Med Surg Exam 1

Which syndrome would the nurse suspect when a patient has a potassium level of 6.2 mEq/dL? 1 Cushing syndrome 2 Milk-alkali syndrome 3 Tumor lysis syndrome 4 Malabsorption syndrome

3 Tumor lysis syndrome causes movement of potassium from the intracellular fluid (ICF) to the extracellular fluid (ECF), resulting in hyperkalemia. Cushing syndrome may cause hypernatremia. Milk-alkali syndrome may cause hypermagnesemia or hypercalcemia and occurs when ingesting an increased amount of antacids, Maalox, or Milk of Magnesia; the electrolytes are affected; and the patient develops metabolic alkalosis. Malabsorption syndrome may cause hypophosphatemia.

When developing the plan of care for a patient with spondylosis, which type of urinary incontinence (UI) would influence the identification of appropriate nursing interventions? 1 Urge incontinence 2 Stress incontinence 3 Reflex incontinence 4 Overflow incontinence

1

The nurse admits a patient reporting severe diarrhea for several days from a Clostridium difficile infection. Which IV fluid would the nurse associate with the need to rapidly replace the patient's fluid volume? 1 0.9% sodium chloride 2 0.45% sodium chloride 3 5% dextrose in 0.9% sodium chloride 4 5% dextrose in 0.25% sodium chloride

1 An isotonic fluid such as 0.9% sodium chloride is used to rapidly replace fluid volume. The solution 0.45% sodium chloride is hypotonic, 5% dextrose in 0.25% sodium chloride is isotonic, and 5% dextrose in 0.9% sodium chloride is hypertonic; therefore these solutions should not be used for rapid fluid volume replacement. Also, solutions containing dextrose do not keep their tonicity over time because the body metabolizes dextrose, which is a sugar. For example, 5% dextrose in water is isotonic initially, but becomes hypotonic over time as the body metabolizes the dextrose—so it is considered physiologically hypotonic and should not be used for rapid fluid volume replacement.Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

While providing postoperative care for a live kidney donor, the nurse monitors the hematocrit levels to assess for which complication? 1 Bleeding 2 Renal impairment 3 Hypokalemia 4 Hyponatremia

1 A patient who has donated a kidney should be monitored for hematocrit levels to assess for bleeding. The nurse should monitor renal function to assess for impairment. The nurse should monitor for electrolytes to assess for hypokalemia and hyponatremia in kidney recipients.

The nurse provides discharge instructions for a patient with chronic kidney disease (CKD). Which action by the patient indicates effective learning? 1 Maintains a pillbox organizer for medication management 2 Takes nonsteroidal antiinflammatory drugs (NSAIDs) for pain 3 Takes aluminum-based laxatives for constipation 4 Takes magnesium-based antacids for heartburn

1 Because patients with CKD take many medications, a pillbox organizer or a list of the drugs and the times of administration may be helpful. The nurse should tell the patient to avoid over-the-counter (OTC) medications, such as NSAIDs and aluminum- and magnesium-based laxatives and antacids. The nurse should instruct the patient to avoid OTC NSAIDs because most of these drugs are nephrotoxic, which leads to further deterioration of kidney function.Test-Taking Tip: Patients with renal failure should be very careful with regard to medicines and foods because they may have increased risk for further kidney function deterioration and other complications.

The nurse is preparing to perform peritoneal dialysis for a patient with chronic kidney disease. Which osmotic agent does the nurse obtain for the dialysis exchanges? 1 Dextrose 2 Normal saline 3 Icodextrin solution 4 Amino acid solution

1 Dextrose is the most commonly used osmotic agent used in peritoneal dialysis. Normal saline solution is not used in peritoneal dialysis. Icodextrin and amino acid solutions are used as alternatives to dextrose.Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care.

Which process involves movement of fluid and molecules across a semipermeable membrane from one compartment to another? 1 Dialysis 2 Osmosis 3 Diffusion 4 Ultrafiltration

1 Dialysis is the movement of fluid and molecules across a semipermeable membrane from one compartment to another. Substances move from the blood through a semipermeable membrane and into a dialysis solution in this process. Osmosis is the movement of fluid from an area of lesser concentration to an area of greater concentration of solutes. Diffusion is the movement of solutes from an area of greater concentration to an area of lesser concentration. Ultrafiltration occurs when there is a pressure gradient across the membrane.

