Exam 4 MS
When calculating the anion gap, what is the predominant cation? A.Sodium B. Potassium C. Chloride D. Bicarbonate
A
A patient has been admitted who is suspected of having thyrotoxicosis. Which laboratory findings would confirm this diagnosis? A. Very low thyroid-stimulating hormone (TSH) B. Decreased T3 uptake ratio C. Increased serum osmolality D. Decreased urine osmolality
A
A patient is admitted after surgery with a history of hyperthyroidism. The nurse suspects the patient may be developing thyroid storm. Which finding would confirm this suspicion? A. Tachycardia B. Hypotension C. Decreased appetite D. Hypothermia
A
A patient is admitted in diabetic ketoacidosis (DKA). The patient presents with dry, cracked lips and is begging for something to drink. Which reply would be the nurse's best response? A. "We can't give you anything to drink until we get your blood sugar under control." B. "You can have one cup of coffee without sugar." C. "You drink anything you want as long as its sugar free." D. "You can drink as much water has you can handle."
A
A patient is admitted with acute kidney injury (AKI). Which event from the patient's history was the most probable cause of the patient's AKI? A. Recent computed tomography of the brain with and without contrast B. A recent bout of acute heart failure after an acute myocardial infarction C. Twice-daily prescription of Lasix 40 mg by mouth D. A recent bout of benign prostatic hypertrophy and transurethral resection of the prostate
A
A patient is admitted with diabetic ketoacidosis. The nurse requests the practitioner to order a glycosylated hemoglobin (HbA1c). What information does this test provide to the health care team? A. It is an indicator of the patient's average blood glucose level over the previous 3 to 4 months. B. It compares blood glucose levels with serum hemoglobin over the previous 3 to 4 weeks. C. It is an indicator of the patient's highest blood ketone level over the past month. D. It associates the serum and urine glucose levels and is an indicator of kidney involvement.
A
Patient has been admitted who is severely malnourished. The patient's serum albumin is very low. Which finding would the nurse expect to see in this patient? A. Peripheral edema B. Extra heart sounds C. Hypertension D. Hyponatremia
A
The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS). Which medical intervention would the nurse expect to see ordered for this patient? A. Rapid rehydration with intravenous fluids B. Insertion of a pulmonary artery catheter C. Administration of high-dose intravenous insulin D. Hourly monitoring of urine glucose and ketone levels
A
The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. The nurse observes that the patient is extremely dehydrated. To make this assessment, what did the nurse evaluate? A. Skin turgor B. Nail bed color C. Capillary refill D. Skin temperature
A
The nurse is caring for a patient with a head injury who has developed diabetes insipidus (DI). What medication would the nurse expect to be prescribed for the patient? A. Vasopressin B. Insulin C. Glucagon D. Propylthiouracil
A
The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which medical intervention would the nurse expect to be ordered for this patient? A. Extensive hydration B. Oral hypoglycemic agents C. Large doses of IV insulin D. Limiting food and fluids
A
To remove fluid during hemodialysis, a positive hydrostatic pressure is applied to the blood and a negative hydrostatic pressure is applied to the dialysate bath. What is this process called? A. Ultrafiltration B. Hemodialysis C. Reverse osmosis D. Colloid extraction
A
What is a continuous venovenous hemodialysis filter permeable to? A. Electrolytes B. Red blood cells C. Protein D. Lipids
A
Which of the following diuretics maybe combined to work on different parts of the nephron? A. Loop and thiazide diuretics B. Loop and osmotic diuretics C. Osmotic and carbonic anhydrase inhibitor diuretics D. Thiazide and osmotic diuretics
A
A patient is admitted with acute kidney injury. The nurse would expect to see elevated values in which laboratory results? (Select all that apply). A. Blood urea nitrogen (BUN) B. Creatinine C. Glucose D. Hemoglobin and hematocrit E. Protein
A B With kidney dysfunction, the blood urea nitrogen (BUN) is elevated because of a decrease in the glomerular filtration rate and resulting decrease in urea excretion. Elevations in the BUN can be correlated with the clinical manifestations of uremia; as the BUN rises, symptoms of uremia become more pronounced. Creatinine levels are fairly constant and are affected by fewer factors than BUN. As a result, the serum creatinine level is a more sensitive and specific indicator of kidney function than BUN. Creatinine excess occurs most often in persons with acute kidney injury resulting from impaired excretion. Decreased hematocrit value can indicate fluid volume excess because of the dilutional effect of the extra fluid load. Decreases also can result from anemias, blood loss, liver damage, or hemolytic reactions. In individuals with acute kidney injury, anemia may occur early in the disease.
