Exam 4 TB

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)?

rine output of 250 ml/24 hours

A nurse is completing preoperative teaching for a client who will undergo laparoscopic cholecystectomy. Which of the following should be included in the teaching?

"You might have shoulder pain after surgery."

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first?

55-year-old with cirrhosis and ascites who has an oral temperature of 102° F (38.8°C)

A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and an emesis of 100mL in the past 24 hours. What is the patient's fluid restriction for the next 24 hours?

950mL

The client with acute glomerular nephritis has periorbital edema. What additional assessment should the nurse perform with the client?

Auscultate breath sounds.

A nurse is planning care for a client who has cystitis. Which of the following interventions should the nurse include in the plan?

Instruct the client to avoid drinking carbonated beverages.

A nurse is reviewing the laboratory data of a client following a hemodialysis. The nurse should expect to find a decrease in which of the following laboratory values?

Potassium

a nurse is planning care for a client who has viral hepatitis which of the following actions should the nurse include in the plan of care?

Provide an adequate balanced diet

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find?

Pyuria

A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurse's most recent assessment indicate that the patient is producing copious quantities of dilute urine. What is the nurse's most appropriate response?

Recognize this as an expected finding.

A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL. The patient's 24 hour urine output is 1.75 liters. Based on these findings, what stage of AKI is the patient in?

Recovery

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 nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?

Serum creatinine 6 mg/dL

Your patient is receiving IV piggyback doses of gentamicin (Garamycin) every 12 hours. Which would be your priority for monitoring during the period that the patient is receiving this drug?

Serum creatinine and blood urea nitrogen levels

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply

Venous Pressure Fluid accumulation

A nurse is providing discharge teaching for client who pancreatitis and a prescription for fat-soluble vitamin supplements. The nurse should instruct the client to take a supplement for which of following.

Vitamins A

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is the most common in the client with chronic pancreatitis?

Weight loss

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

Weight loss

a nurse is caring for a client who has end stage kidney disease and reports having shortness of breath and swelling in his lower extremities upon assessment the nurse nods the client has crackles in his lungs and elevated blood pressure do not shoot suspect which of the following based on the client's manifestations?

hypervolemia

A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?

pH 7.25, HCO3- 19mEq/L, PACO2 30 mm Hg

A nurse is caring for a client who has acute pancreatitis. After treating the client's pain. Which of the following should the nurse address as the priority intervention?

with hold oral fluids and food

A nurse is assessing an older adult client who reports a sudden onset of urinary incontinence. The nurse should recognize which of the following conditions can cause incontinence in the older adult client?

Cystitis

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

D - Inform the health care provider and assess the client for signs on infection

A nurse is reviewing the medical record of a client who has a urinary tract infection (UTI). Which of the following findings should the nurse recognize as a risk factor?

Diabetes mellitus

What change indicates recovery in a patient with nephrotic syndrome?

Disappearance of protein from the urine

Which laboratory data does the nurse correlate with Portal-systemic encephalopathy (hepatic coma) in a client with cirrhosis?

Elevated serum ammonia level

a nurse is providing care for a client who had a lap laparoscopic cholecystectomy which of the following is an appropriate nursing action?

Encourage ambulation once fully awake

Which clinical manifestation in a client with renal impairment is associated with polycystic kidney disease?

Enlarged or protruding abdomen

a nurse is caring for a client who has end stage renal disease which of the following are expected findings? Select all that apply?

Fatigue Anuric Pruritus

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

Fatty Stool

Which finding leads the nurses to suspect acute glomerulonephritis in a 22 year old patient?

Fever Oliguria Hypertension Periorbital edema

A client is admitted to a hospital with a diagnosis of acute pyelonephritis. Which symptom occurs most frequently and should be monitored by the nurse?

Flank pain on the affected side

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

Renal failure can have prerenal, renal or post renal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it?

Heart Failure

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 patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is board-like, and no bowel sounds are detected. What is the major concern for this patient?

The patient has developed peritonitis

which information from a 70-yr-old patient during a history indicates to the nurse that the patient should be screened for hepatitis C?

The patient used IV drugs about 20 years ago.

A patient who has cirrhosis and esophageal varices is being treated with propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective?

Stools test negative for occult blood.

A nurse is providing teaching to a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following statements by the client indicates an understanding of the teaching?

"If my heart starts racing, my provider might need to adjust my dosage."

A nurse is preparing a teaching plan for a client who is starting to receive hemodialysis for chronic kidney disease. Which of the following instructions should the nurse include in the teaching?

