Test 3 Practice Qs
potassium
ACE Inhibitors cause __________ retention
3
An adult female in her 30s complains of numbness and tingling in the hands, fatigue, loss of coordination, incontinence, nystagmus, and ataxia. Which of the following health problems do these symptoms suggest to the nurse? 1. Brain tumor 2. Myasthenia gravis 3. Multiple sclerosis 4. Diabetes
d
An advantage of peritoneal dialysis is that: a. peritoneal dialysis is time intensive. b. a decreased risk of peritonitis exists. c. biochemical disturbances are corrected rapidly. d. the danger of hemorrhage is minimal.
c
Before administration of calcium carbonate to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for a. potassium level. c. serum phosphate. b. total cholesterol. d. serum creatinine.
a,b
Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.) a. Hypotension b. Dysrhythmias c. Muscle cramps d. Hemolysis e. Air embolism
D
Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. The Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse's priority intervention is to: A. Administer the medication exactly on time B. Administer the medication with food or mild C. Evaluate the client s muscle strength hourly after medication D. Evaluate the client s emotional side effects between doses
a,d,e
Identify which substances would indicate a problem with renal function. (Select all that apply). a. protein. b. sodium. c. creatinine. d. red blood cells. e. uric acid.
calcium
If serum phosphate is elevated, the ______ and phosphate can cause soft tissue calcification.
d
In determining the glomerular filtration rate (GFR) or creatinine clearance, a 24-hour urine is obtained. If a reliable 24-hour urine collection is not possible, a. it is not possible to determine the GFR. b. the BUN may be used to determine renal function. c. an elevated BUN/creatinine ratio can be used. d. a standardized formula may be used to calculate GFR.
A
In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will cause a temporary increase in: A.Muscle strength B.Symptoms C.Blood pressure D.Consciousnes
0.6-1.3
Normal Creatinine
b
Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis: a. is more frequently used for acute kidney injury. b. uses the patients own semipermeable membrane (peritoneal membrane). c. is not useful in cases of drug overdose or electrolyte imbalance. d. is not indicated in cases of water intoxication.
4
The 45-year-old client is diagnosed with primary progressive multiple sclerosis and the nurse writes the nursing diagnosis "anticipatory grieving related to progressive loss." Which intervention should be implemented? 1. Consult the physical therapist for assistive devices for mobility. 2. Determine if the client has a legal power of attorney. 3. Ask if the client would like to talk to the hospital chaplain. 4. Discuss the client's wishes regarding end-of-life care.
2
The client diagnosed with MG is admitted to the emergency department with a sudden exacerbation of motor weakness. Which assessment data indicate the client is experiencing a myasthenic crisis? 1. The serum assay of circulating acetylcholine receptor antibodies is increased. 2. The client's symptoms improve when administering on a cholinesterase inhibitor. 3. The client's blood pressure, pulse, and respirations improve after intravenous (IV) fluid. 4. The Tensilon test does not show improvement in the client's muscle strength
1
The client is diagnosed with MG. Which intervention should the nurse implement when administering the anticholinesterase pyridostigmine (Mestinon)? 1. Assess for excess salivation and abdominal cramps. 2. Administer the medication before the client has eaten. 3. Break the capsule and sprinkle the medication on the food. 4. Assess the client's potassium level prior to administering medication.
C
Which of the following is used to diagnose ALS? A) CT scan B) PET scan C) Physical Exam D) hCG protein
Dialysis Disequilibrium Syndrome
caused by the rapid removal of urea during hemodialysis
uremia
condition caused by a buildup of nitrogenous waste products due to kidney impairment. It is characterized by anorexia, itching, nausea, vomiting, and muscle cramps
10-20
normal BUN
b
A 25-yr-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider? a. Serum creatinine level of 2.1 mg/dL b. Serum potassium level of 6.5 mEq/L c. White blood cell count of 11,500/μL d. Blood urea nitrogen (BUN) of 56 mg/dL
c
A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? a. Recommendation to drink at least 4 L of fluid daily b. Need to avoid driving or operating heavy machinery c. How to draw up and administer injections of the medication d. Use of contraceptive methods other than oral contraceptives
c
A 37-yr-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function? a. Urine volume c. Glomerular filtration rate (GFR) b. Creatinine level d. Blood urea nitrogen (BUN) level
c
A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? a. Creatinine 1.6 mg/dL c. Hemoglobin level 13 g/dL b. Oxygen saturation 89% d. Blood pressure 98/56 mm Hg
b
A 62-yr-old female patient has been hospitalized for 4 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider? a. The creatinine level is 3.0 mg/dL. b. Urine output over an 8-hour period is 2500 mL. c. The blood urea nitrogen (BUN) level is 67 mg/dL. d. The glomerular filtration rate is less than 30 mL/min/1.73 m2
a
A 72-yr-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? a. Insert urethral catheter. b. Obtain renal ultrasound. c. Draw a complete blood count. d. Infuse normal saline at 50 mL/hour.
b
A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis? Which initial response by the nurse is best? a. "It depends on which type of dialysis you are considering." b. "Tell me more about what you are thinking regarding dialysis." c. "You are the only one who can make the decision about dialysis." d. "Many people your age use dialysis and have a good quality of life."
B
A client diagnosed with ALS is dealing with muscle spasticity. Which of the following medications is most likely to be prescribed? A) Hydralazine B) Baclofen (Lioresal) C) Lidocaine (Xylocaine) D) Methylpredinsolone (Solu-Medrol)
3
A client diagnosed with Parkinsons disease is beginning medication therapy. The nurse realizes that the goal of treatment for Parkinsons disease is to: 1. improve sleep. 2. reduce appetite. 3. control tremor and rigidity. 4. reduce the need for joint replacement surgery.
1,2,3,4,5
A client has been diagnosed with Parkinsons disease. Which of the following will the nurse most likely assess in this client? (Select all that apply.) 1. Tremor 2. Muscle rigidity 3. Akinesia 4. Mask-like face 5. Dysphagia 6. Reduced appetite
3
A client has end-stage kidney disease and is receiving hemodialysis. During dialysis the client reports nausea and a headache and appears confused. Operating on prescribed protocols, which action will the nurse take? 1 Give an analgesic. 2 Administer an antiemetic. 3 Decrease the rate of exchange. 4 Discontinue the procedure immediately.
3
A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed? 1 It equals the expected urinary output for the next 24 hours. 2 It will prevent the development of pneumonia and a high fever. 3 It will compensate for both insensible and expected output over the next 24 hours. 4 It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.
1
A client is admitted to the hospital with a tentative diagnosis of Guillain-Barré syndrome. Which question by the nurse will best elicit information that supports this diagnosis? 1 "Have you experienced an infection recently?" 2 "Is there a history of this disorder in your family?" 3 "Did you receive a head injury during the past year?" 4 "What medications have you taken in the last several months?"
