EXAM II 3290/3310

A nurse is teaching a group of patients about Metabolic syndrome. Which assessment features are associated with the syndrome? (Select all that apply.) A. Male waist circumference 44 inches B. Fasting blood glucose 66 mg/dL C. Triglyceride value of 162 mg/dL D. Blood pressure 135/85 E. Patient is taking blood pressure medication

A, C, D, E: Beware of PHATS. P - pressure: systolic >130 or diastolic >85 or on hypertension medication H - HDL: if their HDL <40 in men & <50 in women A - Abdominal obesity: abdominal circumference in men: greater than 40 inches & female: greater than 35 inches T - triglycerides: triglycerides > 150 or on medication for high triglycerides S - sugars: fasting BG of >100 or on meds for high glucose

In the Oliguric phase of acute renal injury, the nurse should Anticipate the development of which of the following complications a. Pulmonary Edema. b. Metabolic alkalosis c. Hypotension d. Hypokalemia

A, Due to decreased urine output and fluid retention.

Which visual impairment is characterized by decreased elasticity of the lens causing the inability to focus on nearby objects? a. Presbyopia b. Macular degeneration c. Glaucoma d. Cataracts

A, Presbyopia Cataracts: Lens opacity is distorted Macular: Deterioration of central vision, cannot read Glaucoma: Increased ICP, fluid in eye

Perfectionism is a trait likely to be evident in a person with which personality disorder? A. Obsessive-compulsive B. Narcissistic C. Antisocial D. Avoidant

A, an obsessive-compulsive personality disorder is characterized by orderliness, perfectionism and excessive devotion to work to the point that individuals exclude hobbies and friendships. The individual is often detail-oriented, and when things do not work out in their favor, they can quickly become angry.

Cranial nerve VI, lateral eye movement

Abducens

Cranial nerve XI, shoulder shrug

Accessory

Your patient has a 50% increase serum creatinine, with a urine output of under 0.5mL/kg/hr, with signs and symptoms of azotemia (increased urea, nitrogen, uric acid, and creatinine), you would expect them to have

Acute Kidney Injury

Your patient has acute kidney injury, but it is intrarenal. What would you expect the patient would have?

Acute Tubular Necrosis (ATN) = most common intrarenal cause of AKI -results from ischemia, nephrotoxins, or sepsis Nephrotoxic injury -Drugs, radiocontrast agents, blood transfusion rxn, chemical exposures (ex: lead) Interstitial nephritis: spaces between kidney tubules become inflamed -allergies, NSAIDS, ACE inhibitors

Who does DKA affect? What is present? Hyper or hypoglycemia? Osmolality? Suddenly or slowly? What causes DKA? Who usually is seen with DKA? What are the main problems? What are the S/S? What is the treatment? What lab value is important?

Affects mainly Type 1 diabetics Ketones and Acidosis present Hyperglycemia presents >300 mg/dL Variable osmolality Happens Suddenly Causes: no insulin present in the body or illness/infection Seen in young or undiagnosed diabetics Main problems are hyperglycemia, ketones, and acidosis (blood pH <7.35) Clinical signs/symptoms: Kussmaul breathing, fruity breath, abdominal pain Treatment is the same as in HHNS (fluids, electrolyte replacement, and insulin) Watch potassium levels closely when giving insulin and make sure the level is at least 3.3 before administrating.

Who does HHS affect? Are there ketones/acidosis? Hyper or hypoglycemia? High or low osmolality? Suddenly or gradually? What causes HHS? Who is seen with HHS? What are the problems with HHS? What are you more likely to have? Treatments? What is your pH? What is your breathing rate/breath smell?

Affects mainly Type 2 diabetics No ketones or acidosis present EXTREME Hyperglycemia (remember heavy-duty hyperglycemia) >600 mg/dL sometimes four digits High Osmolality (more of an issue in HHNS than DKA) Happens Gradually Causes: mainly illness or infection and there is some insulin present which prevents the breakdown of ketones Seen in older adults due to illness or infection Main problems are dehydration & heavy-duty hyperglycemia and hyperosmolarity (because the glucose is so high it makes the blood very concentrated) More likely to have mental status changes due to severe dehydration due to hyperosmolarity Treatments are the same as in DKA, however, fluid administration helps just as much as insulin therapy because of the correction of osmolarlity issue. Blood pH will be normal (remember no acidosis as in DKA) No Kussmaul breathing and fruity breath (because there is no KETOSIS)

what will CKD do to the GI system?

Anorexia, nausea, vomiting, metallic taste in mouth, changes in taste, stomatitis, uremic colitis (diarrhea), constipation, uremic fetor (breath odor)

What is stage I of chronic kidney disease? What would the GFR be?

At risk, normal kidney function, urine indicates kidney disease... minimize risk factors GFR = >90

Cranial nerve VIII, Hearing/balance

Auditory/Vestibulocochlear

A 2 year old has hearing loss because of recurrent otitis media. What treatment would the nurse anticipate the practitioner to use? a. Eardrops b. Myringotomy c. Mastoidectomy d. Steroid therapy

B, Myringotomy is surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear Drops would obscure view of tympanic membrane. Removing the mastoid would not relieve pressure from the inflamed ear. Antibiotics would be used, not steroid, for the infectious process.

A patient with End Stage Renal Disease, received erythropoietin a week ago. What complaint by the patient justifies the need to call the doctor? a. The patient complains of being constipated. b. The patient reports elevated blood pressure. c. The patient reports pain in the legs & back. d. The patient complains of flu-like symptoms.

B, Patient's blood pressure will need to be monitored carefully after the initial administration. Hypertension that cannot be controlled is a contraindication to erythropoietin therapy.

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for: A. Low birth weight. B. Macrosomia. C. Preterm birth. D. Congenital anomalies of the central nervous system

B, The term macrosomia is used to describe a newborn with an excessive birth weight. Hyperglycemia in the fetus results in the stimulation of insulin, insulin like growth factors, growth hormone, and other growth factors, that stimulate fetal growth and deposition of fat and glycogen

When is a patient most susceptible to hypoglycemic symptoms after the administration of insulin? A. Onset B. Peak C. Duration D. Duration & Peak

B.

What does visual acuity less than 20/200 in the better eye indicate?

Blindness

A student with type 1 diabetes mellitus goes to the school nurse stating they do not feel well. Which symptoms does the nurse recognize as requiring immediate intervention? A. Tired, BP of 110/60, and blood glucose 108. B. Regular depth respirations with frequent pauses, oliguria, and flushed skin. C. Deep, rapid respirations with long expirations, thirst and abdominal pain. D. Perspiration, BP 130/84 and blood glucose of 150.

C, Deep, rapid respirations with long expiration, thirst and abdominal pain is associated with hyperglycemia, kussmaul breathing, polyuria, polydipsia and polyphagia all know as diabetic ketoacidosis

A nurse is evaluating the effectiveness of treatment for a client with excess fluid volume. What clinical finding indicates that the treatment has been successful? A. Increased urine specific gravity B. Positive pedal pulses C. Clear breath sounds D. Normal potassium level

C, Excess fluid can move into the lungs, causing crackles, clear breath sounds support that treatment was effective. Specific gravity will decrease as client excretes excess fluid. Pedal pulses will not diminish Normal potassium can be maintained independently of fluid excess correction.

A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine output b. Calcium level c. Cardiac rhythm d. Neurologic status

C, Hyperkalemia causes peaked T waves and cardiac dysrhythmias. If the cardiac rhythm returns to NSR, then the calcium gluconate was effective. Calcium gluconate is used in advanced cardiac toxicity.

What should the nurse anticipate about the insulin requirements of a client with diabetes on her first postpartum day? A. The insulin requirement will increase slowly and steadily. B. The insulin requirement will remain unchanged. C. A sudden decrease in the insulin requirement. D. A sudden increase in insulin requirement

C, The mother's insulin requirements tend to be very low for the first few days postpartum. Insulin sensitivity increases dramatically after delivery of placenta. Insulin requirements drop markedly during birth and immediate postpartum period During first few days to 2 weeks postpartum, can drop to less than pre-pregnancy levels with variable return to baseline

Which behavior indicates that a patient diagnosed with borderline personality disorder is improving? A. The patient cries when her roommate refuses to go to the dining room with her. B. The patient yells at the group facilitator when he points out that she is monopolizing the group. C. The patient informs a staff member that she is having thoughts of harming herself. D. The patient tells the evening staff that the day staff excused her from group to smoke when she got upset.

