Med Surg Midterm NCLEX Style - Everything Else

The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the clients recent history? A. Pyelonephritis B. Myocardial infarction C. Bladder cancer D. Kidney stones

B. Rationale: Pre-renal causes of AKI are related to a decrease in perfusion, such as with a myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are post-renal causes of AKI related to urine flow obstruction.

The nurse checks a client's blood sugar and it is 32mg/dl. The nurse immediately gives the client some orange juice and graham crackers. Which of the following should the nurse do next? A. Have the client ambulate B. Give the client more food C. Give the client insulin D. Recheck the blood sugar in 15 minutes

D. Rationale: The nurse should recheck the client's blood sugar in 15 minutes. This will allow for assessment to see if it is improving.

Which of the following oral diabetes agents would be classified as a biguanide medication? A. Miglitol (Glyset) B. Metformin (Glucophage) C. Pioglitazone (Actos) D. Acarbose (Precose)

B Rationale: "Metformin (Glucophage)" is correct. Biguanide medications are most commonly used in the treatment of type 2 diabetes. They lower blood glucose by decreasing glucose production in the liver and increasing the amount of sugar absorbed by cells. An example of a biguanide medication is metformin (Glucophage).

A marathon runner comes into the clinic and states I have not urinated very much in the last few days. The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority? A. Give the client a bottle of water immediately. B. Start an intravenous line for fluids. C. Teach the client to drink 2 to 3 liters of water daily. D. Perform an electrocardiogram.

A. Rationale: This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the client to drink 2 to 3 liters of water each day. An intravenous line may be ordered later, after the clients degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

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

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

You are working telephone triage for an after-hours family medicine clinic. A patient has called who is diabetic and been sick for the last 3 days with a cold. Which of the following symptoms reported by the patient is the LEAST concerning? A. Small amount of ketones in urine B. Confusion C. Glucose of 321 mg/dL D. Unable to keep down liquids

A. Rationale: When a client with diabetes is ill, a small amount of ketones in the urine is something to note, but not overly concerning. Moderate to large amounts would be concerning.

The nurse is caring for a client who has been diagnosed with chronic kidney failure. Which of the following aspects of this client's history could have contributed to this? A. Diabetes mellitus B. Hypertension C. Transient ischemic attack (TIA) D. Generalized anxiety disorder E. Rheumatoid arthritis

A., B., E. Rationale: Diabetes can cause chronic kidney failure, because the high glucose level causes damage to the nephrons, which decreases their ability to filter the blood.Hypertension causes too much pressure on the structures of the kidneys over time, causing them to fail. Autoimmune disorders can cause chronic kidney failure when the body's immune system begins to attack these organs.

After receiving report from the night shift nurse, the nurse is looking over their current complaints. The nurse assistant lets the nurse know that all four clients are hyperglycemic. The nurse knows that which of the following client symptoms is the priority to see first? A. Headache B. Altered mental status C. Febrile D. Fatigue

B. Rationale: Hyperglycemia with altered mental status is concerning for diabeteic ketoacidosis. It is important that all hyperglycemic patients be seen within a reasonable amount of time because leaving the glucose high eventually creates more problems, but a DKA client is already in an emergent stage and needs to be seen first. Altered mental status is a concern of a worsening condition that needs to be assessed.

Which of the following sleep disorders has been most commonly associated with type 1 diabetes? A. Delayed sleep phase syndrome B. Sleepwalking C. Insomnia D. Night terrors

C. Rationale: Sleep disturbances are associated with type 1 diabetes. The most common sleep disorder is insomnia, which has been correlated to uncontrolled blood glucose levels. When a person with diabetes has high blood glucose at bedtime, it is difficult for them to fall asleep. Other symptoms of diabetes that affect sleep are sleep apnea and restless leg syndrome

A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)? A. Antibiotic B. Histamine blocker C. Bronchodilator D. Angiotensin-converting enzyme (ACE) inhibitor

D Rationale: ACE inhibitors stop the conversion of angiotensin I to the vasoconstrictor angiotensin II. This category of medication also blocks bradykinin and prostaglandin, increases renin, and decreases aldosterone, which promotes vasodilation and perfusion to the kidney. Antibiotics fight infection, histamine blockers decrease inflammation, and bronchodilators increase the size of the bronchi; none of these medications helps slow the progression of CKD in clients with hypertension.

A client with neuropathy is being discharged home. The nurse is providing discharge education on which of the following medications for neuropathy? A. Glipizide B. Guaifenesin C. Gentamicin D. Gabapentin

D. Rationale: "Gabapentin" is correct. Gabapentin is an analgesic adjunct that treats seizures, neuropathic pain, peripheral neuropathy.

A 45-year-old diabetic client has been brought in for care of diabetic ketoacidosis. The client's blood glucose level is 367 mg/dL and blood pH is 7.28. Which of the following respiratory rates would the nurse most likely expect to see in this situation? A. 36/min B. 8/min C. 24/min D. 16/min

A. Rationale: "36/min" is correct. The client with diabetic ketoacidosis (DKA) would most likely have Kussmaul respirations, which are rapid and deep. A respiratory rate of 36/minute is abnormally high and would most likely be associated with the rapid breathing pattern of DKA. This is a metabolic acidosis that will continue until the condition is corrected. The rapid breathing rate is the body's way to compensate for the acidosis, but is unlikely to fully correct the client's pH level.

