NURA 308 Practice questions for exam 2

A nurse is performing an admission assessment on a client admitted for complications of cirrhosis. Which client statement indicates a knowledge deficiency about the diagnosis? A. "I know men are more likely to get this than women." B. "This may have happened because I'm overweight." C. "This occurred due to that stroke I had a few years ago." D. "This could have been caused by my heavy drinking."

"This occurred due to that stroke I had a few years ago." This statement indicates deficient knowledge by the client. Stroke describes a condition where blood supply to the brain is cut off or reduced to the point of brain damage. Although a stroke is associated with neurological deficits, it is not a risk factor for cirrhosis.

The nurse caring for a client being treated for diabetic ketoacidosis (DKA) is prioritizing the client's nursing diagnoses. How should the nurse rank the nursing diagnoses in order from highest to lowest priority. All responses must be used. Potential Steps - Deficient knowledge related to inadequate insulin dosing Ineffective breathing pattern related to acidosis. - Activity intolerance related to generalized weakness due to inability to utilize glucose. - Imbalanced nutrition, less than body requirements related to inability to utilize glucose. - Impaired comfort related to frequent blood glucose fingersticks and lab draws. - Deficient fluid volume related to active fluid loss due to osmotic diuresis

1- Ineffective breathing pattern related to acidosis. 2- Deficient fluid volume related to active fluid loss due to osmotic diuresis 3- Imbalanced nutrition, less than body requirements related to inability to utilize glucose. 4- Activity intolerance related to generalized weakness due to inability to utilize glucose. 5- Impaired comfort related to frequent blood glucose fingersticks and lab draws. 6- Deficient knowledge related to inadequate insulin dosing Maslow's Hierarchy of Needs can be used as the basis for prioritizing nursing diagnoses. Physiological needs should be prioritized over psychosocial needs. The client's airway, breathing, and circulation are the highest priorities for the nurse.

Which is a normal value of TSH? A) 0-15 B) 5-13 C) 8-20 D) 4.8-5.6

A) 0-15

Which is a normal value of T4 (thyroxine)? A) 5.4-11.5 B) 5-13 C) 8-20 D) 4.8-5.6

A) 5.4-11.5

Which lab values are within range? Select all that apply. A) Total bilirubin: 0.4 B) ALT: 16 C) ALP: 78 D) AST: 60

A) Total bilirubin: 0.4 B) ALT: 16 C) ALP: 78 Normal value ranges per our textbook Total bilirubin 0.3-1.0 mg/dL ALT: 10-40 for males, 8-35 for females ALP: 52-142 AST: 10-40 for males, 15-30 for females

The nurse notes that a client with stage 1 chronic kidney disease (CKD) and hypertension controlled by lifestyle modifications has developed proteinuria. Which classification(s) of medication should the nurse anticipate the healthcare provider to prescribe? Select all that apply. A. Angiotensin II receptor blockers (ARBs) B. Angiotensin-converting enzyme (ACE) inhibitors C. Alpha-adrenergic blockers D. Neuronal potassium channel openers E. AMPA receptor agonists F. Gamma-aminobutyric acid reuptake inhibitors

A, B The goal of the treatment in chronic kidney disease (CKD) depends on the stage. For clients in stages 1 and 2, the main goal is to make sure the client has an adequate fluid balance, slow down the decline in kidney function, and prevent complications. This involves lifestyle modifications like smoking cessation, stopping any nephrotoxic medications, and maintaining tight blood glucose control among clients with diabetes mellitus. Two main factors involved in CKD progression are hypertension and proteinuria. Clients often require treatment with angiotensin-converting enzymes (ACE) inhibitors like enalapril or an angiotensin II receptor blocker (ARB) like losartan since these medications are proven to slow renal decline. Clients with hyperlipidemia should be started on lipid-lowering agents to reduce cardiovascular risk.

The nurse is preparing to assess a client with stage 2 chronic kidney disease (CKD). Which sign(s) and symptom(s) should the nurse anticipate? Select all that apply. Select all that apply A. Polyuria B. Nocturia C. Urinary incontinence D. Urinary retention E. Dysuria F. Hematuria

A, B The body can cope with a significant reduction in kidney function without causing any symptoms, making chronic kidney disease (CKD) primarily a silent disease. As the kidneys lose their ability to concentrate urine, clients may experience polyuria and nocturia. As damage progresses, fluid retention is more common and may result in edema and oliguria. In addition, as urine output decreases, wasteful substances or toxins like urea and creatinine accumulate in the body; this can lead to uremia, which may cause general symptoms like fatigue, nausea, and loss of appetite. As toxin levels build up, they can affect the functioning of the nervous system, resulting in uremic encephalopathy. This can cause asterixis, a tremor of the hand that appears when a client attempts to extend their wrists, along with ataxia and lethargy. The buildup of toxins can also affect the heart, causing pericarditis. Clients can also develop uremic frost, where urea crystals deposit in the skin, giving it the appearance of powdery snowflakes.

A nurse is reviewing the medical history of a 63-year-old male client who is brought to the emergency department after a fall on the sidewalk and is diagnosed with cirrhosis. Which of this client's previous medical conditions likely contributed to the development of cirrhosis? Select all that apply. A. Previous intravenous drug use B. Cholelithiasis C. Chronic alcoholism D. Hepatitis C E. Celiac disease

A, B, C, D Common causes of cirrhosis include chronic alcoholism, viral infections (hep. B, C and D), metabolic diseases (alpha-1-antitrypsin deficiency), galactosemia and glycogen storage disorders, inherited diseases (Wilson disease and hemochromatosis), biliary cirrhosis resulting from diseases such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), toxic hepatitis caused by severe reactions to prescribed drugs or prolonged exposure to environmental toxins, and repeated bouts of heart failure with liver congestion.

A nurse is caring for a 58-year-old client with a history of alcohol abuse and alcoholic cirrhosis. The client last consumed an alcoholic drink yesterday and is prescribed lactulose to help prevent hepatic encephalopathy. Which health care team member(s) should be included in this client's care? Select all that apply. A. Physician's assistant to initiate the Clinical Institute Withdrawal Assessment (CIWA) protocol B. Social worker to assist with obtaining community resources C. Registered nurse to implement bleeding precautions D. Assistive personnel to offer assistance with toileting every hour E. Dietician to educate the client on a high-protein diet

A, B, C, D, E An interdisciplinary care for the client diagnosed with cirrhosis should include frequent rounding to assist with toileting (especially if the client is prescribed lactulose) or to reorient the client. Cirrhosis can lead to an inadequate amount of protein in the blood and impaired clotting. The client should be on bleeding precautions, and consume a high-protein diet. Also, if the client is displaying signs and symptoms of alcohol withdrawal, it may be necessary to implement the Clinical Institute Withdrawal Assessment (CIWA) protocol.

The nurse is reviewing the possible causes of acute kidney injury (AKI) with a client recently diagnosed with AKI. Which cause(s) should the nurse include? Select all that apply. A. Intrarenal AKI happens when there is damage to the kidney itself B. Extrarenal AKI occurs when a virus infects the kidney, damaging the tissue C. Postrenal AKI occurs due to decreased outflow from the kidneys D. Prerenal AKI occurs due to decreased blood flow to the kidneys E. Hyporenal AKI results from ingestion of nephrotoxic medications leading to lack of oxygen to the kidney

A, C, D The causes of acute kidney injury (AKI) can be classified into prerenal, intrarenal, and postrenal. In prerenal AKI, there is no physical problem with the kidneys themselves, but the problem is caused by decreased blood flow to the kidneys. Intrarenal AKI occurs due to damage to the kidney itself. Finally, postrenal AKI occurs due to decreased outflow of urine from the kidneys.

