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The nurse is caring for a patient who requires administration of a neuromuscular blocking agent to facilitate ventilation with nontraditional modes. The nurse understands that neuromuscular blocking agents provide: antianxiety effects. no sedation or analgesia. high levels of sedation. complete analgesia.
no sedation or analgesia.
When explaining the rationale for the use of lactulose syrup for the patient with chronic cirrhosis, the nurse would choose which of the following statements? Lactulose can be taken intermittently to reduce side effects. Lactulose helps to reverse cirrhos of the liver.is Lactulose suppresses the metabolism of ammonia and aids in its elimination through feces. Lactulose reduces constipation, which is a frequent complaint with cirrhosis.
Lactulose suppresses the metabolism of ammonia and aids in its elimination through feces.
The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). In doing so, the nurse should assess the hemofilter every 6 hours for clotting. use clean technique during vascular access dressing changes. assess that the blood tubing is warm to the touch. cover the dialysis lines to protect them from light.
assess that the blood tubing is warm to the touch.
The patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure. To detect signs of contrast-induced kidney injury, the nurse should evaluate the patient's serum creatinine for up to 72 hours after the procedure. not be concerned unless urine output decreases. obtain an order for a renal ultrasound. evaluate the patient's postvoid residual volume to detect intrarenal injury.
evaluate the patient's serum creatinine for up to 72 hours after the procedure.
In patients with extensive burns, edema occurs in both burned and unburned areas because of decreased glomerular filtration. increased capillary permeability. loss of integument barrier. catecholamine-induced vasoconstriction.
increased capillary permeability.
The patient is admitted with acute pancreatitis and is demonstrating severe abdominal pain, vomiting, and ascites. Using the Ranson classification criteria, the nurse determines that this patient has a 15% chance of dying. has a 99% chance of survival. has a 40% chance of dying. has no chance of survival.
has a 15% chance of dying.
A client presents to the emergency department following a burn injury. The client has burns to the abdomen and front of the left leg. Using the rule of nines, the nurse documents the total body surface area percentage as 27%. 36%. 9%. 18%.
18%.
A client has burns to his anterior trunk and left arm. Using the Rule of the Nines, what is the TBSA burned? 45% 36% 18% 27%
27%
A client's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply. "Have you ever been tested for diabetes?" "Would you say that you eat a particularly high-fat diet?" "Does anyone in your family have cystic fibrosis?" "How many alcoholic drinks do you typically consume in a week?" "Have you ever been diagnosed with gallstones?"
"Have you ever been tested for diabetes?" "Would you say that you eat a particularly high-fat diet?" "How many alcoholic drinks do you typically consume in a week?" "Have you ever been diagnosed with gallstones?"
Which statement by the client who is performing self-catheterization indicates a need for further teaching? "I will wash my catheter will hot soapy water." "I should perform self-catheterization every 4 to 6 hours." "I should lubricate the catheter before insertion." "I will need a sterile catheter kit each time I self-catheterize."
"I will need a sterile catheter kit each time I self-catheterize."
Which of the following statements would reflect that the patient does not understand the long term effects of liver failure? "My skin might become more yellow and change in color." "It is important that I get more rest." "If I stop drinking, my liver will get better." "I need to monitor and limit my salt intake."
"If I stop drinking, my liver will get better."
A client is brought to the emergency department with partial-thickness and full-thickness burns on the left arm, left anterior leg, and anterior trunk. Using the Rule of Nines, what is the total body surface area that has been burned? 36% 27% 18% 30%
36%
What is a minimally acceptable urine output for a patient weighing 75 kg? 150 mL/hour 80 mL/hour 37 mL/hour Less than 30 mL/hour
37 mL/hour
The most common reasons for initiating dialysis in acute kidney injury include which of the following? (Select all that apply.) Acidosis Hypokalemia hyperkalemia Uremia Volume overload
Acidosis hyperkalemia Uremia Volume overload
The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis? Antianxiety Antispasmodic Antiemetic Anti-inflammatory
Antispasmodic
An emergency department nurse assesses a patient admitted after a lightning strike. Which assessment would the nurse complete first? Electrocardiogram (ECG) Wound inspection Creatinine kinase Computed tomography of head
Electrocardiogram (ECG)
The nurse is caring for patient who has been struck by lightning. Because of the nature of the injury, the nurse assesses the patient for which of the following? Contractures Central nervous system deficits Infection Stress ulcers
Central nervous system deficits
A client receiving peritoneal dialysis (PD) has outflow that is 100 mL less than the inflow for two consecutive exchanges. Which of the following actions would be best for the nurse to take first? Irrigate dialysis catheter. Change client's position. Check client's blood pressure. Continue to monitor third exchange.
