ADVANCED MEDSURG | EXAM 6 MASTERSET 2.0

A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to help prevent these infections?" How should the nurse respond?

"Drink more water and empty your bladder more frequently during the day."

A nurse is caring for a client who has hepatitis A. The client asks the nurse how he might have contracted the virus. Before responding, which of the following questions should the nurse first ask the client?

"Have you eaten any shellfish lately?"

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram. Which of the following statement by the client should the nurse report to the provider?

"I don't eat shellfish because it gives me hives."

A client with chronic kidney disease states, "I feel chained to the hemodialysis machine." What is the nurse's best response to the client's statement?

"Tell me more about your feelings regarding hemodialysis treatment."

A patient with a history of injection drug use has been diagnosed with Hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention?

A regimen of antiviral medications

A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply A. "I plan to eat small, frequent meals" B. "I will eat easy-to-digest foods with limited spice" C. "I will use skim milk when cooking" D. "I plan to drink regular cola" E. "I will limit alcohol intake to two drinks per day"

A. "I plan to eat small, frequent meals" B. "I will eat easy-to-digest foods with limited spice" C. "I will use skim milk when cooking"

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? Select all that apply A. diuretic B. beta-blocking agent C. opioid analgesic D. lactulose E. sedative

A. diuretic B. beta-blocking agent D. lactulose

A nurse is teaching a client who has hepatitis B about home care. Which of the following instructions should the nurse include in the teaching? Select all that apply A. limit physical activity B. avoid alcohol C. take acetaminophen for comfort D. wear a mask when in public places E. eat small frequent meals

A. limit physical activity B. avoid alcohol E. eat small frequent meals

A nurse is reviewing risk factors with a client who has cholecystitis. The nurse should identify that which of the following as a risk factor for cholecystitis? A. obesity B. rapid weight gain C. decreased blood triglyceride level D. male sex

A. obesity

A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective?

Abdominal pain is decreased.

A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority?

Administer oxygen

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe?

Administering intravenous fluids through the AV fistula

A nurse is amending a patient's plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patient's care plan?

Administration of diuretics as ordered

A community health nurse is caring for a patient whose multiple health problems include chronic pancreatitis. During the most recent visit, the nurse notes that the patient is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurse's most appropriate action?

Arrange for the patient to be transported to the hospital.

The family of a neutropenic client reports the client is not acting right. What action by the nurse is the priority?

Assess the client for infection.

A nurse is preparing to administer a blood transfusion to an older adult. Understanding age- related changes, what alterations in the usual protocol are necessary for the nurse to implement? (Select all that apply.)

Assess vital signs more often. Hold other IV fluids running.

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan?

Avoid foods high in fat.

A nurse is completing preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following should be included in the teaching? A. "the scope will be passed through your rectum" B. "you might have shoulder pain after surgery" C. "you will have a Jackson-Pratt drain in place after surgery" D. "you should limit how often you walk for 1 to 2 weeks"

B. "you might have shoulder pain after surgery"

A nurse is assessing a client who has advanced cirrhosis. The nurse should identify which of the following findings as indicators of hepatic encephalopathy? Select all that apply A. anorexia B. change in orientation C. asterixis D. ascites E. fector hepaticus

B. change in orientation C. asterixis E. fector hepaticus

A nurse is completing the admission assessment of a client who has renal calculi. Which of the following findings should the nurse expect? a. bradycardia b. diaphoresis c. nocturia d. bradypnea

B. diaphoresis

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? A. instruct the client to chew the medication before swallowing B. offer a glass of water following medication administration C. administer the medication 30 min before meals D. sprinkle the contents on peanut butter

B. offer a glass of water following medication administration

A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following laboratory findings should the nurse expect? A. presence of immunoglobulin G antibodies (IgG) B. positive EIA test C. aspartate aminotransferase (AST) 35 units/L D. alanine aminotransferase (ALT) 15 IU/L

B. positive EIA test

A nurse is providing discharge teaching to a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include in the teaching? Select all that apply A. take baths rather than showers B. resume a diet of choice C. cleanse the puncture site using mild soap and water D. remove adhesive strips from the puncture site in 24 hr E. report nausea and vomiting to the surgeon

B. resume a diet of choice C. cleanse the puncture site using mild soap and water E. report nausea and vomiting to the surgeon

The nurse is caring for a patient with polycystic kidney disease. Which assessment finding requires immediate nursing intervention?

Blood pressure of 170/90

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? A. blood amylase 80 units/L B. WBC 9,000/mm3 C. direct bilirubin 2.1 mg/dL D. alkaline phosphatase 25 units/L

C. direct bilirubin 2.1 mg/dL

A nurse is assessing a client who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis? A. generalized cyanosis B. hyperactive bowel sounds C. gray-blue discoloration of the skin around the umbilicus D. wheezing in the lower lung fields

C. gray-blue discoloration of the skin around the umbilicus

A patient with cirrhosis who has been vomiting blood is admitted to the emergency department. Which action should the nurse take first?

Check BP, heart rate, and respirations.

A nurse in a clinic is caring for a client who has alcohol use disorder. The client reports frequent bruising and nosebleeds. The nurse should identify which of the following conditions is the patient experiencing?

Cirrhosis

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first?

Client who reports shortness of breath

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? A. pain in right upper quadrant radiating to right shoulder B. report of pain being worse when sitting upright C. pain relived with defecation D. epigastric pain radiating to the left shoulder

D. epigastric pain radiating to the left shoulder

A nurse is teaching a client who has chronic kidney disease and is to be begin hemodialysis. Which of the following information should the nurse include in the teaching? a. hemodialysis restores kidney function b. hemodialysis replaces hormonal function of the renal system c. hemodialysis allows for unrestricted diet d. hemodialysis returns a balance to serum electrolytes

D. hemodialysis returns a balance to serum electrolytes

A nurse is reviewing the admission laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? A. decreased blood lipase level B. decreased blood amylase level C. increased blood calcium level D. increased blood glucose level

D. increased blood glucose level

A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A. initiate contact precautions B. weight the client weekly C. measure abdominal girth at the base of the ribcage D. provide a high-calorie, high-carbohydrate diet

D. provide a high-calorie, high-carbohydrate diet

A nurse is reviewing a new prescription for chenodiol with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching? A. this medication is used to decrease acute biliary pain B. this medication requires thyroid function monitoring every 6 months C. this medication is not recommended for clients who have diabetes mellitus D. this medication dissolves gallstones gradually over a period of up to 2 years

D. this medication dissolves gallstones gradually over a period of up to 2 years

A nurse working with clients with sickle cell disease (SCD) teaches about self-management to prevent exacerbations and sickle cell crises. What factors should clients be taught to avoid? (Select all that apply.)

Dehydration Extreme stress High altitudes Pregnancy

A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?

Destruction of the patient's liver tumor

A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first?

Determine whether the client feels like talking about his or her feelings.

A nurse is providing dietary teaching to a client who has a history of recurring calcium oxalate kidney stones. Which of the following instructions should the nurse include in the teaching?

Drink 3 L of fluid every day.

A 23-year-old African-American male with a history of sickle cell disease had an emergent open reduction and internal fixation of his right femur after a car crash. What is the initial postoperative nursing priority?

Ensuring adequate IV hydration

A nurse is assessing a client who has an obstruction of the common bile duct resulting from chronic cholecystitis. Which of the following findings should the nurse expect?

Fatty stools

A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history?

Gallstones

A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best?

Give the client pain medication if it is time for another dose.

The nurse is assessing a patient suspected of having developed acute glomerulonephritis. the nurse should expect to address what clinical manifestation that is characteristic of this health problem?

Hematuria

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?

Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

A patients 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.

How many alcoholic drinks do you typically consume in a week? Have you ever been diagnosed with gallstones?

A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient's increased risk of bleeding. The nurse recognizes that this risk is related to the patient's inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

Inability of the liver to use vitamin K

A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action?

Inform the physician and assess the patient for signs of infection.

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this client's plan of care to reduce discomfort?

Maintain nothing by mouth (NPO) and administer intravenous fluids.

A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema?

Maintaining a balanced intake and output

A patient who has had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices?

Octreotide (Sandostatin)

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patient's liver?

Place hand under right lower rib cage and press down lightly with the other hand.

In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention?

Respiratory rate of 28 breaths/min

A nurse is teaching self-management to a client who has hepatitis B. Which of the following instructions should the nurse include in the teaching?

Rest frequently throughout the day

A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment finding to the physician?

Rigidity of the abdomen

Which assessment finding requires immediate nursing intervention in a patient with severe ascites?

Shallow respirations, rate 32 breaths/min

A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics?

Signs and symptoms of intra-abdominal complications

A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may include what?

Signs and symptoms of septic shock

A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse's priority action?

Slow the infusion

A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recognize as a positive response to the prescribed treatment?

