NU424 Renal

A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are:

cryoprecipitate and fresh frozen plasma. Explanation: The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These products include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, these products aren't specifically used to treat hemostasis. Although platelets may be helpful, the best answer is cryoprecipitate and fresh frozen plasma.

Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply. Hyperkalemia Metabolic alkalosis Anemia Hyperalbuminemia Hypocalcemia

Hyperkalemia Anemia Hypocalcemia

A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess?

Hypertension

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? Hypotension Diabetes mellitus Neuromuscular disorders Pregnancy

Hypotension

A client reports having to get up frequently to void in the night, or nocturia. What is not a probable cause of his problem?

neurogenic bladder

The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for

hypertension

A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:

level of consciousness (LOC).

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to:

low platelet count.

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:

wash her hands after touching the client.

A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient?

ADH stimulation

A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply. Acetaminophen Ketoconazole Valproic acid Diazepam Insulin

Acetaminophen Ketoconazole Valproic acid

A client with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the client's fluid volume excess? Select all that apply. Administering diuretics Administering calcium channel blockers Implementing fluid restrictions Implementing a 1500 kcal/day restriction Enhancing client positioning

Administering diuretics Implementing fluid restrictions Enhancing client positioning

A client with esophageal varices is being cared for in the ICU. The varices have begun to bleed. The client has Ringer lactate at 150 cc/hr infusing. The nurse should also anticipate what intervention?

Administering volume expanders Explanation: Because clients with bleeding esophageal varices have intravascular volume depletion and are subject to electrolyte imbalance, IV fluids with electrolytes and volume expanders are provided to restore fluid volume and replace electrolytes.

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention?

Albumin infusion

Which term is used to describe a chronic liver disease in which scar tissue surrounds the portal areas?

Alcoholic cirrhosis

The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. Alterations in mood Agitation Decreased deep tendon reflexes Report of headache Insomnia

Alterations in mood Agitation Insomnia

The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? Select all that apply. Any voiding disorders The patient's occupation The presence of hypertension or diabetes The patient's financial status The ability of the patient to manage activities of daily living

Any voiding disorders The patient's occupation The presence of hypertension or diabetes

The nurse is caring for a client with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply. Percuss for pain in the right lower abdominal quadrant. Assess for the presence of peripheral edema. Auscultate the client's apical heart rate for dysrhythmias. Assess the client's BP. Assess the client's orientation and judgment.

Assess for the presence of peripheral edema. Assess the client's BP.

A client with a history of IV drug use is being treated for hepatitis, and presents today with jaundice and arthralgias. This client most likely has hepatitis:

B.

The nurse is caring for a client whose acute kidney injury (AKI) resulted from a prerenal cause. Which condition most likely caused this client's health problem? Burns Glomerulonephritis Ureterolithiasis Pregnancy

Burns

A client with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the client's prioritization for receiving a donor liver be determined?

By objectively determining the client's medical need

When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following? Gynecomastia Cutaneous spider angioma Caput medusae Palmar erythema

Caput medusae

A nurse is caring for a client with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL (408 mmol/L). For what complication is this client at risk?

Central nervous system damage

A client comes to the clinic to see the health care provider for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with?

Cholelithiasis

The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable?

Clients have chronic renal failure.

Which part of the kidney contains the nephrons?

Cortex

A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessments?

Daily weights and abdominal girth measurement

In which of the following renal disorders would one suspect a decreased urine specific gravity? Select all that apply Diabetes insipidus Glomerulonephritis Severe renal damage Diabetes Fluid deficits

Diabetes insipidus Glomerulonephritis Severe renal damage

During hemodialysis, toxins and wastes in the blood are removed by which of the following? Diffusion Osmosis Ultrafiltration Filtration

Diffusion

Which phase of acute renal failure signals that glomerular filtration has started to recover?

Diuretic

Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply. Limit protein to 1.6 g/kg/day. Eat foods such as milk, fish, and eggs. Restrict sodium to 2,000 to 3,000 mg daily. Increase potassium to prevent cardiac problems. Restrict fluid to daily urinary output plus 500 to 800 mL.

Eat foods such as milk, fish, and eggs. Restrict sodium to 2,000 to 3,000 mg daily. Restrict fluid to daily urinary output plus 500 to 800 mL.

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. Enlarged liver size Ascites Accelerated behaviors and mental processes Hemorrhoids Excess storage of vitamin C

Enlarged liver size Ascites Hemorrhoids

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is:

acute cholecystitis

A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome? Minimizing social isolation Establishing a stable home environment Reducing the spread of the disease Identifying the source of exposure to hepatitis

Minimizing social isolation

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure?

Nephrotoxic injury secondary to use of contrast media

A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when the client will be able to resume normal activities. What information should the nurse provide?

Normal activities may be resumed in 1 week.

A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding?

Octreotide

A patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first-line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices?

Octreotide (Sandostatin)

A nurse is caring for a client with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate?