Change client's position.
A client seen in the Emergency Department reports painful urination, frequency, and urgency. Which of the following conditions would the nurse suspect? Polycystic kidney disease Glomerulonephritis Renal calculi Cystitis
Cystitis
The 72-year-old client is admitted to the medical unit diagnosed with an acute exacerbation of diverticulosis. The health-care provider has prescribed the intravenous antibiotic ceftriaxone (Rocephin). Which intervention should the nurse implement first? Send a stool specimen to the laboratory. Monitor the client's white blood cell count. Determine if the client has any known allergies. Assess the client's most recent vital signs.
Determine if the client has any known allergies.
The nurse is collecting a 24-hour urine sampling for creatinine clearance on a client hospitalized with acute glomerulonephritis. While making rounds, the nurse learns that the client discarded the 2 a.m. voiding. The nurse should? Record the information in the client's chart and continue the collection Discard the collected urine, obtain a new bottle, and begin the collection again Continue the collection as ordered by the physician Extend the collection time to replace the last voiding
Discard the collected urine, obtain a new bottle, and begin the collection again
The patient is admitted with end-stage liver disease. The nurse evaluates the patient for which of the following? (Select all that apply.) Hypercoagulation Hypoglycemia Disseminated intravascular coagulation Ascites Malnutrition
Disseminated intravascular coagulation Ascites Malnutrition
Which laboratory data should the nurse monitor for the client with inflammatory bowel disease who is prescribed sulfasalazine (Azulfidine), a sulfonamideantibiotic? The client's International Normalized Ratio (INR). The client's serum creatinine level. The client's liver function tests. The client's serum potassium level.
The client's serum creatinine level.
The nurse is managing the pain of a patient with burns. The provider has prescribed opiates to be given intramuscularly. The nurse contacts the provider to change the prescription to intravenous administration because burn pain is so severe it requires relief by the fastest route available. tissue edema may interfere with drug absorption of injectable routes. intramuscular injections cause additional skin disruption. hypermetabolism limits effectiveness of medications administered intramuscularly.
tissue edema may interfere with drug absorption of injectable routes.
The nurse is admitting a client whose medication regimen includes regular injections of vitamin B12. The nurse should question the client about a history of: total gastrectomy. gastroesophageal reflux disease (GERD). bariatric surgery. diverticulitis.
total gastrectomy.
After gastric bypass surgery, the patient is getting vitamin B12 injections. The patient asks about the purpose of this vitamin. The nurse explains that vitamin B12 is always deficient in obese people. vitamin B12 is needed for the formation of red blood cells. vitamin B12 is needed to prevent a type of anemia. vitamin B12 is essential for surgical wound healing.
vitamin B12 is needed for the formation of red blood cells.
Which of the following patients is at the greatest risk of developing acute kidney injury? A patient who was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks has a history of fluid overload as a result of heart failure has been on aminoglycosides for the past 6 days
was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks
The liver detoxifies the blood by converting fat-soluble compounds to water-soluble compounds. metabolizing inactive toxic substances to active forms. converting water-soluble compounds to fat-soluble compounds. excreting fat-soluble compounds in feces.
converting fat-soluble compounds to water-soluble compounds.
A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply. "The pancreas decreases bicarbonate secretion with age." "The pancreas enlarges and atrophies with age." "The pancreas decreases secretion of enzymes with age." "The pancreas develops fatty deposits with age." "The pancreas develops fibrous material with age."
"The pancreas decreases bicarbonate secretion with age." "The pancreas decreases secretion of enzymes with age." "The pancreas develops fatty deposits with age." "The pancreas develops fibrous material with age."
The nurse is planning care to meet the patient's pain management needs related to burn treatment. The patient is alert, oriented, and follows commands. The pain is worse during the day, when various treatments are scheduled. Which statement to the provider best indicates the nurse's knowledge of pain management for this patient? "The patient's pain varies depending on the treatment given. Can we try patient-controlled analgesia to see if that helps the patient better?" "Can we ask the music therapist to come by each morning to see if that will help the patient's pain?" "The patient's pain is often unrelieved. I suggest that we also add benzodiazepines to the opioids around the clock." "The patient's pain is often unrelieved. It would be best if we can schedule the opioids around the clock."