1
A client is admitted to the hospital with the diagnosis of Parkinson disease. What medication does the nurse expect the healthcare provider to prescribe to relieve the client's physiologic responses to this disease? 1 Carbidopa-levodopa 2 Isocarboxazid 3 Selegiline 4 Dopamine 5 Pyridoxine (vitamin B6)
1
A client residing in an assisted living facility is diagnosed with Parkinson disease, and the healthcare provider prescribes selegiline. What precaution will the nurse teach the client? 1 Change to a standing position slowly. 2 Take the medication between meals. 3 Perform self-blood glucose monitoring. 4 Withhold the next dose if nausea occurs.
4
A client with Guillain-Barré syndrome has been hospitalized for three days. Which assessment finding would the nurse expect and need to monitor frequently in this client? 1 Localized seizures 2 Skin desquamation 3 Hyperactive reflexes 4 Ascending weakness
2
A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? 1 Facial flushing 2 Edema and pruritus 3 Dribbling after voiding and dysuria 4 Diminished force and caliber of stream
4
A client with acute kidney failure is fatigued and becomes lethargic. Upon reviewing the client's medical record, which finding does the nurse determine is the most likely cause of this change in symptoms? 1 Hyperkalemia 2 Hypernatremia 3 A limited fluid intake 4 An increased blood urea nitrogen level
4
A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. Which is an appropriate nursing response? 1 "The staff will provide total care, because the infection causes severe fatigue." 2 "Mood elevators will be prescribed to improve depression and irritability." 3 "Vitamin B12 will be prescribed for the anemia, and the stools will be dark." 4 "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."
2
A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information? 1 Prevention of uremic frost 2 Prevention of chronic fatigue 3 Prevention of tubular necrosis 4 Prevention of dependent edema
1
A client with kidney dysfunction reports anorexia, itching, nausea, vomiting, and muscle cramps. Which renal complication do these symptoms indicate? 1 Uremia 2 Nephritis 3 Nephrosis 4 Renal colic
A
A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by: A.Blocking the action of cholinesterase B.Accelerating transmission along neural swaths C.Replacing deficient neurotransmitters D.Stimulating the cerebral cortex
c
A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: A Getting too little exercise B Taking excess medication c. Omitting doses of medication D Increasing intake of fatty foods
C
A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: A. Getting too little exercise B. Taking excess medication C. Omitting doses of medication D. Increasing intake of fatty foods
c
A female client with Guillain-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness? A Giving client full control over care decisions and restricting visitors B Providing positive feedback and encouraging active range of motion C Providing information, giving positive feedback, and encouraging relaxation D Providing intravenously administered sedatives, reducing distractions and limiting visitors
b
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient's abdomen appears bloated after the inflow. d. The patient has abdominal pain during the inflow phase.
d
A male client is having a lumbar puncture performed. The nurse would plan to place the client in which position? A Side-lying, with a pillow under the hip B Prone, with a pillow under the abdomen C Prone, in slight-Trendelenburg's position d. Side-lying, with the legs pulled up and head bent down onto chest.
4
A nurse administers carbidopa-levodopa to a client with Parkinson disease. Which therapeutic effect does the nurse expect the medication to produce? 1 Increase in acetylcholine production 2 Regeneration of injured thalamic cells 3 Improvement in myelination of neurons 4 Replacement of a neurotransmitter in the brain
2
A nurse is caring for a client newly diagnosed with Guillain-Barré syndrome. The nurse expects which procedure will be considered as a treatment option? 1 Hemodialysis 2 Plasmapheresis 3 Thrombolytic therapy 4 Immunosuppression therapy
1,4
A nurse is caring for a client with chronic kidney failure. Which clinical findings should the nurse expect when assessing this client? Select all that apply. 1 Polyuria 2 Lethargy 3 Hypotension 4 Muscle twitching 5 Respiratory acidosis
c
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine volume c. Cardiac rhythm b. Calcium level d. Neurologic status
b
A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? a. Observe for agitation and paranoia. b. Assist with active range of motion (ROM). c. Give muscle relaxants as needed to reduce spasms. d. Use simple words and phrases to explain procedures.
b
A patient with Parkinson's disease has bradykinesia. Which action will the nurse include in the plan of care? a. Instruct the patient in activities that can be done while lying or sitting. b. Suggest that the patient rock from side to side to initiate leg movement. c. Have the patient take small steps in a straight line directly in front of the feet. d. Teach the patient to keep the feet in contact with the floor and slide them forward.
d
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? a. Notify the patient's health care provider. b. Document the QRS interval measurement. c. Review the chart for the patient's current creatinine level. d. Check the medical record for the most recent potassium level.
C
A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client's history. Which preexisting condition would contraindicate the use of pyridostigmine? A. Ulcerative colitis B. Blood dyscrasia C. Intestinal obstruction D. Spinal cord injury
1,5
Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse assesses for which adverse responses that are associated with this medication? Select all that apply. 1 Nausea 2 Lethargy 3 Bradycardia 4 Polycythemia 5 Emotional changes
d
Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that: a. a hemofilter is used to facilitate ultrafiltration. b. it provides faster removal of solute and water. c. it does not allow diffusion to occur. d. the process removes solutes and water slowly
creatinine, 48, 72
Contrast- induced kidney injury is diagnosed by an increase in serum __________ within ____ to ____ hours
a
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the a. bowel sounds. c. blood urea nitrogen (BUN). b. blood glucose. d. level of consciousness (LOC).
3
The 30-year-old female client is admitted with complaints of numbness, tingling, a crawling sensation affecting the extremities, and double vision which has occurred two(2) times in the month. Which question is most important for the nurse to ask the client? 1. "Have you experienced any difficulty with your menstrual cycle?" 2. "Have you noticed a rash across the bridge of your nose?" 3. "Do you get tired easily and sometimes have problems swallowing?" 4. "Are you taking birth control pills to prevent conception
1,3,4,5
The client diagnosed with Guillain-Barré syndrome is admitted to the rehabilitation unit after 23 days in the acute care hospital. Which interventions should the nurse implement?Select all that apply. 1. Refer client to the physical therapist. 2. Include the speech therapist in the team. 3. Request a social worker consult. 4. Implement a regimen to address pain control. 5. Refer the client to the Guillain-Barré Syndrome Foundation
4
The client diagnosed with Guillain-Barré syndrome is on a ventilator. When the wife comes to visit she starts crying uncontrollably, and the client starts fighting the ventilator because his wife is upset. Which action should the nurse implement? 1. Tell the wife she must stop crying. 2. Escort the wife out of the room. 3. Medicate the client immediately. 4. Acknowledge the wife's fears
2
The client diagnosed with Guillain-Barré syndrome is on a ventilator. Which intervention will assist the client to communicate with the nursing staff? 1. Provide an erase slate board for the client to write on .2. Instruct the client to blink once for "no" and twice for "yes." 3. Refer to a speech therapist to help with communication. 4. Leave the call light within easy reach of the client.
1
The client diagnosed with MG is being discharged home. Which intervention should the nurse teach the significant other? 1. Discuss how to perform the Heimlich maneuver. 2. Explain how to perform oral hygiene on a conscious client. 3. Teach how to perform isometric exercises. l 4. Demonstrate correct hand placement for chest compressions.
