Exam 3 Practice Questions

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. palpation of thrill over the fistula 2. presence of a radial pulse in the left wrist 3. visualization of enlarged blood vessels at the fistula site 4. capillary refill less than 3 seconds in the nail beds of the left hand

1 rationale: check for patency by palpating for thrill or auscultating for bruit

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic renal disease. On review of the lab results, the nurse would most likely expect to note which finding? 1. elevated creatinine level 2. decrease hemoglobin level 3. decreased red blood cell count 4. increased number of white blood cells in the urine

1 rationale: the creatinine level is the most specific lab test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decrease hemoglobin level and red blood cell count are associated with anemia or blood loss. Increased WBC are indicated in infection

The nurse monitoring a client recieving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. check the level of drainage in bag 2. reposition the client to his or her side 3. contact the HCP 4. place the client in good body alignment 5. check the peritoneal dialysis system for kinks 6. increase the flow rate of the peritoneal dialysis solution

1,2,4,5

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? 1. maintain NPO status 2. encourage coughing and deep breathing 3. give small, frequent high calorie meals 4. maintain client in supine position 5. give hydromorphone IV as prescribed for pain 6. maintain IV fluids at 10 mL/hr to keep vein open

1,2,5 rationale: the client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress GI secretions, so adequate IV hydration is necessary. Because abdominal pain is a prominent symptom of pancreatitis, pain medications such as morphine are given. A side lying position with head elevated at 45 degrees decreases tension on the abdomen and may help to ease the pain. The client is susceptible to respiratory infections because retroperitoneal fluid raises the diaphragm, which causes the client to take slow, guarded abdominal breaths.

A client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious and the nurse suspects air embolism. What are the priority nursing actions? Select all that apply 1. administer oxygen to the client 2. continue dialysis at a slower rate after checking the lines of air 3. notify HCP and rapid response team 4. stop dialysis, and turn the client to the left side with head lower than feet 5. bolus the client with 500 mL of normal saline to break up the air embolus

1,3,4

Which patient is at greatest risk for developing a UTI? a. 35 yo woman with a fractured wrist b. 20 woman with asthma c. 50 yo postmenopausal woman d. 28 yo with angina

c. rationale: women are more prone to UTI's after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal bacteria, which protect against infection

The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support this diagnosis? Select all that apply 1. fever 2. positive cullen's sign 3. complaints of indigestion 4. palpable mass in the LUQ 5. pain in the RUQ after a fatty meal 6. vague lower right quadrant abdominal discomfort

1,3,5 rationale: during an acute episode of cholecystitis, the client may complain of severe RUQ pain that radiates to the right scapula or shoulder or experience epigastric pain after a fatty or high-volume meal. Fever and signs of dehydration would also be expected, as well as complaints of indigestion, belching, flatulence, nausea, and vomiting. Options 4 and 6 are incorrect with the anatomical location of the gallbladder. Option 2 is a cullen's sign which is associated with pancreatitis

A client has developed hepatitis A after eating contaminated oysters. The nurse assess the client for which expected assessment finding? 1. malaise 2. dark stools 3. weight gain 4. LUQ discomfort

1. rationale: hepatitis causes GI symptoms such as anorexia, RUQ discomfort, and weight loss. Fatigue and malaise are common. Stools will be light or clay-colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts

A client is diagnosed with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instructions should the nurse give this client to provide adequate nutrition? 1. select foods high in fat 2. increase intake of fluids, including juice 3. eat a good supper when anorexia is not as severe 4. eat less often, preferably only 3 large meals daily

2 Rationale: although no special diet is required to treat viral hepatitis, it is generally recommended that clients consume a low-fat diet, as fat may be tolerated poorly because of decreased bile production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning, so it is easier to eat a good breakfast. Including nutritional juices is important.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 101.2. Which nursing assessment is most appropriate? 1. encourage fluid intake 2. notify HCP 3. continue to monitor vital signs 4. monitor site of shunt for infection

2 rationale: a temp of 101.2 is significantly elevated and may indicate an infection. The nurse should notify the HCP. Dialysis clients cannot have fluid intake encouraged.

The nurse is instructing the client with DM about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. peritonitis 2. hyperglycemia 3. hyperphosphatemia 4. diesquilibrium syndrome

2 rationale: remember diabetic clients may need extra insulin when on dialysis!

The healthcare provider has determined that a client has contracted hepatitis A based on flulike symptoms and jaundice. Which statement made by the client supports this medical diagnosis? 1. i have had unprotected sex with multiple partners 2. i ate shellfish about 2 weeks ago at a local restaurant 3. i was an IV drug abuser in the past and shared needles 4. i had a blood transfusion 30 years ago after major abdominal surgery

2.