"Increase your intake of protein to 1 to 1.5 grams per kilogram per day"

A nurse is planning care for a client who has cirrhosis of the liver with ascites which of the following actions should the nurse include in the plan?

Implement a low sodium diet measure the clients abdominal grith administer furosemide.

After a diagnosis of chronic renal failure, a client was started on Epogen. Which finding should a nurse expect when evaluating the desired therapeutic effectiveness of the medication?

Increase in serum hematocrit

A nurse is assessing a client who has cirrhosis. Which of the following is an expected finding for this client?

Spider angiomas

Which type of precautions should the nurse implement to protect from being exposed to any of the hepatitis viruses?

Standard precautions

A nurse is planning care for a client who has acute glomerulonephritis. Which of the following interventions should the nurse include in the plan?

Administer antibiotics

The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information if the client states to record daily the:

Amount of activity.

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 values?

Amylase

During the assessment of a patient with obstructive jaundice, the nurse would expect to find:

Clay colored stools

a nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?

Cold and numb numbness distal to fistula side

The nurse provides discharge instructions for a 64 year old women with ascites and peripheral edema related to cirrhosis. Which statement made by the patient indicates teaching was effective?

Herbs and other should be used to my foods instead of salt

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

A nurse is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?

Hyperkalemia

A patient with acute renal failure has a GFR of 40 mL/min. which signs and symptoms below may this patient present with? Select all that apply

Hypervolemia Increased BUN level

Which of the following is CORRECT regarding continuous renal placement therapy (CRRT)?

It aids fluid removal

The nurse at the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that the patient's teaching is required?

Magnesium Hydroxide

A nurse is caring for a client who has a small bowel obstruction and an NG tube in place. Which of the following actions should the nurse take?

Maintain low intermittent suction.

The nurse is planning care for a patient with severe heart failure who has developed elevated BUN and creatinine levels. The primary collaborative goal in the plan will be?

Maintaining cardiac output

what should the nurse teach patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)?

Mealtime

The nurse is caring for a patient who underwent lithotripsy earlier in the day. What instruction should the nurse give the patient?

Notify the physician about cloudy or foul-smelling urine.

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)?

Obtain the patient's temperature and blood pressure, and pulse before the transfusion

The nurse cares for a client with acute kidney injury (aKI). The client is experiencing an increase in the serum concentration of the urea and creatinine. The nurse determines the client is experiencing which phase of AKI?

Oliguria Phase

A nurse is admitting a dient to the surgical unit from the PACU following a cholecystectomy. Which of the following assessments is the nurse's priority?

Oxygen saturation

The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support the diagnosis?

Pain in the upper right quadrant after a fatty meal

Which assessment finding is of most concern for a patient with acute pancreatitis?

Palpable abdominal mass

A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate?

Pantoprazole 80 mg IV bolus twice daily

Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (caltrate) for a patient with chronic kidney disease (CKD)?

Phosphate level

Atherosclerosis impedes coronary blood flow by which of the following mechanisms?

Plaques obstruct the artery

A nurse is teaching a client who has hepatitis A about preventing transmission of the virus. Which of the following strategies should the nurse include in the teaching?

Practice effective hand hygiene

A nurse is teaching a client who has predialysis end-stage kidney disease about diet. Which of the following instructions should the nurse include?

Reduce intake of food high in potassium

which of the following would a nurse classify as pre prerenal cause of acute renal failure?

Septic shock

A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload?

The client has a 5 lb weight gain since yesterday

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first?

The client who does not have a palpable thrill or auscultated bruit.

A nurse is providing preoperative teaching about stool consistency to a client who will undergo a colectomy with the placement of an ileostomy. Which of the following information about stool consistency should the nurse include in the teaching?

The stool will have a high volume of liquid.

The nurse in the dialysis clinic is reviewing the home medications of patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required?

d. magnesium hydroxide

An adult patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect?

d. recent weight gain

which finding indicates to the nurse that lactulose is effective for an older adult who has advanced Cirrhosis?

the patient is alert and oriented

You are providing education to a patient with CKD (chronic kidney disease) about calcium acetate. Which statement by the patient demonstrated they understood your teaching about this medication? Select all that apply

​​"I will take this medication with meals or immediately after." "This medication will help prevent my phosphate level from increasing."

a client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse which assessment findings would be consistent with the acute pancreatitis?

discoloration at the flank areas

The home care nurse is making a following up visit to a client following a renal transplant. The nurse assesses the client for which signs of acute graft rejection?

fever, hypertension, graft tenderness, and malaise

The nurse should instruct the client to avoid foods that are gas forming, such as cauliflower and cabbage. These foods can increase the client's abdominal discomfort

"Select desserts such as angel-food cake."

