Chapter 68 & chapter 64

In a patient with hyperglycemia, the respiratory center is triggered in an attempt to excrete more carbon dioxide and acid, thus causing a rapid and deep respiratory patter. What is the term for this respiratory pattern? A. Tachypnea b. Cheyne-Stokes respiration c. Kussmaul respiration d. Biot respiration

C

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? Avoiding venipuncture and blood pressure measurements in the affected arm Correct Modifications to allow for complete rest of the affected arm How to assess for a bruit in the affected arm How to practice proper nutrition

Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.

What type of insulin is used in the emergency treatment of DKA and hyperglycemic-hyperosmolar nonketotic syndrome (HHNS)? A. NPH b. Lente c. Regular d. Protamine zinc

c

A client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse? _________

Correct Responses 167 drops/min 20 gtt × 500 mL = 10,000/60 min = 167 drops/min

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? Consuming a low-calcium diet Avoiding peas, nuts, and legumes Correct Drinking cola beverages only once daily Increasing dairy products enriched with vitamin D

Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

From which injection site is insulin absorbed most rapidly? A. Buttocks b. Abdomen c. Deltoid d. Thigh

b

The nurse is providing postdialysis care for a patient. In comparing vital signs and weight measurements to the predialysis data, what does the nurse expect to find? a. Blood pressure and weight are reduced b. Blood pressure is increased and weight is reduced c. Blood pressure and weight are slightly increased d. Blood pressure is low and weight is the same

s

A patient will be using an external insulin pump. What does the nurse tell the patient about the pump? A. SMBG levels should be done three or more times a day b. The insulin supply must be replaced every 2 to 4 weeks c. The pumps battery should be checked on a regular weekly schedule. d. The needle site must be changed every day

A

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) Restricted protein Liberal sodium Restricted fluids Low potassium Low fat

A C D Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

The nurse is preparing to teach a diabetic patient how to select appropriate shoes. Which points must be included in the teaching plan? (SATA) a. "It is best to have the shoes fitted by an experienced shoe fitter such as a podiatrist." B. "The shoes should be 1 to 1.5 inches longer than your longest toe" c. "The heels of the shoes should be less than 2 inches high." D. "Avoid tight-fitting shoes, which can cause tissue damage to your feet." E. "You should get at least two pairs of shoes so you can change them at midday and in the evening."

Acde

What glucose level range does the American Association of Clinical Endocrinologists recommend for a critically ill patient? a. Between 100 to 130 mg/dL b. Between 140 to 180 mg/dL c. Between 180 to 200 mg/dL d. Between 200 to 240 mg/dL

B

The nurse and the dietitian are planning dietary intake for a patient with AKI who is currently not on dialysis therapy. The dietitian informs the nurse that 0.6 g/kg of body weight of protein are needed. The patient weighs 130 pounds. How many grams of protein should the patient receive? (Round grams to the nearest whole number.) _______ grams

35

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? Abrupt decrease in urine output Blood-tinged urine Incisional pain Increase in urine output

A An abrupt decrease in urine output may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? Increased blood urea nitrogen (BUN) Increased creatinine level Pale-colored urine Decreased sodium level

A An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? Nonsteroidal anti-inflammatory drugs (NSAIDs) Angiotensin-converting enzyme (ACE) inhibitors Opiates Calcium channel blockers

A NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? Construction worker Office secretary Schoolteacher Taxicab driver

A Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? Eggs Ham Eggplant Macaroni

A Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? Auscultate for pericardial friction rub. Assess for crackles. Monitor for decreased peripheral pulses. Determine if the client is able to ambulate.

A The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? Client with chronic kidney failure who was just admitted with shortness of breath Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted Client with azotemia whose blood urea nitrogen and creatinine are increasing Client receiving peritoneal dialysis who needs help changing the dialysate bag

A The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) Football player in preseason practice Client who underwent contrast dye radiology Accident victim recovering from a severe hemorrhage Accountant with diabetes Client in the intensive care unit on high doses of antibiotics Client recovering from gastrointestinal influenza

A B C E F To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) Obtain the client's pre-hemodialysis weight. Check the arteriovenous (AV) fistula for a thrill and bruit. Document the amount the client drinks throughout the shift. Auscultate the client's lung sounds every 4 hours. Explain the components of a low-sodium diet.

A C Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? A. Abrupt decrease in urine output B. Blood-tinged urine C. Incisional pain D. Increase in urine output

A. Abrupt decrease in urine output An abrupt decrease in urine output may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation.

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A. Auscultate for pericardial friction rub. B. Assess for crackles. C. Monitor for decreased peripheral pulses. D. Determine if the client is able to ambulate.

A. Auscultate for pericardial friction rub. The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? A. Avoiding venipuncture and blood pressure measurements in the affected arm B. Modifications to allow for complete rest of the affected arm C. How to assess for a bruit in the affected arm D. How to practice proper nutrition

A. Avoiding venipuncture and blood pressure measurements in the affected arm Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? A. Client with chronic kidney failure who was just admitted with shortness of breath B. Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted C. Client with azotemia whose blood urea nitrogen and creatinine are increasing D. Client receiving peritoneal dialysis who needs help changing the dialysate bag

A. Client with chronic kidney failure who was just admitted with shortness of breath The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? A. Construction worker B. Office secretary C. Schoolteacher D. Taxicab driver

A. Construction worker Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? A. Eggs B. Ham C. Eggplant D. Macaroni

A. Eggs Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) A. Football player in preseason practice B. Client who underwent contrast dye radiology C. Accident victim recovering from a severe hemorrhage D. Accountant with diabetes E. Client in the intensive care unit on high doses of antibiotics F. Client recovering from gastrointestinal influenza

A. Football player in preseason practice B. Client who underwent contrast dye radiology C. Accident victim recovering from a severe hemorrhage E. Client in the intensive care unit on high doses of antibiotics F. Client recovering from gastrointestinal influenza To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? A. Increased blood urea nitrogen (BUN) B. Increased creatinine level C. Pale-colored urine D. Decreased sodium level

A. Increased blood urea nitrogen (BUN) An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Angiotensin-converting enzyme (ACE) inhibitors C. Opiates D. Calcium channel blockers

A. Nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

An 84-year-old male client is being admitted after surgery to remove a section of his bowel (colectomy) following a diagnosis of colon cancer. His urine output from an indwelling urinary catheter after 3 hours in the postanesthesia care unit plus the amount in the bag on admission to the medical-surgical unit totals 100 mL. The urine is cloudy and dark yellow. He also has a history of hypertension. After evaluating the patency of the collection device, what is the most appropriate action for the nurse to perform? A. Notify the health care provider of the low urine output. B. Increase the rate of intravenous fluids until urine output is 0.5 mL/kg/hr. C. Continue to assess the client and re-evaluate urine output in 4 hours. D. Ask about his typical voiding patterns and about any previous episodes of urinary problems.

A. Notify the health care provider of the low urine output. Rationale: The lowest acceptable urine output to avoid acute kidney injury (AKI) is 0.5 mL/kg/hr, which, in this 70-kg man, is about 35 mL/hr or a total of at least 105 mL. Surgery places clients at risk for both hypo- and hypervolemia. Waiting an additional 4 hours to obtain 6-hour trend data delays the prompt assessment and intervention necessary to avoid AKI. It is not appropriate to increase fluid rate, and it is unlikely the client is ready to take oral fluid this soon after surgery on the gastrointestinal tract. Voiding is not an issue with a urinary collection device.

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) A. Obtain the client's pre-hemodialysis weight. B. Check the arteriovenous (AV) fistula for a thrill and bruit. C. Document the amount the client drinks throughout the shift. D. Auscultate the client's lung sounds every 4 hours. E. Explain the components of a low-sodium diet.

A. Obtain the client's pre-hemodialysis weight. C. Document the amount the client drinks throughout the shift. Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) A. Restricted protein B. Liberal sodium C. Restricted fluids D. Low potassium E. Low fat

A. Restricted protein C. Restricted fluids D. Low potassium Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

A client with acute kidney injury had normal assessments 1 hour ago. Now the nurse finds that the client's respiration rate is 44 breaths/min and the client is restless. Which assessment does the nurse perform? a. Obtain an oxygen saturation level. b. Send blood for a creatinine level. c. Assess the client for dehydration. d. Perform a bedside blood glucose.

ANS: A A complication of acute kidney injury is pulmonary edema. Manifestations of this include tachypnea; frothy, blood-tinged sputum; and tachycardia, anxiety, and crackles. The nurse needs to obtain an oxygen saturation, listen to the client's lungs, and notify the health care provider, so that treatment can be started. The other interventions are not helpful.

A client is admitted to the hospital with a serum creatinine level of 2 mg/dL. When taking the client's history, which question does the nurse ask first? a. "Do you take any nonprescription medications?" b. "Does anyone in your family have kidney disease?" c. "Do you have yearly blood work done?" d. "Is your diet low in protein?"

ANS: A Acute renal failure can be caused by certain medications considered to have a nephrotoxic effect, such as NSAIDs and acetaminophen. Asking the client whether he or she takes any nonprescription drugs can help determine which medication(s) might have contributed to the problem. A family history is important but is not as vital as assessing for nephrotoxic agents that the client may have ingested. Yearly blood work might reveal a trend in kidney function, but again would not be as important. A diet low in protein would not be an important factor to assess.

Which client is most at risk for developing postrenal kidney failure? a. Client diagnosed with renal calculi b. Client with congestive heart failure c. Client taking NSAIDs for arthritis pain d. Client recovering from glomerulonephritis

ANS: A Causes of postrenal kidney failure include disorders that obstruct the flow of urine, such as renal calculi. Heart failure can lead to prerenal failure, which is due to decreased blood flow to the kidneys. Both NSAIDs and glomerulonephritis can damage the kidney, leading to intrarenal failure.

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take? a. Document the finding in the client's chart. b. Administer a bolus of regular insulin IV. c. Call the surgeon to cancel the procedure. d. Draw blood gases to assess the metabolic state.

ANS: A Clients who have type 1 diabetes and are having surgery have been found to have fewer complications, lower rates of infection, and better wound healing if blood glucose levels are maintained at between 140 and 180 mg/dL throughout the perioperative period. The nurse should document the finding and proceed with other operative care. The need for a bolus of insulin, canceling the procedure, or drawing arterial blood gases is not required.

When evaluating the effects of a low-protein diet in a client with chronic kidney disease, the nurse is most concerned with which result? a. Albumin level of 2 g/dL b. Calcium level of 8.0 mg/dL c. Potassium level of 5.2 mmol/L d. Magnesium level of 3 mEq/L

ANS: A Clients with chronic kidney disease are placed on a low-protein diet. However, decreased serum albumin levels indicate that the protein they are taking in is not enough for their metabolic needs. The electrolyte levels in the other options are not related to protein

Which response by a client indicates an understanding of measures to facilitate the flow of peritoneal dialysate fluid? a. "I will take my stool softeners every day." b. "I will keep the drainage bag at the level of my abdomen." c. "Flushing the catheter is needed with each exchange." d. "Warmed dialysate infusion increases the speed of flow."

ANS: A Constipation is the primary cause of inflow and outflow problems. To prevent constipation, clients are placed on a bowel regimen before placement of a peritoneal catheter. The drainage bag should be lower than the abdomen. Warming the fluid helps prevent discomfort during the procedure. Flushing the catheter will not facilitate the flow of dialysate.

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? a. "Maintain tight glycemic control and prevent hyperglycemia." b. "Restrict your fluid intake to no more than 2 liters a day." c. "Prevent hypoglycemia by eating a bedtime snack." d. "Limit your intake of protein to prevent ketoacidosis."

ANS: A Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as important as maintaining daily glycemic control.

After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional education? a. "If I develop an infection, I should stop taking my corticosteroid." b. "If I have pain over the transplant site, I will call the surgeon immediately." c. "I should avoid people who are ill or who have an infection." d. "I should take my cyclosporine exactly the way I was taught."

ANS: A Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Anti-rejection drugs cause immunosuppression, and the client should avoid crowds and people who are ill. Changing the routine of anti-rejection medications may cause them to not work optimally.

15.A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, "Can I ask my niece to prefill my syringes and then store them for later use when I need them?" How should the nurse respond? a. "Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up." b. "Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light." c. "Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes." d. "No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container."

ANS: A Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plastic syringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with the needle pointing up to prevent suspended insulin particles from clogging the needle.

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition? a. Increased rate and depth of respiration b. Extremity tremors followed by seizure activity c. Oral temperature of 102° F (38.9° C) d. Severe orthostatic hypotension

ANS: A Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis.

A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How should the nurse respond? a. "Your risk of diabetes is higher than the general population, but it may not occur." b. "No genetic risk is associated with the development of type 1 diabetes mellitus." c. "The risk for becoming a diabetic is 50% because of how it is inherited." d. "Female children do not inherit diabetes mellitus, but male children will."

ANS: A Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.

During a hot summer day, an older adult client tells the clinic nurse, "I am not drinking or voiding that much these days." The nurse notes a heart rate of 100 beats/min and a blood pressure of 90/60 mm Hg. Which action does the nurse take first? a. Give the client something to drink. b. Insert an intravenous catheter. c. Teach the client to drink 2 to 3 liters a day. d. Perform a bladder scan to assess urine volume.

ANS: A Severe blood volume depletion can lead to kidney failure, even in those who have no kidney problem. The client is showing signs of mild volume depletion. The first action the nurse should take is to give the client something to drink. After that, the nurse should teach the client to avoid dehydration by drinking at least 2 to 3 L of fluid daily. The client does not need an IV at this time. Performing a bladder scan will not help prevent or reverse the client's problem.