The nurse is reviewing the lab results for a client with cirrhosis and notes that the ammonia level is at 85 mcg/dL. Which dietary selection does the nurse suggest to the client? 1. roast pork 2. cheese omlet 3. pasta with sauce 4. tuna fish sandwich

3. rationale: protein provided by the diet is transported to the liver by the portal vein. The liver breaks down protein, which results in the formation of ammonia. Foods high in protein should be avoided singe the client's ammonia level is elevated

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition? 1. pyelonephritis 2. glomerulonephritis 3. trauma to the bladder or abdomen 4. renal cancer to the client's family

3. rationale: glomerulonephritis and pyelenephritis would be accompanied by fever, renal cancer would be flank pain

A client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestation? 1. hypertension, tachycardia, and fever 2. hypotension, tachycardia, and hypothermia 3. restlessness, irritability, and generalized weakness 4. headache, deteriorating level of consciousness, and twitching

4

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1. monitor the client 2. elevate the head of the bed 3. assess the fistula site and dressing 4. notify the HCP

4 rationale: disequilibrium syndrome may be caused by rapid removal of solutes form the body during hemodialysis.

A hemodialysis cleint with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? 1. warmth, redness, and pain in the left hand 2. ecchymosis and audible bruit over the fistula 3. edema and reddish discoloration on the left arm 4. pallor, diminished pulse, and pain in the left hand

4 rationale: steal syndrome results from vascular insufficiency after creation of fistula

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? select all that apply 1. diarrhea 2. black, tarry stools 3. hyperactive bowel sounds 4. gray-blue color at the flank 5. abdominal guarding and tenderness 6. left upper quadrant pain with radiation to the back

4,5,6 rationale: grayish-blue discoloration of the flank is known as Grey-turner's syndrome

A patient with end stage renal disease has an ateriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care? a. apply pressure to the needle site upon discontinuing hemodialysis b. keep the head of the bed elevated to 45 degrees c. place the left arm on an arm board for at least 30 minutes d. keep the left arm dry

a

What drug is indicated for pain related to acute renal calculi? a. narcotic analgesics b. nonsteroidal anti-inflammatory drugs (NSAIDS) c. muscle relaxants d. salicylates

a rationale: narcotic analgesics are usually needed to relieve the severe pain of renal calculi. NSAIDS and salicylates are used for their anti-inflammatory and antipyretic properties and to treat less severe pain. Muscle relaxants are used to treat skeletal muscle spasms

Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determined that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: a. pork b. milk c. chicken d. broccoli

a rationale: thiamine is present in a variety of foods of plant and animal origin

You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? a. check for kinks in the outflow tubing b. raise the drainage bad above the level of the abdomen c. place the patient in reverse trendelberg position d. ask the patient to cough

a rationale: tubing problems are common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change position, applying gentle pressure on the abdomen, or having a bowel movement

The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas? a. shoulder b. umbilicus c. costovertebral angle d. hip

a. rationale: bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders.

A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient's blood pressure because of which change that is associated with the liver failure? a. hypoalbumenemia b. increased capillary permability c. abnormal peripheral vasodilation d. excess rennin release from the kidneys

a. rationale: blood pressure decreases at the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and excess rennin released from the kidneys aren't direct ramifications of liver failure

Which sign indicated the second phase of acute renal failure? a. daily doubling of urine output (4-5 L/day) b. urine output less than 400 mL/day c. urine output less than 100 mL/day d. stabilization of renal function

a. rationale: daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase of acute renal failure

What is the appropriate infusion time for the dialysate in your 38 years old patient with chronic renal failure? a. 15 minutes b. 30 minutes c. 1 hour d. 2-3 hours

a. rationale: dialysate should be infused quickly. The fluid exchange takes place over a period ranging from 30 minutes to several hours

You're caring for betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? a. astrixis b. chvostek's sign c. trousseau's sign d. hepatojugular reflex

a. rationale: astrexis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Astrexis is present if the hands rapidly extend and flex.

You expect a patient with oliguric phase of renal failure to have a 24 hour urine output less than: a. 200 mL b. 400 mL c. 800 mL d. 1000mL

b

Clinical manifestations of glomuerulonephritis include which of the following? a. chills and flank pain b. oliguria and generalized edema c. hematuria and proteinuria d. dysuria and hypotension

c. rationale: these findings resuly from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis

You have a patient that might have a UTI. Which statement by the patient suggests that a UTI is likely? a. i pee alot b. it burns when i pee c. i go hours without the urge to pee d. my pee smells sweet

b.