When developing the plan of care for a patient with interstitial cystitis, which type of urinary incontinence (UI) would influence the nursing interventions? 1 Urge incontinence 2 Stress incontinence 3 Overflow incontinence 4 Functional incontinence

1 Interstitial cystitis is a bladder disorder that causes urge incontinence. Stress incontinence is caused by prostate surgery for benign prostate hyperplasia. A herniated disc and diabetic neuropathy cause overflow incontinence. Problems affecting balance and mobility in older adults cause functional incontinence.

The nurse reviews the plan of care for a patient in fluid volume overload due to chronic kidney disease. Furosemide and bumetanide have been ineffective. The nurse anticipates a prescription for which medication that is an osmotic diuretic? 1 Mannitol 2 Ethacrynate 3 Chlorothiazide 4 Spironolactone

1 Mannitol is an osmotic diuretic that promotes diuresis by increasing the concentration of filtrates in the kidney and blocking reabsorption of the water by the renal tubules. Chlorothiazide is a thiazide diuretic that inhibits the reabsorption of sodium (Na+) and chloride (Cl-) ions from the distal convoluted tubules. Ethacrynate is a loop diuretic that inhibits sodium (Na+), potassium (K+), and chloride (Cl-) reabsorption. Spironolactone is a potassium-sparing diuretic.

The registered nurse is teaching a nursing student about the preoperative care for a patient before kidney transplantation. Which statement made by the student indicates effective learning? 1 "I will label the access site as 'Dialysis access, no procedures.'" 2 "I will explain that immunosuppressant drugs are not typically needed." 3 "I will inform the patient that dialysis is not required after transplantation." 4 "I will explain that the transplanted kidney usually begins to function immediately after surgery."

1 Nursing care of the patient in the preoperative phase includes emotional and physical preparation for surgery. Because the patient and caregiver may have been waiting years for the kidney transplant, a review of the operative procedure and what can be expected in the immediate postoperative recovery period is necessary. The nurse should label the vascular access extremity "dialysis access, no procedures" to prevent use of that extremity for BP measurement, blood drawing, or IV infusions. The nurse should review the need for immunosuppressant drugs and measures to prevent infection. Dialysis may be needed after transplantation. The nurse should stress that there is a chance that the kidney may not function at once, and dialysis may be needed for days to weeks.

Which continuous renal replacement therapy requires no fluid replacement? 1 Slow continuous ultrafiltration (SCUF) 2 Continuous venovenous hemodialysis (CVVHD) 3 Continuous venovenous hemofiltration (CVVH) 4 Continuous venovenous hemodiafiltration (CVVHDF)

1 SCUF is a simplified version of CVVH. No fluid replacement is required in this process. CVVHD removes both fluids and solutes and requires both dialysate and replacement fluid. CVVH removes both fluids and solutes and requires replacement fluid. CVVHDF removes both fluids and solutes and requires both dialysate and replacement fluid.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

The nurse provides education about maintenance hemodialysis (HD) for a group of nursing students and states that which is the leading cause of death for these patients? 1 Cardiovascular complications 2 Suicide 3 Infection 4 Respiratory complications

1 The yearly death rate of patients receiving maintenance HD is around 19% to 24%. Cardiovascular disease (stroke, myocardial infarction [MI]) causes most deaths. Adaptation to maintenance HD varies considerably. At first, many patients feel positive about the dialysis because it makes them feel better and keeps them alive, but there is often great ambivalence about whether it is worthwhile. Dependence on a machine is a reality. In response to their illness, dialysis patients may be nonadherent or depressed and show suicidal tendencies. Infectious complications are the second leading cause of death. Respiratory complications are not the leading cause of death.

For the patient with bilateral ureteral obstructions, which precautions would the nurse implement when implementing prescribed irrigations via a newly placed nephrostomy tube? Select all that apply. 1 Perform irrigations utilizing strict aseptic precautions. 2 Assess for patency and do not kink, compress, or clamp the catheter. 3 Instill a total of 15 mL of sterile solution at one time to irrigate tube. 4 Assess the patient for any complaints of excessive pain in the affected area. 5 Utilize sterile 4x4s to collect the excessive drainage expected around the catheter

1, 2, 4 Perform the irrigations utilizing strict aseptic precautions to avoid any contamination and infection to the kidneys. Do not kink, compress, or clamp the catheter, as this can affect the passage of urine through the catheter. If the patient complains of any excessive pain in the area, the nurse should check the catheter for patency. Instill no more than 5 mL of sterile saline solution at once to prevent renal damage during irrigation. If there is excessive drainage around the tube, the nurse should check the catheter for patency.

