Med surge exam 3

potential complications for UTI:

-bacteremia -urosepsis -phylonephritis

treatment for DVT:

-immobilize the area -anticoagulants -surgical: embolectomy (removal of the clot) -inferior vena cava filter: filter to keep clots from going to the lungs

the blood transfusion prescribes for a client has completed infusing. what action should the nurse take next? a. flush the line w/ heparin b. flush the line w/ normal saline c. dispose of the tubing in biohazard d. send the blood bag to the lab

b. flush the line w/ normal saline

which topic would the nurse include when doing discharge teaching about ways to avoid another venous thrombosis when caring for a client hospitalized with DVT? a. daily aspirin use b. frequent ambulation c. warm soaks leg d. avoidance of cold

b. frequent ambulation

the UAP reports to the nurse the clients urine output has bright red blood. which intervention should the nurse implement first? a. assess the clients urine and complete a renal assessment b. ask the UAP to take the clients vitals c. instruct the UAP to take a urine specimen to the lab d. document the findings in the clients nursing notes

a. assess the clients urine and complete a renal assessment

which information would the nurse include in the home care instructions for a client being discharge post-lithotripsy for renal calculi? a. do not take any meds after this treatment b. increase you intake of dairy products for 5 days c. drink at least 3L of fluid per day for 4 wks d. call us back immediately if you notice blood in your urine

c. drink at least 3L of fluid per day for 4 wks

which results indicates that albumin therapy is effective? a. improved clotting of blood b. formation of RBC c. effective cardiac output d. activation of WBC

c. effective cardiac output

which information about BPH is important for the nurse to consider when caring for a client with that condition? a. it is a congenital abnormality b. a malignancy usually results c. it predisposes to hydronephrosis d. PSA decreases

c. it predisposes to hydronephrosis

which cause f tremors, pallor, and diaphoresis would be suspected in a client with type I DM? a. overeating b. viral infection c. aerobic exercise d. missed insulin dose

c. aerobic exercise

what is the peak for detemir insulin?

3-14 hrs

labs for PE:

D-dimer

pulmonary embolism pathophysiology:

DVT dislodges traveling through venous system where it lodges in pulmonary arteries -blood flow and perfusion is impeded

what insulin is intermediate?

NPH

which abnormal finding would the nurse monitor for during the oliguric phase of AKI? a. hypothermia b. hyperkalemia c. hypocalcemia d. hypernatremia

b. hyperkalemia

a nurse is preparing a client with suspected BPH for a prostate examination. the nurse should be sure to inform him that which of the following may occur as the prostate is palpated? a. decreased consciousness b. slight bleeding c. significant pain d. urge to urinate

d. urge to urinate

CKD fluid balance:

early CKD: no change s late CKD: s/s FVO -would give diuretics, anti-hypertensives, restrict fluid and sodium

true or false: platelet infusions need to be compatability matched

false

which insulin is long-acting?

glargine and detemir

in late CKD what will be the GFR level?

less than 30

diabetic retinopathy assessment findings:

poor vision

clinical manifestations of early CKD:

potential increase in BP, decrease in Na

what insulin is short acting?

regular (humulin R or Novolin R)

assessment findings for diabetic nephropathy:

s/s kidney failure

Macrovascular DM complications:

stroke, heart attack, PVD

transfusion reaction: allergic reaction

-mild: urticaria (hives), itching -severe: bronchospasms, anaphylaxis

nursing interventions for early CKD:

-monitor and trend vitals -monitor and trend labs -educate on diet: avoid excess protein -heart healthy diet -administer and educate on meds

dx testing for UTI:

-pelvic ultrasound -cystoscopy -pyelogram/pyelography -retrograde (to see if urine is going out in an abnormal pattern)

Causes of Vit B12 deficiency anemia:

-pernicious anemia -diet low in B12- vegans -bariatric surgery -chrons disease chronic diarrhea

nursing interventions for diabetic retinopathy:

-safety -annual eye exams -HTN management

the nurse is preparing meds for a pt with DM. which of the following vials will the RN use to prepare the order for a rapid-acting insulin? a. aspart b. NPH c. glargine d. regular (humulin)

a. aspart

the nurse is reviewing lab values. which lab indicates the need for a blood transfusion? a. hemoglobin 7 b. hematocrit 35% c. hematocrit 29% d. hemoglobin 10

a. hemoglobin 7

which complication of diabetes would the nurse assess for in a client w/ long hx of disease? select all a. leg ulcers b. loss of visual acuity c. increased creatinine clearance d. prolonged cap refill e. decreased sensation in lower extremities

a. leg ulcers b. loss of visual acuity d. prolonged cap refill e. decreased sensation in lower extremities

the nurse is teaching a client w/DM about proper foot care and should provide the client with which instructions? a. cute the toenails with a rounded approach b. use a harsh soap to cleanse the feet to remove dead skin c. check the feet daily for skin problems d. soak the feet in got water after showering

c. check the feet daily for skin problems

the nurse is caring for a client with early CKD. which lab values does the nurse anticipate? select all a. decreased calcium b. elevated potassium c. decreased sodium d. increased phosphorus e. elevated creatinine

c. decreased sodium

what subjective statement made by the client would concern the nurse most for anemia? a. my hands have been very hot recently b. my personal trainer says i need to start weight training c. my eyes are very dry d. i always feel tired, but thats pretty much normal for me

d. i always feel tired, but thats pretty much normal for me

which assessment is necessary for the nurse to complete in a client with CKD receiving loop diuretics? a. hemoglobin levels b. occurrence of nausea c. presence of constipation d. intake and output measurement

d. intake and output measurement

a 15yr old adolescent is found to have type I DM. which would the nurse include when teaching the adolescent about type I DM? a. it does not always require insulin b. it involves early vascular change s c. it occurs more often in obese adolescents d. it has a more rapid onset than does type II

d. it has a more rapid onset than does type II

several minutes after the start of a RBC infusion, the client reports itching. the nurse observes hives on the clients chest. which action would the nurse take? a. administer an antihistamine b. flush the RBC w/ 5% dextrose c. slow the rate of infusion d. stop the infusion

d. stop the infusion

uncomplicated UTI:

no functional abnormality of the urinary tract

iron deficiency anemia pathophysiology:

not enough iron in the diet and stores to keep up with the demands or RBC -challenge in GI absorption

treatment of peripheral neuropathy:

pain meds (gabapentin and pregabalin)

assessment findings for peripheral neuropathy:

-loss of feeling, burning, shooting, numbing

nursing interventions in diuresis phase of AKI:

-monitor I &O -assist in fluid balance -daily weights -urine characterisitics -monitor and trend labs -monitor diet (encourage foods high in K) -telemetry: if electrolyte imbalance

s/s of febrile blood transfusion reaction

-high temp (during transfusion) -hypotension -tachycardia -tachypnea -pyrexia -chills stop transfusion and initiate rapid response -prepare to admin antipyretics and antibiotics

desired outcomes for PE:

-increased activity tolerance -no chest pain -pulse ox within normal limits -vitals at baseline -no further sings PE/DVT -client understands education of sings of DVT

diabetes sick day rules:

-monitor BG at least q4 hrs -test urine for ketones when BG is greater than 240 -drink 8-12 oz sugar free liquids q1 hr -continue to eat meals at regular times -call HCP is these occur: persistent N/V, moderate/large amount of ketones, elevation of BG after 2 supplemental doses of insulin, high temp

labs in the recovery phase of an AKI:

-stabilization of normal kidney function -GFR returns to normal -normal electrolytes -normal urinalysis

nursing actions for blood transfusion allergic reaction:

-stop transfusion -blood and tubing needs to be sent back to the lab -call rapid response -give benadryl (diphenhydramine)

the nurse us admitting a client with newly diagnosed DM. assessment reveals lower BP, increased RR and depth, drowsiness, and confusion. the client report HA and nausea. ABG: pH 7.29, HCO3 14, PcCO2 14. interpret the clients acid base: a. respiratory alkalosis b. metabolic acidosis c. respiratory acidosis d. metabolic alkalosis

b. metabolic acidosis

the nurse provides care for a client diagnosed with pre-renal AKI. which action will the nurse preform first? a. monitor the clients daily weights b. assess for hx of prostate enlargement c. insert an indwelling catheter d. assess the clients blood pressure

d. assess the clients blood pressure

which factor may contribute to a client developing urinary calculi? a. increased fluid intake b. urine specific gravity 1.017 c. jogging 3 miles a day d. hx of hyperparathyroidsim

d. hx of hyperparathyroidsim

labs to monitor for CKD:

urinanlysis: proteinuria BMP: -GFR: low -creatinine: high -BUN: high -electrolytes: decrease Na (early); increase K, Mg, P, and Na (late) -H&H (in late)

lab tests for UTI:

urine culture: -most often E.coli ->100,000 usually not treated; symptoms are the deciding factor of whether or not they are treated urinanlysis: -pH -CASTS -nitrates: byproduct of bacteria living in the baldder

whats the onset for rapid acting insulin?

within 15 minutes

dx testing for urolithiasis:

-KUB -renal ultrasound -pyelogram

labs for BPH:

-PSA -WBC and urinalysis for UTI cuz they are at risk for urinary retention

Microvacular DM complications:

-diabetic neuropathy -peripheral neuropathy -autonomic neuropathy -diabetic nephropathy

treatment of macrovascular complication:

-oral antiglycemics/ insulin -anitlipidemics -antihypertensives -lifestyle mods

treatment of PE:

-oxygen -anticoagulants -embolectomy -IVC filter

causes of folic acid anemia:

-pregnancy -lack of folic acid in the diet -malnutrition -oral contraceptives

DVT risk factors:

-prolonged immobility -central line cath -surgery -pregnancy -obesity -increased age -hx of VTE -trauma

pt education for diabetes:

-s/s hyp/hyperglycemia -foot care -proper procedure on BG testing/monitoring -medication that increase risk for hyperglycemia -s/s all complications -med adherence and admin education -site rotation and s/s cellulitis -before and after exercise BG monitoring -periods of illness and s/s to report to HCP -diet education

nursing interventions for autonomic neuropathy:

-skin care, peri care -provide support -prevent skin breakdown

what is the duration of rapid acting insulin?