A client has been missing some scheduled hemodialysis sessions. Which intervention is most important for the nurse to implement? a. Discussing with the client his or her acceptance of the disease b. Discussing with the client the option of peritoneal dialysis c. Rescheduling the sessions to another day or another time d. Stressing to the client the importance of going to the sessions

ANS: A Some people on dialysis retreat into complete or partial denial of the disease and the need for treatment. They may deny the need for dialysis and/or may not adhere to drug therapy and diet restrictions. Providing support as the client struggles to accept the disease is an important step in ensuring compliance with the dialysis regimen. The nurse should explore scheduling options, but missing so many sessions cues the nurse that a bigger problem than just scheduling is involved. The nurse should provide education, but simply stressing the need for dialysis will not help the client accept it. Peritoneal dialysis, with its technical demands on the client and partner, probably is not an option for a client who appears noncompliant with hemodialysis.

A client has end-stage kidney disease (ESKD). The nurse observes tall, peaked T waves on the client's cardiac monitor. Which action by the nurse is best? a. Check the serum potassium level. b. Document the finding in the client's chart. c. Prepare to give sodium bicarbonate. d. Call the health care provider to request an electrocardiogram (ECG).

ANS: A Tall, peaked T waves are a manifestation of hyperkalemia. Thus, the nurse should check the potassium level. Afterward, the nurse should report findings to the provider. The client may need an ECG, but treatment may be based on monitor tracings and potassium levels. Sodium bicarbonate is not warranted. Documentation is important but is not the priority.

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "The lower abdomen is the best location because it is closest to the pancreas." b. "I can reach my thigh the best, so I will use the different areas of my thighs." c. "By rotating the sites in one area, my chance of having a reaction is decreased." d. "Changing injection sites from the thigh to the arm will change absorption rates."

ANS: A The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration.

A client with acute kidney injury is placed on a fluid restriction. To determine whether outcomes related to fluid balance are being met, the nurse assesses for which finding? a. Absence of lung crackles b. Decreased serum creatinine level c. Decreased serum potassium level d. Increased muscle strength

ANS: A The client with chronic kidney disease is expected to achieve and maintain an acceptable fluid balance. Fluid restriction helps with this outcome. Absence of lung crackles can indicate that the client is not fluid overloaded. The other options are not related to fluid balance.

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first? a. Administer 1 mg of intramuscular glucagon. b. Encourage the client to drink orange juice. c. Insert a new intravenous access line. d. Administer 25 mL dextrose 50% (D50) IV push.

ANS: A The client's blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the client's blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the client's blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.

A client's temperature after dialysis is 99° F (37.2° C) and was normal before dialysis. Which is the nurse's best action? a. Continue to monitor the temperature. b. Encourage the client to drink fluids. c. Obtain a white blood cell count. d. Prepare to culture the fistula site.

ANS: A The client's temperature may be elevated because the dialysis machine warms the blood slightly. An excessive temperature elevation from baseline can signal sepsis. The nurse should inform the provider and obtain blood cultures if this happens. The other actions are not needed.

A client who is 2 days post-femoral vein cannulation begins to have difficulty with outflow of blood during dialysis. For which complication does the nurse assess? a. Hematoma at cannula insertion site b. Infection c. Oliguria d. Skin necrosis at cannula insertion site

ANS: A The puncture site of the femoral vein is prone to hematoma formation because positioning the extremity can cause movement of the cannula and subsequent bleeding at the site. The hematoma can compress the cannula, decreasing flow through it. The other complications would not diminish outflow.

A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next? a. Administer another half-cup of orange juice. b. Administer a half-ampule of dextrose 50% intravenously. c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly.

ANS: A This client is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse should administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment should be repeated. The client does not need intravenous dextrose, insulin, or glucagon.

ANS: A, B, C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.

ANS: A, B, D When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.

A client asks the nurse, "What are the advantages of peritoneal dialysis over hemodialysis?" Which response by the nurse is accurate? (Select all that apply.) a. "It will give you greater freedom in your scheduling." b. "You have less chance of getting an infection." c. "You need to do it only three times a week." d. "You do not need a machine to do it." e. "You will have fewer dietary restrictions."

ANS: A, D, E Although peritoneal dialysis is slower than hemodialysis, it does not require a specially trained registered nurse and can be done at home, allowing for greater flexibility in scheduling. Peritoneal dialysis is ambulatory, and a machine is not needed. Nursing implications for hemodialysis include vascular access care and diet restrictions, whereas peritoneal dialysis allows for a more flexible diet (abdominal catheter care is still necessary).

MULTIPLE RESPONSE 1.A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) a. 56-year-old African-American male b. Female with a 30-pound weight gain during pregnancy c. Male with a history of pancreatic trauma d. 48-year-old woman with a sedentary lifestyle e. Male with a body mass index greater than 25 kg/m2 f. 28-year-old female who gave birth to a baby weighing 9.2 pounds

ANS: A, D, E, F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound gestational weight gain are not risk factors.

A client is 12 hours post-kidney transplantation. The nurse notes that the client has put out 2000 mL of urine in 10 hours. Which assessment does the nurse carry out first? a. Skin turgor b. Blood pressure c. Serum blood urea nitrogen (BUN) level d. Weight of the client

ANS: B After transplantation, the client may have diuresis. Excessive diuresis might cause hypotension. Hypotension needs to be prevented because it can reduce blood flow and oxygen to the new kidney, threatening graft survival. The other assessments can give information about fluid balance, but hypotension is the main concern here, so the nurse needs to check the client's blood pressure, then notify the provider.

A client is scheduled to have dialysis in 30 minutes and is due for the following medications: vitamin C, B-complex vitamin, and cimetidine (Tagamet). Which action by the nurse is best? a. Give medications with a small sip of water. b. Hold all medications until after dialysis. c. Give the supplements, but hold the Tagamet. d. Give the Tagamet, but hold the supplements.

ANS: B All three medications are dialyzable, meaning that they will be removed by the dialysis. They should be given after the treatment is over.

A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, "I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." How should the nurse respond? a. "Following the drug regimen more closely would have prevented this." b. "One acute rejection episode does not mean that you will lose the new organs." c. "Dialysis is a viable treatment option for you and may save your life." d. "Since you are on the national registry, you can receive a second transplantation."

ANS: B An episode of acute rejection does not automatically mean that the client will lose the transplant. Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allow the graft to be maintained. The other statements either belittle the client or downplay his or her concerns. The client may not be a candidate for additional organ transplantation.

A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How should the nurse respond? a. "Glucose is the only fuel used by the body to produce the energy that it needs." b. "Your brain needs a constant supply of glucose because it cannot store it." c. "Without a minimum level of glucose, your body does not make red blood cells." d. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."

ANS: B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.

After teaching a client with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I need to have an annual appointment even if my glucose levels are in good control." b. "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick." c. "I can still develop complications even though I do not have to take insulin at this time." d. "If I have surgery or get very ill, I may have to receive insulin injections for a short time."

ANS: B Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in the future.

The nurse is providing a client with a peritoneal dialysis exchange. The nurse notes the presence of cloudy peritoneal effluent. Which action by the nurse is most appropriate? a. Document the finding in the client's chart. b. Collect a sample to send to the laboratory. c. Reposition the client on the left side. d. Increase the free water content in the next bag. .

ANS: B Cloudy or opaque effluent is an early sign of peritonitis. The nurse should collect and send a sample for culture. Then the nurse should document the finding. The other two options are not appropriate

When providing care for a client receiving peritoneal dialysis, the nurse notices that the effluent is cloudy. Which intervention is most important for the nurse to carry out? a. Irrigate the peritoneal catheter with saline. b. Send a specimen for culture and sensitivity. c. Document the finding in the client's chart. d. Change the dialysate solution and catheter tubing.

ANS: B Cloudy or opaque effluent is the earliest sign of peritonitis. The health care provider should be notified, and a sample of the outflow should be sent for culture and sensitivity. Irrigating the catheter or changing the solution and tubing will not help reveal the cause of the problem so that appropriate treatment can be started. Documentation is important but is not the priority.

28.A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, "My cousin has depression and is taking this drug. Do you think I'm depressed?" How should the nurse respond? a. "Many people with long-term diabetes become depressed after a while." b. "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?" c. "This antidepressant also has anti-inflammatory properties for diabetic pain." d. "No. Many medications can be used for several different disorders."

ANS: B Damage along nerves causes peripheral neuropathy and leads to burning pain along the nerves. Many drugs, including duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The nurse should assess the client for this condition and then should provide an explanation of why this drug is being used. This medication, although it is used for depression, is not being used for that reason in this case. Duloxetine does not have anti-inflammatory properties. Telling the client that many medications are used for different disorders does not provide the client with enough information to be useful.

A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How should the nurse respond? a. "You need to start with multiple injections until you become more proficient at self-injection." b. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." c. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." d. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock."

ANS: B Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the client's risk of insulin shock.

A client with acute kidney failure and on dialysis asks how much fluid will be permitted each day. Which is the nurse's best response? a. "This is based on the amount of damage to your kidneys." b. "You can drink an amount equal to your urine output, plus 700 mL." c. "It is based on your body weight and changes daily." d. "You can drink approximately 2 liters of fluid each day."

ANS: B For clients on dialysis, fluid intake is generally calculated to equal the amount of urine excreted plus 500 to 700 mL.

A client with chronic hypertension is seen in the clinic. Which assessment indicates that the client's hypertension is not under control? a. Heart rate of 55 beats/min b. Serum creatinine level of 1.9 mg/dL c. Blood glucose level of 128 mg/dL d. Irregular heart sounds

ANS: B Increased blood pressure damages the delicate capillaries in the glomerulus and eventually results in acute kidney injury. An elevated serum creatinine level is a manifestation of this. Heart rate, blood glucose level, and irregular heart sounds are not correlated with acute kidney injury.

A client is admitted with a 3-day history of vomiting and diarrhea. The client's vital signs are blood pressure, 85/60 mm Hg; and heart rate, 105 beats/min. Which intervention by the nurse takes priority? a. Obtain blood and urine cultures. b. Start an IV of normal saline as ordered. c. Administer antiemetic medications. d. Assess the client's recent travel history.

ANS: B Many types of problems can reduce kidney function. Severe hypotension from shock or dehydration reduces renal blood flow and leads to prerenal acute renal failure (ARF). Volume depletion leading to prerenal azotemia is the most common cause of ARF and usually is reversible with prompt intervention. The nurse should first initiate the ordered IV fluids. Obtaining cultures will help identify a possible cause of the client's symptoms and should be done quickly after the IV has been started. Attending to the client's discomfort would be next. Assessing for travel history, although important, can wait until after the other interventions have been accomplished.

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client's teaching? a. "Change positions slowly when you get out of bed." b. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." c. "If you miss a dose of this drug, you can double the next dose." d. "Discontinue the medication if you develop a urinary infection."

ANS: B NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide

A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin? a. 0800 b. 1600 c. 2000 d. 2300

ANS: B Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the client at 2000 and 2300 would be too late. The nurse should check the client at 1600.

A client who underwent kidney transplantation 7 days ago has developed the following signs: urine output, 50 mL/12 hr; temperature, 102.2° F (39° C); lethargy; serum creatinine, 2.1 mg/dL; blood urea nitrogen (BUN), 54 mg/dL; and potassium, 5.6 mEq/L. Which initial intervention does the nurse anticipate for this client? a. Immediate hemodialysis b. Increased dose of immune suppressive drugs c. Initiation of IV antibiotics after cultures are obtained d. Placement of a catheter for peritoneal dialysis

ANS: B Oliguria, lethargy, elevated temperature, and increases in serum electrolyte levels, BUN, and creatinine, 1 week to 2 years post-transplantation are hallmarks of acute rejection, which can be reversible with increased immune suppressive therapy. The client does not need hemodialysis, peritoneal dialysis, or antibiotics at this point.

A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urine

ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet should the nurse decrease? a. Carbohydrates b. Proteins c. Fats d. Total calories

ANS: B Restriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients with microalbuminuria to delay progression to renal failure. The client's diet does not need to be decreased in carbohydrates, fats, or total calories.

A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections? a. "Wash your hands after completing each test." b. "Do not share your monitoring equipment." c. "Blot excess blood from the strip with a cotton ball." d. "Use gloves when monitoring your blood glucose."

ANS: B Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught to avoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her hands before testing. The client would not need to blot excess blood away from the strip or wear gloves.

A client has a serum creatinine level of 2 mg/dL and a urine output of 1000 mL/day. How does the nurse categorize the client's kidney injury? a. Intrarenal b. Nonoliguric c. Prerenal d. Postrenal

ANS: B Some clients have a nonoliguric form of acute renal failure (ARF), in which urine output remains near-normal but creatinine rises. The other categories relate to the cause of acute kidney injury.

A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis: Vital Signs and Assessment Laboratory Results Medications Blood pressure: 90/62 mm Hg Pulse: 120 beats/min Respiratory rate: 28 breaths/min Urine output: 20 mL/hr via catheter Serum potassium: 2.6 mEq/L Potassium chloride 40 mEq IV bolus STAT Increase IV fluid to 100 mL/hr Which action should the nurse take? a. Administer the potassium and then consult with the provider about the fluid order. b. Increase the intravenous rate and then consult with the provider about the potassium prescription. c. Administer the potassium first before increasing the infusion flow rate. d. Increase the intravenous flow rate before administering the potassium.

ANS: B The client is acutely ill and is severely dehydrated and hypokalemic. The client requires more IV fluids and potassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurse should first increase the IV rate and then consult with the provider about the potassium.

