MED SURG 1 test 1

PH CO2 CO3

Respiratory: OPP. Metabolic: EQUAL

The nurse is caring for a client who has a NG tube committed to intermitted low wall suction, with large amount of gastric secretion being pulled out, the nurse should consider that the client is at risk for developing what?

- Metabolic Alkalosis

What is a nursing intervention for a patient with congestive heart failure and fluid volume overload?

- Monitor weight each day at the same time.

The nurse is caring for a client with Hypocalcemia, what finding should the nurse observe?

- Positive Trousseau Sign

If a client complains of having urinary frequencies the nurse would inquire about the clients' intake in:

- Soda - Caffeine - Alcohol

Lithotripsy

- Ultrasound waves to crush the stone

Which statement demonstrates that the patient accurately understands the nurse's teaching related to a low-sodium diet?

" I'm going to eat my favorite avocado and orange salad"

The nurse cautions the diabetic pt. that diabetes affects the blood flow through the kidney. which statement indicates that the pt. understands the nurse's teaching.

"Diabetes causes changes to blood vessels, which impacts blood flow to my kidneys"

A 25-year-old woman comes to the emergency department with nonspecific urethritis. Which information is most important for the nurse to obtain?

"How often do you use bath salts or take bubble baths?

Which statement best indicates that the patient understands teaching about dietary restrictions in glomerulonephritis?

"I should avoid canned soups and hot dogs."

A patient is scheduled to undergo a cystogram. Which statement indicates that the patient accurately understands the nurse's teaching about prevention of potential complications of the test

"I should drink plenty of fluids after the test is over.

The nurse is caring for a frustrated patient reports that she still involuntarily voids despite two surgeries to correct incontinence. Which statement indicates that the patient accurately understands the nurse's teaching about incontinence management after surgery

"I will talk to my health care provider about a pessary.

A patient has a kidney stone lodged in the ureter. He questions why it must be removed. What response is most appropriate?

"If the stone is not removed, it could block urine flow from the kidney and cause swelling within the kidney."

A patient with glomerulonephritis has an order to undergo plasmapheresis. Which statement indicates that the patient accurately understands teaching about the procedure?

"This procedure removes my affected plasma and gives me a clean replacement."

The nurse is discussing alternative therapies with a patient who has cystitis. The patient asks the nurse if there are any dietary changes that might help. What response is most appropriate?

"Vitamin C may help decrease the frequency of cystitis."

Hormones that have an effect on fluid balance:

- Aldosterone - Anti-diuretic

Vital sign changes with dehydration

- B/P decreases - Heart rate increases - Respirations - 22 - Temperature increases

Most accurate lab to determine decreased renal function:

- Creatinine

What is a common cause of Metabolic Acidosis?

- Diarrhea

The nurse is caring for a female client who complains of dysuria (painful urination), urgency and bladder spasms; the nurse questions the patient about the use of the following products:

- Douching - Vaginal Spray - Soap

The nurse is assessing a client who was admitted with metabolic alkalosis, what should the nurse recognize as a risk factor for metabolic alkalosis?

- Excessive use of anti-acids.

Signs and symptoms of Pyelonephritis (inflammation of the kidney):

- Fever, chills, fatigue, loss of appetite or malaise. - Pain in back, flank, or pelvis. - Nausea or vomiting. - Frequent urination.

The nurse is providing care to a client with renal failure. Which emergency electrolyte imbalance is common with renal failure?

- Hyperkalemia

When tapping the cheek, the patients lip and face spasm, this is a sign of? (Chvostek Sign)

- Hypocalcemia (low calcium)

The primary care provider writes an order for the patient to receive an IV of a solution that has the same osmotic pressure as intracellular fluid. The nurse would correctly question which IV orders?

0.45% sodium chloride, 5% dextrose in 0.9% sodium chloride

The nurse is caring for a client who is dehydrated, the physician ordered for the client to have an isotonic IV solution, the nurse would be correct to start the following IV solution?