The client has lost 11 pounds in the past 10 days.

A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse most likely explain the pathophysiology of this patient's health problem?

The enzymes that your pancreas produces have damaged the pancreas itself.

A nurse is talking with a client who has cholelithiasis and is about to undergo an oral cholangiogram. Which of the following client statements indicates to the nurse understanding of the procedure?

They are going to examine my gallbladder and ducts

A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for infection when the clients white blood cell count (WBC) is high. What response by the registered nurse is best?

Those WBCs are abnormal and don't provide protection.

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.)

Urine output of 100 mL in 4 hours Large amount of sediment in the urine Blood pressure of 90/60 mm Hg

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing?

Vitamin K deficiency

The nurse is teaching assistive personnel (AP) about care of a client who has advanced cirrhosis. Which statements would the nurse include in the staff teaching? Select all that apply. a. "Apply lotion to the client's dry skin areas." b. "Use a basin with warm water to bathe the patient." c. "For the patient's oral care, use a soft toothbrush." d. "Provide clippers so the patient can trim the fingernails." e. "Bathe with antibacterial and water-based soaps."

a. "Apply lotion to the client's dry skin areas." c. "For the patient's oral care, use a soft toothbrush." d. "Provide clippers so the patient can trim the fingernails." Rationale: Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush would be used to prevent gum bleeding, and the client's nails would need to be trimmed short to prevent the patient from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap.

The nurse is preparing a client who has chronic pancreatitis about how to prevent exacerbations of the disease. Which health teaching will the nurse include? Select all that apply. a. "Avoid alcohol ingestion." b. "Be sure and balance rest with activity." c. "Avoid caffeinated beverages." d. "Avoid green, leafy vegetables." e. "Eat small meals and high-calorie snacks."

a. "Avoid alcohol ingestion." b. "Be sure and balance rest with activity." c. "Avoid caffeinated beverages." e. "Eat small meals and high-calorie snacks." Rationale: Clients who have chronic pancreatitis need to avoid GI stimulants, including alcohol, caffeine, and nicotine. Food and snacks need to be high-calorie to prevent additional weight loss. Green vegetables can be consumed if tolerated by the client.

The nurse is caring for a client who is prescribed lactulose. The client states, "I do not want to take this medication because it causes diarrhea." How would the nurse respond? a. "Diarrhea is expected; that's how your body gets rid of ammonia." b. "You may take antidiarrheal medication to prevent loose stools." c. "Do not take any more of the medication until your stools firm up." d. "We will need to send a stool specimen to the laboratory as soon as possible."

a. "Diarrhea is expected; that's how your body gets rid of ammonia." Rationale: The purpose of administering lactulose to this patient is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The patient must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse would not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first when taking this client's history? a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?" b. "Do you have anyone in your family with renal failure?" c. "Have you had a diet that is low in protein recently?" d. "Has a relative had a kidney transplant lately?"

a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?" Rationale: There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the patient since both the serum creatinine and BUN are elevated, indicating some renal problems. A diet high in protein could be a factor in an increased BUN.

The nurse is caring for a client with hepatitis C. The client's brother states, "I do not want to get this infection, so I'm not going into his hospital room." How would the nurse respond? a. "Hepatitis C is not spread through casual contact." b. "If you wear a gown and gloves, you will not get this virus." c. "This virus is only transmitted through a fecal specimen." d. "I can give you an update on your brother's status from here."

a. "Hepatitis C is not spread through casual contact." Rationale: Although family members may be afraid that they will contract hepatitis C, the nurse would educate them about how the virus is spread. Hepatitis C is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needlesticks, unsanitary tattoo equipment, and sharing of intranasal drug paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the client's status with the brother.

The nurse is assessing a client with hepatitis C. The client asks the nurse how it was possible to have this disease. What questions might the nurse ask to help the client determine how the disease was contracted? Select all that apply. a. "How old are you?" b. "Do you work in health care? c. "Are you receiving hemodialysis?" d. "Do you use IV drugs?" e. "Did you receive blood before 1992?" f. "Have you even been in prison or jail?"

a. "How old are you?" b. "Do you work in health care? c. "Are you receiving hemodialysis?" d. "Do you use IV drugs?" e. "Did you receive blood before 1992?" f. "Have you even been in prison or jail?" Rationale: The nurse would ask all of these questions because "baby boomers," people who use illicit drugs, people on hemodialysis, health workers, and prisoners are at a very high risk for hepatitis C. Additionally, individuals who received blood, blood products, or an organ transplant prior to 1992 before bloodborne disease screening of these products was mandated are at risk for hepatitis C.

A nurse cares for a client with end-stage pancreatic cancer. The client asks, "Why is this happening to me?" How would the nurse respond? a. "I don't know. I wish I had an answer for you, but I don't." b. "It's important to keep a positive attitude for your family right now." c. "Scientists have not determined why cancer develops in certain people." d. "I think that this is a trial so you can become a better person because of it."

a. "I don't know. I wish I had an answer for you, but I don't." Rationale: The client is not asking the nurse to actually explain why the cancer has occurred. The client may be expressing his or her feelings of confusion, frustration, distress, and grief related to this diagnosis. Reminding the client to keep a positive attitude for his or her family does not address the client's emotions or current concerns. The nurse would validate that there is no easy or straightforward answer as to why the client has cancer. Telling a client that cancer is a trial is untrue and may negatively impact the client-nurse relationship.

After teaching a client who has chronic pancreatitis and will be discharged with enzyme replacement therapy, a nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? Select all that apply. a. "I will take the enzymes between meals." b. "The enteric-coated preparations cannot be crushed." c. "Swallowing the tables without chewing is best." d. "I will wipe my lips after taking the enzymes." e. "Enzymes should be taken with high-protein

a. "I will take the enzymes between meals." c. "Swallowing the tables without chewing is best." d. "I will wipe my lips after taking the enzymes." Rationale: Client teaching related to self-management of enzyme replacement therapy would include taking the enzymes with meals and snacks but not mixing enzyme preparations with protein-containing foods. Clients would not crush enteric-coated preparations and should swallow tablets without chewing to minimize oral irritation and allow the drug to be released slowly. Wiping lips after taking enzymes also minimizes skin irritation.

A nurse teaches a client with polycystic kidney disease (PKD). Which statements would the nurse include in this client's discharge teaching? Select all that apply. a. "Take your blood pressure every morning." b. "Weigh yourself at the same time each day." c. "Adjust your diet to prevent diarrhea." d. "Contact your provider if you have visual disturbances." e. "Assess your urine for renal stones."

a. "Take your blood pressure every morning." b. "Weigh yourself at the same time each day." d. "Contact your provider if you have visual disturbances." Rationale: A client who has PKD would measure and record his or her blood pressure and weight daily, limit salt intake, and adjust dietary selections to prevent constipation. The client should notify the primary health care provider if urine smells foul or has blood in it, as these are signs of a urinary tract infection or glomerular injury. The client should also notify the provider if visual disturbances are experienced, as this is a sign of a possible berry aneurysm, which is a complication of PKD. Diarrhea and renal stones are not manifestations or complications of PKD; therefore, teaching related to these concepts would be inappropriate.

A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are correct regarding PD? Select all that apply. a. "You will not need vascular access to perform PD." b. "There is less restriction of protein and fluids." c. "You will have no risk for infection with PD." d. "You have flexible scheduling for the exchanges." e. "It takes less time than hemodialysis treatments."

a. "You will not need vascular access to perform PD." b. "There is less restriction of protein and fluids." d. "You have flexible scheduling for the exchanges." Rationale: PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period of time compared to hemodialysis. There still is risk for infection with PD, especially peritonitis.

A nurse is preoperative teaching with a client who is scheduled for a kidney transplant about rejection of a transplanted kidney. Which of the following statements should the nurse include in the teaching? Select all that apply a. "expect an immediate removal of the donor kidney for hyperacute rejection" b. "you may need to begin dialysis to monitor your kidney function for a hyperacute reaction" c. "a fever is a manifestation of an acute rejection" d. "fluid retention is a manifestation of a

a. "expect an immediate removal of the donor kidney for hyperacute rejection" c. "a fever is a manifestation of an acute rejection" d. "fluid retention is a manifestation of an acute rejection"

A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions would the nurse perform to maintain blood pressure? Select all that apply. a. Adjust the rate of extracorporeal blood flow. b. Place the patient in the Trendelenburg position. c. Stop the hemodialysis treatment. d. Administer a 250-mL bolus of normal saline. e. Contact the primary health care provider.

a. Adjust the rate of extracorporeal blood flow. b. Place the patient in the Trendelenburg position. d. Administer a 250-mL bolus of normal saline. Rationale: Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two boluses and cooling dialysate, the hemodialysis can be stopped and the primary health care provider contacted.

A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority? a. Administer oxygen. b. Apply an oximetry probe. c. Give pain medication. d. Start an IV line.

a. Administer oxygen.

