exam 3 460

A nurse is reviewing the laboratory report of a client with kidney problems. When ammonia is excreted by healthy kidneys, what mechanism usually is maintained?

Acid-base balance of the body

A healthcare provider determines that a client has myasthenia gravis. Which clinical findings does the nurse expect when completing a health history and physical assessment? Select all that apply.

Double vision Difficulty swallowing saliva Drooping of the upper eyelids

A client is admitted and diagnosed with myasthenia gravis. Pyridostigmine bromide therapy via tablets has been prescribed. The nurse anticipates that the dosage will be changed frequently during the first week of therapy. While the dosage is being adjusted, what action does the nurse perform?

Evaluate the client's muscle strength every hour after the medication is given.

What nursing intervention is anticipated for a client with Guillain-Barré syndrome?

Maintaining ventilator settings to support respiration

A client is admitted to the hospital with a diagnosis of Parkinson disease. Which common signs of Parkinson disease does the nurse expect to identify when completing a nursing admission history and physical? Select all that apply.

Muscle rigidity Blank facial expression

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse monitors the client for which side effects of the medication? Select all that apply.

Nausea and vomiting Anorexia Changes in mood

During an exacerbation of multiple sclerosis a client reports urinary urgency and frequency. What is the mostappropriate initial nursing action?

Palpate the suprapubic area of the abdomen

The registered nurse discusses normal renal function with the client. Which statements made by the client are correct regarding regulatory functions of the kidney? Select all that apply.

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

A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. Which is an appropriate nursing response?

"The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."

While reviewing the medical reports in an acute care setting, the nurse finds that the client is at risk for kidney damage and requests the healthcare provider to increase the intravenous fluid rate as a priority nursing intervention. Which finding supports the nurse's conclusion? Pulse pressure is 40 mm Hg Urine output is 25 mL per hr Systolic blood pressure is 120 mm Hg Blood osmolality is 280 milliosmoles per kg

Urine output is 25 mL per hr

During a routine clinic visit of a client who has myasthenia gravis, the nurse reinforces previous teaching about the disease and self-care. The nurse evaluates that the teaching is effective when the client states which information?

Avoid people with respiratory infections

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

Protein

A client with myasthenia gravis is receiving pyridostigmine bromide to control symptoms. Recently, the client has begun experiencing increased difficulty in swallowing. What nursing action is most effective in preventing aspiration of food?

Coordinate mealtimes with the peak effect of the medication

A nurse is assessing a client with multiple sclerosis. Which common initial clinical effects should the nurse expect to find? Select all that apply.

scanning speech, intention tremors, and nystagmus.

A nurse is caring for a client newly diagnosed with Guillain-Barré syndrome. The nurse expects which procedure will be considered as a treatment option?

Plasmapheresis

A client in end-stage kidney disease is receiving peritoneal dialysis. What should the nurse do when caring for this client?

Position the client from side to side if fluid is not draining adequately.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. Which urinary finding should the nurse conclude needs to be reported to the primary healthcare provider?

Presence of large proteins

A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information?

Prevention of chronic fatigue

Selegiline is prescribed for a client with Parkinson disease who is having an inadequate response to levodopa therapy. What information does the nurse include when teaching the client about the addition of this drug to the regimen?

Primary healthcare provider should be contacted immediately if a severe headache occurs

A client with acute kidney failure is fatigued and becomes lethargic. Upon reviewing the client's medical record, which finding does the nurse determine is the most likely cause of this change in symptoms?

An increased blood urea nitrogen level

A client with Guillain-Barré syndrome has been hospitalized for three days. Which assessment finding would the nurse expect and need to monitor frequently in this client?

Ascending weakness

A client who has been experiencing double vision, drooping of the eyelids, and fatigue visits the neurologic clinic. A diagnosis of myasthenia gravis is made, and the healthcare provider prescribes pyridostigmine. The nurse should teach the client that it is important to take this drug based on what schedule?

At the exact time intervals prescribed

A client suspected of having myasthenia gravis is scheduled for an edrophonium chloride test. To treat a common complication associated with the test, the nurse will have what drug available?

Atropine

A client newly diagnosed with myasthenia gravis is to begin taking pyridostigmine, a cholinesterase inhibitor. Two days later the client develops loose stools and increased salivation. What conclusion does the nurse make about these new developments?

Cholinergic effects

A client is diagnosed with myasthenia gravis, and the anticholinesterase medication pyridostigmine is prescribed. When teaching the client about this medication, the nurse explains to expect an increase in what function?

Contraction of skeletal muscles

A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed. What does the nurse recognize as the primary purpose of the IV insulin for this client?