A patient has been admitted in acute kidney failure with a 10-lb weight gain over 5 days. Which findings may be present in the patient? (Select all that apply.) A. S3 or S4 B Distended neck veins C. Crackles D. Tachycardia with hypotension E. Edema that disappears with elevation of extremity
A B C The patient is in fluid overload. An S3 or S4, distended neck veins, and crackles may be present in the patient. Tachycardia with hypotension is indicative of hypovolemia. Dependent edema that disappears with elevation of the extremity is indicative of poor circulation.
The neuroendocrine stress response produces which findings? (Select all that apply.) A. Elevated blood pressure B. Decreased gastric motility C. Tachycardia D. Heightened pain awareness E. Increased glucose
A B C E The fight-or-flight response, or sympathetic nervous response, releases catecholamine that causes an increased heart rate and blood pressure. Blood is shunted form nonessential organs such as the stomach, glucose is made available to the brain cells, and pain awareness is decreased.
A patient is admitted with respiratory failure and is being mechanically ventilated. The nurse understands there is a significant association between acute kidney injury and respiratory failure. How does mechanical ventilation alter kidney function? (Select all that apply.) A. Decreases blood flow to the kidney. B. Decreases glomerular filtration rate (GFR). C. Damages the kidney tubular endothelium. D. Decreases urine output. E. Hinders flow of urine from the kidneys
A B D Mechanical ventilation can alter kidney function. Positive-pressure ventilation reduces blood flow to the kidney, lowers the GFR, and decreases urine output. These effects are intensified with the addition of positive end-expiratory pressure (PEEP).
Which of the following conditions is associated between kidney failure and respiratory failure? (Select all that apply.) A. ARDS B. Lower GFR C. Increased urine output D. Decreased urine output E. Decreased blood flow to the kidneys
A B D E
The nurse is managing a patient with hyperglycemia. Which findings would the nurse expect to note to support this diagnosis? (Select all that apply.) A. Anorexia B. Abdominal pain C. Bradycardia D. Fluid overload E. Change in level of consciousness F. Kussmaul respirations
A B E F More than likely the patient with hyperglycemia will be fluid volume depleted and tachycardic.
A patient is admitted in thyrotoxicosis. Which laboratory tests would the nurse expect to be ordered for this patient? (Select all that apply.) A. Total serum triiodothyronine (TT3) B. Total serum thyroxine (TT4) C. Free urine thyroid-stimulating hormone D. Total urine thyroxine E. Thyroglobulin (Tg) F. Free thyroxine (T4)
A B E F Thyroid tests include total serum thyroxine, free thyroxine, total serum triiodothyronine, free triiodothyronine, thyroid-stimulating hormone (thyrotropin), and thyroglobulin.
A patient has been admitted with acute kidney injury. The nurse knows the most important consideration for evaluating the patient's fluid status is what parameter? Select two. A. Daily weights B. Urine and serum osmolality C. Intake and output D. Hemoglobin and hematocrit levels
A C
The nursing management plan for the patient with a urinary drainage catheter would include which interventions to prevent catheter-associated UTI (CAUTI)? (Select all that apply.) A. Insert urinary catheters using aseptic techniques. B. Change the urinary catheter daily. C. Review the need for the urinary catheter daily and remove promptly. D. Flush the urinary catheter q8 hours to maintain patency. E. Avoid unnecessary use of indwelling urinary catheters.
A C E The key components of CAUTI prevention are to avoid unnecessary use of urinary catheters, insert urinary catheters using aseptic technique, adopt evidence-based standards for maintenance of urinary catheters, review the need for the urinary catheter daily, and remove the catheter promptly.
A patient was admitted with acute kidney injury. Which urinalysis value reflects a decreased ability of the kidneys to concentrate urine? A. pH of 5.0 B. Specific gravity of 1.000 C. No casts D. Urine sodium of 140 mEq/24 hr
B
What causes the presence of myoglobin in urine? (Select all that apply.) A. Infection B. Crush injury C. Acidosis D. Rhabdomyolysis E. Volume deficit
B C
A nurse is teaching a patient with diabetes mellitus. The patient asks the nurse what is an acceptable HbA1c level for him. What should the nurse tell the patient? A. "An acceptable level is less than 5.4%." B. "An acceptable level is less than 6.5%." C. "An acceptable level is determined by your practitioner." D. "It is dependent on your age."
