CHII exam 2 - renal, endocrine
Crt normal
0.8-1.2
DKA occurs more often in patients with Type __ DM
1
BUN normal
10-20
HHS occurs more often in patients with Type ___ DM
2
phosphorous normal
3.0-4.5
normal UO
30 mL/hr (720 mL/24 hr)
calcium normal
9-10.5
What is acute tubular necrosis and what causes it?
ATN = Damaged renal tubular epithelium that leads to necrosis. Caused by either nephrotoxic drugs or ischemic injury.
Which question does the nurse ask the client who has a urinary tract infection to assess the risk for possible pyelonephritis? A. What drugs do you take for asthma? B. How long have you had diabetes? C. How much fluid do you drink daily? D. Do you take your antihypertensive drugs at night or in the morning?
B. (Pyelonephritis risk is increased in the client who has diabetes and a urinary tract infection (UTI). While it is important to know all the drugs that a client takes, neither asthma drugs nor asthma itself increases the risk for pyelonephritis. (An exception would be high-dose systemic corticosteroids; however, these are rarely recommended in current asthma therapy). Although insufficient fluid intake may make a UTI worse, it does not increase the risk for pyelonephritis. Antihypertensives are not a risk factor for pyelonephritis.)
For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter? A. 35-year-old woman who was admitted with a splenic laceration and femur fracture (closed repair completed) following a car crash B. 48-year-old man who has established paraplegia and is admitted for pneumonia C. 61-year-old woman who is admitted following a fall at home and has new-onset dysrhythmia D. 74-year-old man who has lung cancer with brain metastasis and is being transitioned to hospice for end-of-life care
D.
IV calcium chloride (gluconate) is given for what electrolyte imbalance? What is it for?
Hyperkalemia/decreases risk for dysrhythmias
What is an IVP and what nursing priorities are you going to be anticipating?
IVP = intravenous pyelogram (Diagnostic test)/no nephrotoxic meds 24-48 hours before/after and bowel prep beforehand
A 36-year-old man is admitted to your unit 4 hours after a surgical reduction of a compound fracture of the femur. His other health problems include hypercholesterol for which he takes atorvastatin (Lipitor) 80 mg once daily, and bipolar disorder for which he takes lithium (Eskalith) 600 mg once daily. He has an IV of dextrose 5% in 0.45% saline infusing at a rate of 150 mL/hr. His blood pressure is now 96/70, down from the last reading of 128/80 obtained in the post-anesthesia recovery area. His pulse is 84 and regular, and his pulse oximetry is 99%. In assessing him for possible shock, you note that the catheter drainage bag contains 800 mL of pale urine. His last output, measured 1 hour ago, was 1100 mL. According to the operative record, his output during the 3-hour surgery was 1800 mL. His total IV intake for the surgical and post-operative period was 1500 mL. He is to have his IV and Foley catheter removed when stable. What are the possible causes of his urine output volume?
Prolonged lithium use could lead to acquired DI (--> polyuria)
Your patient with CKD comes into the clinic with his grandson. The grandson asks you what caused his grandfather to develop CKD and how he can avoid it in the future. What do you tell him?
The top 3 causes are DM, HTN, and glomerulonephritis (kidney infection).
Which assessment finding of a client 10 hours after a subtotal thyroidectomy indicates to the nurse possible airway obstruction? A. The client is drooling. B. The oxygen saturation is 97%. C. The dressing has a moderate amount of serosanguinous drainage. D. The client responds to questions correctly but does not open the eyes while talking.
a
A patient with suspected AKI that is worsening is sent to the ICU. What type of interventions will be anticipated for his worsening kidney functions? (SATA) a. hemodynamic monitoring b. electrolyte and fluid balance monitoring c. diuretic administration d. continuous RRT e. strict I&Os
a,b,c,e
When caring for a client with a left arm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (select all that apply) a. Check radial 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.