The nurse is caring for a client with diabetes mellitus. Which signs and symptoms would prompt the nurse to get an immediate point-of-care glucose level? Select all that apply. A. Weakness B. Complaints of an ache C. Confusion D. Urinary frequency E. Shortness of breath

A. , C. , D. , E. Rationale: Weakness is a sign of of hypoglycemia or hyperglycemia, and will prompt the nurse to get a blood glucose level. Confusion indicates hypoglycemia and should prompt the nurse to get an immediate blood glucose level.Urinary frequency indicates hyperglycemia. The nurse should check the client's glucose immediately if this symptom is noted. SOB is a sign of hyperglycemia, and will prompt the nurse to get a blood glucose level.

A nurse is assessing a client with a history of diabetes. The client tells the nurse that she does not feel well. The nurse checks her blood glucose levels and gets a result of 51 mg/dL. What signs or symptoms would the nurse expect to see with this blood glucose level? Select all that apply. A. Tremor B. Hot, dry skin C. Anxiety D. Bradycardia E. Weakness

A., C., E. Rationale: "Anxiety", "Tremor", and "Weakness" are correct. The client in this example is suffering from mild hypoglycemia in which blood glucose levels are between 70 and 41 mg/dL. The nurse would expect to see signs or symptoms of restlessness and anxiety, weakness, sweating and tremor in this client. Once the glucose level falls to below 40 mg/dL, the client will experience confusion, double vision, drowsiness, headache, and slurred speech. When the glucose level falls below 20 mg/dL, the client can experience seizures and loss of consciousness.

A client with type 1 diabetes has developed peripheral neuropathy as the result of the disease, resulting in altered sensations in the extremities. What nursing interventions would be most appropriate? Select all that apply. A. Place the patient in the semi-Fowler's position B. Assist the client with ambulation and position changes C. Perform routine neurovascular assessments D. Gently massage bony areas E. Maintain stable temperature of the extremities

B. ,C., E Rationale: "Perform routine neurovascular assessments", "Maintain stable temperature of the extremities" and "Assist the client with ambulation and position changes" are correct. Peripheral diabetic neuropathy causes pain, numbness, and tingling in the extremities as a result of poor glucose control over time. When a client presents with this condition, the nurse should assist with his movements and position changes and help keep him comfortable. Routine neurovascular assessments should be performed to assess baseline and to monitor for changes in neuropathy.

The nurse providing education to a client who is newly diagnosed with diabetes mellitus. Which of the following should the nurse emphasize? Select all that apply. A. Use a heating pad to keep feet warm B. Cut toenails with rounded corners C. Wear proper fitting shoes D. Don't walk barefoot E. Inspect feet daily

C. , D., E. Rationale: There is a risk of injury when walking barefoot, so the client should be taught to always wear shoes. Diabetes Mellitus can cause poor circulation and decreased feeling in the feet. Foot care is important to prevent sores and ulcers, as these wounds heal slowly and poorly in the client with uncontrolled glucose levels.Wearing properly fitting shoes helps reduce the risk of injuries and blisters to the feet.

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

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

A newly diagnosed patient with type 2 diabetes has been prescribed metformin as an oral hypoglycemic agent. Which best describes how the nurse would explain this medication? A. "This is a type of oral insulin taken once a week" B. "You can also use this medicine if you develop complications such as diabetic ketoacidosis" C. "You will need to take this when your blood glucose levels get low" D. "This medication is used for type 2 diabetes but not for type 1"

D. Rationale: "This medication is used for type 2 diabetes but not for type 1" is correct. Metformin is an oral hypoglycemic agent that is used in the management of type 2 diabetes. Metformin is used to control blood glucose levels by increasing the liver's sensitivity to glucose levels in the blood. The patient takes it every day as an oral tablet. Metformin is used in type 2 diabetes, but never exclusively in type 1 diabetes.

The nurse is admitting a client with diabetic ketoacidosis (DKA). The client has a history of type 1 diabetes and informs the nurse that she been taking really good care of herself and her blood glucose has been "really really good." Which of the following assessment data leads the nurse to question this statement? A. Fingerstick blood sugar of 492 mg/dL B. Fruity breath C. Total cholesterol 321 mg/dL D. Hemoglobin A1C 13%

D. Rationale: A hemoglobin A1C of 13% indicates that over the last 3 months the client has been averaging a blood sugar of 326 mg/dL, indicating very poorly controlled blood sugars. A current blood sugar of 492 mg/dL is concerning, but it is indicative of the client's current state, not the client's overall glucose control.

The nurse is caring for a client with a BUN of 28. The nurse recognizes this as a sign of dysfunction of which of the following? A. Heart B. Liver C. Kidneys D. Spleen

C. Rationale: "Kidneys" is correct. Kidneys excrete blood urea nitrogen (BUN) and if they are in acute or chronic failure, they will not eliminate BUN and it will remain high in the blood. Normal BUN range is 7-20 mg/dL.

A 38-year-old client has been diagnosed with type 2 diabetes and must take injectable insulin to manage the disease. The nurse is teaching the client about how to inject insulin and the client becomes very upset and anxious at the thought of giving herself an injection. Which response from the nurse is most appropriate? A. Let's talk about how we can make this as easy as possible for you B. I think you should come to the healthcare clinic for your injections so you do not have to do it yourself C. You are obviously upset, so I will ask the provider if we can get you a prescription for oral insulin D. This is part of your daily routine and you will get used to it

A. Rationale: "Let's talk about how we can make this as easy as possible for you" is correct. Some clients, after being diagnosed with diabetes, become very fearful or upset at the thought of administering insulin injections. The nurse can help a client in this situation by reassurance and discussing how to make it easier for the client to accept. By coming up with methods that could improve the situation, the nurse can help the client to accept the diagnosis and the need to administer insulin.