C, The patient informs a staff member that she is having thoughts of harming herself.

What are intrarenal causes of AKI? Select all that apply a. anaphylaxis b. renal stones c. nephrotoxic drugs d. acute glomerulonephritis e. Radiocontrast agents

C,D,E: Acute Tubular Necrosis (ATN) = most common intrarenal cause of AKI -results from ischemia, nephrotoxins, or sepsis Nephrotoxic injury -Drugs, radiocontrast agents, blood transfusion rxn, chemical exposures (ex: lead) Interstitial nephritis: spaces between kidney tubules become inflamed -allergies, NSAIDS, ACE inhibitors

Which of the following insulins can be administered intravenously? A. NPH B. Lantus C. Humulin R D. Novolog

C.

Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? a. IV tobramycin b. Incompatible blood transfusion c. Poststreptococcal glomerulonephritis d. Dissecting abdominal aortic aneurysm

D, Blood/cardiac are pre-renal

When do most patients tend to develop gestational diabetes during pregnancy? A. Usually during the 1-3 month of pregnancy B. Usually during the 2-3 month of pregnancy C. Usually during the 1-2 trimester of pregnancy D. Usually during the 2-3 trimester of pregnancy

D, GDM comes out around 2/3 trimester

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for a. vasodilation. b. poor skin turgor. c. bounding pulses. d. rapid respirations.

D, Metabolic acidosis can cause Kussmaul's breathing.

A client with a diagnosis of depression who has attempted suicide says to the nurse, " I should have died. I've always been a failure. Nothing ever goes right for me. " Which response by the nurse demonstrates therapeutic communication? A. "You have everything to live for" B. " Why do you see yourself as a failure?" C. "Feeling like this is all part of being depressed." D. "You've been feeling like a failure for a while."

D, Responding to the feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the client's expressed feelings. In addition, use of the word why is nontherapeutic because clients frequently interpret why questions as accusations. Why questions can cause resentment, insecurity and mistrust.

What treatments are important for CKD? At home? In the hospital?

Dialysis: Three times a week for 3-4 hours, requires AV fistula access, filters waste/water from blood Peritoneal dialysis: Abdominal cavity acts as a membrane for filtration, uses dialysate, which draws waste/fluid from the blood Kidney transplant

What FIRST LINE pharmacological interventions are used for AKI management?

Diuretics (Furosemide/Lasix) Osmotic diuretics (Mannitol) NOT IN HIGH DOSES

What is stage V of chronic kidney disease (ESRD)? What would the GFR be?

End Stage Kidney Disease (ESKD)... implement renal replacement GRF = <15

Cranial nerve VII, facial movement/eyelid closing

Facial

What restrictions should AKI pt. be on?

Fluid restriction: 600 ml + previous 24 hour fluid loss

What eye disorder results in increased intraocular pressure (IOP) that can be cured with drug therapy and surgery?

Glaucoma

What are the primary causes of CKD?

Glomerular disease, tubular disease, vascular disease of the kidney, UTI, genetic, infection, systemic vascular disease, metabolic kidney disease, connective tissue disease

What methods do patients use to adaptively improve hearing?

Hearing aids, assistive clisting, sign languagr

Cranial nerve XII, tongue movement

Hypoglossal

Your patient has acute kidney injury, but it is prerenal. What would you expect the patient would have?

Hypovolemia: Dehydration, hemorrhage, GI (diarrhea/vomiting), diuresis, burns Decreased CO: Dysrhythmias, shock, HF, MI Vasodilation: Sepsis, anaphylaxis, antihypertensive meds

What immunity marker is found in mucous, saliva, tears, and breast milk which protects against pathogens?

IgA

Which immunity marker is part of the B cell receptor and activates basophils and mast cells?

IgD

What immunity marker protects against parasitic worms and is responsible for allergic reactons?

IgE

What immunity marker is secreted by plasma cells in the blood which can cross the placenta into the fetus?

IgG

What are the phases of acute kidney injury?

Initiation: initial insult (start of injury) Oliguric: peeing less Diuresis: peeing a lot Recovery: returning to normal function

How does the nurse/medical doctor assess a patient's vision?

Inspection Intervene: Surgery Adaptive methods: Contacts, glasses, braille, guide dogs

What are screening tools for preventing impaired sensory perception (vision and hearing)?

Lifetime long vision screening 40+: EVERY 2 YEARS 60+: EVERY YEAR

What does visual acuity less than 20/40 in the better eye indicate?

Low/impaired vision

WBCs that clean the body; sweeper cells

Macrophages

What eye disorder is defined as deterioration of central vision reducing ability to read, write, or recognize safety hazards (with the only cure being laser surgery/medications)?

Macular degeneration

What type of ABG disorder does CKD lead to

Metabolic Acidosis: results from the inability of kidneys to excrete acid load (primarily ammonia); defective reabsorption/regeneration of bicarbonate

What is stage III of chronic kidney disease? What would the GFR be?

Moderately reduced kidney function... slow the disease progression GFR = 30-59

What are the skeletal muscle CKD manifestations?

Muscle weakness, cramping, bone pain, fractures

What electrolytes will change in CKD?

Na - normal/low K - HYERKALEMIA

What are some additional treatments for AKI?

Nutrition: Proteins/potassium/sodium restriction Treat Hyperkalemia Dialysis, continuous renal replacement therapy

Crainal nerve III, opening eyelids, eye movement

Oculomotor

Cranial nerve I, sense of smell

Olfactory

Your patient has a urine output of <400mL/day for 10-14, and are hyponatremic because their renal tubes cannot conserve Na+ and hyperkalemic because the tubules cannot excrete K+ (inversely related), what stage of AKI are they in? What lab values would you expect in the pt. ?

Oliguric Phase: The longer it lasts, the poorer prognosis for recovery - Elevated Bun/Cr - Increased nitrogenous waste: Fatigue, difficulty concentrating, seizures, stupor, coma Fluid: HF, Pulmonary EDEMA - Metabolic acidosis: Ammonia (confusion) not synthesized, decreased bicarb

What middle ear inflammation occurs commonly in children due to infection causing pain and hearing loss which can be treated with a myringotomy (surgical opening of eardrum to drain fluid)?

Otitis media

What is a rupture or hole of the eardrum as a result of otitis media?

Perforated eardrum

Your patient wants to do dialysis at at home. What should they do? What are they at risk for?

Peritoneal Dialysis •Abdominal cavity acts as a semipermeable membrane for filtration •Can be managed at home in most cases •Use a cleaning solution called dialysate: draws waste and fluid from the blood •Used when patient cannot handle rapid shift in fluid/electrolytes with hemodialysis Risk of infection and peritonitis (due to puncture that hits bowel & fecal matter oozes out - often leads to death r/t sepsis); patient will have board like abdomen

What are the urinary CKD manifestations?

Polyuria, oliguria (late), proteinuria, hematuria, diluted straw colored (early), concentrated cloudy (later)

What sensorineural age-related hearing loss is caused by changes of the inner ear/nerve pathways impairs from minor distortions to complete hearing loss and may lead to communication difficulties and psychosocial consequences like relationship/learning/work/isolation problems?

Presbycusis

What is the inability to focus on near objects due to reduced elasticity of the lens?

Presbyopia

What are primary preventions for preventing impaired sensory perception?

Protective devices, ear plugs, helmets, oral hygiene

What causes olfactory and gustatory (taste/smell) impairment?

Radiation of head and neck, dental issues, head injury, sinus infections, nasal polyps, brain tumor/injury

What is stage IV of chronic kidney disease? What would the GFR be?

Severely reduced kidney function (noticeable jaundice around the eyes)... manage complications/discuss renal replacement GFR = 15-29

What is stage II of chronic kidney disease? What would the GFR be?

Slightly reduced kidney function... minimize risk factors GFR = 60-89

What does TORCH stand for in the TORCH antibody panel for pregnant mothers?