A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of most concern to the nurse? a. Albumin level of 2.5 g/dL (3.63 mcmol/L) b. Phosphorus level of 5 mg/dL (1.62 mmol/L) c. Sodium level of 135 mEq/L (135 mmol/L) d. Potassium level of 5.5 mEq/L (5.5 mmol/L)

a. Albumin level of 2.5 g/dL (3.63 mcmol/L) Rationale: Protein restriction is necessary with CKD due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client's metabolic needs. The electrolyte values are not related to the protein-restricted diet.

The nurse assesses a client who has chronic pancreatitis. What assessment findings would the nurse expect for this client? Select all that apply. a. Ascites b. Weight gain c. Steatorrhea d. Jaundice e. Polydipsia f. Polyuria

a. Ascites c. Steatorrhea d. Jaundice e. Polydipsia f. Polyuria Rationale: The client who has chronic pancreatitis has all of these signs and symptoms except he or she loses weight. Ascites and jaundice result from biliary obstruction; ascites is associated with portal hypertension. Steatorrhea is fatty stool that occurs because lipase is not available in the duodenum; because it is released by the disease pancreas into the bloodstream. Polydipsia, polyuria, and polyphagia result from diabetes mellitus, a common problem seen in clients whose pancreas is unable to release adequate amounts of insulin.

A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease? a. Asterixis b. Constructional apraxia c. Fetor hepaticus d. Palmar erythema

a. Asterixis

A client with chronic kidney disease (CKD) has an elevated serum phosphorus level. What drug would the nurse anticipate to be prescribed for this client? a. Calcium acetate b. Doxycyline c. Magnesium sulfate d. Lisinopril

a. Calcium acetate Rationale: The client with CKD often has a high phosphorus level which tends to lower the calcium level in an inverse relationship, and causes osteodystrophy. To prevent this bone disease, the client needs to take a drug that can bind with phosphorus for elimination via the GI tract. When phosphorus is lowered to within normal limits, normal calcium levels may be restored.

A nurse in a clinic is caring for a client who has a history of alcohol abuse and reports bruising and frequent nosebleeds. For which of the following is the client at risk? a. Cirrhosis b. Diabetes c. Hepatitis A d. Malnutrition

a. Cirrhosis

The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for postrenal acute kidney injury (AKI)? Select all that apply. a. Client with prostate cancer b. Client with blood clots in the urinary tract c. Client with ureterolithiasis d. Client with severe burns e. Client with lupus

a. Client with prostate cancer b. Client with blood clots in the urinary tract c. Client with ureterolithiasis Rationale: Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney stones (ureterolithiasis), causes postrenal AKI. Severe burns would be a prerenal cause. Lupus would be an intrarenal cause for AKI.

A nurse working with clients with sickle cell disease (SCD) teaches about self-management to prevent exacerbations and sickle cell crises. What factors should clients be taught to avoid? Select all that apply. a. Dehydration b. Exercise c. Extreme stress d. High altitudes e. Pregnancy

a. Dehydration c. Extreme stress d. High altitudes e. Pregnancy

55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment? a. Destruction of the patients liver tumor b. Restoration of portal vein patency c. Destruction of a liver abscess d. Reversal of metastasis

a. Destruction of the patients liver tumor

The nurse is caring for a client who was recently diagnosed with pancreatic cancer. What factors present risks for developing this type of cancer? Select all that apply. a. Diabetes mellitus b. Cirrhosis c. Smoking d. Female gender e. Family history f. Older age

a. Diabetes mellitus b. Cirrhosis c. Smoking e. Family history f. Older age Rationale: All of these choices are risk factors except that pancreatic cancer occurs most frequently in men.

A client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse? a. Discuss what the treatment regimen means to the client. b. Refer the client to a mental health nurse practitioner. c. Reschedule the appointments to another date and time. d. Discuss the option of peritoneal dialysis.

a. Discuss what the treatment regimen means to the client. Rationale: The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of the treatment would come first.

A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to immediately contact the primary health care provider? a. Drainage from a fistula b. Diminished bowel sounds c. Pain at the incision site d. Nasogastric (NG) tube drainage

a. Drainage from a fistula Rationale: Complications of a Whipple procedure include secretions that drain from a fistula and peritonitis. Absent bowel sounds, pain at the incision site, and NG tube drainage are normal postoperative findings.

A nurse is providing dietary teaching to a client who has a history of recurring calcium oxalate kidney stones. Which of the following instructions should the nurse include in the teaching a. Drink 3 L of fluid every day b. Eat 12 oz animal protein daily c. Take 3000 mg of vit C daily d. Restrict calcium intake to one serving daily

a. Drink 3 L of fluid every day

The nurse is caring for a client who has possible acute pancreatitis. What serum laboratory findings would the nurse expect for this client? Select all that apply. a. Elevated amylase b. Elevated lipase c. Elevated glucose d. Decreased calcium e. Elevated bilirubin f. Elevated leukocyte count

a. Elevated amylase b. Elevated lipase c. Elevated glucose d. Decreased calcium e. Elevated bilirubin f. Elevated leukocyte count Rationale: All of these choices are correct. Amylase and lipase are pancreatic enzymes that are released during pancreatic inflammation and injury. Leukocytes also increased due to his inflammatory response. Pancreatic injury affects the ability of insulin to be released causing increased glucose levels. Bilirubin is also typically increased due to hepatobiliary obstruction. Calcium and magnesium levels decrease because fatty acids bind free calcium and magnesium causing a lowered serum level; these changes occur in the presence of fat necrosis.

A nurse is assessing a client who has obstruction of the common bile duct resulting from chronic cholecystitis which of the following findings should the nurse expect? a. Fatty stools b. Straw-colored urine c. Tenderness in the left upper abdomen d. Ecchymosis of the extremities

a. Fatty stools

The nurse is assessing a client with acute pyelonephritis. What assessment findings would the nurse expect? Select all that apply. a. Fever b. Chills c. Tachycardia d. Tachypnea e. Flank or back pain f. Fatigue

a. Fever b. Chills c. Tachycardia d. Tachypnea e. Flank or back pain f. Fatigue Rationale: All of these assessment findings commonly occur in clients who have acute pyelonephritis because this health problem is a kidney infection.

A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history? a. Gallstones b. Hypolipidemia c. COPD d. Diabetes mellitus

a. Gallstones

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is most appropriate? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the patient to drink 2 to 3 L of water daily. d. Perform an electrocardiogram.

a. Give the client a bottle of water immediately. Rationale: This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be needed later, after the patient's degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best? a. Give the client pain medication if it is time for another dose. b. Instruct the client not to request pain medication too early. c. Request the provider leave a prescription for a placebo. d. Tell the client it is too early to have

a. Give the client pain medication if it is time for another dose.

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? a. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is ess

a. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

The nurse is teaching a client a client about taking elbasvir for hepatitis C. What information in the client's history would the nurse need prior to drug administration? a. History of hepatitis B b. History of kidney disease c. History of cardiac disease d. History of rectal bleeding

a. History of hepatitis B Rationale: Elbasvir can cause liver toxicity and therefore the nurse would assess for a history of or current hepatitis B.

A patients 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. a. How many alcoholic drinks do you typically consume in a week? b. Have you ever been tested for diabetes? c. Have you ever been diagnosed with gallstones? d. Would you say that you eat a particularly high-fat diet? e. Does anyone in your family have cystic fibrosis?

a. How many alcoholic drinks do you typically consume in a week? c. Have you ever been diagnosed with gallstones?

The nurse is caring for a client with early encephalopathy due to cirrhosis of the liver. Which factors may contribute to increased encephalopathy for which the nurse would assess? Select all that apply. a. Infection b. GI bleeding c. Irritable bowel syndrome d. Constipation e. Anemia f. Hypovolemia

a. Infection b. GI bleeding d. Constipation f. Hypovolemia Rationale: Anemia and irritable bowel syndrome are unrelated to developing or worsening encephalopathy, which is caused by increased protein which breaks down into ammonia. Infection can cause hypovolemia which would increase serum protein concentration. Constipation and GI bleeding causes a large protein load in the intestines.

A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? a. Inform the physician and assess the patient for signs of infection. b. Flush the peritoneal catheter with normal saline. c. Remove the catheter promptly and have the catheter tip cultured. d. Administer a bolus of IV normal saline as ordered.

a. Inform the physician and assess the patient for signs of infection.

The nurse is caring for a client who has late-stage (advanced) cirrhosis. What assessment findings would the nurse expect? Select all that apply. a. Jaundice b. Clay-colored stools c. Icterus d. Ascites e. Petechiae f. Dark urine

a. Jaundice b. Clay-colored stools c. Icterus d. Ascites e. Petechiae f. Dark urine Rationale: All of these assessment findings are very common for a client who has late-stage cirrhosis due to biliary obstruction and poor liver function. The client has vascular lesions and excess fluid from portal hypertension.