Correct hyperkalemia

A client has end-stage kidney disease and is receiving hemodialysis. During dialysis the client reports nausea and a headache and appears confused. Operating on prescribed protocols, which action will the nurse take?

Decrease the rate of exchange.

A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason metabolic acidosis develops with kidney failure?

Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate

A nurse is caring for a group of clients with myasthenia gravis, Guillain-Barré syndrome, and amyotrophic lateral sclerosis (ALS). Which information should the nurse consider when planning care for this group of clients?

Increased risk for respiratory complications

To what does the nurse attribute the increased risk of respiratory complications in clients with myasthenia gravis?

Ineffective coughing

The respiratory status of a client with Guillain-Barré syndrome progressively deteriorates, and a tracheostomy is performed. Nasogastric tube feedings are prescribed. How should the nurse manage the tracheostomy cuff?

Inflate the cuff before the feeding and for 30 minutes after each feeding

A client is admitted to the hospital with a diagnosis of severe chronic kidney disease. Which assessment findings should the nurse expect the client to exhibit? Select all that apply.

Paresthesias Hypertension

A client with a history of parkinsonism recently developed rigidity, tremors, and signs of pneumonia. The client is hospitalized for treatment. What should the nursing plan of care include?

Passive range-of-motion exercises at least every eight hours

A nurse enters the room of a client with myasthenia gravis and identifies that the client is experiencing increased dysphagia. What should the nurse do first?

Raise the head of the bed

A hospitalized client is receiving pyridostigmine for control of myasthenia gravis. In the middle of the night, the nurse finds the client weak and barely able to move. Which additional clinical findings support the conclusion that these responses are related to pyridostigmine? Select all that apply.

Respiratory depression Decreased blood pressure High-pitched gurgling bowel sounds

A nurse is caring for a client with Parkinson disease. Which clinical indicators does the nurse expect to find upon assessment? Select all that apply.

Resting tremors Flattened affect Slow voluntary movements

A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action?

Restores the dopamine levels in the brain

A nurse is caring for a client with the diagnosis of Guillain-Barré syndrome with nasal cannula oxygen. The nurse identifies that the client is having difficulty expectorating respiratory secretions. What should be the nurse's first intervention?

Suction the client's oropharynx

A client with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The nurse should monitor the client for which peritoneal dialysis complications? Select all that apply.

Tachycardia Cloudy outflow Abdominal pain

To prepare for hemodialysis, a client with end-stage kidney disease is scheduled for surgery, specifically for the creation of an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. When considering care for these sites, which difference will the nurse consider?

The graft is more subject to hemorrhage, clotting, and infection than the fistula is

A client with the diagnosis of multiple sclerosis (MS) develops hand tremors. When performing a history and physical assessment, which finding should the nurse expect the client to report?

The tremors increase when I perform an activity.

A client with kidney dysfunction reports anorexia, itching, nausea, vomiting, and muscle cramps. Which renal complication do these symptoms indicate?

Uremia

An ambulatory client with relapsing-remitting multiple sclerosis is to receive every-other-day injections of interferon beta-1a. What adverse effects does the nurse explain may occur when taking this medication? Select all that apply.

depression constipation, diarrhea, vomiting, and abdominal pain. flulike symptoms, such as fever, muscle aches, and lethargy. increased heart rate

Which clinical findings does the nurse anticipate a client with an exacerbation of multiple sclerosis will experience? Select all that apply.

intention tremor, nystagmus, and scanning speech.

A nurse is counseling a client with amyotrophic lateral sclerosis (ALS) about management of this disorder. What important suggestion should the nurse make to the client?

"Activities should be spaced throughout the day."

A nurse is caring for a client with acute kidney injury. Which findings should the nurse anticipate when reviewing the laboratory report of the client's blood level of calcium, potassium, and creatinine? Select all that apply.

A client with acute kidney injury will have a low calcium level, a high potassium level, and an elevated creatinine level.

When helping a client with Parkinson disease to ambulate, what instructions should the nurse give the client?

Avoid leaning forward.

During a follow-up visit the client, who is undergoing treatment for mental illness, complains of painful muscle spasms. The nurse suspects that the client may have pseudoparkinsonism. Which drugs does the nurse anticipate to be prescribed by the primary healthcare provider to counter this condition? Select all that apply.

Benztropine and trihexyphenidyl

Which immunomodulatory is beneficial for the treatment of clients with multiple sclerosis?

Beta interferon

The nurse observes a client with kidney failure has increased rate and depth of breathing. Which laboratory parameter does the nurse suspect is associated with this client's condition?

Bicarbonate 15 mEq/L

A client has a diagnosis of myasthenia gravis. What does the nurse recall are associated clinical manifestations?