A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best? A. Obtain daily weights of the client. B. Auscultate heart and breath sounds. C. Palpate the clients abdomen. D. Assess the clients diet history.

A. Rationale: Furosemide (Lasix) is a loop diuretic that helps reduce fluid overload and hypertension in clients with early stages of CKD. One kilogram of weight equals about 1 liter of fluid retained in the client, so daily weights are necessary to monitor the response of the client to the medication. Heart and breath sounds should be assessed if there is fluid retention, as in heart failure. Palpation of the clients abdomen is not necessary, but the nurse should check for edema. The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic, but this does not assess the effect of the medication.

A client who has been diagnosed with chronic kidney disease is talking to the nurse about his overall health. Which best describes the difference between health promotion and disease management in this situation? A. Health promotion involves the client being active in the care of his health despite his condition while disease management involves seeking treatments and therapies to control the disease B. Health promotion involves the client educating others about his condition while disease management involves the client focusing on his own care needs C. Health promotion means preventing the disease in the first place while disease management involves dealing with the situation once it has occurred D. Health promotion is promoting wellness activities during times of health while disease management involves working with those struggling with a diagnosis

A. Rationale: "Health promotion involves the client being active in the care of his health despite his condition while disease management involves seeking treatments and therapies to control the disease" is correct. Health promotion and disease management are closely related in the client with a chronic illness. A client with a chronic disease can still participate in health promotion, which involves being active in care of his health despite his disease. Alternatively, disease management seeks to control the disease through therapy and treatment.

A client is admitted to the unit with a tumor on located on the pancreas. The nurse is performing an assessment and knows to assess for which of the following complications? A. Hypoglycemia B. Hyperglycemia C. Gastritis D. Diarrhea

A. Rationale: A tumor on the pancreas causes the release of excess insulin in the body, lowering blood sugar levels.

A client arrives at the healthcare clinic for diagnostic testing for diabetes. After reviewing the test results, the provider diagnoses the client with prediabetes. Which information from the nurse would be appropriate to teach this client about prediabetes? A. The client may delay onset of type 2 diabetes with weight loss, regular exercise, and medications B. Type 2 diabetes can be delayed after a diagnosis of prediabetes if the client takes daily exogenous insulin C. A client with prediabetes is not at increased risk of cardiovascular disease, but may be more likely develop kidney disease D. Prediabetes will eventually become type 2 diabetes over time

A. Rationale: Prediabetes is a condition that typically develops before the onset of diabetes. It involves decreased insulin sensitivity or impaired glucose tolerance. Prediabetes does not necessarily have to lead to type 2 diabetes if the client takes steps to care for her health. The client can delay or prevent the onset of type 2 diabetes with weight loss, exercise, and medications.

A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern? A. Albumin level of 2.5 g/dL B. Phosphorus level of 5 mg/dL C. Sodium level of 135 mmol/L D. Potassium level of 5.5 mmol/L

A. Rationale: Protein restriction is necessary with chronic renal failure due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the clients metabolic needs. The electrolyte values are not related to the protein-restricted diet.

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

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

A client with a history of diabetes has a blood sugar of 54 mg/dL. They are conscious and awake, but feel cold and clammy, diaphoretic, weak, and slightly confused. Which of the following is NOT an appropriate intervention at this time? A. Administer glucagon B. Recheck blood sugar 15 min after intervention C. Give 4 oz orange juice D. Review recent insulin administration

A. Rationale: The client is awake and alert, the priority is to administer an oral form of glucose. Glucagon would be indicated if the client is unconscious and doesn't have IV access. If the client has IV access, they should receiving IV Dextrose.

A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse? A. Place the client on a cardiac monitor immediately. B. Teach the client to limit high-potassium foods. C. Continue to monitor the clients intake and output. D. Ask to have the laboratory redraw the blood specimen.

A. Rationale: The priority action by the nurse should be to check the cardiac status with a monitor. High potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

The nurse is caring for a client with diabetes mellitus. Which signs and symptoms would prompt the nurse to immediately check a POC glucose? Select all that apply. A. Diaphoresis B. Loss of consciousness C. Headache D. Blurred vision E. Fruity breath

A. , B. , C. , D. , E. Rationale: Whenever a diabetic client becomes symptomatic, the nurse will want to immediately check a blood glucose level. Each client differs in their glucose level when they become symptomatic, so the nurse cannot assume that the client's glucose level is at a safe level. Diaphoresis, shakiness, double vision, seizures, confusion, and loss of consciousness all indicate hypoglycemia and require the nurse to check a blood glucose level. Diaphoresis, shakiness, double vision, seizures, confusion, and loss of consciousness all indicate hypoglycemia and require the nurse to check a blood glucose level. This is a sign that the client's blood glucose is either too high or too low. The nurse should check the glucose right away.Death non-urgent signs and symptoms of hyperglycemia include: blurred vision, headache, fatigue, increased thirst and urinary frequency. Emergent signs and symptoms include: fruity breath, weakness, loss of consciousness, confusion, shortness of breath and nausea/vomiting. Diaphoresis, shakiness, double vision, seizures, confusion, and loss of consciousness all indicate hypoglycemia and require the nurse to check a blood glucose level. Fruity breath in the diabetic client indicates diabetic ketoacidosis, which is a medical emergency. The nurse should check the client's glucose immediately if this symptom is noted.