"The patient's pain varies depending on the treatment given. Can we try patient-controlled analgesia to see if that helps the patient better?"
A client has a 10-year history of Crohn's disease and is seeing the physician due to increased diarrhea and fatigue. What is the recommended dietary approach to treat Crohn's disease? dietary approach varies. lactose-rich foods low-fiber diet high-fiber diet
dietary approach varies.
The nurse is caring for a patient receiving intravenous ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen? ALT 25 U/L Platelet count 350,000 billion/L Creatinine: 3.1 mg/dL White blood count 13, 550 mm3
Creatinine: 3.1 mg/dL
The nurse is caring for a patient receiving intravenous ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen? Creatinine: 3.1 mg/dL Platelet count 350,000 billion/L White blood count 13, 550 mm3 ALT 25 U/L
Creatinine: 3.1 mg/dL
Infection by Helicobacter pylori bacteria is a major cause of Curling's ulcers. stress ulcers. Cushing's ulcers. duodenal ulcers.
duodenal ulcers.
A client admitted with inflammatory bowel disease asks the nurse for help with menu selections. What menu selection is most likely the best choice for this client? Multigrain bagel Spinach Tofu Blueberries
Tofu
The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of general malaise and is tachypneic. An arterial blood gas shows that the patient's pH is 7.19, with a PCO2 of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to administer intravenous sodium bicarbonate. administer morphine to slow the respiratory rate. prepare for intubation and mechanical ventilation. cancel tomorrow's dialysis session.
administer intravenous sodium bicarbonate.
The nurse is caring for a critically ill patient with respiratory failure who is being treated with mechanical ventilation. As part of the patient's care to prevent stress ulcers, the nurse would provide: (Select all that apply.) antacids. cholinergic drugs. vagal stimulation. anticholinergic drugs. proton pump inhibitors.
antacids anticholinergic drugs. proton pump inhibitors.
The patient is admitted with the diagnosis of GI bleeding. The patient's heart rate is 140 beats per minute, and the blood pressure is 84/44 mm Hg. These values may indicate: approximately 25% loss of total blood volume. increased blood flow to the skin, lungs, and liver. a need for hourly vital signs. resolution of hypovolemic shock.
approximately 25% loss of total blood volume.
The nurse is caring for a patient with an electrical injury. The nurse understands that patients with electrical injury are at a high risk for acute kidney injury secondary to nephrotoxic antibiotics for prevention of infection. increased incidence of ureteral stones. release of myoglobin from injured tissues. hypervolemia from burn resuscitation.
release of myoglobin from injured tissues.
The nurse is caring for a patient with cirrhosis of the liver. The nurse notes fresh blood starting to ooze from the patient's rectum and intravenous site. The nurse contacts the provider expecting a prescription for a laboratory test to determine factor X level. an infusion of protein S factor. blood work to evaluate protein C level. vitamin K injections.
vitamin K injections.
The patient's potassium level is 7.0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction? Sodium polystyrene sulfonate with sorbitol Regular insulin Calcium gluconate Sodium polystyrene sulfonate
Sodium polystyrene sulfonate
The patient asks the nurse if the placement of the autograft over his full-thickness burn will be the only surgical intervention needed to close his wound. The nurse's best response would be: "Yes, an autograft will transfer your own skin from one area of your body to cover the burn wound." "Unfortunately, an autograft skin is a temporary graft and a second surgery will be needed to close the wound." "Unfortunately, autografts frequently do not adhere well to burn wounds and a xenograft will be necessary to close the wound." "An autograft is a biological dressing that will eventually be replaced by your body generating new tissue."
"Yes, an autograft will transfer your own skin from one area of your body to cover the burn wound."
The patient's serum creatinine level is 0.7 mg/dL. The expected BUN level should be 20 to 30 mg/dL. 7 to 14 mg/dL. 1 to 2 mg/dL. 10 to 20 mg/dL.
7 to 14 mg/dL.