3
The client diagnosed with PD is being discharged on carbidopa/levodopa (Sinemet), an antiparkinsonian drug. Which statement is the scientific rationale for combining these medications? 1. There will be fewer side effects with this combination than with carbidopa alone. 2. Dopamine D requires the presence of both of these medications to work. 3. Carbidopa makes more levodopa available to the brain. 4. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.
2
The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain these assessment data? 1. Masklike facies and shuffling gait. 2. Difficulty swallowing and immobility. 3. Pill rolling of fingers and flat affect. 4. Lack of arm swing and bradykinesia.
3
The client diagnosed with Parkinson's disease is being discharged. Which statement made by the significant other indicates an understanding of the discharge instructions? 1. "All of my spouse's emotions will slow down now just like his body movements." 2. "My spouse may experience hallucinations until the medication starts working." 3. "I will schedule appointments late in the morning after his morning bath." 4. "It is fine if we don't follow a strict medication schedule on weekends."
3
The client diagnosed with an acute exacerbation of multiple sclerosis is placed on high-dose intravenous injections of corticosteroid medication. Which nursing intervention should be implemented? 1. Discuss discontinuing the proton pump inhibitor with the HCP. 2. Hold the medication until after all cultures have been obtained. 3. Monitor the client's serum blood glucose levels frequently .4. Provide supplemental dietary sodium with the client's meals.
2
The client diagnosed with multiple sclerosis is scheduled for a magnetic resonanceimaging (MRI) scan of the head. Which information should the nurse teach the client about the test? 1. The client will have wires attached to the scalp and lights will flash off and on. 2. The machine will be loud and the client must not move the head during the test. 3. The client will drink a contrast medium 30 minutes to one (1) hour before the test. 4. The test will be repeated at intervals during a five (5)- to six (6)-hour period.
A
The client is experiencing a myasthenic crisis. Which of the following is a priority action of the following ordered actions? A) Insert NG tube B) Administer Ativan C) Monitor I&O D) Immediately stop anticholinesterase medications
A
The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is: A. Prostigmine (neostigmine) B. Atropine (atropine sulfate) C. Didronel (etidronate) D. Tensilon (edrophonium)
3
The home health nurse is caring for the client newly diagnosed with multiple sclerosis. Which client issue is of most importance? 1. The client refuses to have a gastrostomy feeding. 2. The client wants to discuss if she should tell her fiancé. 3. The client tells the nurse life is not worth living anymore .4. The client needs the flu and pneumonia vaccines.
C
The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to: A. Develop a teaching plan B. Facilitate psychologic adjustment C. Maintain the present muscle strength D. Prepare for the appearance of myasthenic crisis
a,c,d,e
The most common reasons for initiating dialysis in acute kidney injury include which of the following? (Select all that apply.) a. Acidosis b. Hypokalemia c. Volume overload d. Hyperkalemia e. Uremia
a
The nurse advises a patient with myasthenia gravis (MG) to a. perform physically demanding activities early in the day. b. anticipate the need for weekly plasmapheresis treatments. c. do frequent weight-bearing exercise to prevent muscle atrophy. d. protect the extremities from injury due to poor sensory perception.
4
The nurse and a licensed practical nurse (LPN) are caring for a group of clients.Which nursing task should not be assigned to the LPN? 1. Administer a skeletal muscle relaxant to a client diagnosed with low back pain. 2. Discuss bowel regimen medications with the HCP for the client on strict bed rest. 3. Draw morning blood work on the client diagnosed with bacterial meningitis. 4. Teach self-catheterization to the client diagnosed with multiple sclerosis.
1
The nurse and the unlicensed assistive personnel (UAP) are caring for clients on a medical-surgical unit. Which task should not be assigned to the UAP? 1. Feed the 69-year-old client diagnosed with Parkinson's disease who is having difficulty swallowing. 2. Turn and position the 89-year-old client diagnosed with a pressure ulcer secondary to Parkinson's disease. 3. Assist the 54-year-old client diagnosed with Parkinson's disease with toilet-training activities. 4. Obtain vital signs on a 72-year-old client diagnosed with pneumonia secondary to Parkinson's disease.
4
The nurse caring for a client diagnosed with Parkinson's disease writes a problem of "impaired nutrition." Which nursing intervention would be included in the plan of care? 1. Consult the occupational therapist for adaptive appliances for eating. 2. Request a low-fat, low-sodium diet from the dietary department. 3. Provide three (3) meals per day that include nuts and whole-grain breads. 4. Offer six (6) meals per day with a soft consistency.
2
The nurse caring for the client diagnosed with Guillain-Barré syndrome writes the client problem "impaired physical mobility." Which long-term goal should be written for this problem? 1. The client will have no skin irritation. 2. The client will have no muscle atrophy. 3. The client will perform range-of-motion exercises. 4. The client will turn every two (2) hours while awake.
2
The nurse enters the room of a client diagnosed with acute exacerbation of multiple sclerosis and finds the client crying. Which statement is the most therapeutic response for the nurse to make? 1. "Why are you crying?The medication will help the disease." 2. "You seem upset. I will sit down and we can talk for awhile." 3. "Multiple sclerosis is a disease that has good times and bad times." 4. "I will have the chaplain come and stay with you for a while."
C
The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? a. Acetaminophen c. Magnesium hydroxide b. Calcium phosphate d. Multivitamin with iron
1,3,4,5
The nurse is admitting a client diagnosed with multiple sclerosis. Which clinical manifestation should the nurse assess?Select all that apply. 1. Muscle flaccidity. 2. Lethargy. 3. Dysmetria. 4. Fatigue. 5. Dysphagia.
4
The nurse is admitting a client with the diagnosis of Parkinson's disease. Which assessment data support this diagnosis? 1. Crackles in the upper lung fields and jugular vein distention. 2. Muscle weakness in the upper extremities and ptosis. 3. Exaggerated arm swinging and scanning speech. 4. Masklike facies and a shuffling gait.
4
The nurse is assessing a 48-year-old client diagnosed with multiple sclerosis. Which clinical manifestation warrants immediate intervention? 1. The client has scanning speech and diplopia. 2. The client has dysarthria and scotomas. 3. The client has muscle weakness and spasticity. 4. The client has a congested cough and dysphagia.
a
The nurse is caring for a patient receiving peritoneal dialysis. The patient suddenly complains of abdominal pain and chills. The patients temperature is elevated. The nurse should: a. assess peritoneal dialysate return. b. check the patients blood sugar. c. evaluate the patients neurological status. d. inform the provider of probable visceral perforation.
d
The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is evaluating the patients urinalysis results. The nurse should become concerned when a. creatinine levels in the urine are similar to blood levels of creatinine. b. sodium and chloride are found in the urine. c. urine uric acid levels have the same values as serum levels. d. red blood cells and albumin are found in the urine.
a
The nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patients urine output has been less than 20 mL/hour for the past 2 hours. It is 0200 in the morning. The patients blood pressure is 100/60 mm Hg, and the pulse is 110 beats per minute. Previously, the pulse was 90 beats per minute with a blood pressure of 120/80 mm Hg. The nurse should: a. contact the provider and expect an order for a normal saline bolus. b. wait until 0900 when the provider makes rounds to report the assessment findings. c. continue to evaluate urine output for 2 more hours. d. ignore the urine output, as this is most likely postrenal in origin.
d
The nurse is caring for a patient with acute kidney injury who is being treated with hemodialysis. The patient asks if he will need dialysis for the rest of his life. Which of the following would be the best response? a. Unfortunately, kidney injury is not reversible; it is permanent. b. Kidney function usually returns within 2 weeks. c. You will know for sure if you start urinating a lot all at once. d. recovery is possible, but it may take several months.
b
The nurse is caring for an elderly patient who was admitted with renal insufficiency. The nurse realizes that with advance age often comes declining renal function. An expected laboratory finding for this patient may be: a. an increased glomerular filtration rate (GFR). b. a normal serum creatinine level. c. increased ability to excrete drugs. d. hypokalemia.
