patient wants to be evaluated as a living kidney donor. Which diagnostic tests would the mother need to be considered as a living donor?
Select all that apply. 1. Tissue typing 2. Antibody screening 3. Screening for transmissible diseases 4. Renal function tests Correct Answer: 1,2,3,4
A patient with end-stage renal disease wants to be considered for a kidney transplant. What would the nurse explain about the United Network for Organ Sharing waiting list process?
Select all that apply. 1. Waiting time begins when the patient begins chronic dialysis maintenance. 2. The patient's location in proximity to the available kidney is a consideration in determining who will receive the kidney. 3. The number of matches between the candidate's and donor's HLA antigens is a significant consideration in who will receive an organ. Correct Answer: 1,2,3
A patient is being discharged to home after receiving a liver transplant. What can the nurse instruct the patient and family to reduce the risk of developing an infection?
Select all that apply. 1. Wash hands before eating and after using the bathroom. 2. Wear a mask when in a crowd for the first few months post-transplant. 3. Remove plants and flowers in vases from the home. 4. Wash, peel, and cook all fruits and vegetables. Correct Answer: 1,2,3,4
A patient who developed signs of rejection to a liver transplant within the first week of receiving the organ is asking about the possibility of organ failure. What is the nurse's most appropriate response to this patient?
1. "You are receiving medications to prevent the rejection. We will continue to do everything to treat the rejection and keep you informed of what is happening." Correct Answer: 1
A patient is placed on an organ transplant list for a living or deceased kidney donor. What percentage of organ donors are living organ donors?
1. 20% 2. 30% 3. 40% 4. 50% Correct Answer: 4
A patient is demonstrating signs of organ rejection 3 months following a kidney transplant. The nurse recognizes this reaction as being what type of rejection?
1. Acute rejection Correct Answer: 1
The nurse is teaching a patient about the antigen-antibody response. Which statement best describes an antigen?
1. Antigens are recognized by the body as foreign or non-self. 2. The presence of HLA antigens means that the recipient cannot receive an organ. 3. A recipient may have antihuman antigens that would react with a donated organ. 4. An organ can only be transplanted if the potential donor and recipient antigens completely match. Correct Answer: 1
The nurse is caring for a patient who is approaching death. When must the nurse notify the organ bank? When:
1. Death is imminent in all cases. Correct Answer: 1
A patient candidate for organ donation has developed diabetes insipidus. What will the nurse most likely assess in this patient?
1. Large urine output and low urine specific gravity Correct Answer: 1
The nurse is reviewing the tissue requirements for organ recipients and donors. Which statement correctly describes which recipients can receive an organ from which donor?
1. Recipients with blood type O are universal recipients. 2. Recipients with blood type A can receive donations from donors with blood types A, AB, and O. 3. Recipients with blood type B can receive donations from donors with blood types A, B, and O. 4. Recipients with blood type AB can receive an organ from any donor blood type. Correct Answer: 4
A patient is being evaluated for rejection after a heart transplant. What will this assessment include?
1. Repeated heart biopsies to assess for myocyte damage or necrosis Correct Answer: 1
A nurse recognizes that advocating for organ donation is important because:
1. The supply of donor organs meets the demand of potential recipients. 2. Organ recipients are not expected to have a long life span because of complications associated with the transplant. 3. The organ recipient usually enjoys a better quality of life at less cost to the health care system. 4. The organ recipient is often confined by frequent health care visits in order to maintain health. Correct Answer: 3
Which intervention is important when the nurse is caring for a patient who is a potential lung donor in order to ensure that the lungs remain suitable for transplant?
2. Avoiding excess fluid replacement Correct Answer: 2
A patient is a candidate for organ donation. A pulmonary artery catheter has been inserted to help maintain hemodynamic stability. Which finding demonstrates that the patient has adequate hemodynamic stability?
2. CVP 6 and PCWP 10 Correct Answer: 2
Which finding by the nurse assessing a potential organ donor would indicate that the patient did not meet the criteria for donation based on brain death?
2. Decorticate posturing Correct Answer: 2
Which intervention is most important to include in the multidisciplinary plan to prevent infection in a patient during the early post-transplant period?
2. Encouraging the patient to ambulate and use an incentive spirometer Correct Answer: 2
What best describes the role of the critical care nurse in the organ donation process?
2. Reinforce the explanation of brain death after the doctor has talked to the family. Correct Answer: 2
The nurse is determining the MELD score for a patient waiting for a liver transplant. This score contains which criteria?
2. Serum creatinine level, INR, and bilirubin Correct Answer: 2
A patient in a critical care area has passed away. Who is the best person to approach the family about organ donation?
2. The organ procurement specialist Correct Answer: 2
A patient has become a candidate to donate organs in Town A. Based on the UNOS priority system, which potential recipient would be the best candidate to receive a kidney transplant?