Blurred vision along with episodes of vertigo

A nurse is performing the history and physical examination of a client with Parkinson disease. Which assessments identified by the nurse support this diagnosis? Select all that apply.

Nonintention tremors Masklike facial expression Rigidity to passive movement

A client with acute kidney injury states, "Why am I twitching and my fingers and toes tingling?" Which process should the nurse consider when formulating a response to this client?

Calcium depletion

A client residing in an assisted living facility is diagnosed with Parkinson disease, and the healthcare provider prescribes selegiline. What precaution will the nurse teach the client?

Change to a standing position slowly.

A client is experiencing kidney failure. Which is the most serious complication for which the nurse must monitor a client with kidney failure?

Hyperkalemia

A client develops kidney damage as a result of a transfusion reaction. What is the most significant clinical response that the nurse will assess when determining kidney damage?

Decreased urinary output

A nurse is caring for two clients. One has Parkinson disease, and the other has myasthenia gravis. For which common complication associated with both disorders should the nurse assess these clients?

Difficulty swallowing

A client is admitted to the hospital with a diagnosis of myasthenia gravis. For which common early clinical finding should the nurse assess the client?

Diplopia

Which monoamine oxidase inhibitor is used to treat Parkinson disease?

Selegiline

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse assesses for which adverse responses that are associated with this medication? Select all that apply.

Nausea Emotional changes

A client is scheduled for a kidney ultrasound. Which instructions given by the nurse to the client would be most beneficial? Select all that apply.

"Drink plenty of fluids." "Do not urinate prior to the exam." "Lie flat and perfectly still during the test."

A client with myasthenia gravis improves and is discharged from the hospital. The discharge medications include pyridostigmine bromide 10 mg every 6 hours. The nurse evaluates that the drug regimen is understood when the client makes which statement?

"I need to set an alarm so I take the medication on time."

A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse's best response?

"It helps perform some of the work usually done by the kidneys."

A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy?

"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."

Carbidopa/levodopa is prescribed for a client with Parkinson disease. What will the nurse teach the client about this medication?

"You may experience dizziness when moving from sitting to standing."

Myasthenia crisis

difficulty breathing or speaking, morning headaches, feeling tired during the daytime, waking up frequently at night, not sleeping well, weak cough with increased secretions (mucus or saliva), an inability to clear secretions, a weak tongue, trouble swallowing or chewing, and weight loss.

A client who recently gave birth has myasthenia gravis. For which clinical manifestation should the nurse monitor the newborn?

Feeble limb movements

A nurse anticipates that dialysis will be necessary for a 12-year-old child with chronic kidney disease when the child begins to exhibit which symptom?

Hypervolemia

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed?

It will compensate for both insensible and expected output over the next 24 hours

A nurse is assessing a client with Parkinson disease. Which assessment finding indicates the presence of bradykinesia?

Lack of spontaneous movement

A nurse is caring for a client with chronic kidney failure. Which clinical findings should the nurse expect when assessing this client? Select all that apply.

Lethargy Muscle twitching

A primary healthcare provider prescribes a diagnostic workup for a client who may have myasthenia gravis. What is the initial nursing goal for the client during the diagnostic phase?

Maintain present muscle strength

A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action should the nurse take first?

Take vital signs and notify the primary healthcare provider.

A nurse is caring for a client with acute kidney injury who is receiving a protein-restricted diet. The client asks why this diet is necessary. Which information should the nurse include in a response to the client's questions?

This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.

The healthcare provider prescribes neostigmine for a client with myasthenia gravis. The nurse evaluates that the client understands the teaching about this drug when the client makes what statement regarding drug management plans?

"Take the drug at the exact time that is listed on the prescription."

A nurse provides education to a client with myasthenia gravis about how to prevent myasthenic crisis. The nurse evaluates that the teaching is effective when the client makes which statement?

"The healthcare provider may need to adjust the dosage of my medication if I'm more active."

A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency?

Edema and pruritus

A client is suspected of having myasthenia gravis. What are the most significant initial nursing assessments that should be performed?

Effectiveness of respiratory exchange and ability to swallow

Steroid therapy is prescribed for a client with common signs and symptoms of multiple sclerosis. In response to the steroid therapy, what symptom does the nurse expect to decrease?

Episodes of vision loss

A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication?

Hepatitis B

A home care nurse is counseling a client with amyotrophic lateral sclerosis (ALS). What information should the nurse include in the discussion? Select all that apply.

Space activities throughout the day. Anticipate the use of alternate ways to communicate.

A nurse is teaching a client with multiple sclerosis (MS) about how to manage urinary retention. Which instructions should the nurse include in the teaching session? Select all that apply.

Using Credé maneuver Monitoring for and reporting signs of urinary tract infection