Exam 6
The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of A)hypokalemia. B)anemia. C)metabolic alkalosis. D)hypophosphatemia.
B) anemia Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.
A nurse cares for a client who is post op open cholecystectomy and has a T-tube in place. Which clinical situation will the nurse notify the health care provider about as a possible complication of the surgery? A)Absence of blood or serous fluid in the T-tube. B)Greater than 250 mL bile output from the T-tube in 24 hours. C)Significantly reduced bile output from the T-tube. D)Finding the T-tube placed below the level of the incision.
C) Significantly reduced bile output from the T-tube A T-tube is placed after open cholecystectomy to drain excess bile. The T-tube should remain below the level of the incision in order to ensure proper drainage. The nurse should report an output of greater than 500 mL in 24 hours or a significantly reduced bile output from the T-tube. There should not be bloody or serous output from the T-tube.
The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? A)Creatinine clearance level B)Uric acid level C)Blood urea nitrogen (BUN) D) BUN to creatinine ratio
A) Creatinine clearance level The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? A) Decreased fluid intake B)Increased fluid intake C)Glomerulonephritis D)Diabetes insipidus
A) Decreased fluid intake When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? A)Initiation B)Oliguria C)Diuresis D)Recovery
B) Oliguria The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
A nurse who provides care in a high-acuity medical setting is aware of the high incidence and morbidity of acute renal failure (ARF). To reduce patients' risks of developing ARF during their stay in hospital, it is imperative that: A)Standard precautions be adhered to rigorously B)Patients be encouraged to ambulate as soon as they are able C)Patients' medication regimens be monitored closely D)Tube feeding or parenteral nutrition be initiated for patients who cannot eat
C) Patients medications regimens be monitored carefully Medications are frequently implicated in cases of hospital-acquired ARF. Malnutrition, lack of infection control, and inactivity are not directly causative of ARF.
The single modality of pharmacologic therapy for chronic type B viral hepatitis is: A) Alpha-interferon B)Hepsera C)Epivir D)Baraclude
A) Alpha- interferon Alpha-interferon is a biologic response modifier that is highly effective for treatment of hepatitis B. The other antiviral agents are effective but not the preferred single-agent therapy.
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as: A)oliguria. B)polyuria. C) anuria. D)hematuria.
C) Anuria Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.
Which term describes the passage of a hollow instrument into a cavity to withdraw fluid? A)Asterixis B)Paracentesis C) Ascites D)Dialysis
B) Paracentesis Paracentesis may be used to withdraw fluid (ascites) if the accumulated fluid is causing cardiorespiratory compromise. Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction. Ascites refers to accumulation of serous fluid within the peritoneal cavity. Dialysis refers to a form of filtration to separate crystalloid from colloid substances.
A female client who suffers from urethral strictures undergoes a dilation procedure. Following the procedure, she experiences a burning sensation while voiding. Which of the following instructions would be most helpful? A)Encourage her to visit a local ostomy support group. B)Advise her to cleanse her perineum frequently. C)Urge her to apply moisture sealants. D) Instruct her to take warm sitz baths.
D) Instruct her to take warm sitz baths Taking warm sitz baths and nonnarcotic analgesics can relieve the client's discomfort while voiding. A client may be advised to visit a local stoma support group following a urinary diversion procedure. Applying moisture sealants and frequent cleaning and washing of the perineum will protect the skin but may not relieve the client of the discomfort.
A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? A)Hypertension B) Bile-stained vomiting C) Warm, dry skin D)Weight loss
B) Bile- stained vomiting Nausea and vomiting are common in acute pancreatitis. The emesis is usually gastric in origin but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur.
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? A)Acute pyelonephritis B)Osmotic dieresis. C)Dysrhythmias D)Renal calculi
D) Renal calculi Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).
The nurse is assisting in the preoperative planning for stoma placement in a client scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located? A)Over a bony prominence B) Away from skin folds C)At the belt line D)At the umbilicus
B) Away from skin folds The nurse plans to have the stoma located away from skin folds and creases, bony prominences, the belt line, and the umbilicus. The stoma should be located in an area where the client can see and reach it.