B
A patient has acute kidney injury (previously known as acute tubular necrosis). The following blood work was noted: complete blood count shows a white blood cell count of 11,000 mm3, a hemoglobin of 8 g/dL, and a hematocrit of 30%. His chemistry panel shows serum potassium, 4.5 mg/dL; serum sodium, 135 mg/dL; serum calcium, 8.5 mg/dL; BUN, 20 mg/dL; and creatinine, 1.5 mg/dL. What laboratory value(s) need(s) to be treated most immediately and why? A. Administration of 5% dextrose in water and insulin because the patient is hyperkalemic and needs this level reduced B. Administration of Epogen to treat anemia C. Administration of a broad-spectrum antibiotic to treat the elevated blood cell count D. Administration of a calcium supplement for low calcium
B
A patient has been admitted in acute heart failure. Which parameter would indicate to the nurse that the patient is fluid overloaded? A. Central venous pressure of 4 mm Hg B. Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg C. Cardiac index of 2.5 L/min/m2 D. Mean arterial pressure of 40 mm Hg
B
A patient has been admitted with a brain mass. The practitioner suspects it might be a pituitary tumor and orders a computed tomography (CT) scan. What area of brain should be scanned to confirm this diagnosis? A. Frontal lobe B. Base of the skull C. Temporal lobe D. Anterior fossa
B
A patient has been admitted with abdominal pain. The patient's fasting blood glucose is 120 mg/dL. Which statement regarding this finding is accurate? A. This is a normal finding in critically patients. B. This finding is indicative of prediabetes. C. This finding is indicative of diabetes. D. This finding is indicative of diabetic ketoacidosis
B
A patient has been admitted with diabetic ketoacidosis. The nurse knows that the top priority in the initial treatment of diabetic ketoacidosis (DKA) which intervention? A. Lowering the blood sugar as quickly as possible B. Administering intravenous fluids C. Administering sodium bicarbonate D. Determining the precipitating cause
B
A patient has been admitted with uncontrolled atrial fibrillation and muscle wasting. The practitioner suspects the patient may have a thyroid disorder. The nurse auscultates a bruit over the thyroid. What does this finding indicate? A. Normal function B. Enlargement of the thyroid C. Hypoplasia of the thyroid D. Tumor of the thyroid
B
A patient has been hospitalized for a subtotal gastrectomy. After the procedure, an infection developed that eventually had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of administration, oliguria occurred, and subsequent laboratory values indicated elevated BUN and creatinine levels. The patient is transferred to the critical care unit with acute kidney injury (previously known as acute tubular necrosis). The patient's vital signs are stable. Which dialysis method would be most appropriate for the patient's condition? A. Peritoneal dialysis B. Hemodialysis C. Continuous renal replacement therapy D. Continuous venovenous hemodialysis (CVVH)
B
A patient has been on complete bed rest for 3 days. The practitioner has left orders to get the patient out of bed for meals. The patient complains of feeling dizzy and faint while sitting at the bedside. The nurse suspects that the patient is experiencing what problem? A. Orthostatic hypertension B. Orthostatic hypotension C. Hypervolemia D. Electrolyte imbalance
B
A patient has developed acute kidney injury (AKI) secondary to cardiogenic shock. Which laboratory value would the nurse find helpful in evaluating patient's renal status? A. Serum sodium B. Serum creatinine C. Serum potassium D. Urine potassium
B
A patient has thyroid storm. The nurse is providing medication instruction for home. The patient asks "If I have a fever, should I take Tylenol or aspirin?" Which response would be the most appropriate? A."Either one is fine because they do not affect the antithyroid medication." B. "Tylenol rather than aspirin because aspirin increases the amount of free thyroid hormone in circulation." C. "Aspirin rather than Tylenol because Tylenol increases the amount of free thyroid hormone in circulation." D. "They both prevent the antithyroid medication from working correctly. I would recommend an NSAID."
B
A patient is admitted in acute heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. Which diagnostic tests would provide the best information about the internal kidney structures, such as the parenchyma, calyces, pelvis, ureters, and bladder? A. Kidney-ureter-bladder (KUB) B. Intravenous pyelography (IVP) C. Renal ultrasonography (USG) D. Renal angiography
B
A patient is admitted with hyponatremia. The practitioner suspects the patient may have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and orders a serum ADH level for the next morning. Which medications must be stopped or withheld at least 8 hours prior to the test? A. Insulin and furosemide B. Morphine and carbamazepine C. Digoxin and potassium D. Heparin and lopressor
B
A patient is admitted with severe hyperglycemia due new-onset type 1 diabetes mellitus. The nurse notes a sweet-smelling odor on the patient's exhaled breath. What causes this phenomenon? A. Metabolic alkalosis B. Ketoacidosis C. Glycosylation D. Dehydration
B
A patient was admitted with acute heart failure a few days ago. Today the patient's urine has a specific gravity of 1.040. What could be the potential cause for this value? A. Volume overload B. Volume deficit C. Acidosis D. Urine ketones
B
A patient was admitted with an infection that had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of administration, the patient developed oliguria, and an elevated blood urea nitrogen and creatinine levels. The nurse suspects the patient has developed what type of kidney injury? A. Prerenal B. Intrarenal C. Anuric D. Postrenal
B
An alert and oriented patient presents with a pulmonary artery wedge pressure of 4 mm Hg and a cardiac index of 0.8. The BUN is 44 mg/dL, creatinine is 3.2 mg/dL, and BP is 88/36 mm Hg. Urine output is 15 mL/hr. Lungs are clear to auscultation with no peripheral edema noted. Which of the following treatments would the physician most likely order? A. Lasix 40 mg intravenous push B. 0.9% normal saline at 125 mL/hr C. Dopamine 15 μg/kg/min D. Transfuse 1 U of packed red blood cells
B
Percussion of kidneys is usually done to assess what parameter? A. Size and shape of the kidneys B. Presence of pain in the renal area C. Presence of a fluid wave D. Patient's overall fluid status
B
The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS). Which findings would the nurse expect to observe in this patient? A. Hyperglycemia with low serum osmolality B. Severe hyperglycemia with minimal or absent ketosis C. Little or no ketosis in serum with rapidly escalating ketonuria D. Hyperglycemia and ketosis
B
The nurse is caring for a patient with a traumatic brain injury. Yesterday the patient weighed 62 kg and today the patient weighs 60 kg. How much fluid loss does this change in weight reflect? A. 1 L B. 2 L C. 4 L D. 10 L
B
The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which symptom is most suggestive of DKA? A. Irritability B. Excessive thirst C. Rapid weight gain D. Peripheral edema
B
The patient is a gravida 6, para 1. She is admitted after a cesarean section after an amniotic embolus. Her heart rate (HR) is more than 150 beats/min with a systolic BP less than 80 mm Hg. Her temperature is 38°C, and her condition has caused her to develop prerenal azotemia. The patient was fluid resuscitated through a double-lumen catheter, which was placed into her right femoral access, and started on vasopressors with a fair response (BP, 80/50 mm Hg; HR, 122 beats/min). Because of her diagnosis and a concern regarding fulminating sepsis, the patient was begun on CVVH. Which of the statements best describes CVVH? A. Complete renal replacement therapy requiring large volumes of ultrafiltrate and filter replacement B. Complete renal replacement therapy that allows removal of solutes and modification of the volume and composition of extracellular fluid to occur evenly over time C. Involves the introduction of sterile dialyzing fluid through an implanted catheter into the abdominal cavity, which relies on osmosis, diffusion, and active transport to help remove waste from the body D. Complete renal replacement therapy that allows an exchange of fluid, solutes, and solvents across a semipermeable membrane at 100 to 300 mL/hr
B
What is the most common site for short-term vascular access for immediate hemodialysis? A. Subclavian artery B. Subclavian vein C. Femoral artery D. Radial vein
B
What is the recommended nutritional intake of protein to control azotemia in the patient with acute kidney injury? A. 0.5 to 1.0 g/kg/day B. 1.2 to 1.5 g/kg/day C. 1.7 to 2.5 g/kg/day D. 2.5 to 3.5 g/kg/day
B
Which electrolytes pose the most potential hazard if not within normal limits for a person with renal failure? A. Phosphorous and calcium B. Potassium and calcium C. Magnesium and sodium D. Phosphorous and magnesium
B
Which of the following IV solutions is recommended for treatment of prerenal failure? A. Dextrose in water B. Normal saline C. Albumin D. Lactated Ringer solution
B
Which of the following medications is considered a loop diuretic? A. Acetazolamide (Diamox) B. Furosemide (Lasix) C. Mannitol D. Metolazone (Zaroxolyn)
B
Which pathophysiologic mechanism occurs in the patient with type 2 diabetes? A. Lack of insulin production and excessive glucose intake B. Insulin resistance and decreased insulin secretion C. Overproduction of glucose and decreased metabolism D. Increased uptake and decreased release of glucose in the cells
B
Which pathophysiologic mechanism occurs in the syndrome of inappropriate antidiuretic hormone (SIADH)? A. Hemoconcentration B. Dilutional hyponatremia C. Massive diuresis D. Hypermetabolism
B
A patient has been admitted after surgery for removal of a brain tumor. The nurse suspects the patient may be developing diabetes insipidus (DI). Which findings would confirm the nurse's suspicion? A. Hyperglycemia and hyperosmolarity B. Hyperglycemia and peripheral edema C. Intense thirst and passage of excessively large quantities of dilute urine D. Peripheral edema and pulmonary crackles
C
A patient has sepsis and is placed on broad-spectrum antibiotics. Her temperature is 37.8°C. Her BUN level is elevated. She continues on vasopressor therapy. What other steps should be taken to protect the patient from inadequate organ perfusion? A. Increase net ultrafiltrate of fluid. B. Discontinue vasopressor support. C. Assess the patient for blood loss and hypotension. D. Notify the physician of access pressures.
C
A patient is admitted in acute kidney injury. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. The nurse suspects the main cause of ascites is what condition? A. Hypovolemia B. Dehydration C. Volume overload D. Liver damage
C
A patient is admitted with acute kidney injury. The patient's weight upon admission was 176 lb and the next day it is 184 lb. What is the approximate amount of fluid retained with this weight gain? A. 800 mL B. 2200 mL C. 3600 mL D. 8000 mL
C
A patient is admitted with diabetic ketoacidosis (DKA). The patient's arterial blood gas indicates the patient has an uncompensated metabolic acidosis. The patient has rapid, regular respirations. Which medical intervention would the nurse expect to initiate to correct the acidosis? A. Initiate oxygen therapy via a face mask. B. Administer sodium bicarbonate. C. Administer insulin and fluids intravenously. D. Prepare for intubation.
C
A patient is admitted with hypernatremia secondary to neurogenic diabetes insipidus. The patient's serum osmolality is 350 mOsm/kg. What does this finding indicate? A. The patient is overhydrated. B. The patient's serum osmolality is normal. C. The patient is dehydrated. D. The patient is hypothyroid
C
A patient was admitted with acute heart failure who has been receiving diuretic therapy. The nurse suspects the patient is hypovolemic. What auscultatory parameter would confirm the nurse's suspicion? A. Hypertension B. Third or fourth heart sound C. Orthostatic hypotension D. Vascular bruit
C
A patient was admitted with acute heart failure. The nurse is assessing the patient for peripheral edema. The nurse presses two fingers over the tibial area, and it takes 1 minute before the indention disappears. What would the nurse in the medical record? A. +1 pitting edema B. +2 pitting edema C. +3 pitting edema D. +4 pitting edema
C
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodiafiltration (CVVHDF). The nurse understands the patient should be closely monitored for what circuit-related complications of the therapy? A. Hypervolemia, hypothermia, and hyperkalemia B. Access dislodgment, decreased outflow pressures, and bleeding C. Filter clotting, access failure, and air embolism D. Increased overflow pressure, dehydration, and calcium loss
C
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands that this type of continuous renal replacement therapy (CRRT) is indicated for the patient who needs what type of treatment? A. Fluid removal only B. Fluid removal and moderate solute removal C. Fluid removal and maximum solute removal D. Maximum fluid and solute removal
C
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands the patient should be closely monitored for what patient-related complications of the therapy? A. Air embolism, access failure, and blood leaks B. Decreased inflow pressure, air bubbles, and power surge C. Infection, hypotension, and electrolyte imbalances D. Catheter dislodgement, decreased outflow pressure, and acid-base imbalances
C
A patient with chronic renal failure receives hemodialysis treatments 3 days a week. Every 2 weeks, the patient requires a transfusion of 1 or 2 U of packed red blood cells. What is the probable reason for this patient's frequent transfusion needs? A. Too much blood phlebotomized for tests B. Increased destruction of red blood cells because of the increased toxin levels C. Lack of production of erythropoietin to stimulate red blood cell formation D. Fluid retention causing hemodilution
C
An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage. The nurse knows the patient is at risk for developing what type of acute kidney injury (AKI)? A. Intrinsic B. Postrenal C. Prerenal D. Intrarenal
C
As serum osmolality rises, intravascular fluid equilibrium will be maintained by the release of what substance? A. Ketones B. Glucagon C. Antidiuretic hormone D. Potassium
C
The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. Which laboratory results would the nurse note confirming this diagnosis? A. Glycated Hemoglobin A1c of 3% B. Absence of ketones in the urine C. Presence of ketones in the blood D. Fasting glucose of 105 mg/dL
C
The nursing management plan for a patient with thyrotoxicosis would include which intervention? A. Providing diversional stimuli B. Restricting fluids C. Maintaining a quiet, restful environment D. Administering thyroid supplements at the same time each day
C
The patient is a gravida 6, para 1. She is admitted after a cesarean section after an amniotic embolus. Her heart rate (HR) is more than 150 beats/min with a systolic BP less than 80 mm Hg. Her temperature is 38°C, and her condition has caused her to develop prerenal azotemia. The patient was fluid resuscitated through a double-lumen catheter, which was placed into her right femoral access, and started on vasopressors with a fair response (BP, 80/50 mm Hg; HR, 122 beats/min). Because of her diagnosis and a concern regarding fulminating sepsis, the patient was begun on CVVH. Identify three complications of CVVH therapy. A. Fat emboli, increased ultrafiltration, and hypertension B. Hyperthermia, overhydration, and power surge C. Air embolism, decreased inflow pressure, and electrolyte imbalance D. Blood loss, decreased outflow resistance, and acid-base imbalance
C
To assess whether or not an arteriovenous fistula is functioning, what must the nurse do and why? A. Palpate the quality of the pulse distal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow. B. Palpate the quality of the pulse proximal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow. C. Palpate gently over the site of the fistula to determine whether a thrill is present; listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow. D. Palpate over the site of the fistula to determine whether a thrill is present; check whether the extremity is pink and warm.
C
What is the dose for low-dose dopamine? A. 1 to 2 mcg/kg/min B. 1 to 2 mg/kg/min C. 2 to 3 mcg/kg/min D. 2 to 3 mg/kg/min
C
Which nursing intervention should be initiated on all patients with the syndrome of inappropriate antidiuretic hormone (SIADH)? A. Placing the patient on an air mattress B. Encouraging oral fluids C. Initiating seizure precautions D. Applying soft restraints
C
A patient was admitted with liver failure and acute kidney injury (AKI). Which intravenous solution should the nurse question if it was ordered for this patient? A. D5W B. 0.9% NaCl C. Lactated Ringer solution D. 0.45% NaCl
C Rationale: LR is contraindicated for patients with kidney or liver disease or in lactic acidosis because LR has Sodium and potassium, which may cause electrolyte disturbances, fluid retention, etc.
The nurse is caring for a patient with a traumatic brain injury. The nurse suspects the patient is developing diabetes insipidus. Which test or procedures would confirm this diagnosis? A. Skull radiographs B. Serum glucose level C. Water deprivation test D. Antidiuretic hormone (ADH) stimulation test
D
A patient has been admitted who is suspected of having thyrotoxicosis. Which sign or symptom would support this diagnosis? A. Moist, shiny buccal membranes B. Presence of a headache with fatigue and weakness C. Lack of visibility of the thyroid gland in the anterior neck D. Presence of a bruit upon auscultation of the thyroid
D
A patient has been hospitalized for a subtotal gastrectomy. After the procedure, an infection developed that eventually had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of administration, oliguria occurred, and subsequent laboratory values indicated elevated BUN and creatinine levels. The patient is transferred to the critical care unit with acute kidney injury (previously known as acute tubular necrosis). The fluid that is removed each hour is not called urine; it is known as A. convection. B. diffusion. C. replacement fluid. D. ultrafiltrate.
D
A patient is admitted with diabetic ketoacidosis (DKA). The nurse knows that the lack of insulin results in which process? A. Decreased glucagon release B. Decreased glycogenolysis C. Decreased ketone production D. Increased gluconeogenesis
D
A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). The practitioner suspects the patient has nephrogenic DI. Which finding would confirm this diagnosis? A. A slight increase in urine osmolality B. A decrease in urine output C. A decrease in serum osmolality D. No change in urine osmolality
D
A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). Which test would help the practitioner differentiate between central and nephrogenic DI? A. Water deprivation test B. Serum osmolality C. Thyroid-stimulating hormone test D. Antidiuretic hormone (ADH) test
D
A patient is admitted with sepsis and acute kidney injury (AKI). The patient is started on continuous renal replacement therapy (CRRT). The nurse knows that fluid removed each hour is charted as what on the CRRT flow sheet? A. Convection B. Diffusion C. Replacement fluid D. Ultrafiltrate
D
A patient is admitted with severe hyperglycemia due to new-onset type 1 diabetes mellitus. Which signs and symptoms obtained as part of the patient's history might indicate the presence of hyperglycemia? A. Recent episodes of tachycardia and missed heart beat B. Decreased urine output accompanied by peripheral edema C. Periods of hyperactivity with weight gain D. Increased thirst and increased urinary output
D
A patient is admitted with severe hyperglycemia. The patient is very lethargic and has a "fruity" odor to his breath. The nurse knows the odor on the patient's breath is indicative of which situation? A. Alcohol intoxication B. Lack of sodium bicarbonate C. Hypokalemia D. Presence of acetone
D
A patient is reporting a headache, fatigue, abdominal pain, and blurred vision. The nurse knows that these signs may indicate the patient has what problem? A. Hypothyroidism B. Pituitary tumor C. Cushing syndrome D. Hyperglycemia
D
A patient was admitted with multiple trauma who has been volume resuscitated. The nurse suspects the patient is fluid overloaded. Which assessment findings would confirm the nurse's suspicion? A. Venous filling of the hand veins greater than 5 seconds B. Distended neck veins in the supine position C. Presence of orthostatic hypotension D. Presence of a third heart sound
D
A patient with a history of type 2 diabetes was admitted after aneurysm repair. The patient's serum glucose levels have been elevated for the past 2 days and the patient is concerned about becoming dependent on insulin. Which statement is the nurse's best response to the patient's concerns? A. "This surgery may have damaged your pancreas. We will have to do more evaluation." B. "Perhaps your diabetes was more serious from the beginning." C. "You will need to discuss this with your physician." D. "The stress on your body has temporarily increased your blood sugar levels."
D
In a patient with a distended abdomen differentiating ascites from solid bowel contents is accomplished by performing what assessment? A. Auscultation of bowel sounds B. Palpation of the liver margin C. Measuring abdominal girth D. Eliciting a fluid wave
D
One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. Which description regarding how this treatment works is accurate? A. Forces potassium out of the serum into the lymphatic space. B. Promotes higher excretion of potassium in the urine. C. Binds with potassium lowering available amounts. D. Forces potassium out of the serum into the cells.
D
The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which statement best describes the rationale for administrating potassium supplements with the patient's insulin therapy? A. Potassium replaces losses incurred with diuresis. B. The patient has been in a long-term malnourished state. C. IV potassium renders the infused solution isotonic. D. Insulin drives the potassium back into the cells.
D
The patient complains of a metallic taste and loss of appetite. The nurse is concerned that the patient has developed what problem? A. Glycosuria B. Proteinuria C. Myoglobin D. Uremia
D
The patient is a gravida 6, para 1. She is admitted after a cesarean section after an amniotic embolus. Her heart rate (HR) is more than 150 beats/min with a systolic BP less than 80 mm Hg. Her temperature is 38°C, and her condition has caused her to develop prerenal azotemia. The patient was fluid resuscitated through a double-lumen catheter, which was placed into her right femoral access, and started on vasopressors with a fair response (BP, 80/50 mm Hg; HR, 122 beats/min). Because of her diagnosis and a concern regarding fulminating sepsis, the patient was begun on CVVH. Why would this therapy be chosen for this patient? A. Hyperdynamic patients can better tolerate abrupt fluid and solute changes. B. It is the treatment of choice for patients with diminished renal perfusion who are unresponsive to diuretics. C. It is indicated for patients who require large-volume removal for severe uremia or critical acid-base imbalances. D. It is indicated for hemodynamically unstable patients, who are often intolerant of the abrupt fluid and solute changes that can occur with hemodialysis.
D