The nurse is performing discharge teaching with a client diagnosed with intrarenal acute kidney injury (AKI). Which instruction(s) should the nurse include? Select all that apply. A. Limit consumption of bananas and oranges B. Strain all urine C. Report chest discomfort to the healthcare provider D. Take ibuprofen for mild to moderate pain E. Avoid physical activity

A, C, D There are several important treatments and interventions for clients experiencing acute kidney injury (AKI). It is important for nurses to educate clients and their family members on interventions to prevent the development of complications from AKI such as reporting chest discomfort, limiting high potassium foods, maintaining physical activity, and avoiding nephrotoxic medications such as ibuprofen.

The nurse is performing a head to toe assessment on a male adult client diagnosed with acute kidney injury (AKI). Which finding(s) support(s) this diagnosis? Select all that apply. Select all that apply A. Lethargy B. Urine output of 120 mL in three hours C. Foul smelling urine D. Scrotal edema E. Hypotension

A, D. Clients diagnosed with acute kidney injury (AKI) have several expected findings usually related to fluid retention and waste build-up. Clients may present with peripheral edema, hypertension, low urine output and fatigue. It is the responsibility of the nurse to determine which are expected findings associated with AKI and which findings indicate a serious complication has occurred.

The nurse assesses a client diagnosed with stage 4 chronic kidney disease (CKD). Which assessment finding(s) should lead the nurse to conclude that the client's condition is worsening? Select all that apply. Select all that apply A. S3 heart sound B. Heart rate 60/min C. +4 pitting edema in the bilateral lower extremities D. Pale yellow urine E. 3+ bilateral pedal pulses F. Bilateral basilar crackles

A, F The nurse should assess the client's kidney function by reviewing their most recent laboratory test results, including blood urea nitrogen (BUN), creatinine, urinalysis, and estimated glomerular filtration rate (GFR). To assess the client's current fluid status, the nurse should monitor vital signs, heart and lung sounds, fluid intake and output, urine frequency, color, and characteristics. The nurse should report signs of fluid overloads, such as a rapid or bounding pulse, hypertension, extra heart sounds, or signs and symptoms of pulmonary edema like shortness of breath, lung crackles, restlessness, anxiety, or frothy, blood-tinged sputum to the healthcare provider as these indicate the client's condition is worsening.

The student nurse is discussing the pathological process of diabetes mellitus (DM) with the nursing instructor. Which statement best describes this process? A. "DM is when cells fail to take in glucose, leading to high levels of circulating blood glucose and cellular starvation due to an impairment with insulin." B. "DM is a result of the body failing to produce enough cortisol and aldosterone. When these hormones are lacking, the regulation of fluid and electrolytes are disturbed, causing extreme thirst and excessive urination." C. "DM causes an imbalance of fluids in the body due to a malfunction of the pituitary gland. This imbalance leads clients to produce large amounts of urine and experience an insatiable thirst." D. "DM occurs due to the pathological inflammation of the pancreas. Digestive enzymes erode the pancreas, leading to scar tissue blocking the secretion of insulin and causing severe pain."

A. "DM is when cells fail to take in glucose, leading to high levels of circulating blood glucose and cellular starvation due to an impairment with insulin." In DM, commonly just called diabetes, the body has trouble moving glucose from the blood into the tissue cells. As a result, cells starve for energy despite having high circulating blood glucose levels, which is called hyperglycemia. Normally, high blood glucose stimulates the pancreatic beta cells to produce and secrete the hormone insulin, which, in turn, reduces blood glucose by stimulating the uptake of glucose into the cells. In diabetes, the blood glucose stays high because insulin is not able to function properly.

A client with a history of cirrhosis who is scheduled for a liver biopsy tells the nurse, "I'm glad I won't have to have my blood drawn again once I get the biopsy." Which is the most appropriate response by the nurse? Elimination tool A. "Liver function is routinely monitored using blood tests as well." B. "There are no blood tests that measure liver function." C. "A liver biopsy tells your medical team everything they need to know about your cirrhosis." D. "A liver biopsy will only reveal whether you have cancer or not."

A. "Liver function is routinely monitored using blood tests as well." Lab tests such as bilirubin levels, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), amylase, lipase, albumin, coagulation studies, complete blood count (CBC), electrolyte panel, blood urea nitrogen (BUN), creatinine (Cr), and ammonia can all be detected in the blood and are used to monitor liver disease.

The newly graduated nurse is caring for a client diagnosed with acute kidney injury (AKI) experiencing hyperkalemia. The newly graduated nurse states to the nurse preceptor, "My client doesn't have diabetes but the doctor ordered intravenous insulin for my client. This must be a mistake." Which is the best response by the nurse preceptor? A. "The administration of intravenous insulin treats hyperkalemia by shifting extra potassium into the cells, decreasing extracellular potassium." B. "Clients with AKI have elevated levels of creatinine which causes damage to the pancreas, leading to decreased insulin production." C. "The glucose molecules formed during hyperglycemic episodes can cause kidney stones, so the doctor orders insulin to decrease this risk." D. "You are right, we need to contact the provider and question this order. This is a mistake."

A. "The administration of intravenous insulin treats hyperkalemia by shifting extra potassium into the cells, decreasing extracellular potassium." Acute kidney injury (AKI) can be reversible when promptly treated, so the goal is to prevent further injury, manage the signs and symptoms, prevent complications, and promote recovery. The underlying cause should be addressed while carefully managing the body's fluids, electrolytes, and waste products of metabolism. This is achieved via a combination of intravenous (IV) fluids, diuretics, and correction of electrolyte disturbance, such as hyperkalemia. Intravenous insulin administration is a method of treating hyperkalemia by shifting potassium into the cells and out of the bloodstream. Clients who do not respond to treatment may require renal replacement therapy, such as dialysis, to control their volume overload, electrolyte imbalances, metabolic acidosis, and uremic symptoms.

A nurse is completing the assessment documentation for a client presenting to the emergency department with hematuria, flank pain, and intermittent dizziness. In addition to a genitourinary assessment, which focused assessment should the nurse complete and document? A. Cardiovascular assessment B. Psychological C. Respiratory assessment D. HEENT assessment

A. A cardiovascular assessment is most relevant to this client's symptoms, because it involves assessment of pulses, skin color, heart rate and rhythm, and cardiac symptoms.

A client with a history of alcohol abuse has the following diagnostic tests ordered: Complete blood count (CBC) Alanine transaminase (ALT) Aspartate transaminase (AST) Prothrombin time (PTT) International Normalized Ratio (INR) Ammonia Which result(s) may indicate liver dysfunction? Select all that apply. A. AST 322 units/L B. Ammonia 52 µ/dL C. PTT 89 sec D. ALT 101 units/L E. Albumin 1 g/dL

A. AST 322 units/L B. Ammonia 52 µ/dL C. PTT 89 sec D. ALT 101 units/L E. Albumin 1 g/dL All of these are like, super out of range.