The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? A)Assisting the client to turn, cough, and deep breathe every 2 hours B)Teaching the client to choose low-fat foods from the menu C)Performing range-of-motion (ROM) leg exercises hourly while the client is awake D)Assisting the client to ambulate the evening of the operative day
A) Assisting the client to turn, cough, and deep breathe every 2 hours Assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.
During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? A)Dehydration B)Hypokalemia C)Oliguria D)Renal calculi
A) Dehydration Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia. The concern with acute kidney injury (AKI) is hyperkalemia. The diuresis phase of AKI is marked by normal or elevated urine output. Oliguria is urine output less than 400 mL in 24 hours and is seen in the oliguria phase. Renal calculi are a possible cause but not a complication of AKI.
A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention? A)Discuss meals that include low-fat high-carbohydrate content. B)Discuss the importance of drinking at least 64 oz (1,893 ml) of water daily. C)Discuss meals that have a high-fiber, high-protein content. D) Discuss the importance of eliminating caffeine in the diet.
A) Discuss meals that include low-fat high- carb content In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for carbohydrates and other energy sources for cellular metabolism. The nurse should limit the client's fat intake to prevent satiation and should restrict protein intake because a cirrhotic liver can't metabolize protein effectively. A client with cirrhosis may have increased edema as a result of reduced plasma albumin, so he should restrict fluid intake rather than drink 64 oz of water daily. Increasing fiber intake isn't a priority intervention for a client with cirrhosis. A client with cirrhosis doesn't need to eliminate caffeine from his diet.
The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? A) Hemodialysis B)Peritoneal dialysis C)Continuous arteriovenous hemofiltration (CAVH) D)Continuous venovenous hemofiltration (CVVH)
A) Hemodialysis The client is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for clients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for clients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for clients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for client who are hemodynamically unstable.
A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer? A)Painless, gross hematuria B)Deep flank and abdominal pain C)Muscle spasm and abdominal rigidity over the flank D)Decreasing kidney function associated with fever and hematuria
A) Painless, gross hematuria Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.
A client who was recently diagnosed with carcinoma of the pancreas and is having a procedure in which the head of the pancreas is removed. In addition, the surgeon will remove the duodenum and stomach, redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is this client having performed? A)radical pancreatoduodenectomy B)cholecystojejunostomy C)total pancreatectomy D) distal pancreatectomy
A) Radical pancreatoduodenectomy Radical pancreatoduodenectomy involves removing the head of the pancreas, resecting the duodenum and stomach, and redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the jejunum. Cholecystojejunostomy is a rerouting of the pancreatic and biliary drainage systems, which may be done to relieve obstructive jaundice. This measure is considered palliative only. A pancreatectomy is the surgical removal of the pancreas. A pancreatectomy may be total, in which case the entire organ is removed, usually along with the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach. A distal pancreatectomy is a surgical procedure to remove the bottom half of the pancreas.
A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact? A)The left kidney usually is slightly higher than the right one. B) The kidneys are situated just above the adrenal glands. C) The average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. D) The kidneys lie between the 10th and 12th thoracic vertebrae.
A) The left kidney usually is slightly higher than the right one The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? A)Fluid volume excess B)Urinary retention C)Activity intolerance D)Disturbed body image
A) fluid volume excess The oliguric phase is characterized by fluid retention.
A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about: A)renal circulation. B)kidney function. C)kidney structure. D)urine production.
A) renal circulation A renal angiography (renal arteriography) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.
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? A)Elevated urea levels B) Hyperkalemia C) Hypocalcemia D)Elevated white blood cells
B) Hyperkalemia Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.