a,b,c,e
Your patient is a 32 y/o male who presented to the ED with intractable renal colic pain. After running some diagnostics, he was diagnosed with having calcium oxalate renal calculi. After some time and increasing his fluid intake, he successfully passes all the kidney stones. The patient then asks you how he can avoid this from ever happening again. How do you respond? (Select all that Apply) a. increase your fluid intake and prevent dehydrating yourself b. try taking a potassium citrate supplement c. increase time outside d. decrease salt intake e. decrease animal products f. decrease high oxalate foods (beets, coffee, nuts)
a,b,d,e,f (sun exposure does nothing to prevent kidney stones)
A patient with AKI comes into the ICU, and the health care provider asks you to monitor for S+S of uremia. Which of the following are manifestations you will be looking out for? (SATA) a. headache b. confusion c. diarrhea d. nausea/vomiting e. pruritis f. hypotension g. Kussmaul breathing pattern
a,b,d,e,g (diarrhea and hypotension are NOT S+S of uremia)
The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? (select all that apply) a. calcium gluconate b. emergency tracheostomy kit c. furosemide (Lasix) d. Hypertonic saline e. suction f. supplemental oxygen
a,b,e,f (calcium gluconate is to help if hypocalcemia occurs, the rest is to reverse an airway obstruction event)
A client at the medical clinic is being evaluated for hypothyroidism. For which of these symptoms consistent with hypothyroidism does the nurse assess? (select all that apply) a. Pulse rate below 60 beats per minute b. Agitation and inability to sleep c. Increasing thermostat settings in the home d. Increase in appetite over the last year e. Bizarre or manic behavior
a,c (not d because increase only in WEIGHT not appetite in HYPOthyroidism)
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. increased sodium c. Restricted fluids d. low potassium e. low fat
a,c,d (reduced sodium recommended)
Which statements made by a client who has diabetes insipidus indicates to the nurse that moreteaching is needed? Select all that apply. A. If I gain more than 2 lb (1 kg) in a day, I'll limit my fluid intake. B. If I become thirstier, I'll take another dose of the drug. C. I'll avoid aspirin and aspirin-containing substances. D. I'll stop taking the drug for 24 hours before I have any dental work performed. E. I'll limit my intake of salt and sodium to no more than 2 g daily. F. I'll wear my medical alert bracelet at all times.
a,c,d,e (fluid overload is a complication of not having enough ADH, NSAIDs= no-no's, Na+ restrictions)
Which of the following are prerenal causes for acute kidney injury? (SATA) a. hypovolemia b. lupus c. sepsis d. a pulmonary embolism e. nephrotoxic medications f. heart failure g. renal calculi h. severe vomiting/diarrhea i. pyelonephritis
a,c,d,f,h (lupus is intrarenal, nephrotoxic drugs are intrarenal, renal calculi are postrenal, and pyelonephritis is intrarenal)
Which physiologic actions result from normal insulin secretion? Select all that apply. A. Increased liver storage of glucose as glycogen B. Increased gluconeogenesis C. Increased cellular uptake of blood glucose D. Increased breakdown of lipids (fats) for fuel E. Increased production and release of epinephrine F. Decreased storage of free fatty acids in fat cells G. Decreased blood glucose levels H. Decreased blood cholesterol levels
a,c,g,h
A nurse is caring of a patient following a thyroidectomy due to hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (SATA) a. hypertension and tachycardia b. negative Chvostek's sign c. RR of 16 br/min d. laryngeal stridor and hoarseness e. positive Trousseau's sign
a,d,e (HTN and ↑HR = thyroid storm, laryngeal stridor = airway obstruction, + Trousseau's sign = hypocalcemia)
Which actions/interventions are most important for the nurse to perform when caring for a 70-year-old client who is scheduled for a contrast-medium enhanced CT scan? (Select all that apply.) a. Assess for co-existing conditions of pre-existing diabetes, heart failure, and established CKD. b. Assess the hourly urine output for at least 6 hours prior to the procedure. c. Assess creatinine clearance using a 24-hour urine collection test. d. Alert the provider to a serum creatinine that has increased from 0.2 to 0.4 mg/dL (20 to 40 mcmol/L) in the previous 24 hours. e. Alert the provider to a glomerular filtration rate (GFR) <60 mL/min/1.73 m2. f. Assess for hypovolemia, including evaluation of the mean arterial pressure (MAP). g. Collaborate with the provider to determine whether isotonic IV fluids should be infused before the test. h. Discuss with the provider about whether the client's prescribed diuretic should be held immediately before the test.
a,e,f,g,h
A 48-year-old African-American man is newly diagnosed with hypertension and Stage 1 chronic kidney disease (CKD). His primary health care provider has prescribed a thiazide diuretic. The client reports that he has increased his activity and changed his diet, which resulted in a 10-lb (4.5-kg) weight loss in the past 2 months. The client says he feels well and does not want to take any drugs. What is the nurse's best response? A. "Reducing your blood pressure may slow or prevent progression of your chronic kidney disease." B. "Your primary health care provider prescribed the diuretic because it will reverse the damage caused by kidney disease." C. "Taking medications is a personal decision, and you have the right to decline this prescription." D. "Because your lifestyle changes have resulted in weight loss, this intervention is all that is needed to reduce your risk for progression of kidney disease."
a.