3-4 hrs

electrolyte balance in CKD:

K: increase if oliguria Na: low Mg: increase Ca: late stage decrease P: increase

which complications would the nurse monitor a client hospitalized with end-stage kidney disease? select all a. anemia b. dyspnea c. jaundice d. hyperexcitability e. hypophosphatemia

a. anemia b. dyspnea

which information should the nurse include when developing a teaching plan for a client with newly diagnosed type II DM? select all a. annual eye examinations are recommended b. supplemental insulin is mandatory for controlling the disease c. exercise increased insulin resistance d. the primary nutritional source requiring monitoring in the diet is carbohydrates e. a major risk factor for complications is obesity and central abdominal obesity

a. annual eye examinations are recommended e. a major risk factor for complications is obesity and central abdominal obesity

which clients would the nurse identify as being at risk for anemia? a. client who appears cachectic and fatigued b. client who has a GI absorption disorder c. client who has osteoarthritis d. client w/ a gunshot wound who lost 3L of blood e. a client who recently underwent bariatric surgery

a. client who appears cachectic and fatigued b. client who has a GI absorption disorder d. client w/ a gunshot wound who lost 3L of blood e. a client who recently underwent bariatric surgery

the provider has just entered in orders for lab assessments to rule out BPH. which of these assessments are a priority to rule out this condition? select all a. creatinine and BUN b. urinalysis and urine culture c. CBC. d. CMP e. PSA

a. creatinine and BUN b. urinalysis and urine culture c. CBC. e. PSA

a client is taking an estrogen-progestin oral contraceptive. which adverse side effects from the contraceptive would the nurse teach the client to report to the HCP? a. normal d-dimer b. calf tenderness c. nausea d. clear LS

b. calf tenderness

which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia? a. uremic frost b. chronic fatigue c. tubular necrosis d. dependent edema

b. chronic fatigue

the nurse should teach the diabetic client that which symptom is most indicative of hypoglycemia? a. anorexia b. bradycardia c. nervousness d. kussmauls respirations

c. nervousness

which finding would the nurse expect when assessing a client who has a ureteral calculus? a. foul odor and dark urine b. urgency and mild aching c. frequency w/ small amounts of urine d. hematuria w/ sharp pain when voiding

d. hematuria w/ sharp pain when voiding

folic acid anemia pathophysiology:

helps in production of RBC, needed to split RBCs into two, and for replication of RBC; all of this is diminished with this anemia

cystitis:

inflammation of the bladder which can lead to a UTI

treatment of urolithiasis with stone less than 5cm:

medically managed with tamulosin or oxybutynin

nursing interventions for initial AKI:

monitor creatinine and urine output

how often does blood typing and Rh status need to be checked?

new type and screen every 2-3 days because the supply in the blood bank may change

complicated UTI:

something complicating infection could be anatomy, disease process, neurogenic bladder, pregnancy, or an autoimmune disorder

labs for urolithiasis:

urinalysis -+ blood -pH to help determine what kind of stone -r/o infection analization of stone that has been passed -kidney function only if decrease in urine output

s/s AKI in diuresis phase:

-3-6 L/24 hr -dilute urine -at risk for dehydration

prevention of a DVT:

-ambulation -amboletic stockings -enoxaparin/ subcut heparin -ankle/ foot pumps -adequate hydration

active PE nursing actions:

-assist with positioning pt upright -bleeding precautions d/t anticoagulant therapy

clinical manifestations of BPH:

-hesitancy -weak/ dribbling stream -post void dribbling -multiple unintended interruptions during urination -incomplete bladder emptying -nocturia -bladder outlet obstruction

potential complication of CKD:

-hyperkalemia -FVO -renal osteodystrophy

nursing interventions late CKD:

-monitor vitals: there will be an increase in BP -labs -monitor I&O -daily weights -educate on diet restrictions: fluid, protein, k, Na, P, and food high in Ca -educate on meds -care pre/post dialysis -psychosocial consideration

treatment for UTI:

-notrofuratin -flucanozole: for yeast -surgical: bladder prolapse

clinical manifestations of a UTI:

-urgency -hesitancy -frequency -dysuria -hematuria -pyuria -urine consistency changes: could be cloudy -malodorous urine -incontinence -mental stat changes: in older adults

how long is the oliguria stage of an AKI?

1-7 days

what is the duration of intermediate insulin?

10-16 hrs

which finding in a client with right calf venous thrombosis is most important to communicate to the HCP? a. O2 sat 89% b. right calf redness and swelling c. heart rate 136 d. severe right calf pain

a. O2 sat 89%

for which pt is the nurse most concerned about the risk of developing kidney disease? a. a 62 yr old pt with type II diabetes b. a 25 yr old pt who developed a UTI during pregnancy c. a 79 yr old pt with stress urinary incontinence d. a 55 yr old pt who has hx of kidney stones

a. a 62 yr old pt with type II diabetes

the nurse is caring for a pt with late stage CKD. which hormones does the nurse recognize the kidneys will not produce in needed amounts? a. activated vit D b. erythropoietin c. prostaglandins d. renin e. bradykinins

a. activated vit D b. erythropoietin c. prostaglandins d. renin e. bradykinins

which finding would the nurse expect when assessing the nasal passages of a client with thrombocytopenia? a. blood clots b. nasal polyps c. purulent discharge d. pale, swollen turbinates

a. blood clots

which psychological changes would the nurse expect to find in a client with a 20yr hx of type II DM? a. blurry, spotty, or hazy vision b. arthritic changes in the hands c. hyperactive knee and ankle jerk reflexes d. dependent pallor of the feet and lower legs

a. blurry, spotty, or hazy vision

a client with an AKI states, "why am I experiencing twitching and tingling of my fingers and toes?" which process would the nurse consider when formulating a response to this client? a. calcium depletion b. polyuria c. azotemia d. potassium excess

a. calcium depletion

the nurse is educating a client on the macrovascular complications associated with DM. which conditions should the nurse include? select all a. cardiovascular dz b. cerebrovascualr accident c. peripheral vascular dz d. diabetic retinopathy e. autonomin neuropathy

a. cardiovascular dz b. cerebrovascualr accident c. peripheral vascular dz

which action would the nurse take NEXT when a 78 yr old client comes to the health clinic presenting w/ fatigue, and lab results indicate a hematocrit of 32% and hemoglobin of 10.5? a. conduct a complete nutritional assessment of the client b. plan to teach the client about taken daily iron supplements c. schedule the client to return to have the test repeated in 3 months d. explain that mild anemia is an expected response to the aging process

a. conduct a complete nutritional assessment of the client

after reviewing the lab results of a group of clients, a nurse suspects a client to have kidney disease. which client findings support the nurses suspicion? a. creatinine 2.5 b. creatinine 1.1 c. BUN 18 d. BUN 30

a. creatinine 2.5

the nurse is formulating a teaching plan for a client recently diagnosed w/ type II DM. which interventions would the nurse include to decrease the risk of complications? select all a. examine the feet daily b. wear well fitting shoes c. preform regular exercise d. powder the feet after showering e. visit the primary HCP weekly d. test the bathwater with the toes before bathing

a. examine the feet daily b. wear well fitting shoes c. preform regular exercise

the RN is supervising a senior nursing student in discussing methods for preventing AKI. which points would the RN be sure to include in this discussion? select all a. monitor lab values that reflect kidney function b. never take any medication that is nephrotoxic c. immediately report a urine output of less than 30 mL/hr d. encourage pts to avoid dehydration by drinking adequate fluids e. instruct the pt to drink extra fluids during periods of strenuous exercise

a. monitor lab values that reflect kidney function c. immediately report a urine output of less than 30 mL/hr d. encourage pts to avoid dehydration by drinking adequate fluids e. instruct the pt to drink extra fluids during periods of strenuous exercise