The nurse working in the emergency department receives a client with altered mental status and fruity breath. The provider diagnosis the client with diabetic ketoacidosis (DKA). Which intervention will be included in the treatment of this client? Select all that apply A. Getting an EKG B. Getting a POC glucose C. Administering IV insulin D. Giving IV fluids E. Starting an IV

A. , B. , C. , D., E Rationale: Electrolyte imbalances are common in DKA, due to the rapid fluid loss, and the IV insulin, which pulls glucose and potassium across the cell membrane, further altering electrolyte levels. Since potassium imbalances can lead to arrhythmias, the client will need an EKG. The nurse must monitor the glucose level, so this is a priority nursing intervention.The client in DKA will need an insulin infusion in order to bring down the glucose level, so this is a priority.This client will need volume restored in the form of IV fluids. This is a priority for the nurse.The client in DKA will be dehydrated, so starting an IV may be difficult. For medicine and hydration getting IV access is a priority.

The nurse is caring for a client who has suffered an acute kidney injury. Which of the following nursing interventions are appropriate? Select all that apply. A. Daily weights B. Monitor I&O C. Head CT with contrast D. Fluid restriction E. 1 gm NaCl tabs q6hrs

A. , B. , D. Rationale: Injury to the kidneys can result in fluid retention, and tracking the client's daily weights is a way to monitor how well the kidneys are working. A client with an acute kidney injury should be monitored for I&O to see how much fluid is being retained, and how much urine is being made by the kidneys.With a fluid restriction, the client will retain less fluid and fluid overload will be less of a risk. With fluid overload, the client will begin to demonstrate adventitious heart sounds and crackles in the lungs, which indicates the need for diuresis and/or dialysis.

A client presents to the emergency room complaining of abdominal pain. The client states "I feel sick", then begins dry heaving and suddenly becomes pale and sweaty. What are the priority interventions for this client at this time? Select all that apply. A. Get a set of vital signs B. Obtain a fingerstick glucose level C. Obtain a STAT abdominal CT scan D. Perform a focused neuro exam E. Lay the client down on the stretcher

A. , B. , E. Rationale: Possible causes for someone to be pale, sweaty, and nauseated include hypoglycemia, vasovagal response, and shock states. A set of vital signs can confirm whether the client is hypotensive or if they just experienced a vasovagal response. Possible causes for someone to be pale, sweaty, and nauseated include hypoglycemia, vasovagal response, and shock states. Checking a glucose level can immediately rule out (or in) hypoglycemia so that it can be treated if necessary. Although it is likely this client is experiencing a vasovagal response due to dry heaving, it is imperative that hypoglycemia is ruled out. Possible causes for someone to be pale, sweaty, and nauseated include hypoglycemia, vasovagal response, and shock states. Laying the client down can help alleviate the vasovagal response by taking pressure off the vagus nerve. In this case, it is highly likely that the client is experiencing a vasovagal response due to the dry heaving. Note - if the client was actually vomiting, laying flat would be contraindicated due to aspiration risk.

The nurse is caring for a client in the emergency department following prolonged exposure to sun and heat. The nurse notes that the client has a high pulse rate, poor skin turgor and a BUN of 30 mg/dL. Which of the following interventions are appropriate for the client? Select all that apply. A. Provide isotonic intravenous fluids B. Offer oral rehydration therapy to the client C. Arrange for a consult with neurology D. Check blood and urine cultures for the presence of infection E. Monitor level of consciousness and note changes

A. , B., E. Rationale: -"Provide isotonic intravenous fluids", "Monitor level of consciousness and note changes" and "Offer oral rehydration therapy to the client" are correct. Dehydration occurs when the amount of fluid taken in by a client is not sufficient to meet their body's fluid needs. The goal of dehydration treatment is to eliminate the cause of the fluid deficit, restore electrolyte balance and and replace the fluid volume that was lost. Interventions for dehydration include monitoring vital signs, urine output, respiratory status and level of consciousness, replacing the fluid deficit either orally or intravenously, and monitoring electrolyte values to replace if necessary.

A nurse is talking to a patient who has been newly diagnosed with type 2 diabetes. The nurse is giving the patient information about what signs or symptoms to monitor that could indicate poorly controlled blood glucose levels. Which signs or symptoms should be included in the teaching? Select all that apply. A. Numbness in the feet B. Weight loss C. Confusion D. Inability to concentrate E. Blurred vision

A. ,B, C. , D., E Rationale: "Blurred vision", "Inability to concentrate", "Weight loss", "Confusion" and "Numbness in the feet" are correct. A patient with diabetes should be educated about signs and symptoms of complications of the disease. Type 2 diabetes complications that are most likely to develop are related to hyper or hypoglycemia. Hypoglycemic symptoms include confusion, vision changes, impaired coordination and inability to concentrate, numbness and tingling in extremities, lips and/or tongue. Hyperglycemic symptoms include increased thirst, frequent urination, confusion, weight loss and fatigue.

