Complex: Renal Review
A nurse is caring for a variety of clients. In which client is it most essential for the nurse to implement measures to prevent pulmonary embolism? 1 A 59-year-old who had a knee replacement 2 A 60-year-old who has bacterial pneumonia 3 A 68-year-old who had emergency dental surgery 4 A 76-year-old who has a history of thrombocytopenia
A 59-year-old who had a knee replacement Clients who have had a joint replacement have decreased mobility; they are at risk for developing thrombophlebitis, which may lead to pulmonary embolism if the clot becomes dislodged into the circulation. Bacterial pneumonia and emergency dental surgery are not associated with an increased risk for pulmonary embolism. A history of thrombocytopenia leads to a decreased ability to clot, so it increases the risk of bleeding but decreases the risk of a thrombus or embolus.
A client is receiving warfarin for a pulmonary embolism. Which drug is often contraindicated when taking warfarin? 1 Atenolol 2 Ferrous sulfate 3 Chlorpromazine 4 Acetylsalicylic acid
Acetylsalicylic acid Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with administration of anticoagulants. It should not be administered unless specifically prescribed, usually by a cardiologist or other specialist, to manage serious risks of thrombosis. Ferrous sulfate does not affect warfarin; it is used for red blood cell synthesis. Atenolol is a beta-blocker that reduces blood pressure; it does not affect bleeding. Chlorpromazine is a neuroleptic; it does not affect bleeding.
A healthcare provider prescribes thigh-high antiembolism stockings for a client with varicose veins. The client's thighs are heavier than the lower legs, and the stockings fit on the lower leg but are causing discomfort and indentations on the upper thighs. What should the nurse do? 1 Slightly slit the top of the stockings to relieve pressure. 2 Leave the antiembolism stockings off to prevent tissue damage. 3 Roll the top of the stockings to below the knees to limit popliteal pressure. 4 Ask the healthcare provider if an elastic bandage can be used in place of the stockings.
Ask the healthcare provider if an elastic bandage can be used in place of the stockings. An elastic bandage can be adjusted to the varying proportions of the client's legs. Cutting the stockings to relieve pressure is inappropriate and will decrease the effectiveness of the stockings. Leaving the antiembolism stockings off to prevent tissue damage is unsafe; this permits venous stasis. Rolling the top of the stockings to below the knees to limit popliteal pressure will increase the pressure in the popliteal space, which increases venous stasis and the risk of thrombophlebitis.
A nurse is caring for several clients in the intensive care unit. Which is the greatest risk factor for a client to develop acute respiratory distress syndrome (ARDS)? 1 Aspirating gastric contents 2 Getting an opioid overdose 3 Experiencing an anaphylactic reaction 4 Receiving multiple blood transfusions
Aspirating gastric contents Aspirating gastric contents is a common cause of ARDS. Gastric enzymes injure alveolar-capillary membranes, which release inflammatory mediators; the process progresses to pulmonary edema, vascular narrowing and obstruction, pulmonary hypertension, and impaired gas exchange. Getting an opioid overdose is not as common a cause of ARDS as is aspiration pneumonia; this more likely will cause depressed respirations. Although anaphylaxis may cause ARDS, it is not a common cause. Although multiple blood transfusions have been known to precipitate ARDS, they are not a common cause.
A client with a suspected pulmonary embolism is scheduled for a spiral computed tomography scan. Which intervention should the nurse perform when preparing the client for the test? 1 Check the client's blood glucose levels. 2 Obtain informed consent from the client. 3 Assess if the client is allergic to shellfish. 4 Instruct the client to remove his or her dentures.
Assess if the client is allergic to shellfish. Instruct the client to remove his or her dentures. A spiral computed tomography scan may be used to diagnose a pulmonary embolism. Before preparing the client for the test, the nurse should assess if the client is allergic to shellfish since the contrast used in the test is iodine based. The client may be asked to remove his or her dentures while preparing for magnetic resonance imaging. An informed consent may not be needed for the spiral computed tomography; it may be required for endoscopic procedures such as a bronchoscopy. High blood glucose levels may interfere with the positron emission tomography scan; therefore, the nurse should check the blood glucose levels of the client before preparing for this test.
A client with acute respiratory distress syndrome is intubated and placed on a ventilator. What should the nurse do when caring for this client and the mechanical ventilator? 1 Deflate the cuff on the endotracheal tube for a few minutes every one to two hours. 2 Assess the need for suctioning when the high-pressure alarm of the ventilator is activated. 3 Adjust the temperature of fluid in the humidification chamber depending on the volume of gas delivered. 4 Regulate the positive end-expiratory pressure (PEEP) according to the rate and depth of the client's respirations.
Assess the need for suctioning when the high-pressure alarm of the ventilator is activated. The high-pressure alarm signifies increased pressure in the tubing or the respiratory tract; obstruction usually is caused by excessive secretions. Cuff should be inflated; it does not need to be tested this often. Humidification should occur, but the temperature should not be routinely changed. Regulating the PEEP according to the rate and depth of the client's respirations is a dependent function of the nurse and cannot be implemented without a healthcare provider's prescription.
A client is admitted with a tentative diagnosis of pneumonia. On admission the client is not in respiratory distress, but later develops chest pain and a fever of 103° F (39.4° C). A productive cough produces rust-colored sputum. How should the nurse interpret these findings? 1 Onset of pulmonary edema 2 Expected course of pneumonia 3 Presence of a pulmonary embolus 4 Insidious onset of tuberculosis (TB
Expected course of pneumonia Chest pain, fever, productive cough, and rust-colored sputum are cardinal signs of pneumonia [1] [2]. Chest pain results from excessive coughing; fever, increased sputum, and rust-colored sputum result from the infectious process. Dependent edema, respiratory distress, and crackles on auscultation of the lungs are associated with pulmonary edema. Although chest pain is expected with a pulmonary embolus, rust-colored sputum and a high fever are not. Pulmonary TB is associated with a low-grade fever, nonproductive or mucopurulent blood-tinged sputum, night sweats, and fatigue.
A client with late-stage dementia of the Alzheimer type aspirates gastric contents and develops acute respiratory distress syndrome (ARDS). Which phase characterized by signs of pulmonary edema and atelectasis should the nurse consider when planning care? 1 Fibrotic 2 Exudative 3 Reparative 4 Proliferative
Exudative Exudative (injury) phase of ARDS is the early phase. Alveoli become fluid-filled with pulmonary shunting and atelectasis. Fibrotic phase of ARDS leads to pulmonary hypertension and fibrosis. Reparative (resolution) phase starts about two weeks after injury; it is characterized by recovery. If this phase persists for a prolonged time, extensive fibrosis, death, or chronic disease may result.
A client with respiratory distress due to an overdose of antidepressant drugs is hospitalized. Which intervention should be performed as a priority? 1 Intubating the client 2 Administering an antidote 3 Administering activated charcoal 4 Initiating electrocardiogram monitoring
Intubating the client The immediate intervention is to intubate a client with respiratory distress due to an overdose of antidepressant drugs. Intubation serves as a conduit to administer drugs. The antidote can be administered only after intubation. Activated charcoal absorbs toxins and reduces poisoning in the circulatory system. This can be performed after ensuring the airway and intubation. Electrocardiogram monitoring is an ongoing monitoring assessment.
The nurse is caring for a client with a possible pulmonary embolism (PE). Which diagnostic test should the nurse initially anticipate will be prescribed for this client because it is the evidence-based gold standard for a PE diagnosis? 1 Spiral (helical) computed tomographic angiography (CTA) 2 D-dimer and arterial blood gas (ABG) laboratory tests 3 Ventilation-perfusion (V/Q) scan 4 Pulmonary angiography
Spiral (helical) computed tomographic angiography (CTA) A spiral (helical) computed tomographic angiography (CTA) is considered the gold standard for a pulmonary embolism (PE) medical diagnosis. The spiral CTA also has the added advantage of diagnosing other pulmonary abnormalities. A pulmonary angiography is still used as a PE diagnostic test, usually if the client also has coronary disease and invasive treatment (i.e., angioplasty) may become necessary; however, it is no longer the gold standard because it is expensive and invasive, and the spiral CTA has excellent accuracy and better accessibility. Ventilation/perfusion (V/Q) scans are currently used only in certain circumstances such as when the client has contrast dye allergy. D-dimer and arterial blood gas (ABG) laboratory tests are typically prescribed for a client with a possible PE; however, these tests are not specific or sensitive enough to be used alone to make the PE diagnosis. An ABG is used to evaluate the client's oxygenation status during medical diagnosis and treatment to determine if additional emergency treatment is needed, such as intubation and mechanical ventilation. A D-dimer simply reveals the presence or absence of fibrin split products which occur when a blood clot degrades or breaks down; however, about half of clients with a PE still test negative (a normal result) and several other conditions can produce a positive D-dimer result.