What would be a patient goal for your patient with oliguria? a. Patient will have an output of > 600 mL in the next 24 hours b. Patient will have an output of < 400 mL in the next 24 hours c. Patient will decrease fluid intake d. Patient will increase fluid intake
a.
A client with diabetes has all of the following changes after a percutaneous nephrolithotomy procedure. Which change is most important for the nurse need to immediately report to the healthcare provider? A. Difficulty breathing and an oxygen saturation of 88% on 2 L of oxygen by nasal cannula B. A point-of-care blood glucose of 150 mg/dL and client report of thirst C. A decreased hematocrit by 1% (compared with preoperative values and hematuria D. An oral temperature of 38° C (101° F) and cloudiness of urine draining from the nephrostomy tube right after IV administration of a broad-spectrum antibiotic
a. (This is NOT an expected problem associated with the procedure and is potentially life-threatening. The blood glucose elevation, thirst, temperature elevation, cloudiness of the urine, and slight decrease in hematocrit are expected and do not pose an immediate threat.)
1. Delegation: When a UAP tells you that your AKI patient is more confused, what would be your first action? a. assess the patient's neuro status b. assess the patient's lung sounds c. check the patient's most recent labs for increased BUN/Creatinine d. call the HCP
a. (assess for neuro status, S+S of uremia include confusion)
A client with syndrome of inappropriate antidiuretic hormone (SIADH) is admitted with a serum sodium level of 105 mEq/L (105 mmol/L). Which request by the health care provider does the nurse carry out first? a. Administer infusion of 150 mL of 3% NaCl over 3 hours. b. Draw blood for hemoglobin and hematocrit (H&H). c. Insert an indwelling catheter and monitor urine output. d. Weigh the client on admission and daily thereafter.
a. (best to get that Na+ up ASAP)
A nurse is teaching a patient with acute pyelonephritis. Which of the following instructions should she include in her teaching? a. "You should complete the entire cycle of antibiotic therapy." b. "You should maintain complete bed rest until you feel better." c. "You should drink 1L of fluids a day." d. "You should take NSAIDs for the pain."
a. (completing abx is most important, the rest are not true - pt should consume 2L of fluid daily)
Which assessment finding of a client 10 hours after a subtotal thyroidectomy indicates to the nurse possible airway obstruction? a. The client is drooling. b. The oxygen saturation is 97%. c. The dressing has a moderate amount of serosanguinous drainage. d. The client responds to questions correctly but does not open the eyes while talking.
a. (drooling, stridor, or vocal hoarseness could indicate an airway/breathing issue)
The nurse is teaching a client with newly diagnosed type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? a. "I will begin exercising for at least an hour a day." b. "I will monitor my diet and avoid empty calories." c. "If I lose weight, I may not need to use the insulin anymore." d. "Weight loss can be a sign of diabetic ketoacidosis."
a. (exercising from over an hour from sitting on the couch is a huge lifestyle change and physical activity should be increased slowly. Also, weight loss IS a sign of DKA due to osmotic diuresis
A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L (130 mmol/L), K+ 6.6 mEq/L (6.6 mmol/L), and glucose 72 mg/dL (4 mmol/L). Which prescription will the nurse implement first? a. Administer insulin with dextrose in normal saline. b. Give spironolactone (Aldactone) orally. c. Initiate ulcer prophylaxis protocol with a histamine2 (H2) blocker d. Obtain arterial blood gases.
a. (insulin + glucose to decrease that K+)
3. Rapport: Your patient with Cushing's disease tells you, "I am so ugly no one will want me." What would be your best response to this statement? a. I can see you're concerned about your body image. Let's talk about how to boost your confidence. b. I can see you're upset I'll come back later. c. That's not true! Have you ever had thoughts of suicide? d. Have you tried diet and exercise?
a. (validate feelings and open ended questions/promptings!)
A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. The client has a prescription for Desmopressin (DDAVP). Which outcome indicates a positive response to treatment? a. Urine output of 60-80 mL/hour b. Blood glucose level of 110 mg/dL (6.1 mmol/L) c. Ability to sit quietly and read a magazine d. Potassium level within expected range
a. (vasopressors should increase ADH therefore decrease diuresis and increase BP!!)
What fluid imbalance would you expect for a patient in acute renal failure? a. fluid excess b. fluid deficit c. increased fluid output d. increased fluid input
a. fluid excess (oliguric phase = not peeing --> water retention --> ↑BP)
What medications are avoided for a patient diagnosed with AKI?
antacids and penicillin K (high in K+)
The client is a 62-year-old admitted 2 days ago with traumatic injuries and hypovolemic shock from a car crash. The nurse reviewing the client's daily laboratory test results notices the following values. Which result is most important to report to the primary health care provider immediately? A. Serum sodium 132 mEq/L (mmol/L) B. Serum potassium 6.9 mEq/L (mmol/L) C. Blood urea nitrogen 24 mg/dL (mmol/L) D. Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L)
b
Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites? A. 75-year-old client whose blood glucose levels show little variation B. 55-year-old client who has hypoglycemic unawareness C. 80-year-old client with type 2 diabetes mellitus D. 45-year-old client with type 1 diabetes mellitus
b
A patient comes into the ED with suspected DKA crisis. His blood sugar is at 455 and his K is at 3.6. The HCP gives you orders to start an insulin drip with glucose in order to decrease his sugar. You are also concerned about his potential for hypokalemia, what do you do first? a. call the provider to ask for a potassium supplement and give it after the insulin drip b. call the provider to ask for a potassium supplement and give it before the insulin drip c. start the insulin drip and watch the patient's continuous heart monitor d. start the insulin drip and monitor his electrolytes with a lab draw later in the shift
b (K+ supplement should be given before the insulin drip which will decrease the K+ further)
1. The charge nurse is preparing assignments on a busy medical unit. For this shift, there are two LPNs, two RNs, and one nursing assistant. Which client assignments are most appropriate? (Select all that apply.) a. An LPN is assigned to a client who is receiving the first dose of an oral immunomodulating agent to manage acute glomerulonephritis. b. An RN is assigned to the client who is receiving an IV corticosteroid twice daily to manage systemic lupus erythematous that has resulted in chronic glomerulonephritis. c. An LPN is assigned to replace a urinary catheter (in place >2 weeks) in a client with a fever who requires a chronic urinary catheter to assist healing from a genitourinary fistula. d. An RN is assigned to administer IV antibiotics to a client admitted with pyelonephritis. e. A nursing assistant is assigned to do all the morning baths. f. LPNs are assigned to clients who have oral drugs prescribed and will perform the vital signs for those clients. g. An RN is assigned to the client who is being discharged with a new diagnosis of diabetic nephropathy that is serious (stage 3 CKD).
b,c,d,e,f,g
For which adverse drug effects does the nurse assess in a client who is hospitalized for an acute problem and is also prescribed an anticholinergic drug to manage incontinence? Select all that apply. A. Insomnia B. Blurred vision C. Constipation D. Dry mouth E. Loss of sphincter control F. Increased sweating G. Worsening mental function H. Hypotension
b,c,d,g (Anticholinergic drugs tend to block the parasympathetic nervous system and mimic the sympathetic nervous system responses. In addition to reducing urinary output, these commonly include dry mouth, reduced gastric motility, constipation, blurred vision, hypertension, increasing confusion, dizziness, and sleepiness)
Which symptoms are most often seen in hypothyroidism? Select all that apply. A. Increased appetite B. Cold intolerance C. Constipation D. Hypotension E. Exophthalmia F. Palpitations G. Tremors H. Weight gain
b,c,d,h
Which symptoms are most often seen in hypothyroidism? (Select all that apply.) a. Increased appetite b. Cold intolerance c. Constipation d. Hypotension e. Exophthalmia f. Palpitations g. Tremors h. Weight gain
b,c,d,h
A patient in the emergency room comes in with a suspected AKI. What would you monitor the patient for if they start experiencing fluid overload? (SATA) a. bradypnea b. jugular vein distention c. peripheral edema d. increased UO e. low Hct f. decreased weight gain
b,c,e (tachypnea, JVD, edema, decreased UO, low Hct, and inc. Wt gain = fluid overload)
Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites? a. 75-year-old client whose blood glucose levels show little variation b. 55-year-old client who has hypoglycemic unawareness c. 80-year-old client with type 2 diabetes mellitus d. 45-year-old client with type 1 diabetes mellitus
b.
The nurse is teaching a client about the manifestations and emergency management of hypoglycemia. Which response by the client indicates a correct understanding of what to do if the client feels hungry and shaky? a. "I will drink a glass of water." b. "I will eat three graham crackers." c. "I will give myself 1 mg of glucagon." d. "I will sit down and rest."
b. (3 graham crackers should do the trick for mild hypoglycemia, glucagon is for more severe cases)
The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? a. anxiety b. headache c. nausea d. weight loss
b. (A side effect of fludrocortisone is hypertension, likely related to hyponatremia and fluid retention. New onset of headache must be reported, and the client's blood pressure would be monitored)
A client had a parathyroidectomy 8 hours ago. Which finding requires immediate attention? a. Edema at the surgical site b. Hoarseness c. Pain on moving the head d. Sore throat
b. (could be airway obstruction, along with drooling or stridor could indicate respiratory distress)
A nurse is caring for a patient who is diagnosed with acute kidney injury and is in the oliguric stage. the patient is complaining of muscle cramps, headache, palpitations, diarrhea, and muscle weakness. What should the nurse do first? a. administer an analgesic b. check the patient's electrolyte values c. measure the patient's weight d. restrict the patient's protein intake
b. (could be experiencing hyperkalemia)
1. The client is a 62-year-old admitted 2 days ago with traumatic injuries and hypovolemic shock from a car crash. The nurse reviewing the client's daily laboratory test results notices the following values. Which result is most important to report to the health care provider immediately? a. Serum sodium 132 mEq/L (mmol/L) b. Serum potassium 6.9 mEq/L (mmol/L) c. Blood urea nitrogen 24 mg/dL (mmol/L) d. Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L)
b. (hyperkalemia)
The client is a 62-year-old admitted 2 days ago with traumatic injuries and hypovolemic shock from a car crash. The nurse reviewing the client's daily laboratory test results notices the following values. Which result is most important to report to the health care provider immediately? a. Serum sodium 132 mEq/L (mmol/L) b. Serum potassium 6.9 mEq/L (mmol/L) c. Blood urea nitrogen 24 mg/dL (mmol/L) d. Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L)
b. (hyperkalemia)
Your patient comes into the ED with from a MVC vs. pedestrian accident. She is showing evidence of acute renal failure. What are the top 2 causes of acute kidney failure? a. HTN and DM b. nephrotoxic agents and hypoperfusion c. HTN and NSAIDS/Abx d. DM and sepsis
b. (nephrotoxic agents - NSAIDs and Abx & ↓ BP)
A client who is admitted to the intensive care unit with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What will the nurse do next? a. Call the primary health care provider. b. Reduce any stimulation to the client. c. Keep the client's door open to visualize the client's actions. d. Tell the client to slow down.
b. (reduce stimulation to the client to prevent complications of hyperthyroidism including cardiac dysrhythmias. The client with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. The nurse also encourages the client to rest, keeps the environment as quiet as possible by closing the door to the room)
What electrolyte imbalance would you expect for your patient experiencing an acute renal failure? a. hyponatremia b. hyperkalemia c. hypocalcemia d. hypermagnesemia
b. hyperkalemia (>5)
In the preoperative holding area, the client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by IV infusion. What is the nurse's best action? A. Request a "time-out" to determine whether this is a valid prescription. B. Ask the client whether he or she usually takes prednisone. C. Hold the dose because the client has a high cortisol level. D. Administer the drug as prescribed.
c
The nurse is preparing a client for discharge who developed an acute kidney injury during coronary artery bypass graft surgery. The nurse notices that the client has a serum creatinine of 1.2mg/dL (106 mcmol/L) and a glomerular filtration rate (GFR) of 75 mL/kg/1.73 m2. Which is the priority nursing action? A. Reminding the client to remain hydrated by drinking 500 mL of an electrolyte-based solutiondaily B. Encouraging the client to reduce protein intake to reduce creatinine production until the follow-up visit with the nephrologist occurs C. Checking the remaining values on the metabolic panel and informing the primary care provider of all results before the client is discharged D. Educating the client about the need for follow-up, including re-evaluation of serum creatinine with the primary care provider or nephrologist in 8-12 weeks
c
When assessing a client with acute glomerulonephritis, which question about self-management will the nurse ask to determine whether the client is currently following best practices to slow progression of kidney damage? A. "Have you increased your protein intake to promote healing of the damaged nephrons?" B. "Do you avoid contact sports while you're taking cyclosporine?" C. "How are you evaluating the amount of daily fluid you drink?" D. "Have you contacted anyone from our dialysis support services?"
c
A 25-year-old sexually active female client diagnosed with cystitis tells the nurse that she doesn't understand why she has these infections yearly because she tries to avoid them by drinking very little at work so she doesn't have to use the "dirty" public toilet. Which suggestions or actions by the nurse are most likely to help this client reduce her risk for cystitis? Select all that apply. A. Reinforce her choice to avoid using a public toilet. B. Teach her to shower immediately after having sexual intercourse .C. Suggest that she drink at least 2-3 L of fluid throughout the day. D. Urge her to change her method of birth control from oral contraceptives to a barrier method. E. Instruct her to always wipe her perineum from front to back after each toilet use. F. Reinforce that she should complete the entire course of antibiotics as prescribed. G. Instruct her to empty her bladder immediately before having intercourse.
c,e,f,g
which of the following 24 hour UOs would indicate your patient is oliguric? a. < 600 mL b. 0 mL c. < 400 mL d. < 1000 mL
c.
A client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? a. "Don't mind this. The disease is causing this." b. "I need to check the client's cortisol level." c. "The disease can sometimes affect emotional responses." d. "Medication is available to help with this."
c. (Cushing's disease can cause inappropriate or psychotic behavior or difficulty concentrating as a result of high blood cortisol levels.)
The nurse is assessing a client who had a transsphenoidal hypophysectomy yesterday. Which finding requires immediate notification to the primary health care provider? a. Dry lips and oral mucosa on examination b. Nasal drainage that tests negative for glucose c. Client report of a headache and stiff neck d. Urine specific gravity of 1.016
c. (Severe HA and stiff neck can be signs of meningitis)
A 70-year-old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? A. A five-pack year history of smoking 45 years ago B. Difficulty starting and stopping the urine stream C. A 30-year occupation as a long-distance truck driver D. A recent colon cancer diagnosis in his 72-year-old brother
c. (The latest research indicates exposure to gasoline and diesel fuel is a major risk factor for bladder cancer)
A nurse is assessing a patient with Addison's disease (low __________). Which of the following skin manifestations would the nurse expect? a. purple striae on chest and abdomen b. butterfly rash along bridge of the nose c. bronze pigmentation d. jaundice of the face and sclera
c. (bronze pigmentation and Addison's = LOW Aldosterone and Cortisol)
The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? a. "I will have more energy with this medication." b. "I will take the medication every morning." c. "If I continue to lose weight, I may need an increased dose." d. "If I gain weight and feel tired, I may need an increased dose."
c. (decreased weight SHOULD occur, hypothyroidism is associated with increased weight)
A nurse is teaching a new grad how to complete a 24 hour urine sample for creatinine clearance. Which of the following instructions should the nurse include? a. include the first voided specimen b. discard the last voided specimen c. place a reminder sign in the restroom that the test is in progress d. instruct the client to increase exercise during this time period
c. (discard FIRST void, reminders are good - especially for people who go in to help who aren't assigned to the patient)
Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes? a. "Avoid drinking ice-cold beverages." b. "Be sure to check your blood pressure twice daily." c. "Change positions slowly when moving from sitting to standing." d. "Check your hands and feet weekly for areas of numbness or sensation change."
c. (don't want to cause any falls)
The nurse reviewing the laboratory work of a client with hypoparathyroidism finds all the following blood values. For which value does the nurse immediately assess the client's reflexes? a. Sodium 131 mEq/L (mmol/L~) b. Potassium 5.1 mEq/L (mmol/L~) c. Calcium 7.8 mg/dL (1.76 mmol/L~) d. pH 7.33
c. (hypocalcemia --> muscle weakness)
When reviewing the laboratory values of a client who has chronic obstructive pulmonary disease and pneumonia, the nurse observes these findings. Which one does the nurse report to the provider immediately? a. International normalized ratio (INR) 2.1 b. Serum chloride 96 nEq/L (mmol/L) c. Serum sodium 117 mEq/L (mmol/L) d. pH 7.28
c. (hyponatremia --> seizures)
A nurse is monitoring a patient diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? a. polyuria b. dehydration c. hyponatremia d. hyperthermia
c. (hyponatremia from the fluid retention and dilution of Na+)
The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse should provide the client with which information? a. It indicates nerve damage. b. The hoarseness is permanent. c. It is normal during this time and will subside. d. It will worsen before it subsides, which may take 6 months.
c. (normal because from edema and laryngeal pressure that is normal post op)
An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. When the cardiac monitor shows ventricular ectopy, which assessment will the nurse make? a. UO b. 12-lead ECG c. Potassium levels d. rate of IV infusions
c. (potassium - b/c hypokalemia could be causing PVCs)
The nurse is providing discharge instructions to a client receiving spironolactone (Aldactone) therapy. Which comment by the client indicates a need for further teaching? a. "I must call the primary health care provider if I am more tired than usual." b. "I need to increase my salt intake." c. "I will eat a banana every day." d. "This drug will not control my heart rate."
c. (spironolactone is a K+-sparing diuretic therefore eating a lot of K+ in the form of bananas will increase serum K+)
When reviewing the laboratory values of a client who has chronic obstructive pulmonary disease and pneumonia, the nurse observes these findings. Which one does the nurse report to the provider immediately? A. International normalized ratio (INR) 2.1 B. Serum chloride 96 mEq/L (mmol/L) C. Serum sodium 117 mEq/L (mmol/L) D. pH 7.28
c. serum sodium (hyponatremia)
2. Polystyrene sulfate: What classification is this drug? Why is it used for patients with severe AKI? What is an important assessment and intervention done before giving this drug?
class= laxative, used with severe AKI to increase K+ excretion in stool, important to assess bowel sounds before administration
The laboratory values of a client who has diabetes mellitus include a fasting blood glucose level of 82 mg/dL (mmol/L) and hemoglobin A1C of 5.9%. What is the nurse's interpretation of these findings? A. The client's glucose control for the past 24 hours has been good, but the overall control is poor. B. The client's glucose control for the past 24 hours has been poor, but the overall control is good. C. The values indicate that the client has poorly managed his or her disease. D. The values indicate that the client has managed his or her disease well.
d
The nurse is preparing a client for discharge who experienced an acute kidney injury during coronary artery bypass graft surgery. The nurse notices that the client has a serum creatinine of 1.2 mg/dL (106 mcmol/L) and a glomerular filtration rate (GFR) of 75 mL/kg/1.73 m2. Which is the priority nursing action? a. Reminding the client to remain hydrated by drinking 500 mL of an electrolyte-based solution daily. b. Encouraging the client to reduce protein intake to reduce creatinine production until the follow-up visit with the nephrologist occurs. c. Checking the remaining values on the metabolic panel and informing the primary care provider of all results before the client is discharged. d. Educating the client about the need for follow-up, including re-evaluation of serum creatinine with the primary care provider or nephrologist in 8 to 12 weeks.
d
When the nurse caring for a client with severe chronic kidney disease asks what dietary modifications he has made for the disease, he reports the following actions. Which action indicates to the nurse that additional client education is needed? A. Using a scale to measure protein weight B. Taking calcium and vitamin D supplements daily C. Eliminating bananas, citrus fruits, and avocados D. Using a salt-substitute instead of ordinary table salt
d
The nurse is preparing a client for discharge who developed an acute kidney injury during coronary artery bypass graft surgery. The nurse notices that the client has a serum creatinine of 1.2mg/dL (106 mcmol/L) and a glomerular filtration rate (GFR) of 75 mL/kg/1.73 m2. Which is the priority nursing action? A. Reminding the client to remain hydrated by drinking 500 mL of an electrolyte-based solution daily B. Encouraging the client to reduce protein intake to reduce creatinine production until the follow-up visit with the nephrologist occurs C. Checking the remaining values on the metabolic panel and informing the primary care provider of all results before the client is discharged D. Educating the client about the need for follow-up, including re-evaluation of serum creatinine with the primary care provider or nephrologist in 8-12 weeks
d.
A client with newly diagnosed hypothyroidism tells the nurse, "I just want to feel better now. Why can't I just get a standard dose of medication instead of all this dosage adjustment?" The nurse explains that starting levothyroxine sodium (Synthroid) at a high dose may cause which of these problems? a. Bradycardia and decreased level of consciousness b. Decreased respiratory rate and hypoxemia c. Hypotension and Shock d. Hypertension and Heart Failure
d. (HTN and HF can result from too much T3 and T4)
In the preoperative holding area, the client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by intravenous infusion. What is the nurse's best action? a. Request a "time-out" to determine whether this is a valid prescription. b. Ask the client whether he or she usually takes prednisone. c. Hold the dose because the client has a high cortisol level. d. Administer the drug as prescribed.
d. (administering a steroid before surgery helps mitigate an addisonian crisis afterwards from lack of cortisol production)
The nurse reviews the vital signs of a client diagnosed with Graves' disease and notes that the client's temperature is 99.6°F (37.6°C). After notifying the primary health care provider, what does the nurse do next? a. Administers acetaminophen b. Call a Rapid Response c. Ask any visitors to leave d. assess cardiac status
d. (assess before giving antipyretic)
A nurse is reviewing the lab results of a pt experiencing DKA. Which of the following is consistent with DKA? a. blood glucose of 656 b. negative urine ketones c. pH of 7.40 d. Bicarbonate level of 12 mEq/L
d. (blood glucose of <300, + ketones, pH<7.35, and bicarb of < 15 are expected findings in DKA)
The charge nurse is making client assignments for the medical-surgical unit. Which client will be best to assign to an RN who has floated from the pediatric unit? a. Client who is receiving IV hydrocortisone for an Addisonian crisis b. Client admitted with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to lung cancer c. Client being discharged after a unilateral adrenalectomy to remove a pheochromocytoma d. Client with Cushing's syndrome who requires frequent glucose monitoring and administration of insulin
d. (giving insulin and checking blood glucose should be tasks familiar to a pediatric nurse.)
A nurse is monitoring a patient with Graves disease for thyrotoxicosis (thyroid storm). Which of the following manifestations should the nurse inform the health care provider? a. headache b. constipation c. bradycardia d. hypertension
d. (hypertension b/c thyroid storm is ↑↑ vital signs including: fever, hypertension, abdominal pain, and tachycardia)
A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response? a. "You will see effects of this medication immediately." b. "You will see effects of this medication within 1 week." c. "You will see full effects from this medication within 1 to 2 days." d. "You will see some effects of this medication within 2 weeks."
d. (it takes a couple weeks and still then won't see full effects!)
The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first? a. Client with Hashimoto's thyroiditis and a large goiter b. Client with hypothyroidism and an apical pulse of 51 beats/min c. Client with parathyroid adenoma and flank pain due to a kidney stone d. Client who had a parathyroidectomy yesterday and has muscle twitching
d. (muscle twitching is an indication of hypocalcemia)
The intensive care nurse is caring for a client admitted in a hyperglycemic-hyperosmolar state. Which of these prescriptions made by the primary health care provider will the nurse question? a. Add 20 mEq of KCl to each liter of IV fluid b. IV regular insulin at 2 units/hr c. IV normal saline at 100 mL/hr d. 1 ampule Sodium Bicarbonate IV now
d. (sodium bicarb is given for the pH changes found in DKA not in HHS!!!!)
A client is referred to a home health agency after a transsphenoidal hypophysectomy. Which action does the RN case manager delegate to the home health aide who will see the client daily? a. Document symptoms of incisional infection or meningitis. b. Give over-the-counter laxatives if the client is constipated. c. Set up medications as prescribed for the day. d. Test any nasal drainage for the presence of glucose.
d. (we want to test for glucose to see if it's CSF draining from the incisional site - bad!)
What's the purpose of giving calcium chloride for a patient with hyperkalemia?
decreases risk for dysrhythmias
monitor calcium and phos for what conditions (endocrine)?
hypo/hyperparathyroidism
What is the difference between DKA and HHS?
ketones and pH change (both + in DKA and not in HHS)
Kayexalate is a __________ given for which electrolyte imbalance? Seen in what renal disease process? What do you have to do before administration?
laxative/hyperkalemia/AKI/check for bowel sounds
A dual lumen venous catheter for emergency dialysis for your patient going through an acute kidney injury can be used for up to ___________ weeks. At what sites is this catheter usually placed? (SATA) a. aortic b. Erb's point c. subclavian vein d. internal jugular v. e. femoral v.
three/c,d,e
A 36-year-old man is admitted to your unit 4 hours after a surgical reduction of a compound fracture of the femur. His other health problems include hypercholesterol for which he takes atorvastatin (Lipitor) 80 mg once daily, and bipolar disorder for which he takes lithium (Eskalith) 600 mg once daily. He has an IV of dextrose 5% in 0.45% saline infusing at a rate of 150 mL/hr. His blood pressure is now 96/70, down from the last reading of 128/80 obtained in the post-anesthesia recovery area. His pulse is 84 and regular, and his pulse oximetry is 99%. In assessing him for possible shock, you note that the catheter drainage bag contains 800 mL of pale urine. His last output, measured 1 hour ago, was 1100 mL. According to the operative record, his output during the 3-hour surgery was 1800 mL. His total IV intake for the surgical and post-operative period was 1500 mL. He is to have his IV and Foley catheter removed when stable. 1. Is his output cause for concern? Provide a rationale for your response.
yes, could lead to dehydration and lithium poisoning!
primary hypothyroidism = ___ T3/T4 and ___ TSH
↓ T3/T4 and ↑ TSH (issue with the thyroid)
secondary hypothyroidism =___ T3/T4 and __ TSH
↓ T3/T4 and ↓TSH (issue with the P.G.)
