module 11 target quiz
The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching? "I should limit foods high in potassium in my diet, such as bananas." "I should limit the amount of protein in my diet." "I should drink as much as possible to keep my kidneys working." "My intake of high sodium foods should be limited."
"I should drink as much as possible to keep my kidneys working." Explanation: Dietary management of acute post-streptococcal glomerulonephritis includes restrictions of protein, sodium, potassium, and fluids.
A nurse working at a pediatric clinic is teaching a group of parents. A parent asks the nurse if it is okay to let the young child recover from a sore throat naturally, rather than bringing the child to the clinic for diagnosis and treatment. What is the nurse's best response? "It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment." "It is fine to let the child recover naturally; it will save you time and money." "It is not a good idea to give antibiotics for every sore throat that your child has because of the overuse of antibiotics." "Health care providers tend to overtreat children with antibiotics so the child recovers quickly."
"It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment." Explanation: A sore throat may be streptococcal pharyngitis. Diagnosing and treating the sore throat can prevent rheumatic fever and, therefore, rheumatic heart disease. Letting children recover naturally can be dangerous if the sore throat is a streptococcal infection. The use of antibiotics is considered by each prescribing heath care provider. General statements about treatments are not helpful.
A nurse and a nursing student are performing a physical assessment of a client with pericarditis. The client has an audible pericardial friction rub on auscultation. When leaving the room, the student asks the nurse what causes the sound. The nurse's best response is which of the following? "The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other." "The layers of the heart become loose from each other and rub together with each heart beat." "The great vessels rub against the pericardium with each heart beat." "The lung surfaces lose their lubrication and rub against the myocardium with each heart beat."
"The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other." Explanation: A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid due to inflammation. The rub is audible on auscultation and is synchronous with the heartbeat. The layers of the heart never become loose from each other. The great vessels are not in contact with the inside of the pericardium, where the inflammation is located. The lungs have nothing to do with a pericardial friction rub.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Acute renal failure Acute glomerulonephritis Chronic renal failure Nephrotic syndrome
Acute glomerulonephritis Explanation: Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
A client with a history of rheumatic heart disease knows they are at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the client knows the importance of taking which of the following drugs? Enoxaparin Metoprolol Azathioprine Amoxicillin
Amoxicillin Explanation: Although rare, bacterial endocarditis may be life threatening. A key strategy is primary prevention in high-risk clients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic
While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement? Notify the health care provider. Document that the pericarditis has resolved. Ask the patient to lean forward and listen again. Prepare to insert a unilateral chest tube.
Ask the patient to lean forward and listen again. Explanation: The most characteristic sign of pericarditis is a creaky or scratchy friction rub heard most clearly at the left lower sternal border. Having the patient lean forward and to the left uses gravity to force the heart nearer to the chest wall, which allows the friction rub to be heard. These assessment data are not life-threatening and do not require a call to the health care provider. The nurse should try multiple times to auscultate the friction rub before deciding that the rub is gone. Chest tubes are not the treatment of choice for not hearing friction rubs.
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Azotemia Proteinuria Hematuria Bacteremia
Azotemia Explanation: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? Cola-colored urine Left upper quadrant pain Pyuria Low blood pressure
Cola-colored urine Explanation: Cola-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.
A client who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following? To take steroids To take aspirin To take prophylactic antibiotics To avoid any kind of activity
Dental procedures Explanation: Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa (not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth). There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to people who are immunosuppressed.
A client is experiencing symptoms of infective endocarditis. Which tests will the nurse expect to be prescribed for this client? Select all that apply. Ejection fraction Echocardiogram Two blood cultures White blood cell count Erythrocyte sedimentation rate
Echocardiogram Two blood cultures White blood cell count Erythrocyte sedimentation rate Explanation: Infective endocarditis is a microbial infection of the endothelial surface of the heart. A definitive diagnosis is made when a microorganism is found in two separate blood cultures and there is evidence of vegetation on imaging of the heart or echocardiogram. Negative blood cultures do not definitely rule out infective endocarditis. Clients may have elevated white blood cell (WBC) counts. In addition, clients may have an elevated erythrocyte sedimentation rate (ESR). Ejection fraction is not used to diagnose infective endocarditis.
A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? Constipation related to immobility Risk for injury related to altered thought processes Hyperthermia related to the inflammatory process Excess fluid volume related to generalized edema
Excess fluid volume related to generalized edema Explanation: The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is "Excess fluid volume related to generalized edema." Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen.
An adult client with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. The medical history reveals diabetes mellitus, hypertension, and pernicious anemia. The client underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. What history finding is a major risk factor for infective endocarditis? Anemia Age History of diabetes mellitus History of aortic valve replacement
History of aortic valve replacement Explanation: A heart valve prosthesis such as an aortic valve replacement is a major risk factor for infective endocarditis. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, I.V. drug abuse, and immunosuppression. Although age and a history of diabetes mellitus or anemia may predispose a person to cardiovascular disease, they aren't major risk factors for infective endocarditis.
Which nursing intervention would reduce cardiac workload in a client with myocarditis? Maintain the client on bed rest. Administer a prescribed antipyretic. Lower the client's head. Eliminate all phone calls and visitors.
Maintain the client on bed rest. Explanation: The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing. The nurse would administer a prescribed antipyretic only if the client has a fever. The nurse elevates the client's head to promote maximal breathing potential. Treatment for myocarditis does not preclude allowing the client to have visitors or use the telephone.