A 58-year-old man has a longstanding diagnosis of poorly controlled type 2 diabetes. As a result of hyperglycemia, the man has developed chronic glomerulonephritis. In light of this new diagnosis, the nurse who is caring for this patient would anticipate that he will exhibit: A) Hypokalemia B)Proteinuria C)Hematuria D)Arrhythmias
B) Proteinuria Chronic glomerulonephritis is characterized by proteinuria, usually caused by repeated episodes of glomerular injury that results in renal destruction. Hypokalemia does not typically accompany renal disease, and arrhythmias are unlikely to be evident at this stage of kidney disease. Hematuria may or may not be present.
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? A) Notify the health care provider. B) Turn the client from side to side. C)Lower the head of the bed. D)Push the catheter further into the abdomen.
B) Turn the client from side to side If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.
A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? A) "You must have the second one in 2 weeks and the third in 1 month." B) "You must have the second one in 1 month and the third in 6 months." C)"You must have the second one in 6 months and the third in 1 year." D)"You must have the second one in 1 year and the third the following year."
B) You must have the second one in 1 month and the third in 6 months. Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.
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: A)hematuria. B)weight loss. C) increased urine output. D) increased blood pressure.
B) weight loss Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure
A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has? A)Hemolytic jaundice B)Hepatic insufficiency C)Bleeding esophageal varices D)Portal hypertension
C) Bleeding esophageal varices The patient with bleeding esophageal varices may present with hematemesis, melena, or general deterioration in mental or physical status and often has a history of alcohol abuse. Signs and symptoms of shock (cool clammy skin, hypotension, tachycardia) may be present. The scenario does not describe hemolytic jaundice, hepatic insufficiency, or portal hypertension.
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? A)"I should limit foods high in potassium in my diet, such as bananas." B)"I should limit the amount of protein in my diet." C)"I should drink as much as possible to keep my kidneys working." D)"My intake of high sodium foods should be limited."
C) I should drink as much as possible to keep my kidneys working Dietary management of acute post-streptococcal glomerulonephritis includes restrictions of protein, sodium, potassium, and fluids.
The nurse advises the patient with chronic pyelonephritis that he should: A) Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys. B) Decrease his sodium intake to prevent fluid retention. C)Increase fluids to 3 to 4 L/24 hours to dilute the urine. D)Decrease his intake of calcium rich foods to prevent kidney stones.
C) Increase fluids to 3 to 4 L/24 hours to dilute the urine Unless contraindicated, fluids should be increased to dilute the urine, decrease burning on urination, and prevent dehydration. A balanced diet would be recommended but there is no need to restrict sodium or calcium.
A client undergoes renal angiography. Which postprocedure care intervention should the nurse provide to the client? A)Encourage the client to void. B) Monitor the client for signs and symptoms of pyelonephritis. C)Palpate the pulses in the legs and feet. D) Assess for signs of electrolyte and water imbalanc
C) Palpate the pulses in the legs and feet To observe for signs of arterial occlusion in a client who has undergone renal angiography, the nurse should palpate the pulses in the legs and feet. While preparing the client for renal angiography, the nurse asks the client to void. The nurse assesses for signs of electrolyte and water imbalances during the physical examination of a client. The nurse should monitor for signs and symptoms of pyelonephritis in a client who has undergone retrograde pyelography.
A client requires hemodialysis. Which type of drug should be withheld before this procedure? A)Phosphate binders B)Insulin C)Antibiotics D)Cardiac glycosides
D) Cardiac glycosides Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.
The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance. A)Sodium B) Bicarbonate C)Creatinine D)Glucose
D) Glucose Glucose is usually filtered at the level of the glomerulus. It does not normally appear in the urine. Renal glycosuria occurs if the glucose in the blood exceeds the amount that is able to be reabsorbed. The other substances are normally excreted in the urine.
Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure? A)Overflow B)Urge C)Reflex D)Stress
D) Stress Stress incontinence may occur with sneezing, coughing, or changing position. Overflow incontinence refers to the involuntary loss of urine associated with overdistention of the bladder. Urge incontinence refers to involuntary loss of urine associated with urgency. Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.