A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the renal-specific formulation for the enteral solution compared to standard formulas. What components would be discussed in the teaching plan? Select all that apply. a. Lower sodium b. Higher calcium c. Lower potassium d. Higher phosphorus e. Higher calories

a. Lower sodium c. Lower potassium e. Higher calories Rationale: Many clients with AKI are too ill to meet caloric goals and require tube feedings with renal-specific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas.

A client is taking furosemide 40 mg/day for management of early chronic kidney disease (CKD). To assess the therapeutic effect of the medication, what action of the nurse is best? a. Obtain daily weights of the client. b. Auscultate heart and breath sounds. c. Palpate the client's abdomen. d. Assess the client's diet history.

a. Obtain daily weights of the client. Rationale: Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in patients with early stages of CKD. One kilogram of weight equals about 1 L of fluid retained in the client, so daily weights are necessary to monitor the response of the client to the medication. Heart and breath sounds would be assessed if there is fluid retention, as in heart failure. Palpation of the client's abdomen is not necessary, but the nurse would check for edema. The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic, but this does not assess the effectiveness of the medication.

The nurse plans care for a patient who has hepatopulmonary syndrome. Which interventions would the nurse include in this client's plan of care? Select all that apply. a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy f. Respiratory therapy

a. Oxygen therapy c. Feet elevated on pillows d. Daily weights f. Respiratory therapy Rationale: Care for a client who has hepatopulmonary syndrome would include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the patient in a prone position, on the patient's stomach. Although physical therapy may be helpful to a patient who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome. However, respiratory support from a specialized therapist may be needed.

A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse? a. Place the client on a cardiac monitor immediately. b. Teach the client to limit high-potassium foods. c. Continue to monitor the client's intake and output. d. Ask to have the laboratory redraw the blood specimen.

a. Place the client on a cardiac monitor immediately. Rationale: The best action by the nurse would be to check the cardiac status with a monitor. High-potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

The nurse is reviewing the results of a client's urinalysis. The client has a diagnosis of acute glomerulonephritis. Which urine findings would the nurse expect? Select all that apply. a. Presence of protein b. Presence of red blood cells c. Presence of white blood cells d. Acidic urine e. Dilute urine

a. Presence of protein b. Presence of red blood cells c. Presence of white blood cells d. Acidic urine Rationale: The nurse would expect all of these findings except that the urine is usually concentrated with a high specific gravity.

A nurse assesses a client with nephrotic syndrome. Which assessment findings would the nurse expect? Select all that apply. a. Proteinuria b. Hypoalbuminemia c. Dehydration d. Lipiduria e. Dysuria f. Costovertebral angle (CVA) tenderness

a. Proteinuria b. Hypoalbuminemia d. Lipiduria Rationale: Nephrotic syndrome is caused by glomerular damage and is characterized by proteinuria (protein level higher than 3.5 g/24 hr), hypoalbuminemia, edema, and lipiduria. Fluid overload leading to edema and hypertension is common with nephrotic syndrome; dehydration does not occur. Dysuria is present with cystitis. CVA tenderness is present with inflammatory changes in the kidney.

The nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members would the nurse collaborate to provide appropriate nutrition to this client? Select all that apply. a. Registered dietitian nutritionist b. Nursing assistant c. Clinical pharmacist d. Certified herbalist e. Primary health care provider

a. Registered dietitian nutritionist c. Clinical pharmacist e. Primary health care provider Rationale: Clients who are prescribed NPO while experiencing an acute pancreatitis episode may need enteral or parenteral nutrition. The nurse would collaborate with the registered dietitian nutritionist, clinical pharmacist, and primary health care provider to plan and implement the more appropriate nutritional interventions. The nursing assistant and certified herbalist would not assist with this clinical decision.

A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recognize as a positive response to the prescribed treatment? a. The client has lost 11 pounds in the past 10 days. b. The clients urine specific gravity is 1.048. c. No blood is observed in the clients urine. d. The clients blood pressure is 152/88 mm Hg.

a. The client has lost 11 pounds in the past 10 days.

A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding would the nurse recognize as a positive response to the prescribed treatment? a. The client lost 11 lb (5 kg) in the past 10 days. b. The client's urine specific gravity is 1.048. c. No blood is observed in the client's urine. d. The client's blood pressure is 152/88 mm Hg.

a. The client lost 11 lb (5 kg) in the past 10 days. Rationale: Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram a. They are going to examine my gallbladder and ducts b. I will have a camera put down my throat and I can see my gallbladder c. Soon the shockwaves will get rid of my gallstone d.. They will put medication into my gallbladder to dissolve the stones

a. They are going to examine my gallbladder and ducts

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? Select all that apply. a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg

a. Urine output of 100 mL in 4 hours c. Large amount of sediment in the urine e. Blood pressure of 90/60 mm Hg

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse would prompt immediate action to prevent acute kidney injury? Select all that apply. a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg

a. Urine output of 100 mL in 4 hours c. Large amount of sediment in the urine e. Blood pressure of 90/60 mm Hg Rationale: The low urine output, sediment, and blood pressure would be reported to the primary health care provider. Postoperatively, the nurse would measure intake and output, check the characteristics of the urine, and report sediment, hematuria, and urine output of less than 0.5 mL/kg/hr for 3 to 4 hours. A urine output of 100 mL is low, but a urine output of 500 mL in 12 hours would be within normal limits. Perfusion to the kidneys is compromised with low blood pressure. The amber odorless urine is normal.

The nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding would require immediate action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 22 to 16 breaths/min d. A decrease in the client's weight by 3 lb (1.4 kg)

a. Urine output via indwelling urinary catheter is 20 mL/hr Rationale: Rapid removal of ascitic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the client's weight to drop as fluid is removed. To prevent hypovolemic shock, no more than 2000 mL are usually removed from the abdomen at one time. The patient's weight typically only decreases by less than 2 kg or 4.4 lb.

A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? Select all that apply a. a client who is at 32 weeks gestation b. a client who has a kidney calculi c. a client who has a urine pH of 4.2 d. a client who has a neurogenic bladder e. a client who has diabetes mellitis

a. a client who is at 32 weeks gestation b. a client who has a kidney calculi d. a client who has a neurogenic bladder e. a client who has diabetes mellitis

A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the client's risk of surgery? Select all that apply a. age older than 70 years b. BMI of 41 c. administering NPH insulin each morning d. past history of lymphoma e. blood pressure averaging 120/70 mmHg

a. age older than 70 years b. BMI of 41 c. administering NPH insulin each morning d. past history of lymphoma

A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? Select all that apply a. anuria b. marked azotemia c. crackles in the lungs d. increased calcium level e. proteinuria

a. anuria b. marked azotemia c. crackles in the lungs e. proteinuria

A nurse is planning care for a client who has Stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? (Select all that apply) a. assess for jugular vein distention b. provide frequent mouth rinses c. auscultate for a pleural friction rub d. provide a high-sodium diet e. monitor for dysrhythmias

a. assess for jugular vein distention b. provide frequent mouth rinses c. auscultate for a pleural friction rub e. monitor for dysrhythmias

A nurse is preparing educational material to present to a female client who has frequent urinary tract infections. Which of the following information should the nurse include? Select all that apply a. avoid sitting in a wet bathing suit b. wipe the perineal area back to front following elimination c. empty the bladder when there is an urge to void d. wear synthetic fabric underwear e. take a shower daily

a. avoid sitting in a wet bathing suit c. empty the bladder when there is an urge to void e. take a shower daily

A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) a. check the BUN/serum creatinine b. administer medications the nurse withheld prior to dialysis c. observe the signs of hypovolemia d. assess the access site for bleeding e. evaluate blood pressure on the arm with AV access

a. check the BUN/serum creatinine b. administer medications the nurse withheld prior to dialysis c. observe the signs of hypovolemia d. assess the access site for bleeding

A nurse is reviewing discharge instructions with a client who had spontaneous passage of calcium phosphate renal calculus. Which of the following instructions should the nurse include in the teaching? Select all that apply a. limit intake of food high in animal protein b. reduce sodium intake c. strain urine for 48 hours d. report burning with urination to the provider e. increase fluid intake to 3L/day

a. limit intake of food high in animal protein b. reduce sodium intake d. report burning with urination to the provider e. increase fluid intake to 3L/day

A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? Select all that apply a. monitor serum glucose levels b. report cloudy dialysate return c. warm the dialysate in a microwave oven d. assess for shortness of breath e. check the access site dressing for wetness f. maintain medical asepsis when accessing the catheter insertion site

a. monitor serum glucose levels b. report cloudy dialysate return d. assess for shortness of breath e. check the access site dressing for wetness