3
The nurse is caring for clients on a medical-surgical floor. Which client should be assessed first? 1. The 65-year-old client diagnosed with seizures who is complaining of a headache that is a "2" on a 1-to-10 scale. 2. The 24-year-old client diagnosed with a T10 spinal cord injury who cannot move his toes. 3. The 58-year-old client diagnosed with Parkinson's disease who is crying and worried about her facial appearance. 4. The 62-year-old client diagnosed with a cerebrovascular accident who has a resolving left hemiparesis.
2
The nurse is conducting a support group for clients diagnosed with Parkinson's disease and their significant others. Which information regarding psychosocial needs should be included in the discussion? 1. The client should discuss feelings about being placed on a ventilator. 2. The client may have rapid mood swings and become easily upset. 3. Pill-rolling tremors will become worse when the medication is wearing off. 4. The client may automatically start to repeat what another person says.
3
The nurse is discharging a client diagnosed with MG. Which statement by the client indicates an understanding of the discharge instructions? 1. "I can control the MG with medication, but an adenectomy will cure it." 2. "I should take a holiday from my medications every 4 or 5 weeks." 3. "I must take my medications on time every day, or I could have problems." 4. "I should take my steroid medications with food so it won't upset my stomach."
2,3,4,5,6
The nurse is instructing a client and family regarding the diagnosis of amyotrophic lateral sclerosis. Which of the following should be included in this teaching? (Select all that apply.) 1. The length of the curative treatment 2. That exercise and physical therapy can help the patient maximize function 3. The physical, emotional, and social aspects of the disease 4. End-of-life issues 5. The use of devices to prevent aspiration pneumonia 6. The use of a speech therapist to aid with communication
2
The nurse is instructing a client newly diagnosed with multiple sclerosis (MS). To determine the effectiveness of his teaching, the nurse would expect the client to state: 1. It is best for me to be in a cold environment. 2. I should avoid taking a hot bath. 3. I should eat foods low in salt. 4. I should be better in a week.
B,C,D
The nurse is performing an assessment on a patient with amyotrophic lateral sclerosis (ALS). Which of the following symptoms would the nurse expect to find? SATA A) Urinary incontinence B) Asymmetric muscle weakness C) Nasal vocal quality D) Fatigue E) Muscle weakness beginning in lower extremities
1,3,4,6
The nurse is planning care for a client diagnosed with myasthenia gravis. Which of the following should be included in this clients plan of care? (Select all that apply.) 1. Monitor activities frequently and assist as needed. 2. Encourage progressive increase in activities. 3. Determine the best communication method. 4. Monitor weight. 5. Restrict fluids. 6. Instruct in energy conservation measures
b
The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will be a. augmenting fluid volume. c. diluting nephrotoxic substances. b. maintaining cardiac output. d. preventing systemic hypertension.
4
The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a therapeutic goal of treatment for the disease process? 1. The client will experience periods of akinesia throughout the day. 2. The client will take the prescribed medications correctly. 3. The client will be able to enjoy a family outing with the spouse. 4. The client will be able to carry out activities of daily living.
C
The nurse is teaching a client about myasthenia gravis. Which statement, if made by the patient indicates the need for further teaching? A) The doctor will take me off of my beta blocker because it could exacerbate my symptoms B) I should report any signs of infection to my PCP C) I can take a ibuprofen to help with pain that may occur with spasms D) I should avoid taking long walks
b
The nurse is teaching a female client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to: a.take a hot bath. b. rest in an air-conditioned room. C. increase the dose of muscle relaxants. D. avoid naps during the day.
d
The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: A Eating large, well-balanced meals B Doing muscle-strengthening exercises C Doing all chores early in the day while less fatigued D Taking medications on time to maintain therapeutic blood levels
D
The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: A. Eating large, well-balanced meals B. Doing muscle-strengthening exercises C. Doing all chores early in the day while less fatigued D. Taking medications on time to maintain therapeutic blood levels
A
The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: A.Taking medications on time to maintain therapeutic blood levels B.Doing all chores early in the day while less fatigued C.Doing muscle-strengthening exercises D.Eating large, well-balanced meals
4
The nurse observes a client with kidney failure has increased rate and depth of breathing. Which laboratory parameter does the nurse suspect is associated with this client's condition? 1 Potassium 8 mEq/L 2 Hemoglobin 10 g/dL 3 Phosphorous 7 mg/dL 4 Bicarbonate 15 mEq/L
4
The nurse researcher is working with clients diagnosed with Parkinson's disease. Which is an example of an experimental therapy? 1. Sterotactic pallidotomy/thalamotomy. 2. Dopamine receptor agonist medication. 3. Physical therapy for muscle strengthening. 4. Fetal tissue transplantation.
1
The nurse writes the client problem of "altered sexual functioning" for a male client diagnosed with multiple sclerosis (MS). Which intervention should be implemented? 1. Encourage the couple to explore alternative ways of maintaining intimacy. 2. Make an appointment with a psychotherapist to counsel the couple. 3. Explain daily exercise will help increase libido and sexual arousal. 4. Discuss the importance of keeping physically calm during sexual intercourse.
b
The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. The nurse should: a. prepare to assist with a routine dialysis catheter change to replace the existing catheter. b. evaluate the patient for signs and symptoms of infection. c. teach the patient that the catheter is designed for long-term use. d. use one of the three lumens for fluid administration.
b
The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier. His blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; he has not voided in 8 hours and his bladder is not distended. The nurse anticipates an order for stat administration of: a. a blood transfusion. b. fluid replacement with 0.45% saline. c. infusion of an inotropic agent. d. an antiemetic.
b
The patient is a new postoperative patient. She weighs 75 kg. The nurse expects the minimal acceptable urine output to be: a. less than 30 mL/hour. b. 37 mL/hour. c. 80 mL/hour. d. 150 mL/hour.
b
The patient is admitted to the unit with the diagnosis of rhabdomyolysis. The patient is started on intravenous (IV) fluids and IV mannitol. Because mannitol is an osmotic diuretic, the nurse should: a. assess the patients hearing. b. assess the patients lungs. c. decrease IV fluids once the diuretic has been administered. d. give extra doses prior to giving radiological contrast agents.