0.9% normal saline

The nursing is caring for newly admitted pt. with uncontrolled nausea and vomiting. The patient has a history of alcoholism and diabetes. After receiving these orders from the health care provider, which orders should the nurse question?

1. Administer 10 mg prochlorperazine maleate (Compazine), IM every 4 to 6 hours for nausea and vomiting 2. administer diphenoxylate atropine (Lomotil), 2 tabs, by mouth after first occurrence of nausea and vomiting 3. administer furosemide (Lasix) 40 MG by slow IV push.

The nurse caring for a patient who has just had an arteriovenous (AV) access created in his right forearm. Which finding(s) is/are important for the nurse to assess?

1. Presence of bruit on auscultation of the AV site 2. Capillary refill in the left hand 3.Abdominal incision site

In which situation(s) should the nurse question an order for carbenicillin for a patient with a urinary infection

1. The patient is allergic to penicillin. 2. The patient takes warfarin daily. 3. The patient takes oral contraceptives.

When discussing bladder health with a patient, the nurse emphasizes the importance of regular voiding in a timely manner. Which statement(s) indicate(s) that the patient accurately understands the underlying rationale for this recommendation

1. Urinating regularly will prevent prolonged exposure of the bladder wall to harmful wastes." 2. "Allowing my bladder to overfill causes the walls to overstretch." 3. "A full bladder can cause undue strain on the urinary sphincters."

The nurse is assessing the hydration status of the patient. Which Actions demonstrates knowledge of proper assessment?

1. monitoring the patient's daily weight, 2.Assessing for skin tenting on the patient's forehead 3.Asking the patient if her is experiencing thirst.

chain of events that result in hypocalcemia for the pt. in early renal failure occurs

1. retention of phosphates 2. loss of CA ions 3. loss of absorption of calcium from the GI tract

The nurse is caring for a patient who is undergoing plasmapheresis. The nurse should carefully monitor the patient for which potential complication(s)?

1.A bruit at the shunt site 2. Decreasing blood pressure 3. Signs of hyperkalemia 4.Bleeding at the puncture site

While caring for a patient with an indwelling catheter, which intervention(s) is/are important for the nurse to include in the plan of care

1.Observe tube placement and note the level of urine in the collection bag 2. Use a syringe to deflate the balloon before discontinuing the catheter. 3. Clean the meatus and catheter with soap and water

The nurse is caring for a patient with urinary retention. Which measure(s) should the nurse take when assisting the patient to void

1.Offer the patient tea or soda. 2. Provide a warm 3.bath Run water in the lavatory.

Which age-related change(s) occur(s) in the urinary system?

1.Prostate hypertrophy 2. Decreased renin secretion 3. Decreased bladder muscle tone

Which statement(s) accurately describe the functions of the kidneys?

1.Regulation of electrolytes 2. Regulation of fluid volume 3. Regulation of blood pressure 4. Secretion of erythropoietin

The home health nurse is caring for a patient with chronic renal failure. Which assessment finding(s) indicate(s) that the patient is experiencing uremic syndrome

1.Restless legs 2. Dry, scaly skin 3. Crystals in the eyebrows 4. Muscle cramp

The nurse is collecting the health history of a patient who has had multiple episodes of renal calculi formation. Which finding(s) increase(s) the patient's risk for the development of renal calculi

1.Uric acid crystals in urine 2. Frequent bacterial urinary infections 3. Excessive fluid intake 4. Prolonged bed rest 5. Parathyroid gland tumor

The nurse demonstrates knowledge of IV solutions by identifying that the IV solution which provides free water, as well as 340 calories/L is

10% dextrose in water

The nurse explains to the 85 yr old pt. with a temperature that, with each degree of fever, the body loses ____% of water

10% of water

NA LEVELS

135-145

The nurse explains that the urge to void occurs when the bladder contain as little as ______ mL of urine.