TO: Toxoplasmosis RC: Rubella, Cytomegalovirus (CMV) H: HSV (herpes simplex virus), HIV (human immunodeficiency virus)

A patient newly diagnosed with diabetes is about to be discharged home. You are watching the patient administer insulin. Which of the following actions causes you to re-educate them? A. They massaged the site after administering the insulin. B. They injected into the fat of their thighs. C. They used an opposite side for injection compared to the last insulin injection. D. They engaged the safety after administering the medication.

The answer is A.

Which of the following statements are INCORRECT about exercise management for the diabetic patient? A. "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising." B. "I plan on exercising for an extended period. So I will check my blood glucose prior, during, and after exercising." C. "My blood glucose is 268 and I have ketones in my urine. Therefore, I will avoid exercising today." D. All of the options are correct statements.

The answer is A.

A 25-year-old female is about to deliver a baby. The patient is HIV-positive and has been taking antiretroviral therapy during the pregnancy. What steps can be taken to help prevent transmitting the virus to the baby after birth? A. Substitute formula for breastfeeding. B. Administer antiretroviral treatment to the newborn for 2 weeks after birth. C. Avoid kissing and hugging the newborn. D. Stop taking antiretroviral therapy for 2 months postpartum.

The answer is A. Breastmilk can transmit the HIV virus. The patient should avoid breastfeeding but use formula instead. Option B is wrong because the newborn should receive antiretroviral treatment for 4-6 weeks after birth (NOT 2 weeks). The mother can kiss and hug her newborn (this does NOT transmit the virus), and the patient should not quit taking antiretroviral therapy during the postpartum period.

Which fluid below is considered an isotonic solution but works as a hypotonic solution? A. Dextrose 5% in water B. Lactated Ringer's solution C. Dextrose 10% in water D. 0.33% Normal Saline

The answer is A. Dextrose 5% in water (D5W) starts out as an isotonic solution, but ends up working as a hypotonic solution. This occurs because once the dextrose in the solution is used by the body (metabolized), there is only free water left over, which has a low osmolarity and acts as a hypotonic solution.

Which patient below with acute kidney injury is in the oliguric stage of AKI: A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day. C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day. D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day.

The answer is A. During the oliguric stage of AKI the patient will have a urinary output of 400 mL/day or LESS. This is due to a decreased GRF (glomerular filtration rate), which will lead to increased amounts of waste in the blood (increased BUN/Creatinine), metabolic acidosis (decreased excretion of hydrogen ions), hyperkalemia, hypervolemia (edema/hypertension), and urinary output of <400 mL/day.

The patient has been fasting overnight and arrives to the lab where a CMP is collected. CMP results show that the patient's glucose is 98 mg/dL. This result is interpreted as? A. Euglycemic B. Hypoglycemic C. Hyperglycemic

The answer is A. Euglycemic means normal glucose level. A normal glucose is 70-100 mg/dL, if fasting. If NOT fasting a normal glucose is 70-125 mg/dL.

A patient is 35 weeks pregnant. She has gestational diabetes and uncontrolled hyperglycemia. Her current blood glucose is 290 mg/dL. You administer insulin per physician's order and recheck the blood glucose level per protocol. It is now 135 mg/dL. Which statement by the patient requires you to notify the physician? A. "It burns when I urinate." B. "My back is hurting." C. "I feel tired." D. "I feel the baby kick about 10 times an hour."

The answer is A. Gestational diabetes places a patient at risk for urinary tract infections because the glucose can leak into the urine leading to infection (remember bacteria thrive on glucose). This scenario tells us the patient has uncontrolled hyperglycemia, which definitely puts her at risk for glycosuria (glucose in the urine). The physician should be notified if the patient reports burning on urination so a urine analysis can be performed. All the other options are normal findings in a pregnancy at this stage.

You administered 5 units of Humalog at 0800. What is the ONSET and DURATION of this medication? A. Onset: 15 minutes, Duration: 3 hours B. Onset: 2 hours, Duration: 16 hours C. Onset: 30 minutes, Duration: 1 hour D. Onset: 2 hours, Duration: 24 hours

The answer is A. Humalog is a rapid-acting insulin. It has an onset: 15 minutes and duration: 3 hours Watch the YouTube video to learn the mnemonics on how to remember these times...very helpful.

A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia? A. 1900 B. 1300 C. 1130 D. 1500

The answer is A. Humulin N is an intermediate-acting insulin. The peak of this medication is 8 hours.

While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last? A. 1-2 weeks B. 1-3 days C. Few hours to 2 weeks D. 12 months

The answer is A. The oliguric stage can last 1-2 weeks. Regarding the other stages of AKI: Initiation: few hours to several days, diuresis: 1-3 weeks, and recovery: 12 months or more.

A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a: A. Low protein, low sodium, low potassium, low phosphate diet B. High protein, low sodium, low potassium, high phosphate diet C. Low protein, high sodium, high potassium, high phosphate diet D. Low protein, low sodium, low potassium, high phosphate diet

The answer is A. The patient should follow this type of diet because protein breaks down into urea (remember patient will have increased urea levels), low sodium to prevent fluid excess, low potassium to prevent hyperkalemia (remember glomerulus isn't filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia.

A 65 year old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys? A. Lisinopril B. Metoprolol C. Amlodipine D. Verapamil

The answer is A. There are two types of drugs that can be used to treat hypertension and protect the kidneys in patients with CKD. These drugs include angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). The only drug listed here that is correct is Lisinopril. This drug is known as an ACE inhibitor. Metoprolol is a BETA BLOCKER. Amlodipine and Verapamil are calcium channel blockers.

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change? A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

The answer is A. When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with? A. SIADH B. Diabetes Insipidus C. Addison's Disease D. Fluid Volume Deficient

The answer is A: SIADH

Which of the following patient statements about the diabetic diet regime is correct? A. "I'll try to consume about 20% carbs and 40% fats on a daily basis." B. "Foods that are high in mono and poly fats are avocados, olives, and nuts." C. "Meats increase the glycemic index; therefore, I should only consume 5% of them on a daily basis." D. "I should completely avoid starchy vegetables like potatoes and corn."

The answer is B.

You're assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician? A. Potassium level 4.2 mEq/L B. Creatinine clearance 35 mL/min C. BUN 20 mg/dL D. Blood pH 7.40

The answer is B. A normal creatinine clearance level in a female should be 85-125 mL/min (95-140 mL/min males). A creatinine clearance level indicates the amount of blood the kidneys can make per minute that contain no amounts of creatinine in it. Remember creatinine is a waste product of muscle breakdown. Therefore, the kidneys should be able to remove excessive amounts of it from the bloodstream. A patient who has experienced a myocardial infraction is at risk for pre-renal acute injury due to decreased cardiac output to the kidneys from a damaged heart muscle (the heart isn't able to pump as efficiently because of ischemia). All the other labs values are normal.

While assessing morning labs on your patient with CKD. You note the patient's phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be? A. Elevated B. Low C. Normal D. Same as the phosphate level

The answer is B. A normal phosphate level is 2.7-4.5 mg/dL. This patient is experiencing HYPERphosphatemia. When hyperphosphatemia presents the calcium level DECREASES because phosphate and calcium bind to each. When there is too much phosphate in the blood it takes too much calcium with it and it decreases the calcium in the blood. Therefore, the nurse would expect to find the calcium level decreased.

Which lab results on the Comprehensive Metabolic Panel (CMP) measures the complete amount of proteins in the blood such as albumin and globulin? A. Bilirubin B. Total Protein C. AST (aspartate transaminase) D. Anion Gap

The answer is B. A normal total protein is 6.2-8.2 g/dL and it measures the complete amount of proteins in the blood such as albumin and globulin.

What type of solution below can be used to treat cerebral edema? A. Isotonic B. Hypertonic C. Hypotonic

The answer is B. Cerebral edema is swelling of the brain. Hypertonic solutions dehydrate the cell which is helpful with cerebral edema.

______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine. A. Urea B. Creatinine C. Potassium D. Magnesium

The answer is B. Creatinine is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a creatinine clearance test is used as an indicator for determining renal function and for calculating the glomerular filtration rate.