Which clinical manifestations would the nurse observe when assessing cardiovascular changes in a patient suspected of having a medical diagnosis of fluid volume excess? Select all that apply. 1 Full, bounding pulse 2 Distended neck veins 3 Orthostatic hypotension 4 Increase in the heart rate 5 Presence of an S3 heart sound

1, 2, 5 Fluid volume excess results in a full, bounding pulse; presence of an S3 heart sound; and jugular venous distention (distended neck veins). Orthostatic hypotension and an increased heart rate are clinical manifestations of deficient, not excess, fluid volume.

When teaching a patient about techniques to manage urinary incontinence, which instructions would the nurse to include? Select all that apply. 1 Practice timed voiding. 2 Drink a cup of coffee. 3 Perform pelvic floor muscle training. 4 Perform intermittent catheterization. 5 Use incontinence protective pads.

1, 3, 5

Which are complications of peritoneal dialysis? Select all that apply. 1 Hernias 2 Hepatitis 3 Peritonitis 4 Hypotension 5 Exit-site infection

1, 3, 5 Peritoneal dialysis is removal of waste products from the body when kidneys no longer work adequately. The complications of peritoneal dialysis include hernias, peritonitis, and exit-site infection. Hernias are caused by increased intraabdominal pressure secondary to the dialysate infusion. Peritonitis results from contamination or from progression of an exit site or tunnel infection. Exit-site infection is caused by infection of the peritoneal catheter. Hepatitis and hypotension are complications of hemodialysis.Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Which intervention would the nurse implement when a pregnant patient reports headaches and shortness of breath and the nurse auscultates crackles and a bounding pulse? 1 Apply hot and cold compresses. 2 Restrict the intake of dietary sodium. 3 Ask the patient to sit and then stand. 4 Provide ice chips to hydrate the patient.

2 A pregnant woman with increased extracellular fluid may develop hypertension and pregnancy-related complications. Restriction of dietary sodium helps to control the fluid accumulation and may help to maintain fluid balance. Application of warm and cold compresses will not relieve the patient's symptoms. Changing the position does not benefit the patient, and providing ice chips may increase the fluid volume and worsen the condition.

The morning laboratory results of a patient admitted with heart failure reveal a serum potassium level of 2.9 mEq/L. Which classification of medications would be withheld until consulting with the health care provider? 1 Antibiotics 2 Loop diuretics 3 Bronchodilators 4 Antihypertensives

2 Loop diuretics are contraindicated during episodes of hypokalemia because these medications cause the kidneys to excrete sodium and potassium. Thus administration of this type of medication at this time would worsen the hypokalemia, putting the patient at risk for dysrhythmias. The prescribing health care provider should be consulted for potassium replacement therapy, and the drug should be withheld until the potassium has returned to normal range. Antibiotics, bronchodilators, and antihypertensives are not an issue in this case.

Which indicator would the nurse use when assessing the fluid balance of a patient being treated for heart failure? 1 Skin turgor 2 Daily weighing 3 Intake and output 4 Blood urea nitrogen (BUN), sodium, and hematocrit levels

2 Measuring body weight daily is the most accurate measure of fluid volume status. Skin turgor; intake and output; and BUN, sodium, and hematocrit levels are also indicators of fluid volume status, but these are not as accurate or helpful in gaining information as is daily weighing.

The nurse suspects that which electrolyte abnormality is a cause of cerebral edema in a patient with chronic kidney disease? 1 Hyperkalemia 2 Hyponatremia 3 Hypermagnesemia 4 Hypophosphatemia

2 Damaged tubules cannot conserve sodium. Urinary sodium excretion may increase, resulting in normal or below-normal levels of serum sodium. Uncontrolled hyponatremia or water excess can lead to cerebral edema. Hyperkalemia can cause cardiac dysrhythmias. Hypermagnesemia may lead to absence of reflexes, decreased mental status, and hypotension. Hypophosphatemia can lead to bone weakness, fractures, and muscle damage.