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: • Fasting blood glucose: 75 mg/dL • Postprandial blood glucose: 200 mg/dL • Hemoglobin A1c level: 5.5% How should the nurse interpret these laboratory findings? a. Increased risk for developing ketoacidosis b. Good control of blood glucose c. Increased risk for developing hyperglycemia d. Signs of insulin resistance

ANS: B The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the client's glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance.

The nurse is assessing a client with acute kidney injury and hears the following sound when auscultating the lungs. For what complication does the nurse plan care? Audio Clip a. Cardiac tamponade b. Pericarditis c. Pulmonary edema d. Myocardial Infarction

ANS: B The sound heard is a pericardial friction rub. This is heard in pericarditis because the pericardial sac becomes inflamed from uremic toxins. Other manifestations include low-grade fever, tachycardia, and chest pain. A tamponade would manifest as muffled heart tones. Pulmonary edema would manifest with crackles in the lungs. A myocardial infarction may or may not have abnormal chest sounds associated with it.

A client who is admitted to the hospital with a history of kidney disease begins to have difficulty breathing. Vital signs are as follows: blood pressure, 90/70 mm Hg; heart rate, difficult to feel peripheral pulses. His heart sounds are difficult to hear. Which intervention does the nurse prepare for? a. Administration of digoxin (Lanoxin) b. Draining of pericardial fluid with a needle c. Emergency hemodialysis d. Placement of a pacemaker

ANS: B These signs and symptoms are of cardiac tamponade, an emergency situation in which fluid accumulates in the pericardial sac, making it difficult for the heart to pump normally. Treatment includes a pericardiocentesis, or withdrawing the fluid with a needle or catheter. The other interventions are not appropriate in this situation.

11.A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? a. Assess for pain or burning with urination. b. Review the client's liver function study results. c. Instruct the client to increase water intake. d. Test a sample of urine for occult blood.

ANS: B Thiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at the start of therapy and at regular intervals while the client continues to take these drugs. Dark urine is one indicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurse should check the client's most recent liver function studies. The nurse does not need to assess for pain or burning with urination and does not need to check the urine for occult blood. The client does not need to be told to increase water intake.

A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching? a. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." b. "Monitor your blood glucose levels at least every 4 hours while sick." c. "If vomiting, do not use insulin or take your oral antidiabetic agent." d. "Try to continue your prescribed exercise regimen even if you are sick."

ANS: B When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick

The nurse is providing dietary teaching to a client who was just started on peritoneal dialysis (PD). Which instruction does the nurse provide to this client regarding protein intake? a. "Your protein needs will not change, but you may take more fluids." b. "You will need more protein now because some protein is lost by dialysis." c. "Your protein intake will be adjusted according to your predialysis weight." d. "You no longer need to be on protein restriction."

ANS: B When renal disease has progressed and requires treatment with dialysis, increased protein is required in the diet to compensate for protein losses through peritoneal dialysis. The other statements are inaccurate.

A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client? a. pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg b. pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg c. pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg d. pH 7.32, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg

ANS: B When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels.

A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted? a. Serum potassium level has increased. b. Blood osmolarity has decreased. c. Glasgow Coma Scale score is unchanged. d. Urine remains negative for ketone bodies.

ANS: C A slow but steady improvement in central nervous system functioning is the best indicator of therapy effectiveness for HHS. Lack of improvement in the level of consciousness may indicate inadequate rates of fluid replacement. The Glasgow Coma Scale assesses the client's state of consciousness against criteria of a scale including best eye, verbal, and motor responses. An increase in serum potassium, decreased blood osmolality, and urine negative for ketone bodies do not indicate adequacy of treatment.

A client is receiving continuous arteriovenous hemofiltration (CAVH). Which laboratory value does the nurse monitor most closely? a. Hemoglobin b. Glomerular filtration rate c. Sodium d. White blood cells

ANS: C CAVH is used for clients who have fluid volume overload. It continuously removes large quantities of plasma, water, waste, and electrolytes, such as sodium. Fluid removal can also affect the serum sodium level.

A client with chronic kidney disease is scheduled to be given the following medications: digoxin (Lanoxin) and epoetin alfa (Epogen). The client reports nausea and vomiting and wishes to wait to take the medications. Which action by the nurse is most appropriate? a. Administer both medications with soda crackers. b. Allow the client to wait an hour before taking the medications. c. Review today's potassium level and notify the health care provider. d. Call the health care provider to get an order for anti-nausea medication.

ANS: C Clients with kidney failure are particularly at risk for digoxin toxicity because the drug is excreted by the kidneys. When caring for clients with chronic kidney disease (CKD) who are receiving digoxin, monitor for signs of toxicity, such as nausea and vomiting. Potassium imbalances can alter digoxin levels as well. The nurse should hold the dose, check the current potassium level, and notify the provider. Giving the digoxin could be dangerous, so the nurse should not administer it with crackers, give it later, or ask for an anti-nausea medication.

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first? a. Document the finding in the client's chart. b. Assess tactile sensation in the client's hands. c. Examine the client's feet for signs of injury. d. Notify the health care provider.

ANS: C Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the client's chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed.

A client has end-stage kidney disease (ESKD). Which food selection by the client demonstrates understanding of a low-sodium, low-potassium diet? a. Bananas b. Ham c. Herbs and spices d. Salt substitutes

ANS: C Herbs and spices can be used in place of salt to enhance food flavor. Bananas are high in potassium. Ham is high in sodium. Many salt substitutes contain potassium chloride and should not be used.

A client with a decreased glomerular filtration rate asks how to prevent further damage to the kidneys. Which is the nurse's best response? a. "The diuretics you are taking will prevent further damage." b. "Kidney damage is inevitable as you age." c. "Avoid taking NSAIDs." d. "You will need to follow a high-protein diet."

ANS: C Kidney failure causes many problems, including decreased glomerular filtration rate. Nephrotoxins can worsen renal failure, especially in someone who already has some loss of kidney function.

A client is taking furosemide (Lasix). To detect a common adverse effect, the nurse obtains which assessment as a priority? a. Breath sounds b. Heart sounds c. Intake and output d. Nutritional patterns

ANS: C Lasix is a diuretic that causes increased urine output. If too much urine output occurs, the client may be at risk for hypovolemia, which is a cause of prerenal kidney failure. A marked change in fluid balance seen in the intake and output measurement can help identify the client who may be at risk for hypovolemia. Heart sounds and breath sounds would be more important to assess if the client was receiving Lasix for fluid overload conditions, such as heart failure. Nutrition assessment is important to ensure that the client gets enough potassium, but dehydration is more common and needs more vigorous assessment.

The nurse is caring for a client who is receiving peritoneal dialysis (PD). Which nursing intervention has the greatest priority when a dialysis exchange is performed? a. Adding potassium and antibiotic to the dialysate bags b. Positioning the client on either side c. Using sterile technique when hooking up dialysate bags d. Warming the dialysate fluid in a microwave oven

ANS: C Peritonitis is the major complication of PD. The most common cause of peritonitis is connection site contamination. To prevent peritonitis, use meticulous sterile technique when caring for the PD catheter and when hooking up or clamping off dialysate bags. This safety precaution is the priority. Never warm dialysate fluid in the microwave. Positioning the client may help with the flow of fluid. Clients may need additives to their dialysate fluid, but potassium and antibiotics are not added together because interactions between them can reduce the effectiveness of the antibiotic.

A client has been diagnosed with acute postrenal kidney injury. Which assessment finding does the nurse assess most carefully for? a. Blood urea nitrogen (BUN), 35 mg/dL b. Creatinine, 2.5 mg/dL c. Feeling of urgency d. Weight gain and edema

ANS: C Postrenal kidney failure is identified by focusing on urinary obstructive problems. Symptoms include changes in the urine stream or difficulty starting urination. All the other distractors can be seen with prerenal and intrarenal kidney injury.

Assessment findings reveal that a client with chronic kidney disease is refusing to take prescribed medications because of the "cost." The client also is having difficulty performing activities of daily living and prefers to sleep most of the day. To which health care team member does the nurse refer the client? a. Home health aide b. Physical therapist c. Psychiatric nurse practitioner d. Physician

ANS: C Professionals from many disciplines are resources for the client with renal failure. A psychiatric evaluation may be needed if depressive symptoms are present. Refusing treatment, having difficulty performing activities of daily living, and excessive sleeping could be signs of depression.

Which staff member does the charge nurse assign to care for a client newly diagnosed with chronic kidney disease? a. Licensed practical nurse who usually works on the unit b. Registered nurse floated from the hemodialysis unit c. Registered nurse who has taken care of this client before d. Registered nurse with the most years of experience

ANS: C Provide continuity of care, whenever possible, by using a consistent nurse-client relationship to decrease anxiety and promote discussion of concerns.

A client has a serum creatinine level of 2.5 mg/dL, a serum potassium level of 6 mmol/L, an arterial pH of 7.32, and a urine output of 250 mL/day. Which phase of acute kidney failure is the client experiencing? a. Intrarenal b. Nonoliguric c. Oliguric d. Postrenal

ANS: C The oliguric phase of acute kidney failure is characterized by the accumulation of nitrogenous wastes, resulting in increasing levels of serum creatinine and potassium, bicarbonate deficit, and decreased or no urine output. Intrarenal and postrenal refer to causes of kidney injury. Nonoliguric is not a classification.

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a "fruity" odor. Which action should the nurse take? a. Encourage the client to use an incentive spirometer. b. Increase the client's intravenous fluid flow rate. c. Consult the provider to test for ketoacidosis. d. Perform meticulous pulmonary hygiene care.

ANS: C The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a "fruity" odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this client's problem.

A client was just admitted to the emergency department for new-onset confusion. As the nurse starts the IV line, the client says he just finished a hemodialysis session. The IV site is bleeding briskly. What action by the nurse takes priority? a. Assess for a bruit and thrill over the vascular access site. b. Draw blood for coagulation studies and white blood cell count. c. Prepare to administer protamine sulfate. d. Hold constant firm pressure with a gauze pad for 5 minutes.

ANS: C To prevent blood clots from forming within the dialyzer or blood tubing, anticoagulation is needed during hemodialysis treatment. The drug used is heparin, which makes the client at risk for hemorrhage for the next 4 to 6 hours. Protamine sulfate is the antidote to heparin, and the nurse should prepare to administer it. Pressure may help, and someone else can apply it while the nurse is getting the medication. Laboratory studies are not needed because the client is at known risk for bleeding from heparin. Assessing the vascular access device does nothing to help the situation.

A client with chronic kidney disease states that he will be going to the dentist for a planned tooth extraction. Which is the nurse's best response? a. "Rinse your mouth with an antiseptic solution after the procedure." b. "Kidney disease is probably what caused your dental decay." c. "You should receive prophylactic antibiotics before any dental procedure." d. "You may take any medication for pain that the dentist prescribes."

ANS: C To prevent sepsis from oral cavity bacteria, the client should be given prophylactic antibiotics before any dental procedure. Rinsing the mouth with antiseptic solution would not be sufficient to prevent infection. Kidney disease may have contributed to the dental decay through loss of calcium from the teeth, but this cannot be confirmed. Clients with kidney disease should not take antibiotics known to be nephrotoxic. Dosage adjustments based on the client's kidney function may be needed.

The nurse is caring for a client with chronic kidney disease who has developed uremia. Which assessment finding does the nurse correlate with this problem? a. Decreased breath sounds b. Foul-smelling urine c. Heart rate of 50 beats/min d. Respiratory rate of 40 breaths/min

ANS: D A client with uremia will also have metabolic acidosis. With severe metabolic acidosis, the client will develop hyperventilation, or Kussmaul respirations, as the body attempts to compensate for the falling pH. The other manifestations would not be associated with acidosis.

Which statement by a client who has undergone kidney transplantation indicates a need for more teaching? a. "I will need to continue to take insulin for my diabetes." b. "I will have to take my cyclosporine for the rest of my life." c. "I will take the antibiotics three times daily until the medication is finished." d. "My new kidney is working fine. I do not need to take medications any longer."

ANS: D A crucial role of the nurse in long-term follow-up of the kidney transplantation client involves maintenance of prescribed drug therapy. Such clients will need to take immune suppressants for the rest of their lives to prevent rejection of the kidney.

A client who has chronic kidney disease is being discharged from the hospital after receiving treatment for a hip fracture. Which information is most important for the nurse to provide to the client before discharge? a. "Increase your intake of foods with protein." b. "Monitor your daily intake and output." c. "Maintain bedrest until the fracture is healed." d. "Take your aluminum hydroxide (Nephrox) with meals."

ANS: D Aluminum hydroxide lowers serum phosphate levels by binding phosphorus present in food. High blood phosphate levels cause hypocalcemia and osteodystrophy; this makes a client prone to fracture. Increasing protein may not be feasible for a client with chronic kidney disease and would not help prevent fracture. Intake and output will not be helpful for orthopedic problems. Bedrest will promote complications.

Which intervention is most important for the nurse to implement in a client after kidney transplant surgery? a. Promote acceptance of new body image. b. Monitor magnesium levels daily. c. Place the client on protective isolation. d. Remove the indwelling (Foley) catheter as soon as possible.

ANS: D Because of increased risk for infection related to immune suppressive drugs given to prevent rejection, the catheter is removed as soon as possible to avoid infection, usually 3 to 7 days after surgery. The client may need assistance with changes in body image, but this is not the priority. The client does not require protective precautions. Laboratory values will be monitored frequently in a post-transplant client, but this is not as important as preventing a complication by removing the catheter.

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this client's teaching to prevent injury? a. "Examine your feet using a mirror every day." b. "Rotate your insulin injection sites every week." c. "Check your blood glucose level before each meal." d. "Use a bath thermometer to test the water temperature."

ANS: D Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.