150

The patient taking furosemide (lasix) to correct excess edema shows a weight loss of 5.5 pounds in 24 hours. The nurse calculates that this weight loss is equivalent to how many (L) if fluid?

2.5 L

In order to keep optimal flow through the urinary system, a person should have a minimum daily intake of how many mL of fluid?

2000 mL

HC03

22- 28

Potassium levels

3.5-5.0 mEq/L

pCO2

35-45

pH

7.35- 7.45

The nurse is reviewing a history and physical examination of a 22-year-old man hospitalized for acute glomerulonephritis. Which finding best alerts the nurse to a potential causative agent?

A recent strep throat infection

The nurse is caring for a patient with a potassium level of 2.0 mEq/L. The nurse should carefully monitor the patient for which potential problem?

Abdominal distension

Pyelonephritis

Acute pyelonephritis is an infection of the kidneys. It is thought to occur when bacteria (such as Escherichia coli) from a bladder infection travel up the ureters to infect the kidneys. A frequent cause of pyelonephritis is an obstruction, causing stasis of urine and stones that cause irritation of the tissue. Both situations provide an environment in which bacteria can grow. When bacteria enter the renal pelvis, inflammation and infection occur. Pyelonephritis causes nausea and vomiting, flank pain, temperature elevation with chills, headache, and malaise.

The nurse assessing a patient with vomiting and diarrhea observed that the urine is scant and concentrated. Which controlling factor is responsible for compensatory reabsorbtion of water?

Antidiuretic hormone in the posterior pituitary

Absence of urine

Anuria

The nurse is caring for patient who is postoperative after a bladder repair. The patient complains of pain. Which independent nursing intervention is best?

Apply a cold compress to the surgical site.

The nurse assesses the patient's IV insertion site and observes that the vein is hard, the skin is red and tender, and a blood return in the IV line. After removing the IV catheter, which action should the nurse take next?

Apply a warm moist pack

The nurse is caring for patient with a urinary tract infection (UTI) who is to receive cefazolin (Ancef). The nurse should carefully monitor the patient for which side effect(s)?

Arrhythmias Rash Confusion Vaginitis

The nurse is caring for a patient with glomerulonephritis. Which finding best leads the nurse to suspect that the patient is developing nephrotic syndrome?

Ascites

The nurse is caring for a patient who underwent a right nephrostomy to relieve hydronephrosis. Which intervention is most important for this patient?

Assess urinary output from the left kidney

When the patient asks why he has so many urinary tract infections (UTIs), the nurse informs the patient that his recurrent UTIs most likely result from which causative factor?

Bacteria that colonize in the kidney

Foods high in potassium

Bananas, mangos, tomato, leafy green vegetables

The nurse is caring for a 50-year-old female who presented to the emergency department after being involved in a motor vehicle collision. The patient displays marked tenderness and spasm in the suprapubic area and a nonpulsating mass. The nurse anticipates that this patient will undergo additional workup for which complication

Bladder trauma

The nurse reminds the pt. that the three body mechanisms that attempt to compensate to correct acid- base imbalances are the

Buffer, Respiratory, Kidneys

The nurse is collecting data from a patient who complains of having urinary frequency. The nurse should inquire about which dietary habit

Caffeine intake

While the nurse is washing the face of a patient in renal failure, the patient demonstrates a spasm of the lips and face. Which lab value corresponds with the nurses assessment findings?

Calcium of 7.9 mg/dL

Which finding is most important for the nurse to confirm prior to hanging an IV bag containing potassium?

Check for urine output of at least 30mL/hr

The nurse is caring for a patient who has been on total parenteral nutrition (TPN) for 48 hours. Which action demonstrates effective nursing care?

Checking the patient's blood sugar level according to facility protocol.

How can nephrotoxic drugs such as doxycycline and rifampin cause kidney damage?

Chemical alterations of glomeruli

Early indicator of dehydration?

Concentrated urine

The nurse is caring for an 80-year old patient. Which finding is the best early indicator of dehydration in the pt.?

Constipation

Signs of fluid volume overload

Crackling of the lungs

The nurse reviewing laboratory reports for a patient admitted for acute pyelenophritis. Which finding is most concerning to the nurse?

Creatinine of 2.0 mg/dL

The nurse uses a picture to show ions equalize their concentration by which passive transport process

Diffusion

The nurse is caring for a young pt. with asthma. which activity should the nurse encourage in order to help prevent respiratory acidosis?

Engage in deep-breathing exercises every 2 hours

The nurse is aware that 80% of UTIs in females are the result of contamination from

Escherichia coli E. coli Escherichia coli E. coli

The nurse is assessing a patient who is being treated for acute pyelonephritis. When finding best indicates to the nurse that the patient is in the early stages of pyelonephritis?

Flank pain

A patient has been admitted to the acute care facility to rule out glomerulonephritis. Which assessment finding(s) is/are supportive of the potential diagnosis?

Flank pain Hematuria Periorbital edema Hypertension

What do you encourage to a patient experiencing diarrhea and vomiting?

Fluids

The nurse explains that when the kidney suffers an autoimmune inflammatory reaction, the glomeruli lose their ability to function effectively. The nurse is describing the etiology of which problem?

Glomerulonephritis

Blood in the urine

Hematuria

The nurse is caring for a woman suspected of having a vaginal fistula. Which finding supports the potential diagnosis

Pneumaturia

When the nurse is caring for a patient who reports he has blood that begins when he initiates the urine stream and then abates. Based on underlying pathophysiology, the nurse concludes that the hematuria is occurring in which location?

In the urethra

The nurse is caring for a patient who has been taking a sulfa drug for a urinary tract infection (UTI). Which intervention is most important for the nurse to add to the patient's care plan?

Increase fluid intake to 1.5 L/day

A patient has just returned to the nursing unit after having a renal biopsy. Which intervention is most important to include in the patient's nursing care plan?

Instruct the patient to avoid laughing and use a pillow to splint when sneezing.

Vascular changes related to diabetes mellitus

Intrarenal ARF

The nurse is caring for a patient with metabolic acidosis. Which assessment finding reveals that the compensatory mechanism to correct this imbalance is in effect?

Kussmaul respirations

The nurse is caring for a patient with deteriorating kidney function. Laboratory work indicates 900 mg of uric acid in 24 hours. In addition to administering prescribed medication, which dietary modification should the nurse address

Limit servings of beef to 3-ounce portions.

The nurse is caring for a patient who is scheduled to undergo hemodialysis. Based on awareness of potential complications, the nurse correctly withholds which medication?

Lisinopril (Zestril)

Normal creatinine levels

Male 0.6 - 1.2 Female 0.5 - 1.1

The pt. who has had diarrhea for the last 3 days has blood gases of pH of 7.1, HCO3- of 20, and PCO2 of 36 mm Hg. These lab values are consistent with which acid-base imbalance?

Metabolic acidosis

Urination at night

Nocturia

Diminished urine

Oliguria

The nurse uses a diagram to demonstrate how in dehydration the water is drawn into the plasma from the cells by which process

Osmosis

High urinary output

Polyuria

Prostate hypertrophy

Postrenal ARF

Ureteral obstruction

Postrenal ARF

Hypovolemic shock

Prerenal ARF

While reviewing a patient's medications, the nurse notes that a patient has been prescribed liquid nitrofurantoin (Furadantin). Which intervention should the nurse add to the nursing care plan?

Provide a straw and instruct the patient to rinse the mouth after taking nitrofurantoin.

A 25-year-old man comes to the college clinic with fever of 101° F, nausea, and flank pain that radiates into the thigh and genitals. The nurse anticipates that the patient will undergo workup for which infection

Pyelonephritis

The nurse is caring for a patient who received an instillation of doxorubicin (Adriamycin) into the bladder for treatment of cancer in situ. What should the nurse do next?

Reposition the patient every 15 to 30 minutes.

The nurse is caring for a 90-year-old resident in a long-term care facility who is becoming progressively confused and irritable. What should the nurse do next

Request an order for a urinalysis.

The nurse is providing care to a client who is in a deep sleep and has a slow and shallow respiratory rate in a pattern due to pain medication. What condition will the nurse anticipate the client is experiencing?

Respiratory Acidosis

The nurse is caring for a child suspected of having acute glomerulonephritis. When reviewing the health history, which finding is most concerning to the nurse?

Recent upper respiratory infection

The nurse is caring for a confused patient who requires bladder training. Which component of the bladder training program can the nurse safely delegate to the nursing assistant?

Recording instances of linen changes and fluids offered

The nurse is caring for a client who can be anxious and has been hyperventilating for the past 45 minutes, what arterial blood gas results would be consistent with these findings

Respiratory Alkalosis

Hypokalemia (low potassium)

S&S: Muscle weakness, weakness, muscle cramps, drowsiness, confusion, new onset of bradycardia, hypertension, cardiac dysrhythmia, polyuria, shallow respiratory, lethargic.

cause of renal calculi

Sedentary/immobility

The nurse is assessing a patient with renal failure, and notes fatigue, muscle cramps, confusion, and headache. Which Lab abnormality corresponds with these findings?

Sodium of 129

Which term describes the active transport process that moves sodium and potassium into or out of cells?

Sodium pump

The patient confides that sneezing makes her "wet her pants." The nurse recognizes this cardinal sign of which type of incontinence

Stress incontinence

The nurse is caring for a young man who has been prescribed ciprofloxacin (Cipro) for pyelonephritis. Which information should the nurse include in order to prevent recurrence?

Take this medication with a full glass of water.

As chronic glomerulonephritis progresses, how is the kidney usually affected?

The kidney atrophies.

The nurse is instructing a patient about use of vaginal weight training. Which technique indicates that the patient accurately understands the nurse's teaching?

The patient inserts the smallest cone and holds it in place with muscle tightening for 15 minutes before removing it

The nurse is caring for a patient diagnosed with glomerulonephritis. The patient reports feeling "bored and caged," and asks when he can resume normal activities. Which finding indicates that bed rest may be discontinued?

The patient's blood pressure is 110/74.

The student nurse is attempting to irrigate an indwelling catheter. Which action best indicates that the student nurse accurately understands the correct procedure

The student nurse irrigates using a steady, gentle stream.

Pyridium (phenazopyridine)

Urinary Tract Analgesic

The nurse is caring for a patient who recently had abdominal surgery. Which assessment finding requires the nurse's immediate attention?

Urine output of 20 mL in the last hour

After selecting an appropriate fluid which action should the nurse take to correctly flush a PRN lock?

Use slow, gentle pressure to clear the lumen

The nurse is caring for a frustrated client who reports that after two surgeries to correct incontinence she is still having involuntary voiding, the nurse will suggest what to the patient?

Voiding Diary

Cardiogenic shocka. Prerenal ARF

a. Prerenal ARF

Causes of hyponatremia (low sodium):

excessive vomiting

The patient with long-term obstructive pulmonary disease has a pH of 7, HCO3- of 18 mEq/L, and a PaCO2 of 40 mm Hg. These lab values are consistent with which acid-base imbalance?

metabolic acidosis

The nurse is caring for a patient that has a potassium level of 5.0. The nurse should carefully monitor the patient for which signs and symptoms?

muscle weakness, cardiac dysrhythmias, hypotension

The basic functional unit of the kidney is the

nephron

An 85 yr old pt. who has been NPO since midnight last night for diagnostic testing just completed the procedure. Which intervention is most important.

offer 4 ounces of water or juice every hour