Orange and foamy urine

Which of the following the are early manifestations of liver cancer? Select all that apply. Pain Continuous aching in the back Increased appetite Fever Jaundice Vomiting

Pain Continuous aching in the back

The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should physically assess what parameter(s)? Select all that apply. Quantity of output Color of the output Visible characteristics of the output Specific gravity of the output Potential hydrogen (pH) of the output

Quantity of output Color of the output Visible characteristics of the output

A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan?

Reduction in sodium intake

Common tests of renal function include which of the following? Select all that apply. Renal concentration test Creatinine clearance Serum creatinine Blood urea nitrogen (BUN) Arterial blood gas analysis

Renal concentration test Creatinine clearance Serum creatinine Blood urea nitrogen (BUN)

The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. Altered nutrition, more than body requirements, related to decreased activity and bed rest Risk for injury related to altered clotting mechanisms Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Urinary incontinence related to general debility and muscle wasting Disturbed body image related to changes in appearance, sexual dysfunction, and role function

Risk for injury related to altered clotting mechanisms Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Disturbed body image related to changes in appearance, sexual dysfunction, and role function

Which of the following is the most sensitive indicator of renal function? Serum creatinine Blood urea nitrogen (BUN) Creatinine clearance Potassium

Serum creatinine

The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis?

Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back

A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?

The physician will use an ultrasound guided paracentesis

A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply. The incubation period for this virus is up to 4 months. There is a 70% chance that jaundice will occur. Transmission of the virus is possible with oral-anal contact during sex. Typically there is a spontaneous recovery. There is a 50% risk that cirrhosis will develop.

There is a 70% chance that jaundice will occur. Transmission of the virus is possible with oral-anal contact during sex. Typically there is a spontaneous recovery.

A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for?

Transjugular intrahepatic portosystemic shunting (TIPS)

The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy?

Upright

The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply. Urine: RBC 20 BUN 28 mg/dL Urine: WBC 1 Serum creatinine 0.8 mg/dL Urine specific gravity 1.020

Urine: RBC 20 BUN 28 mg/dL

A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is:

anaphylaxis

A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for:

cardiac arrhythmia.

A nurse in the surgical ICU just received a client from recovery following a Whipple procedure. Which nursing diagnoses should the nurse consider when caring for this acutely ill client? Select all that apply. potential for infection acute pain and discomfort alterations in respiratory function fluid volume excess

potential for infection acute pain and discomfort alterations in respiratory function

A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply. Instructing the client to remove salty and salted foods from the diet Administering prescribed spironolactone (Aldactone) Assisting with placement of a transjugular intrahepatic portosystemic shunt Mobilizing the client every 2 hours Taking the client's weight every 3 to 4 days

Instructing the client to remove salty and salted foods from the diet Administering prescribed spironolactone (Aldactone) Assisting with placement of a transjugular intrahepatic portosystemic shunt

A client with acute pancreatitis has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, lab results indicate hypovolemia. What will the physician order to treat the large amount of protein-rich fluid that has been released into the client's tissues and peritoneal cavity? Select all that apply. diuretics albumin sodium dextrose solution

diuretics albumin

A client's health care provider has ordered a "liver panel" in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply. Alanine aminotransferase (ALT) C-reactive protein (CRP) Gamma-glutamyl transferase (GGT) Aspartate aminotransferase (AST) B-type natriuretic peptide (BNP)

Alanine aminotransferase (ALT) Gamma-glutamyl transferase (GGT) Aspartate aminotransferase (AST)

The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.

0.5

A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? Hemodialysis Peritoneal dialysis Continuous venovenous hemodialysis (CVVHD) Plasmapheresis

Continuous venovenous hemodialysis (CVVHD)

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver?

Excrete bile

Enlargement of the prostate causes which of the following to occur? Select all that apply. Frequency Oliguria Anuria Obstruction of urine flow Polyuria

Frequency Oliguria Anuria Obstruction of urine flow

A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply. Glucose metabolism Ammonia conversion Protein metabolism Carbohydrate metabolism Zinc storage

Glucose metabolism Ammonia conversion Protein metabolism

Acute dialysis is indicated during which situation?

Impending pulmonary edema

A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply. Infection at school Suboptimal sanitary habits Consumption of sewage-contaminated water or shellfish Sexual activity Ingestion of undercooked beef

Infection at school Suboptimal sanitary habits Consumption of sewage-contaminated water or shellfish Sexual activity

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?

Irritability and drowsiness Explanation: Although all the options are associated with hepatitis B, the onset of irritability and drowsiness suggests a decrease in hepatic function. To detect signs and symptoms of disease progression, the nurse should observe for disorientation, behavioral changes, and a decreasing level of consciousness and should monitor the results of liver function tests, including the blood ammonia level. If hepatic function is decreased, the nurse should take safety precautions.

Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? Palpate the abdominal wall for rebound tenderness. Inspect the catheter site for leakage of dialysate. Observe for evidence of bleeding. Measure fluid drainage to estimate incomplete recovery of fluid.

Palpate the abdominal wall for rebound tenderness. Explanation: Peritonitis is the most serious complication of peritoneal dialysis. To detect rebound tenderness, the nurse presses one hand firmly into the abdominal wall and quickly withdraws the hand. Rebound tenderness exists when pain occurs upon removal; this pain is associated with inflammation of the peritoneal cavity.