A 36-year-old driver was pulled from a car after it collided with a tree and the gas tank exploded. What assessment data suggest the patient suffered tissue damage consistent with a blast injury? Blood pressure 82/60 mm Hg, heart rate 122 beats/min, respiratory rate 28 breaths/min Irregular heart rate and rhythm Responsive only to painful stimuli Crackles (rales) on auscultation of bilateral lung fields
Crackles (rales) on auscultation of bilateral lung fields
A nurse is aware that both the sympathetic and parasympathetic portions of the autonomic nervous system affect GI motility. What are the actions of the sympathetic nervous system? Select all that apply. Creates an inhibitory effect on the GI tract Decreases gastric motility Relaxes the sphincters Increases secretary activities Causes blood vessel constriction
Creates an inhibitory effect on the GI tract Decreases gastric motility Causes blood vessel constriction
The patient is admitted with end-stage liver disease. The nurse evaluates the patient for which of the following? (Select all that apply.) Disseminated intravascular coagulation Malnutrition Ascites Hypoglycemia Hypercoagulation
Disseminated intravascular coagulation Malnutrition Ascites
Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.) Dysrhythmias Hemolysis Air embolism Hypotension Muscle cramps
Dysrhythmias Hypotension
A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. Following a regular schedule for rest, relaxation, and meals Eating whenever hungry Substituting decaffeinated products for all forms of coffee Smoking cessation Avoidance of alcohol
Following a regular schedule for rest, relaxation, and meals Substituting decaffeinated products for all forms of coffee Smoking cessation Avoidance of alcohol
The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply. Inferior vena cava Saphenous vein Inferior mesenteric vein Splenic vein Gastric vein
Inferior mesenteric vein Splenic vein Gastric vein
Which is a true statement regarding the nursing considerations in administration of metronidazole? It leaves a metallic taste in the mouth. The drug should be given before meals. It may cause weight gain. Metronidazole decreases the effect of warfarin.
It leaves a metallic taste in the mouth.
Noninvasive diagnostic procedures used to determine kidney function include which of the following? (Select all that apply.) Renal angiography Intravenous pyelography (IVP) Kidney, ureter, bladder (KUB) x-ray Magnetic resonance imaging (MRI) Renal ultrasound
Kidney, ureter, bladder (KUB) x-ray Magnetic resonance imaging (MRI) Renal ultrasound
The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the client's signs/symptoms should the nurse report to the physician? Nausea Left lower quadrant pain Pain when pressure is applied to the right lower quadrant High fever
Nausea
The nurse recognizes that which patient is likely to benefit most from patient-controlled analgesia (PCA)? Postoperative patient who had elective bariatric surgery Patient with a femur fracture and closed head injury Postoperative patient who had elective bariatric surgery Patient with a C4 fracture and quadriplegia
Postoperative patient who had elective bariatric surgery
The nurse instructs the client taking dexamethasone (Decadron) to take it with food or milk because this medication? Decreases production of hydrochloric acid Slows stomach emptying time Stimulates hydrochloric acid production Retards pepsin production
Stimulates hydrochloric acid production
The patient is receiving neuromuscular blockade. Which nursing assessment indicates a target level of paralysis? Glasgow Coma Scale score of 3 Bispectral index of 60 Train-of-four yields two twitches CAM-ICU positive
Train-of-four yields two twitches
A nurse is caring for a client admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the pancreas secrete? Select all that apply. Ptyalin Pepsin Trypsin Amylase Lipase
Trypsin Amylase Lipase
The nurse is caring for an elderly patient who was admitted with renal insufficiency. An expected laboratory finding for this patient may be hypokalemia. increased ability to excrete drugs. a normal serum creatinine level. an increased glomerular filtration rate (GFR).
a normal serum creatinine level.
The nurse is caring for a patient who has circumferential full-thickness burns of his forearm. A priority in the plan of care is active or passive range-of-motion exercises every hour. to keep the extremity in a dependent position. to prepare for an escharotomy as a prophylactic measure. to splint the forearm.
active or passive range-of-motion exercises every hour.
A postsurgical patient is on a ventilator in the critical care unit. The patient has been tolerating the ventilator well and has not required any sedation. On assessment, the nurse notes the patient is tachycardic and hypertensive with an increased respiratory rate of 28 breaths/min. The patient has been suctioned recently via the endotracheal tube, and the airway is clear. The patient responds appropriately to the nurse's commands. The nurse should: assess the patient's level of pain. provide sedation as ordered. decrease the ventilator rate. suction the patient again.
assess the patient's level of pain.
The patient is on intake and output (I&O), as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should insert an indwelling catheter. obtain an order to place the patient on fluid restriction. assess the patient's lungs. draw a trough level after the next dose of antibiotic.
assess the patient's lungs.