A nurse is providing teaching for a client who has conspaon-predominant irritable bowel syndrome (IBS-C). Which of the following statements should the nurse include in the teaching?

"Take psyllium in the evening."

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the likelihood of liver problems?

Jaundice Ecchymosis Petechiae

A nurse is assessing a client who has an exacerbation of diverticular disease. In which of the following quadrants should the nurse anticipate the client to be experiencing abdominal pain?

Left lower quadrant

the nurse is caring for a patient who has nephropathy with protein in the urine the nurse can anticipate the patient will receive which of the following medication to delay disease progression?

Lisinopril.

A nurse is caring for a school-age child with acute glomerulonephritis who has peripheral edema and is producing 35 mL of urine per hr. The client should be placed on which of the following diets?

Low-sodium, fluid-restricted

The client diagnosed with acute renal failure (ARF) had a potassium level of 6.8 mEq/L. which collaborative treatment should the nurse anticipate for the client?

Prepare the client for dialysis

The client diagnosed with end stage liver failure is admitted with hepatic encephalopathy. Which dietary restriction should be implemented by the nurse to address this complication?

Reduce protein intake to 60 to 80 g/day.

A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client's ammonia level?

Reduce the client's intake of protein

A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life threatening effect of renal failure for which the nurse should monitor the patient?

Retention of potassium

Which assessment finding should the nurse expect when a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30?

b. rapid, deep respirations

During routine hemodialysis, a patient reports nausea and dizziness. Which action should the nurse take first?

c. check the blood pressure

A client with urinary tract infection is prescribed phenazopyridine. Which of the following instructions would the nurse give the client?

"This medication should be taken at bedtime"

a nurse is preparing to administer a dose of Lactulose to a client who has cirrhosis the client states "I don't need this medication I am not constipated" the nurse should explain that in clients who have cirrhosis Lactulose is used to decrease levels of which of the following components in the bloodstream?

Ammonia

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnosed right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?

Acute Pain

A client has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the client's admission assessment, the nurse should be aware of the signs and symptoms that are characteristics of this diagnosis? Select all that apply.

Acute pain Hematuria Urinary frequency

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)

The nurse monitors for which complications with end stage cirrhosis who develops severe vomiting?

Bleeding esophageal varices

When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next?

Check the calcium level in the chart

The female nurse sticks herself with a dirty needle. Which action should the nurse implement first?

Cleanse the area with soap and water

A nurse is caring for a client who has suspected cholecystitis. The nurse should expect the client's urine to appear which of the following colors?

Dark and foamy

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what?

Decreased ammonia levels

The nurse identifies a risk for urinary stones in a patient who relates a health history that includes:

Hyperparathyroidism

A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate?

Stop the dialysis

The nurse is caring for a patient with acute pancreatitis. The patient has an order for anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason?

To reduce gastric and pancreatic secretions

A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to:

Turn cough, and deep breathe every 2 hours

A nurse is teaching a client who has acute kidney injury about the oliguric phase. Which of the following information should the nurse include in the teaching?

Urine output is less than 400 mL per 24 hr.

on nurse is providing discharge teaching for a client who has chronic pancreatitis which of the following statements should the nurse make?

You should decrease your daily intake of fat

Which finding leads the nurse to suspect acute glomerulonephritis in a 22 year old patient? SATA

a. Oliguria, Hypertension, Periorbital edema

The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with:

a. anticoagulants

Which finding for a patient admitted with glomerulonephritis indicates to the nurse that the treatment has been effective?

a. the periorbital and peripheral edema are resolved

what should the nurse ask the patient about to determine possible causes of acute glomerulonephritis?

b. recent sore throat and fever

A nurse is caring for a client who has acute pancreatitis. After treating the client's pain, which of the following would the nurse address as the priority intervention?

c. Withhold oral fluids and food

A patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?

c. glomerular filtration rate (GFR)

The nurse is planning care for a patient with severe heart failure who has developed increased blood urea nitrogen (BUN) and creatinine levels. What will be the primary treatment goal n the plan?

c. maintaining cardiac output

A nurse is providing discharge teaching for a client who has chronic pancreatitis. Which of the following statements should the nurse make?

d. "You should decrease your daily intake of fat*