the nurse is providing instructions about foot care for a client w/ DM. which would the nurse include in the instructions? select all a. wear should when out of bed b. soak the feet in warm water daily c. dry between the toes after bathing d. remove corns as soon as they appear e. use a heating pad when the feet feel cold

a. wear should when out of bed c. dry between the toes after bathing

anemia caused by blood loss:

acute: trauma chronic: -menorrhagia: heavy menstrual periods -GI bleed -hemorrhoids

an adult w/ type 2 DM has been NPO since 2200 in preparation for having a nephrectomy the next day. at 0600 on the day of surgery, the nurse reviews the clients medical record and lab results. which finding should the nurse report to the HCP? a. urine specific gravity 1.015 b, BG 140 c. urine output of 350 mL/hr d. potassium of 4

b, BG 140

which assessment finding would warrant immediate intervention by the nurse? a. the client who has an open cholecytectomy who states pain when coughing and breathing deeply b. the client diagnosed with DVT who complains of pain on inspiration c. the immobile client who has refused to turn for the last 3 hrs d. the client who has an inguinal hernia repair who must void before discharge

b. the client diagnosed with DVT who complains of pain on inspiration

when caring for a client with a possible PE, the nurse will anticipate the client for which test? a. thoracic ultrasound b. chest x-ray c. CT d. MRI

c. CT

which diagnostic study is used to detect DVT in the clients extremities? a. thermography b. plethysmography c. duplex venous doppler d. somatosensory evoked potential

c. duplex venous doppler

the lab values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine. which type of stone composition is consistent with these lab values? a. cholinergic b. probiotic c. urine acid d. calcium acetate

c. urine acid

DVT pathophysiology:

collection of elements of blood that form where there is stasis, hypercoaguability, or vessel wall injury

which condition would the nurse suspect in a pt who complains of nocturia, bladder pain, urinary frequency, urgency, and dribbling w/ a digital rectal examination indicating smooth, firm, and enlarged prostate tissue surrounding the urethra? a. prostatitis b. paraphimosis c. prostate cancer d. BPH

d. BPH

a client w/ which diagnosis will be at risk for development of PE? a. migraine headache b. respiratory infection c. forehead laceration d. atrial fibrillation

d. atrial fibrillation

treatment of diabetic retinopathy:

glasses/ contacts

what is the peak for glargine insulin?

no peak

TURP aftercare:

-continuous bladder irrigation 1-2 days after -3 way catheter -tirate clamp until we see a pink tinged urine -drain bag sits in bath basin on the floor -q 10-30 min irrigation solution bag needs to be changed -empty drainage bag every time new irrigation bag is hung -risk for bleeding 1-2 days after -monitor and trend vitals: at risk for hypovolemia -trend H&H and RBC -genital and pain assessment -assist in calculating tue urine output

labs in the oliguric phase of AKI:

-creatinine increase by 0.3 or 1.5x baseline -increase BUN, decrease GFR -increase in K, Na, Mg, P, decrease in Ca -ABG- decrease pH and HCO3

which statement indicates the nurse has a correct understanding of kidney ultrasonography? a. kidney ultrasonography primarily makes use of iodinated contrast b. kidney ultrasonography is preformed on the client with an empty bladder c. kidney ultrasonography makes use of sound waves and has minimal risk d. kidney ultrasonography provides three dimensional information regarding the kidneys

c. kidney ultrasonography makes use of sound waves and has minimal risk

which action would the nurse take after reviewing laboratory results and noting that a client with AKI has a potassium level of 6.2? a. alert the cardiac arrest team b. call the lab to repeat the test c. notify HCP d. obtain an antiarrhythmic med

c. notify HCP

which substance is released in response to low serum levels of calcium? a. renin b. erythropoietin c. parathyroid hormone d. atrial natriuretic peptide

c. parathyroid hormone

which symptom is not a clinical manifestation for a client with anemia? a. headache b. cool hands and feet c. polyuria d. dyspnea on exertion

c. polyuria

which instruction would the nurse give to the client with renal calculi? select all a. have spinach soup every day b. drink plenty of water c. include high amount of protein in your diet d. have at least two servings of dairy with each meal e. collect all your urine in a jug for analysis, be sure to keep on ice

b. drink plenty of water

the nurse is educating the client with iron deficiency anemia on foods to add to her diet. which of the following should the nurse recommend? a. 1 cup whole milk b. leafy green vegetables c. 1 large apple d. 1/2 cup of peanuts

b. leafy green vegetables

a 60 yr old client w/ gastric cancer has a shiny tongue, paresthesias of the limbs and ataxia. the lab results show cobalamin levels of 125. which med would the nurse expect to be prescribed? a. oral hydroxyurea b. vit B12 injections c. oral iron supplements d. erthropoietin injections

b. vit B12 injections

why do we not give meds before hemodialysis?

because the med will be filtered out with the blood in the body

vitamin B12 deficiency anemia pathophysiology:

body is keeping the body from absorbing B12

pathophysiology type II diabetes:

body is resistant to insulin -can be at any age -usually slower onset -body lives in chronic hyperglycemic state -fatigue -headache -blurry vision -can see glucose in the urine

which indicates a potential complication of DM? a. stooped appearance b. inflamed painful joints c. blood pressure 160/100 d. hemoglobin of 9

c. blood pressure 160/100

which deficiency is an example of microcytic anemia? a. vitamin B12 deficiency anemia b. folic acid deficiency anemia c. iron deficiency anemia d. pernicious anemia

c. iron deficiency anemia

nursing interventions for hypoglycemic pt:

-give them sugary drink if they can swallow: stay with them and get BG in 15 min -monitor cognition and neuro -question rapid and short acting insulin

nursing interventions diabetic nephropathy:

-urinalysis for protein in the urine -DASH diet -avoid excess protein -avoid nephrotoxic meds -assess kidney function

why is a client who has kidney disease most at risk for developing anemia? a. difficulty producing enough erythropoieitin b. thirst mechanism is impaired c. cannot eat foods high in protein d. unable to take iron supplements

a. difficulty producing enough erythropoieitin

which instruction would the nurse include when providing medication teaching to a client prescribed trimethoprim-suldamethoxazole for cystitis? a. drink eight to ten glasses of water a day b. take this med with OJ c. take the med with meals d. tale the med until symptoms subside

a. drink eight to ten glasses of water a day

which clinical finding is commonly associated w/ hyperglycemia? select all a. polyuria b. polydipsia c. polyphagia d. polyphrasia e. polydysplasia

a. polyuria b. polydipsia c. polyphagia

which assessment finding in a hospitalized client with a hx of CKD would alert the nurse to suspect kidney insufficiency? a. facial flushing b. edema and pruritus c. dribbling after voiding d. diminished force of urination

b. edema and pruritus

a client has undergone a transurethral resection of the prostate (TURP) has arrived to the med surge unit. which of the following client symptoms is highest priority for the nurse to monitor? a. infection b. hemorrhage c. pain d. hypoactive bowel sounds

b. hemorrhage

the nurse is caring for a pt who returns to the unit post TURP with a 3-way indwelling catheter in. the pt states that has the urge to urinate and wants the catheter removed. which response by the nurse is the most appropriate? a. the spasm is an expected finding because the procedure does not invade the urethra b. this is an expected sensation but an indwelling catheter must remain in place c. the sensation is caused by the silicone used in the catheter. i will speak to the doctor about switching to a different catheter d. this must be a complication because the indwelling catheter is supposed to evacuate clots that cause the sensation you are describing

b. this is an expected sensation but an indwelling catheter must remain in place

the nurse is caring for a client diagnosed w/ DVT. which would be contraindicated? select all a. encouraging oral fluid intake b. vigorously washing the clients legs during bath time c. placing SCDs on the clients legs d. performing the homans sign e. administer warfarin as ordered

b. vigorously washing the clients legs during bath time c. placing SCDs on the clients legs d. performing the homans sign

when teaching the diabetic client about foot care, the nurse should instruct the client to: a. use heating pads for sore feet b. cute toenails at angles c. avoid going barefoot d. buy shoes half a size larger

c. avoid going barefoot

the nurse is educating a client with type I DM on measures to take when exercising. which statement by the client indicated a need for further education? a. i will not exercise if i feel shaky and clammy b, i will have a simple carb snack with me during exercise c. i will check my BG level prior to exercising d. i will give myself additional insulin prior to exercising

d. i will give myself additional insulin prior to exercising

the nurse is caring for a client in the oliguric phase of AKI. which assessment findings does the nurse anticipate? select all a. hypokalemia b. bradypnea c. creatinine 1.2 d. polyuria e. hypertension

e. hypertension

manifestations for iron deficiency anemia:

-chelitis: cracks in the skin on the side of the mouth -excessive fatigue

labs for DVT:

D-dimer -protein given off by body when its trying to break down a clot

a 56 yr old pt comes into the clinic complaining of restricted urinary flow. suspecting BPH, the nurse asks if the pt has had frequency and nocturia, which the pt immediately denies. what is the nurses priority concern at this time? a. the pt may develop a UTI or other kidney damage as a result of urinary retention b. the restricted urinary flow can cause build up of calcium crystals and allow kidney stones to form c. the pt may develop prostatitis due to holding the urine for too long d. the pts bladder may burst d/t holding an extreme volume of urine for an extended period of time

a. the pt may develop a UTI or other kidney damage as a result of urinary retention

the client received 15 units of Humulin insulin at 0730. the nurse should assess the client for symptoms of hypoglycemia at approximately what time? a. 0800 b. 1330 c. 1000 d. 2330

b. 1330

the nurse is reviewing the lab reports of 4 pts. which pt does the nurse identify with lab values consistent w/ polycythemia vera? a. 74 yr old male with hematocrit of 54% b. 43 yr old female hemoglobin 17.1 c. 63 yr old female w/ RBC 5.5 d. 25 yr old male w/ hemoglobin 17.3

b. 43 yr old female hemoglobin 17.1

on the 2nd day of surgery, a client reports pain in the right calf. what should the nurse do first? a. elevated the leg above the heart b. apply a warm soak c. document the symptom d. assess the extremities bilaterally

d. assess the extremities bilaterally

nursing actions for hyperglycemia:

-encourage fluids -monitor vitals -monitor BG -find out why they are hyperglycemic -wait 2 hrs after dose of insulin to give another

treatment of late CKD:

-erythropoietin: hemoglobin less than 10 -ferrous sulfate -fluid restriction -decrease diet in protein, Na, P -antihypertensives -increase diet in calcium

clinical manifestations for all anemia:

-fatigue -somnolence: sleepy -dyspnea w/ exertion -tachypnea -low O2 (in significant cases) -bruising -tachycardia -pallor -orthostatic hypotension -intolerance to cold -nails/ hair = brittle

treatment for BPH

-finastride and tamulosin -prostatectomy -TURP

post renal causes:

-BPH -nerve damage -urinary system cancer -urolithiasis

dx tests for PE:

-CT scan or CTA (pulmonary angiography) -requires contrast dye know shellfish allergy, iodine allergy, and creatinine -fluids after to flush out dye because its nephrotoxic

nursing interventions for macrovacular complications:

-change positions slowly -attend annual lipid labs -take BP at home -DASH diet

labs in the diuresis phase of AKI:

-decrease in creatinine, BUNm increase in GFR -decrease in K (Na, Mg, Ca, P)

desired outcomes for CKD:

-delayed progression -preserved kidney function

what is the ratio for units of blood to hemoglobin increase?

1 unit = 1 point increase in hemoglobin

which instruction would the nurse provide to the client who has been diagnosed w/ a urinary tract infection? a. void every 2 hrs b. record fluid intake and urinary output c. pour warm water over the vulva after voiding d. urinate after intercourse

d. urinate after intercourse

preventing CAUTI's:

-make sure clients have appropriate indication -parameters for removal -cath care minimum 2x a day -cath bag less than half full, lower than the bladder, clipped to the bed

a postpartum client is being treated with subcut enoxaparin for DVT of the left calf. which client cue is of most concern to the nurse? a. dyspnea b. pulse 62 beats/min c. BP 136/88 d. positive homan sign in left leg

a. dyspnea

which characteristics of O neg blood explains why people with this blood type are classified as "universal donors"? a. it does not have any of the antigens that can cause a reaction b. the donor can donate blood more frequently than other people c. more people have this blood type, so it is more universally available d. it is more frequently administered compared to other blood types

a. it does not have any of the antigens that can cause a reaction

which nursing intervention is necessary before a blood transfusion is administered? select all a. obtain the clients vital signs b. monitor H&H c. allow the blood to reach room temp d. determine typing and crossmatching of blood e. use a y-type infusion set to initiate 0.9 normal saline

a. obtain the clients vital signs d. determine typing and crossmatching of blood e. use a y-type infusion set to initiate 0.9 normal saline

which dx study is used to detect DVT in clients lower extremities? a. ECG b. transthroacic echocardiogram (TTE) c. duplex venous ultrasound d. arteriography

c. duplex venous ultrasound

the nurse is preparing to admin insulins. which insulins can be combined into one syringe to be administered in 1 injection? a. NPH and levemir b. aspart and lispro c. regular and NPH d. lispro and glargine

c. regular and NPH

risk factors for a UTI:

-obstruction -stones -reflux -diabetes -urine characteristics (the more alkaline the more likely it is for bacteria to grow) -sexual activity -recent antibiotic use -age: older adult clients more at risk -catheters

assessment findings for macrovascular complication:

-stroke: facial drooping, slurred speech -heart attack: chest pain -PVD: cool extremities, decrease hair growth on lower extremities etc. -HTN -hyperlipidemia

clinical manifestations for PE:

-sudden onset dyspnea -feeling of impending doom -sharp stabbing chest pain -cough -hemoptysis -tachypnea -tachycardia -increased BP

clinical manifestations of a DVT:

-unilateral pain, swelling, and discoloration - + homans sign (pain in calves when feet are dorsiflexed)

a client with type 1 DM has influenza. the nurse should instruct the client to: a. eat as able and increase oral fluids b. decrease the frequency of BG self-monitoring c. take half of the normal dose of insulin d. discontinue that dose of insulin if unable to eat

a. eat as able and increase oral fluids

which manifestations may indicate the client with type I diabetes has insulin induced hypoglycemia? select all a. excessive hunger b. weakness c. diaphoresis d. excessive thirst e. deep respirations

a. excessive hunger b. weakness c. diaphoresis

to reduce the risk of developing type II DM, the nurse should instruct the client to: a. maintain weight in normal limits b. prevent hypertension c. stop smoking cigarettes d. obtain a high cholesterol diet

a. maintain weight in normal limits

which post op care instructions would the nurse include when providing pre op teaching for a client scheduled for a TURP? a. the urine will be bright red for 24-48 hrs b. spasms of the bladder occur during the first 24-48 hrs c. to decrease bladder contractions the valsalva maneuver and kegel exercises will be encouraged d. to maintain proper fluid balance, oral fluids are restricted during continuous bladder irrigation

b. spasms of the bladder occur during the first 24-48 hrs

when a client in the emergency department has a BP of 90/60, weak radial pulse of 108 beats/min, and reports working outside for several hours on a hot day, which prescribed action would the nurse take first? a. complete a head to toe assessment b. start infusion of normal saline 500 mL c. ask the client about current medications d. obtain blood samples for lab testing

b. start infusion of normal saline 500 mL

which action would the nurse implement when providing care for a client with continuous bladder irrigation? a. monitor urinary specific gravity to determine hydration b. subtract irrigant from output to determine urine volume c. record urinary output every hr to determine kidney function d. obtain a 24 hr urine specimen to determine concentration

b. subtract irrigant from output to determine urine volume

a 60 yr old man with a recent diagnosis of BPH asks the nurse what precautions should take to manage his BPH. select all a. do not strain to defecate b. tell all future HCP about BPH diagnosis c. do not lift more than 15 ibs d/t possible bladder rupture d. avoid drinking large amounts of fluids in a short period of time e. avoid alcohol, diuretics, and caffeine

b. tell all future HCP about BPH diagnosis d. avoid drinking large amounts of fluids in a short period of time e. avoid alcohol, diuretics, and caffeine

a client with DM calls the clinic because they are experiencing nausea and flu-like symptoms. which advice from the nurse will be best for this client? a. come to the clinic immediately for evaluation and treatment b. hold fluid intake until the nausea subsides c. administer the usual insulin dosage d. monitor BG every 1 to 2 hrs and call if it rises over 150

c. administer the usual insulin dosage

the charge nurse is educating a new nurse on blood transfusions. the charge nurse knows that the teaching has been effective when the new nurse says which of the following? a. i will give the IV antibiotics and blood transfusion through the same IV at the same time b. a will have a UAP verify client information with me if a other RN is bust c. when the blood is brought to the unit, i will make sure to put it in the fridge right away d. i will make sure to us IV tubing with a filter when administering a blood product

d. i will make sure to us IV tubing with a filter when administering a blood product

which action would the nurse perform immediately after applying capsaicin to a client with diabetic nueropathy? a. monitor for skin irritation b. prefrom a painful procedure c. notify the HCP d. remove gloves and wash hands

d. remove gloves and wash hands

which action will the nurse take to determine whether therapy for vit B12 deficiency is effective? a. monitor electrolyte levels b. assess skin integrity c. check for peripheral edema d. review H&H levels

d. review H&H levels

a client with esophageal varices is admitted w/ hematemesis, and 2 units of packed RBCs are prescribed. the client complains of flank pain halfway through the first unit of blood. what should be the nurses first action? a. obtain vitals b. assess the pain further c. monitor the hourly urine output d. stop the transfusion

d. stop the transfusion

causes of hemolytic anemia:

-breaking of RBCs -sickle cell anemia -polycythemia vera -aplastic anemia: body attacks RBCs and breaks them

pre renal causes:

-burns -dehydration -hemorrhage -sepsis -renal artery stenosis

clinical manifestations for B12 deficiency anemia:

-glossitis: inflammation of the tongue -paresthesias

nursing actions for if a DVT is suspected:

-immobilize the extremity -dont massage the leg -no heat or ice -gently palpate around the muscle -elevate extremity slightly above the heart -if they have SCDs take them off

hormone regulation in CKD:

-impairment in renin: decrease BP -impairment in erythropoietin: s/s anemia -impairment in activated vit D: osteoporosis (osteodystrophy) -impairment in bradykinins: increased BP -impairment of prostaglandins: decrease in production, decrease in renal function

treatment for iron deficiency anemia:

-iron supplements: ferrous sulfate -food containing iron: green leafy veggies, red/ organ meat, mussels

nursing interventions for the oliguric phase of AKI:

-monitor I & O -assist in fluid balance -assess fluid status -assess electrolyte imbalances -daily weights -monitor and trend labs -urine characteristics -administer and educate on meds -monitor diet -telemetry: of electrolyte imbalance

nursing interventions for clients with a UTI:

-monitor/ trend vitals -urine characteristics -education on meds -encourage 2-3 L of fluid -monitor labs -help obtain urine culture -encourage comfort

which eye problem ins the leading cause of blindness in clients with DM? a. cataracts b. glaucoma c. retinopathy d. astigmatism

c. retinopathy

A client with a large claculus in the calyces of the right kidney has surgery scheduled for removal of the stone. which information would the nurse include when teaching post op care? a. after surgery a suprapubic catheter will be placed b. during surgery the right ureter will be removed c. the calculi is too large for a transurethral removal d. there will be a small incision in the right flank area

d. there will be a small incision in the right flank area

which response would the nurse provide to a client who asks about what to expect post op before a TURP? a. your urine will be pink and free of clots b. you will have an abdominal incision and a dressing c. there will be an incision between your scrotum and rectum d. there will be a urinary catheter and continuous bladder irrigation

d. there will be a urinary catheter and continuous bladder irrigation

which information would the nurse include in response to a clients questioning a protein-restricted dietary change required for their AKI? a. currently your body is unable to synthesize amino acids, so nitrogen for amino acid synthesis must come from the diet b. essential and nonessential amino acids are necessary in the diet to supply material for tissue protein synthesis c. a high protein intake ensures an adequate daily supply of amino acids to compensate for losses d. this diet supplies only needed amino acids, reducing the amount of metabolic waste

d. this diet supplies only needed amino acids, reducing the amount of metabolic waste

which result would the nurse expect to find when assessing the lab values of a client with type II DM? a. ketones in the blood but not the urine b. glucose in the urine but not the blood c. urine and blood positive for glucose and ketones d. urine negative for ketones and positive glucose in the blood

d. urine negative for ketones and positive glucose in the blood

treatment of early CKD:

goal is to preserve kidney function! -antihypertensives -lifestyle mods: smoking cessation, wt loss -DM: BG within normal limits -adequate hydration -reduce nephrotoxic meds

Causes of hypercoagulability:

-cancer -smoking -obesity -pregnancy -oral contaceptives -SERMs -COVID

s/s bacterial blood transfusion reaction:

-fever -elevated WBC -chills -high vitals -expected to be treated with antibiotics

treatment for folic acid anemia

-folic acid supplement -increase diet in folic acid: citrus, leafy greens, nuts

when caring for a client with end stage renal disease, the nurse notices that the patient understands the diagnosis when the patient selects which dinner choice? a. hamburger patty with a garden salad and ranch dressing b. fried rice with vegetables and shrimp c. turkey, salami, and cheese sandwich with 12 oz tomato juice d. 13 oz new york strip steak with loaded mashed and corn on the cob

a. hamburger patty with a garden salad and ranch dressing

which statement by the client with type II DM indicates to the nurse that additional dietary teaching is needed? a. i can eat as much dietetic fruit as I want b. i can have a lettuce salad whenever I want c. i know that half of my diet should be carbs d. i need to reduce the amounts of saturated fats in my diet

a. i can eat as much dietetic fruit as I want

the nurse has finished teaching a post op client about prevention of PE, which client statement indicates that the teaching has been effective? a. i will avoid crossing my legs b. pillows placed under my knees will help avoid clots c. staying on bed rest as long as possible is best for me d. 3x a day i will massage my lower legs to get blood moving

a. i will avoid crossing my legs

which statement indicates to the nurse providing discharge medication education to a client prescribed warfarin that teaching was effective? a. i will avoid taking aspirin and nonsteroidal anti-inflammatory drugs b. i will need to develop a more sedentary routine c. i will need to have regular complete blood counts to guide warfarin dosages d. before going to the dentist i will ask my health care provider for antibiotics

a. i will avoid taking aspirin and nonsteroidal anti-inflammatory drugs

which strategy would the nurse include in the clients plan of care regarding preventing the development of ureteral colic from renal calculi in the future? a. instruct the client to drink at least 3L of fluid a day b. suggest interventions to decrease the serum creatinine level c. establish a urinary output goal of 2000mL per 24 hrs d. teach the client to exclude milk products from their diet

a. instruct the client to drink at least 3L of fluid a day

which information would the nurse include in the teaching plan of an adolescent who is found to have type I diabetes? select all a. insulin therapy b. prophylactic antibiotics c. blood glucose monitoring d. oral hypoglycemic agents e. adherence to the treatment regimen

a. insulin therapy c. blood glucose monitoring e. adherence to the treatment regimen

which statement indicates the nurse has a correct understanding of kidney ultrasonography? a. kidney ultrasonography uses sound waves and has minimal risk b. kidney ultrasonography primarily makes use of iodinated contrast dye c. kidney ultrasonography is performed on the client with an empty bladder d. kidney ultrasonography provides three dimensional information regarding the kidneys

a. kidney ultrasonography uses sound waves and has minimal risk

the nurse is educating the client with newly diagnosed type II DM on oral antidiabetic meds. which instruction would the nurse include in the teaching plan? select all a. obtain a finger-stick BG reading before each meal b. they do not need to follow a specific diet until insulin is required c. the plan should include s/s of hypoglycemia d. the plan should include how to administer regular insulin e. the plan should include sick day rules

a. obtain a finger-stick BG reading before each meal c. the plan should include s/s of hypoglycemia e. the plan should include sick day rules

which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or infleunza? a. obtaining adequate food intake b. relieving pain c. increasing activity d. managing own health

a. obtaining adequate food intake

a child is prescribed insulin glargine before breakfast. which instruction is MOST appropriate for the nurse to give the parent regarding a bedtime snack? a. offer a snack to prevent hypogylcemia during the night b. give the child a snack if signs of hyperglycemia are present c. avoid a snack because the child is being treated w/ long acting insulin d. keep a snack at the bedside in case the child gets hungry during the night

a. offer a snack to prevent hypogylcemia during the night

where is the BP cuff placed on a client with dialysis access fistula in the right arm? a. on the left arm b. over the fistula c. below the fistula d. above the fistula

a. on the left arm

a pt w/ anemia has a sore, beefy-red tongue with tingling finger tips. which type of anemia does this assessment finding support? a. pernicious b. polycythemia vera c. iron deficiency d. folic acid deficiency

a. pernicious

the RN supervising a nurse orienting to the acute care unit who is discharging a pt admitted with kidney stones and who underwent lithotripsy, which statement by the orienting nurse to the pt requires intervention by the RN? a. report any sings of bruising to the HCP immediately because this indicates bleeding b. remember to drink at least 3 L of fluid everyday to prevent another stone from forming c, you can return to work based on what your HCP indicates d. you should finish all of your antibiotics to make sure that you dont get a UTI

a. report any sings of bruising to the HCP immediately because this indicates bleeding

during a blood transfusion, the client states "im feeling a little chilled, could you get me a warm blanket?" what is the priority nursing intervention? a. stop the blood transfusion b. get the client a warm blanket c. inform the client that the warm blankets are not allowed during a blood transfusion d. inform the provider of the clients request

a. stop the blood transfusion

a pt who is a jehovas witness was brought to the emergency room and requires a blood transfusion. which nursing action would be taken in such situation? a. the pt should be asked to decide about the transfusion b. only RBCs should be transfused c. an immediate blood transfusion should be started d. the pts family should be notified of the situation

a. the pt should be asked to decide about the transfusion

what nursing intervention below would the nurse NOT include in the pts plan of care to prevent DVT formation? a. the pt will eat all meals out of bed daily by sitting in the bedside chair b. the nurse will apply SCDs to the patients lower legs c. the pt will ambulate daily d. the nurse will administer enoxaparin in the subcut tissue of the abdomen

a. the pt will eat all meals out of bed daily by sitting in the bedside chair

the client develops hypoglycemia. the nurse institutes the hypoglycemic protocol. what is necessary to be included in the documentation of the event? select all a. the treatment given b. the initial glucose result c. repeat glucose level after the treatment d. client assessment pre and post treatment e. HgA1C results

a. the treatment given b. the initial glucose result c. repeat glucose level after the treatment d. client assessment pre and post treatment

the nurse is teaching a client with BPH. what statement indicates a lack of understanding by the client? a. there should be no problem with a glass of wine with dinner each night b. i am so glad that i weaned myself off of coffee about a year ago c. i will limit drinking fluids in the evening time d. i will out nightlights in the hallway and bathroom

a. there should be no problem with a glass of wine with dinner each night

a client has a platelet count of 49,000. the nurse would instruct the client to avoid which activity? a. ambulation b. blowing nose c. visiting with children d. eating fresh fruits and veggies

b. blowing nose

which process would the nurse consider when formulating a response to a pt with AKI who states "why am I experiencing twitching and tingling of my fingers and toes?" a. acidosis b. calcium depletion c. potassium retention d. sodium chloride depletion

b. calcium depletion

a client reports not feeling well. VS- 102.9-109-22-92/56-96% RA. what type of potential blood transfusion reaction does the nurse recognize these findings? a. allergic b. hemolytic c. bacterial d. febrile

c. bacterial

while obtaining a pts health hx, which factor would the nurse identify as predisposing the client to type II DM? a. having diabetes insipidus b. eating low-cholesterol foods c. being 20 Ibs overweight d. drinking a daily alcoholic bev

c. being 20 Ibs overweight

a nurse recognizes that a common cause of anemia is: a. your body creates too many RBC b. an injury causes you to leak cerebrospinal fluid (CSF) c. bleeding causes you to lose RBCs more quickly then replaces d. your body does not have enough WBC

c. bleeding causes you to lose RBCs more quickly then replaces

when evaluating teaching a client how to admin short acting insulin w/ a concentration of 100 units/mL, which action indicates that additional teaching is necessary? a. pt identifies that the syringe is U-100 b. the client injects the dose 30 min before breakfast c. client does not check BG before admin d. client rotates site from backs of arms, legs, and abdomen

c. client does not check BG before admin

which clinical response will the nurse assess to determine kidney damage in a client who develops a transfusion reaction? a. glycosuria b. blood in urine c. decrease urinary output d. acute pain over the kidney

c. decrease urinary output

after treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. which response would the nurse give? a. avoid regular use of tampons b. decrease your intake of prune juice c. increase your daily fluid consumption d. cleanse the perineum from back to front

c. increase your daily fluid consumption

which action would the nurse take when administering a transfusion of 2 units of packed RBS to a client? a. infuse lactated ringer solution w/ the RBC's b. warm the blood to 98 F to prevent chills c. infuse the blood at a slow rate during the first 15 min d. draw blood samples from the client after each unit is transfused

c. infuse the blood at a slow rate during the first 15 min

after abdominal surgery a client suddenly reports numbness in the right leg and a "funny feeling" in the toes. what should the nurse do first? a. tell the client to drink more fluids b. gently rub the clients legs for circulation c. instruct the client to remain in bed d. tell the client about the dangers of prolonged bedrest

c. instruct the client to remain in bed

the client reports a headache and fatigue, and has pale skin. the provider diagnosis the client with microcytic anemia. which of the following supports this diagnosis? a. low TIBC b. high MCV c. low ferritin d. hemoglobin 15

c. low ferritin

the nurse educator is preparing an in-service on AKIs. which causes should be included as possible pre-renal acute kidney injuries? select all a. urinary nerve damage b. nephrolithiasis c. renal artery stenosis d. hemorrhage e. nephrotoxic medications

c. renal artery stenosis d. hemorrhage

risk factors for venous stasis:

-immobility #1 -paralysis -venous insufficiency -heart failure

treatment for urolithiasis stones greater than 10cm:

-ureteroscopy -temporary stent -percutaneous nephrolithotomy

causes of hypoproliferative anemia:

-late stage CKD -cancer of the bone marrow -iron deficiency anemia -B12 deficiency

treatment for vitamin B12 deficiency anemia:

-B12 supplements -increase diet in B12 more animal products and fortified cereal and foods

nursing actions for a confirmed DVT:

-pain management -initiate anticoagulants -updated mobility orders -teach clients how to put on stocking smoothly -cardiopulmonary assessment -hydration

causes of iron deficiency anemia:

-poor intake -gastric bypass -chrons disease

urolithiasis pathophysiology:

-presence of stone (calculi) in urinary tract

s/s hyperglycemia:

-warm -thirsty -headache -double vision -tired -weak -dizzy treatment: rapid/ short acting insulin

whats the peak for rapid acting insulin?

1-2 hrs

which client would the nurse be most concerned about having anemia? a. male w/ HCT 38% who is pale and weak b. female with HCT 36% who has their menstrual period c. male w/ HCT 54% who appears dehydrated d. female with HCT 32% who is hypervolemic

a. male w/ HCT 38% who is pale and weak

what is the onset of intermediate insulin?

2-4 hrs

what is the peak of short acting insulin?

2-4 hrs

what is the duration for long acting insulin?

24 hrs

what is the onset for short acting insulin?

30-60 min

what is the peak of intermediate insulin?

4-10 hrs

what is the duration of short acting insulin?

5-7 hrs

How long is the recovery phase of an AKI?

6 months -1 yr

a client has continuous bladder irrigation after surgery yesterday. the amount of bladder irrigation solution that has infused over the past 12 hrs us 1050 mL. the amount of fluid in the urinary drainage bag in 1825. the nurse records that the client had _____________ mL of urinary output in the past 12 hrs

775 mL

treatment for diabetic nephropathy:

ACE and ARBs

labs for folic acid anemia:

RBC: low MCV: high H&H: low ferritin: = serum Fe: = TIBC: = reticulocyte: low or = B12: = folic acid: low

acid base balance in CKD

metabolic acidosis: will see kussmauls resporations

clinical manifestations of the oliguric phase of AKI:

- < 400 mL/ 24 hr -< 30 mL/hr x 6hrs -s/s FVI -metabolic acidosis -s/s hyperkalemia, hypocalcemia

treatment in diuresis phase of AKI:

- may need fluids and repletion of potassium

labs for vitamin B12 deficiency anemia:

-RBC: low -MCV: high -H&H: low -ferritin: = -serum Fe: = -TIBC: = -reticulocyte: low/ = -B12: low -folic acid: =

potential complications of BPH:

-UTI -AKI -for turp: bleeding, urinary obstruction, pain/ bladder spasms, infection

preventing UTI's:

-adequate sleep and nutrition -adequate fluid intake 2-3L a day -wiping front to back -avoid taking baths encourage taking showers -avoid irritating scents -wear cotton underwear -dont hold urination -100% cranberry juice

s/s hemolytic blood transfusion reaction:

*high likelihood of death* -flank pain #1 -chest pain -headache -feeling of impending doom -tachycardia -tachypnea -hypotension prepare to bolus NS, and insert indwelling cath

what is the onset for long acting insulin?

3-4 hrs

how to care for pts with dialysis before and after:

AV fistula: merging of artery and vein -feel for thrill and bruit in AV fistula -no BP or labs on affected extremity -limit weight lifted with extremity

late s/s of CKD:

GFR lower than 15 -s/s FVO -s/s anemia -s/s fracture and bone pain -s/s uremia -hypocalcemia: positive trusseasus and chovestek -anorexia -N/V -dry flaky skin -pruritus -ecchymosis -prupura -behavioral changes -weakness/ fatigue -confusion

dx testing for a DVT:

DVT ultrasound bilaterally

labs for iron deficiency anemia:

RBC: low MCV: low H&H: low ferratin: low serum Fe: low TIBC: high reticulocyte: low or = B12: = folic acid: =

the nurse is caring for clients on a med surg unit and identifies that which client has the highest risk for developing a PE? a. an obese client with leg trauma b. a client with diabetes who has cholecystitis c. a client with pneumonia who is immunocompromised d. a pregnant client with acute asthama

a. an obese client with leg trauma

the nurse is caring for a client status post TURP. how long does the nurse expect the catheter to remain in place? a. 1-3 days b. 5-7 days c. 12-24 hrs d. 1-3 weeks

a. 1-3 days

the nurse is preparing to administer levemir. which supply is the most appropriate to gather to admin the med? a. 29 gauge 1/2 inch needle b. medication cup c. 31 gauge 1 in needle d. blunt tip cannula and syringe

a. 29 gauge 1/2 inch needle

a nurse is providing teaching for a client who has late stage CKD. which of the following client statements indicates an understanding of the teaching? a. I will weigh myself each morning b. i will monitor my BP on the same day each week c. i will take milk of magnesia if I am constipated d. i will use salt substitutes in my diet

a. I will weigh myself each morning

a nurse is participating in a DM screening program. who are at risk for developing type II DM? select all a. a 12 yr old who is overweight b, a 32 yr old female who gave birth to a 9.5 Ib baby c. a 55 yr old asian who has HTN and two siblings with type II DM d. a 18 yr old immigrant form mexico who jog 4x a week e. a 44 yr old native American who has a BMI of 32

a. a 12 yr old who is overweight b, a 32 yr old female who gave birth to a 9.5 Ib baby c. a 55 yr old asian who has HTN and two siblings with type II DM e. a 44 yr old native American who has a BMI of 32

a client is to have hemodialysis. what must the nurse do before this treatment? a. weigh the client to establish a baseline for later comparison b. obtain a urine specimen to evaluate kidney function c. explain that the peritoneum serves as a semipermeable membrane to remove wastes d. administer medication that is scheduled to be given within the next hr

a. weigh the client to establish a baseline for later comparison

pathophysiology type I DM:

autoimmune: body attacks pancreas and body doesn't produce insulin -age of onset: greater than 30 -polyphagia, polydipsia, polyuria -fruity smelling breath -skinner body presentation -# 1 side effect: hypoglycemia

a pt with AKI is moved into the diuretic phase after 1 week of therapy. during this phase, which clinical indicators would the nurse assess? select all a. skin rash b. dehydration c. hypovolemia d. hyperkalemia e. metabolic acidosis

b. dehydration c. hypovolemia

the RN is supervising a senior nursing student who is caring for a 78yr old pt scheduled for an IV pyelography test. what information would the RN be sure to stress about this procedure to the nursing student? a. the purpose of this procedure is to measure kidney size b. after the procedure monitor urine output because contrast dye increases risk for kidney failure in older adults c. because this procedure assesses the kidney function there is no need for a bowel prep d. keep the pt NPO after the procedure because during the procedure the pt will receive drugs that affect the gag reflex

b. after the procedure monitor urine output because contrast dye increases risk for kidney failure in older adults

the nurse is caring for a 84 yr old client diagnosed with BPH. this client has undergone a TURP and is complaining of bladder spasms. which intervention should the nurse implement first? a. admin antispasmodic meds for bladder spasms b. assess the clients three way urinary cath c. calculate the clients urinary output d. palpate the clients abdomen for bladder distention

b. assess the clients three way urinary cath

a client is diagnosed with BPH and seems sad and irritable. after assessing the clients behavior which statement by the nurse would be most appropriate? a. the urine incontinence should not prevent you from socializing b. nocturia could cause interruptions of your sleep and cause changes in mood c. it is common for men at your age to have changes in mood d. you seem depressed and should seek more pleasant things to do

b. nocturia could cause interruptions of your sleep and cause changes in mood

which response would the nurse expect a client experiencing hypoglycemia to exhibit? select all a. nausea b. palpitations c. tachycardia d. nervousness e. warm, dry skin f. increased respirations

b. palpitations c. tachycardia d. nervousness

which goal would the nurse expect a client receiving treatment for bacterial cystitis to achieve before their discharge from the hospital? a. understand the need to drink 4L of water per day to prevent from dehydration b. demonstrate an ability to identify dietary restrictions and plan menus c. achieve relief of clinical symptoms and mantain kidney function d. recognize signs of bleeding as a complication associated with this type of procedure

c. achieve relief of clinical symptoms and mantain kidney function

which rationale supports the nurses instruction that a client with CKD is to avoid salt substitutes? a. a persons body tends to retain fluid when salt substitute is included in the diet b. limiting salt substitutes in the diet prevents buildup of waste products in the blood c. salt substitutes contain potassium, which must be limited to prevent abnormal heart beats d. the salt substitutes substances interfere with capillary membrane transfer resulting in anasarca

c. salt substitutes contain potassium, which must be limited to prevent abnormal heart beats

the nurse is assessing the clients understanding of the use of medications. which med may cause complications w/ the treatment plan of a client with DM? a. sulfonylureas b. aspirin c. steroids d. ACE inhibitors

c. steroids

which information would the nurse include in response to a clients questioning a protein restricted dietary change required for AKI? a. a high protein intake ensures an adequate daily supply of amino acids to compensate for losses b. essential and nonessential amino acids are necessary in the diet to supply material for tissue protein synthesis c. this diet supplies only essential amino acids, reducing the amount of metabolic waster products, this decreasing stress on the kidneys d. currently you body is unable to synthesize amino acids, so the nitrogen for amino acid synthesis must come from the dietary protein

c. this diet supplies only essential amino acids, reducing the amount of metabolic waster products, this decreasing stress on the kidneys

what is the gold standard lab for kidney function?

creatinine

a clients fasting BG levels are being evaluated. the nurse identifies that the client is considered to be diabetic if the results are within which range? a. 40-60 b. 80-99 c. 100-125 d. 126-140

d. 126-140

ACE inhibitor may be prescribed to the client with DN to reduce vascular changes and possibly to prevent or delay development of: a. COPD b. pancreatic CA c. CVA d. Renal failure

d. Renal failure

which lab result in a client who has just been admitted with anemia of unknown etiology requires the most rapid action by the nurse? a. hematocrit 30% b. hemoglobin 10 c. platelet count 120,000 d. WBC 950

d. WBC 950

the nurse is caring for a client in the recovery phase of an AKI. which assessment findnings does the nurse anticipate? select all a. bradypnea b. hypokalemia c. hypertension d. creatinine 1.2 e. polyuria

d. creatinine 1.2

a client arrives at a health clinic reporting a recent onset of hematuria, frequency, urgency, and pain on urination. which diagnosis will the nurse observe in the clients medical record? a. chronic glomeruloneohritis b. nephrotic syndrome c. pyelonephritis d. cystitis

d. cystitis

which clinical manifestation would the nurse associate with BPH? a. perineal edema b, urethral discharge c. flank pain radiating to the groin d. distention of the lower abdomen

d. distention of the lower abdomen

in early CKD what will be the GFR level?

greater than 30

what is polycythemia vera?

type of blood cancer; causes bone marrow to make to many RBC's

dx testing for CKD:

wont identify CKD but will rule out abnormalities or cause of CKD -renal ultrasound -CT scan -KUB

diabetes diet and nutrition:

-collab w/ RD -avoid excessive carbs -method/ procedure of carb counting -avoid excess dietary fat -avoid excessive protein consumption -safe consumption of alcohol

nursing intervention in the recovery phase of an AKI:

-educate on adequate hydration -protect the kidneys -attend PCP visits -educate on the cause of an AKI

nursing interventions for peripheral neuropathy:

-educate on foot care -safety -wear clothes toed shoes, well fitting shoes, have a good sole -first sign of skin breakdown notify HCP

nursing interventions for iron deficiency anemia:

-ferrous sulfate side effects -increase fluid, fiber, and activity -continue to take med even if you are feeling better -take on an empty stomach -take w/ vit C -dont take with milk or fortified OJ

clinical manifestations urolithiasis:

-flank pain -pain in abdomen -renal colic: N/V, pallor, diaphoretic -hematuria -fever -painful urination -decrease urine output

treatment in the oliguric phase of AKI:

-fluids -diuretics -severe AKI: temporary dialysis -hyperkalemia management

risk factors for urolithiasis:

-genetics -gender: male at higher risk -obesity -not consuming enough fluids -medications -foods rich in purine

causes of CKD:

-age: 60 + -HTN -diabetes -recurrent kidney infection -cardiovascular problems/ stroke -smoking -obesity -family hx -african american/ asian american -kidney anatomy -AKI -severe dehydration

assessment findings for autonomic neuropathy:

-atonic bladder -gastroparesis -retrograde ejaculation -nocturnal diarrhea

treatment in recovery phase of an AKI:

-avoid nephrotoxic meds and additional AKI

intra renal causes:

-blood clots in urinary system -embolism of renal vessels -localized kidney infection (glomerulonephritis) -nephrolithiasis -nephrotoxic meds

before supper, an adult is found pallor and unconcious with LR @ 75 mL/hr running. the nurse should prepare to admin: a. a carb snack b. dextrose 10% in water c. rapid acting insulin subcut d. glucagon intramuscularly

b. dextrose 10% in water

which symptoms would the nurse observe in a client with hyperglycemia and ketoacidosis? select all a. irritability b. dry skin c. diaphoresis d. increased thirst e. deep, rapid breathing

b. dry skin d. increased thirst e. deep, rapid breathing

the clinical finding of a client with DM shows decreased glucose tolerance. which complication is anticipated in the client? a. cystitis b. frequent yeast infections c. decreased bone density d. thin and dry skin

b. frequent yeast infections

which goal is the nurse trying to achieve when instructing a client with a hx of frequent urinary tract infections to drink cranberry juice? a. exert a bactericidal effect against the bacteria b. prevent bacterial attachment to the bladder wall c. improve glomerular filtration rate d. relieve the symptoms of dysuria

b. prevent bacterial attachment to the bladder wall

which element would the nurse teach the client with CKD to limit as an intervention to control uremia associated with end-stage renal disease? a. fluid b. protein c. sodium d. potassium

b. protein

the nurse is caring for a post-surgical patient w/ an EBL of 750 mL. the pt is tired, pallor, heart rate 88, BP 106/56, and hemoglobin of 9.2. which nursing intervention would be most appropriate? a. encourage the client to walk around the nursing station every hr b. schedule care together to limit disruptions to rest c. do not wake the client to give scheduled meds d. check vitals every hr around the clock

b. schedule care together to limit disruptions to rest

a client asks the nurse to clarify how soon after admin of lispro insulin will it begin to have effect. what should the nurse reply? a. 30 min - 1 hr b. within 15 min to 30 min c. 1-2 hrs d. 10-16