You're developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing diagnosis would you include in the care plan? A. Excess fluid volume B. Risk for electrolyte imbalance C. Urinary retention D. Acute pain

The answer is B. During the diuresis stage of AKI, the patient will be losing an excessive amount of urine (3-6 Liters/day) and is at risk for fluid volume deficient and electrolyte imbalance. The nurse must monitor the patient's electrolyte levels, especially potassium (hypokalemia).

A patient with CKD has a low erythropoietin (EPO) level. The patient is at risk for? A. Hypercalcemia B. Anemia C. Blood clots D. Hyperkalemia

The answer is B. EPO (erythropoietin) helps create red blood cells in the bone marrow. The kidneys produce EPO and when the kidneys are damaged in CKD they can decrease in the production of EPO. Therefore, the patient is at risk for anemia.

Your patient is 36 weeks pregnant and has gestational diabetes. Which lab result below is euglycemic? A. Blood glucose 55 mg/dL B. Blood glucose 82 mg/dL C. Blood glucose 148 mg/dL D. Blood glucose 325 mg/dL

The answer is B. Euglycemic means "normal" blood glucose level. Typically a normal blood glucose level is about 70-140 mg/dL. The only option that reflects a normal blood glucose level is option B: 82 mg/dL...Option A is HYPOglycemic, Option C is slightly HYPERglycemic, Option D is HYPERglycemic.

A patient with Type 2 Diabetes is started on the medication Glyburide. Which of the following statements by the patient causes concern? A. "I will monitor my blood glucose regularly because I know this medication can cause a low blood sugar." B. "I will consume no more than 8 oz. of alcohol per week." C. "I will continue monitoring my diet and participating in exercise while taking this medication." D. "This medication works by stimulating the beta cells in the pancreas to make insulin."

The answer is B. Glyburide is a sulfonylureas diabetic medication and a patient should NEVER consume alcohol while taking this medication because it can cause severe hypoglycemia.

A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct? A. Administer the medication as ordered. B. Hold the dose and notify the doctor for further orders. C. Administer the medication as ordered but hold the next day's dose. D. Check the patient's blood glucose prior to administering the medication.

The answer is B. Metformin (Glucophage) is held 48 hours prior to surgery (however a doctor's order is needed for this). Therefore, you should hold the dose and call the doctor for further orders.

You're discharging a patient who just gave birth to a baby at 39 weeks gestation. The patient had gestational diabetes throughout her pregnancy. Her blood glucose levels have now returned to normal. When should the patient first follow-up with her physician for blood glucose testing? A. 1-3 years B. 6-12 weeks postpartum C. 1 year postpartum D. Not applicable since this condition has resolved and only occurs during pregnancy

The answer is B. Patients who've had gestational diabetes are at high risk for developing Type 2 diabetes. She should first follow-up with her physician at 6-12 weeks postpartum for initial blood glucose testing. After this, she should follow-up 1-3 years for blood glucose testing since there is a high risk of her developing Type 2 diabetes.

A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins? A. These insulins cannot be mixed, therefore, should be drawn up in different syringes. B. Draw-up the Humulin R insulin first and then the NPH insulin. C. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D. Draw-up the NPH insulin first and then the Humulin R insulin.

The answer is B. Remember when drawing up regular and intermediate insulins...you draw-up clear (regular insulins) to cloudy (NPH intermediate). R.N.

The Human Immunodeficiency Virus (HIV) mainly attacks what type of cells in the human body? A. Red Blood Cells B. CD4 positive cells C. Stem Cells D. Platelets

The answer is B. The HIV virus attacks the human body's immune system, specifically the CD4 positive cells...mainly the helper t cells. These cells are white blood cells that help the immune system fight infection.

A 25-year-old patient reports that they engage in high risk activities that could lead to an HIV infection. The patient's test results show the patient is HIV-negative. The nurse should provide the patient with education about? A. PEP B. PrEP C. Opportunistic Infections D. Nucleic Acid Test (NAT)

The answer is B. The nurse should provide the patient with education about PrEP (Pre-Exposure Prophylaxis). These medications are taken BEFORE a possible encounter with HIV, which helps prevent a possible HIV infection. The patient must be HIV-negative before taking these medications.

A 36-year-old pregnant female is diagnosed with gestational diabetes at 28 weeks gestation. You're educating the patient about this condition. Which statement by the patient demonstrates they understood your teaching about gestational diabetes? A. "Once I deliver the baby, it will go away, and I will not need any further testing." B. "It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals." C. "There are no risks or complications related to gestational diabetes other than hyperglycemia." D. "I'm at risk for delivering a baby that is too small for its gestational age due to this condition."

The answer is B. This is the only correct statement in the scenario. It is important the mother monitors her blood glucose level regularly and tries to maintain an euglycemic level (normal blood glucose level): 70-95 mg/dL fasting and <140 mg/dL 1 hour after meals. In most cases, once the baby is delivered, the gestational diabetes will disappear, BUT at 6-12 weeks postpartum the mother will need to be reassessed for diabetes. Remember in the lecture, according to the CDC.gov 50% of women who are diagnosed with gestational diabetes will develop Type 2 diabetes later on. There are risks and complications associated with gestational diabetes such as pre-term labor, preeclampsia, hyper/hypoglycemia, macrosomia (large baby), hypoglycemia in baby at birth etc.

A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood? A. Calcium B. Urea C. Phosphate D. Erythropoietin

The answer is B. This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this.

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as? A. The patient has an active infection of Hepatitis A. B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. C. The patient is in the preicetric phase of viral Hepatitis. D. The patient is in the icteric phase of viral Hepatitis.

The answer is B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A.

A 48-year-old patient is HIV positive. The patient has no signs and symptoms and has a CD4 count of 400 cells/mm3. In addition, no opportunistic infections or diseases are present. These findings correlate with what stage of HIV? A. Acute B. Chronic C. AIDS

The answer is B: Chronic. These findings correlate with the Chronic Stage (also called the Asymptomatic Stage) of HIV. Signs and symptoms may not be experienced, the viral load is lower than the Acute Stage, but the virus is still replicating and destroying the cells. The patient can still transmit the virus to others. In addition, the CD4 count should be more than 200 cells/mm3 to about 500 cells/mm3. In addition, no opportunistic infections or diseases should be present.

What is the fluid compartment that surrounds the outside of the cells and plays a vital role in helping be a medium for electrolytes and other substances to move to and from the cell to the plasma? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment

The answer is B: interstitial compartment

Which patients below should not receive Lactated Ringer's solution? Select all that apply: A. A patient with a mild case of metabolic acidosis. B. A pre-op patient for abdominal surgery. C. A patient experiencing hyperkalemia. D. A patient with liver failure.

The answer is C and D. Lactated Ringer's solution (LR) contains water, potassium, sodium, chloride, calcium, and lactate. Patients who are experiencing hyperkalemia (high potassium level) should not receive this solution since it already has potassium in it. In addition, a patient with liver failure is not a candidate for LR because it contains lactate. The liver is responsible for converting lactate to bicarbonate. When the liver is failing this conversion process cannot happen, which can lead to the buildup of lactate.

What type of fluid can cause the cell the swell and rupture? A. Isotonic B. Hypertonic C. Hypotonic

The answer is C.

Your patient is receiving 0.45% Normal Saline for hypernatremia. What finding requires you to stop the fluid and notify the doctor? A. decreasing sodium level B. increased urination C. confusion D. polydipsia

The answer is C. 0.45% Normal saline is a hypotonic solution. It can be used to treat hypernatremia (lower the sodium levels in the blood). This fluid causes osmosis to move water from the extracellular space to the intracellular space. If too much is moved to the extracellular space cell swelling can present. Signs of this include mental status changes like confusion. Therefore, the nurse would want to hold the fluid and notify the doctor for further orders. Polydipsia is excessive thirst which presents with hypernatremia. Increase urination and a decreasing sodium level are expected with IV fluid administration.

Which fluid type is MOST likely to cause hypernatremia along with fluid volume overload and requires close monitoring by the nurse during administration? A. 0.45% Normal Saline B. Dextrose 5% in water C. 3% Saline D. 0.225% Saline

The answer is C. 3% Saline is a hypertonic solution and contains a concentrated amount of the sodium. It will cause fluid to leave the intracellular space and enter the extracellular space. This could lead to fluid volume overload and requires very close monitoring by the nurse. The other solutions listed here are hypotonic.

