NUR 2038 Exam 4 Questions

A diet that contains restricted amounts of protein, sodium, and potassium has been prescribed for a client with end-stage renal disease who is receiving dialysis. The nurse is providing dietary instructions. Which statement by the client indicates that the teaching is effective? 1. "I should avoid using salt substitutes." 2. "I should exclude meat from my diet." 3. "I may not add seasoning to my food." 4. "I may eat low-sodium canned vegetables."

1. "I should avoid using salt substitutes." (High in potassium)

While the nurse is at the bedside of a client in acute renal failure, the client states, "My healthcare provider said that I will be getting some insulin. Do I also have diabetes?" What is the best nursing response? 1. "No, the insulin will help your body handle the increased potassium level." 2. "I suggest that you ask your healthcare provider that question." 3. "You probably had an elevated blood glucose level, so your healthcare provider is being cautious." 4. "No, but insulin will reduce the toxins in your blood by lowering your metabolic rate."

1. "No, the insulin will help your body handle the increased potassium level."

client's arterial blood gas report indicates that pH is 7.25, Pco 2 is 60 mm Hg, and HCO 3 is 26 mEq/L (26 mmol/L). Which client should the nurse consider is most likely to exhibit these blood gas results? 1. A 65-year-old with pulmonary fibrosis 2. A 24-year-old with uncontrolled type 1 diabetes 3. A 45-year-old who has been vomiting for 3 days 4. A 54-year-old who takes sodium bicarbonate for indigestion

1. A 65-year-old with pulmonary fibrosis

A registered nurse writes a care plan for a client undergoing a renal scan. Which of the following interventions should the nurse include? Select all that apply. 1. Administering furosemide after initial imaging 2. Asking the client to fast before the scan 3. Taking precautions related to radioactive exposure 4. Telling the client to avoid drinking fluids after the imaging 5. Inserting the peripheral intravenous (IV) catheter to give the radioisotope

1. Administering furosemide after initial imaging 5. Inserting the peripheral intravenous (IV) catheter to give the radioisotope

A client with end-stage renal disease is hospitalized. For which complications should the nurse monitor the client? Select all that apply. 1. Anemia 2. Dyspnea 3. Jaundice 4. Hyperexcitability 5. Hypophosphatemia

1. Anemia 2. Dyspnea

A client with kidney dysfunction is about to undergo renal testing using a contrast medium. Which nursing interventions should be conducted before the procedure to ensure the client's safety? Select all that apply. 1. Assessing the client for a history of cirrhosis 2. Asking the client if he or she has a known shellfish allergy 3. Assessing the client for a history of lactic acidosis 4. Assessing the client's hydration status by checking blood pressure and respiratory rate 5. Asking the client to discontinue metformin 12 hours before the procedure

1. Assessing the client for a history of cirrhosis 2. Asking the client if he or she has a known shellfish allergy 4. Assessing the client's hydration status by checking blood pressure and respiratory rate

A nurse is caring for a client with end-stage renal disease who has a mature arteriovenous (AV) fistula. Which nursing care should be included in the client's plan of care? Select all that apply. 1. Auscultate for a bruit. 2. Palpate the site to identify a thrill. 3. Irrigate with saline to maintain patency. 4. Avoid drawing blood from the affected extremity. 5. Keep the fistula clamped until ready to perform dialysis.

1. Auscultate for a bruit. 2. Palpate the site to identify a thrill. 4. Avoid drawing blood from the affected extremity.

The nurse plans interventions for a client with smoke inhalation based on a negative chest x-ray and arterial blood gases that show a PO 2 of 85 mm Hg, a PCO 2 of 45 mm Hg, and a pH of 7.35. Which interventions should the nurse anticipate will be prescribed? Select all that apply. 1. Coughing 2. Deep breathing 3. Bronchodilators 4. Humidified oxygen 5. Bronchial suctioning

1. Coughing 2. Deep breathing 4. Humidified oxygen

A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco 2 is 35 mm Hg, and HCO 3- is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