A nurse is planning postoperative care for a client following a kidney transplant surgery. Which of the following actions should the nurse include in the plan of care? Select all that apply a. obtain daily weights b. assess dressings for bloody drainage c. replace hourly urine output with IV fluids d. expect oliguria in the first 4 hrs e. monitor serum electrolytes

a. obtain daily weights b. assess dressings for bloody drainage c. replace hourly urine output with IV fluids e. monitor serum electrolytes

A nurse is planning care for a client who has postrenral AKI due to metastatic cancer. The client has a serum creatinine of 5mg/dL. Which of the following interventions should the nurse include in the plan? a. provide a high-protein diet b. assess the urine for blood c. monitor for intermittent anuria d. weigh the client once per week e. provide nsaids for pain

a. provide a high-protein diet b. assess the urine for blood c. monitor for intermittent anuria

A nurse is planning care for a client who has chronic pyelonephritis. Which of the following actions should the nurse plan to take? Select all that apply a. provide a referral for nutrition counseling b. encourage daily fluid intake of 1 L c. palpate the costovertebral angle d. monitor urinary output e. administer antibiotics

a. provide a referral for nutrition counseling c. palpate the costovertebral angle d. monitor urinary output e. administer antibiotics

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury. Which of the following actions should the nurse take? Select all that apply a. review the medications the client currently takes b. assess the AV fistula for a bruit c. calculate the client's hourly urine output d. measure the client's weight e. check serum electrolytes f. use the access site for venipuncture

a. review the medications the client currently takes b. assess the AV fistula for a bruit d. measure the client's weight e. check serum electrolytes

A patient with cirrhosis has 4+ pitting edema of the feet and legs. The data indicate that it is most important for the nurse to monitor the patients

albumin level.

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client's understanding. Which statement by the client indicates correct understanding of the teaching? a. "Some medications have been known to cause hepatitis A." b. "I may have been exposed when we ate shrimp last weekend." c. "I was infected with hepatitis A through a recent blood transfusion." d. "My infection with Epstein-Barr virus can co-infect me with hepatitis A."

b. "I may have been exposed when we ate shrimp last weekend." Rationale: The route of transmission for hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.

After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I will take a laxative every night before going to bed." b. "I must increase my intake of dietary fiber and fluids." c. "I shall only use salt when I am cooking my own food." d. "I'll eat white bread to minimize gastrointestinal gas."

b. "I must increase my intake of dietary fiber and fluids." Rationale: Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. Laxatives would be used cautiously. Clients with PKD would be on a restricted salt diet, which includes not cooking with salt. White bread has a low-fiber count and would not be included in a high-fiber diet.

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? Select all that apply. a. "I can continue to take antacids to relieve heartburn." b. "I need to ask for an antibiotic when scheduling a dental appointment." c. "I'll need to check my blood sugar often to prevent hypoglycemia." d. "The dose of my pain medication may have to be adjusted." e. "I should watch

b. "I need to ask for an antibiotic when scheduling a dental appointment." c. "I'll need to check my blood sugar often to prevent hypoglycemia." d. "The dose of my pain medication may have to be adjusted." e. "I should watch for bleeding when taking my anticoagulants." Rationale: In discharge teaching, the nurse must emphasize that the client needs to have an antibiotic prophylactically before dental procedures to prevent infection. There may be a need for dose reduction in medications if the kidney is not excreting them properly (antacids with magnesium, antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants).

After teaching a client with nephrotic syndrome and a normal glomerular filtration, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the diet therapy for this condition? a. "I must decrease my intake of fat." b. "I will increase my intake of protein." c. "A decreased intake of carbohydrates will be required." d. "An increased intake of vitamin C is necessary."

b. "I will increase my intake of protein." Rationale: In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss would be matched by increased intake of protein. The client would not need to adjust fat, carbohydrates, or vitamins based on this disorder.

After teaching a client with hypertension secondary to renal disease, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I can prevent more damage to my kidneys by managing my blood pressure." b. "If I have increased urination at night, I need to drink less fluid during the day." c. "I need to see the registered dietitian to discuss limiting my protein intake." d. "It is important that I take my antihypertensive medica

b. "If I have increased urination at night, I need to drink less fluid during the day." Rationale: The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions, and would be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by consuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian nutritionist as needed.

The nurse is caring for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic, and the family expresses distress that the patient is receiving little dietary protein. How would the nurse respond? a. "A low-protein diet will help the liver rest and will restore liver function." b. "Less protein in the diet will help prevent confusion associated with liver failure." c. "Increasing dietary protein will help the patient gain weight and muscle mass." d. "Low di

b. "Less protein in the diet will help prevent confusion associated with liver failure." Rationale: A low-protein diet is prescribed when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the patient's dietary protein will cause complications of liver failure and would not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

A client has an external percutaneous transhepatic biliary catheter inserted for a biliary obstruction. What health teaching about catheter care would the nurse provide for the client? a. "Cap the catheter drain at night to prevent leakage and skin damage." b. "Position the drainage bag lower than the catheter insertion site." c. "Irrigate the catheter with an ounce of saline every night." d. "Pierce a hole in the top of the drainage bag to get rid of odors."

b. "Position the drainage bag lower than the catheter insertion site." Rationale: An external temporary or permanent catheter drains bile by gravity into a bag that collects bile. Therefore, the drainage bag should be lower that the catheter insertion site. The catheter should not be capped or irrigated, and no holes should be made in the bag to prevent bile from having contact with the skin.

A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, "I'm having right belly pain and have a temperature of 101° F (38.3° C)." How would the nurse respond? a. "The anti-rejection drugs you are taking make you susceptible to infection." b. "You should go to the hospital immediately to get checked out." c. "You should take an additional dose of cyclosporine today." d. "Take acetaminophen every 4 hours until you feel better soon."

b. "You should go to the hospital immediately to get checked out." Rationale: Fever, right abdominal quadrant pain, and jaundice are signs of possible liver transplant rejection; the client would be admitted to the hospital as soon as possible for intervention. Antirejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse would not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.

A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patients treatment, the nurse should anticipate what intervention? a. Administration of immune globulins b. A regimen of antiviral medications c. Rest and watchful waiting d. Administration of fresh-frozen plasma (FFP)

b. A regimen of antiviral medications

A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of the following lab values? a. Calcium b. Amylase c. Red blood cell count d. Magnesium

b. Amylase

The nurse is caring for a client with a new diagnosis of chronic kidney disease. Which priority complications would the nurse anticipate? Select all that apply. a. Dehydration b. Anemia c. Hypertension d. Dysrhythmias e. Heart failure

b. Anemia c. Hypertension d. Dysrhythmias e. Heart failure Rationale: The client who has CKD has fluid overload and electrolyte imbalances, especially hyperkalemia, that can cause hypertension, heart failure, and dysrhythmias. Anemia results because erythropoietin production by the kidneys is decreased.

The family of a neutropenic client reports the client is not acting right. What action by the nurse is the priority? a. Ask the client about pain. b. Assess the client for infection. c. Delegate taking a set of vital signs. d. Look at todays laboratory results

b. Assess the client for infection.

The nurse is caring for a patient with polycystic kidney disease. Which assessment finding requires immediate nursing intervention? a. Temperature of 99° F b. Blood pressure of 170/90 c. Heart rate of 100 beats/min d. Urine output less than 30 cc/hr

b. Blood pressure of 170/90

A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? Select all that apply. a. Clear drainage b. Bloody drainage at site c. Client reports headache d. Foul-smelling drainage e. Urine draining from site

b. Bloody drainage at site d. Foul-smelling drainage e. Urine draining from site

A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings would alert the nurse to urgently contact the primary health care provider? Select all that apply. a. Clear drainage b. Bloody drainage at site c. Patient reports headache d. Foul-smelling drainage e. Urine draining from site

b. Bloody drainage at site d. Foul-smelling drainage e. Urine draining from sitee Rationale: After a nephrostomy, the nurse would assess the client for complications and urgently notify the primary health care provider if drainage decreases or stops, drainage is cloudy or foul smelling, the nephrostomy site leaks blood or urine, or the client has back pain. Clear drainage is normal. A headache would be an unrelated finding.

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first? a. Client with a blood pressure of 180/98 mm Hg b. Client who reports shortness of breath c. Client who reports calf tenderness and swelling d. Client with a swollen and painful left great toe

b. Client who reports shortness of breath

The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initial rounding? a. Client with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Client with skin itching from head to toe d. Client with halitosis and stomatitis

b. Client with Kussmaul respirations Rationale: Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of CKD. The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs to lower serum pH. Hypertension is common in most patients with CKD, and skin itching increases with calcium-phosphate imbalances and elevations of nitrogenous wastes, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.

The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient's recent history? a. Pyelonephritis b. Dehydration c. Bladder cancer d. Kidney stones

b. Dehydration Rationale: Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are postrenal causes of AKI related to urine flow obstruction.