When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How should the nurse respond? a. "I can give your injections to you while you are here in the hospital." b. "Everyone gets used to giving themselves injections. It really does not hurt." c. "Your disease will not be managed properly if you refuse to administer the shots." d. "Tell me what it is about the injections that are concerning you."

ANS: D Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed. Giving the injections for the client does not promote self-care ability. Telling the client that others give themselves injections may cause the client to feel bad. Stating that you don't know another way to manage the disease is dismissive of the client's concerns.

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? a. A 29-year-old Caucasian b. A 32-year-old African-American c. A 44-year-old Asian d. A 48-year-old American Indian

ANS: D Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-aged places this client at highest risk.

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. "At my age, I should continue seeing the ophthalmologist as I usually do." b. "I will see the eye doctor when I have a vision problem and yearly after age 40." c. "My vision will change quickly. I should see the ophthalmologist twice a year." d. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

ANS: D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.

17.After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I have so many complications; exercising is not recommended." b. "I will exercise more frequently because I have so many complications." c. "I used to run for exercise; I will start training for a marathon." d. "I should look into swimming or water aerobics to get my exercise."

ANS: D Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.

A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this client's discharge education? a. "Test your urine daily for ketones." b. "Use only buffered insulin in your pump." c. "Store the insulin in the freezer until you need it." d. "Change the needle every 3 days."

ANS: D Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk for infection in or through the delivery system. Having an insulin pump does not require the client to test for ketones in the urine. Insulin should not be frozen. Insulin is not buffered

During hemodialysis, a client with chronic kidney disease develops headache, nausea, vomiting, and restlessness. After notifying the health care provider, which action by the nurse is most appropriate? a. Administer a bolus of dextrose solution. b. Draw blood for sodium and potassium. c. Order a blood urea nitrogen level stat. d. Prepare to administer phenytoin (Dilantin).

ANS: D Headache, nausea, vomiting, and restlessness may be signs of dialysis disequilibrium syndrome. Rapid decreases in fluid and in blood urea nitrogen (BUN) level can cause cerebral edema and increased intracranial pressure (ICP). Early recognition and treatment of this syndrome are essential for preventing a life-threatening situation. Treatment includes administration of anticonvulsants (Dilantin) or barbiturates. Dextrose is not used to treat disequilibrium syndrome, and sodium and potassium levels are not helpful because the symptoms are related to changes in urea levels and increased intracranial pressure. Obtaining the BUN would provide useful information; however, it is more important to treat the problem.

A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria? a. Serum sodium: 163 mEq/L b. Serum creatinine: 1.6 mg/dL c. Presence of urine ketone bodies d. Serum osmolarity: 375 mOsm/kg

ANS: D Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The client's serum osmolarity is high. The client's sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria.

A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this client's teaching to decrease the client's insulin needs? a. "Limit your fluid intake to 2 liters a day." b. "Animal organ meat is high in insulin." c. "Limit your carbohydrate intake to 80 grams a day." d. "Walk at a moderate pace for 1 mile daily."

ANS: D Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day.

10.After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy? a. "I'll take this medicine during each of my meals." b. "I must take this medicine in the morning when I wake." c. "I will take this medicine before I go to bed." d. "I will take this medicine immediately before I eat."

ANS: D Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the client's blood glucose levels. The medication should be taken before meals instead of during meals.

The RN has assigned a client with a newly placed arteriovenous (AV) fistula in the right arm to an LPN. Which information about the care of this client is most important for the RN to provide to the LPN? a. "Avoid movement of the right extremity." b. "Place gentle pressure over the fistula site after blood draws." c. "Start any IV lines below the site of the fistula." d. "Take blood pressure in the left arm."

ANS: D Repeated compression of a fistula site can result in loss of vascular access. Therefore, avoid taking blood pressures and performing venipunctures or IV placement in the arm with the vascular access. The other statements are not appropriate.

A client hospitalized for worsening kidney injury suddenly becomes restless and agitated. Assessment reveals tachycardia and crackles bilaterally at the bases of the lungs. Which is the nurse's first intervention? a. Begin ultrafiltration. b. Administer an antianxiety agent. c. Place the client on mechanical ventilation. d. Place the client in high Fowler's position.

ANS: D Restlessness, anxiety, tachycardia, dyspnea, and crackles at the bases of the lungs are early manifestations of pulmonary edema, which is a complication of kidney failure. Initial treatment of pulmonary edema consists of placing the client in high Fowler's position and administering oxygen. Mechanical ventilation and ultrafiltration may be indicated if symptoms become worse. An antianxiety agent would not be helpful. Morphine, however, has both vasoactive and sedating effects.

A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take? a. Apply ice to the site to reduce inflammation. b. Consult the provider for a new administration route. c. Assess the client for other signs of cellulitis. d. Instruct the client to rotate sites for insulin injection.

ANS: D The client's tissue has been damaged from continuous use of the same site. The client should be educated to rotate sites. The damaged tissue is not caused by cellulitis or any type infection, and applying ice may cause more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be appropriate or practical to change the administration route.

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? a. Administration of oxygen via face mask b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin

ANS: D The rapid, deep respiratory efforts of Kussmaul respirations are the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the client glucose would be contraindicated. The client does not require seizure precautions.

A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an occasional glass of wine?" How should the nurse respond? a. "Drinking any wine or alcohol will increase your insulin requirements." b. "Because of poor kidney function, people with diabetes should avoid alcohol." c. "You should not drink alcohol because it will make you hungry and overeat." d. "One glass of wine is okay with a meal and is counted as two fat exchanges."

ANS: D Under normal circumstances, blood glucose levels will not be affected by moderate use of alcohol when diabetes is well controlled. Because alcohol can induce hypoglycemia, it should be ingested with or shortly after a meal. One alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated. Kidney function is not impacted by alcohol intake. Alcohol is not associated with increased hunger or overeating.

Which assessment parameter does the nurse monitor in a client with chronic kidney disease to determine fluid and sodium retention status? a. Capillary refill b. Intake and output c. Muscle strength d. Weight and blood pressure

ANS: D Weight and blood pressure are helpful in estimating fluid and sodium retention. Weight and blood pressure rise with excess fluid and sodium. Weight is the most accurate noninvasive assessment for fluid status and therefore sodium status. Capillary refill also gives information on perfusion and oxygenation so is not specific for fluid status. Intake and output are part of the assessment for fluid status but do not account for insensitive water losses. Muscle strength is unrelated.

When glucagon is administered, what does it do? A. Competes for insulin at the receptor sites b. Frees glucose from hepatic stores of glycogen c. Supplies glycogen directly to the vital tissues d. Provides a glucose substitute for rapid replacement

B

Which statement about dietary concepts for a patient with diabetes is true? A. Alcoholic beverage consumption is unrestricted b. Carbohydrate counting is emphasized when adjusting dietary intake of nutrients c. Sweeteners should be avoided because of the side effects d. Both soluble and insoluble fiber foods should be limited

B

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? "I'll talk to the health care provider and have your name removed from the waiting list." "You sound frustrated with the situation." "You're right, the wait is endless for some people." "I'm sure you'll get a phone call soon that a kidney is available."

B Acknowledging the client's frustration reflects the feelings the client is having and offers assistance and support. Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs; the nurse should not offer false hope by suggesting that the client will get a phone call soon.

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? Diltiazem (Cardizem) Lisinopril (Zestril) Clonidine (Catapres) Doxazosin (Cardura)

B Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? A "Should we filter air circulation?" B "Can we use less radiographic contrast dye?" C "Should we add low-dose dobutamine?" D "Should we decrease IV rates?"

B Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? Mild discomfort at the insertion site Temperature 100.8° F 1+ ankle edema Anorexia

B Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed. Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? Adherence to therapy Handwashing Monitoring for low-grade fever Strict clean technique

B The most important infection control measure for the client receiving immune-suppressive therapy is handwashing. Adherence to therapy and monitoring for low-grade fever are important, but are not infection control measures. The nurse should practice aseptic technique for this client, not simply clean technique.

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) Check brachial pulses daily. Auscultate for a bruit every 8 hours. Teach the client to palpate for a thrill over the site. Elevate the arm above heart level. Ensure that no blood pressures are taken in that arm.

B C E A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL Crackles in the lung fields Temperature of 98.8° F (37.1° C) Blood pressure of 164/98 mm Hg 3+ edema of the lower extremities

B D E Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? A. "Should we filter air circulation?" B. "Can we use less radiographic contrast dye?" C. "Should we add low-dose dobutamine?" D. "Should we decrease IV rates?"

B. "Can we use less radiographic contrast dye?" Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? A. "I'll talk to the health care provider and have your name removed from the waiting list." B. "You sound frustrated with the situation." C. "You're right, the wait is endless for some people." D. "I'm sure you'll get a phone call soon that a kidney is available."

B. "You sound frustrated with the situation." Acknowledging the client's frustration reflects the feelings the client is having and offers assistance and support. Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs; the nurse should not offer false hope by suggesting that the client will get a phone call soon.

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) A. Check brachial pulses daily. B. Auscultate for a bruit every 8 hours. C. Teach the client to palpate for a thrill over the site. D. Elevate the arm above heart level. E. Ensure that no blood pressures are taken in that arm.

B. Auscultate for a bruit every 8 hours. C. Teach the client to palpate for a thrill over the site. E. Ensure that no blood pressures are taken in that arm. A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? A. Consuming a low-calcium diet B. Avoiding peas, nuts, and legumes C. Drinking cola beverages only once daily D. Increasing dairy products enriched with vitamin D

B. Avoiding peas, nuts, and legumes Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) A. Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL B. Crackles in the lung fields C. Temperature of 98.8° F (37.1° C) D. Blood pressure of 164/98 mm Hg E. 3+ edema of the lower extremities

B. Crackles in the lung fields D. Blood pressure of 164/98 mm Hg E. 3+ edema of the lower extremities Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? A. Adherence to therapy B. Handwashing C. Monitoring for low-grade fever D. Strict clean technique

B. Handwashing The most important infection control measure for the client receiving immune-suppressive therapy is handwashing. Adherence to therapy and monitoring for low-grade fever are important, but are not infection control measures. The nurse should practice aseptic technique for this client, not simply clean technique.

A 60-year-old African-American client is newly diagnosed with mild chronic kidney disease (stage 2 CKD). She has a history of diabetes, and her current A1C is 8.0%. She asks the nurse whether any of the following factors could have caused this problem. Which factor should the nurse indicate may have influenced the development of CKD? A. She heavily salted her food as a child and teenager but added no extra salt to her food as an adult. B. Her chronic hyperglycemia caused blood vessel changes in the kidney that can damage kidney tissue. C. Her paternal grandparents had type 2 diabetes and hypertension. D. She drinks 2 cups of coffee water daily.

B. Her chronic hyperglycemia caused blood vessel changes in the kidney that can damage kidney tissue. Rationale: Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) needing dialysis. Managing hyperglycemia delays the onset and progression of CKD. This level of caffeine intake would not lead to either kidney damage or hypertension. The fact that she has reduced her salt intake during adulthood would only help prevent hypertensive kidney disease. The family history of type 2 diabetes and hypertension is a potential risk factor, but her own diabetes and lack of glycemic control manifested by the elevated A1C have a more direct and great adverse effect on kidney function.

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? A. Diltiazem (Cardizem) B. Lisinopril (Zestril) C. Clonidine (Catapres) D. Doxazosin (Cardura)

B. Lisinopril (Zestril) Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.

When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? A. Mild discomfort at the insertion site B. Temperature 100.8° F C. 1+ ankle edema D. Anorexia

B. Temperature 100.8° F Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed. Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

Which statement by a patient with DM indicates an understanding of the principles of self-care? A. "I don't like the idea of sticking myself so often to measure my sugar." B. "I plan to measure the sugar in my urine at least four times a day." C. "I plan to get my spouse to exercise with me to keep me company." D. "If I get cold, I can take my regular cough medication until I feel better."

C

Which statement is true about insulin? A. It is secreted by alpha cells in the islets of Langerhans b. It is a catabolic hormone that builds up glucagon reserves c. It is necessary for glucose transport across cell membranes d. it is stored in muscles and converted to fat for storage

C

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? "Your diseased kidneys will be removed at the same time the transplant is performed." "The new kidney will be placed directly below one of your old kidneys." "It is essential for you to wash your hands and avoid people who are ill." "You will receive dialysis the day before surgery and for about a week after."

C Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.

A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? Blood pressure of 118/78 mm Hg Weight loss of 3 pounds during hospitalization Dyspnea and anxiety at rest Central venous pressure (CVP) of 6 mm Hg

C Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? "I can stop my medications when my kidney function returns to normal." "If my urine output is decreased, I should increase my fluids." "The anti-rejection medications will be taken for life." "I will drink 8 ounces of water with my medications."

C Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? RN who has floated from pediatrics for this shift LPN/LVN with experience working on the medical unit RN who usually works on the general surgical unit New graduate RN who just finished a 6-week orientation

C The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.

Which factor represents a sign or symptom of digoxin toxicity? Serum digoxin level of 1.2 ng/mL Polyphagia Visual changes Serum potassium of 5.0 mEq/L

C Visual changes, anorexia, nausea, and vomiting are symptoms of digoxin toxicity. A digoxin level of 1.2 ng/mL is normal (0.5 to 2.0 ng/mL). Polyphagia is a symptom of diabetes. Although hypokalemia may predispose to digoxin toxicity, this represents a normal, not low, potassium value.

While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? Instruct the client to deep-breathe and cough. Document the effluent as output. Turn the client to the opposite side. Re-position the catheter.

C With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? A. "Your diseased kidneys will be removed at the same time the transplant is performed." B. "The new kidney will be placed directly below one of your old kidneys." C. "It is essential for you to wash your hands and avoid people who are ill." D. "You will receive dialysis the day before surgery and for about a week after."