3. A patient on dialysis with compatible blood type and six matching antigens who lives in Town B (60 miles away) Correct Answer: 3
A patient 3 months post-transplant is experiencing a sore mouth and throat and is having trouble eating. Upon assessment the nurse sees white patches on the mucous membranes. This patient has probably developed what opportunistic infection?
3. Candidiasis Correct Answer: 3
A patient recovering from a kidney transplant is taking daclizumab (Zenapex) and has developed a fever and chills with joint pain. What action should the nurse take?
3. Continue to give the medication as scheduled and communicate the reaction to the doctor. Correct Answer: 3
Which assessment findings would cause the nurse to suspect acute rejection of a transplanted kidney?
3. Decreased urine output Correct Answer: 3
What would the nurse include when providing discharge instructions to a patient recovering from a kidney transplant?
4. "Contact the transplant center if your cardiologist changes your heart medications." Correct Answer: 4
The critical care nurse is reviewing patients who would be good candidates for organ donation. Which patient would be appropriate for this process?
4. A 55-year-old with intracranial pressure from a primary intracranial tumor Correct Answer: 4
A patient wants to donate organs after cardiac death. One hour after the withdrawal of life support the patient continues to breathe shallowly and has a slow heartbeat. What is the nurse's most appropriate response?
4. Allow death to occur naturally without organ donation. Correct Answer: 4
A patient's urine output is greater than 200 mL/hour and hemodynamic stability cannot be achieved by using fluids and vasoactive medications. The nurse anticipates that which medication may be prescribed?
4. Hormone such as vasopressin Correct Answer: 4
A newly admitted patient with HHNK has a serum glucose of 850 mg/dL and a potassium level of 3.9 mEq/L. An important nursing consideration that should precede replacement of potassium includes: 1. Assessment of urine output. 2. Assessment of lung sounds. 3. Assessment of dehydration. 4. Calculation of serum osmolarity.
Correct Answer: 1
A patient in the intensive care unit is reported to be in the oliguric phase of intrinsic renal failure, which is reflected by: 1. Urine output of less then 400 mL/day 2. BUN and creatinine that may begin to increase slightly 3. Urinary output of up to 5 liters of urine each day 4. Abnormal laboratory values that can last from 6 months to a year in duration
Correct Answer: 1
The nurse is determining if a patient is experiencing DKA or HHNS. Which information would help the nurse in making this determination? 1. Patients with DKA exhibit Kussmauls respirations to blow off CO2 and reduce pH levels. 2. Patients with HHNS have lower arterial pH levels than those with DKA. 3. Patients with DKA have more visual disturbances than patients with HHNS. 4. Patients with HHNS have moderate hyperglycemia, whereas patients with DKA have more severe hyperglycemia.
Correct Answer: 1
The nurse monitors the patient undergoing intermittent hemodialysis (IHD) for the most common complication of the procedure, which is: 1. Hypotension 2. Infection 3. Hyperglycemia 4. Hypokalemia
Correct Answer: 1
When instructing a patient about metabolic syndrome, the nurse would include that which finding is a risk factor for the development of diabetes? 1. Central obesity 2. Decreased triglycerides 3. Low LDL levels 4. Low insulin levels
Correct Answer: 1
When instructing a patient about metabolic syndrome, what will the nurse include? 1. It is also called insulin resistance syndrome. 2. Fasting blood sugars are over 140 mg/dL. 3. It is seen more frequently in people who carry extra weight in their hips and legs. 4. It affects about 10% of the U.S. population.
Correct Answer: 1
Which nursing diagnosis would not be applicable when planning care for a patient with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1. Excessive fluid volume related to (RT) fluid shifts from hyperosmolarity 2. Imbalanced nutrition, less than body requirements RT inability to utilize glucose 3. Ineffective tissue perfusion RT hypovolemia and decreased peripheral blood flow 4. Risk for infection RT increased blood glucose and decreased peripheral blood flow
Correct Answer: 1
A patient is brought to the emergency department with manifestations of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What will the nurse assess to determine the patients hydration status? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Vision 2. Weight loss 3. Respiratory rate 4. Oxygen saturation level 5. Urine for ketones
Correct Answer: 1,2
The nurse is concerned that a patient in the critical care area is experiencing short-term complications of diabetes. What did the nurse find when assessing this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Infected leg wound 2. Declining hourly urine output 3. Numb feet 4. Vision changes 5. Dropping oxygen saturation level
Correct Answer: 1,2
The nurse is planning care for a patient with an acute kidney injury. Which interventions would prevent further injury to the patient's kidneys? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Use strict aseptic technique when providing care. 2. Discuss the need for acetylcysteine with the health care provider prior to testing that uses contrast dye. 3. Measure urine output every 8 hours. 4. Prepare a fluid challenge with Dextrose 5% and water. 5. Calculate fluid restriction.
Correct Answer: 1,2