1. Metabolic acidosis

An arterial blood gas report indicates the client's pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

1. Metabolic acidosis

Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1. pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L) 2. pH 7.35, CO 2 47 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 3. pH 7.46, CO 2 30 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 4. pH 7.50, CO 2 50 mm Hg, HCO 3 - 22 mEq/L (22 mmol/L)

1. pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L)

A nurse in the pediatric unit is reviewing the arterial blood gas values of a 4-year-old child recovering from severe dehydration. Which results most accurately reflect the child's recovery? 1. pH 7.40, Po 2 85 mm Hg, Pco 2 40 mm Hg 2. pH 7.50, Po 2 85 mm Hg,Pco 2 35 mm Hg 3. pH 7.25, Po 2 60 mm Hg, Pco 2 50 mm Hg 4. pH 7.45, Po 2 70 mm Hg, Pco 2 25 mm Hg

1. pH 7.40, Po 2 85 mm Hg, Pco 2 40 mm Hg

A 3-year-old child is admitted to the pediatric unit with a diagnosis of acute asthma. The child is short of breath, with a respiratory rate of 56 breaths/min; the pulse is 102, and the child has a nonproductive cough. What blood gas value does the nurse expect to see? 1. pH of 7.32 2. Po 2 of 95 mm Hg 3. Pco 2 of 30 mm Hg 4. HCO 3 - of 20 mEq/L (20 mmol/L)

1. pH of 7.32

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results are associated with this diagnosis? 1. pH: 7.28; PCO 2: 28; HCO 3: 18 2. pH: 7.30; PCO 2: 54; HCO 3: 28 3. pH: 7.50; PCO 2: 49; HCO 3: 32 4. pH: 7.52; PCO 2: 26; HCO 3: 20

1. pH: 7.28; PCO 2: 28; HCO 3: 18 (Metabolic acidosis)

The registered nurse discusses normal renal function with the client. Which statements made by the client are correct regarding regulatory functions of the kidney? Select all that apply. 1. "They play a role in erythropoiesis." 2. "They play a role in acid-base balance." 3. "They play a role in vitamin D activation." 4. "They play a role in blood pressure regulation." 5. "They play a role in fluid and electrolyte balance."

2. "They play a role in acid-base balance." 5. "They play a role in fluid and electrolyte balance."

A client has acute tubulointerstitial renal disease and is experiencing fluid and electrolyte imbalances. The client is confused and complains of nausea and muscle weakness. What does the nurse anticipate will be prescribed to help correct the electrolyte imbalance associated with this diagnosis? 1. Infuse normal saline intravenously. 2. Administer a cation-exchange resin. 3. Increase the intake of dairy products. 4. Restrict the intake of foods high in fiber.

2. Administer a cation-exchange resin. (Low potassium)

A client who is obtunded has a blood pressure of 80/35 mm Hg after a blood transfusion. In an effort to support renal perfusion, the nurse administers dopamine at 2 mcg/kg/min as prescribed. What is the most relevant outcome indicating effectiveness of the medication for this client? 1. A decrease in blood pressure 2. An increase in urinary output 3. A decrease in core temperature 4. An increase in level of consciousness

2. An increase in urinary output

The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? 1. Increase in blood pressure 2. Decrease in erythropoietin 3. Increase in serum phosphate levels 4. Decrease in serum sodium concentration

2. Decrease in erythropoietin

A nurse assesses a client who is experiencing profound (late) hypovolemic shock. When monitoring the client's arterial blood gas results, which response does the nurse expect? 1. Hypokalemia 2. Metabolic acidosis 3. Respiratory alkalosis 4. Decreased carbon dioxide level

2. Metabolic acidosis

A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end-stage renal disease (ESRD)? 1. Fluid 2. Protein 3. Sodium 4. Potassium

2. Protein (0.6g/kg/day)

After reviewing the laboratory reports, the nurse anticipates that the client has renal impairment. Which test reports support the nurse's concern? Select all that apply. 1. Serum albumin: 4.7 g/dL(6.815 µmol/L) 2. Serum creatinine: 2.0 mg/dL (176.8 µmol/L) 3. Serum potassium: 5.9 mEq/L (5.9 mmol/L) 4. Serum cholesterol: 120 mg/dL (3.108 mmol/L) 5. Blood urea nitrogen: 32 mg/dL (11.424 mmol/L)

2. Serum creatinine: 2.0 mg/dL (176.8 µmol/L) 3. Serum potassium: 5.9 mEq/L (5.9 mmol/L) 5. Blood urea nitrogen: 32 mg/dL (11.424 mmol/L)

A client's arterial blood gas report indicates that pH is 7.25, Pco 2 is 35 mm Hg, and HCO 3 is 20 mEq/L (20 mmol/L). Which client should the nurse consider is most likely to exhibit these results? 1. A 54-year-old with vomiting 2. A 17-year-old with panic attacks 3. A 24-year-old with diabetic ketoacidosis 4. A 65-year-old with advanced emphysema

3. A 24-year-old with diabetic ketoacidosis

A nurse is caring for a client with end-stage renal disease. For which clinical indicator should the nurse monitor the client? 1. Polyuria 2. Jaundice 3. Azotemia 4. Hypotension

3. Azotemia

A nurse is caring for a client with end-stage renal disease. Which clinical indicators of end-stage renal disease should the nurse expect? Select all that apply. 1. Polyuria 2. Jaundice 3. Azotemia 4. Hypertension 5. Polycythemia

3. Azotemia 4. Hypertension

A client who experienced smoke inhalation has a negative chest x-ray and arterial blood gases that demonstrate PaO 2 of 75 mm Hg, PaCO 2 of 45 mm Hg, and pH of 7.35. Which intervention should the nurse anticipate will be prescribed by the healthcare provider? 1. Deep suctioning 2. Bronchodilators 3. Breathing exercises 4. Mechanical ventilation

3. Breathing exercises

A client suspected of a renal disorder is scheduled for an imaging procedure. The nurse instructs the client to drink lots of fluids after the procedure and informs that a contrast dye will be administered before the procedure. Which imaging procedure is the client undergoing? 1. Renal scan 2. Electromyography 3. Computed tomography 4. Kidney ultrasonography

3. Computed tomography

The arterial blood gases of a client with chronic obstructive pulmonary disease (COPD) deteriorate, and respiratory failure is impending. Which clinical indicator should the nurse assess first? 1. Cyanosis 2. Bradycardia 3. Mental confusion 4. Distended neck veins

3. Mental confusion

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco 2 of 50 mm Hg, HCO 3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support what diagnosis? 1. Hypocapnia 2. Hyperkalemia 3. Metabolic alkalosis 4. Respiratory acidosis

3. Metabolic alkalosis

A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. Which test result should the nurse anticipate? 1. Arterial pH of 7.5 2. Hematocrit of 54% 3. Potassium of 6.3 mEq/L (6.3 mmol/L) 4. Creatinine of 1.2 mg/dL (106 mcmol/L)

3. Potassium of 6.3 mEq/L (6.3 mmol/L)

A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet. What is the rationale for the nurse's instruction? 1. A person's body tends to retain fluid when a salt substitute is included in the diet. 2. Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. 3. Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. 4. A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca.

3. Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats.

The nurse is assessing a newborn and anticipates that the newborn has renal impairment. Which finding supports the nurse's conclusion? 1. The newborn has odorless urine. 2. The newborn has colorless urine. 3. The newborn first voids after 76 hours. 4. The newborn's urine has a specific gravity of 1.020.

3. The newborn first voids after 76 hours.

A nurse is caring for an infant with severe dehydration. Which blood gas report most likely reflects the acid-base balance of this infant? 1. pH of 7.50 and Pco 2 of 34 mm Hg 2. pH of 7.23 and Pco 2 of 70 mm Hg 3. pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) 4. pH of 7.56 and HCO 3 - of 30 mEq/L (30 mmol/L)

3. pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) Low blood pH and bicarbonate levels indicate metabolic acidosis, which occurs with severe dehydration because the reduced urine output causes retention of hydrogen ions.

A 5-year-old child in renal failure who has undergone creation of an arteriovenous fistula access begins hemodialysis three times a week. The nurse teaches the mother the specific care her child needs. What statement indicates that further teaching is necessary? 1. "I'll offer more drinks in warm weather." 2. "I should call the clinic if he vomits or has diarrhea." 3. "I'll check his pulse at the wrist on each arm every day." 4. "It's OK to take his blood pressure on the arm with the fistula."

4. "It's OK to take his blood pressure on the arm with the fistula."

A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse identify when monitoring this client's laboratory values? 1. Increased pH 2. Decreased PO 2 3. Increased PCO 2 4. Decreased HCO 3

4. Decreased HCO 3

A preterm infant with respiratory distress syndrome (RDS) has blood drawn for an arterial blood gas analysis. Which test result should the nurse anticipate for this infant? 1. Increased Po 2 2. Lowered HCO 3 3. Decreased Pco 2 4. Decreased blood pH

4. Decreased blood pH

Surgery is performed on a client with a parotid tumor. Postoperative arterial blood gas values are pH 7.32, PCO 2 53 mm Hg, and HCO 3 25 mEq/L (25 mmol/L). Which action should the nurse take? 1. Administer a potent diuretic 2. Obtain a prescription for an alkalinizing agent 3. Have the client breathe into a rebreather bag at a slow rate 4. Encourage the client to cough and then take deep breaths between coughs

4. Encourage the client to cough and then take deep breaths between coughs

A 5-year-old child is admitted to the pediatric intensive care unit with a diagnosis of acute asthma. A blood sample is obtained to measure the child's arterial blood gases. What finding does the nurse expect? 1. High oxygen level 2. Increased alkalinity 3. Decreased bicarbonate 4. Increased carbon dioxide level

4. Increased carbon dioxide level

A nurse is caring for a 6-year-old child with a diagnosis of glomerulonephritis. The child's urine output decreases to less than 100 mL/24 hr, the creatinine clearance is 60 mL/min, and there is an irregular apical pulse. A diagnosis of acute renal failure is made. Blood is drawn for testing. Which serum level requires immediate intervention? 1. Sodium 126 mEq/L (126 mmol/L) 2. Bilirubin 0.3 mg/dL (5.1 mcmol/L) 3. Creatinine 1.3 mg/dL (114.4 mcmol/L) 4. Potassium 6.1 mEq/L (6.1 mmol/L)

4. Potassium 6.1 mEq/L (6.1 mmol/L)

In a patient with acute renal failure, what type of diet is not recommended? A. High Protein B. Low sodium C. High carbohydrate D. Low Potassium

A. High Protein

A patient is admitted to the hospital with chronic kidney disease. Which choice below describes this condition? A. Progressive irreversible destruction of the kidneys with subsequent decrease in GFR and increase in creatinine B. a rapid decrease in urine output with an elevated BUN C. an increasing creatinine clearance with a decrease in urine output D. somnolence, confusion with coma and imminent death due to electrolyte disorders

A. Progressive irreversible destruction of the kidneys with subsequent decrease in GFR and increase in creatinine

In a patient with renal failure, edema is most likely to appear in the morning around which of the following? A. Abdomen B. Eyes C. Extremities D. Ankles

B. Eyes

A patient received gentamicin sulfate 3 mg/kg every 8 hours to treat a life-threatening infection. Following the administration of this drug, the patient complained of nausea and vomiting. Fluid balance indicates a blood urea nitrogen of 46 mg/dl, creatinine of 2.6 mg/l, sodium of 148 mEq/l, and potassium of 4.8 mEq/l. These laboratory results suggest which of the following? A. Fluid deficit B. Hypokalemia C. Fluid overload D. Acute kidney injury

D. Acute kidney injury