Your patient has liver disease. On assessment you note that your patient has an orangish/yellowish hue to their skin and the sclera of the eyes. In addition, you note that the patient's urine is orange in color. What lab result on the CMP correlates with these findings? A. ALP 50 U/L B. Creatinine 1 mg/dL C. Bilirubin 3 mg/dL D. Albumin 4 g/dL

The answer is C. A normal Bilirubin is 0.1-1 mg/dL. Bilirubin is a waste product from the breakdown of RBCs. When RBCs breakdown it creates an orangish/yellowish substance. This breakdown is mainly performed in the liver, and this substance from the RBCs is normally excreted in the bile, which is then excreted in the stool. This substance gives stool it brown color and very little Bilirubin should be in the urine. If too much is in the blood it will leak into skin and mucous membranes along with the urine.

A patient completes a one hour glucose tolerance test. The patient's result is 190 mg/dL. As the nurse you know that the next step in the patient's care is to? A. Continue monitoring pregnancy, the test is normal B. Reassess blood glucose in 2 weeks C. Notify the physician who will order the patient to take a 3 hour glucose tolerance test D. Provide education to the patient about how to manage gestational diabetes during pregnancy

The answer is C. A test result >140 mg/dL for 1 hour glucose tolerance test requires that the patient take a 3 hour glucose tolerance test. This test will be used to diagnose if the patient has gestational diabetes.

A patient with diabetes asks you about what type of exercise they should perform throughout the week. The best response is: A. Lifting weights B. Sprinting C. Swimming D. Jumping

The answer is C. Aerobic exercise is the best and swimming is the only option that is an aerobic exercise.

Which statement below is not true regarding the role of the helper t cell? A. The helper T cell releases cytokines to help activate other immune system cells. B. The helper T cell is part of the adaptive immune system. C. The helper T cell is cytotoxic and kills invaders. D. The helper T cell has CD4 receptors found on its surface.

The answer is C. All the other options are true statements about the helper T cell. Option C is NOT true. Helper T cells are not cytotoxic and kill invaders (this is another type of t cells called cytotoxic t cell). Helper T cells are "helpers" in that they HELP the immune system by releasing cytokines, which help activate other immune system cells.

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis? A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

The answer is C. Hand hygiene can help prevent all types of viral hepatitis. However, not all types of viral Hepatitis have a vaccine available or are spread through needle sticks or blood/organs donations. Remember Hepatitis A and E are spread only via fecal-oral routes.

A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak? A. 1300 B. 0930 C. 1100 D. 1700

The answer is C. Humulin-R is a SHORT-ACTING insulin which has a PEAK time of 2 hours. If you gave the medication at 0900...it would peak at 1100.

Which patient below is at risk for fluid volume overload while receive 0.9% Normal Saline? A. A patient with hyponatremia. B. A patient experiencing dehydration. C. A patient with heart failure. D. A patient who is vomiting.

The answer is C. In cases of the heart failure, the heart is too weak to pump fluid out of the heart. This can lead the body to become overwhelmed with fluid. Patients who are experiencing heart or kidney failure are at risk for fluid volume overload when receiving fluids.

Which of the following insulins has no peak but a duration of 24 hours? A. NPH B. Novolog C. Lantus D. Humulin N

The answer is C. Lantus is the only option here that is a LONG-ACTING insulin which has NO peak and a 24 hour duration

Which patient below is NOT at risk for developing chronic kidney disease? A. A 58 year old female with uncontrolled hypertension. B. A 69 year old male with diabetes mellitus. C. A 45 year old female with polycystic ovarian disease. D. A 78 year old female with an intrarenal injury.

The answer is C. Options A, B, and D are all at risk for developing CKD. However, option C is not at risk for CKD.

Which statement below is the most accurate about the process of osmosis? A. Water will moves from a solution with a higher solute concentration to a solution with a lower solute concentration. B. Water and solutes will move from a lower water concentration solution to a higher water concentration solution. C. Water will move from a lower solute concentration solution to a higher solute concentration solution. D. Water will move from a fluid of a lower water concentration to a fluid of a higher water concentration.

The answer is C. Osmosis is the movement of water from a fluid of higher water concentration to a fluid of lower water concentration, or, in other words, water will move from a lower solute concentration fluid to a higher solute concentration fluid.

A patient with HIV is prescribed to start antiretroviral therapy. The nurse is providing education about these medications. Which statement below by the patient indicates they need re-education on these medications? A. "If I take these medications as prescribed by viral load will become undetectable, and I have a low risk of transmit the virus to others." B. "Drug resistance is likely to develop if I'm non-compliant with my medications." C. "I currently take a medication called St. John's Wort to treat depression." D. "This therapy does not cure me from HIV but helps me live a healthier and longer life."

The answer is C. Patients who take ART should be educated about how these medications can interact with over-the-counter medications, especially herbal supplements like St. John's Wort. This medication is used to treat depression. The patient should be re-educated about this topic.

A 55 year old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? A. Post-renal B. Intra-renal C. Pre-renal D. Intrinsic renal

The answer is C. Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding...patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged.

A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient? A. Low-sodium, high-protein, and low-potassium B. High-protein, low-potassium, and low-sodium C. Low-protein, low-potassium, and low-sodium D. High-protein and high-potassium

The answer is C. The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein, low-potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products, excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown (creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for hyperkalemia and fluid overload (needs low-potassium and sodium foods).

A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as? A. Stage 1 B. Stage 3 C. Stage 4 D. Stage 5

The answer is C. This is known as Stage 4 of CKD because the GFR (glomerular filtration rate) for this stage is 15-29 mL/min (patient's GFR is 25 mL/min). The other stage's criteria are as follows: Stage 1: Kidney damage with normal renal function GFR >90 ml/min but with proteinuria (3 months or more); Stage 2: Kidney damage with mild loss of renal function GFR 60-89 ml/min with proteinuria (3 months or more); Stage 3: Mild-to-severe loss of renal function GFR 30-59 mL/min; Stage 4: Severe loss renal function GFR 15-29 mL/min; Stage 5: End stage renal disease GRF less 15 mL/min

When are most pregnant patients tested for gestational diabetes? A. 6-12 weeks gestation B. 12-20 weeks gestation C. 24-28 weeks gestation D. 34-36 week gestation

The answer is C: 24-28 weeks gestation

What is a normal CD4 count? A. 200-500 cells/mm3 B. 1500-3500 cells/mm3 C. 500-1500 cells/mm3 D. <200 cells/mm3

The answer is C: 500-1500 cells/mm3

Which of the following signs and symptoms is NOT expected with Diabetes Insipidus? A. Polyuria B. Polydipsia C. Polyphagia D. Extreme thirst

The answer is C: Polyphagia

What is the fluid compartment that is found inside the blood vessels? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment

The answer is C: intravascular compartment

The anti-diuretic hormone is __________ in Diabetes Insipidus and _________ in SIADH. A. high, low B. absent, absent C. low, high D. low, low

The answer is C: low, high

What type of fluid below has a low osmolarity? A. 0.9% Normal Saline B. 3% Saline C. Dextrose 5% in 0.9% Normal Saline D. 0.45% Normal Saline

The answer is D. 0.45% Normal Saline is a hypotonic solution. It contains a lower concentration on solutes compared to the blood plasma. Due to this, it will cause water to move from the extracellular space to the intracellular space, which could swell the cell leading to possible rupture.

What is the only fluid type that can be administered with blood products? A. Lactated Ringer's solution B. 0.45% Normal Saline C. 3% Saline D. 0.9% Normal Saline

The answer is D. 0.9% Normal Saline is the ONLY fluid that can be administered with blood products.

The CMP ordered on your patient shows that the patient's potassium level is 6.5 mEq/L. How do you interpret this potassium level, and which option below could cause this type of potassium level? A. This potassium level is within normal limits. B. Hypokalemia; loop diuretics C. Hyperkalemia; Cushing's Syndrome D. Hyperkalemia; ACE Inhibitors

The answer is D. A normal potassium level is 3.5-5 mEq/L. A level of 6.5 mEq/L is known as HYPERkalemia. Causes of hyperkalemia include: renal failure, medications: ACE inhibitors, potassium-sparing diuretics, Addison's Disease (causes low aldosterone production which causes the kidneys to keep more potassium, which increase's blood levels).

When do most patients tend to develop gestational diabetes during pregnancy? A. usually during the 1-3 month of pregnancy B. usually during the 2-3 month of pregnancy C. usually during the 1-2 trimester of pregnancy D. usually during the 2-3 trimester of pregnancy

The answer is D. Gestational diabetes is a form of diabetes that develops during pregnancy, usually during 2nd or 3rd trimester.

What is the MOST common transmission route of Hepatitis C? A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

The answer is D. IV drug use is the MOST common transmission route of Hepatitis C.

A 32-year-old female is diagnosed with gestational diabetes. As the nurse you know that what test below is used to diagnose a patient with this condition? A. 1 hour glucose tolerance test B. 24 hour urine collection C. Hemoglobin A1C D. 3 hour glucose tolerance test

The answer is D. If a patient has a positive 1 hour glucose tolerance test (which is administered at about 24-28 weeks), a 3 hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.

Which patient below is a candidate for PEP (Post-exposure Prophylaxis)? A. A 32-year-old patient who reports sharing IV drug injection devices with a person who is HIV-positive 5 days ago. B. A 28-year-old patient who engages in high risk activities on a regular basis that could lead to an HIV infection. C. A 55-year-old who is HIV-positive. D. A 30-year-old who was sexually assaulted two days ago.

The answer is D. PEP (post-exposure prophylaxis) is medication that is taken AFTER an encounter with an HIV infected person. These medications can help prevent becoming infected with HIV, if started within 72 HOURS of the exposure (option A is not a candidate). These medications are NOT for routine usage but for emergencies (sexual assault, needle stick etc.). If a patient is at high risk (as with the patient in option B), they should consider PrEP (pre-exposure prophylaxis). PEP is taken for 28 days.

A patient has a blood glucose of 58 and is sweating, cold, and clammy. The patient is conscious. What is your next nursing intervention? A. Recheck the blood glucose in 5 minutes. B. Give the patient 15 grams of a complex carbohydrate. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 15 grams of a simple carbohydrate.

The answer is D. Simple carbohydrates work faster than complex. Example of a simple carbohydrate would be 4 oz of fruit juice or soda, glucose tablet or gel, etc.

The kidneys are responsible for performing all the following functions EXCEPT? A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production

The answer is D. The adrenal glands are responsible for maintaining cortisol production not the kidneys.

Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality? A. Phosphate 3.2 mg/dL B. Calcium 9.3 mg/dL C. Magnesium 2.2 mg/dL D. Potassium 7.1 mEq/L

The answer is D. The patient's potassium level is extremely elevated. A normal potassium level is 3.5-5.1 mEq/L. This patient is experiencing hyperkalemia, which can cause tall peak T-waves. Remember in CKD (especially prior to dialysis), the patient will experience electrolyte imbalances, especially hyperkalemia.

Fill-in the blank: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is _____________. This is majorly influenced by hormones such as estrogen, progesterone, _______________ and _______________. A. high; prolactin and human chorionic gonadotropin (hCG) B. low; estriol and human placental lactogen (hPL) C. high; human chorionic gonadotropin (hCG) and cortisol D. low; human placental lactogen (hPL) and cortisol

The answer is D. The statement should read: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is LOW. This is majorly influenced by hormones such as estrogen, progesterone, HUMAN PLACENTAL LACTOGEN (hPL) and CORTISOL.

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 urinary output is 1.75 Liters. Based on these findings, what stage of AKI is this patient in? A. Initiation B. Diuresis C. Oliguric D. Recovery

The answer is D. This patient is in the recovery stage of AKI. The patient's labs and urinary output indicate the renal function has returned to normal. Remember the recovery stages starts when the GFR (glomerular filtration rate) has returned to normal (normal GFR 90 mL/min or higher), which will allow waste levels and electrolyte levels to be maintained.

You educate a pregnant patient with gestational diabetes that she should try to have a blood glucose level of ______________ 1 hour after a meal. A. <70 mg/dL B. <250 mg/dL C. >160 mg/dL D. <140 mg/dL

The answer is D: <140 mg/dL

Which fluid below is NOT categorized as an isotonic fluid? A. 0.9% Normal Saline B. Lactated Ringer's solution (LR) C. Dextrose 5% in water D. Dextrose 5% in 0.45% Normal Saline

The answer is D: Dextrose 5% in 0.45% Normal Saline This is a hypertonic solution. Dextrose 5% in water is considered isotonic but once administered it become hypotonic (it categorized as an isotonic fluid).

A patient, who is in the Chronic Stage of HIV, has a CD4 count ordered. What does this test measure? A. Red blood cells B. B cells C. Cytotoxic T cells D. Helper T cells

The answer is D: Helper T cells

What is the fluid compartment that is found in certain body cavities like the spinal cavity, heart, lungs, and joints? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment

The answer is D: transcellular compartment

True or False: A normal estimated glomerular filtration rate (eGFR) is <60.

The answer is FALSE. A normal estimated glomerular filtration rate (eGFR) is >60 (NOT <60). This is an estimation of how well the glomerulus in the kidney is filtering water, ions, and water from the blood to create urine. The eGFR is determined by many factors such as the patient's creatinine level, age, sex, and race.

True or False: Lactated Ringer's Solution is first-line treatment for fluid resuscitation situations.

The answer is FALSE. LR contains glucose which can increase the blood glucose and is not first-line treatment for fluid resuscitations situations.

True or False: Osmosis is an active transport process.

The answer is FALSE. Osmosis is a passive type of transport process.

True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not all patients will progress through the diuresis stage.

The answer is FALSE. Some patients will skip the oliguric stage of AKI and progress to the diuresis stage.

TRUE OR FALSE: The Center for Disease Control and Prevention (CDC) recommends that all people between the ages of 13-64 be tested at least once for HIV during a routine health visit, regardless of risk factors.

The answer is TRUE.

True or False: If a solution has a high concentration of solutes, it is considered to have a high osmolarity.

The answer is TRUE.

True or False: Most of the fluid in the body is found in the intracellular space.

The answer is true. The intracellular space is the space inside of the cell. The fluid in it accounts for 2/3 of our body water. Therefore, most of our fluid is inside the cell.

Select the criteria below that is used to help diagnosed a patient with Acquired Immunodeficiency Syndrome (AIDS): A. CD4 count <200 cells/mm3 B. Presence of opportunistic infection C. CD4 count >1500 cells/mm3 D. WBC 9500 E. Absence of opportunistic infection

The answers are A and B. A patient is diagnosed with AIDS if: CD4 count drops to less than 200 cells/mm3 or an opportunistic infection is present

Identify the correct statements about the anatomy of the Human Immunodeficiency Virus (HIV). Select all that apply: A. HIV is a retrovirus. B. Inside the virus is packaged DNA. C. The protein projections found on the virus' surface play a key role in attaching to the receptors on the helper t-cell. D. The glycoproteins (specifically GP140) are vital for engaging the receptors on the targeted cell.

The answers are A and C. Options B is an incorrect statement, it should say "Inside the virus is packaged RNA (not DNA)", and Option C is incorrect because it should say "The glycoproteins (specifically GP120...NOT GP140) are vital for engaging the CD4 receptor on the targeted cell.

A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply: A. Hypervolemia B. Hypokalemia C. Increased BUN level D. Decreased Creatinine level

The answers are A and C. The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney's ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood...hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine.

A 34-year-old female is currently 16 weeks pregnant. You're collecting the patient's health history. She has the following health history: gravida 5, para 4, BMI 28, hypertension, depression, and family history of Type 2 diabetes. Select below all the risk factors in this scenario that increases this patient's risk for developing gestational diabetes? A. 34-years-old B. 16 weeks pregnant C. Gravida 5, para 4 D. BMI 28 E. Hypertension F. Depression G. Family history of Type 2 diabetes

The answers are A, C, D, and G. Remember from the lecture we talked about the risk factors for gestational diabetes. To help you remember the risk factors think of the word "MOMMA". Maternal age > 25, Obese or overweight (BMI >25), Macrosomia (fetal) previous babies greater than 9 lbs, Multiple pregnancies, A history (previous diagnoses of gestational diabetes or family history of diabetes).

The nurse plays a vital role in screening patients for a possible HIV infection. What questions below could the nurse ask to help identify a patient who is at risk for HIV? Select all that apply: A. "How often do you use alcohol or drugs?" B. "Have you recently experienced an abusive relationship?" C. "If you are sexually active, do you or your partner use protection?" D. "In the past month, have you felt sad or unable to get out of bed?" E. "Have you ever been treated for a sexually transmitted infection?" F. "Do you ever experience intrusive or unwanted thoughts?"

The answers are A, C, E. The nurse should screen patients for HIV. Questions about sexual behavior (if the patient is sexually active, how often, treatment for STI, barrier devices used, and number of partners), drug/alcohol usage, and if they've had a blood transfusion before 1985, can all help the nurse identify patients who may need to undergo HIV testing.

Select all the fluid spaces that make up the extracellular compartment: A. transcellular B. extravascular C. intravascular (plasma) D. interstitial

The answers are A, C, and D. The interstitial, intravascular, and transcellular fluid compartments make up the extracellular compartment.

The physician orders a Basic Metabolic Panel (BMP) on your patient. You know this blood test will assess all of the following EXCEPT? Select all that apply: A. Bilirubin B. Sodium C. Glucose D. ALP (alkaline phosphatase) E. AST (aspartate transaminase) F. Potassium G. Calcium H. BUN I. Creatinine J. Total Protein K. CO2 L. Albumin M. Chloride N. Globulin O. ALT (alanine transaminase)

The answers are A, D, E, J, L, N, and O. A BMP will assess electrolytes (ex: Glucose, Calcium, Sodium, Chloride, Potassium) and renal function, BUT it does NOT assess liver studies (ex: ALP, AST, ALT, Bilirubin, Total Protein, Albumin, Globulin). A Comprehensive Metabolic Panel (CMP) assesses everything a BMP assesses but it also goes further and assesses liver function, hence why it's called a "comprehensive" metabolic panel.

A patient has a 3 hour glucose tolerance test performed. The results are the following: Fasting 94 mg/dL, 1 hour 210 mg/dL, 2 hour 180 mg/dL, 3 hour 130 mg/dL. Identify which results are abnormal: Select all that apply: A. Fasting result B. 1 hour result C. 2 hour result D. 3 hour result

The answers are B and C. Abnormal results for a 3 hour glucose tolerance test are: Fasting >95 mg/dL, 1 hour >180 mg/dL, 2 hour >155 mg/dL, 3 hour >140 mg/dL

Which statements below best describe a hypotonic solution? Select all that apply: A. It has a high osmolarity. B. These fluid types have a lower amount of solutes in it compared to the blood plasma. C. There is more water than solutes in these types of fluids. D. These fluids can lead to cell shrinkage.

The answers are B and C. Hypotonic solutions have a lower osmolarity than the blood plasma (lower concentration of solutes in the fluid). Osmosis will cause water to move from the extracellular space to the intracellular and swell the cell, which can rupture.

You're providing an educational class for pregnant women about gestational diabetes. You discuss the role of insulin in the body. Select all the CORRECT statements about the role and function of insulin: A. "Insulin is a type of cell that provides glucose to the body from the blood." B. "Insulin is a hormone secreted by the beta cells of the pancreas." C. "Insulin influences cells by causing them to uptake glucose from the blood." D. "Insulin is a protein that helps carry glucose into the cell for energy."

The answers are B and C. Insulin is a HORMONE secreted by the beta cells found in the pancreas. It influences or causes cells to take in glucose from the blood. Option A and D are incorrect statements about insulin.

A patient has gestational diabetes and is currently 34 weeks pregnant. Which assessment findings below should you immediately report to the physician? Select all that apply: A. Blood glucose 129 mg/dL B. Blood pressure 190/102 C. Proteinuria D. Linea nigra E. Negative glycosuria

The answers are B and C. Preeclampsia is a potential complication of gestational diabetes. It can cause hypertension (option B) and protein in the urine (option C). Option A is a normal blood glucose reading, option D is a normal finding during pregnancy, and option E is a normal finding (an abnormal finding would be positive glycosuria...meaning there is glucose leaking in the urine).

A baby is born at 37 weeks gestation to a mother with gestational diabetes. As the nurse you know at birth that the newborn is at risk for? Select all that apply: A. Hyperglycemia B. Hypoglycemia C. Respiratory distress D. Jaundice E. Hyperthermia

The answers are B and C. The newborn is at risk for hypoglycemia and respiratory distress. When a baby of a mom, who has gestational diabetes, is still in utero there is a constant high supply of glucose. This causes the baby to increase its fat stores (producing a large baby) and create a lot of insulin to deal with the high glucose it is receiving from mom. BUT once the baby leaves utero, the glucose supply decreases but the baby still has a lot of insulin on board. This can lead to a drop in blood glucose (hypoglycemia) at birth. In addition, uncontrolled gestational diabetes can affect lung maturity in babies and this increases the newborn's risk of respiratory distress at birth.

The Human Immunodeficiency Virus (HIV) can NOT be spread in what type of fluid below? Select all that apply: A. Breastmilk B. Blood C. Tears D. Semen E. Vaginal Fluid F. Sweat

The answers are C and F. HIV can NOT be spread in tears or sweat (unless blood is present which rarely occurs). HIV is spread in the following fluids: breastmilk, blood, semen, and vaginal fluid.

You're teaching a pregnant mother with gestational diabetes about the signs and symptoms of hyperglycemia. What are the signs and symptoms you will include in your education to the patient? Select all that apply: A. Sweating B. Confusion C. Frequent hunger D. Polydipsia E. Anxiety F. Frequent urination

The answers are C, D, and F. Remember the 3 Ps for hyperglycemia: Polyphagia (frequent hunger), polydipsia (frequent thirst), polyuria (frequent urination). Sweating, confusion, and anxiety are signs and symptoms of HYPOglycemia (low blood glucose).

A 36 year old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply: A. Water intoxication B. Hypotension C. Low urine specific gravity D. Hypokalemia E. Normal GFR

The answers are: B, C, and D. This patient is in the DIURESIS stage of AKI. The nephrons are now starting to filter out waste but cannot concentrate the urine. There is now a high amount of urea in the filtrate (because the nephrons can filter the urea out of the blood) and this causes osmotic diuresis. Urinary output will be excessive (3 to 6 L/day). Therefore, the patient is at risk for hypotension, diluted urine (low urine specific gravity), and hypokalemia (waste potassium in the urine). The patient is not at risk for water intoxication and will not have a normal GFR until the recovery stage.

A patient's morning BMP results are back with the following results: Glucose 93 mg/dL, Calcium 8.5 mg/L, Sodium 115 mEq/L, Chloride 100 mEq/L, Potassium 7 mEq/L, CO2 30 mEq/L, BUN 40, Creatinine 3 mg/dL. Which labs results are abnormal? Select all that apply: A. Glucose B. Calcium C. Sodium D. Chloride E. Potassium F. CO2 G. BUN H. Creatinine

The answers are: C, E, G, and H. The Sodium, Potassium, BUN, and Creatinine are abnormal in this BMP.

Select all the patients below that are at risk for acute intra-renal injury? A. A 45 year old male with a renal calculus. B. A 65 year old male with benign prostatic hyperplasia. C. A 25 year old female receiving chemotherapy. D. A 36 year old female with renal artery stenosis. E. A 6 year old male with acute glomerulonephritis. F. An 87 year old male who is taking an aminoglycoside medication for an infection.

The answers are: C, E, and F. These patients are at risk for an intra-renal injury, which is where there is damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury because there is an obstruction that can cause back flow of urine into the kidney, which can lead to decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is an issue with perfusion to the kidney.

Nursing interventions for Mastitis

The nurse will verbalize and demonstrate to the patient how to apply warm compresses to right breast every 2 hours. The nurse will observe the mother breastfeeding her infant to assess the possible latching problems. The nurse will assist the patient with helping her develop a plan for proper latching techniques with her newborn before the end of the office visit. The patient will take Ibuprofen 200mg every 6 hours per md orders for pain and to decrease inflammation in right breast. The nurse will educated the patient about the early signs and symptoms of Mastitis before the end of the office visit.