A nurse is discussing options for home hemodialysis with a patient who has kidney disease. Which of the following is correct regarding home hemodialysis? Select all that apply. A. The catheter system must remain sterile in the home B. Home hemodialysis sessions are shorter than outpatient sessions C. Home hemodialysis may involve nocturnal sessions D. The home care nurse will be present to assist with the dialysis process E. Home hemodialysis promotes patient independence

A., C., E Rationale: "The catheter system must remain sterile in the home", "Home hemodialysis may involve nocturnal sessions" and "Home hemodialysis promotes patient independence" are correct. Home peritoneal hemodialysis is an option for some patients with renal failure. It allows the patient to live a more normal life, and often the patient can perform dialysis independently. There are different types of peritoneal dialysis; continuous cycling, intermittent and nightly peritoneal dialysis. All involve the instillation of dialysate into the peritoneum, allowed to dwell, and drained. This process of exchange is repeated on a schedule based on which type of dialysis is being utilized. The same rules of cleanliness apply in the home that would apply in a facility. If there is a catheter that enters the body internally, it must be kept clean. In this case, sterility must be maintained to avoid an infection.

The nurse is caring for a client who has chronic kidney disease. Which of the following medications would the nurse question? A. Calcium gluconate B. Insulin C. Kayexalate D. Spironolactone

D. Rationale: Spironolactone is a medication that should not be given to a client with kidney disease. Hyperkalemia is a major concern, and since spirolactone is a potassium-sparing diuretic it should NOT be used in clients with CKD.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this clients care? A. Edema and pain B. Electrolyte and fluid imbalance C. Cardiac and respiratory status D. Mental health status

B. Rationale: This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance is essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the clients cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

The nurse working in the emergency department is receiving report. Out of the following group of clients, which would the nurse be concerned about developing hypovolemic shock? A. A 19-year-old with tricholillomania B. A 16-year-old in diabetic ketoacidosis C. A 20-year-old with fibromyalgia D. A 15-year-old with a urinary tract infection

B. Rationale: "A 16-year-old in diabetic ketoacidosis" is correct. Diabetic ketoacidosis (DKA) causes polyuria which can lead to severe dehydration and hypovolemic shock. The main concern of the nurse will be to treat the underlying cause, and keep the client hydrated. Causes of hypovolemic shock include body fluid depletion, hemorrhage due to trauma, surgery, GI ulcer, and increased clotting, dehydration due to nausea, vomiting and diarrhea, hyperglycemia, and diuretic therapy.

The provider has ordered a creatinine level on a client who is experiencing delirium. The nurse knows that which of the following are components of creatinine in the serum? A. Carbonic acid and sodium bicarbonate neutralization B. Protein and muscle metabolism C. Blood urea and nitrogen build up D. Calcium and parathyroid hormone synthesis

B. Rationale: "Protein and muscle metabolism" is correct. A serum creatinine level measures the amount of creatinine, which is a product of protein and muscle metabolism. This number reflects the glomerular filtration rate (GFR) of the kidneys. The level increases during kidney disease once 50% of renal function has been compromised. "Blood urea and nitrogen build up" is incorrect. Blood urea nitrogen (BUN) is a waste product. The level of BUN in the serum indicates how much waste is being cleared by the kidneys. A BUN/creatinine ratio reflects renal problems, but blood urea nitrogen is not a component of creatinine.

Which of the following is NOT caused by an autoimmune response? A. Type 1 diabetes B. Type 2 diabetes C. Multiple sclerosis D. Guillain-Barre syndrome

B. Rationale: "Type 2 diabetes" is correct. With type 2, beta cells do not produce enough insulin OR the body becomes resistant to insulin due to lifestyle choices. This is not caused from an attack by body's immune system.

A provider has ordered a serum creatinine test for a client who is being assessed for chronic kidney disease. The client asks the nurse about the test. Which of the following responses correctly explains serum creatinine? A. This test tells us if you are releasing excess sugar in your urine B. We are testing to see if your kidneys are able to excrete waste through your urine C. The provider ordered this test to check for an infection D. This will tell us if your kidneys are damaged and you will need dialysis

B. Rationale: "We are testing to see if your kidneys are able to excrete waste through your urine" is correct. A creatinine test is a test of kidney function that measures the amount of creatinine in the bloodstream. Creatinine is a waste product of creatine, which is produced by the muscles for energy. Creatinine is removed from the body by the kidneys, and increased levels indicate that the kidneys are not able to excrete normal amounts of creatinine from the body. An increased serum creatinine is not seen until there is at least 50% renal function lost.

A nurse is caring for a client who is being hospitalized for dehydration. The nurse checks the client's lab results and notes that the BUN is 20 mg/dL and the creatinine level is 0.5 mg/dL. What is the BUN-creatinine ratio? A. 20:01 B. 40:01 C. 60:01 D. 10:01

B. Rationale: 40:01" is correct. The BUN and creatinine are tests of kidney function that measure by-products that should normally be excreted by the kidneys. When their levels are high, it can indicate that the kidneys are not working properly. The BUN and creatinine may be expressed as a ratio to indicate if they are rising in proportion to each other. To calculate the BUN-creatinine ratio, the nurse divides the creatinine by the BUN. In this case, 20 divided by 0.5 is equal to 40, which means the ratio is 40:1.