C. "It is essential for you to wash your hands and avoid people who are ill." Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? A. "I can stop my medications when my kidney function returns to normal." B. "If my urine output is decreased, I should increase my fluids." C. "The anti-rejection medications will be taken for life." D. "I will drink 8 ounces of water with my medications."

C. "The anti-rejection medications will be taken for life." Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.

The nurse is completing documentation for a client with acute kidney injury who is being discharged today. The nurse notices that the client has a serum potassium level of 5.8 mEq/L. Which is the priority nursing action? A. Asking the client to drink an extra 500 mL of water to dilute the electrolyte concentration and then re-checking the serum potassium level B. Encouraging the client to eat potassium-binding foods and to contact his or her primary care provider within 24 hours. C. Checking the remaining values on the electrolyte panel and informing the provider of all results before the client is discharged. D. Applying a cardiac monitor and evaluating the client's muscle strength and muscle irritability.

C. Checking the remaining values on the electrolyte panel and informing the provider of all results before the client is discharged. Rationale: Repeating the laboratory test is a reasonable option, but the provider must make this decision after being informed about the context, including the results of the entire electrolyte panel, which will also have information about renal function (creatinine and blood urea nitrogen). Although the potassium level is slightly elevated, it is not a value commonly associated with cardiac dysrhythmias or skeletal muscle changes. Although additional fluid intake may dilute some electrolytes, potassium is not generally altered by plasma volume. There are no foods that specifically bind potassium and, depending on the rapidity of the rise in serum potassium, waiting a day may result in harm to the patient.

A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? A. Blood pressure of 118/78 mm Hg B. Weight loss of 3 pounds during hospitalization C. Dyspnea and anxiety at rest D. Central venous pressure (CVP) of 6 mm Hg

C. Dyspnea and anxiety at rest Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? A. RN who has floated from pediatrics for this shift B. LPN/LVN with experience working on the medical unit C. RN who usually works on the general surgical unit D. New graduate RN who just finished a 6-week orientation

C. RN who usually works on the general surgical unit The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.

While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? A. Instruct the client to deep-breathe and cough. B. Document the effluent as output. C. Turn the client to the opposite side. D. Re-position the catheter.

C. Turn the client to the opposite side. With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.

Which factor represents a sign or symptom of digoxin toxicity? A. Serum digoxin level of 1.2 ng/mL B. Polyphagia C. Visual changes D. Serum potassium of 5.0 mEq/L

C. Visual changes Visual changes, anorexia, nausea, and vomiting are symptoms of digoxin toxicity. A digoxin level of 1.2 ng/mL is normal (0.5 to 2.0 ng/mL). Polyphagia is a symptom of diabetes. Although hypokalemia may predispose to digoxin toxicity, this represents a normal, not low, potassium value.

A patient will be using an external insulin pump. What does the nurse tell the patient about the pump? A. SMBG levels can be done only twice a day b. The insulin supply must be replaced every 2 to 4 weeks. C. The pumps battery should be checked on a regular weekly schedule d. The needle must be changed every two to three days

D

A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? "All of this is new. What can't you do?" "Are you afraid of dying?" "How are you doing this morning?" "What concerns do you have about your kidney disease?"

D Asking the client about any concerns is open-ended and specific to the client's concerns. Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? History of hiatal hernia Presence of diabetes and glycosylated hemoglobin of 6.8% History of basal cell carcinoma on the nose 5 years ago Presence of tuberculosis

D Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.

When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? Pulse oximetry reading of 95% Sinus bradycardia, rate of 58 beats/min Blood pressure of 148/90 mm Hg Temperature of 101.2° F (38.4° C)

D Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? Hematocrit of 26.7% Potassium within normal range Absence of spontaneous fractures Less fatigue

D Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.

A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? A. "All of this is new. What can't you do?" B. "Are you afraid of dying?" C. "How are you doing this morning?" D. "What concerns do you have about your kidney disease?"

D. "What concerns do you have about your kidney disease?" Asking the client about any concerns is open-ended and specific to the client's concerns. Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? A. Hematocrit of 26.7% B. Potassium within normal range C. Absence of spontaneous fractures D. Less fatigue

D. Less fatigue Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? A. History of hiatal hernia B. Presence of diabetes and glycosylated hemoglobin of 6.8% C. History of basal cell carcinoma on the nose 5 years ago D. Presence of tuberculosis

D. Presence of tuberculosis Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.

When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? A. Pulse oximetry reading of 95% B. Sinus bradycardia, rate of 58 beats/min C. Blood pressure of 148/90 mm Hg D. Temperature of 101.2° F (38.4° C)

D. Temperature of 101.2° F (38.4° C) Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.

A diabetic patient is scheduled to have a blood glucose test the next morning. What does the nurse tell the patient to do before coming in for the test? A. Eat the usual diet but have nothing after midnight b. Take the usual oral hypoglycemic tablet in the morning c. Eat a clear liquid breakfast in the morning d. Follow the usual diet and medication regimen

a

A patient has been receiving erythropoietin (Epogen). Which statement by the patient indicates that the therapy is producing the desired effect? a. "I can do my housework with less fatigue" b. "I have been passing more urine than I before" c. "I have less pain and discomfort now" d. "I can swallow and eat much better than before."

a

A patient has returned to the medical-surgical unit after having a dialysis treatment. The nurse notes that the patient is also scheduled for an invasive procedure on the same day. What is the primary rationale for delaying the procedure for 4 to 6 hours? a. The patient was heparinized during dialysis b. The patient will have cardiac dysrhythmias after dialysis c. The patient will be incoherent and unable to give consent d. The patient needs routine medications that were delayed

a

A patient is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dL. Which complication is the patient most at risk for developing? a. Hypoglycemia b. Pulmonary embolus c. Renal shutdown d. Pulmonary edema

a

A patient is undergoing a dialysis treatment and exhibits a progression of symptoms which include headache, nausea, and vomiting; and fatigue. How does the nurse interpret these symptoms? a. Mild dialysis disequilibrium syndrome b. Expected manifestations in ESKD c. Transient symptoms in a new dialysis patient d. Adverse reaction to the dialysate

a

A patient sustained extensive burns and depletion of vascular volume. The nurse expects which changes in vital signs and urinary function? a. Decreased urine output, hypotension, tachycardia b. Increased urine output, hypertension, tachycardia c. Bradycardia, hypotension, polyuria d. Dysrhythmias, hypertension, oliguria

a

A patient with AKI has a high rate of catabolism. What is this related to? a. Increased levels of catecholamines, cortisol, and glucagon b. Inability to excrete excess electrolytes c. Conversion of body fat into glucose d. Presence of retained nitrogenous wastes

a

A patient with AKI is receiving TPN. What is the therapeutic goal of using TPN? a. Preserve lean body mass b. Promote tubular reabsorption c. Create a negative nitrogen balance d. Prevent infection

a

A patient with CKD develops severe chest pain, an increased pulse, low-grade fever, and a pericardial friction rub with a cardiac dysrhythmia and muffled heart tones. The nurse immediately alerts the health care provider and prepares fo which emergency procedure? a. Pericardiocentesis b. CVVH c. Kidney dialysis d. Endotracheal intubation

a

IN order to assist a patient in the prevention of osteodystrophy, which intervention does the nurse perform? a. Administer phosphate binders with meals b. Encourage high-quality protein foods c. Administer iron supplements d. Encourage extra milk at mealtimes

a

The community health nurse is designing programs to reduce kidney problems and kidney injury among the general public. In order to do so, the nurse targets health promotion and compliance with therapy for people with which conditions? a.Diabetes mellitus and hypertension b. Frequent episodes of sexually transmitted disease c. Osteoporosis and other bone disease d. Gastroenteritis and poor eating habits

a

The home health nurse is evaluating the home setting for a patient who wishes to have in-home hemodialysis. What is important to have in the home setting to support this therapy? a. Specialized water treatment system to provide a safe, purified water supply b. Large dust-free space to accommodate and store the dialysis equipment c. Modified electrical system to provide high voltage to power the equipment d. Specialized cooling system to maintain strict temperature control

a

The home health nurse is visiting a patient who independently performs PD. Which question does the nurse ask the patient to assess for the major complication associated with PD? a. "Have you noticed any signs or symptoms of infection?" b. "Are you having any pain during the dialysis treatments" c. "Is the dialysate fluid slow or sluggish?" d. "Have you noticed any leakage around the catheter?"

a

The nurse is caring for a patient requiring PD> In order to monitor the patient's weight, what does the nurse do? a. Check the weight after a drain and before the next fill to monitor the patients "dry weight" b. Calculate the "dry weight" by weighing the patient every day and comparing the measurements to baseline c. Determine "dry weight" by comparing the patient's weight to a standard weight chart based on height and age d. Weigh the patient each day and count fluid intake and dialysate volume to determine the patients "dry weight"

a

The nurse is caring for a patient with AKI and notes a trend of increasingly elevated BUN levels.How does the nurse interpret this information? a. Breakdown of muscle for protein which leads to an increase in azotemia b. Sign of urinary retention and decreased urinary output c. Expected trend that can be reversed by increasing dietary protein d. Ominous sign of impending irreversible kidney failure

a

The nurse is caring for a patient with AKI who does not have signs or symptoms fo fluid overload. A fluid challenge is performed to promote kidney perfusion by doing what? a. Administering normal saline 500 to 1000 mL infused over 1 hour b. Administering drugs to suppress aldosterone release c. Instilling warm, sterile normal saline into the bladder d. Having the patient drink several large glasses of water

a

The nurse is caring for a postoperative patient and is evaluating the patient's intake and output as a measure to prevent AKI. The patient weighs 60 kilograms and has produced 180 mL of urine in the past 4 hours. HWat should the nurse do? a. Perform other assessments related to fluid status and record the output b. Call the health care provider and obtain an order for a fluid bolus c. Encourage the patient to drink more fluid, so that the output is increased d. Compare the patient weight to baseline to determine fluid retention

a

The nurse is caring for patient with DM. The patient's urine is positive for ketones. What does the nurse instruct the patient with regard to exercise? A. "When urine ketones are present, you should not exercise." B. "You may exercise as long as serum ketones are negative." C. "If you exercise now, be sure to perform aerobic exercises." D. "Exercise is always a good option because it helps with glucose utilization."

a

The nurse is caring for several patients on a medical-surgical unit. None of the patients currently has any acute or chronic kidney problems. Which patient has the greatest risk to develop AKI? a. 73-year-old male who has hypertension and peripheral vascular disease b. 32-year-old female who is pregnant and has gestational diabetes c. 49-year-old male who is obese and has a history of skin cancer d. 23-year-old female who has been treated for a urinary tract infection

a

The patient with CKD reports chronic fatigue and lethargy with weakness and mild shortness of breath with dizziness when rising to a standing position. In addition, the nurse notes pale mucous membranes. Based on the patient's illness and the presenting symptoms, which laboratory result does the nurse expect to see? a. Low hemoglobin and hematocrit b. low white cell count c. Low blood glucose d. Low oxygen saturation

a

What type of exercise does the nurse recommend for the patient with diabetic retinopathy? A. Non-weight-bearing activities such as swimming b. Weight-bearing activities such as jogging c. Vigorous aerobic and resistance exercise d. Weight training and heavy lifting

a

Which disorder could be a complication from AKI? a. Heart failure b. Diabetes mellitus c. Kidney cancer d. Compartment syndrome

a

A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Do not walk around barefoot." b. "Soak your feet in a tub each evening." c. "Trim toenails straight across with a nail clipper." d. "Treat any blisters or sores with Epsom salts." e. "Wash your feet every other day."

a. "Do not walk around barefoot." c. "Trim toenails straight across with a nail clipper." ANS: A, C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.

A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: • Insulin glargine: 12 units daily at 1800 • Regular insulin: 6 units QID at 0600, 1200, 1800, 2400 Based on the client's medication administration record, which action should the nurse take? a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. b. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin. c. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together. d. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix, and inject the two insulins together.

a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. ANS: A Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in an unpredictable alteration in the onset of action and time to peak action. The correct instruction is to draw up and inject first the glargine and then the regular insulin right afterward.

A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.) a. Stroke b. Kidney failure c. Blindness d. Respiratory failure e. Cirrhosis

a. Stroke b. Kidney failure c. Blindness ANS: A, B, C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.

