Exam 1 Prep U Med complex
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include:
restricting sources of potassium.
To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should:
stay with the client and encourage him to eat.
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
fatigue and weakness.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
Urine output of 20 ml/hour
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
Urine output of 250 ml/24 hours
A nurse is preparing a presentation for a local senior center about the health status of older adults. What trends in health promotion and disease prevention activities would the nurse explain as contributing to declining death rates in the older adult population? Select all that apply.
decreased smoking improved nutrition screening for hypertension early detection of elevated cholesterol levels
A client has been diagnosed with acute glomerulonephritis. This condition causes:
proteinuria.
The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?
1,000 mL
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of:
1,500 mL of fluid
An older adult is experiencing bowel changes. She used to have a bowel movement every day, but she is now having one every 3 to 4 days. She also states that the stools are hard. Which of the following assessments would the nurse make? Select all answers that apply.
Amount of dietary fiber Use of laxatives Activity level of the client Quantity of daily fluid intake
The nurse is able to identify which condition as uremia?
An excess of urea in the blood
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client?
Anemia
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
Cola-colored urine
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate?
Donors are selected from compatible living or deceased donors.
Nursing students are reviewing statistics related to the older adult population and leading causes of death in this age group. The students demonstrate understanding of this information when they rank the following conditions in the order from highest to lowest.
Heart disease Malignant neoplasms Cerebrovascular disease Chronic obstructive pulmonary disease Alzheimer's disease Diabetes
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?
Hypertension
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
Dehydration
Which action by the nurse demonstrates ageism?
Directing all health decisions to the older adult's child
When assessing an older adult, the nurse anticipates an increase in which component of respiratory status?
Residual lung volume
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?
Decrease in the blood flow through the kidneys
A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate?
Distract the client with a familiar object or music.
A family of a patient with Alzheimer's disease asks the nurse what causes this condition? Which response by the nurse would be most appropriate?
"Evidence shows that there are changes in nerve cells and brain chemicals."
After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching?
"I should use a laxative every other day."
An older adult female client tells the nurse, "I have lost an inch [2.5 cm] of height and have a hump on my back. What can I do about this?" What is the best response by the nurse?
"In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus."
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
"It is appropriate to warm the dialysate in a microwave."
When administering medications to an older adult patient, which medication does the nurse understand may remain in the body longer due to increased body fat?
Barbiturates
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has?
Calcium
Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.
Citrus fruits
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause?
Renal calculi
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
Fever
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure?
Gray-bronze skin color
A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching?
How old you feel will be determined by your physical and cognitive abilities.
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
Hyperphosphatemia
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
Increased BUN
What is a characteristic of the intrarenal category of acute renal failure?
Increased BUN
The nurse identifies which of the following as an age-related change in the respiratory system?
Increased residual lung volume
An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to
Ingest five or six small meals each day.
An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of
Loss of bone density
Which of the following occurs late in chronic glomerulonephritis?
Peripheral neuropathy
A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess?
Complaints about frequently waking up during the night
The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?
Diminished erythropoietin production
An older adult female patient informs the nurse that she is sexually active but has a problem with vaginal dryness. What can the nurse tell the patient that may help relieve this problem?
Use a water-based lubricant with sexual intercourse.
A client reports to the nurse that her mother had macular degeneration and is concerned that she, too, may be at risk. What should the nurse tell the client?
Wear sunglasses with ultraviolet (UV) protection when outside.
Which of the following is the most accurate indicator of fluid loss or gain?
Weight
The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse?
Assess the need for pneumococcal and influenza vaccinations.
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?
Azotemia
An elderly client is contemplating a move to a continuing care retirement community (CCRC). The nurse assesses that the client requires assistance with food preparation and recommends placement in
Assisted-living apartment
The nurse is teaching about preventing pneumonia and influenza to a group of clients in a senior citizens' wellness class. The nurse includes which of the following topics in the class? Select all options that apply.
Avoiding environmental smoke Participating in regular exercise Ensuring appropriate fluid intake
A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply.
Place grab bars in the shower and tub Have routine vision and hearing screenings Wear nonslip shoes or socks when walking Review medications routinely for side effects
A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by
Placing one food at a time in front of the client during meals
Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which condition after a rib fracture?