A nurse assesses a client who has cirrhosis of the liver. Which laboratory findings would the nurse expect in clients with this disorder? Select all that apply. a. Elevated aspartate transaminase b. Elevateterm-15d international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

b. Elevated international normalized ratio (INR) e. Elevated serum ammonia f. Elevated prothrombin time (PT) Rationale: Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the client's confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

A nurse is providing care for a client who had a laparoscopic cholecystectomy. Which of the following is an appropriate nursing action? a. Place the client in a supine position postoperatively. b. Encourage ambulation once fully awake. C. Offer the client ice cream postoperatively. D. Instruct the client not to lift over 4.5 kg (10 lb)

b. Encourage ambulation once fully awake.

A 23-year-old African-American male with a history of sickle cell disease had an emergent open reduction and internal fixation of his right femur after a car crash. What is the initial postoperative nursing priority? a. Treating the patient's pain b. Ensuring adequate IV hydration c. Titrating oxygen to an Spo2 >95% d. Examining the surgical incision for signs and symptoms of infection

b. Ensuring adequate IV hydration

A nurse assesses a client who has a family history of polycystic kidney disease (PKD). Which assessment findings would the nurse expect? Select all that apply. a. Nocturia b. Flank pain c. Increased abdominal girth d. Dysuria e. Hematuria f. Diarrhea

b. Flank pain c. Increased abdominal girth e. Hematuria Rationale: Clients with PKD experience abdominal distention that manifests as flank pain and increased abdominal girth. Bloody urine is also present with tissue damage secondary to PKD. Clients with PKD often experience constipation, but would not report nocturia or dysuria.

A nurse is reviewing client laboratory data. The nurse should recognize that which of the following findings is expected for a client who has Stage 4 chronic kidney disease? a. BUN 15 mg/dL b. GFR 20 mL/min c. serum creatinine 1.1 mg/dL d. serum potassium 5.0 mEq/L

b. GFR 20 mL/min

A nurse is preparing to administer blood transfusion to an older adult. Understanding age-related changes what alteration in the usual protocol are necessary for the nurse to implement a. Transfuse each unit over 8 hours b. Hold other IV fluids running c. Transfuse smaller bag of blood d. Pre-medicate to prevent reaction e. Access vital signs more often

b. Hold other IV fluids running e. Access vital signs more often

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this clients plan of care to reduce discomfort? a. Administer morphine sulfate intravenously every 4 hours as needed. b. Maintain nothing by mouth (NPO) and administer intravenous fluids. c. Provide small, frequent feedings with no concentrated sweets. d. Place the client in semi-Fowlers position with the head of bed elevated.

b. Maintain nothing by mouth (NPO) and administer intravenous fluids.

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse? a. Warm the dialysate solution in a microwave before instillation. b. Obtain a sample of the effluent and send to the laboratory. c. Flush the tubing with normal saline to maintain patency of the catheter. d. Check the peritoneal catheter for kinking and curling.

b. Obtain a sample of the effluent and send to the laboratory. Rationale: An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding would alert the nurse to immediately contact the primary health care provider? a. Flank pain b. Periorbital edema c. Bloody and cloudy urine d. Enlarged abdomen

b. Periorbital edema Rationale: Periorbital edema would not be a finding related to PKD and would be investigated further. Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or infection.

The nurse is caring for a client who is recovering from an open traditional Whipple surgical procedure. What action would the nurse take? a. Clamp the nasogastric tube. b. Place the patient in semi-Fowler position. c. Assess vital signs once every shift. d. Provide oral rehydration.

b. Place the patient in semi-Fowler position. Rationale: Postoperative care for a patient recovering from an open Whipple procedure would include placing the client in a semi-Fowler position to reduce tension on the suture line and anastomosis sites and promote breathing, setting the nasogastric tube to low continuous suction to remove free air buildup and pressure, assessing vital signs frequently to assess fluid and electrolyte complications, and providing intravenous fluids.

The nurse is assessing a client who has hepatitis C. What extrahepatic complications would the nurse anticipate? Select all that apply. a. Pancreatitis b. Polyarthritis c. Heart disease d. Myalgia e. Peptic ulcer disease f. Ulcerative colitis

b. Polyarthritis c. Heart disease d. Myalgia Rationale: The client who has hepatitis C has complications that do not relate to the liver, including polyarthritis, myalgia, heart disease and vasculitis, renal disease, and cognitive impairment.

The nurse is caring for a client who has cirrhosis of the liver. What nursing action is appropriate to help control ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the patient daily.

b. Provide a low-sodium diet. Rationale: A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.

A nurse is teaching self management to a client who has hepatitis B. Which of the following instructions should the nurse include in the teaching a. Consume a high protein diet b. Rest frequently throughout the day c. You may donate blood in in 6 months d. After completing the medication regiment take acetaminophen every 4 hrs. as needed for discomfort

b. Rest frequently throughout the day

A client is admitted with acute pancreatitis. What priority problem would the nurse expect the client to report? a. Nausea and vomiting b. Severe boring abdominal pain c. Jaundice and itching d. Elevated temperature

b. Severe boring abdominal pain Rationale: The client who has acute pancreatitis reports severe boring abdominal pain that is often rated by clients as a 10+ on a 0-10 pain scale. Nausea, vomiting, and fever may also occur, but that is not the client's priority for care.

A nurse is assessing a client who has cirrhosis which of the following is an expected finding for this client? a. Moist skin b. Spider angiomas c. Blood in the urine d. Black stool

b. Spider angiomas

A nurse assesses a client who is recovering from an open traditional Whipple surgical procedure. Which assessment finding(s) alert(s) the nurse to a complication from this surgery? Select all that apply. a. Clay-colored stools b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr Rationale: Myocardial infarction (chest pain), pulmonary embolism (shortness of breath), adynamic ileus (lack of bowel sounds or flatus), and acute kidney injury (urine output of 20 mL/6 hr) are common complications for which the nurse must assess the client after the Whipple procedure. Clay-colored stools are associated with cholecystitis and are not a complication of a Whipple procedure.

A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate calculus. To decrease the chance of recurrence, the nurse should instruct the client to avoid which of the following foods? Select all that apply a. red meat b. black tea c. cheese d. whole grains e. spinach

b. black tea e. spinach

A nurse is reviewing urinalysis results for four clients. Which of the following urinalysis results indicates a urinary tract infection? a. positive for hyaline cysts b. positive for leukocyte esterase c. positive for ketones d. positive for crystals

b. positive for leukocyte esterase

A nurse cares for a middle-age female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to help prevent these infections?" How would the nurse respond? a. "Test your urine daily for the presence of ketone bodies and proteins." b. "Use tampons rather than sanitary napkins during your menstrual period." c. "Drink more water and empty your bladder more frequently during the day." d. "Keep your hemoglob

c. "Drink more water and empty your bladder more frequently during the day." Rationale: Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH, and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client's sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1C of 9% is too high.

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? a. "I cannot drink any alcohol at all anymore." b. "I should not take over-the-counter medications." c. "I need to avoid protein in my diet." d. "I should eat small, frequent, balanced meals."

c. "I need to avoid protein in my diet." Rationale: Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching? a. "I should leave the drainage bag above the level of my abdomen." b. "I could flush the tubing with normal saline if the flow stops." c. "I should take a stool softener every morning to avoid constipation." d. "My diet should have low fiber in it to prevent any irritation."

c. "I should take a stool softener every morning to avoid constipation." Rationale: Inflow and outflow problems of the dialysate are best controlled by preventing constipation. A daily stool softener is the best option for the client. The drainage bag should be below the level of the abdomen. Flushing the tubing will not help with the flow. A diet high in fiber will also help with a constipation problem.

The nurse is caring for a client who has cirrhosis from substance abuse. The client states, "All of my family hates me." How would the nurse respond? a. "You should make peace with your family." b. "This is not unusual. My family hates me too." c. "I will help you identify a support system." d. "You must attend Alcoholics Anonymous."

c. "I will help you identify a support system." Rationale: Clients who have cirrhosis due to addiction may have alienated relatives over the years because of substance abuse. The nurse would assist the client to identify a friend, neighbor, clergy/spiritual leader, or group for support. The nurse would not minimize the patient's concerns. Attending AA may be appropriate, but this response doesn't address the client's concern. "Making peace" with the client's family may not be possible. This statement is not client-centered.

A nurse cares for a client who has pyelonephritis. The client states, "I am embarrassed to talk about my symptoms." How would the nurse respond? a. "I am a professional. Your symptoms will be kept in confidence." b. "I understand. Elimination is a private topic and shouldn't be discussed." c. "Take your time. It is okay to use words that are familiar to you." d. "You seem anxious. Would you like a nurse of the same gender to care for you?"

c. "Take your time. It is okay to use words that are familiar to you." Rationale: Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse would encourage the client to use language that is familiar to the client. The nurse must assess the client and cannot take the time to stop the discussion or find another nurse to complete the assessment.