b. within 15 min to 30 min

a client w/ type I DM is admitted to the ED. which respiratory pattern in a client w/ DM requires immediate action? a. regular depth respirations w/ frequent pauses b. short expirations and inspirations c. deep, rapid respirations w/ long expirations d. shallow respirations alternating with long expirations

c. deep, rapid respirations w/ long expirations

a client has experienced a PE. the nurse should assess for which symptom, which is more commonly reported? a. hot, flushed feeling b. chest pain that occurs suddenly c. dyspnea when deep breaths are taken d. sudden chills and fever

c. dyspnea when deep breaths are taken

a client with a hx of CKD is hospitalized. which assessment findings will alert the nurse to kidney insufficiency? a. diminished force and caliber of stream b. dribbling after voiding and dysuria c. edema and pruritus d. facial flushing and weight gain

c. edema and pruritus

the nurse is caring for a client in the diuretic phase of an AKI. which assessment findings does the nurse anticipate? select all a. hypertension b. bradypnea c. hypokalemia d. creatinine 1.2 e. polyuria

c. hypokalemia e. polyuria

after the nurse has finished teaching a post op client about prevention of PE, which client statement indicates teaching has been effective? a. staying on bedrest as long as possible is what is best for me b. pillows placed under my knees will help to avoid clots c. i will avoid crossing my legs d. three times a day i will massage my legs to get blood flowing

c. i will avoid crossing my legs

a client with type I DM receives humulin R insulin in the morning. shortly before lunch the nurse identifies that the client is diaphoretic and trembling. which intervention is appropriate? a. administer insulin to the client b. give the client lunch immediately c. encourage the client to drink fluids d. assess the clients BG level

d. assess the clients BG level

which nurse would be BEST for the nurse manager to assign to give a unit of packed RBC to a client who is experiencing post op bleeding after abdominal surgery? a. an experienced LPN who works regularly on the post op unit b. a RN who is currently starting IV chemotherapy on another client c. a RN who is on-call and will be able to arrive on the unit in about 30 min d. a RN who has floated from the post anesthesia care unit (PACU) for the day

d. a RN who has floated from the post anesthesia care unit (PACU) for the day

which information would the nurse provide to a pt with BPH after the HCP prescribes finasteride? a. male pattern baldness can occur b. results can be expected in 4-6 wks c. the medication relaxes the muscles in the bladder neck d. a condom should be worn during intercourse with a pregnant female

d. a condom should be worn during intercourse with a pregnant female

which information provides the rationale for a nurse writing a goal of preventing renal calculi in a care plan for a client who has parapalegia? a. high fluid volume intake b. increased calcium intake c. inadequate kidney function d. accelerated bone demineralization

d. accelerated bone demineralization

what is capsaicin?

topical to interrupt transmission pf pain to the brain for a pt with diabetic neuropathy

what are the rapid acting insulins?

lispro, aspart

BPH pathophysiology:

non cancerous overgrowth of the prostate; increase tissue d/t aging and hormonal changes

dx tests for BPH:

transrectal/ transabdominal ultrasound

nursing actions for pt prior going to dialysis:

-take weight and vitals (we expect decrease in wt and BP after) -typically done 3x a week -clients often feel fatigued after

nursing interventions for all anemia:

-safety -monitor and trend vitals -monitor and trend labs -cluster care to provide conservation of energy -cardiovascular focused assessment

parameters for a blood transfusion:

-usually hemoglobin less than 7 -if clients have had a 25% loss of hemoglobin compared to baseline -vitals 30 min B4 trasfusion -check IV patencey: pts veins will be small when they need blood -filter tubing -NS is spiked and primed with blood -need 2 RNs to verify blood @ bedside -1-2mL/min to start transfusion -stay with them for 15 min -before increasing infusion get vitals (if change in vitals stop infusion) -max amount of time to transfuse blood is 4hrs -after infusion is completed get vitals -check H&H 2 hrs after transfusion -blood needs to be started within 30 min of receiving it from the blood bank -every infusion required new tubing you cannot use the same as previous

nephrotoxic medications to avoid:

-vanco IV -gentamicin IV -diuretics -NSAIDs -IV contrast dye -alopurinol methotrexate -metfromin

diabetes and exercise:

-wear appropriate footwear -do not exercise within 1 hr of insulin injection -dont exercise unless BG is at least 80 and lower than 250 -have carb snack B4 exercise if 1hr has passed since last meal -simple sugar to eat during exercise if s/s hypoglycemia occur

which client has the highest risk for developing a PE? a. an obese client with leg trauma b. a pregnant client with acute asthma c. a client with DM who has cholecystitis d. a client w/ pneumonia who is immunocompromised

a. an obese client with leg trauma

a pathology report states a clients urinary calculus is composed of uric acid. which food item would the nurse instruct the client to avoid? a. liver b. cheese c. vegetables d. milk

a. liver

a client is diagnosed as having type 2 DM. what is the priority teaching goal for the client? a. to identify pending hypoglycemia or hypergylcemia b. to test urine for both sugar and acetone c. to administer insulin as prescribed d. to perform foot care daily

a. to identify pending hypoglycemia or hypergylcemia

NPH insulin is ordered for a client. based on the type of insulin it is, when should the nurse admin this insulin? a. twice a day b. once a day c. 30-45 min before meals d. at mealtime or within 15 minutes of meals

a. twice a day

the nurse educator is preparing an in service on AKI. which causes should be included as possible post-renal AKI? select all a. urinary nerve damage b. hemorrhage c. nephrolithiasis d. renal artery stenosis e. nephrotoxic meds

a. urinary nerve damage

a client with type I DM is admitted to the ED w/ dehydration following the flu. the client has a BG of 325 and a serum potassium of 3.5. the HCP has prescribed 1L D5W to be infused q8 hrs. prior to implementing the HCPs prescriptions the nurse should contact the HCP, explain the situation, provide background info, report the current assessment, and.......? a. verify the prescription for 5% dextrose in water b. request an increase in the volume of IV fluids c. suggest adding potassium to the fluids d. determine if the client should be placed in isolation

a. verify the prescription for 5% dextrose in water

which instruction would the nurse include in a health practice teaching plan for a female client with a hx of recurrent UTIs? a. wear cotton underwear or lingerie b. void at least every 6 hrs around the clock c. increase foods containing alkaline ash in the diet d. wipe the peri from back to front after toileting

a. wear cotton underwear or lingerie

hypoglycemia:

life threatening medical emergency -clammy -cool to touch -tremors -nervous -anxious -hungry

a 23 yr old with DM type I corrected a BG of 312 w/ 22 units of lisipro. which clinical manifestation determines the medication was effective? a. reports feeling hungry and thirsty b. HR 88 and BG of 138 c. reports feeling tremulous and like heart is beating fast d. reports double vision and feeling warm

b. HR 88 and BG of 138

the nurse is reviewing orders for a client with DM. which of the following orders should the nurse clarify with the HCP? a. lisipro insulin sliding scale subcut before meals and bedtime b. NPH insulin 12 units subcut before meals and bedtime c. detemir insulin 39 units subcut every bedtime d. glargine insulin 34 units subcut every 12 hrs

b. NPH insulin 12 units subcut before meals and bedtime

after assessing a clients condition, the nurse suspects that the client has DM type I. which statement made by the client would be MOST appropriate in helping the nurse reach this conclusion? a. i sometimes experience shortness of breath b. i quite often feel thirsty c. i have excessive sweating d. i am 55 yrs old

b. i quite often feel thirsty

when teaching a health awareness class, which situation would the nurse teach as being the HIGHEST risk factor for the development of a DVT? a. pregnancy b. inactivity c. aerobic exercise d. tight clothing

b. inactivity

the client is scheduled to have a KUB. to prepare the client for the procedure, the nurse should explain to the client that: a. fluid and food will be withheld the morning of the exam b. no special prep is required c. an enema will be given before the examination d. a tranquilizer will be given before the exam

b. no special prep is required

which description of pain would the nurse expect in a client w/ a ureteral calculus to report? a. located at the level of the kidney and occuring with every urination b. sposmodic and radiating from the side to the suprapubic area c. dull and constant at the costovertebral angle d. boring type pain located in the flank area

b. sposmodic and radiating from the side to the suprapubic area

a pt with blood type O needs platelets. how would the nurse choose a donor for platelet transfusion? a. the donor can be of any blood group b. the donor should be blood group O c. Rh compatibility is excluded d. the donor can be exempt from screening for infections

b. the donor should be blood group O

treatment of urolithiasis stones greater than 5 cm:

lithotripsy: strong shock wave to break up stones -expect bruising after

a client with DM is being tested to measure long-term diabetic control. this test is based on the fact that chronic high BG levels lead to irreversible glucose binding to which item? a. muscle tissues b adipose tissue c. RBC d. platelets

c. RBC

the nurse is caring for a variety of clients. in which client is it most essential for the nurse to implement measures to prevent PE? a. a 60 yr old with bacterial pneumonia b. a 76 yr old who has a hx of thrombocytopenia c. a 59 yr old with a total knee replacement d. a 68 yr old who had emergent dental surgery

c. a 59 yr old with a total knee replacement