You're caring for Lewis, a 67 year old patient with liver cirrhosis who developed ascites and requires a paracentesis. Relief of which symptom indicated that the paracentesis was effective? a. pruritus b. dyspnea c. jaundice d. peripheral neuropathy

b. rationale: ascites puts pressure on the diaphragm. Parecentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient's breathing.

Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? a. infection b. disequilibrium syndrome c. air embolus d. acute hemolysis

b. rationale: disequilibrium is cause by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased ICP. Signs and symptoms include headache, nausea, restlessness, confusion, twitching, and seizures

Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? a. jaundice and flank pain b. costoverebral angle tenderness and chills c. burning sensation on urination d. polyuria and nocturia

b. rationale: jaundice indicates gallbladder or liver obstruction. Burning sensation indicates lower UTI

Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? a. increase the rate of dialysis b. infuse normal saline solution c. administer a 5% dextrose solution d. encourage active ROM exercises

b. rationale: treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed too quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps

A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: a. meperidine provides a better, more prolonged analgesic effect b. morphine may cause spasms of Oddi's sphincter c. meperidine is less addictive than morphine d. morphine may cause hepatic dysfunction

b. this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end pancreatic duct), causing irritation of the pancreas. Meperidine has somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn't associated with hepatic dysfunction.

Which of the following causes the majority of UTIs in hospitalized patients? a. lack of fluid intake b. inadequate perineal care c. invasive procedures d. immunosupression

c

Marie, a 51 year old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse's teaching has been successful? a. 4-6 small meals of low carb foods daily b. high fat, low carb meals c. low fat, high carb d. high fat, low protein

c rationale: for the client with cholecystitis, fat intake should be reduced. The calories from fat should be substituted with carbs. Reducing carb intake would be contraindicated. Any diet high in fat may lead to another attack of cholecystitis

An 18 year old is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which most likely would be in the student's health history? a. renal calculi b. renal trauma c. recent sore throat d. family history of acute glomerulonephritis

c rationale: the most common form of acute glomerulonephritis is caused by group A beta-hemolytic strep infection elsewhere in the body

A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects? a. overflow b. reflec c. stress d. urge

c. rationale: stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as coughing or sneezing

A patient diagnosed with sepsis from UTI is being discharged. What do you plan to include in her discharge teaching? a. take cool baths b. avoid tampon use c. avoid sexual activity d. drink 8-10 oz of water daily

d rationale: drinking 2-3 L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity

A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client's status after dialysis? a. potassium level and weight b. BUN and creatinine levels c. VS and BUN d. VS and weight

d.

Which intervention do you plan to include with a patient who has a renal calculi? a. maintain bed rest b. increase dietary puriness c. restrict fluids d. strain all urine

d. rationale: all urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Ambulation may help the movement of the stone down the urinary tract. Encourage fluids to help flush the stones out.

A 22 year old patient with diabetic neuropathy says "i have two kidneys and im still young. if i stick to my insulin schedule, i dont have to worry about kidney damage, right?" which of the following statements is the best response? a. you have little to worry about as long as your kidneys keep making urine b. you should talk to your doctor because statistics show that you're being unrealistic c. you would be correct if your diabetes could be managed with insulin d. even with insulin, kidney damage is still a concern

d. rationale: microvascular changes occur in both of the patients kidneys as a complication of diabetes. Diabetic neuropathy is the leading cause of end-stage renal disease. Neuropathy occurs even with insulin management

Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? a. rub the skin vigorously with a towel b. take frequent baths c. apply alcohol-based emollients to skin d. keep fingernails short and clean

d. rationale: calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the risk of infection

Your patient complains of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphretic. Vital signs are 140/90, HR 118, respirations 33, and temop 98. Which subjective data supports a diagnosis of renal calculi? a. pain radiating to the RUQ b. history of mild flu symptoms last week c. dark-colored coffee-ground emesis d. dark, scanty uring output

d. rationale: patients with renal calculi commonly have blood in the urine caused by the stone's passage through the urinary tract. The urine appears dark, test positive for blood, and is typically scant

Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium)? a. if the urine turns orange-red, call the doctor b. take phenazopyrodine just before urination to relieve pain c. once painful urination is relieved, discontiue prescribed antibiotics d. after painful urination is relieved, stop taking phenazopyridine

d. rationale: pyridium is taken to relive dysuria because it provides an analgesic and anesthetic effect.