A client recovering from hepatitis B develops acute nephrotic syndrome. Which treatment will the nurse anticipate being prescribed for this client? Vancomycin Methylprednisolone Increase in sodium intake Low-carbohydrate diet
Methylprednisolone Explanation: Acute nephritic syndrome is a type of acute glomerulonephritis. The focus of management is to treat symptoms, preserve kidney function, and treat complications. Treatment may include corticosteroids such as methylprednisolone. Antibiotics such as vancomycin are used to treat bacterial infections. Hepatitis B is caused by a virus. Sodium would be restricted if the client has hypertension, edema, or heart failure. Carbohydrates should be ingested liberally to provide energy and reduce the catabolism of protein.
Which of the following occurs late in chronic glomerulonephritis? Peripheral neuropathy Nosebleed Stroke Seizure
Peripheral neuropathy Explanation: Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.
What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Proteinuria Hyperalbuminemia Hypokalemia
Proteinuria Explanation: Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Previous episode of acute pyelonephritis History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis
Recent history of streptococcal infection Explanation: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.
The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all that apply. Red blood cells in the urine Polyuria Proteinuria White blood cell casts in the urine Hemoglobin of 12.8 g/dL
Red blood cells in the urine Proteinuria Explanation: The primary presenting features of an acute glomerular inflammation are hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria (excess protein in the urine). The urine may appear cola colored because of red blood cells (RBCs) and protein plugs or casts; RBC casts may be present, indicating glomerular injury. Acute glomerulonephritis does not present with white blood cell (WBC) casts.
A client with infective endocarditis is admitted to the hospital. While obtaining a history, what should the nurse ask the client about? Select all that apply. Renal dialysis Intravenous (IV) drug use Nasal piercing Prosthetic cardiac valves Recent urinary tract infection
Renal dialysis Intravenous (IV) drug use Nasal piercing Prosthetic cardiac valves Recent urinary tract infection Explanation: Endocarditis infections are common among IV injection drug users; clients with debilitating disease or indwelling catheters; clients receiving hemodialysis or prolonged IV fluid or antibiotic therapy; clients with oral, nasal, or nipple body piercings; and, clients with prosthetic cardiac valves.
A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? Croup Rheumatic fever Severe staphylococcal infection Medullary sponge kidney
Rheumatic fever Explanation: Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures.
A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? Sore throat 2 weeks ago Red blood cells in the urine Elevation of blood pressure Protein elevation in the urine
Sore throat 2 weeks ago Explanation: Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. Red blood cells and protein found in the urine and elevated blood pressure are symptoms associated with glomerulonephritis.
A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? Psychosocial stress Hypersensitivity to an immunization Menarche Streptococcal infection
Streptococcal infection Explanation: Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress, and hypersensitivity are not typical causes.
Which instruction should a nurse provide a client with a history of rheumatic fever before the client has any dental work done?
To take prophylactic antibiotics rationale: Clients with a history of rheumatic fever are susceptible to infective endocarditis and should be asked to take prophylactic antibiotics before any invasive procedure, including dental work. Steroids are prescribed to suppress the inflammatory response and aspirin to control the formation of blood clots around heart valves. Activities that require minimal activity are recommended to reduce the work of the myocardium and counteract the boredom of weeks of bed rest.
The nurse is assessing a client suspected of having developed acute glomerulonephritis. Which clinical manifestation assessed by the nurse correlate with this suspicion? Urine positive for blood Precipitous decrease in serum creatinine levels Hypotension unresolved by fluid administration Decrease in blood urea nitrogen levels
Urine positive for blood Explanation: In acute glomerulonephritis, the kidneys become large, edematous, and congested. All renal tissues, including the glomeruli, tubules, and blood vessels, are affected to varying degrees. The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most clients.
A client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment? acute pain anxiety fatigue denial
acute pain Explanation: Pain is the primary symptom of the client with pericarditis. Pain relief and the absence of complications are two major nursing goals. The client may have anxiety, fatigue, or denial, but these symptoms are not the nurse's priority for care.
A change that occurs during chronic glomerulonephritis is termed hypokalemia. anemia. metabolic alkalosis. hypophosphatemia.
anemia. Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.
What are contributing causes to pericarditis? Select all that apply. cardiac surgery common cold tuberculosis myocarditis chest trauma
cardiac surgery tuberculosis myocarditis chest trauma Explanation: Pericarditis usually is secondary to endocarditis, myocarditis, chest trauma, or MI (heart attack), or develops after cardiac surgery. The common cold is not a contributing cause of pericarditis.
A client has been diagnosed with acute glomerulonephritis. This condition causes: proteinuria. pyuria. polyuria. No option is correct.
proteinuria. Explanation: The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.
The nurse is providing discharge teaching to a client with recurrent endocarditis. What prevention strategies will be included with the teaching? Select all that apply. use a nail clipper for fingernail care body piercing can be done in a clean area report recurrent fever lasting longer than 7 days to the health care provider use a toothpick to keep food from accumulating in the mouth notify dentist of the history of endocarditis with any planned dental procedures
use a nail clipper for fingernail care report recurrent fever lasting longer than 7 days to the health care provider notify dentist of the history of endocarditis with any planned dental procedures Explanation: The client at high risk for endocarditis should report recurrent fever lasting longer than 7 days to the health care provider, avoid nail biting, and notify the dentist of the history of endocarditis before any planned dental procedures. Body piercing and using toothpicks can provide an entry for infection for high-risk clients.