Which client is at highest risk for development of diabetic ketoacidosis (DKA)? A. An unemployed client diagnosed with Type I diabetes mellitus (DM) being treated for gastroenteritis B. A client diagnosed with diabetes insipidus (DI) following a traumatic brain injury who's experiencing polydipsia C. A client diagnosed with Type II diabetes mellitus (DM) who takes insulin and has worsening renal function D. A client diagnosed with Type I diabetes mellitus (DM) with private health insurance and an implanted insulin pump

A. An unemployed client diagnosed with Type I diabetes mellitus (DM) being treated for gastroenteritis Clients with Type I DM are at increased risk for DKA due to their body's inability to produce insulin. Unemployment, or being from a low socioeconomic background, can increase the risk of developing DKA because of the difficulty in obtaining resources to manage the disease process. Clients with DM who have gastroenteritis are particularly at risk for developing DKA because of vomiting, diarrhea, and/or inability to consume foods/liquids while ill. Additionally, during times of stress or illness, blood glucose levels may increase.

While receiving shift report on a client with diabetic ketoacidosis (DKA), the assistive personnel (AP) tells the nurse, "Wow, the client must be a heavy sleeper because they were difficult to wake up!" What should the nurse do first? A. Assess the client's level of consciousness. B. Notify the provider and inform them of the client's condition. C. Prepare for rapid-sequence intubation. D. Allow the client to rest and reassess in one hour.

A. Assess the client's level of consciousness. Clients with DKA are at risk for developing neurological complications due to hyperglycemia and shifting of glucose and electrolytes. Any report of change in the client's level of consciousness should be immediately reassessed by the nurse.

A nurse is discharging a client who was admitted for hepatic encephalopathy related to cirrhosis. Which instruction should the nurse include in the discharge teaching? A. Consume a high-protein, low salt diet B. Shave manually with a straight razor blade C. Take a maximum of 6,000 mg acetaminophen per day for pain D. Drink beer, but not liquor

A. Consume a high-protein, low salt diet Individuals with cirrhosis should consume a diet that is high in protein and low in salt to nourish the body with necessary protein while preventing fluid retention. Components of the plan of care for clients with cirrhosis include eliminating alcohol use, weight loss if applicable, consuming a high-protein, low salt diet, reducing the use of liver-toxic medication, and monitoring for signs and symptoms of abnormal bleeding, jaundice, changes in mental status, or abdominal swelling.

The development of ketones in the body during dabetic ketoacidosis (DKA) results from which pathophysiological process? A. Fat is broken down by hepatocytes in the liver for energy. B. Proteins are broken down into amino acids to be used for energy. C. Glucose that cannot be used by the cells degenerates into ketone bodies. D. Ketones are produced by the pancreas in the setting of increased glucose demand.

A. Fat is broken down by hepatocytes in the liver for energy. When the body's cells do not get the glucose they need, the liver begins breaking down fat to use as energy instead. Ketones are the direct byproduct of fat metabolism. Ketones are acidic, and as they build up in the blood, they contribute to the increasing acidity level of the blood, leading to diabetic ketoacidosis (DKA).

The nurse is caring for a client with advanced cirrhosis. Which symptom(s) should the nurse anticipate? Select all that apply. A. Slurred speech B. Generalized bruising C. Abdominal swelling D. Generalized itching E. White sclera

A. Slurred speech B. Generalized bruising C. Abdominal swelling D. Generalized itching Signs and symptoms of cirrhosis include fatigue, easily bleeding or bruising, loss of appetite, nausea, edema of the legs, feet, and ankles, weight loss, itchy skin, jaundice, ascites, spider-like blood vessels on the skin, redness in the palms of the hands, sexual dysfunction, confusion, drowsiness and slurred speech (hepatic encephalopathy).

The nurse is caring for a client with cirrhosis who has come to the emergency department for uncontrolled epistaxis. The client also has HIV, is experiencing increased urine output, and is found to have a high serum iodine level. Which client condition is a likely complication of cirrhosis? Elimination tool A. Uncontrolled epistaxis B. Contracting HIV C. Increased urine output D. High serum iodine level

A. Uncontrolled epistaxis The liver is responsible for production of a number of clotting factors that assist with coagulation of blood. Complications of cirrhosis include risk for several hematological problems, including risk for bleeding from lack of clotting factors. Epistaxis, or nosebleed, is one manifestation of this.

Put these responses into sequential order. The nurse in the emergency department is teaching a newly graduated nurse about the pathological process of acute kidney injury (AKI). The nurse evaluates that the teaching has been effective when the newly graduated nurse describes the process in which order? Arrange the options in order from first to last. All options must be used. Potential Steps -- Acidosis develops when hydrogen ions are retained and uremia leads to impaired coagulation and pericarditis -- Potassium levels elevate leading to fluid overload; phosphate retention leads to hypocalcemia -- Creatinine and urea build up in the bloodstream -- Renal cell damage occurs leading to rapid loss of kidney function

Answer: 1) Renal cell damage occurs leading to rapid loss of kidney function 2) Creatinine and urea build up in the bloodstream 3) Potassium levels elevate leading to fluid overload; phosphate retention leads to hypocalcemia 4) Acidosis develops when hydrogen ions are retained and uremia leads to impaired coagulation and pericarditis In all cases of acute kidney injury (AKI), creatinine and urea build up in the blood over several days, and fluid and electrolyte disorders develop. The most serious of these disorders are hyperkalemia and fluid overload, possibly causing pulmonary edema. Phosphate retention leads to hyperphosphatemia. Hypocalcemia is thought to occur because the impaired kidney no longer produces calcitriol and because hyperphosphatemia causes calcium phosphate precipitation in the tissues. Next, acidosis develops because hydrogen ions cannot be excreted. With significant uremia, coagulation may be impaired, and pericarditis may develop. Urine output varies with the type and cause of AKI.

Acalculous cholecystitis, or cholecystitis without obstruction by gallstones occurs in only 10% of cases. What are some potential causes? Select all that apply. 1) burns 2) major surgical procedures 3) severe trauma 4) primary bacterial infection of the gallbladder 5) alterations in fluids and electrolytes 6) having a super bad day at work

Answer: 1-5 Acalculous cholecystitis describes acute gallbladder inflammation in the absence of obstruction by gallstones. Acalculous cholecystitis occurs after major surgical procedures, orthopedic procedures, severe trauma, or burns. Other factors associated with this type of cholecystitis include torsion, cystic duct obstruction, primary bacterial infections of the gallbladder, and multiple blood transfusions. It is speculated that acalculous cholecystitis is caused by alterations in fluids and electrolytes and alterations in regional blood flow in the visceral circulation.

The nurse on an orthopedic inpatient unit is rounding on the assigned clients. Which client is at highest risk for developing a urinary tract infection (UTI) while hospitalized? A. 65-year-old female who requires straight catheterization every 4 hours B. 48-year-old male with type II diabetes mellitus with an hemoglobin A1C of 5.4% C. 20-year-old female who denies recent sexual activity D. 81-year-old continent female with a compound humerus fracture

Answer: A

An infection of the urinary tract may affect which organ(s)? Select all that apply. A. Kidneys B. Urethra C. Adrenal glands D. Ureters E. Uterus

Answer: A, B, D. An infection of the urinary tract commonly affects the lower urinary tract, comprising the urethra and bladder. Sometimes the infection can also migrate to the upper urinary tract which includes the ureters and kidneys.