The nurse is admitting a client with a history of chronic kidney disease. Which of the following lab values would you NOT expect to see? A. BUN 42 mg/dL B. BUN 7 mg/dL C. Creatinine 2.1 mg/dL D. K 6.1 mEq/L

B. Rationale: A client with kidney problems will have an increased BUN rather than a low-to-normal BUN.

The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding? A. Woman with a blood pressure of 158/90 mm Hg B. Client with Kussmaul respirations C. Man with skin itching from head to toe D. Client with halitosis and stomatitis

B. Rationale: Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs. Hypertension is common in most clients with CKD, and skin itching increases with calcium-phosphate imbalances, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.

A nurse is caring for a patient who is in end-stage renal disease and requires dialysis. Choose which alternative best describes the type of diet the nurse should recommend for this patient. A. A diet low in protein B. A diet high in protein C. A diet low in carbohydrates D. A diet high in salt

B. Rationale: Many patients with kidney disease require low-protein diets because of the effects of protein on the kidneys. HOWEVER, when a patient is in end-stage renal disease and requires dialysis, a low-protein diet may not be necessary. In fact, the patient may more likely require a high-protein diet at this stage because of the loss of nutrients from dialysis.

A nurse gave a diabetic client insulin with breakfast but the client did not eat any food. Two hours later, the client appeared diaphoretic and had slurred speech. The client became unconscious, so the nurse checked his blood sugar. The blood sugar was 15. Which of the following at is the next step that the nurse should take? A. Recheck blood sugar B. Administer IV glucagon C. Administer glucose tablets D. Give the client orange juice

B. Rationale: The nurse should administer IV glucagon to the unconscious client to bring up the blood sugar. Since the client is unconscious, the client will not be able to drink juice and since the client is symptomatic we need to treat immediately prior to rechecking.

A client with altered mental status and fruity breath has been brought into the emergency department. Which of the following is the priority for the nurse to monitor? A. Hypervolemia B. Hypovolemia C. Hyperglycemia D. Hypoglycemia

B. Rationale: This client is in diabetic ketoacidosis (DKA). The main concern once the client is in DKA is the rapid rate at which they losing fluid. They will develop electrolyte imbalances and acute kidney injury.

The nurse is caring for a client with poorly managed diabetes mellitus. The nurse is planning education for this client. Which statement by the client indicates a need for more education? A. "As long as I inspect my feet for cuts or wounds daily, I shouldn't have to worry about getting a foot infection" B. "As long as I administer insulin and maintain a normal glucose, I can eat whatever I want" C. "I should check my glucose about six to seven times a day to get my HbA1C down" D. "If I skip a couple meals, my glucose may go up"

B. Rationale: This statement is not true, and indicates a need for more education. The client needs to eat a balanced diet along with insulin use to achieve stable glucose control.

A nurse is educating a newly diagnosed diabetic client about what to do when they are sick. Which of the following statements by the client demonstrates that further education is necessary? A. "I'll make sure to keep taking my Metformin, even though I'm sick." B. "I'll double my insulin dosages while sick." C. "I'll make sure to test my urine for ketones." E. "I'll try to drink a glass of water every hour if possible."

B. Rationale: When sick, a client with diabetes may experience higher blood sugars, but insulin dosages should continue to be based on the actual blood sugar level and food intake. Clients should not simply double their insulin levels, this would not be appropriate.

A nurse receives a client that came by ambulance. The nurse suspects that this client is in diabetic ketoacidosis (DKA). Which of the following signs would suggest DKA? A. Strawberry red tongue B. Anuria C. Fruity breath D. Halitosis

C. Rationale: "Fruity breath" is correct. Clients in DKA often have fruity odor on their breath, which is caused by excess ketones in the body.

A 56-year-old client is suffering from interstitial nephritis and is seen in the hospital for care. The client's creatinine levels are elevated and the client has poor skin turgor and dry mucous membranes upon exam. The nurse ensures that the client does not receive any nephrotoxic medications that would worsen the condition. Which medication should be avoided? A. Amantadine B. Combivir C. Gentamicin D. Abilify

C. Rationale: "Gentamicin" is correct. Nephrotoxic medications are those that can cause damage to the kidneys. When a client is at risk, nephrotoxic drugs could cause such damage that a client goes into a state of acute renal failure. Categories of nephrotoxic medications include aminoglycoside antibiotics (gentamicin is in this category), antineoplastics, and nonsteroidal antiinflammatory drugs.

The nurse is caring for a client in end stage renal disease. The client has an internal arteriovenous fistula for dialysis. Which of the following interventions are appropriate in caring for the client with an AV fistula? Select all that apply. A. Monitor client for neurological changes B. Avoid checking blood pressure on the extremity with the fistula C. Monitor for signs of blood clotting D. Palpate the fistula to ensure patency E. Assess for prolonged Q-T intervals on the ECG

B. , C. , D. Rationale: "Palpate the fistula to ensure patency", "Avoid checking blood pressure on the extremity with the fistula" and "Monitor for signs of blood clotting" are correct. An internal arteriovenous (AV) fistula is created by surgically joining an artery and a vein in the arm. This is permanent access for the client with chronic kidney disease. Care for the client with an AV fistula includes preventing and monitoring for complications. "Feel the thrill and hear the bruit" is important to assess for fistula patency. Teach the client to notify all health care personnel of the presence of a fistula, because the affected extremity should not be used for blood pressure checks, IV lines, blood draws or injections. The client should be monitored for signs of clotting, infection, heart failure and arterial steal syndrome. Heart failure can occur if too much arterial blood is shunted into the venous system. Arterial steal syndrome can occur if not enough arterial blood reaches the hand due to shunting into the venous system, compromising circulation to the hand.