Which factors differentiate DKA from HHS? (SATA) a. Level of hyperglycemia b. Amount of ketones produced c. Serum bicarbonate levels d. Amount of volume depletion e. Dosage of insulin needed

ab

The nurse is caring for a patient receiving gentamicin. Because this drug has potential for nephrotoxicity, which laboratory results does the nurse monitor? (SATA) a. BUN b. Creatinine c. Drug peak and trough levels d. PT e. Platelet count f. Hemoglobin and hematocrit

abc

Which are the most accurate ways to monitor kidney function in the patient with CKD? (SATA) a. Monitoring intake and output b. Checking urine specific gravity c. Reviewing BUN and serum creatinine levels d. Reviewing x-ray reports e. Consulting the dietitian's notes

abc

A patient can develop intrarenal kidney injury from which causes? (SATA) a. Vasculitis b. Pyelonephritis c. Strenuous exercise d. Exposure to nephrotoxins e. Bladder cancer

abd

Which are signs and symptoms of mild hypoglycemia? (SATA) a. Headache b. Weakness c. Cold, clammy skin d. Irritability e. Pallor f. Tachycardia

abd

Which complications of DM are considered emergencies? (SATA) a. DKA b. hypoglycemia c. Diabetic retinopathy d. Hyperglycemic hyperosmolar state (HHS) e. Diabetic neuropathy

abd

Which cultures tend to have a higher incidence of DM? (SATA) a. Mexican American B. African American c. Caucasian d. American Indian E. Eastern European

abd

In developing an individualized meal plan for a patient with diabetes, which goals will be focal points of the plan? (SATA) a. Maintain blood glucose levels at or as close to the normal range as possible. B. Patient food preferences c. Allowing patients to eat as much as they desire d. Patient cultural preferences e. Limiting food choices only when guided by scientific evidence

abde

Which characteristics are associated with ESKD? (SATA) a. Severe fluid overload b. Renal osteodystrophy c. Nephrons compensate d. Dialysis or transplant needed to maintain homeostasis e. Excessive waste products

abde

Which statements about type 2 DM are accurate? (SATA) a. It peaks at about the age of 50 b. Most people with type 2 DM are obese c. It typically has an abrupt onset d. People with type 2 DM have insulin resistance e. It can be treated with oral antidiabetic medications and insulin

abde

A patient with CKD is taking digoxin (Lanoxin). Which signs of digoxin toxicity does the nurse vigilantly monitor for? (SATA) a. Nausea and vomiting b. Visual changes c. Respiratory depression d. Restlessness or confusion e. Headache or fatigue f. Tachycardia

abdef

Intensive therapy with good glucose control result in delays in which diabetic complications? (SATA) a. Macrovascular disease b. Cardiovascular disease c. Stroke d. Retinopathy e. Nephropathy f. Neuropathy

abdef

What might the nurse notice if the patient is experiencing reduced perfusion and altered urinary elimination related to AKI? (SATA) a. Hemodynamic instability, especially persistent hypotension and tachycardia b. Urine output of less than 0.5 mL/kg/hour for 6 or more hours c. Serum creatinine below baseline or admission values d. Urien may be clear o have a pale yellow color e. Abnormal serum and urine potassium and sodium values

abe

The nurse is caring for a patient in the intensive care unit who sustained blood loss during a traumatic accident. For early identification of signs and symptoms that would suggest the development of kidney dysfunction, what does the nurse observe for? (SATA) a. Hypotension b. Bradycardia c. Decreased urine output d. Decreased cardiac output e. Increased central venous pressure

acd

Which signs/symptoms does the nurse expect to see in the patient with AKI that has progressed in severity? (SATA) a. Oliguria b. Hypotension c. Shortness of breath d. Pulmonary crackles e. Weight loss

acd

Which statements about type 1 DM are accurate? (SATA) a. It is an autoimmune disorder b. Most people with type 1 DM are obese c. Age of onset is typically younger than 30 d. Etiology can be attributed to viral infections e. It can be treated with oral antidiabetic medications and insulin

acd

Which patients with CKD are candidates for intermittent hemodialysis (SATA) a. Patients with fluid overload who does not respond to diuretics b. Patient with injury stage according to the RIFLE classification c. Patient with symptomatic toxin ingestion d. patient with uremic manifestations, such as decreased cognition e. Patient with symptomatic hyperkalemia and calciphylaxis

acde

SMBG levels is most important in which patients? (SATA) a. Patients taking multiple daily insulin injections b. Patients with mild type 2 diabetes c. Patients with hypoglycemic unawareness d. patients using a portable infusion device for insulin administration e. Patients with acute illnesses f. Pregnant patients

acdef

The nurse is taking a history of a patient at risk for kidney failure. What does the nurse ask the patient about during the interview? (SATA) a. Exposure to nephrotoxic chemicals b. Increased appetite c. History of diabetes mellitus, hypertension, systemic lupus erythematosus d. Recent surgery, trauma, or transfusions e. Leakage of urine when coughing or laughing f. Recent or prolonged use of antibiotics and NSAIDs

acdf

In which situations does the nurse teach a patient to perform urine ketone testing? (SATA) a. Acute illness or stress b. When blood glucose levels are above 240 mg/dL c. When symptoms of DKA are present d. To evaluate the effectiveness of DKA treatment e. When a diabetic patient is in a weight-loos program

ace

The patient with type 2 diabetes is prescribed sitagliptin (Januvia) for glucose regulation. Which key changes does the nurse teach a patient to report to the health care provider immediately? (SATA) a. Report any signs of jaundice b. Report any signs of bleeding c. Report any blue-grey discoloration of the abdomen d. Report any cough or flu symptoms e. Report any sudden onset of abdominal pain

ace

The home health nurse is reviewing the medication list of a patient with CKD. The nurse calls the health care provider as a reminder that the patient might need which nutritional supplements? (SATA) a. Iron b. Magnesium c. Phosphorus d. Calcium e. Vitamin D f. Water-soluble vitamins

adef

A diabetic patient is on a mixed-dose insulin protocol of 8 units regular insulin and 12 units NPH insulin at 7 AM. At 10:30 AM, the patient reports feeling uneasy, shaky, and has a headache. Which is the probable explanation for this? A. The NPH insulins action is peaking, and there is an insufficient blood glucose level. B. The regular insulins action is peaking, and there is an insufficient blood glucose level. C. The patient consumed too many calories at breakfast and now has an elevated blood glucose level d. They symptoms are unrelated to the insulin administered in the early morning or food taken in a lunchtime

b

A patient and family are trying to plan a schedule that coordinates with the patient dialysis regimen. The patient asks, "How often will I have to go and how long does it take?" What is the nurse's best response? a. "If you are compliant with the diet and fluid restrictions, you spend less time in dialysis; about 12 hours a week" b. "Most patients require about 12 hours per week; this is usually divided into three 4-hour treatment" c. "It varies from patient to patient. You will have to call your health care provider for specific instructions" d "If you gain a large amount fo fluid weight, a longer treatment time may be needed to prevent severe side effects"

b

A patient is in the diuretic phase of AKI. During this phase, what is the nurse mainly concerned about? a. Assessing for hypertension and fluid overload b. Monitoring for hypovolemia and electrolyte loss c. Adjusting the dosage of diuretic medications d. Balancing diuretic therapy with intake

b

A patient receives dialysis therapy and the health care provider has ordered sodium restriction to 3 g daily. What does the nurse teach the patient? a. Add smaller amounts of salt at the table or during cooking b. Identify foods that are high in sodium (e.g., bacon, potato chips, fast foods). c. Avoid foods that have a metallic, salty, or bitter taste d. Eat larger amounts of bland foods with very minimal amounts of spicing

b

A patient with CKD is restless, anxious, and short of breath. The nurse hears crackles that begin at the base of the lungs. The pulse rate is increased and the patient has frothy, blood-tinged sputum. What does the nurse do first? a Facilitate transfer to the ICU for aggressive treatment b. Place the patient in a high-Fowlers position c. Continue to monitor vital signs and assess breath sounds d. Administer a loop diuretic such as furosemide (Lasix)

b

A patient with DM has signs and symptoms of hypoglycemia. The patient is alert and oriented with a blood glucose of 56 mg/dL. What does the nurse do next? A. Give a glass of orange juice with two packets of sugar and continue to monitor the patient b. Give 8 oz of skim milk and then a carbohydrate and protein snack c. Give a complex carbohydrate and continue to monitor the patient d. Administer D50 IV push and give the patient something to eat

b

A patient with diabetes presents to the ED with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate "all of the time." How does the nurse document this subjective finding? A. Polydipsia and polyphagia b. Polydipsia and polyuria c. Polycoria and polyuria d. Polyphagia and polyesthesia

b

A patient with type 2 DM often has which laboratory value? A. Elevated thyroid studies b. Elevated triglycerides c. Ketones in the urine d. Low hemoglobin

b

As a patient with ESKD experiences isosthenuria, what must the nurse be alert for? a. The diuretic stage b. Fluid volume overload c. Dehydration d. Alkalosis

b

As a result of kidney failure, excessive hydrogen ions cannot be excreted. With acid retention, the nurse is most likely y to observe what type of respiratory compensation? a. Cheyne-Stokes respiratory pattern b. Increased depth of breathing c. Decreased respiratory rate and depth d. Increased arterial carbon dioxide levels

b

The critical care nurse is caring for an older patient admitted with HHS. What is the first priority in caring for this patient? A. Slowly decreasing blood glucose b. Fluid replacement to increase blood volume c. Potassium replacement to prevent hypokalemia d. Diuretic therapy to maintain kidney function

b

The night shift nurse sees a patient with kidney failure sitting up in bed. The patient states, "I feel a little short of breath at night or when I get up to walk to the bathroom." What assessment does the nurse do? a. Check for orthostatic hypotension because of potential volume depletion b. Auscultate the lungs for crackles, which indicate fluid overload c. Check the pulse and blood pressure for possible decreased cardiac output d. Assess for normal sleep pattern and need for a PRN sedative

b

The nurse is caring for a patient with AKI that developed after a severe anaphylactic reaction. What is a primary treatment goal of the initial phase that will help to prevent permanent kidney damage for this patient? a. Correct fluid volume by administering IV normal saline b. Maintain a mean arterial pressure (MAP) of 65 mm Hg. c. Prevent kidney infections by administering antibiotics d. Give antihistamines to prevent allergic response

b

The nurse is caring for a patient with ESKD and dialysis has been initiated. Which drug order does the nurse question? a. Erythropoietin b. Diuretic c. ACE inhibitor d. Calcium channel blocker

b

The nurse is reviewing a patient's laboratory results. IN the early phase of CKD, the patient is at risk for which electrolyte abnormality? a. Hyperkalemia b. Hyponatremia c. Hypercalcemia d. Hypokalemia

b

The nurse is reviewing the medication list and appropriate dose adjustments made for a patient with CKD. The nurse would question the use and/or dosage adjustment of which type of medication? a. Antibiotics b. Magnesium antacids c. Oral antidiabetics d. Opioids

b

The nurse reads in the patient's chart that he has acute-on-chronic kidney disease. How does the nurse interpret this information? a. Kidney disease has progressed to the need for dialysis or transplant b. Patient has chronic kidney disease and has sustained an acute kidney injury c. Acute kidney injury requires aggressive management to prevent chorionic disease d The condition could be acute or chronic; further diagnostic testing is needed

b

Which diabetic complication is associated with neuropathy? A. ESKD b. Muscle weakness c. Permanent blindness d. Eye hemorrhage

b

Which statement about insulin administration is correct? A. Insulin may be given orally, intravenously or subcutaneously b. Insulin injections should be spaced no closer than one-half inch apart c. Rotating injection sites improves absorption and prevents lipohypertrophy d. Shake the bottle of intermediate-acting insulin, and then draw it into the syringe

b

Which statement about insulin is true? A. Exogenous insulin is necessary for management of all cases of type 2 DM b. Insulins effectiveness depends on the individual patient's absorption of the drug c. Insulin doses should be regulated according to self-monitoring urine glucose levels d. Insulin administered in multiple does per day decreases the flexibility of a patient's lifestyle

b

A nurse prepares to administer prescribed regular and NPH insulin. Place the nurse's actions in the correct order to administer these medications. 1. Inspect bottles for expiration dates. 2. Gently roll the bottle of NPH between the hands. 3. Wash your hands. 4. Inject air into the regular insulin. 5. Withdraw the NPH insulin. 6. Withdraw the regular insulin. 7. Inject air into the NPH bottle. 8. Clean rubber stoppers with an alcohol swab. a. 1, 3, 8, 2, 4, 6, 7, 5 b. 3, 1, 2, 8, 7, 4, 6, 5 c. 8, 1, 3, 2, 4, 6, 7, 5 d. 2, 3, 1, 8, 7, 5, 4, 6

b. 3, 1, 2, 8, 7, 4, 6, 5 ANS: B After washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubber stoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. It is important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoid mixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first

The diabetic patient experiences early morning hyperglycemia (Somogyi effect) as a result of the counterregulatory response to hypoglycemia. What treatment does the nurse expect for this condition? (SATA) a. Administer a 10 PM does of intermediate-acting insulin b. Provide an evening snack to ensure adequate dietary intake c. Evaluate insulin dosage and exercise program d. Add an oral antidiabetic drug to patient's regimen e. Increase blood glucose check to every 2 hours around the clock

bc

which patients are likely to be excluded from receiving a transplant? (SATA) a. Patient who had breast cancer 6 years ago b. Patient with advanced and uncorrectable heart disease c. Patient with a chemical dependency d. Patient who is 70 years old and has a living related donor e. Patient with diabetes mellitus

bc

What are the characteristics of continuous venovenous hemofiltration (CVVH)? (SATA) a. Requires placement of arterial and venous access b. Uses a pump to drive blood from the patient catheter into the dialyzer c. Risk for air embolus d. More commonly used for patients who are critical ill e. Most convenient method for home care patients

bcd

A patient has been diagnosed with DM. Which aspects does the nurse consider in formulating the teaching plan for this patient? (SATA) a. Covering all needed information in one teaching session b. Assessing visual impairment regarding insulin labels and markings on syringes c. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe d. Assessing patient motivation to learn and comprehend instructions e. Assessing the patient's ability to read printed material

bcde

A daughter is considering donating a kidney her mother for organ transplant what information does the nurse give to the daughter about the criteria for donation? (SATA) a. Age limit is at least 21 hours b. Systemic disease and infection must be absent c. There must be no history of cancer d. Hypertension or kidney disease must be absent e. There must be adequate kidney function as determined by diagnostic studies f. The donor must understand the surgery and be willing to give up the organ

bcdef

The nurse is caring fro a patient with an arteriovenous fistula. What is included in the nursing care for this patient? (SATA) a. Keep small clamps handy by the bedside b. Encourage routine range-of-motion exercises c. Avoid venipuncture or IV administration on the arm with the access device d. Instruct the patient to carry heavy objects to build muscular strength e. Assess for manifestations of infection of the fistula f. Instruct the patient to sleep on the side with the affected arm in the dependent position