A patient with chronic kidney failure is prescribed erythropoietin for treatment of anemia. The nurse would monitor the patient for indications of which adverse effect? 1 Paralytic ileus 2 Iron deficiency 3 Hyperparathyroidism 4 Systemic lupus erythematosus

2 Erythropoietin is a hematopoietic agent that is prescribed for anemia in people with chronic kidney failure. Erythropoietin promotes erythropoiesis. An adverse effect of the medication is iron-deficiency anemia as a result of increased demand for iron to support erythropoiesis. Paralytic ileus is a side effect of sodium polystyrene sulfonate administered for the treatment of hyperkalemia. Hyperparathyroidism occurs in the patient with end-stage renal failure. Systemic lupus erythematosus leads to chronic renal failure.

A patient with chronic kidney disease is prescribed regular peritoneal dialysis (PD). Which does the nurse inform the patient while teaching about PD? 1 Limit protein intake. 2 Reposition frequently. 3 Avoid restrictive devices such as abdominal binders. 4 Restrict fluid intake.

2 Longer dwell times increase the risk for pulmonary problems. Frequent repositioning and deep-breathing exercises can help. The patient need not restrict protein or fluid intake. The patient should include enough protein in the diet to compensate for loss of protein in dialysate. Increased intraabdominal pressure can cause or worsen lower back pain. The lumbosacral curvature is increased by intraperitoneal infusion of dialysate. Orthopedic binders and a regular exercise program for strengthening the back muscles are helpful for some patients. Patients on hemodialysis have a more restricted fluid intake than patients receiving peritoneal dialysis (PD).

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse recalls that ultrafiltration in peritoneal dialysis is achieved by which method? 1 Increasing the pressure gradient 2 Increasing osmolality of the dialysate 3 Decreasing the glucose in the dialysate 4 Decreasing the concentration of the dialysate

2 Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis, the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the bloodstream.

Which patient disorder has a potential complication of developing increased extracellular fluids? 1 Osmotic diuresis 2 Renal impairment 3 Intestinal obstruction 4 Drainage from a rectal fistula

2 renal impairment Extracellular fluid accounts for one third of total body fluids, which consist of interstitial fluid, plasma, and transcellular fluid. The extracellular fluid may become excessive when the elimination of water is impaired, especially during kidney failure. Conditions such as fistula drainage, osmotic diuresis, and intestinal obstruction result in a loss of body fluid.

For which conditions would the nurse include plan of care interventions related to the potential development of hypophosphatemia? Select all that apply. 1 Renal failure 2 Respiratory alkalosis 3 Diabetic ketoacidosis 4 Tumor lysis syndrome 5 Malabsorption syndrome

2 respiratory alkalosis 3 diabetic ketoacidosis 5 malabsorption syndrome The nurse would include interventions to address hypophosphatemia when providing care to patients with respiratory alkalosis, diabetic ketoacidosis, and malabsorption syndrome. The nurse should create a care plan for hyperphosphatemia when providing care to patients with renal failure and tumor lysis syndrome.

When asked to explain the potential cause of a patient's urge incontinence, which disorders would the nurse recall? Select all that apply. 1 Cystoscopy 2 Brain tumor 3 Carcinoma in situ 4 Neurogenic bladder 5 Diabetic neuropathy

2, 3 Central nervous system disorders (such as a brain tumor) and bladder disorders (such as carcinoma in situ) are causes of urge incontinence. Cystoscopy, neurogenic bladder, and diabetic neuropathy cause overflow incontinence.

When developing a patient's plan of care, which potential complications would the nurse associate with intermittent bladder catheterization? Select all that apply. 1 Infection 2 Urethritis 3 Urethral stricture 4 Creation of false passage 5 Secondary stone formation

2, 3, 4 Urethritis, urethral stricture, and creation of false passages are complications associated with intermittent catheterization. Infection and secondary stone formation are complications that may occur due to a nephrostomy tube.Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Which complications would the nurse associate with the long-term use of indwelling catheters? Select all that apply. 1 Bowel injury 2 Bladder spasms 3 Fistula formation 4 Bladder perforation 5 Periurethral abscess

2, 3, 5 Complications associated with long-term use of indwelling catheters include bladder spasms, fistula formation, and periurethral abscess. Bowel injury and bladder perforation are the complications associated with suburethral slings.