a,c,d
The patient is admitted with acute kidney injury from a postrenal cause. Acceptable treatments for that diagnosis include: (Select all that apply.) a. bladder catheterization. b. increasing fluid volume intake. c. ureteral stenting. d. placement of nephrostomy tubes. e. increasing cardiac output.
c
The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patients urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has: a. acute kidney injury from a prerenal condition. b. acute kidney injury from postrenal obstruction. c. intrarenal disease, probably acute tubular necrosis. d. a urinary tract infection.
b
The patient is complaining of severe flank pain when he tries to urinate. His urinalysis shows sediment and crystals along with a few bacteria. Using this information along with the clinical picture, the nurse realizes that the patients condition is: a. prerenal. b. postrenal. c. intrarenal. d. not renal related.
c
The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of general malaise and is tachypneic. An arterial blood gas is ordered and shows that the patients pH is 7.19, with a PCO2 of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to: a. administer morphine to slow the respiratory rate. b. prepare for intubation and mechanical ventilation. c. administer intravenous sodium bicarbonate. d. cancel tomorrows dialysis session.
c
The patient is getting hemodialysis for the second time when he complains of a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of: a. dialyzer membrane incompatibility. b. a shift in potassium levels. c. dialysis disequilibrium syndrome. d. hypothermia
a
The patient is in need of immediate hemodialysis, but has no vascular access. The nurse prepares the patient for insertion of: a. a percutaneous catheter at the bedside. b. a percutaneous tunneled catheter at the bedside. c. an arteriovenous fistula. d. an arteriovenous graft.
d
The patient is in progressive care unit following arteriovenous fistula implantation in his left upper arm, and is due to have blood drawn with his next set of vital signs and assessment. When the nurse assesses the patient, the nurse should: a. draw blood from the left arm. b. take blood pressures from the left arm. c. start a new intravenous line in the left lower arm. d. auscultate the left arm for a bruit and palpate for a thrill.
a,c,d
The patient is in the critical care unit and will receive dialysis this morning. The nurse will: (Select all that apply.) a. evaluate morning laboratory results and report abnormal results. b. administer the patients antihypertensive medications. c. assess the dialysis access site and report abnormalities. d. weigh the patient to monitor fluid status. e. give all medications except for antihypertensive medications.
c
The patient is on intake and output (I&O) as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should: a. draw a trough level after the next dose of antibiotic. b. obtain an order to place the patient on fluid restriction. c. assess the patients lungs. d. insert an indwelling catheter.
b
The patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure. To detect signs of contrast-induced kidney injury, the nurse should: a. not be concerned unless urine output decreases. b. evaluate the patients serum creatinine for up to 72 hours after the procedure. c. obtain an order for a renal ultrasound. d. evaluate the patients post void residual volume to detect intrarenal injury.
C
The patient with myasthenia gravis arrives to the clinic and states that he is experiencing nausea and diarrhea. His blood pressure is 125/85 HR 70 Temp 100.0 R 19 O2 97%. What is the nursing priority? A) Prepare the patient for intubation. He is about to go into a myasthenic crisis. B) Perform teaching on medication side effects C) Assess for signs of infection D) Further assess for other thymectomy complication
D
The patient with myasthenia gravis is complaining about dealing with muscle weakness. Which of the following could the nurse do for this patient? A) Administer antispasmodic medication B) Teach the patient to do physical exercise for several hours each day to help strengthen muscles C) Teach the patient it is important to avoid all forms of physical activity whenever possible D) Help the patient form a plan to take medications on time
1
To prepare for hemodialysis, a client with end-stage kidney disease is scheduled for surgery, specifically for the creation of an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. When considering care for these sites, which difference will the nurse consider? 1 The graft is more subject to hemorrhage, clotting, and infection than the fistula is. 2 Blood pressure readings can be taken in the arm with the fistula but not in the one with the shunt. 3 Intravenous (IV) fluids can be administered in the arm with the shunt but not in the one with the fistula. 4 The fistula should be covered with a light dressing, and the shunt should be covered thoroughly with a heavy dressing.
2
What nursing intervention is anticipated for a client with Guillain-Barré syndrome? 1 Providing a straw to stimulate the facial muscles 2 Maintaining ventilator settings to support respiration 3 Encouraging aerobic exercises to avoid muscle atrophy 4 Administering antibiotic medication to prevent pneumonia
3
What should the nurse include when teaching a client with severe Parkinson's Disease about carbidopa-levodopa? 1 Multivitamins should be taken daily. 2 Alcohol consumption should be moderate. 3 The medication can be taken with meals. 4 A high-protein diet should be followed.
b
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of a. persistent skin tenting c. hot, flushed face and neck. b. rapid, deep respirations. d. bounding peripheral pulses.
D
When evaluating the extent of Parkinson's disease, a nurse observes for which condition? A) Bulging eyeballs B) Diminished distal sensation C) Increased dopamine levels D) Muscle Rigidity
b
When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should a. assess for the presence of chest pain. b. inquire about urinary tract problems. c. inspect the skin for rashes or discoloration. d. ask the patient about any increase in libido.
C
When prioritizing care, which of the following patients should the nurse see first? A) The 52 year old patient who is admitted for a relapse of MS day three whose being treated effectively with Solu-Medrol B) The patient who has been put on seizure precautions 24 hours ago C) The 32 year old female with a recent diagnosis of Guillain-Barre syndrome D) The 65 year old man who has just been diagnosed with early stage Parkinson's disease
C
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while taking a bath each day. d. The patient slows the inflow rate when experiencing abdominal pain.
b
Which action will the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder? a. Encourage a decreased evening intake of fluid. b. Teach the patient how to use the Credé method. c. Suggest the use of adult incontinence briefs for nighttime only. d. Assist the patient to the commode every 2 hours during the day.
4
Which assessment data should the nurse assess in the client diagnosed with Guillain-Barré syndrome? 1. An exaggerated startle reflex and memory changes. 2. Cogwheel rigidity and inability to initiate voluntary movement. 3. Sudden severe unilateral facial pain and inability to chew. 4. Progressive ascending paralysis of the lower extremities and numbness.
C
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid prescribed after kidney transplantation? a. Postural hypotension c. Knee and hip joint pain b. Recurrent tachycardia d. Increased serum creatinine
1
Which assessment intervention should the nurse implement specifically for the diagnosis of Guillain-Barré syndrome? 1. Assess deep tendon reflexes. 2. Complete a Glasgow Coma Scale. 3. Check for Babinski's reflex. 4. Take the client's vital signs
c
Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient walks a mile each day for exercise. b. The patient complains of pain with neck flexion. c. The patient has an increased serum creatinine level. d. The patient has the relapsing-remitting form of MS.
B
Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation? a. The patient has type 1 diabetes. b. The patient has metastatic lung cancer. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with human immunodeficiency virus.
a,c,d
Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)? a. Avoid commercial salt substitutes. b. Restrict fluid intake to 1000 mL daily. c. Take phosphate binders with each meal. d. Choose high-protein foods for most meals. e. Have several servings of dairy products daily.
b
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure c. Neurologic status b. Phosphate level d. Creatinine clearance
b
Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? a. Start continuous pulse oximetry. b. Restrict physical activity to bed rest. c. Restrict the patient's oral protein intake. d. Discontinue the urethral retention catheter.
3
Which is a common cognitive problem associated with Parkinson's disease? 1. Emotional lability. 2. Depression. 3. Memory deficits. 4. Paranoia.
3
Which is the priority assessment for the client with Guillain-Barré syndrome with rapidly ascending paralysis? 1 Monitoring urinary output 2 Assessing nutritional status 3 Monitoring respiratory status 4 Assessing communication needs
c
Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful? a. Split-pea soup, English muffin, and nonfat milk b. Oatmeal with cream, half a banana, and herbal tea c. Poached eggs, whole-wheat toast, and apple juice d. Cheese sandwich, tomato soup, and cranberry juice
1
Which monoamine oxidase inhibitor is used to treat Parkinson disease? 1 Selegiline 2 Phenelzine 3 Isocarboxazid 4 Tranylcypromine
A,B,C
Which of the following are common symptoms of a herniation of a cervical intervertebral disk? SATA A) Nuchal stiffness B) Head pain C) Paresthesia in upper extremities D) Ptosis E) General muscle weakness
C
Which of the following is not an autoimmune disease? A. Insulin-dependent diabetes mellitus B.Myasthenia gravis C.Alzheimer's disease D.Graves disease
A
Which of the following would the nurse include as a priority when planning teaching for the patient diagnosed with ALS? A) Advanced Directives B) Bowel and bladder diversions C) Vision protection D) Treatment for dyskinesia
4
Which priority client problem should be included in the care plan for the client diagnosed with Guillain-Barré syndrome? 1. High risk for injury. 2. Fear and anxiety. 3. Altered nutrition. 4. Ineffective breathing pattern.
4
Which referral is appropriate for the client in the late stages of myasthenia gravis? 1. The infection control nurse. 2. The occupational health nurse. 3. A vocational guidance counselor. 4. The speech therapist.
4
Which response to the Tensilon (edrophonium chloride) injection indicates the client has myasthenia gravis? 1. The client has no apparent change in the assessment data. 2. There is reduced amplitude of electrical stimulation in the muscle. 3. The anti-acetylcholine receptor antibodies are present. 4. The client shows a marked improvement of muscle strength.
c
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? a. "I need to get most of my protein from low-fat dairy products." b. "I will increase my intake of fruits and vegetables to 5 per day." c. "I will measure my urinary output each day to help calculate the amount I can drink." d. "I need to take erythropoietin to boost my immune system and help prevent infection."
2
While reviewing the medical reports in an acute care setting, the nurse finds that the client is at risk for kidney damage and requests the healthcare provider to increase the intravenous fluid rate as a priority nursing intervention. Which finding supports the nurse's conclusion? 1 Pulse pressure is 40 mm Hg 2 Urine output is 25 mL per hr 3 Systolic blood pressure is 120 mm Hg 4 Blood osmolality is 280 milliosmoles per kg
b
With sudden cessation of renal function, all body systems are affected by the inability to maintain fluid and electrolyte balance and eliminate metabolic waste. In critically ill patients, renal dysfunction: a. is a very rare problem. b. affects nearly two thirds of patients. c. has a low mortality once renal replacement therapy has been initiated. d. has little effect on morbidity, mortality, or quality of life.
B
You are teaching your patient diagnosed with myasthenia gravis about treatments. Which of the following statements, if made by the patient indicates the need for further teaching? A) Plasmapheresis is way to reduce symptoms but will need to be done every day B) A thymectomy is a removal of my thymus gland and will show some immediate relieving of my symptoms C) Corticosteroids can be used for short periods of time to help improve my symptoms, but it isn't good for long periods of time D) I need to take my Mestinon four times a day at the same time each day
c
The nurse is assessing a patient with a new arteriovenous fistula, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable. The nurse should: a. reassess the patient in an hour. b. raise the arm above the level of the patients heart. c. notify the provider immediately. d. apply warm packs to the fistula site and reassess.
D
The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis? A. Visual disturbances, including diplopia B. Ascending paralysis and loss of motor function C. Cogwheel rigidity and loss of coordination D. Progressive weakness that is worse at the day s end
d
A normal urine output is considered to be: a. 80 to 125 mL/min. b. 180 L/day. c. 80 mL/min. d. 1 to 2 L/day.
b
A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).
2
A healthcare provider prescribes selegiline 5 mg twice a day for a client with a diagnosis of Parkinson disease. What is most important for the nurse to teach the client? 1 Eat food high in tyramine. 2 Ensure that an opioid is not taken currently. 3 Take the medication in the morning and evening. 4 Monitor for signs of hypoglycemia and hyperglycemia.
a,b,c
Noninvasive diagnostic procedures used to determine kidney function include which of the following? (Select all that apply.) a. Kidney, ureter, bladder (KUB) x-ray b. Renal ultrasound c. Magnetic resonance imaging (MRI) d. Intravenous pyelography (IVP) e. Renal angiography
A
The most significant initial nursing observations that need to be made about a client with myasthenia include: A. Ability to chew and speak distinctly B. Degree of anxiety about her diagnosis C. Ability to smile an to close her eyelids D. Respiratory exchange and ability to swallow
c
The nurse is caring for a patient who has a temporary percutaneous dialysis catheter in place. In caring for this patient, the nurse should: a. apply a sterile gauze dressing to maintain sterility. b. replace the transparent dressing every 10 days to prevent manipulation. c. assess the catheter site for redness and/or swelling. d. use the catheter for drawing blood samples to reduce patient discomfort.
1
A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason metabolic acidosis develops with kidney failure? 1 Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate 2 Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention 3 Inability of the renal tubules to reabsorb water to dilute the acid contents of blood 4 Impaired glomerular filtration, causing retention of sodium and metabolic waste products
2
A nurse is caring for a client with the diagnosis of Guillain-Barré syndrome with nasal cannula oxygen. The nurse identifies that the client is having difficulty expectorating respiratory secretions. What should be the nurse's first intervention? 1 Auscultate for breath sounds. 2 Suction the client's oropharynx. 3 Administer and continue to monitor oxygen via nasal cannula. 4 Place the client in the orthopneic position
2
A nurse is reviewing the laboratory report of a client with kidney problems. When ammonia is excreted by healthy kidneys, what mechanism usually is maintained? 1 Osmotic pressure of the blood 2 Acid-base balance of the body 3 Low bacterial levels in the urine 4 Normal red blood cell production
1,2,4
A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? 1 Facial flushing 2 Edema and pruritus 3 Dribbling after voiding and dysuria 4 Diminished force and caliber of stream
b
A normal glomerular filtration rate is: a. less than 80 mL/min. b. 80 to 125 mL/min c. 125 to 180 mL/min d. more than 189 mL/min
3
he male client diagnosed with MG is prescribed the cholinesterase inhibitor neostigmine (Prostigmin). Which data indicate the medication is not effective? 1. The client is able to perform activities of daily living (ADLs) independently. 2. The client states that his vision is clear. 3. The client cannot speak or look upward at the ceiling. 4. The client is smiling and laughing with the nurse.
crushing injuries
hyperkalemia associated with _____________ may cause cardiac arrest and should be treated immediately.
Peritonitis
is the most common complication of peritoneal dialysis therapy and is usually caused by contamination in the system.
35-45
normal CO2 range
90-120
normal GFR
Kayexalate
reduces plasma potassium levels and total body potassium content in a patient with renal dysfunction
blood, protein (albumin, globulin)
should not be found in urine
a
The patients potassium level is 7.0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction? a. Kayexalate b. Kayexalate with sorbitol c. Regular insulin d. Calcium gluconate
b
The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is: a. oliguria. b. azotemia. c. acute kidney injury. d. prerenal disease
B
Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by: A.Brudzinski's sign B. A positive edrophonium (Tensilon) test C. A positive sweat chloride test D. Kernigs sign
3
A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action? 1 Blocks the effects of acetylcholine 2 Increases the production of dopamine 3 Restores the dopamine levels in the brain 4 Promotes the production of acetylcholine
4
A client is experiencing kidney failure. Which is the most serious complication for which the nurse must monitor a client with kidney failure? 1 Anemia 2 Weight loss 3 Uremic frost 4 Hyperkalemia
1,3,4
A client is scheduled for a kidney ultrasound. Which instructions given by the nurse to the client would be most beneficial? Select all that apply. 1 "Drink plenty of fluids." 2 "Eat foods rich in fiber." 3 "Do not urinate prior to the exam." 4 "Lie flat and perfectly still during the test." 5 "A urinary catheter may be needed temporarily for the test."
B
A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. More protein is allowed because urea and creatinine are removed by dialysis. c. Dietary potassium is not restricted because the level is normalized by dialysis. d. Unlimited fluids are allowed because retained fluid is removed during dialysis.
A
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can accommodate larger needles. d. A fistula can be used sooner after surgery.
4
A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? 1 "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." 2 "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." 3 "It decreases the need for immobility because it clears toxins in short and intermittent periods." 4 "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."
a
A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a. "MS symptoms may be worse after the pregnancy." b. "Women with MS frequently have premature labor." c. "MS is associated with an increased risk for congenital defects." d. "Symptoms of MS are likely to become worse during pregnancy."
aminoglycoside, 10
Acute kidney injury can be caused by _____________ nephrotoxicity, especially prolonged use of the drug (more than ________ days).
a
Acute kidney injury from post renal etiology is caused by: a. obstruction of the flow of urine. b. conditions that interfere with renal perfusion. c. hypovolemia or decreased cardiac output. d. conditions that act directly on functioning kidney tissue.
d
After receiving change-of-shift report, which patient should the nurse assess first? a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L d. Patient who has just returned from having hemodialysis and has a heart rate of 124/min
1
An elderly adult with Parkinson's disease falls while going to the bathroom and gets injured. The nurse taking care of the client informs the primary healthcare provider. What step should the nurse take to alert the risk management system? 1 The nurse should document the incident in the occurrence report tool. 2 The nurse should provide information in the medical record about the occurrence. 3 The nurse should document in the client's medical report that an occurrence report has been filed. 4 The nurse should document in the client's medical report that the primary healthcare provider has been contacted
1,2,5
Antipsychotic drugs can cause extrapyramidal side effects. Which responses does the nurse document as indicating pseudoparkinsonism? Select all that apply. 1 Rigidity 2 Tremors 3 Mydriasis 4 Photophobia 5 Bradykinesia
B
Before administration of captopril to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's a. glucose. c. creatinine. b. potassium. d. phosphate.
4
Carbidopa/levodopa is prescribed for a client with Parkinson disease. What will the nurse teach the client about this medication? 1 "Take this medication between meals." 2 "Blood levels of the drug should be monitored weekly." 3 "It can cause happy feelings followed by feelings of depression." 4 "You may experience dizziness when moving from sitting to standing.
c
Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal. The most common intrarenal condition is: a. prolonged ischemia. b. exposure to nephrotoxic substances. c. acute tubular necrosis (ATN). d. hypotension for several hours.
a
Daily weights are being recorded for the patient. His urine output has been less than his intravenous and oral intake. His weight yesterday was 97.5 kg. This morning it is 99 kg. The nurse understands that this corresponds to a(n): a. fluid retention of 1.5 liters. b. fluid loss of 1.5 liters. c. equal intake and output due to insensible losses. d. fluid loss of 0.5 liters
b
During routine hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Check the blood pressure (BP). c. Review the hematocrit (Hct) level. d. Give prescribed PRN antiemetic drugs.
2
During the neurologic assessment of a client with a tentative diagnosis of Guillain-Barré syndrome, what does the nurse expect the client to manifest? 1 Diminished visual acuity 2 Increased muscular weakness 3 Pronounced muscular atrophy 4 Impairment in cognitive reasoning
2
For a client diagnosed with Parkinsons disease, which of the following might be contraindicated? 1. Performing range-of-motion exercises 2. Drinking bottled water 3. Instituting fall precautions 4. Taking naps
D
Helen, a client with myasthenia gravis, begins to experience increased difficulty in swallowing. To prevent aspiration of food, the nursing action that would be most effective would be to: A. Change her diet order from soft foods to clear liquids B. Place an emergency tracheostomy set in her room C. Assess her respiratory status before and after meals D. Coordinate her meal schedule with the peak effect of her medication, Mestinon
B
Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: A.Inhibits the breakdown of acetylcholine at the neuromuscular junction. B.Decreases the production of autoantibodies that attack the acetylcholine receptors. C.Promotes the removal of antibodies that impair the transmission of impulses D.Stimulates the production of acetylcholine at the neuromuscular junction.
metabolic acidosis
Kussmaul respiration and occurs due to
a
Renin plays a role in blood pressure regulation by: a. activating the renin-angiotensin-aldosterone cascade. b. suppressing angiotensin production. c. decreasing sodium reabsorption. d. inhibiting aldosterone release.
1
The charge nurse is making assignments. Which client should be assigned to the new graduate nurse? 1. The client diagnosed with aseptic meningitis who is complaining of a headache and the light bothering his eyes. 2. The client diagnosed with Parkinson's disease who fell during the night and is complaining of difficulty walking. 3. The client diagnosed with a cerebrovascular accident whose vitals signs are P 60, R 14, and BP 198/68. 4. The client diagnosed with a brain tumor who has a new complaint of seeing spots before the eyes.
4
The client admitted with rule-out Guillain-Barré syndrome has just had a lumbar puncture. Which intervention should the nurse implement post procedure? 1. Monitor the client for hypotension. 2. Apply pressure to the puncture site. . Test the client's cerebrospinal fluid. 4. Increase the client's fluid intake.
b
The patient has elevated blood urea nitrogen (BUN) and serum creatinine levels with a normal BUN/creatinine ratio. These levels most likely indicate: a. increased nitrogen intake. b. acute kidney injury, such as acute tubular necrosis (ATN). c. hypovolemia. d. fluid resuscitation
1
Which statement by the 20-year-old female client diagnosed with MG indicates the client understands the discharge teaching? 1. "I can have children, but I will have to see my neurologist during my pregnancy." 2. "I have a new job at a children's day care center to help with expenses." 3. "I should not take a bath because I could pass out and drown while in the tub." 4. "I will drink at least 1000 mL of water or other liquid every day."
2
Which statement by the client supports the diagnosis of myasthenia gravis (MG)? 1. "I have weakness and fatigue in my feet and legs." 2. "My eyelids droop, and I see double everything." 3. "I get chest pain and faint after I walk in the hall." 4. "I gained 3 pounds this week, and I am spitting up pink frothy sputum."
2
Which statement by the client supports the diagnosis of Guillain-Barré syndrome? 1. "I just returned from a short trip to Japan." 2. "I had a really bad cold just a few weeks ago." 3. "I think one of the people I work with had this." 4. "I have been taking some herbs for more than a year."
BUN
______ levels can fluctuate based on factors such as fluid volume status and protein intake.
GFR
________ is the preferred method for evaluating kidney function.
2
A client in end-stage kidney disease is receiving peritoneal dialysis. What should the nurse do when caring for this client? 1 Maintain the client in the supine position during the entire procedure. 2 Position the client from side to side if fluid is not draining adequately. 3 Remove the cannula at the end of the procedure, applying a dry, sterile dressing. 4 Notify the primary healthcare provider if there is a deficit of 100 mL in the drainage return.
4
A client presents complaining of abnormal muscle weakness and fatigability. The physician suspects myasthenia gravis. Which drug can be used to test for this disease? 1. Pyridostigmine (Mestinon) 2. Neostigmine (Prostigmin) 3. Ambenonium (Mytelase) 4. Edrophonium (Tensilon)
a
A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond? A "You may have difficulty believing this, but the paralysis caused by this disease is temporary." B "You'll have to accept the fact that you're permanently paralyzed. However, you won't have any sensory loss." C "It must be hard to accept the permanency of your paralysis." D "You'll first regain use of your legs and then your arms."
b
A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrateD. I can't do anything without help!" This comment best supports which nursing diagnosis? A Anxiety B Powerlessness C Ineffective denial D Risk for disuse syndrome
d
Female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse inquires during the nursing admission interview if the client has history of: A Seizures or trauma to the brain B Meningitis during the last 5 years C Back injury or trauma to the spinal cord D Respiratory or gastrointestinal infection during the previous month.
1
Selegiline is prescribed for a client with Parkinson disease who is having an inadequate response to levodopa therapy. What information does the nurse include when teaching the client about the addition of this drug to the regimen? 1 Primary healthcare provider should be contacted immediately if a severe headache occurs. 2 Therapeutic blood level of the drug should be monitored each month. 3 Dosage of the drug can be adjusted daily depending on the client's response that day. 4 Side effects of levodopa will decrease when the selegiline and levodopa are taken concurrently.
1
The client diagnosed with Guillain-Barré syndrome asks the nurse, "Will I ever get back to normal?I am so tired of being sick." Which statement is the best response by the nurse? 1. "You should make a full recovery within a few months to a year." 2. "Most clients with this syndrome have some type of residual disability." 3. "This is something you should discuss with the health-care team." 4. "The rehabilitation is short and you should be fully recovered within a month."
3
The client diagnosed with Guillain-Barré syndrome is having difficulty breathing and is placed on a ventilator. Which situation warrants immediate intervention by the nurse? 1. The ventilator rate is set at 14 breaths per minute. 2. A manual resuscitation bag is at the client's bedside. 3. The client's pulse oximeter reading is 85%. 4. The ABG results are pH 7.40, PaO288, PaCO235, and HCO324.
B
The client is admitted with Parkinson's disease. His face is expressionless and his speech is monotone. Which of the following observations is the most accurate? A) The client is mostly likely depressed and should be left alone B) These are common symptoms of Parkinson's disease that produce an undesired façade of an alert and responsive individual C) The client's antipsychotic medications should be adjusted D) The client probably has dementia
1
The client newly diagnosed with multiple sclerosis (MS) states, "I don't understand how I got multiple sclerosis. Is it genetic?" On which statement should the nurse base the response? 1. Genetics may play a role in susceptibility to MS, but the disease may be caused by a virus. 2. There is no evidence suggesting there is any chromosomal involvement in developing MS. 3. Multiple sclerosis is caused by a recessive gene, so both parents had to have the gene for the client to get MS. 4. Multiple sclerosis is caused by an autosomal dominant gene on the Y chromosome,so only fathers can pass it on.
a
The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). In doing so, the nurse should: a. assess that the blood tubing is warm to the touch. b. assess the hemofilter every 6 hours for clotting. c. cover the dialysis lines to protect them from light. d. use clean technique during vascular access dressing changes.
2
The health-care provider scheduled a lumbar puncture for a client admitted with rule-out Guillain-Barré syndrome. Which pre procedure intervention has priority? 1. Keep the client NPO. 2. Instruct the client to void. 3. Place in the lithotomy position. 4. Assess the client's pedal pulse.
1
The male client diagnosed with multiple sclerosis states he has been investigating alternative therapies to treat his disease. Which intervention is most appropriate by the nurse? 1. Encourage the therapy if it is not contraindicated by the medical regimen. 2. Tell the client only the health-care provider should discuss this with him. 3. Ask how his significant other feels about this deviation from the medical regimen. 4. Suggest the client research an investigational therapy instead.
1
The male client with MG is undergoing plasmapheresis at the bedside. Which assessment data would warrant immediate intervention by the nurse? 1. The client complains of being lightheaded and dizzy. 2. The client can smile and clamp his teeth together. 3. The client states that his leg cramps have gone away. 4. The client has a small hematoma at the vascular access site.
a
The most common cause of acute kidney injury in critically ill patients is: a. sepsis. b. fluid overload. c. medications. d. hemodynamic instability.
c
The patient has just returned from having an arteriovenous fistula placed. The patient asks, When will they be able to use this and take this other catheter out? The nurse should reply, a. It can be used immediately so the catheter can come out anytime. b. It will take 2 to 4 weeks to heal before it can be used. c. The fistula will be usable in about 4 to 6 weeks. d. The fistula was made using graft material so it depends on the manufacturer.
2,5
The registered nurse discusses normal renal function with the client. Which statements made by the client are correct regarding regulatory functions of the kidney? Select all that apply. 1 "They play a role in erythropoiesis." 2 "They play a role in acid-base balance." 3 "They play a role in vitamin D activation." 4 "They play a role in blood pressure regulation." 5 "They play a role in fluid and electrolyte balance."
c
Which of the following patients is at the greatest risk of developing acute kidney injury? A patient who: a. has been on aminoglycosides for the past 6 days. b. has a history of controlled hypertension with a blood pressure of 138/88 mm Hg. c. was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks. d. has a history of fluid overload as a result of heart failure.
C
Which of the following would be most likely given as a top nursing diagnosis for a patient experiencing a cholinergic crisis? A) Impaired Gas Exchange B) Acute Fatigue C) Ineffective airway clearance D) Altered mental status
1000 ml
a 1 kg gain indicates how much gained in fluid?