bce

The nurse is providing discharge teaching to a patient about self-monitoring of blood glucose (SMBG). What information does the nurse include? (SATA) a. Only perform SMBG before breakfast b. Wash hands before using the meter c. Do a retest if the results seem unusual d. It is okay to reuse lancets in the home setting e. Do not share the meter

bce

The older adult with DM asks the nurse for advice about beginning an exercise program. What is the nurse's best response (SATA) a. Begin with high-intensity activities b. Start low-intensity activities in short sessions c. Be sure to include warm-up and cool-down periods d. Start with periods of 20 minute or less e. Changes inactivity should be gradual

bce

Postrenal kidney injury can result from which conditions? (SATA) a. Septic shock b. Cervical cancer c. Nephrolithiasis or ureterolithiasis d. Heart failure e. Neurogenic bladder f. Prostate cancer

bcef

Which are characteristics of regular insulin? (SATA) a. This insulin does not have a peak time b. When mixing types of insulin, this insulin is always drawn up first c. This insulin is given once daily for basal insulin coverage d. This insulin should be given 30 minutes before meals e. This insulin should not be diluted or mixed with any other insulin

bd

Which descriptors are typical of type 2 DM? (SATA) a. Autoimmune process causes beta cell destruction b. Cells have decreased ability to respond to insulin c. Diagnosis is based on results of 100-g glucose tolerance test d. Most patients diagnosed are obese adults e. Usually has abrupt onset of thirst and weight loss

bd

What are common causes of prerenal kidney injury? (SATA) a. Urethral cancer b. Hypovolemic shock c. Enlarged prostate gland d. Sepsis e. Severe burns

bde

A patient is diagnosed with renal osteodystrophy. What does the nurse instruct the UAP to do in relation to this patient diagnosis? a. Assist the patient with toileting every 2 hours b. Gently wash the patient's skin with a mild soap and rinse well c. Handle the patient gently because of risk for fractures d. Assis the patient with eating because of loss of coordination

c

A patient laboratory results show an elevated creatinine level. The patient's history reveals no risk factors for kidney disease. Which question does the nurse ask the patient to shed further light on the laboratory result? a. "How many hours of sleep did you get the night before the test?" b. "How much fluid did you drink before the test?" c. "Did you take any type of antibiotic before taking the test?" d "When and how much did you last urinate before having the test?"

c

Glucagon is used primarily to treat the patient with which disorder? A. DKA b. Idiosyncratic reaction to insulin c. Severe hypoglycemia d. HHNS

c

The intensive care nurse is caring for the kidney transplant patient who was just transferred from the recovery unit. Which finding is the most serious within the first 12 hours after surgery and warrants immediate notification of the transplant surgeon? a. Diuresis with increased output b. Pink and bloody urine c. Abrupt decrease in urine d. Small clots in bladder irrigation fluid

c

The nurse is monitoring a patient's PD treatment. The total outflow is slightly less than the inflow. What does the nurse do next? a. Instruct the patient to ambulate b. Notify the health care provider c. Record the difference as intake d. Put the patient on fluid restriction

c

The nurse is talking to a group of healthy young college students about maintaining good kidney health and preventing AKI. Which health promotion point is the nurse most likely to emphasize this group? a. "Have your blood pressure checked regularly" b. "Find out if you have a family history of diabetes" c. "Avoid dehydration by drinking at least 2 to 3 L of water daily" d. "Have annual testing for microalbuminuria and urine protein"

c

The nurse notes an abnormal laboratory test finding for a patient with CKD and alerts the health care provider. The nurse also consults with the registered dietitian because an excessive dietary protein intake is directly related to which factor? a. Elevated serum creatinine level b. Protein presence in the urine c. Elevated BUN level d. Elevated serum potassium level

c

What is the recommended protocol for patients with type 2 DM who must lose weight? A. Participate in an aerobic program twice a week for 20 minutes each session b. Slowly increase insulin dosage until mild hypoglycemia occurs c. Reduce calorie intake moderately and increase exercise d. Reduce daily calorie intake to 1000 calories and monitor urine for ketones

c

What type of breath odor is most likely to be noted in a patient with CKD? a. Fruit smell b. Fecal smell C Smell like urine d. Smells like blood

c

Which behavior is the strongest indicator that a patient with ESKD is not coping well with the illness and may need a referral for psychological counseling? a. Displays irritability when the meal tray arrives b. Refuses to take one of the drugs because it causes nausea c. Repeatedly misses dialysis appointments d. Seems distracted when the health care provider talks about the prognosis

c

Which class of antidiabetic medication should be given 1-30 minutes before meals? A. Alpha-glucosidase inhibitors, which include miglitol (Glyset) b. Biguanides, which include metformin (Glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)

c

Which combination of drugs is the most nephrotoxic? a. ACE inhibitors and aspirin b. Angiotensin II receptor blockers and antacids c. Aminoglycoside antibiotics and NSAIDs d. Calcium channel blockers and antihistamines

c

Which electrolyte is most affected by hyperglycemia? A. Sodium b. Chloride c. Potassium d. Magnesium

c

Which individual is at greatest risk for developing type 2 DM? a. 25-year-ld African-American woman b. 36-year-old African-American man c. 56-year-old Hispanic woman d. 40-year-old Hispanic man

c

Which oral agent may cause lactic acidosis? A. Nateglinide b. Repaglinide c. Metformin d. Miglitol

c

Which patient is the most likely candidate for CVVH? a. Patient with fluid volume overload b. Patient who needs long-term management c. Patient who is critically ill d. Patient who is ready for discharge to home

c

Which statement about sexual intercourse for patients with diabetes is true? A. The incidence of sexual dysfunction is lower in men than women b. Retrograde ejaculation does not interfere with male fertility c. Impotence is associated with DM in male patients d. Sexual dysfunction in female patients include inability to achieve pregnancy

c

40.After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I should increase my intake of vegetables with higher amounts of dietary fiber." b. "My intake of saturated fats should be no more than 10% of my total calorie intake." c. "I should decrease my intake of protein and eliminate carbohydrates from my diet." d. "My intake of water is not restricted by my treatment plan or medication regimen."

c. "I should decrease my intake of protein and eliminate carbohydrates from my diet." ANS: C The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present

At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominal hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews the assessment data provided in the chart below: Capillary Blood Glucose Testing (AC/HS) Dietary Intake At 0630: 95 At 1130: 70 At 1630: 47 Breakfast: 10% eaten - client states she is not hungry Lunch: 5% eaten - client is nauseous; vomits once After reviewing the client's assessment data, which action is appropriate at this time? a. Assess the client's oxygen saturation level and administer oxygen. b. Reorient the client and apply a cool washcloth to the client's forehead. c. Administer dextrose 50% intravenously and reassess the client. d. Provide a glass of orange juice and encourage the client to eat dinner.

c. Administer dextrose 50% intravenously and reassess the client. ANS: C The client's symptoms are related to hypoglycemia. Since the client has not been tolerating food, the nurse should administer dextrose intravenously. The client's oxygen level could be checked, but based on the information provided, this is not the priority. The client will not be reoriented until the glucose level rises.

Which statements about sensory alteration in patient with diabetes are accurate? (SATA) a. Healing of foot wounds is reduced because of impaired sensation b. Very few patients with diabetic foot ulcers have peripheral sensory neuropathy c. Loss of pain, pressure, and temperature sensation in the foot increases the risk for injury d. Sensory neuropathy causes loss of normal sweating and skin temperature regulation. E It can be delayed by keeping the blood glucose level as close to normal as possible

cde

The nurse is teaching a patient with diabetes about proper foot care. Which instructions does the nurse include? (SATA) a. Use rubbing alcohol to toughen the skin on the soles of the feet b. Wear open-toed shoes or sandals in warm weather to prevent perspiration c. Apply moisturizing cream to the feet after bathing, but not between the toes d. Use cold water for bathing the feet to prevent inadvertent thermal injury e. do not go barefoot f. Inspect the feet daily

cef

A 25-year-old female patient with type 1 DM tells the nurse, "I have two kidneys and I'm still young. I expect to be around for a long time, so why should I worry about my blood sugar?" What is the nurse's best response? A. "You have little to worry about as long as your kidneys keep making urine." B. "You should discuss this with your physician because you are being unrealistic." C "You would be right if your diabetes was managed with insulin." D. "Keeping your blood sugar under control now can help to prevent damage to both kidneys."

d

A patient has AKI related to nephrotoxins. In order to maintain cell integrity, improve GFR, and improve blood flow to the kidneys, which type of medication does the nurse anticipate the health care provider will prescribe? a. Loop diuretics b. Alpha-adrenergic blockers c. Beta blockers d. Calcium channel blockers

d

A patient has been diagnosed with AKI, but the cause is uncertain. The nurse prepares patient education material about which diagnostic test? a. Flat plate of the abdomen b. Renal ultrasonography c. Computed tomography d. Kidney biopsy

d

A patient with AKI is ill and has a poor appetite. What would the health care team try first? a. IV normal saline to prevent dehydration b. Familiar food brought by the family c. Nasogastric tube for enteral feedings d. Oral supplements designed for kidney patients

d

A patient with diabetes has signs and symptoms of hypoglycemia. The patient has a blood glucose of 56 mg/dL, is not alert but responds to voice, and is confused and is unable to swallow fluids. What does the nurse do next? A. Give a glass of orange juice with two packets of sugar and continue to monitor the patient b. Give a glass of orange or other type of juice and continue to monitor the patient c. Give a complex carbohydrate and continue to monitor the patient d. Administer D50 IV push

d

A patient with type 2 DM, usually controlled with a second-generation sulfonylurea, develops a urinary tract infection. Due to the stress of the infection, the patient must be treated with insulin. What additional information about this treatment does the nurse relay to the patient? A. The sulfonylurea must be discontinued and insulin taken until the infection clears. B Insulin will now be necessary to control the patient's diabetes for life c. The sulfonylurea dose must be reduced until the infection clears d. The insulin is necessary to supplement the second-generation sulfonylurea until the infection clears

d

According to the American Diabetes Association (ADA), which laboratory finding is most indicative of DM? a. Fasting blood glucose = 80 mg/dL b. 2-hour postprandial blood glucose = 110 mg/dL c. 1-hour glucose tolerance blood glucose = 110 mg/dL d. 2-hour glucose tolerance blood glucose = 2010 mg/dL

d

Early treatment of DKA and HHNS includes IV administration of which fluid? A. Glucagon b. Potassium c. Bicarbonate d. Normal saline

d

Increased BUN and creatinine, hyperkalemia, and hypernatremia are all characteristics of which stage of kidney disease? a. Stage 1 CKD b. Mild CKD c. Moderate CKD d. ESKD

d

The male diabetic patient asks the nurse for advice about alcohol consumption. What is the nurse's best response? A. "It is best to have alcohol near bedtime." B. "As long as your diabetes is under control you can drink as much as you like." C. "You should drink only one alcoholic beverage with each meal." D. "Avoid more than two drinks a day and have them with or shortly after meals."

d

The nurse is assessing a patient who has just returned from hemodialysis. Which assessment finding is cause for greatest concern? a. Feeling of malaise b. Headache c. Muscle cramps in the legs d. Bleeding at the access site

d

The nurse is assessing the skin of a patient with ESKD. Which clinical manifestation is considered a sign of very late, premorbid, advanced uremic syndrome? a. Ecchymoses b. Sallowness c. Pallor d. Uremic frost

d

The nurse is caring for a patient with an arteriovenous fistula. What instructions are give to the UAP regarding the care of this patient? a. Palpate for thrills and auscultate for bruits every 4 hours b. Check for bleeding at needle insertion sites c. Assess the patient distal pulses and circulation d. Do not take blood pressure readings in the arm with fistula

d

The nurse is caring for the kidney transplant patient in the immediate postoperative period. During this initial period, the nurse will assess the urine output at least every hour for how many hours? a. First 8 hours b. First 12 hours c. First 24 hours d. First 48 hours

d

The nurse is taking a history on a patient with diabetes and hypertension. Because of the patient's high risk for developing kidney problems, which early sign of CKD does the nurse assess for? a. Decreased output with subjective thirst b. Urinary frequency of very small amounts c. Pink or blood-tinged urine d. Increased output of very dilute urine

d

The nursing student is explaining principles of hemodialysis to the nursing instructor. Which statement by the student indicates a need for additional study and research on the topic? a. "Dialysis works as molecules from an area of higher concentration move to an area of lower concentration" b. "Blood and dialyzing solution flow in opposite directions across an enclosed semipermeable membrane" c. "Excess water, waste products, and excess electrolytes are removed from the blood" d. "Bacteria and other organisms can also pass through the membrane, so the dialysate must be kept sterile."

d

Untreated hyperglycemia results in which condition? A. Respiratory acidosis b. Metabolic alkalosis c. Respiratory alkalosis d. Metabolic acidosis

d

What is the basic principle of meal planning for patient with type 1 DM? a. Five small meals per day plus a bedtime snack b. Taking extra insulin when planning to eat sweet foods c. High-protein, low-carbohydrate, and low-fiber foods d. Considering the effects and peak action times of the patient insulin

d

Which class of antidiabetic medication is most likely to cause a hypoglycemic episode because of the long duration of action? A. Alpha-glucosidase inhibitors, which include miglitol (Glyset) b. Biguanides, which include metformin (Glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)

d

Which laboratory test is the best indicator of a patient's average blood glucose level and/or compliance with the DM regimen over the last 3 months? A. Postprandial blood glucose test b. Oral glucose tolerance test (OGTT) c. Casual blood glucose test d. Glycosylated hemoglobin (HbA1C)

d

Which patient with kidney problems is the best candidate for peritoneal dialysis (PD)? a. Patient with peritoneal adhesions b. Patient with a history fo extensive abdominal surgery c. Patient with peritoneal membrane fibrosis d. Patient with a history of difficulty with anticoagulants

d

A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? a. Pioglitazone (Actos) b. Glimepiride (Amaryl) c. Glipizide (Glucotrol) d. Metformin (Glucophage)

d. Metformin (Glucophage) ANS: D Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast.