The nurse provides education for a group of nursing students about cardiovascular problems associated with chronic kidney disease (CKD). The nurse explains that arterial stiffness is related to which event? 1 Excessive sodium retention 2 Increase in nitrogenous waste products 3 Decrease in the sodium bicarbonate level 4 Excessive calcium deposition in the vascular smooth layer

4 A patient with CKD may have arterial stiffness due to calcium deposition in the vascular smooth layer of the blood vessels. Excessive sodium retention causes extracellular fluid accumulation that leads to hypertension and edema. Decrease in the sodium bicarbonate level in the body leads to metabolic acidosis. Accumulation of the nitrogenous waste products leads to neurologic complications.

To prevent a recurrence of hypocalcemia, the nurse would encourage the patient to increase intake of which foods? 1 Fish 2 Lean meat 3 Dairy products 4 Potatoes and starches

3

Which medical diagnosis would cause the nurse to include nursing interventions appropriate for hyponatremia in the plan of care? 1 Diabetes insipidus 2 Cushing syndrome 3 Congestive heart failure 4 Uncontrolled diabetes mellitus

3 Congestive heart failure increases the patient's risk for developing hyponatremia due to inefficient pumping of excessive fluids; therefore this diagnosis would cause the nurse to include interventions specific to hyponatremia in the plan of care. Diabetes insipidus, Cushing syndrome, and uncontrolled diabetes mellitus increase the patient's risk for hypernatremia, not hyponatremia.

When developing the plan of care for a patient with a bladder outlet obstruction, which common cause would the nurse associate with this disorder? 1 Overdistention 2 Diabetes mellitus 3 Enlarged prostate 4 Chronic alcoholism

3 An enlarged prostrate is a common cause of bladder outlet obstruction. Overdistention, diabetes mellitus, and chronic alcoholism are common causes of deficient detrusor contraction.

The nurse educates a patient about the insertion of a catheter with a Dacron cuff for delivery of peritoneal dialysis. The nurse lists which benefit of this type of catheter? 1 It removes nonprotein solutes. 2 It propels blood through the circuit. 3 It prevents the migration of microorganisms. 4 It acts as a bridge between arterial and venous blood.

3 Dacron cuffs acts as anchors and prevent the migration of microorganisms into the peritoneal cavity. Hemofilters in continuous renal replacement therapy (CRRT) remove nonprotein solutes and plasma water. Blood pumps are a part of CRRT; they are used to pump blood through the circuit. Grafts are used in hemodialysis to separate the blood from arteries and veins.

Which antiincontinence device would the nurse discuss with a patient experiencing minor pelvic organ prolapse? 1 External collection devices 2 Penile compression devices 3 Intravaginal support devices 4 Intraurethral occlusive devices

3 Intravaginal support devices include pessaries and bladder neck support prostheses. These devices relieve minor organ prolapse. External collection devices, such as penile sheaths, help to direct the urine into a drainage bag. Applied penile compression devices prevent leakage through the urethra. Intraurethral occlusive devices include urethral plugs that provide mechanical obstruction to prevent urine leakage.

The nurse provides postoperative care 18 hours after a patient received a kidney during transplant surgery. Which is an expected assessment finding for this patient during this stage of recovery? 1 Hypokalemia 2 Hyponatremia 3 Large urine output 4 Leukocytosis with cloudy urine output

3 Patients frequently experience diuresis (a large volume of urine output) in the hours and days immediately following a kidney transplant. Hypokalemia, hyponatremia, and signs of infection are unexpected findings that warrant prompt intervention.STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

In the regulation of water balance, which system's primary effect is antiinflammatory and increases serum glucose levels? 1 Renal 2 Cardiac 3 Adrenal-cortical 4 Hypothalamic-pituitary

3 The adrenal-cortical system secretes glucocorticoids and mineralocorticoids to regulate water and electrolyte balance. Glucocorticoids have an antiinflammatory effect and increase serum glucose levels. The renal system regulates water balance through urine volume changes and excretion of electrolytes. The cardiac system produces natriuretic peptides that promote the excretion of sodium and water. The hypothalamic-pituitary system releases antidiuretic hormone, which results in increased water reabsorption into the blood and decreased excretion in the urine.