The nurse is assessing a patient admitted with pancreatitis. In doing so, the nurse assesses symptoms that could indicate involvement of the stomach. emphasizes to the patient that pancreatic inflammation does not spread. palpates the pancreas for size and shape. explains to the patient that back pain is not a sign of pancreatitis.
assesses symptoms that could indicate involvement of the stomach.
Nursing priorities for the management of acute pancreatitis include: (Select all that apply.) withholding analgesics that could mask abdominal discomfort. stimulating gastric content motility into the duodenum. assessing and maintaining electrolyte balance. utilizing supportive therapies aimed at decreasing gastrin release. managing respiratory dysfunction.
assessing and maintaining electrolyte balance. utilizing supportive therapies aimed at decreasing gastrin release. managing respiratory dysfunction.
Nursing priorities for the management of acute pancreatitis include: (Select all that apply.) stimulating gastric content motility into the duodenum. assessing and maintaining electrolyte balance. withholding analgesics that could mask abdominal discomfort. utilizing supportive therapies aimed at decreasing gastrin release. managing respiratory dysfunction.
assessing and maintaining electrolyte balance. utilizing supportive therapies aimed at decreasing gastrin release. managing respiratory dysfunction.
The patient is admitted with acute pancreatitis and is demonstrating severe abdominal pain, vomiting, and ascites. Using the Ranson classification criteria, the nurse determines that this patient has a 15% chance of dying. has a 99% chance of survival. has no chance of survival. has a 40% chance of dying.
has a 15% chance of dying.
Tissue damage from burn injury activates an inflammatory response that increases the patient's risk for stress ulcers. infection. acute respiratory distress syndrome. acute kidney injury.
infection.
A patient with a 60% burn in the acute phase of treatment develops a tense abdomen, decreasing urine output, hypercapnia, and hypoxemia. Based on this assessment, the nurse anticipates interventions to evaluate and treat the patient for intra-abdominal hypertension. acute respiratory distress syndrome. acute kidney injury. disseminated intravascular coagulation disorder.
intra-abdominal hypertension.
The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patient's urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has: intrarenal disease, probably acute tubular necrosis. a urinary tract infection. acute kidney injury from postrenal obstruction. acute kidney injury from a prerenal condition.
intrarenal disease, probably acute tubular necrosis.
An autograft is used to optimally treat a partial- or full-thickness wound that (Select all that apply.) is infected. involves a joint. involves the face, hands, or feet. requires more than 2 weeks for healing.
involves a joint. involves the face, hands, or feet. requires more than 2 weeks for healing.
Silver is used as an ingredient in many burn dressings because it stimulates tissue granulation. provides topical pain relief. stimulates wound healing. is effective against a wide spectrum of wound pathogens.
is effective against a wide spectrum of wound pathogens.
Acute kidney injury from postrenal etiology is caused by conditions that act directly on functioning kidney tissue. hypovolemia or decreased cardiac output. obstruction of the flow of urine. conditions that interfere with renal perfusion.
obstruction of the flow of urine.
Acute kidney injury from postrenal etiology is caused by obstruction of the flow of urine. conditions that interfere with renal perfusion. conditions that act directly on functioning kidney tissue. hypovolemia or decreased cardiac output.
obstruction of the flow of urine.
The primary mode of action for neuromuscular blocking agents used in the management of some ventilated patients is sedation. analgesia. anticonvulsant therapy. paralysis.
paralysis
Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that the process removes solutes and water slowly. it provides faster removal of solute and water. it does not allow diffusion to occur. a hemofilter is used to facilitate ultrafiltration.
the process removes solutes and water slowly.
The patient is being admitted to the hospital. At home, the patient takes an over-the-counter supplement of vitamin D and is concerned because the doctor did not order that vitamin D to be given in the hospital. The nurse explains that vitamin D is stored in the liver with a 10-month supply to prevent deficiency. the body does not store vitamins so the doctor will have to be called. over-the-counter supplements are never given in the hospital.
vitamin D is stored in the liver with a 10-month supply to prevent deficiency.
Which of the following patients is at the greatest risk of developing acute kidney injury? A patient who: has a history of controlled hypertension with a blood pressure of 138/88 mm Hg was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks has a history of fluid overload as a result of heart failure has been on aminoglycosides for the past 6 days
was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks