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? a. Serum chloride level of 98 mmol/L b. Serum calcium level of 8.8 mg/dL c. Serum sodium level of 132 mmol/L d. Serum potassium level of 2.5 mmol/L

d. Serum potassium level of 2.5 mmol/L ANS: D Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration.

Place the sequence of steps of continuous ambulatory peritoneal dialysis (CAPD in the correct order a. Fluid stays in the cavity for a specified time prescribed by the health care provider b. 1 to 2 L of dialysate is infused by gravity over a 10- to 20-minute period c. Fluid flows out fo the body by gravity into a drainage bag d. Warm the dialysate bags before installation by using a heating pad to wrap the bag

dbac

Which are modifiable risk factors for type 2 DM? (SATA) a. Age b. Family history c. Working in a low-stress environment d. Maintaining ideal body weight e. Maintaining adequate physical activity

de

A patient with CKD has a potassium level of 8 mEq/L. The nurse notifies the health care provider after assessing for which sing/symptoms? a. Cardiac dysrhythmias b. Respiratory depression c. Tremors or seizures d. Decreased urine output

a

Which insulins are considered to have a rapid onset of action? (SATA) a. Novolin 70/30 b. Glulisine c. Humulin N d. Aspart e. Lispro

bde

Which are considered the early signs of diabetic nephropathy? (SATA) a. Positive urine red blood cells b. Microalbuminuria c. Positive urine glucose d. Positive urine white blood cells e. Elevated serum uric acid

be

A patient asks the nurse how insulin injection site rotation should be accomplished. What is the nurse's best response? A. "Rotation within one site is preferred to avoid changes in insulin absorption." B. "Change rotation sites after a week or two to avoid lipohypertrophy." C. "Rotation from site to site each day is best for the best insulin absorption." D. "Always rotate insulin injection sites within 4 to 5 inches from the umbilicus."

a

A patient with DKA is on an insulin drip of 50 units of regular insulin in 250 mL of normal saline. The current blood glucose level is 549 mg/dL. According to insulin protocol, the insulin drop needs to be changed to 8 units per hour. At what rate does the nurse set the pump? A. 40 mL/hr b. 50 mL/hr c. 60 mL/hr d. 75 mL/hr

a

According to the RIFLE classification. How would the nurse interpret the following data? Serum creatinine increased x 1.5 or GFR decrease > 25%; Urine output is <0.5 mL/kg/hr for more than 6 hours. a. Risk stage b. Injury stage c. Failure stage d. ESKD

a

For which patient should the health care provider avoid prescribing rosiglitazone (Avandia)? A. Patient with symptomatic heart failure b. Patient with new-onset asthma c. Patient with kidney disease d. Patient with hyperthyroidism

a

The nurse is caring for a diabetic patient in the ED. The patient's lab values include serum glucose 353 mg/dL, positive serum ketones, and positive urine ketones. What complication does the nurse suspect? a. DKA b. HHS c. Hyperglycemia d. Hypoglycemia

a

The nurse is caring for a patient who had hypovolemic shock secondary to trauma in the ED 2 days ago. Based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess at least every hour? a. Urinary output b. Presence of edema c. Urine color d. Presence of pain

a

The nurse is evaluating a patient's treatment response to erythropoietin (Epogen). Which hemoglobin reading indicates that the goal is being met? a. Around 10 g/dL b. Greater than 20 g/dL c. Upward trend d. At baseline for gender

a

The nurse is reviewing urinalysis results for a patient who is in the early stage of CKD, What results might the nurse expect to see? a. Excessive protein, glucose, red blood cells, and white blood cells b. Increased specific gravity with a dark amber discoloration c. Dramatically increased urine osmolarity d. Pink tinged urine with obvious small blood clots

a

The nurse is talking to a patient with ESKD. The patient frequently displays weight gain and increased blood pressure beyond the baseline measurements. Which question is the nurse most likely to ask to determine if the patient is doing something that is contributing to these assessment findings? a. "Are you controlling your salt intake?" b. "Are you following the protein restrictions?" c. "Have you been eating a lot of sweets" d. "Have you been exercising regularly?"

a

The nurse monitors a CKD patients daily weights because of the risk for fluid retention. What instruction does the nurse give to the UAP? a. Weigh the patient daily at the same time each day, same scale, with the same amount of clothing b. Weigh the patient daily and add 1 kilogram of weight for the intake of each liter of fluid c. Weigh the patient in the morning before breakfast and weigh the patient at night just before bedtime d. Ask the patient what his or her normal weight is and then weight the patient before and after each voiding

a

The patient's urinalysis shows proteinuria. Which pathophysiology does the nurse suspect? A. Nephropathy b. Neuropathy c. Retinopathy d. Gastroparesis

a

What is the best description of CAPD? a. Daily infusion of four 2 L exchanges of dialysate every 4 to 6 hours while awake b. Is a form of automated dialysis that uses an automated cycling machine c. Functions of the cycling machine are programmed to the patient's needs d. This form decreases the risk of peritonitis and poor dialysate flow

a

Which class of antidiabetic medication should be taken with the first bite of a meal to be fully effective? A. Alpha-glucosidase inhibitors, which include miglitol (Glyset) b. Biguanides, which include metformin (Glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)

a

Which diabetic patient is at greatest risk for diabetic foot ulcer formation? A. 75-year-old African-American male with history of cardiovascular b. 53-year-old Caucasian female with history of renal insufficiency c. 38-year-old American Indian with history of gastric ulcers. D. 28-year-old Caucasian male with history of chronic kidney disease

a

Which infection control measures must the nurse teach a patient who will be performing SMBG? (SATA) a. Always wash hands before monitoring glucose b. Regular cleaning of the meter is critical c. Do not reuse lancets d. Do not share blood glucose monitoring equipment e. Sterilize blood glucose monitor before each use

abcd

The nurse is assessing a patient with uremia. Which gastrointestinal changes does the nurse expect to find? (SATA) a. Halitosis b. Hiccups c. Anorexia d. Nausea e. Vomiting f. Salivation

abcde

In collaboration with the registered dietitian, the nurse teaches the patient about which diet recommendations for management of CKD? (SATA) a. Controlling protein intake b. Limiting fluid intake c. Restricting potassium d. Increasing sodium e. Restricting phosphorus f. Reducing calories

abce

Which problems occur with AKI (SATA) a. Decreased peristalsis b. Anemia c. Metabolic acidosis d. Hypokalemia e. Peripheral edema

abce

When shock or other problems cause an acute reduction in blood flow to the kidneys, how do the kidneys compensate? (SATA) a. Constrict blood vessels in the kidneys b. Activate the renin-angiotensin-aldosterone pathway c. Release beta blockers d. Dilate blood vessels throughout the body e. Release antidiuretic hormones

abe

A patient with prerenal azotemia is administered to a fluid challenge. IN evaluating response to the therapy, which outcome indicates that the goal was met? a. Patient reports feeling better and indicate an eagerness to go home b. Patient produces urine soon after the initial bolus c. The therapy is completed without adverse effects d. The health care provider orders a diuretic when the challenge is complete

b

A patient with type 1 DM is planning to travel by air and asks the nurse about preparations for the trip. What does the nurse tell the patient to do? A. Pack insulin and syringes in a labeled, crushproof kit in the check luggage b. Carry all necessary diabetes supplies in a clearly identified pack aboard the plane c. Ask the flight attendant to put the insulin in the galley refrigerator once on the plane d. Take only minimal supplies and get the prescription filled at his or her destination

b

A patient with type 1 DM is taking a mixture of NPH and regular insulin at home. The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patient's morning dose of insulin? A. Administer the dose that is routinely prescribed at home because the patient has type 1 DM and needs the insulin b. Administer half the does because the patient is NPO c. Hold the insulin with all the other medications because the patient is NPO and there is no need for insulin d. Contact the health care provider for an order regarding the insulin

b

Along with exercise, what is the recommended calorie reduction of patient with diabetes who must lose weight? A. 100-200 calories/day b. 250-500 calories/day c. 501-600 calories/day d. 601-750 calories/day

b

The nurse is assessing a patient's extremity with an arteriovenous graft. The nurse notes a thrill and a bruit, and the patient reports numbness and a cool feeling in the fingers. How does the nurse interpret this information in regards to the graft? a. The graft is functional and these symptoms are expected b. The patient has "steal syndrome" and may need surgical intervention c. The graft is patent, but the blood is flowing in the wrong direction d. The patient needs to increase active use of hands and fingers

b

The nurse is caring for the kidney transplant patient who is 3-day post surgery. The nurse notes a sudden and abrupt decrease in urine. The nurse alerts the health care provider because this is a sign of which anomaly a. Rejection b. Thrombosis c. Stenosis d. Infection

b

The nurse is talking to an older adult male patient who is reasonably healthy for his age, but has BPH. Which condition does the BPH potentially place him at risk for? a. Prerenal acute kidney injury b. Postrenal acute kidney injury c. Polycystic kidney disease d. Acute glomerulonephritis

b

The nurse is teaching a patient about performing PD at home. In order to identify the earliest manifestation of peritonitis, what does the nurse instruct the patient to do? a. Monitor temperature before starting PD b. Check the effluent for cloudiness c. Be aware of feelings of malaise d. Monitor for abdominal pain

b

Which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established? A. Alpha-glucosidase inhibitors, which include miglitol (Glyset) b. Biguanides, which include metformin (Glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)

b

Why is glucose vital to the body's cells? A. It is used to build cell membranes b. It is used by cells to produce energy c. It affects the process of protein metabolism d. It provides nutrients for genetic material

b

During PD, the nurse notes slowed dialysate outflow. What does the nurse do to troubleshoot the system? (SATA) a. Ensure that the drainage bag is elevated b. Inspect the tubing for kinking or twisting c. Ensure that clamps are open d. Turn the patient to the other side e. Make sure the patient is in good body alignment f. Instruct the patient to stand or cough

bcde

In determining if a patient is hypoglycemic, the nurse looks for which characteristics in addition to checking the patient's blood glucose? (SATA) a. Nausea b. Hunger c. Irritability d. Palpitations e. Profuse perspiration f. Rapid, deep respirations

bcde

A 47-year-ol patient with a history of type 2 DM and emphysema who reports smoking three packs of cigarettes per day is admitted to the hospital with a diagnosis of acute pneumonia. The patient is placed on the regular oral antidiabetic agents, sliding-scale insulin, and antibiotic medications. On day 2 of hospitalization, the health care provider orders prednisone therapy. What does the nurse expect the blood glucose to do? A. Decrease b. Stay the same c. Increase d. Return to normal

c

A patient has been receiving insulin in the abdomen for 3 days. ON day 4, where does the nurse give the insulin injection? A. Deltoid b. Thigh c. Abdomen, but in an area different from the previous day's injection d. Abdomen, in the same area as the previous day's injection

c

A patient has recently started PD therapy and reports some mild pain when the dialysate is flowing in. What does the nurse do next? a. Immediately reports the pain to the health care provider b. Try warming the dialysate in the microwave oven c. Reassure that pain should subside after the first week or two d. Assess the connection tubing for kinking or twisting

c

After a 2-hour glucose challenge, which result demonstrates impaired glucose tolerance? A. Less than 100 mg/dL b. Less than 140 mg/dL c. Greater than 140 mg/dL d. Greater than 250 mg/dL

c

For a patient with AKI, the nurse would consider questioning the order for which diagnostic test? a. Kidney biopsy b. Ultrasonography c. Computed tomography with contrast dye d. Kidney, ureter, bladder (KUB) x-ray

c

The health care provider ahs ordered intraperitoneal heparin for a patient with a new PD catheter to prevent clotting of the catheter by blood and fibrin formation. How does the nurse advise the patient? a. Watch for bruising or bleeding from the gums b. Make a follow-up appointment for coagulation studies c. Intraperitoneal heparin does not affect clotting times d. Heparin will be given with a small subcutaneous needle

c

The nurse is assessing a patient with kidney injury and notes a marked increase in the rate and depth of breathing. The nurse recognized this as Kussmaul respiration, which is the body's attempt to compensate for which condition? a. Hypoxia b Alkalosis c. Acidosis d. Hypoxemia

c

The nurse is caring for a patient with CKD. The family asks about when renal replacement therapy will begin. What is the nurse's best response? a. "As early as possible to prevent further damage in stage I" b. When there is reduced kidney function and metabolic wastes accumulate" c. "When the kidneys are unable to maintain a balance in body functions." d. "It will be started with diuretic therapy to enhance the remaining function"

c

The patient with DM had a pancreas transplant and takes daily doses of cyclosporine (Neoral). For which key lab assessment does the nurse monitor? A. Serum electrolytes b. CBC with differential count c. Serum creatinine d. Clotting studies

c

The patient with diabetes has a foot that is warm, swollen, and painful. Walking causes the arch of the foot to collapse and give the food a "rocker bottom" shape. Which foot deformity does the nurse recognize? A. Hallux valgus b. Claw-toe deformity c. Charcot foot d. Diabetic foot ulcer

c

All patients with hypertension or diabetes should have yearly screenings for which factor? a. Creatinine b. BUN C. Glycosuria d. Microalbuminuria

d