A client has an open reduction and internal fixation (ORIF) of a fractured hip. The nurse monitors this client for signs and symptoms of a fat embolism. Which client assessment finding reflects this complication? 1 Fever and chest pain 2 Positive Homans sign 3 Loss of sensation in the operative leg 4 Tachycardia and petechiae over the chest
Tachycardia and petechia over the chest. Tachycardia occurs because of an impaired gas exchange; petechiae are caused by occlusion of small vessels within the skin. Chest pain is not a common complaint with a fat embolism; fever may occur later. A positive Homans sign occurs with thrombophlebitis; it is not an indication of a fat embolism. Loss of sensation suggests neurologic dysfunction; it is not an indication of a fat embolism.
A client has a compound fracture of the femur. The nurse should assess the client for the typical signs and symptoms of a fat embolus. In comparison to thromboembolism, which unique clinical indicator can help the nurse identify a fat embolus? 1 Anxiety 2 Restlessness 3 Pinpoint red spots on the chest 4 Decreased arterial oxygen level
Pinpoint red spots on the chest. Fat emboli cause capillary fragility; rupture of capillary walls results in pinpoint red spots (petechiae) on the chest and conjunctiva of the eye. Anxiety occurs in both fat embolism and thromboembolism. There often is a feeling of dread or impending doom. Restlessness and confusion from cerebral hypoxia occur in both fat embolism and thromboembolism. The arterial oxygen may be decreased in both fat embolism and thromboembolism.
After surgery, a client is extubated in the postanesthesia care unit. Which clinical manifestations should the nurse expect if the client is experiencing acute respiratory distress? Select all that apply. 1 Confusion 2 Hypocapnia 3 Tachycardia 4 Constricted pupils 5 Slow respiratory rate
Confusion Hypocapnia Tachycardia Inadequate cerebral oxygenation produces restlessness and confusion. Tachycardia occurs as the body attempts to compensate for the lack of oxygen. A low carbon dioxide level in the blood (hypocapnia) occurs with an increase in respiratory rate. The pupils dilate, not constrict, with hypoxia. An elevated respiratory rate (tachypnea), not a slow respiratory rate (bradypnea), occurs.
After surgery, a client reports sudden severe chest pain and begins coughing. The nurse suspects the client has a thromboembolism. What characteristic of the sputum supports the nurse's suspicion that the client has a pulmonary embolus? 1 Pink 2 Clear 3 Green 4 Yellow
Pink With a pulmonary embolus, there is partial or complete occlusion of pulmonary blood flow; when infarcted areas or areas of atelectasis produce alveolar damage, red blood cells move into the alveoli, resulting in hemoptysis. Clear sputum is associated with a viral infection. Green and yellow sputum are associated with a bacterial infection.
A client is extubated in the postanesthesia care unit after surgery. For which common response should the nurse be alert when monitoring the client for acute respiratory distress? 1 Bradycardia 2 Restlessness 3 Constricted pupils 4 Clubbing of the fingers
Restlessness Inadequate oxygenation of the brain from acute respiratory distress may produce restlessness or behavioral changes. The pulse increases with cerebral hypoxia from acute respiratory distress. The pupils dilate with cerebral hypoxia. Clubbing of the fingers is the result of prolonged hypoxia.
A nurse teaches a client about wearing thigh-high antiembolism elastic stockings. What would be appropriate to include in the instructions? 1 "You do not need to wear them while you are awake, but it is important to wear them at night." 2 "You will need to apply them in the morning before you lower your legs from the bed to the floor." 3 "If they bother you, you can roll them down to your knees while you are resting or sitting down." 4 "You can apply them either in the morning or at bedtime, but only after the legs are lowered to the floor."
"You will need to apply them in the morning before you lower your legs from the bed to the floor." Applying antiembolism elastic stockings in the morning before the legs are lowered to the floor prevents excessive blood from collecting and being trapped in the lower extremities as a result of the force of gravity. Elastic stockings are worn to prevent the formation of emboli and thrombi, especially in clients who have had surgery or who have limited mobility, by applying constant compression. It is contraindicated for antiembolism elastic stockings to be applied and worn at night, rolled down, or applied after the legs are lowered to the floor.
A nurse is caring for a group of clients on a medical-surgical unit. Which client has the highest risk for developing a pulmonary embolism? 1 An obese client with leg trauma 2 A pregnant client with acute asthma 3 A client with diabetes who has cholecystitis 4 A client with pneumonia who is immunocompromised
An obese client with leg trauma. An obese client with leg trauma has two risk factors for the development of pulmonary embolism: obesity and leg trauma. A pregnant client with acute asthma has one risk factor for the development of pulmonary embolism: pregnancy. A client with diabetes who has cholecystitis has one risk factor for the development of pulmonary embolism: diabetes. A client with pneumonia who is immunocompromised has no risk factors for the development of pulmonary embolism.
A nurse is teaching a client about the use of antiembolism stockings. What instruction should the nurse include? 1 Keep the stockings on 2 hours and off 2 hours. 2 Wear the stockings only at bedtime when activity decreases. 3 Put the stockings on before rising in the morning. 4 Leave the stockings in place until the primary healthcare provider advises otherwise.
Put the stockings on before rising in the morning. Support hose apply external pressure on the veins, preventing the retrograde pressure or flow that may occur in the standing or sitting positions; application before rising prevents the veins from having the opportunity to become engorged. If keeping the stockings on 2 hours and off 2 hours is followed, at some point the feet will be dependent before the stockings are put on; venous pooling and edema may occur. Application of elastic stockings at this time can cause tissue trauma. The stockings usually need not be worn while in bed with the feet elevated during sleep, because gravity prevents venous pooling. Stockings must be removed so that the legs can be washed and dried at least daily.
A client with a history of emphysema develops a respiratory infection and is admitted to the hospital in acute respiratory distress. The client's arterial blood studies indicate pH 7.30, PO2 60 mm Hg, PCO2 55 mm Hg, and HCO3 23 mEq/L (23 mmol/L). How should the nurse interpret these findings? 1 Hypocapnia 2 Hyperkalemia 3 Generalized anemia 4 Respiratory acidosis
Respiratory acidosis The client is experiencing respiratory acidosis. The pH is less than the norm of 7.35 to 7.45, indicating acidosis. The PO2 is less than the norm of 80 to 100 mm Hg. The PCO2 is increased more than the norm of 35 to 45 mm Hg. The HCO3 is within the norm of 21 to 28 mEq/L (21 to 28 mmol/L). These results indicate a respiratory etiology. The client's carbon dioxide level is increased (hypercapnia), not decreased. These values are unrelated to hyperkalemia; a serum potassium level of more than 5 mEq/L (5 mmol/L) indicates hyperkalemia. These values are unrelated to anemia; decreased levels of red blood cells (RBCs), hemoglobin, and hematocrit are related to anemia.
The nurse is caring for a client who has undergone a total hip replacement. The nurse recognizes which clinical manifestations that indicate a pulmonary embolism? Select all that apply. 1 Sudden chest pain 2 Flushing of the face 3 Elevation of temperature 4 Abrupt onset of shortness of breath 5 Pain rating increase from 2 to 8 in the hip
Sudden chest pain. Abrupt shortness of breath. Sudden chest pain is caused by decreased oxygenation to pulmonary tissues. Because capillary perfusion is blocked by the pulmonary embolus, oxygen saturation drops and the client experiences shortness of breath, dyspnea, and tachypnea. Flushing of the face and fever are not classic signs of pulmonary embolus. The pain associated with pulmonary embolus generally is sudden in onset, severe, and located in the chest, not the hip.
A client is experiencing severe respiratory distress. Which response should the nurse expect the client to exhibit? 1 Tremors 2 Anasarca 3 Bradypnea 4 Tachycardia
Tachycardia The heart rate increases in an attempt to compensate for the lack of oxygen to body cells. Tremors are not associated with respiratory distress; tremors are associated with neurologic problems. Severe generalized edema (anasarca) is not associated with respiratory distress; anasarca is associated with renal failure. An increased respiratory rate (tachypnea), not a decreased respiratory rate (bradypnea), is associated with respiratory distress.
What points should be considered when a client with a respiratory disorder undergoes a spiral-computed tomography (CT) scan to diagnose a pulmonary embolism? Select all that apply. 1 The test involves the administration of a contrast medium. 2 Clients should have their hydration levels assessed. 3 Clients are instructed to lie still on a hard table. 4 Clients are served shellfish before the test. 5 A client's serum creatinine level is evaluated after the test
The test involves the administration of a contrast medium. Clients should have their hydration levels assessed. Clients are instructed to lie still on a hard table. A contrast medium may be given intravenously when performing a spiral-computed tomography (CT). The nurse should make sure that the client is well hydrated before and after the procedure to help flush out the contrast medium. The nurse should instruct the client to lie still on the hard table and that the scanner will revolve around the body with clicking noises. The nurse should assess if the client is allergic to shellfish because the contrast medium used is iodine-based. The nurse should evaluate the client's blood urea nitrogen and serum creatinine before the test to assess renal function.