The nurse is composing a teaching plan for a group of clients about the primary prevention of client chronic kidney disease (CKD). Which modifiable risk factor(s) should the nurse include in the teaching? Select all that apply. A. Obesity B. Alcohol use C. Age over 60 years old D. Smoking E. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) F. Genetic predisposition

Answer: A, D, E. Modifiable risk factors for chronic kidney disease (CKD) can be changed by the client, including obesity, cardiovascular disease, uncontrolled diabetes mellitus, smoking, and exposure to nephrotoxic medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or aminoglycosides. Nonmodifiable risk factors refer to risk factors that cannot be changed and include being over 60 years of age and having a genetic predisposition to kidney disease.

The nurse is creating a care plan for an 88-year-old female client on a medical unit for a urinary tract infection (UTI). Which intervention(s) should the nurse include? Select all that apply. A. Instruct the AP to strain all urine B. Communicate with the provider if the client becomes confused C. Put "high fall risk" signage on the client's door D. Offer toileting with each client encounter E. Communicate with the assistive personnel to record intake and output once per day

Answer: B, C, D Clients with UTIs may experience urinary frequency and urgency, requiring frequent toileting. The nurse should offer toileting with each client encounter, especially if the client is at risk for falls. Older clients with UTIs may present with confusion and altered mental status, as opposed to typical symptoms like frequency and urgency. The nurse should monitor mental status and communicate with the provider if needed. Clients with UTIs may experience urinary frequency and urgency. Additionally, UTIs may manifest as altered mental status in elderly clients. Clients with UTIs are, therefore, high fall risks and the nurse should communicate this with other staff members.

A client suspected of having acute kidney injury (AKI) after experiencing a kidney stone is being seen by the nephrologist in the emergency department. Which diagnostic test(s) should the nurse anticipate? Select all that apply. Select all that apply A. Abdominal computed tomography (CT) scan with contrast B. Post-void urine residual C. Comprehensive metabolic panel (CMP) D. Urine culture and sensitivity E. Renal ultrasound

Answer: B, C, E. A post-void residual test for urine retention may be used to diagnose AKI when a post-renal obstruction is suspected, as in the case of a kidney stone. This test includes a bladder scan to assess for urine amount after clients have voided. A CMP will be drawn to assess for electrolyte disturbances caused by AKI, such as hyperkalemia, hyperphosphatemia, and hypocalcemia. It can also include a blood urea nitrogen level and creatinine to assess for renal impairment. Renal ultrasound may be indicated if the client was recently diagnosed with a kidney stone to assess for additional urinary tract obstructions. Although a CT scan would provide a proper assessment of the kidney, in clients diagnosed with AKI, contrast dye should be avoided due to the possibility of causing further kidney injury. The main diagnostic studies used for acute kidney injury (AKI) include standard laboratory tests, such as a comprehensive metabolic panel (CMP) which can show abnormal electrolyte levels like hyperkalemia, hyperphosphatemia, and hypocalcemia. Blood urea nitrogen (BUN) and creatinine will also be evaluated. A blood gas analysis can show metabolic acidosis. In addition, urinalysis can reveal proteinuria, hematuria, and casts. Computed tomography (CT) scan without contrast dye can assess renal blood flow and allow identification of an underlying cause. Renal ultrasound may be indicated to assess for urinary tract obstructions.

The nurse reviews the clients scheduled to be seen at the community health clinic for the day. Which client(s) should the nurse recognize is/are at risk for developing chronic kidney disease (CKD)? Select all that apply. A. A 52-year-old client with a history of chronic pancreatitis B. A 39-year-old client was recently diagnosed with amyloidosis. C. A 51-year-old client diagnosed with Parkinson's disease D. A 38-year-old client diagnosed with systemic lupus erythematosus (SLE) E. A 44-year-old client with primary hypertension. F. A 28-year-old client with type 1 diabetes mellitus (DM)

Answer: B, D, E, F. Several conditions can speed up the rate at which the glomerular filtration rate (GFR) deteriorates, increasing the risk of developing chronic kidney disease (CKD). The leading causes of CKD in the United States are diabetes mellitus and hypertension, which are more common in elderly clients. Less common causes include renal artery stenosis, glomerular diseases, polycystic renal disease, tubulointerstitial diseases, and systemic disorders like lupus or amyloidosis. Additionally, repeated episodes of pyelonephritis or obstructive uropathy, such as prostate disease, can lead to CKD. Regarding risk factors for CKD, modifiable ones include obesity, cardiovascular disease, uncontrolled diabetes mellitus, smoking, and nephrotoxic medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or aminoglycosides. In contrast, non-modifiable risk factors include being over 60 years of age and having a genetic predisposition to kidney disease.

The nurse is triaging a 23-year-old female client presenting to the emergency department for a suspected urinary tract infection (UTI). Which symptom correlates with this diagnosis? Elimination tool A. Small, painful blisters on the vulva B. Urinary frequency and urgency and burning during urination C. Sudden onset pain in the right lower quadrant (RLQ) of the abdomen D. Pain on the right side of the pelvis and clear, sticky vaginal discharge

Answer: B. Symptoms of a UTI include pain with urination, called dysuria, urinary frequency, urgency, and hesitancy.

The student nurse caring for a client diagnosed with acute kidney injury (AKI) asks the nursing instructor, "How do I choose which nursing diagnosis is most important?" The nursing diagnoses include: Fluid volume excess related to renal insufficiency Risk for electrolyte imbalance related to renal insufficiency Acute pain related to urinary retention Deficient knowledge related to medication self-care Which is the best response by the nursing instructor? A. "If clients have deficient knowledge about medications, they will never be able to independently manage their care so this takes priority." B. "Fluid volume excess takes priority since additional body fluids can lead to pulmonary edema and respiratory distress." C. "Acute pain is the priority diagnosis because clients who are in pain cannot accomplish activities of daily living (ADLs) and heal properly." D. "Risk for electrolyte imbalance is the most important since electrolyte disturbances can lead to arrhythmias."

Answer: B. This is the best response by the nursing instructor. According to airway, breathing, circulation (ABCs), the airway should be the nurse's main concern when prioritizing client problems.

The nurse in the primary care office is reviewing the laboratory results of a client with a history of hypertension. Which finding(s) should the nurse report to the healthcare provider? Click on the finding(s) which support(s) your answer. Serum Laboratory Results Blood urea nitrogen (BUN)- 27 mg/dL Hematocrit (Hct)- 45% Hemoglobin (Hgb)- 14.5 g/dL Creatinine- 2.2 mg/dL Glomerular filtration rate (GFR)- 70 mL/min

Answer: BUN, Creatinine, GFR. The diagnosis of chronic kidney disease (CKD) is based on a client's history, physical assessment, and laboratory tests. Serum test results associated with CKD include an increase in blood creatinine, the normal creatinine is 0.6 to 1.2 mg/dL, blood urea nitrogen (BUN), the normal BUN is 8 to 23 mg/dL, and lastly, a decrease in the estimated glomerular filtration rate (GFR), the normal GFR for an adult is 100 to 120 mL/min. A urinalysis will show proteinuria, hematuria, white blood cells (WBCs), glucose, and casts. If the exact cause of CKD is unknown, an abdominal ultrasound can be done to evaluate the kidneys for signs of scarring or polycystic kidneys, as well as obstructive uropathy. In long-term end-stage kidney disease (ESRD), X-rays may be done to check for renal osteodystrophy. Finally, a kidney biopsy can be performed to look for inflammation, scarring, or unusual protein deposits and determine how far CKD has advanced.

The nurse has provided education to a client with type 1 diabetes mellitus (DM) and stage 3 chronic kidney disease (CKD). Which client statement indicates an understanding of the teaching? A. "I will notify my healthcare provider if I gain four pounds in a week." B. "I will ensure that the calcium is restricted in my diet." C. "I will schedule my fluid intake to be spread out over 24 hours." D. "I can expect to feel my heart flutter in my chest once in a while."

Answer: C. Fluid restriction is necessary for clients with stage 3 CKD that are not receiving dialysis to prevent fluid volume overload. Clients should be advised to restrict their fluids and plan to spread out all daily intake of fluids over 24 hours. Additional info: Included in teaching a client with stage 3 chronic kidney disease (CKD) is an explanation of the best ways to reduce the risk of further injury to the kidneys, including following their treatment plan, optimizing their blood pressure, and maintaining tight blood glucose control. The nurse should instruct clients to talk to their healthcare provider before starting new medications. Clients should avoid nephrotoxic medications like certain antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs), exposure to radiographic contrast dye, pesticides, and heavy metals like arsenic. Clients must also follow up regularly with their healthcare provider to monitor their CKD. Included in client education are also lifestyle modifications. Encourage clients to maintain good nutrition while following a renal diet that consists of a moderate protein intake and low sodium, potassium, and phosphorus. Advise clients that they should restrict their fluids and plan to spread out all daily intake of fluids over 24 hours. The nurse should provide clients with a list of foods to include in their diet and avoid and refer them to the renal dietician for additional support. Clients should also be taught how to safely self-administer any prescribed medications and advised to weigh themselves daily at the same time and in the same type of clothing; and report any weight gain greater than 2 kg (4.4 pounds), as well as any increases in blood pressure, shortness of breath, swelling in the extremities, or changes to their urine appearance, frequency, or volume.

The nurse is caring for a client diagnosed with Acute Kidney Injury (AKI) requiring hemodialysis due to persistent and severe hyperkalemia. Which statement by the client indicates that this treatment has been effective? A. "My hands have been tingling ever since I arrived at the hospital." B. "The hospital food is not agreeing with me, I keep having loose stools." C. "I'm not trying to diet, but I lost two pounds since I had dialysis" D. "My heart has been fluttering off and on since I woke up today."

Answer: C. This statement indicates that treatment has been effective since clients diagnosed with AKI can retain fluid and electrolytes, such as potassium, resulting in weight gain. Losing weight after dialysis indicates that excess water weight and electrolytes were shed.

The client's spouse asks the nurse, "Can you explain what chronic kidney disease is?" Which is the best response by the nurse? A. "Chronic kidney disease occurs when there is a sudden reduction in kidney function." B. "Chronic kidney disease is an infection in one or both kidneys." C. "Chronic kidney disease is a condition that occurs when the bladder wall becomes weakened." D. "Chronic kidney disease is a condition in which the function of the kidneys slowly declines."

Answer: D. Chronic kidney disease (CKD) is characterized by a slow and progressive decrease in kidney function. A glomerular filtration rate (GFR) of less than 60 mL/minute that develops over a minimum of three months is consistent with a diagnosis of CKD.

The nurse reviews the stages of chronic kidney disease (CKD) with a group of nursing students. Complete the following sentences by using the list of options. In stage (2, 3, 1) of CKD, there is still normal kidney function since the remaining healthy (nephrons, Bowman's capsules, renal tubules) can adapt. They become (longer, smaller, larger) and work harder to maintain (plasma, red blood cells, urine) production.

Answer: Stage 1, nephrons, larger, urine Chronic kidney disease (CKD) results from progressive and irreversible damage to the kidneys, leading to a gradual decline in kidney function. As a result, the kidneys gradually lose their ability to concentrate the urine and excrete wasteful substances or toxins. CKD can be classified into five stages by determining the estimated glomerular filtration rate (GFR), measured in milliliters per minute per 1.73 square meters. There is still normal kidney function for clients with stage 1 CKD since the remaining healthy nephrons can adapt, become larger, and work harder to maintain urine production. As the disease progresses into stage 2 CKD, kidney function is mildly decreased, while in stage 3 CKD, there's a moderate decrease, and in stage 4 CKD, there is a severe decrease in kidney function. Over time, as CKD progresses into stage 5, kidney function is completely lost, and clients develop renal failure, also known as end-stage kidney disease (ESRD).

The nurse is preparing to summarize the signs and symptoms of glomerulonephritis for a nursing student. Which information should the nurse include in the statement? Complete the following sentences by choosing from the drop-down lists. General manifestations of glomerulonephritis include ____________[lethargy constipation delirium], irritability, pallor and _____________[myalgia diplopia headaches]. Clients can also have abdominal or flank pain, as well as nausea, vomiting, anorexia, periorbital edema, generalized edema, or _____________________[pulmonary embolism pulmonary edema atrial fibrillation], which could present as dyspnea. Urinary manifestations include decreased urine output, _________________[dysuria incontinence urinary] frequency, and hematuria, which could turn the urine tea or cola-colored with a cloudy, smoky aspect. Mild to moderate _____________[wheezing nocturia hypertension] is also often present.

Answer: lethargy, headaches, pulmonary edema, dysurea, hypertension

Sister Julienne is helping at a West End hospital with a cholecystectomy. Which diet would she recommend to her patient after recovery? A) A diet low in protein and carbohydrates B) A diet with cooked fruits, rice, coffee, mashed potatoes, and non-gas-forming vegetables C) The "old-timey French pauper" diet consisting of bread, cheese, and wine D) Keto diet with lots of pork and brussels sprouts

B) A diet with cooked fruits, rice, coffee, mashed potatoes, and non-gas-forming vegetables. The diet immediately after an episode is usually low-fat liquids. These can include powdered supplements high in protein and carbohydrate stirred into skim milk. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be added as tolerated. The patient should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the patient that fatty foods may induce an episode of cholecystitis. Dietary management may be the major mode of therapy in patients who have had only dietary intolerance to fatty foods and vague GI symptoms (Kellerman & Rakel, 2018).

Which is a digestive enzyme mainly secreted by the acinar cells of the pancreas and by the parotid glands, with a normal range of 25-125 u/L? A) Total bilirubin B) Amylase C) covfefe D) Albumin

B) Amylase

A patient uses a purewick after abdominal surgery because it is too painful to get out of bed to go to the bathroom. Which type of incontinence fits this scenario best? A) Mixed incontinence B) Functional incontinence C) Overflow incontinence D) Urge incontinence

B) Functional incontinence Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time.

Which statement by a client with Type 1 diabetes mellitus (DM) indicates that the client may be experiencing diabetic ketoacidosis (DKA)? Select all that apply. A. "It burns when I urinate, and it feels like I still have to go even after I think I'm finished." B. "I don't know why, I just have no energy at all. My body just doesn't want to move." C. "People have been telling me that my breath smells weird, almost like nail polish remover." D. "I have stomach pain that won't go away and feel like I'm going to vomit" E. "My chest pain is a 10/10. It feels like an elephant is sitting on my chest, and it's hard to breathe."

B, C, D Common signs and symptoms of DKA include lethargy, generalized weakness, "fruity" smelling breath, abdominal pain, nausea, and vomiting. It is important that the nurse recognize these as signs and symptoms of DKA in the diabetic client and prioritize obtaining electrolyte and glucose levels to guide stabilization and treatment.

The nurse has provided education to a client diagnosed with acute kidney injury (AKI) who requires a low sodium and low phosphorus diet. Which food choice(s) made by the client after teaching should prompt the nurse to ask for a consult with the dietician for additional reinforcement of dietary education? Select all that apply. A. Baked chicken breast on white bread B. Canned soup and a diet cola C. Peanut butter and jelly on crackers D. Fresh green beans and salmon filet E. Macaroni and cheese with broccoli

B, C, E Crackers contain high levels of phosphorus and peanut butter can contain excess sodium. These electrolytes should be reduced in a renal diet. This indicates that the client needs additional teaching by the dietician.

The nurse is creating a health promotion teaching plan for a client who has type 2 diabetes mellitus (DM) and is diagnosed with a foot ulcer. Which instruction(s) should the nurse provide the client? Select all that apply. A. "Only go barefoot inside your own house." B. "Never treat corns or calluses yourself." C. "Wear loose fitting shoes to prevent foot sores." D. "Bathe in water that is lukewarm." E. "Inspect your feet once per week."

B, D Clients diagnosed with type 2 DM should be instructed to have a medical professional treat corns or calluses due to the risk of injury and infection. Clients diagnosed with type 2 DM should be instructed to bathe in water that is lukewarm to prevent burns. Diabetic neuropathy can prevent clients from feeling how hot the water is, especially in the feet. Clients diagnosed with type 2 DM should be instructed to perform foot inspections daily. Clients diagnosed with type 2 DM should refrain from going barefoot anywhere to prevent injuries resulting from diabetic neuropathy. Clients should be instructed to wear socks or slippers inside their home. Clients diagnosed with type 2 DM should wear properly fitting shoes to ensure they do not develop injuries to the feet. Shoes that are too small or too large can lead to injuries to the feet.

Which is a normal range for Hgb A1C per our textbook? A) 3.5-5 B) 4.4-6.4 C) 5.7-6.4 D) 8.8-10.4

B. 4.4-6.4

A 75-year-old female client was admitted to the hospital 5 days ago for a congestive heart failure (CHF) exacerbation. She had an indwelling catheter inserted on hospital day 1 for strict intake and output assessment. The nurse is reviewing the client's electronic health record (EHR) and notices a increase in white blood cell count from 9.8x109/L to 14.3x109/L in 24 hours, a recent temperature of 37.5℃ (99.5℉), and a nursing note from the previous shift that states the client was more confused than baseline. Which is the most appropriate action by the nurse? A. Communicate with the charge nurse that this client needs a private room B. Ask the provider to order a urinalysis and urine culture C. Instruct the assistive personnel (AP) to administer 325mg of acetaminophen D. Instruct the assistive personnel (AP) to redraw a complete blood count (CBC)

B. Ask the provider to order a urinalysis and urine culture The nurse should suspect a catheter associated urinary tract infection (UTI) in this client because signs and symptoms of urinary tract infection began 48 hours post-catheter placement. The nurse should request a urinalysis and urine culture to confirm the presence of infection so the client can start treatment.

The nurse is caring for a client in the oliguric phase of acute kidney injury (AKI). Which client statement should alert the nurse that the client may be experiencing a long-term complication of AKI? A. "I checked my blood pressure and it was higher than it normally is." B. "I took an extra nitroglycerin tablet last night. My angina is acting up." C. "I've gained two pounds since yesterday! I need to go on a diet." D. "My rings don't fit on my fingers anymore."

B. Nitroglycerin tablet. A, C, and D are expected findings. This statement indicates that the client may be experiencing a long-term complication of AKI known as uremic pericarditis. Over time, build up of urea can cause inflammation of the pericardium, leading to chest pain. This is not an expected finding associated with AKI. There are several long-term complications associated with acute kidney injury (AKI) such as uremic pericarditis, pulmonary edema, electrolyte imbalance, permanent kidney damage, and death. It is the responsibility of the nurse to determine which are expected findings associated with AKI and which findings indicate a long-term complication is occuring.

The nurse is caring for a client with advanced cirrhosis due to years of alcohol abuse. The client is currently alert and oriented x 4 and reports no pain. The client is receiving heparin 5,000 units every 8 hours subcutaneously for deep vein thrombosis prophylaxis while hospitalized. Which nursing diagnosis should the nurse select as the highest priority? A. Risk for acute substance withdrawal due to history of alcohol abuse B. Risk for bleeding due to impaired liver function C. Risk for venous thromboembolism related to immobility D. Risk for activity intolerance due to withdrawal symptoms

B. Risk for bleeding due to impaired liver function Risk for bleeding is important to consider in clients with cirrhosis. Liver dysfunction may lead to impaired clotting factor production, as well as the risk of bleeding from portal hypertension. This should be the priority nursing diagnosis, and the nurse should closely monitor for signs and symptoms of bleeding in this client.

The public health nurse is educating a group of clients about the risk of developing acute kidney injury (AKI). Which non-modifiable factor(s) should the nurse include? Select all that apply. Select all that apply A. Smoking tobacco B. Increased stress levels C. History of acute coronary syndrome (ACS) D. Uncontrolled hypertension E. History of autoimmune disease F. Advanced age

C, E, F. There are several factors that may put an individual at risk for acute kidney injury (AKI). Non-modifiable risk factors are ones that clients cannot change, whereas modifiable factors are ones that can be changed. There are some factors that can put an individual at risk for AKI. Unfortunately, many of the risk factors are non-modifiable and decrease kidney function over time, such as advanced age, diabetes mellitus, autoimmune diseases, certain cancers, uncontrolled hypertension, and heart, liver, or kidney disease.

The nurse is providing discharge teaching to an adult client with diabetic ketoacidosis (DKA). Which statement indicates that additional teaching is needed? A. "My doctor may tell me to monitor the level of ketones in my urine." B. "I will take my medication, including insulin, even if I'm sick" C. "I will limit my fluid intake to 32 oz per day." D. "I will check my blood glucose levels before eating and before bedtime."

C. "I will limit my fluid intake to 32 oz per day." Clients with diabetes need to maintain adequate hydration. 32 oz of fluid intake per day is not sufficient for the average adult and may result in dehydration, which would further exacerbate the complications of DKA.

The nurse is performing an assessment on a client diagnosed with type 2 diabetes mellitus (DM). Which statement indicates the development of a possible long-term complication of type 2 DM? A. "I feel so thirsty; I keep drinking water, but I never feel satisfied." B. "I have been losing my hair for the last year." C. "I've had to get a new prescription for my glasses twice this year." D. "My dentist told me I need a root canal this year. I've never needed one before."

C. "I've had to get a new prescription for my glasses twice this year." Clients diagnosed with type 2 DM may experience retinopathy due to the microvascular damage to ocular blood vessels. Damage to these blood vessels occurs due to inflammation caused by constant hyperglycemia.

A client is in the Intensive Care Unit (ICU) being treated for diabetic ketoacidosis (DKA). The client is receiving a continuous IV infusion of insulin, and the nurse notes the blood glucose level is 250 mg/dL. The client's son asks, "Why aren't you doing anything about that high sugar level?" What is the best response by the nurse? A. "You're right, I will increase the insulin rate." B. "The infusion is regular insulin, which has a peak time of 6-10 hours, so it'll take several hours for the glucose levels to return to normal." C. "You're right, this is an elevated blood glucose level. However, it is important that the blood glucose level does not decrease too quickly, which would increase the risk for complications." D. "DKA causes damage to the kidneys, so glucose levels will remain elevated for several days."

C. "You're right, this is an elevated blood glucose level. However, it is important that the blood glucose level does not decrease too quickly, which would increase the risk for complications." "You're right, this is an elevated blood glucose level. However, it is important that the blood glucose level does not decrease too quickly, which would increase the risk for complications."

The emergency department nurse is reviewing the laboratory results for several clients. Which client's results are consistent with the diagnosis of prerenal acute kidney injury (AKI)? Client results- Day 1 ... Day 2 Client 1- Urine specific gravity: 1.020.... Urine specific gravity: 1.025 Client 2- Blood urea nitrogen (BUN): 25 mg/dL... Blood urea nitrogen (BUN): 24 mg/dL Client 3- Creatinine: 1.8 mg/dL.... Creatinine 3.8 mg/dL Client 4- Potassium 5.2 mEq/L..... Potassium 5.3mEq/L A. Client 4 B. Client 2 C. Client 3 D. Client 1

C. Client 3 The main diagnostic study used for diagnosis of acute kidney injury (AKI) includes a progressive elevation of creatinine over 24 to 48 hours. Other standard laboratory tests, such as a comprehensive metabolic panel (CMP), can assist in diagnosis indicating hyperkalemia, hyperphosphatemia, and hypocalcemia, but should be correlated with creatinine. Blood urea nitrogen (BUN) will also be elevated, but it may be misleading because it is frequently elevated in response to increased protein catabolism resulting from other non-renal causes. Urine specific gravity may also be used to diagnose AKI. A progressive rise in creatinine over 24 to 48 hours is indicative of AKI. Normal creatinine is 0.6-1.2 mg/dL.

The nurse is performing a head to toe assessment on a client diagnosed with type 2 diabetes mellitus (DM). Which finding(s) support(s) this diagnosis? Select all that apply. A. Lack of thirst B. Decreased appetite C. Increased urination D. Bruising more easily than normal E. Recent unexplained weight loss of 10 lbs

C. Increased urination, E. Recent unexplained weight loss of 10 lbs A classic symptom of both type 1 and type 2 DM is polyuria, which means that clients urinate frequently, which is associated with polydipsia, which means they are constantly thirsty and drink a lot of fluids. Although obesity is a risk factor for the development of type 2 DM, clients may experience weight loss due to cellular starvation. Despite having high levels of circulating blood glucose, the cells are unable to absorb the glucose because of insulin resistance, leading to starvation and weight loss.

The nurse is caring for a client who was recently diagnosed with type 2 diabetes mellitus (DM). Which nursing diagnosis is considered the highest priority? A. Impaired walking related to diabetic neuropathy B. Risk for unstable blood glucose related to insufficient diabetes management C. Ineffective peripheral tissue perfusion related to vascular inflammation due to hyperglycemia D. Readiness for enhanced health management related to desire to prevent disease complications

C. Ineffective peripheral tissue perfusion related to vascular inflammation due to hyperglycemia This is the priority nursing diagnosis because ineffective tissue perfusion is considered a physiological need in Maslow's hierarchy of needs. Nurses must focus care on physiological problems before addressing other client needs. Ineffective tissue perfusion can lead to ischemia and necrosis.

Which patient is most likely to have cholesterol-based gallstones? A) A 35 year old female gym rat who eats baked chicken with rice and broccoli for dinner each day B) An 21 year old "boulder bro" with 13% body fat C) A 60 year old childfree man weighing 130 pounds D) A 45 year old woman who has had three pregnancies, is obese, and is nervous about switching her birth control to an IUD

D) A 45 year old woman who has had three pregnancies, is obese, and is nervous about switching her birth control to an IUD Two to three times more women than men develop cholesterol stones and gallbladder disease; affected women are usually older than 40 years, multiparous, and have obesity (Feldman et al., 2016; Goldman & Schafer, 2019; Hammer & McPhee, 2019). Stone formation is more frequent in people who use oral contraceptives, estrogens, or clofibrate; these medications are known to increase biliary cholesterol saturation (Hammer & McPhee, 2019).

Lucille Bluth comes into to the ER complaining of pain and tenderness in her upper right abdomen. She says she feels nauseous. The nurse asks her if the pain radiates anywhere and she says it radiates to her right shoulder. The nurse also notes rigidity of the upper right abdomen. What is the probable cause of Mrs. Bluth's illness? A) Seal attack B) Stress from hiding a surreptitious affair with her husband's brother C) The increasing cost of bananas D) Cholecystitis

D) Cholecystitis Cholecystitis (inflammation of the gallbladder which can be acute or chronic) causes pain, tenderness, and rigidity of the upper right abdomen that may radiate to the midsternal area or right shoulder and is associated with nausea, vomiting, and the usual signs of an acute inflammation.

The nurse is discussing the use of the hemoglobin A1c (HbA1c) test used in the diagnosis of type 2 diabetes mellitus (DM) with a client. Which client statement indicates additional teaching is necessary? A. "If I have a blood transfusion, my HbA1c levels may change." B. "I can have my HbA1c checked every few months to gauge my average blood sugar levels." C. "I am aiming for my level to be below 5.7%." D. "I am going to fast before my blood work is done, so my sugar levels are lower."

D. "I am going to fast before my blood work is done, so my sugar levels are lower." The HbA1c test analyzes the proportion of hemoglobin in red blood cells that has glucose stuck to it, called glycosylated hemoglobin. This proportion does not change day-to-day, so the test gives a sense for whether the blood glucose levels have been high over the past two to three months. Therefore, fasting prior to the test is not necessary and will not change the results.

The nurse has provided education to a client prescribed insulin for the treatment of type 1 diabetes mellitus (DM). Which statement made by the client indicates further teaching is required? Elimination tool A. "I will rotate my injection site with each new injection." B. "I will store my opened vial of insulin at room temperature." C. "If I experience dizziness, I will immediately check my blood sugar." D. "I do not need to monitor my blood glucose if I feel well."

D. "I do not need to monitor my blood glucose if I feel well." The client should be instructed to monitor their blood glucose as prescribed by the healthcare provider, even if they feel well.

A student nurse tells the nurse they do not understand how the insulin will help lower their client's blood sugar. Which is the best response by the nurse? Elimination tool A. "Insulin destroys the molecules of glucose." B. "Insulin blocks glucose from entering the blood." C. "Insulin increases the excretion of glucose excreted from the body." D. "Insulin stimulates glucose uptake from the blood into the cells."

D. "Insulin stimulates glucose uptake from the blood into the cells." Once administered, insulin binds to its receptors on the surface of the cell membrane on insulin-responsive tissues like muscle cells and adipose tissue, and facilitates their uptake of glucose from the blood.

The nurse is caring for a client currently being treated for diabetic ketoacidosis (DKA) who is asking for a lunch tray. The client is currently receiving a continuous insulin infusion. The most recent glucose level is 210mg/dL. What is the most appropriate action by the nurse? A. Administer a bolus of IV insulin and allow the client to eat B. Keep the client NPO until glucose is less than 150mg/dL C. Administer a subcutaneous injection of long-acting insulin and discontinue the insulin infusion. D. Administer a subcutaneous injection of rapid-acting insulin and allow the client to eat.

D. Administer a subcutaneous injection of rapid-acting insulin and allow the client to eat. Clients being treated for DKA who eat or drink must be "bridged" with rapid-acting, meal-coverage insulin. This means that the client should receive meal-coverage insulin while simultaneously receiving the IV insulin infusion for two more hours. Subcutaneous rapid-acting insulin has an onset of 15-30 minutes and will accomodate for the client's intake.

A nurse is caring for a client in an outpatient interventional radiology unit who undergoes paracentesis weekly. During this visit, the nurse observes the client to be more confused and with more abdominal swelling than usual. What is the most appropriate action by the nurse? Elimination tool A. Ask the client when their last bowel movement was B. Communicate with the client the need to stop drinking alcohol C. Instruct the assistive personnel to obtain vital signs in 2 hours D. Immediately notify the health care provider

D. Immediately notify the health care provider The physician should be made aware that the client has a change in mental status and increased volumes of ascites, which both indicate worsening of condition. Severely impaired liver function can lead to buildup of toxins in the blood that can ultimately lead to hepatic encephalopathy. It is important for the nurse to communicate the findings to the physician urgently, to prevent worsening of this client's condition.

The nurse is caring for a client diagnosed with acute kidney injury (AKI) who has a urine output of 600 mL in 24 hours, jugular venous distention, and pitting edema in the bilateral ankles. The nurse should suspect that the client is experiencing which phase of AKI? Elimination tool A. Recovery B. Diuresis C. Onset D. Oliguric

D. Oliguric This phase generally begins when urine output decreases to less than 30 mL per hour, which can lead to fluid overload, peripheral edema, and weight gain. This can last from one to three weeks.

The nurse in the intermediate care unit is reviewing the laboratory results for a client diagnosed with diabetic ketoacidosis (DKA) who is prescribed intravenous (IV) insulin. Which laboratory result should the nurse evaluate prior to administration? Elimination tool A. White blood cell count (WBC) B. Thyroid panel C. Pancreatic enzymes D. Potassium level

D. Potassium level The nurse should review the potassium level of a client prescribed IV insulin. The normal potassium range is 3.5 to 5.1 mEq/L. IV insulin can decrease the potassium level, causing hypokalemia. This is because insulin causes potassium to shift into the cells.

A client comes to the emergency department reporting severe abdominal pain. During the assessment of the client, the nurse notes a grossly distended abdomen with increased vascularity. There is dullness to palpation. Which action is most appropriate for the nurse to implement first? A. Alert the substance abuse team B. Educate the client about the importance of weight loss C. Administer albumin intravenously D. Prepare the client for paracentesis

D. Prepare the client for paracentesis This client has symptoms of ascites which is a condition experienced by clients with advanced cirrhosis. It describes the buildup of fluid in the peritoneal space surrounding the abdomen. It can present as abdominal swelling and distension with increased vascularity or striae. Dullness to palpation can indicate the presence of fluid. The most appropriate action is to prepare the client for paracentesis, which is a minimally invasive procedure performed to drain the fluid from the abdomen to relieve the client's discomfort.

The nurse has been assigned to care for a client with diabetic ketoacidosis (DKA). Which assessment findings should the nurse anticipate? A. Dizziness, headache, pH 7.5 B. Ammonia level of 66 µ/dL, distended abdomen, slurred speech C. Oral temperature 102.2°F, photophobia, neck pain D. Respiratory rate of 28 breaths per minute, bilious emesis, confusion

D. Respiratory rate of 28 breaths per minute, bilious emesis, confusion Assessment findings in clients with DKA commonly include deep, labored, and rapid breathing (known as Kussmaul respirations); abdominal pain; nausea and vomiting; confusion; lethargy; and weakness as well as a decreased pH and elevated blood glucose.

The nurse is caring for a client diagnosed with Acute Kidney Injury (AKI) with the following laboratory results: Laboratory value Result Potassium 4.3 mEq/L Phosphate 7 mg/dL Sodium 155 mEq/L Based upon the laboratory results, which prescription order should the nurse question? A. 5% dextrose (D5W) intravenously B. Furosemide C. Sevelamer carbonate D. Sodium polystyrene

D. The nurse should question this medication since sodium polystyrene is a potassium binder used to treat hyperkalemia. Normal potassium levels are 3.5-5.1 mEq/L, so this medication is not indicated. Sevelamer carbonate is a phosphate binder administered orally to prevent hyperphosphatemia in clients with kidney disease. This medication does not need to be questioned because this client is experiencing hyperphosphatemia. Normal phosphate levels are 3.0-4.5 mg/dL.

A patient has just been diagnosed with BPH (benign prostatic hyperplasia). What kind of incontinence could the patient experience if his condition worsens? A) Mixed incontinence B) Functional incontinence C) Stress incontinence D) Urge incontinence

D. Urge incontinence

The nurse is reviewing the electronic health record (EHR) of a client with type 2 diabetes mellitus (DM) being treated with subcutaneous insulin lispro. The last administration time of insulin lispro was 1015. When should the onset of the medication begin?

Insulin lispro is a rapid acting insulin that begins to exert its effects within 15 minutes of subcutaneous administration, and peak levels occur 30 to 90 minutes after administration. Duration of insulin lispro is five hours or less. If the medication was administered at 1015, onset would begin at 1030.

The nurse reviews the causes of jaundice with a newly graduated nurse.For each classification of jaundice, click to indicate which condition is associated. - Hemolytic (prehepatic) - Hepatocellular (intrahepatic) - Obstructive (posthepatic) ********************* Sickle cell disease Pregnancy Gilbert Syndrome Pancreatitis Blood transfusion reaction Cirrhosis

Sickle cell disease - Hemolytic Pregnancy - Obstructive Gilbert Syndrome - Hepatocellular Pancreatitis - Obstructive Blood transfusion reaction - Hemolytic Cirrhosis - Hepatocellular The causes of jaundice can be classified as hemolytic or prehepatic, hepatocellular or intrahepatic, and obstructive or posthepatic. Hemolytic jaundice is caused by hemolysis or breakdown of red blood cells, which occurs in conditions like hemolytic anemia, sickle cell disease, spherocytosis, thalassemia, G6PD deficiency, or blood transfusion reactions, as well as with reabsorption of large hematomas. Hepatocellular jaundice can be caused by conditions that damage the liver, such as hepatitis, cirrhosis, liver failure, or liver cancer, and certain medications that may cause hepatotoxicities, such as acetaminophen or rifampin. Hepatocellular jaundice can also be caused by inherited disorders affecting liver function, such as Gilbert syndrome, Crigler-Najjar syndrome, or Dubin-Johnson syndrome. Lastly, obstructive jaundice is caused by conditions that block the bile ducts, causing cholestasis or obstructed bile flow. These conditions include gallstones, pancreatitis, pancreatic cancer, congenital defects, and pregnancy. Lastly, risk factors for jaundice include newborn and elderly clients, hepatic disease, alcohol use, certain medications, and pregnancy.