A patient with end-stage renal disease is to begin peritoneal dialysis (PD), and the nurse is creating a plan of care to lower the risk of complications that could arise. Which of the following interventions would assist in minimizing complications associated with PD? Select all that apply. A. Assess potassium levels daily B. Monitor for signs of cloudy dialysis outflow C. Maintain aseptic technique when changing the implanted port dressing D. Maintain sterile technique when caring for the catheter insertion site E. Obtain a sample for culture if peritonitis is suspected

B. , D. , E. Rationale: -"Maintain sterile technique when caring for the catheter insertion site", "Monitor for signs of cloudy dialysis outflow" and "Obtain a sample for culture if peritonitis is suspected" are correct. A patient with peritoneal dialysis is at higher risk of infection because of the decreased immunity that comes with renal failure, and because dialysis techniques - taking body fluid out of the body and returning it to the body - increase the risk of contamination. Sterile technique is important for the nurse to maintain during care of the insertion site, dressing changes and connecting and disconnecting the tubing. If the outflow of fluid becomes cloudy, this indicates infection. A sample of the fluid for culture and sensitivity is going to help determine the infective organism so that treatment can begin quickly.

A 28-year-old female client has been diagnosed with type 2 diabetes. The nurse is talking with the client about diet, such as what foods to include and what foods to avoid. Which statement made by the client indicates that more teaching is needed? A. I shouldn't drink more than one alcoholic beverage each day B. I should try to eat carbohydrates that come from whole grains and fruits C. I should increase my fiber intake to at least 45 grams each day D. I can't go on a high-protein diet to lose weight. I need some carbs in my diet

C. Rationale: Dietary instruction is very important when working with diabetic clients. Often, a diabetic client has a lot of information to learn, and the nurse can have the client teach back information to assess learning. The nurse should teach the client to increase fiber intake to 25 to 35 grams per day to regulate the gastrointestinal system. 45 grams per day is too much fiber intake. This can cause gastrointestinal difficulties such as bloating and gas, so the client who is not used to consuming large amounts of fiber should increase their intake slowly.

A nurse is working with a client is brought in the emergency department with abdominal pain and dehydration. His glucose level is 388 mg/dL and he has positive serum ketones. Based on theses symptoms and lab values, which action would the nurse expect to perform first? A. Provide breathing support with bag-mask ventilation B. Establish central line access C. Administer IV regular insulin at 0.1 unit/kg bolus D. Administer 0.25% NaCl at a rate of 200 mL/hr

C. Rationale: "Administer IV regular insulin at 0.1 unit/kg bolus" is correct. This client is experiencing diabetic ketoacidosis (DKA), which is a life-threatening complication of diabetes that can cause severe hyperglycemia. The client may have blood glucose levels above 300 mg/dL and rapid breakdown of fat for energy. In this situation, the nurse should administer isotonic fluids to maintain hydration and give a bolus of insulin to bring down the blood glucose levels.

A nurse is working with a client brought to the emergency department in a comatose state after developing hyperosmolar hyperglycemic syndrome (HHS). The nurse ensures the client's airway is patent and vital signs are stable. What is the nurse's next priority in this situation? A. Administering insulin IM B. Monitoring serum chloride levels C. Providing isotonic fluid replacement D. Maintaining the client's cervical spine

C. Rationale: "Providing isotonic fluid replacement" is correct. In this situation, the treatment goals are to vigorously rehydrate, correct the hyperglycemia, treat the underlying cause and monitor cardiac, renal, CNS and pulmonary status. The nurse should first provide fluid replacement by administering isotonic IV fluids such as normal saline or lactated Ringer's solution. This increases intravascular volume and dilutes the blood when glucose levels are high. Most clients respond to IV fluid replacement only, but the nurse may also administer insulin as ordered. Insulin would be given IV, not IM. Other measures include monitoring oxygen saturations and checking glucose and electrolyte levels such as potassium and sodium.

A provider has ordered a serum creatinine test for a client who is being assessed for chronic kidney disease. The client asks the nurse about the test. Which of the following responses correctly explains serum creatinine? A. The provider ordered this test to check for an infection B. This will tell us if your kidneys are damaged and you will need dialysis C. We are testing to see if your kidneys are able to excrete waste through your urine D. This test tells us if you are releasing excess sugar in your urine

C. Rationale: "We are testing to see if your kidneys are able to excrete waste through your urine" is correct. A creatinine test is a test of kidney function that measures the amount of creatinine in the bloodstream. Creatinine is a waste product of creatine, which is produced by the muscles for energy. Creatinine is removed from the body by the kidneys, and increased levels indicate that the kidneys are not able to excrete normal amounts of creatinine from the body. An increased serum creatinine is not seen until there is at least 50% renal function lost.

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

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

The nurse is caring for a client in diabetic ketoacidosis (DKA). What is the treatment priority for this client? A. Fluid replacement B. Decrease the blood glucose C. Correct acidosis D. Monitor cardiac rhythm

C. Rationale: Since the body has no insulin in type 1 diabetes, the client can have an acute episode of DKA. Glucose cannot get into the cells, so the body breaks down fatty acids for energy. This leaves ketones as a waste product, which makes the blood acidic. The goal of treatment in diabetic ketoacidosis is to correct underlying acidosis caused by the breakdown of fatty acids. Insulin therapy is used.

A nurse is assigned 4 clients and receives report. The nurse knows to monitor which of the following clients for hypoglycemia? A. A diabetic that took a normal dose of insulin with lunch prior to being admitted B. Client who took metformin with lunch C. A diabetic that drank a fifth of vodka before being admitted D. Client that did not eat much food, and did not take insulin

C. Rationale: The nurse should keep a close eye on the client's blood sugars because the client drank alcohol before being admitted. Alcohol can inhibit gluconeogenesis, lowering blood sugar levels.

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? A. Palpating the access site for a bruit or thrill B. Using the right arm for a blood pressure reading C. Administering intravenous fluids through the AV fistula D. Checking distal pulses in the left arm

C. Rationale: The nurse should not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The AV fistula should be monitored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment.

The nurse is caring for a client with an acute kidney injury. Which of the following dietary recommendations is inappropriate? A. Limit intake of whole grains B. Limit processed or canned foods C. Increase foods high in potassium D. Increase fresh vegetables and fruit

C. Rationale: This is an inappropriate dietary recommendation for a client with acute kidney injury, because the kidneys are not able to excrete potassium as well as normal. If the client increases these foods, he or she could get hyperkalemia.

A nurse is teaching a community class about diabetes prevention and maintenance. The nurse is reviewing the differences between type 1 and type 2 diabetes. Which information would be included in this segment of the teaching? A. Type 1 diabetes always starts in childhood, while type 2 diabetes is diagnosed in adulthood B. Type 1 diabetes is related to body size and weight management, while type 2 diabetes may affect anyone C. Type 1 diabetes usually has abrupt onset of symptoms, while the symptoms of type 2 diabetes may be subtle D. Type 1 diabetes is much more common than type 2 diabetes

C. Rationale: Types 1 and 2 diabetes have similarities and differences, which should be reviewed when teaching clients about this chronic disease. When providing information, the nurse should teach clients that type 1 diabetes causes an abrupt onset of symptoms, while type 2 is more subtle. Some people with type 2 diabetes are not even aware that they have the disease.

A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema? A. Maintaining oxygen saturation of 89% B. Minimal crackles and wheezes in lung sounds C. Maintaining a balanced intake and output D. Limited shortness of breath upon exertion

C. Rationale: With an optimal fluid balance, the client will be more able to eject blood from the left ventricle without increased pressure in the left ventricle and pulmonary vessels. Other ideal goals are oxygen saturations greater than 92%, no auscultated crackles or wheezes, and no demonstrated shortness of breath.

A client with severe, uncontrolled hypertension is being evaluated for chronic kidney disease. The provider checks the glomerular filtration rate and determines that it is 22 mL/min. Which stage of chronic kidney disease does this GFR place the client? A. Stage II B. Stage III C. Stage IV D. Stage I

C. Rationale: "Stage IV" is correct. The glomerular filtration rate (GFR) is a measure of kidney function that determines how well the kidney is able to filter waste products. A normal GFR is approximately 125 mL/minute. A client who has a GFR of 22 mL/min would be categorized as having severe kidney disease and would be classified at stage IV. Stage I GFR is >90 mL/minute. Stage II GFR is 60-89 mL/min. Stage III 30-59 mL/min. Stage IV 15-29 mL/min. Stage V <15 mL/min.

A nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which pH level would be consistent with this diagnosis? A. 7.41 B. 7.35 C. 7.52 D. 7.31

D. Rationale: Normal pH range is 7.35 to 7.45. Acidosis exists with pH levels under 7.35.

A nurse is caring for a client that has just been diagnosed with Type II Diabetes. Which of the following would NOT be an appropriate education topic regarding foot care for this newly diagnosed client? A. Separate overlapping toes B. Dry feet entirely after bathing C. Inspect feet on a daily basis D. Wear open-toed shoes

D. Rationale: Open-toed shoes should actually be discouraged, as they increase the likelihood of injury. Due to the diabetes, they will have an increased healing time and greater difficulty with wound healing, therefore it's essential to prevent injury as much as possible.

A client is admitted for dehydration and on assessment complains of dizziness. The nurse takes the client's vitals which are the following: BP 163/86 HR 88 Temperature 100.1 Respirations 18 Blood sugar 43 The nurse knows that which of the following orders should be implemented first? A. Give acetaminophen 650 mg PO for fever B. Administer normal saline IV fluid at 100/hr C. Give hydralazine 20 mg IV for high blood pressure with systolic greater than 160 D. Give the client a glucose tablet for blood sugar below 70

D. Rationale: The priority in this situation is the client's low blood sugar level, therefore the nurse should administer the glucose tablet first. This client is symptomatic. Although the IV fluids will be needed to treat the dehydration, the nurse should first address the low blood sugar since the client is symptomatic.

A nurse in the Intensive Care Unit (ICU) is caring for a client with diabetic ketoacidosis (DKA). Which of the following is NOT a priority nursing intervention for this patient? A. Monitor serum potassium levels and replace as needed B. Monitor blood glucose at least hourly C. Administer IV regular insulin D. Administer hypertonic saline for fluid resuscitation

D. Rationale: While fluid resuscitation is a cornerstone of DKA treatment, they are treated with isotonic fluid replacement rather than hypertonic. The primary fluid choice would be normal saline or D5 1/2NS once the sugar comes down a bit.