The patient presents with a one-time prescription for potassium chloride 20 mEq in 250 mL of normal saline IV, to be given immediately. Upon reviewing a more recent potassium level, which result would trigger the nurse to seek clarification of the patient's prescription? 1 1.7 mEq/L 2 2.9 mEq/L 3 3.6 mEq/L 4 4.5 mEq/L

4 The normal range for serum potassium is 3.5 to 5 mEq/L. The IV prescription provides a substantial amount of potassium, so the patient's potassium level must be low. A level of 4.5 mEq/L would not warrant this medication.

Which clinical action plan is most appropriate for a patient in stage 3 of chronic kidney disease? 1 Diagnosis and treatment 2 Estimation of progression 3 Renal replacement therapy 4 Evaluation and treatment of complications

4 A patient in stage 3 of chronic kidney disease has a moderate decrease in the glomerular filtration rate (GFR). The most appropriate clinical action plan for this patient is evaluation and treatment of complications. Diagnosis and treatment is the clinical action plan for patients in stage 1 of chronic kidney disease. Estimation of progression is the clinical action plan for patients in stage 2 of chronic kidney disease because this stage is associated with kidney damage with mild decrease in GFR. Renal replacement therapy is the clinical action plan for patients in stage 5, which is associated with kidney failure.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

The nurse identifies that a patient with chronic kidney disease (CKD) is at risk for which electrolyte disturbance? 1 Hypokalemia 2 Hyponatremia 3 Hypercalcemia 4 Hyperphosphatemia

4 A patient with CKD has hyperphosphatemia due to a decrease in elimination of phosphate by the kidneys. Hyperkalemia, rather than hypokalemia, is a serious electrolyte disturbance that occurs in the patient with CKD. Hypernatremia, rather than hyponatremia, leads to hypertension and fluid retention in a patient with CKD. Hypocalcemia, not hypercalcemia, occurs in the later stages of CKD due to the inability to absorb calcium in the absence of active vitamin D.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

A patient with a glomerular filtration rate (GFR) of 30 mL/min has a hemoglobin of 5 g/dL. The peripheral smear tests show that the red blood cells are normocytic and normochromic. The nurse suspects that which physiologic change led to this condition? 1 Reduced excretion of potassium 2 Increased extracellular fluid volume 3 Defective reabsorption of bicarbonate 4 Decreased production of erythropoietin

4 A patient with a GFR of 30 mL/min has stage 3 chronic kidney disease (CKD). Normocytic normochromic anemia is common in patients with CKD due to reduced production of the erythropoietin hormone by the kidneys. Erythropoietin stimulates precursor cells in the bone marrow and helps in production of red blood cells. The patient with CKD may have a high serum potassium level, which can cause fatal dysrhythmias. An increase in extracellular fluid volume may lead to hypertension in patients with CKD. Metabolic acidosis may occur in CKD patients with defective reabsorption and regeneration of bicarbonate.

The nurse is caring for a patient with chronic kidney disease. Which electrolyte, if abnormal, can result in decreased mental status, absence of reflexes, and respiratory failure for this patient? 1 Sodium 2 Calcium 3 Potassium 4 Magnesium

4 A patient with hypermagnesemia, or an increase in the level of magnesium in the body, may have absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, and respiratory failure. Sodium retention contributes to edema, hypertension, and heart failure in a patient with chronic kidney disease. Patients with hypocalcemia are at an increased risk for fractures. Hyperkalemia, or abnormally high potassium levels, is a serious electrolyte disorder in a patient with chronic renal failure that can lead to fatal dysrhythmias.

Which mediation would the nurse associate with treatment of a patient's voiding dysfunction by increasing the bladder's storage capacity? 1 Tamsulosin (Flomax) 2 Finasteride (Proscar) 3 Imipramine (Tofranil) 4 Mirabegron (Myrbetriq)

4 Mirabegron is a β3-adrenergic agonist that relaxes the bladder muscle during filling, thereby improving the bladder's storage capacity. Tamsulosin is an α-adrenergic antagonist that reduces urethral sphincter resistance. Finasteride is a 5α-reductase inhibitor that causes epithelial atrophy through androgen suppression, resulting in a decrease in total prostate size. Imipramine is a tricyclic antidepressant that reduces sensory urgency and burning pain of interstitial cystitis.