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? a. "The capsules can be opened and the Lower sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that

c. "The best time to take the enzymes is immediately after I have a meal or a snack." Rationale: The enzymes must be taken immediately before eating meals or snacks. If the client cannot swallow the capsules whole, they can be opened up and the powder sprinkled on applesauce, mashed fruit, or rice cereal. The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin. Protein items will be dissolved by the enzymes if they are mixed together.

The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has acute kidney injury (AKI). The client's 24-hour urinary output is 120 mL. How much fluid would the client be allowed to have over the next 24 hours? a. 380 mL b. 500 mL c. 620 mL d. 750 mL

c. 620 mL Rationale: The general principle for fluid restriction for clients is that they may have a daily fluid intake of 500 mL plus the amount of their urinary output. In this case, 120 mL urinary output plus 500 mL equals 620 mL fluid allowance.

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

c. Administering intravenous fluids through the AV fistula

The charge nurse is orienting a new nurse about care for an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

c. Administering intravenous fluids through the AV fistula Rationale: The nurse would not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The AV fistula would be monitored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment.

A community health nurse is caring for a patient whose multiple health problems include chronic pancreatitis. During the most recent visit, the nurse notes that the patient is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurses most appropriate action? a. Administer a PRN dose of pancreatic enzymes as ordered. b. Teach the patient about the importance of abstaining from alcohol. c. Arrange for the patient to be transported to the hospital. d.

c. Arrange for the patient to be transported to the hospital.

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan? a. Include foods high in starch and proteins. b. Include foods high in fiber. c. Avoid foods high in fat. d. Avoid foods high in sodium

c. Avoid foods high in fat.

A client is started on continuous venovenous hemofiltration (CVVH). Which finding would require immediate action by the nurse? a. Potassium level of 5.5 mEq/L (5.5 mmol/L) b. Sodium level of 138 mEq/L (138 mmol/L) c. Blood pressure of 76/58 mm Hg d. Pulse rate of 88 beats/min

c. Blood pressure of 76/58 mm Hg Rationale: Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure. The nurse needs to monitor for ongoing fluid and electrolyte replacement. The sodium level is normal and the potassium level is slightly elevated, which could be normal findings for someone with acute kidney injury. A pulse rate of 88 beats/min is within usual limits.

A nurse assesses a client who has cholecystitis. Which sign or symptom indicates that this condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy sign c. Clay-colored stools d. Upper abdominal pain after eating

c. Clay-colored stools Rationale: Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen in clients with either chronic or acute cholecystitis.

A nurse dis assessing a client who has chronic kidney disease a. Intake and output b. Skin turgor c. Daily weight d. Serum sodium level

c. Daily weight

A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem? a. Assessment of blood pressure and assessment for headaches and visual changes b. Assessments for signs and symptoms of venous thromboembolism c. Daily weights and abdominal girth measurement d. Blood glucose monitoring q4h

c. Daily weights and abdominal girth measurement

A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first? a. Bring the client to a quiet room for privacy. b. Pull up a chair and sit next to the clients bed. c. Determine whether the client feels like talking about his or her feelings. d. Review the health care providers notes about the prognosis for the client.

c. Determine whether the client feels like talking about his or her feelings.

A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, What can I do to help prevent these infections? How should the nurse respond? a. Test your urine daily for the presence of ketone bodies and proteins. b. Use tampons rather than sanitary napkins during your menstrual period. c. Drink more water and empty your bladder more frequently during the day. d. Keep your hemoglobin A1c

c. Drink more water and empty your bladder more frequently during the day.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this patient's care? a. Edema and pain b. Cardiac and respiratory status c. Electrolyte and fluid imbalance d. Mental health status

c. Electrolyte and fluid imbalance Rationale: This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client's cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

A nurse is caring for a client with hepatitis A the client as the nurse how might I have contracted the virus. Which of the following is a question the nurse might ask the client? a. Did you receive a blood transfusion lately b. Do you take any recreational drugs c. Have you eaten any fresh fish lately d. Have you been to a third world country lately

c. Have you eaten any fresh fish lately

The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? a. Precipitous b. Decrease in creatinine level c. Hematuria d. Hypotension unresolved by fluid administration

c. Hematuria

The nurse is caring for a client who has chronic pyelonephritis. What assessment finding would the nurse expect? a. Fever b. Flank pain c. Hypertension d. Nausea and vomiting

c. Hypertension Rationale: The client who has chronic pyelonephritis has renal damage and therefore has hypertension. The other assessment findings commonly occur in clients with acute pyelonephritis.

A nurse reviews the laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium: 136 mEq/L (135 mmol/L) Potassium: 5 mEq/L (5 mmol/L) Blood urea nitrogen(BUN): 44 mg/dL (15.7 mmol/L) Serum creatinine: 2.5 mg/dL (221 mcmol/L) What initial intervention would the nurse anticipate? a. Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration.

c. Increase the dose of immunosuppression. Rationale: The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point.

The nurse documents the vital signs of a client diagnosed with acute pancreatitis: Apical pulse = 116 beats/min Respirations = 28 breaths/min Blood pressure = 92/50 What complication of acute pancreatitis would the nurse suspect that the client might have? a. Electrolyte imbalance b. Pleural effusion c. Internal bleeding d. Pancreatic pseudocyst

c. Internal bleeding Rationale: The client is exhibiting signs of hypovolemia most likely due to internal bleeding or hemorrhage. Due to decreased blood volume, the blood pressure is low and the heart rate increases to compensate for hypovolemia to ensure organ perfusion. Respirations often increase to increase oxygen in the blood.

The nurse is caring for a client who has a risk gene for developing cirrhosis. Which racial/ethnic group has this gene most often? a. Blacks b. Asian/Pacific Islanders c. Latinos d. French

c. Latinos Rationale: The Patatin-like phospholipase domain containing 3 gene (PNPLA3) has been identified as a risk gene for cirrhosis, which occurs most often in Latinos when compared to other populations.

A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema? a. Maintaining oxygen saturation of 89% b. Minimal crackles and wheezes in lung sounds c. Maintaining a balanced intake and output d. Limited shortness of breath upon exertion

c. Maintaining a balanced intake and output

A client is placed on fluid restriction because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time? a. Decreased calcium levels b. Increased phosphorus levels c. No adventitious sounds in the lungs d. Increased edema in the legs

c. No adventitious sounds in the lungs Rationale: The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the client's body. Decreased calcium levels and increased phosphorus levels are common findings with CKD. Edema would indicate a fluid imbalance.

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patients liver? a. Place hand under the right lower abdominal quadrant and press down lightly with the other hand. b. Place the left hand over the abdomen and behind the left side at the 11th rib. c. Place hand under right lower rib cage and press down lightly with the other hand. d. Hold hand 90 degrees to right side of the abdomen and push down firmly.

c. Place hand under right lower rib cage and press down lightly with the other hand.

A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics? a. Management of fluid balance in the home setting b. The need for blood glucose monitoring for the next week c. Signs and symptoms of intra-abdominal complications d. Appropriate use of prescribed pancreatic enzymes

c. Signs and symptoms of intra-abdominal complications

A nurse is assessing a client receiving one unit of packed RBCs to treat intraoperative blood loss. The client reports chills and back pain, and the client BP is 80/64. Which of the following action should nurse take first? a. Inform the provider b. Notify the lab c. Stop the infusion of blood d. Obtain a urine sample

c. Stop the infusion of blood

A client with diabetes mellitus type 2 has been well controlled with metformin. The client is scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the nurse take at this time? a. Teach the client about the purpose of the MRI. b. Assess the client's blood urea nitrogen and creatinine. c. Tell the client to withhold metformin for 24 hours before the MRI. d. Ask the client if he or she is taking antibiotics.

c. Tell the client to withhold metformin for 24 hours before the MRI. Rationale: Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be nephrotoxic and the client should not be exposed to two agents. Clients who have diabetes are already at risk for renal damage.

A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessment findings is the priority for the nurse to report to the provider? a. flank pain that radiates to the lower abdomen b. client reports of nausea c. absent urine output for 1 hr d. serum WBC count 15,000/mm3

c. absent urine output for 1 hr

A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? a. administer an opioid medication b. monitor for hypertension c. assess level of consciousness d. increase the dialysis exchange rate

c. assess level of consciousness

A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include? a. "decrease your intake in protein-rich foods" b. "take this medication with grapefruit juice" c. monitor for and report a sore throat to your provider d. "expect your skin to turn yellow"

c. monitor for and report a sore throat to your provider

A nurse is planning care for a client who has a prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and the blood pressure is 92/58 mmHg. The nurse should anticipate which of the following interventions? a. prepare the client for a CT scan with contrast dye b. plan to administer nitroprusside c. prepare to administer a fluid challenge d. plan to position the client in trendelenburg

c. prepare to administer a fluid challenge

A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? a. reduced BUN b. elevated cardiac enzyme c. reduced urine output d. elevated serum creatinine e. elevated serum calcium

c. reduced urine output d. elevated serum creatinine

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates that more teaching is needed? a. "I will probably lose weight by cutting out potato chips." b. "I will cut out bacon with my eggs every morning." c. "My cooking style will change by not adding salt." d. "I am thrilled that I can continue to eat fast food."

d. "I am thrilled that I can continue to eat fast food." Rationale: Fast-food restaurants usually serve food that is high in sodium. This statement indicates that more teaching needs to occur. The other statements show a correct understanding of the teaching.

The nurse is preparing to teach a client with chronic hepatitis B about lamivudine therapy. What health teaching would the nurse include? a. "Follow up on all appointments to monitor your lab values." b. "Do not take amiodorone at any time while on this drug." c. "Monitor for jaundice, rash, and itchy skin while on this drug." d. "Report any changes in urinary elimination while on this drug."

d. "Report any changes in urinary elimination while on this drug." Rationale: Lamivudine can cause renal impairment and the nurse would remind the client of changes that may indicate kidney damage.

A nurse is teaching a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statements by the client indicates understanding of the teaching? a. "I will be fully awake during the procedure" b. "lithotripsy will reduce my chances of having stones in the future" c. "I will report any bruising that occurs to my doctor" d. "Straining my urine following the procedure is important"

d. "Straining my urine following the procedure is important"

A client is scheduled for a hepatobiliary iminodiacetic acid (HIDA) scan. What would the nurse include in client teaching about this diagnostic test? a. "You'll have to drink a contrast medium right before the test." b. "You'll need to do a bowel prep the nursing before the test." c. "You'll be able to drink liquids up until the test begins." d. "You'll have a large camera close to you during the test."

d. "You'll have a large camera close to you during the test." Rationale: Clients having a HIDA scan are NPO and receive an injectable nuclear medicine contrast. No bowel preparation is required. A large camera is close to the client for most of the test which can be a problem for clients who are claustrophobic.

A nurse is amending a patients plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patients care plan? a. Mobilization with assistance at least 4 times daily b. Administration of beta-adrenergic blockers as ordered c. Vitamin B12 injections as ordered d. Administration of diuretics as ordered

d. Administration of diuretics as ordered

The nurse is admitting a client who has acute glomerulonephritis caused by beta streptococcus. What drug therapy would the nurse expect to be prescribed for this client? a. Antihypertensives b. Antilipidemics c. Antidepressants d. Antibiotics

d. Antibiotics Rationale: Beta streptococcus is a bacterium that can cause acute glomerulonephritis, so antibiotic therapy is indicated.

A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. What action would the nurse take? a. Position the client to lay on the surgical incision. b. Measure the specific gravity of the client's urine. c. Administer intravenous pain medications. d. Assess the rate and quality of the client's pulse.

d. Assess the rate and quality of the client's pulse. Rationale: The nurse would first fully assess the client for signs of volume depletion and shock, and then notify the primary health care provider. The extensive nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Repositioning the patient, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

The nurse is caring for a client who is scheduled for a paracentesis. Which action is appropriate for the nurse to take? a. Have the client sign the informed consent form. b. Get the patient into a chair before the procedure. c. Help the client lie flat in bed on the right side. d. Assist the client to void before the procedure.

d. Assist the client to void before the procedure. Rationale: For safety, the patient would void just before a paracentesis to prevent bladder damage to the procedure. The primary health care provider would have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table.

The nurse is caring for a client scheduled to have a transjugular intrahepatic portal-systemic shunt (TIPS) procedure. What client assessment would the nurse perform prior to this procedure? a. Musculoskeletal assessment b. Neurologic assessment c. Mental health assessment d. Cardiovascular assessment

d. Cardiovascular assessment Rationale: A post procedure complication of a TIPS procedure is right-sided heart failure. Therefore, the nurse would perform a cardiovascular assessment before the procedure to determine if the client has signs and symptoms of heart failure.

A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client starts to develop shortness of breath. What is the nurse's priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the client's pulse. d. Decrease the rate of the IV infusion.

d. Decrease the rate of the IV infusion. Rationale: The nurse would assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter would evaluate the client's hemodynamic status, but this would not be the initial or priority action by the nurse. Vital signs are also important after adjusting the intravenous infusion.

A client had an open traditional Whipple procedure this morning. For what priority complication would the nurse assess? a. Urinary tract infection b. Chronic kidney disease c. Heart failure d. Fluid and electrolyte imbalances

d. Fluid and electrolyte imbalances Rationale: Due to the length and complexity of this type of surgery, the client is at risk for fluid and electrolyte imbalances. The nurse would assess for signs and symptoms of these imbalances so they can be managed early to prevent potentially life-threatening complications.

The nurse administers epoetin alfa to a client who has chronic kidney disease (CKD). Which laboratory test value would the nurse monitor to determine this drug's effectiveness? a. Potassium b. Sodium c. Renin d. Hemoglobin

d. Hemoglobin Rationale: The purpose of giving epoetin alfa to a client with CKD is to manage anemia by stimulating the bone marrow to produce more red blood cells. Therefore, monitoring the client's hemoglobin, hematocrit, and red blood cell count would indicate if the drug was effective.

The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading cause of cirrhosis? a. Metabolic syndrome b. Liver cancer c. Nonalcoholic fatty liver disease d. Hepatitis C

d. Hepatitis C Rationale: Hepatitis C is the leading cause of cirrhosis and an also cause liver cancer. Clients with nonalcoholic fatty liver disease often have metabolic syndrome and can also develop cirrhosis.

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram which of the following statements by the client should the nurse report to the provider a. The last time I voided it was painful and red tinged b. My period ended 2 days ago c. I drink at least 2 quarts of fluids every day d. I don't eat shellfish because it gives me hives

d. I don't eat shellfish because it gives me hives

The nurse is caring for a client with liver failure and is performing assessment and the knowledge of the clients increase risk of bleeding. The nurse recognizes that this risk is related to the client inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function? a. Alterations in glucose metabolism b. Retention of bile salts c. Inadequate production of albumin by hepatocytes d. Inability of the liver to use vitamin K

d. Inability of the liver to use vitamin K

In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention? a. Heart rate of 105 beats/min b. Serum glucose of 136 mg/dL c. Blood pressure of 102/76 mm Hg d. Respiratory rate of 28 breaths/min

d. Respiratory rate of 28 breaths/min

After teaching a client who has a history of cholelithiasis, the nurse assesses the client's understanding. Which menu selection indicates that the client understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

d. Roasted chicken breast, baked potato with chives, and orange juice Rationale: Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, low-fat milk, grilled cheese, cream, and cream of potato soup all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner.

Which assessment finding requires immediate nursing intervention in a patient with severe ascites? a. Confusion b. Temperature 38.2º C c. Tachycardia, rate 110 beats/min d. Shallow respirations, rate 32 breaths/min

d. Shallow respirations, rate 32 breaths/min

A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may include what? a. Fever and pain b. Chills and jaundice c. Nausea and vomiting d. Signs and symptoms of septic shock

d. Signs and symptoms of septic shock

A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurses priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the clients pulse. d. Slow down the normal saline infusion

d. Slow down the normal saline infusion

A client with chronic kidney disease states, I feel chained to the hemodialysis machine. What is the nurses best response to the clients statement? a. That feeling will gradually go away as you get used to the treatment. b. You probably need to see a psychiatrist to see if you are depressed. c. Do you need help from social services to discuss financial aid? d. Tell me more about your feelings regarding hemodialysis treatment.

d. Tell me more about your feelings regarding hemodialysis treatment.

A client newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse most likely explain the pathophysiology of this patient health problem a. Toxins have accumulated and inflamed your pancreas b. Bacterial likely migrated from your intestines and became lodged in your pancreas c. A virus that was likely already present in your body has begun to attack your pancreatic cells d. The enzymes that your pancreas produces have damaged the pancreas itself.

d. The enzymes that your pancreas produces have damaged the pancreas itself.

A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for nfection when the clients white blood cell count (WBC) is high. What response by the registered nurse is best? a. If the WBCs are high, there already is an infection present. b. The client is in a blast crisis and has too many WBCs. c. There must be a mistake; the WBCs should be very low. d. Those WBCs are abnormal and dont provide protection.

d. Those WBCs are abnormal and dont provide protection.

A nurse is caring for a client who has a urinary tract infection (UTI). Which of the following is the priority intervention by the nurse? a. offer a warm sitz bath b. recommend drinking cranberry juice c. encourage increased fluids d. administer antibiotics

d. administer antibiotics

A patient who has advanced cirrhosis is receiving lactulose (Cephulac). Which finding by the nurse indicates that the medication is effective?

he patient is alert and oriented

When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of

rapid, deep respirations.