Pneumonia
An elderly client recovering from a hip repair becomes disoriented and tries to get out of bed frequently. The client states, "I forget I am in the hospital." The best nursing intervention is to
Post a sign stating "You are in the hospital" at the client's eye level.
Which is an age-related change associated with the nervous system?
Postural hypotension
What is a nurse's role in providing home care for a client with Alzheimer disease?
Provide emotional and physical support.
A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply.
Providing a calm, quiet environment Supervising nutritional intake Using familiar cues about the environment
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
Recent history of streptococcal infection
Which is a factor that contributes to urinary incontinence in older female adults?
Relaxed perineal muscle
A nurse is completing the history and physical examination of an older adult patient. When assessing the patient's eyes, which of the following would the nurse document as a normal finding?
Reports of being sensitive to glare
Which neurotransmitter is implicated in depression?
Serotonin
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
Tall, peaked T waves
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection?
Tenderness over transplant site
The nurse brings the older adult patient a dinner tray and observes the patient placing excess amounts of salt on the food. What suggestions for flavoring can the nurse provide to decrease the amount of salt the patient is placing on her food? (Select all that apply.)
Use low-sodium herbs and spices. Use pepper instead of salt. Use lemon instead of salt to flavor food.
An elderly client is reporting changes in bowel movements from every day to every 3 to 4 days. The client also states that the stools are hard. Nursing interventions include instructing the client to
Increase fluid intake.
The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching?
"I should drink as much as possible to keep my kidneys working."
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching?
"As long as I have one normal kidney, I should be fine."
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
"As the disease progresses, you will most likely require renal replacement therapy."
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?
"Even a perfect match does not guarantee organ success."
An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate?
"Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."
A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include?
"The drug helps to control the symptoms of the disease."
A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds:
"What precipitates the outbursts?"
Approximately what percentage of home care required by elderly people with Alzheimer disease is provided by informal caregivers?
80
A nurse notes that an older female client has lost 2 inches in height since her appointment last year. The client reports lumbar back pain as unchanged. Which of the following would the nurse instructs the client? Select all answers that apply.
Increase intake of foods that are high in calcium. Take calcium and vitamin D supplements daily. Obtain the prescribed bone density screening.
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?
Brief, hot daily showers
The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium?
Citrus fruits
Which condition is characterized by a decline in intellectual functioning?
Dementia
Which is an age-related change associated with the cardiovascular system?
Decreased cardiac output
Which factor alters urinary elimination patterns in older adults?
Decreased muscle tone
A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to
Ensure that the mother does not have access to car keys or drive an automobile.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?
Glomerulonephritis
The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take?
Hold the medications until after dialysis.
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values?
Hyperkalemia
An elderly client experienced a cerebrovascular accident (CVA) and was unable to ambulate following his CVA. The client was transferred from a hospital and is now at a subacute care facility. For continuation of Medicare coverage, the nurse evaluates that the client must demonstrate
Improvement in ambulation
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
Increase carbohydrates and limit protein intake.
An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to
Limit ingestion of caffeinated beverages.
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?
Limiting fluid intake
The reason that governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement?
Older adult clients are vulnerable.
Why are IV solutions usually given at a slower rate to older adults?
Older adults may have cardiac or renal disorders.
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?
Oliguria
The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed:
hyperacute rejection.
Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit:
no symptoms.
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?
"Very few symptoms are associated with renal cancer."
The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for
hypertension.
What is a hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate?
"The most common cause of dementia in the elderly is Alzheimer's disease."
An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?
"This type of dialysis will provide more independence."
Which is a true statement regarding pharmacologic aspects of aging?
Absorption may be affected by changes in gastric pH.
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?
Administration of sodium polystyrene sulfonate [Kayexalate])
A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend?
Encouraging clients to avoid cigarette smoking
When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal?
Feeling of fullness
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?
Increased serum creatinine level
An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to
Instruct the family to remove the toddler from the room for the protection of the client.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
Risk for infection
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition?
Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.
A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes?
Decreased acetylcholine level
The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client?
Keep the dialysis supplies in a clean area, away from children and pets
Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away?
Presbyopia
Which action is included in a nurse's role when providing home care for a client with Alzheimer disease?
Provide emotional and physical support
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?
SpO2 at 90% with fine crackles in the lung bases
Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse?
Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
White blood cell (WBC) count of 20,000/mm3
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
A GFR of 30-59 mL/min/1.73 m2
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.
4000