When the patient has (from minor distortion to complete loss) from an injury which decreases their ability to sense pain/heat/cold, they developed a loss of _________________ which decreases ADL and occupational/IADLs

Touch

Cranial nerve IV, Downward eye movement

Trochlear

Your patient is in the oliguric phase of AKI, and has hyperkalemia. What would you do to treat this?

- Cardiac Monitoring - Regular insulin IV, give IV glucose with it (prevent hypoglycemia) - Sodium Bicarb: Shifts K into the cell - Calcium Gluconate: Advanced cardiac toxicity, (raises calcium threshold of excitation, causing dysrhythmias) Sodium Polystyrene Sulfonate (Kayexalate) - CODE BROWN Diet restriction: Limit K, (bananas/spinach/leafy green)

What is it most important to prevent in AKI? Think of local/systemic/WBC

-infection = leading cause of death in AKI -local: redness, swelling, pain -systemic: fever, elevated WBC, fatigue

Your patient has acute kidney injury, but it is postrenal. What would you expect the patient would have?

1. Calculi (kidney stones) 2. Benign prostatic hypertrophy (BPH) 3. Bladder & prostate cancer 4. Trauma (back, pelvis, perineum) 5. Neuromuscular disorders (Ex: patients with MS have a spastic bladder in which they can urinate too much or not enough)

Your patient has a diagnosis of CKD. What would you expect the doctor to administer to the patient? What non-pharm treatments?

1. Drug Therapy (antihypertensives, diuretics, Ca Channel Blockers, ACE inhibitors, ARBs) 2. Erythropoietin (Made by the Kidney): treats anemia, lack of this being made causes this a. Administered IV or SubQ b. Increases hemoglobin & hematocrit c. Adverse effect: hypertension 3.Hemodialysis

What treatment is used to filter wastes and water from your blood, as your kidneys did when they were healthy? How often? What is the fistula?

1. Hemodialysis 2. Requires creation of a vascular access (AV fistula) and special dialysis equipment, 3 times a week for 3-4 hours, Achieves rapid correction of fluid and electrolyte abnormalities 3. A surgically-created connection between an artery and vein (usually in the arm) ***Instead of a fistula, can also do a central catheter for short term use, but that is a higher risk of infection

How long will the recovery phase of AKI last for?

12 months for stabilization

The nurse is assessing a client who has had a current history of alcohol dependence for signs of major withdrawal. What findings would the nurse expect to find? 1. Anxiety and increased appetite 2. Hypotension, bradycardia 3. Tachycardia, severe diaphoresis 4. Cold, clammy skin, decreased body temperature

3, Withdrawal symptoms include tachy/diaphoresis

A patient who has a history of chronic back pain requires a higher dose of an opioid medication in order to achieve adequate pain relief. The health care provider suspects that these findings are a result of which of the following? 1. Addiction 2. Dependence 3. Pseudoaddiction 4. Tolerance

4, Tolerance is a person's diminished response to a drug that is the result of repeated use.

What is defined as anuria in CKD and AKI?

<40 mL in 24hr

What is defined as oliguria in CKD and in AKI?

<400mL in 24hr

Which result would the nurse expect to find when reviewing the serum screening tests of a client with acquired immunodeficiency syndrome (AIDS)? A. A decrease in CD4 T cells B. An increase in thymic hormones C. An increase in immunoglobulin E D. A decrease in the serum level of glucose-6-phosphate dehydrogenase

A

Which result below represents hypercalcemia? A. Potassium 7 mEq/L B. Potassium 2.2 mEq/L C. Calcium 9 mg/L D. Calcium 15 mg/L

The answer is D. A normal calcium level is 8.5-10.5 mg/L. Hypercalcemia is a HIGH calcium level.

What clinical finding does the nurse anticipate when admitting a client with an extracellular fluid volume excess? A. Distended neck veins B. Elevated hematocrit C. Hypernatremia D. Rapid, thready pulse

A, Because of fluid overload in the intravascular space the neck veins become visibly distended. Elevated hematocrit level and Rapid, thread pulse represent a fluid deficit, sodium causes fluid retention, its concentration is unchanged; if fluid is retained independently of sodium, its concentration is decreased.

During an annual physical exam, a client reports not being able to smell coffee & most foods. Which cranial nerve function would the nurse assess? a. I b. II c. X d. VII

A. Olfactory

Use of splitting is most associated with which personality disorder? A. Antisocial B. Borderline C. Dependent D. Schizotypal

B, idealizing someone one moment, then later calling them abusive or toxic. not seeing nuance in the relationships or actions of others. cutting people out of their life, then expressing feelings of abandonment.

What triggers immune response; and is produced in bone marrow

B/T lymphocytes

The nurse is teaching a patient with type 1 diabetes about exercise. The nurse understands the patient should avoid exercise during what time? A. During colder months B. When serum glucose is less than 150 C. When ketones are present in the urine D. When emotional stressors are high for the patient

C: Exercise should be avoided if ketones are present in the urine. Ketones indicate that current insulin levels are not adequate and that exercise would elevate blood glucose levels

What are the consequences of impaired taste and smell (think safety and psychosocial)?

Can lead to anorexia, weightless, malnutrition, food poisoning SAFETY: Environmental danger PSYCHOSOCIAL: Quality of life

What eye issue is defined as the lens opacity that distorts the image projected onto the retina (that can only be fixed with surgery)?

Cataracts

What can acute and chronic renal disease pt. use in the ICU for help with injury?

Continuous Renal Replacement Therapy •Requires access to the circulation and blood to pass through an artificial filter (Hemofilter- extremely porous containing semi-permeable membrane •Clinically unstable for traditional hemodialysis •Patients with fluid overload secondary to oliguric renal failure

A patient has a blood glucose of 400. Which of the following medications could be the cause of this? A. Glyburide B. Atenolol C. Bactrim D. Prednisone

D. (-sone)

Cranial nerve II, visual acuity

Optic

cells that engulf bacteria

Phagocytes (Cause phagocytosis)

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply: A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

The answers are B, C, and E. This is associated with a high bilirubin level. A normal bilirubin level is 1 or less.

Cranial nerve V, sensations of face/chewing

Trigeminal

What tests would you administer to confirm that a patient has CKD?

Urine Dipstick: Persistent proteinuria (1+ protein on standard dipstick testing two or more times over a 3-month period) should have further assessment Albumin-creatinine ratio GFR Renal ultrasound CT scan Renal biopsy

Your patient is experiencing urinary changes during the diuretic phase of acute kidney injury, but the urine is not concentrated. How much urination would you expect? For how long? Pt. Education?

Urine output of 1-3L a day, can also be 3-5L a day. Time frame: 1-3 weeks Pt. Education: DRINK WATER!!

Cranial nerve X, uvula/swallowing

Vagus

What are the hematologic clinical manifestations of CKD?

anemia, abnormal bleeding & bruising

What does CKD do to the cardiac system and perfusion?

cardiomyopathy, HTN, heart failure, peripheral edema, uremic pericarditis, pericardial effusion, pericardial friction rub, cardiac tamponade

Cranial nerve IX, taste

glossopharyngeal

What neurological problems will CKD manifest with?

lethargy & drowsiness, seizures, coma, slurred speech, ataxia (uncoordinated), tremors, twitching or jerking movements

the ingestion of bacteria or other material by phagocytes and amoeboid protozoans is ____________

phagocytosis

Assessment of AKI include

strict I&Os, blood pressure, daily weights, edema, mucous membranes, evaluate mental status, monitor for seizures, lung/breath sounds (fluid overload = crackles), heart sounds (murmurs & pericardial friction rub), EKG (hyperkalemia = tall T waves), lab values, monitor for anemia

What will CKD do to the respiratory system?

uremic halitosis, deep sighing, SOB, pulmonary edema, crackles, Kussmaul respirations, depressed cough reflex

Patient has CKD, what would you expect to see in his reproductive system?

↓fertility, infrequent or absent menses, ↓ libido, impotence.

Patient has CKD, what would you expect to see in his skin?

↓skin turgor, yellow gray pallor, dry skin, ecchymosis (bruising), purpura (red spots, uremic frost (late - concentrated sweat that is so concentrated that it forms crystals on the skin & makes you itchy ; nurse can feel crystals on the skin ).