When providing preprocedural instructions for a patient requiring anesthesia, which type of incontinence might the patient experience postoperatively? 1 Urge incontinence 2 Stress incontinence 3 Reflex incontinence 4 Overflow incontinence

4 Overflow incontinence occurs after a patient receives anesthesia. Urge incontinence occurs due to bladder obstruction, central nervous system disorders, or bladder disorders. Prostate surgery causes stress incontinence. Reflex incontinence results when spinal cord lesions above S2 interfere with central nervous system inhibition.

Which substance can pass through the peritoneal membrane? 1 Glucose 2 Creatinine 3 Fatty acids 4 Amino acids

4 Peritoneal membranes allow the passage of amino acids, polypeptides, and plasma proteins. Glucose, creatinine, and fatty acids cannot permeate the peritoneal membrane.

The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD) recalls that the medication should have a beneficial effect on which laboratory value? 1 Sodium 2 Potassium 3 Magnesium 4 Phosphorus

4 Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore,administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not affect sodium, potassium, or magnesium levels.STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process.

A patient had the surgical creation of a subcutaneous arteriovenous fistula (AVF) for the administration of hemodialysis. The nurse monitors for which complication? 1 Bruit 2 Bulging under the skin surface at the site 3 Arterial blood flowing through the vein 4 Steal syndrome

4 Surgical creation of AVF access for hemodialysis has several risks. These include distal ischemia (steal syndrome) and pain because too much arterial blood is being shunted or "stolen" from the distal extremity. Manifestations of steal syndrome are pain distal to the access site, numbness or tingling of fingers that may worsen during dialysis, and poor capillary refill. With an AVF, a bruit (rushing sound) is normal; it can be heard with a stethoscope. The thrill and bruit are created by arterial blood moving at a high velocity through the vein. The AVF is placed under the skin surface; bulging is expected. The AVF is designed to allow arterial blood to flow through the vein.

A patient with chronic kidney disease has an arteriovenous (AV) graft in the right forearm. Which is the nurse's priority in determining the patency of the graft? 1 Determine the range of motion of the right arm and shoulder. 2 Observe for clubbing of the fingers on the right hand of the AV graft site. 3 Compare radial pulses by checking the right and left pulses simultaneously. 4 Check for a bruit by listening over the right arm AV graft site with a stethoscope.

4 The AV graft is an artificial connection between an artery and vein to provide access for hemodialysis. Thrombosis may occur; therefore the need to determine patency is an essential assessment. Palpation of the site should indicate a thrill, which also indicates that the graft is patent. Listening over the AV graft should reveal a bruit sound, indicating patency. A bruit sounds similar to the impulse beat heard when measuring BP. The arm that has the AV graft site should not be put through range-of-motion movements or exercises. Clubbing is not a complication observed in the fingers of a patient with an AV graft. Comparing the left radial pulse with the pulse on the AV graft site is not an accurate patency assessment procedure.

The IV prescription reads "1000 mL of D5.45 normal saline (NS) with 40 mEq KCl/L at 125 mL/hour." The nurse needs to add KCl to the liter of D5.45 NS solution because no premixed solutions are available. The unit's medication supply has a stock of KCl 5 mEq/mL in multidose vials. The nurse would need to draw up __________ mL of KCl to add to the IV solution. Record your answer using a whole number.

5 mEq/mL The end concentration of the KCl is listed on the vial as follows: "5 mEq/mL." Using ratio and proportion, multiply 5 by x and multiply 40 × 1 to yield 5x = 40. Divide 40 by 5 to yield 8 mL. The nurse would add 8 mL of KCl to the 1000 mL of D5.45 NS.

A patient with chronic kidney disease is at risk for anemia. The nurse identifies that the events that lead to this condition occur in which order? 1. Shortened survival of red blood cells (RBCs) 2. Bone marrow fibrosis 3. Elevated levels of parathyroid hormone (PTH) 4. Inhibition of erythropoiesis

Correct1.Elevated levels of parathyroid hormone (PTH) Correct2.Inhibition of erythropoiesis Correct3.Shortened survival of red blood cells (RBCs) Correct4.Bone marrow fibrosis Increased PTH (made to compensate for low serum calcium levels) can inhibit erythropoiesis, shorten survival of RBCs, and cause bone marrow fibrosis, which can result in decreased numbers of hematopoietic cells.Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal.