Online Practice Questions

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct? Kidneys convert inactive vitamin D to its active form, calcitriol. Calcitriol stimulates release of parathyroid hormone (PTH). Suppression of parathyroid hormone release is characteristic of CKD. Calcitriol blocks gastrointestinal absorption of calcium.

Kidneys convert inactive vitamin D to its active form, calcitriol. Explanation: Inactive vitamin D is converted to active calcitriol in the kidneys. Calcitriol enhances gastrointestinal absorption of calcium, and suppresses release of PTH. Elevated levels of PTH are characteristic of CKD as blood levels of phosphate rise and levels of calcium fall.

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema? Lower extremities Abdomen Eyelids Hands

Lower extremities Explanation: Initially, the edema caused by nephritic syndrome presents in the dependent parts of the body, such as the lower extremities, but becomes more generalized as the disease progresses

A nurse suspects a client may be experiencing flaccid bladder dysfunction based on 24-hour intake and output. Which diagnostic method is most likely to confirm or rule out whether the client is retaining urine? Blood test for creatinine, blood urea nitrogen, and glomerular filtration rate Urine test for culture and sensitivity Routine urinalysis Measurement of postvoid residual (PVR) by ultrasound

Measurement of postvoid residual (PVR) by ultrasound Explanation: Measurement of postvoid residual (PVR) can be achieved quickly, accurately, and painlessly by the use of ultrasonography. A PVR value of less than 50 mL is considered adequate bladder emptying, and more than 200 mL indicates inadequate bladder emptying. Urine tests and blood tests will not directly indicate whether a client is experiencing bladder fill with insufficiency in emptying.

A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which statement is the nurse likely to make? "Lupus is a disease of older individuals." "More women than men are affected by lupus." "Lupus is more common in white people." "Drug-induced lupus requires lifelong treatment."

More women than men are affected by lupus." Explanation: There is a female predominance of 10:1 in those with SLE. This ratio is closer to 30:1 during childbearing years. SLE is more common in blacks, Hispanics, and Asians than in whites, and the incidence in some families is higher than in others.

A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs "more fluids in my vein." The nurse responds: "Albumin will stay in your blood vessels a long time so that you will not seep out more fluid in your belly for at least a few weeks." "Albumin works like your diuretics to help you get rid of excess fluid through your kidneys. It's just more potent than your home water pills." "After the albumin, your potassium level will stay steady and you should keep excess water weight off for several weeks." "Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."

"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water." Explanation: Large-volume paracentesis (removal of 5 L or more of ascitic fluid) may be done in persons with massive ascites and pulmonary compromise. Because the removal of fluid produces a decrease in vascular volume along with increased plasma renin activity and aldosterone-mediated sodium and water reabsorption by the kidneys, a volume expander such as albumin usually is administered to maintain the effective circulating volume.

The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which statement? "Alterations in bladder function can include urinary obstruction with retention or stasis of urine." "Alterations in bladder function can include urinary incontinence with involuntary loss of urine." "Alterations in bladder function can only occur when there is incontinence." "Alterations in bladder function occurs frequently in the elderly."

"Alterations in bladder function can only occur when there is incontinence." Explanation: Alterations in bladder function include urinary obstruction with retention or stasis of urine and urinary incontinence with involuntary loss of urine. Alterations in bladder function does occur more frequently with aging.

A client has been diagnosed with rheumatoid arthritis (RA). What will the nurse tell the client about this disorder's etiology? "Environment is the biggest contributing factor to the development of RA." "Exposure to workplace chemicals is a causative agent." "Genetic predisposition is very likely." "The disease is most common in those under 30."

"Genetic predisposition is very likely." Explanation: The cause of RA is uncertain but evidence points to genetic predisposition. The disease usually occurs later in life.

A middle-aged adult is diagnosed with diverticular disease based on recent history and the results of a computed tomography (CT) scan. Which statement demonstrates an accurate understanding of this diagnosis? "From now on, I'm going to stick to an organic diet and start taking more supplements." "I think this might have happened because I have used enemas and laxatives too much." "I have always struggled with heartburn and indigestion, and I guess I should not have ignored those warning signs." "I suppose I should try to eat a bit more fiber in my diet."

"I suppose I should try to eat a bit more fiber in my diet." Explanation: Increased bulk/fiber is important in both the prevention and treatment of diverticular disease. Overuse of laxatives is not linked to diverticular disease, and heartburn and indigestion are not specific signs of the problem. An organic diet and the use of dietary supplements are not key treatments.

A client with a recent diagnosis of renal failure requiring hemodialysis is being educated in the dietary management of the disease. Which statement by the client shows an accurate understanding of this component of treatment? Select all that apply. "I'll increase the carbohydrates in my diet to provide sufficient energy." "I've made a list of high-phosphate foods so that I can try to avoid them." "I'm making a point of trying to eat lots of bananas and other food rich in potassium." "I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day." "I'm going to try a high-protein, low-carbohydrate diet."

"I'll increase the carbohydrates in my diet to provide sufficient energy." "I've made a list of high-phosphate foods so that I can try to avoid them." Persons with chronic kidney disease (CKD) are usually encouraged to limit their dietary phosphorus as a means of preventing secondary hyperparathyroidism, renal osteodystrophy, and hypocalcemia. Excessive protein, potassium, and fluids can be detrimental in individuals whose kidney disease requires hemodialysis. Because protein intake is limited, carbohydrate consumption should increase to meet daily energy requirements.

A client with rheumatoid arthritis is taking high doses of aspirin to control inflammatory pain. Which statement leads the health care provider to suspect the client is experiencing an adverse reaction? "I can't go to the movies anymore. It's so noisy, I miss half the words." "I've been getting a lot of upset stomach attacks and I think I saw some blood in my stool." "I get dizzy and lightheaded sometimes." "When my grandchildren whisper, I can't hear a word they are saying."

"I've been getting a lot of upset stomach attacks and I think I saw some blood in my stool." Explanation: The incidence of adverse reactions to the nonsteroidal anti-inflammatory drugs (like gastric irritation and bleeding, fluid retention, and kidney damage) tends to increase with age and long-term use. Hearing loss in older adults is further characterized by reduced hearing sensitivity and speech understanding in noisy environments, slowed central processing of acoustic information, and impaired localization of sound sources. High-frequency warning sounds, such as beepers, turn signals, and escaping steam, are not heard and localized, with potentially dangerous results. Clinical measures for hearing loss such as whispered voice tests and finger friction tests are reportedly imprecise and are not reliable methods for screening.

With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury? "The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney." "Prescribed medications may not be monitored as closely as they should be since Medicare does not reimburse for routine laboratory testing." "The health care provider does not always monitor for toxicity at each follow-up appointment." "Every drug dosage should be determined by client weight but most clients refuse to get on the scale."

"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney." Explanation: Alterations in pharmacokinetics occur with advancing age and increase the likelihood of toxic reactions. The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney. The toxic effects, which cause some minor necrosis, are generally limited to the proximal tubule. In addition, the kidney is an important site for metabolic processes that transform relatively harmless agents into toxic metabolites. It would not necessarily be effective care to rely on medication therapy as only a last resort. Monitoring would not prevent toxicity but rather identify it earlier. Not all medications can be prescribed by a client's weight.

A client with bladder cancer asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to go for treatments over months and months?" The best response would be: "This is when they put the chemotherapy directly into the bladder to kill any cancer cells." "They will take you to radiology and inject some chemotherapy through your abdomen into your bladder." "The doctor will place a scope up your urethra, into the bladder, and burn the lining of the bladder with a laser and then inject some tuberculosis bacillus into the lining." "This is when they use a CyberKnife to cut off any lesions and then inject chemotherapy into the remaining portion of the bladder."

"This is when they put the chemotherapy directly into the bladder to kill any cancer cells." Explanation: Surgical treatment of superficial bladder cancer is often followed by intravesicular chemotherapy or immunotherapy, a procedure in which the therapeutic agent is directly instilled into the bladder. None of the other responses describe this procedure. The chemotherapy drug is not injected through the abdomen into the bladder. Bacillus Calmette-Guerin (BCG) vaccine is instilled into the bladder to elicit an inflammatory response that can kill the tumor. A CyberKnife is used with the brain, not the bladder.

A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client? "This is a normal value." "This value indicates you are having difficulty emptying your bladder." "This value indicates you are emptying your bladder too completely." "This test indicates you do not have adequate bladder control."

"This value indicates you are having difficulty emptying your bladder." Explanation: The nurse should inform the client that values over 200 mL indicate an inability to adequately empty the bladder and that further evaluation is necessary. It is not a normal value, nor does it indicate that the client does or does not have adequate bladder control.

A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized? "It is important to begin with vigorous exercise of the affected area as soon as the cast is removed." "To prevent cartilage atrophy, slowly and gradually resume exercising." "Once the elbow has been casted, you will not be able to exercise that joint for 3-6 months." "If you take a nonsteroidal anti-inflammatory medication prior to exercise, you will be able regain mobility faster."

"To prevent cartilage atrophy, slowly and gradually resume exercising." Explanation: Cartilage atrophy is rapidly reversible with activity after a period of immobilization; impact exercise during the period of remobilization can prevent reversal of the atrophy. Slow and gradual remobilization may be important in preventing cartilage injury.

The nurse is evaluating client risk for the development of overactive bladder/urge incontinence and determines that which client is at highest risk for this condition? A client who gave birth to two large-for-gestational age infants A client with diabetes mellitus A client embarrassed to use a bedpan A client whose arthritis makes walking difficult

A client with diabetes mellitus Explanation: Overactive bladder/urge incontinence can be caused by disorders of the detrusor muscle structure, which can occur as the result of the aging process or disease conditions such as diabetes mellitus. A stroke client develops this condition as a result of neurogenic causes rather than having a disorder of detrusor muscle problem.

A parent brings his child to the emergency department after the child sustains a fall from a tree. The child has severe right arm pain. A radiograph shows a complete break in the humerus with multiple pieces of bone at the fracture line and the skin is not broken. This type of fracture is classified as: A compound, compression fracture A closed, comminuted fracture A closed, greenstick fracture An open, impacted fracture

A closed, comminuted fracture Explanation: The type of fracture is determined by its communication with the external environment, the degree of break in continuity of the bone, and the character of the fracture pieces. A fracture can be classified as open or closed. When bone fragments have broken through the skin, the fracture is called an open or compound fracture. The character of a fracture is determined by its pieces. A comminuted fracture has more than two pieces. A fracture is called impacted when the fracture fragments are wedged together. A greenstick fracture is a type of partial break in the continuity of the bone.

A client has begun to display manifestations of hepatic encephalopathy. The family is concerned and asks the nurse what caused this condition to develop. Which is the best response by the nurse? Accumulation of ammonia in the blood Lack of hemoglobin in the blood Increase of clotting factors in the blood Intake of a high-protein, high-fat diet

Accumulation of ammonia in the blood Explanation: Hepatic encephalopathy occurs in liver failure and results from the liver being unable to convert ammonia to urea. Ammonia moves directly into the general circulation and from there to the cerebral circulation, resulting in central nervous system manifestations. Hepatic encephalopathy may become worse after a large protein meal or gastrointestinal tract bleeding. A client with liver disease would have decreased clotting factors. Hemoglobin levels would not cause encephalopathy.

A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is this? Aspirin Acetaminophen Ibuprofen Phenylephrine

Acetaminophen Explanation: The drug most commonly involved is acetaminophen, with half the cases reported to be unintentional overdoses. Unintentional overdoses may occur when people unknowingly take several over-the-counter preparations that contain acetaminophen (e.g., an acetaminophen containing cold preparation and acetaminophen pain medication). Phenylephrine is a nasal decongestant often combined with acetaminophen for relief of cold symptoms.

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication? Cerebral hemorrhage Acute tubular necrosis Bilateral pneumothorax Complete heart block

Acute tubular necrosis Explanation: Complications of acute pancreatitis include the systemic inflammatory response, acute respiratory distress syndrome, acute tubular necrosis, and organ failure. Cerebral hemorrhage, bilateral pneumothorax, and complete heart block are not associated with the complications of acute pancreatitis.

A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs? Administration of diuretics as ordered to promote frequent bladder emptying Administration of alpha-adrenergic agonist drugs as ordered Bladder ultrasonography two to three times daily Intermittent catheterization

Administration of alpha-adrenergic agonist drugs as ordered Explanation: The client likely has stress incontinence, for which alpha-adrenergic agonist drugs may be ordered. Diuretics are not used to treat incontinence. Bladder ultrasound neither assesses nor treats stress incontinence. Catheterization does not address the underlying problem.

The nurse is assessing a client's risk for osteoarthritis. Which factor places the client at greatest risk for this condition? Age Injury Social status Exposure to smoke

Age Explanation: Age is the single greatest risk factor for development of osteoarthritis, in part because of the mechanical impact on joints over time. Other factors, such as obesity, injury, and heredity can also play a part, but age is the single greatest risk factor. Smoke exposure and social status are not identified risk factors for osteoarthritis.

A client with history of alcohol abuse is brought to the emergency department after a weekend of heavy drinking, experiencing right upper quadrant pain, anorexia, nausea, jaundice and ascites. The nurse identifies these as manifestations of what disorder? Fatty liver Alcoholic hepatitis Cancer of the gallbladder Cholestasis

Alcoholic hepatitis Explanation: Fatty liver occurs when there is an accumulation of fat in the liver cells. The liver enlarges and becomes yellow. The fatty changes are reversible when alcohol intake stops. Alcoholic hepatitis is the next stage of liver disease after fatty liver. It is common when there is a sudden increase in alcohol intake and has a mortality rate of approximately 34 percent. The liver becomes inflamed and necrosis occurs. If the client survives and continues to use alcohol, alcoholic hepatitis develops into alcoholic cirrhosis. The liver develops fine, uniform nodules on the surface. As the disease progresses, the nodules become larger, and blood flow is obstructed resulting in portal hypertension, extrahepatic portosystemic shunts, and cholestasis. Gallbladder cancer occurs insidiously and has similar signs/symptoms as cholelithiasis.

Which client would be considered high risk for falling and fracturing the hip? A 54-year-old man with obesity and short stature A 36-year-old woman whose diet consists of excessive sugar intake A 77-year-old man with hearing impairment and corrective eye lenses An 81-year-old woman taking medication for osteoporosis

An 81-year-old woman taking medication for osteoporosis Explanation: Risk factors for hip fracture include excessive consumption of alcohol and caffeine (rather than sugar), physical inactivity, low body weight, tall stature, use of certain psychotropic drugs, residence in an institution, visual impairment (rather than hearing), and dementia. Osteoporosis weakens the bone and is an important contributing factor. Most hip fractures result from falls.

A client has been admitted with hepatocellular jaundice as a result of taking medications. From the following list of medications in the client's home, which medications may place the client at high risk for developing hepatocellular jaundice? Select all that apply. Oral contraceptives for birth control Nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain Anabolic steroids taken for body building Isoniazid for tuberculosis Ciprofloxacin for recurrent sinus infection.

Anabolic steroids taken for body building Isoniazid for tuberculosis Oral contraceptives for birth control Explanation: Intrahepatic or hepatocellular jaundice is caused by disorders that directly affect the ability of the liver to remove bilirubin from the blood or conjugate it so it can be eliminated in the bile. Liver diseases such as hepatitis and cirrhosis are the most common causes of intrahepatic jaundice. Drugs such as the anesthetic agent halothane, oral contraceptives, estrogen, anabolic steroids, isoniazid, rifampin, and chlorpromazine may also be implicated in this type of jaundice. NSAIDs and ciprofloxacin are not common causes of jaundice.

Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD? Polycythemia Erythrocythemia Anemia Leukocytosis

Anemia

Which type of pharmacologic therapy does the nurse anticipate administering to a client for treatment of a spastic bladder in order to decrease bladder hyperactivity? Anticholinergic medications Antibiotics Biofeedback Calcium channel blockers

Anticholinergic medications Explanation: Among the methods used to treat spastic bladder and detrusor-sphincter dyssynergia are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying. Antibiotics are used to treat urinary tract infections. Biofeedback is a behavioral method of treatment. Calcium channel blockers would not be effective in treating this disorder.

A client suffers a musculoskeletal injury while participating in a sporting event. Which treatment is most appropriate initially? Applying an elastic wrap and returning to the game Applying ice and sitting out the rest of the game Applying a splint after straightening the limb Applying heat and massaging the limb

Applying ice and sitting out the rest of the game Explanation: The initial treatment of a musculoskeletal injury involves rest, ice, compression, and elevation. These activities reduce pain, swelling, and further injury. In some injuries, elevation followed by local application of cold may be sufficient. Any immobilization device should be applied in a functional position. If there is a deformity, there should be no attempt to straighten the limb.

The health care provider is evaluating a client who is at risk for the development of osteonecrosis. The client is at risk for: Aseptic necrosis of a bone segment caused by interruption of the blood supply An acute infection of the bone An chronic infection of the bone Development of an unspecified mass or growth on the bone

Aseptic necrosis of a bone segment caused by interruption of the blood supply Explanation: Osteonecrosis, also known as avascular necrosis, is an aseptic destruction of a segment of bone that is due to an interruption in blood flow rather than an infection. It is relatively common and can occur in the medullary cavity of the metaphysis and the subchondral region of the epiphysis, especially in the hips, knees, shoulders, and ankles. Destruction of bone frequently is severe enough to require joint replacement surgery.

A nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease? Infectious process Autoimmune process Genetic disorder Ischemic response

Autoimmune process Explanation: The cause of SLE is unknown. It is characterized by the formation of autoantibodies and immune complexes.

Symptoms of gastric cancer include vague epigastric pain, which makes early detection difficult. The nurse would expect a client to undergo which diagnostic examination to determine the location of the gastric cancer? Blood test Chemotherapy Barium x-ray Occult blood

Barium x-ray Explanation: Diagnosis of gastric cancer is accomplished by a variety of techniques, including barium x-ray studies, endoscopic studies with biopsy, and cytologic studies of gastric secretions. Cytologic studies can prove particularly useful as routine screening tests for persons with atrophic gastritis or gastric polyps. Computed tomography and endoscopic ultrasonography often are used to delineate the spread of a diagnosed stomach cancer. Treatment of choice, depending on location and extent, are surgery, irradiation, and chemotherapy.

The client has right upper quadrant pain caused by acute choledocholithiasis. The health care provider suspects the common bile duct is obstructed, based on which flowing lab value? Albumin 2.0 g/dL (20 g/L) (low) Amylase 150 units/L (2.50 µkat/L) (high) Bilirubin 15 mg/dL (256.56 µmol/L) (high) Serum calcium level 7 mg/dL (1.75 mmol/L) (low)

Bilirubin 15 mg/dL (256.56 µmol/L) (high) Explanation: Choledocholithiasis, stones in the common duct, usually originate in the gallbladder but can form spontaneously in the common duct. Bilirubinuria and an elevated serum bilirubin are present if the common duct is obstructed. With acute cholecystitis, approximately 75% of clients have vomiting. Ascites is common with late-stage liver failure rather than duct obstructions. Bleeding is associated with liver failure due to deficiency of clotting factors and acute pancreatitis due to activated enzymes, causing fat necrosis and hemorrhage from the necrotic vessels.

A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescribed to help determine the cause of these new symptoms? Blood work for white cells and differential Cystoscopy and ureteroscopy Assessment of pancreatic exocrine and endocrine function Blood work for hemoglobin, red blood cells, and hematocrit

Blood work for hemoglobin, red blood cells, and hematocrit Anemia is a frequent and debilitating consequence of CKD. The anemia may be due to chronic blood loss, hemolysis, bone marrow suppression due to retained uremic factors, and decrease in red cell production due to impaired production of erythropoietin and iron deficiency. Pancreatic function is not typically affected by CKD, and endoscopic examination is less likely to reveal a cause of fatigue. An infectious etiology is possible and would be informed by white cell assessment, but this is less likely than anemia given the client's report of symptoms.

Hospitalized neonates are at greatest risk of developing septicemia related to which procedure? Catheter-associated bacteriuria Collection of urine for analysis Arterial blood gas measurement Suctioning of tracheostomy

Catheter-associated bacteriuria Explanation: Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized neonates. The other procedures can cause bacteremia but are not the primary cause for this.

Which client would the nurse consider having the highest risk for developing a urinary tract infection? Client with obstructed urinary outflow from a kidney stone Client with infective endocarditis Client with septicemia Client with high levels of glucose in the urine

Client with obstructed urinary outflow from a kidney stone Explanation: Factors that contribute to the development of ascending infections of the urinary tract are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, sexually active women, postmenopausal women, and neurogenic bladder.

The incidence of stomach cancer has significantly decreased in the United States, yet it remains the leading cause of death worldwide. The nurse understands the reason for the high mortality rate in stomach cancer is because of which reason? The progression of the disease is rapid. Clients are afraid to talk about their symptoms. Clients have few early symptoms of the disease. Diagnostic testing is not available for detection of the disease.

Clients have few early symptoms of the disease. Explanation: Although the incidence of cancer of the stomach has declined over the past 50 years in the United States, it remains the leading cause of death worldwide. Because there are few early symptoms with this form of cancer, the disease is often far advanced at the time of diagnosis. Diagnosis of gastric cancer is accomplished by a variety of techniques, including barium x-ray studies, endoscopic studies with biopsy, and cytologic studies (e.g., Papanicolaou smear) of gastric secretions. Chronic infection with Helicobacter pylori appears to serve as a cofactor in some types of gastric carcinomas. The bacterial infection causes gastritis, followed by atrophy, intestinal metaplasia, and carcinoma.

Crohn disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which description? Mosaic Pyramidal Cobblestone Triangular

Cobblestone Explanation: A characteristic feature of Crohn disease is the sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. When there are multiple lesions, they are often referred to as "skip lesions" because they are interspersed between what appear to be normal segments of the bowel. The surface of the inflamed bowel usually has a characteristic "cobblestone" appearance resulting from the fissures and crevices that develop, surrounded by areas of submucosal edema.

An older adult client has been placed on a broad-spectrum antibiotic for a recurrent urinary tract infection. Which potential problem would the nurse anticipate in this client? Colonization of Clostridium difficile Transmission of Escherichia coli Dehydration Inability to eat

Colonization of Clostridium difficile Explanation: Clostridium difficile colitis is associated with antibiotic therapy. Almost any antibiotic may cause C. difficile colitis, but broad-spectrum antibiotics with activity against Gram-negative enteric bacteria are the most frequent agents. After antibiotic therapy has made the bowel susceptible to infection, colonization by C. difficile occurs by the oral-fecal route.

Which type of fracture involves healing of more than two pieces of bone? Comminuted fracture Transverse fracture Oblique fracture Midshaft fracture

Comminuted fracture Explanation: Comminuted fractures have more than two pieces of bone that need to heal.

The nurse is assessing a client who sustained a fractured radius. A cast was applied to the extremity approximately 1 hour ago, and the client is now complaining of increased pain and numbness to the finger tips. The client is most likely experiencing: Compartment syndrome Complex regional pain syndrome Fracture blisters Thromboemboli

Compartment syndrome Explanation: Compartment syndrome occurs as a result of increased pressure within a limited space (e.g., abdominal and limb compartments) that compromises the circulation and function of the tissues within the space. The hallmark symptom of an acute compartment syndrome is severe pain that is out of proportion to the original injury or physical findings. Nerve compression may cause changes in sensation (e.g., paresthesias such as burning or tingling or loss of sensation), diminished reflexes, and eventually the loss of motor function. Fracture blisters are skin bullae and blisters. The complex regional pain syndrome or reflex sympathetic dystrophy is caused by involvement of nerve fibers.

A client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse should anticipate educating this client with regard to which common treatment regimen? Increase intake of cranberry juice to 2 L/day. Continue taking antibiotics for 10 to 14 days even if symptoms of infection disappear. Force micturition every 2 hours while awake. Take prescribed diuretics early in the day to avoid having to get up during the night.

Continue taking antibiotics for 10 to 14 days even if symptoms of infection disappear. Explanation: Chronic pyelonephritis involves a recurrent or persistent bacterial infection superimposed on urinary tract obstruction, urine reflux, or both. Chronic obstructive pyelonephritis can be bilateral (caused by conditions that obstruct bladder outflow) or unilateral (such as occurs with ureteral obstruction). Cranberry juice, forced micturition, and diuretics are not standard treatments for chronic pyelonephritis.

The nurse is conducting preoperative teaching for a client with bladder cancer who is scheduled to undergo surgical creation of an alternative bladder reservoir. The nurse determines that the client is understanding the preoperative teaching when the client identifies the surgical treatment as: Cystectomy Diathermy Endoscopic resection Segmental surgical resection

Cystectomy Explanation: A cystectomy requires the creation of a urinary diversion (reservoir) that collects the urine, and it is usually created from the ileum.

The nurse is caring for a client with several fractures that have been immobilized. Which assessment finding would be most indicative of a potential complication? Pulses palpable with warm skin Pulse 105 bpm, blood pressure 134/86 mm Hg Peripheral capillary refill 2 seconds Deep, severe, unrelenting pain

Deep, severe, unrelenting pain Explanation: Complications of fractures include compartment syndrome, when swelling after the injury impairs blood and nerve function. As the tissue is compressed, the extremity becomes edematous, has reduced capillary refill, is cold, and the pain is described as severe (and out of proportion to the original injury); additionally, the pain is not relieved by medication or positioning. Some elevation of vital signs is not unusual with acute pain and does not automatically indicate a complication.

What factor may adversely affect bone healing? Immobilization Weight bearing Delayed union Tight alignment

Delayed union Explanation: Delayed union is the failure of a fracture to unite within the normal period (e.g., 20 weeks for a fracture of the tibia or femur in an adult). Malunion is caused by inadequate reduction or malalignment of the fracture. For healing to occur, the bone needs to be aligned and immobilized to maintain the alignment during bone remodeling. Weight-bearing helps to maintain some muscle tone while the bone is immobilized, avoiding muscle atrophy and loss of range of motion.

Disruption of which muscle's contraction can lead to the inability to expel urine from the bladder? Trigone Sphincter Detrusor Trabeculae

Detrusor

A client with quadriplegia adheres to a regular bowel protocol. Which action performed by the client's caregiver is likely to promote defecation? Digital stimulation of the client's rectum Massage of the client's abdomen Seating the client in an upright position Administration of large amounts of free water

Digital stimulation of the client's rectum Explanation: When the nerve endings in the rectum are stimulated, signals are transmitted first to the sacral cord and then reflexively back to the descending colon, sigmoid colon, rectum, and anus by the pelvic nerves. These impulses greatly increase peristaltic movements as well as relax the internal sphincter, resulting in defecation. Massage, increased fluid intake, and upright positioning are less likely to promote defecation.

A pregnant woman who is beginning her third trimester has been diagnosed with a urinary tract infection (UTI). Which factors most likely predisposed this client to the development of a UTI? Increased urine alkalinity during pregnancy Hypertrophy of the bladder wall Dilation of the upper urinary structures Spastic peristalsis of the ureters

Dilation of the upper urinary structures Explanation: Normal changes in the functioning of the urinary tract that occur during pregnancy predispose to UTIs. These changes involve the collecting system of the kidneys and include dilation of the renal calyces, pelves, and ureters that begin during the first trimester and become most pronounced during the third trimester. Bladder hypertrophy, spastic peristalsis, and increased urine pH are not phenomena that are common accompaniments to pregnancy.

A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output? Onset phase Diuretic phase Oliguric phase Recovery phase

Diuretic phase Explanation: The onset phase lasts hours/days and is the time from the onset of the precipitating event until tubular injury occurs. The oliguric phase is characterized by a marked decrease in glomerular filtration rate, causing sudden retention of endogenous metabolites, such as urea, potassium, sulfate, and creatinine. The diuretic phase occurs when the kidneys try to heal and one will see an increase/excessive output (diuresis) of dilute urine. The recovery phase is the period during which tubular edema resolves and renal function improves. There is normalization of fluid and electrolyte balance.

What is the most common cause of a lower urinary tract infection?

E. coli

A client with chronic kidney disease (CKD) asks the nurse, "Why do I itch all the time?" The nurse bases there response on which integumentary physiologic factors that causes pruritis? Select all that apply. Too harsh of soap while bathing Decrease in perspiration Limited sodium intake Enlarged size of sweat glands Elevated serum phosphate levels

Elevated serum phosphate levels Decrease in perspiration Dry, itchy skin is a common consequence of CKD. Pruritus is common; it results from the high serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism. Harsh soap (may dry the skin), limited Na+ intake, and enlarged sweat glands are not noted to accompany or result in pruritus.

The nurse is assessing a client who has been diagnosed with gastroesophageal reflux disease (GERD). The nurse recognizes which sign/symptom may be associated with GERD? Select all that apply. Epigastric pain Retrosternal pain Wheezing Hoarseness Heartburn before eating Relief of discomfort with aspirin

Epigastric pain Retrosternal pain Wheezing Hoarseness The most frequent symptom of GERD is heartburn. It frequently is severe, occurring 30 to 60 minutes after eating. A recumbent position may increase pain and usually is relieved by sitting upright. Often, the heartburn occurs during the night. Antacids provide prompt, although transient, relief. Other symptoms include belching and chest pain. The pain usually is located in the epigastric or retrosternal area and often radiates to the throat, shoulder, or back. The pain may be confused with angina. The reflux of gastric contents also may produce respiratory symptoms such as wheezing, chronic cough, and hoarseness. Aspirin would increase distress.

Pharmacologic treatment for peptic ulcers has changed over the past several decades. The nurse knows that the goal for pharmacologic treatment is focused on: Increasing acid production Neutralizing blood count Promoting special diet Eradicating Helicobacter pylori (H. pylori)

Eradicating Helicobacter pylori (H. pylori) Explanation: Treatment of peptic ulcer is aimed at eradicating the cause and promoting a permanent cure for the disease. Pharmacologic treatment focuses on eradicating H. pylori, relieving ulcer symptoms, and healing the ulcer crater. Acid-neutralizing, acid-inhibiting drugs and mucosa-protective agents are used to relieve symptoms and promote healing of the ulcer crater. There is no evidence that special diets are beneficial in treating peptic ulcer.

Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra.

Escherichia coli Explanation: Most commonly, urinary tract infections (UTIs) are caused by Escherichia coli bacteria that enter through the urethra. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs, and both non-E. coli Gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and Gram-positive cocci (Staphylococcus aureus, Group B Streptococcus) in complicated UTIs.

A client had developed jaundice. The nurse recognizes that the jaundice may have resulted from which cause? Select all that apply. Excessive destruction of red blood cells Impaired uptake of bilirubin by the liver cells Decreased conjugation of bilirubin Obstruction of bile flow Decreased production of bile Impaired production of red blood cells

Excessive destruction of red blood cells Impaired uptake of bilirubin by the liver cells Decreased conjugation of bilirubin Obstruction of bile flow The four major causes of jaundice are excessive destruction of red blood cells, impaired uptake of bilirubin by the liver cells, decreased conjugation of bilirubin, and obstruction of bile flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts.

A child tripped while running in the yard and reports pain with weight bearing. The next morning, the foot is swollen, discolored, and painful to touch and pressure of walking. About which problem will the health care provider likely be talking to the parents and the child related to this injury? Strained ligament Bone cancer Fractured bone Nerve impingement

Fractured bone Explanation: The signs and symptoms of a fracture include pain, tenderness at the site, swelling, loss of function, deformity of the affected part, and abnormal mobility. If nerve impingement occurs, there will be numbness of the affected area. A sprain is a stretch or tear in a ligament. Ligaments are bands of fibrous tissue that connect bones to bones at joints. A strain is also a stretch or tear, but it happens in a muscle or a tendon. Signs and symptoms of bone cancer include bone pain, swelling and tenderness near the affected area, fatigue and unintended weight loss.

A client informs the nurse that she is afraid of developing bladder cancer because her mother had it. She asks the nurse what signs and symptoms are present with this cancer. What does the nurse tell the client is the most common sign of bladder cancer? Frequent urination Gross hematuria Pus in urine Amber-colored urine

Gross hematuria Explanation: The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in the majority of cases. Frequency, urgency, and dysuria occasionally accompany the hematuria.

The most common forms of peptic ulcer are duodenal and gastric ulcers. What is the most common risk factors for peptic ulcer disease?

Helicobacter pylori (H. pylori) Explanation: Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. H. pylori promotes the development of peptic ulcers by inducing inflammation and stimulation of cytokines and other mediators of inflammation that contribute to mucosal damage. There is no convincing evidence that dietary factors play a role in development of peptic ulcers.

Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? Urinary urgency Hematuria Oliguria Cloudy urine

Hematuria Explanation: Presenting features of renal cancer include hematuria, flank pain, and presence of a palpable flank mass. Gross or microscopic hematuria, which occurs in more than 50% of cases, is an important clinical clue. Urgency, oliguria, and cloudy urine are not as closely associated with renal carcinoma.

A client in the intensive care unit is receiving a blood transfusion. The client immediately developed a reddish-color urine flowing into the Foley bag. What is likely the cause of this red urine and what priority intervention should the nurse implement? Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be stopped immediately. Myoglobinuria causes urine color change and is associated with muscle destruction; call the health care provider immediately. Trauma to the urethra can cause blood in the urine; increase the fluid intake by increasing IV flow rate. Exposure to bacteria causing urinary tract infection with bleeding; contact health care provider for antibiotic prescription.

Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be stopped immediately.

A nurse is caring for a client who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this client? Hydration Bed rest Bowel elimination Skin care

Hydration Explanation: A major goal of treatment in people who have passed kidney stones or have had them removed is to prevent their recurrence. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged.

The nurse is caring for a client with right upper quadrant pain secondary to acute choledocholithiasis. If the common bile duct becomes obstructed, which manifestation will the nurse expect? Ascites Vomiting Hyperbilirubinemia Hemorrhage

Hyperbilirubinemia Explanation: Choledocholithiasis, stones in the common duct, usually originate in the gallbladder but can form spontaneously in the common duct. Bilirubinuria and an elevated serum bilirubin (hyperbilirubinemia) are present if the common duct is obstructed. With acute cholecystitis, approximately 75% of clients have vomiting. Ascites is common with late-stage liver failure rather than duct obstructions. Bleeding is associated with liver failure due to deficiency of clotting factors, and is also associated with acute pancreatitis due to activated enzymes causing fat necrosis and hemorrhage from the necrotic vessels.

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication? Hyperglycemia due to inability to synthesize insulin Nutritional imbalance due to inability to synthesize protein Bleeding related to lack of clotting factors Gallstones related to inability to digest fat

Hyperglycemia due to inability to synthesize insulin Explanation: The endocrine pancreas supplies the insulin needed to lower glucose levels in the blood; damage to the pancreas may alter this function, causing hyperglycemia.

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display? Hypertension Impotence Terry nails Asterixis

Hypertension: Hypertension is commonly an early manifestation of CKD. The mechanisms that cause the hypertension are multifactorial: they include increased vascular volume, increased peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system. Impotence occurs in as many as 56% of males on dialysis. Terry nails are a dark band just behind the leading edge of a fingernail followed by a white band that occurs in the late stages. Asterixis, a sign of hepatic encephalopathy, is due to the inability of the liver to metabolize ammonia to urea.

An older adult client has had mobility and independence significantly impaired by the progression of rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this client's decline in health? A mismatch between bone resorption and remodeling Immunologically mediated joint inflammation Excessive collagen production and deposition Cytokine release following mechanical joint injury

Immunologically mediated joint inflammation Explanation: The pathogenesis of RA can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joint architecture. Paget disease is caused by abnormal bone resorption and remodeling, whereas collagen deposition underlies scleroderma. Osteoarthritis is believed to be initiated by mechanical injury and subsequent cytokine release.

The health care provider has completed the assessment on a client with jaundice. The provider determines that which pathophysiologic abnormality could cause the jaundice? Impaired uptake of bilirubin by the liver Increased conjugation of bilirubin Increased red blood cell development Decreased oxygen demands at birth

Impaired uptake of bilirubin by the liver Explanation: The five major causes of jaundice are (1) excessive destruction of RBCs, (2) impaired uptake of bilirubin by the liver cells, (3) decreased conjugation of bilirubin, (4) obstruction of the bowel flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts, and (5) excessive extrahepatic production of bilirubin. Jaundice would not occur as a result of decreased oxygen. Jaundice in newborns is the result of the breakdown of fetal hemoglobin.

Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction? Distended abdominal area Failure to void for 8 or more hours Incontinence Severe cramping

Incontinence Explanation: A spastic bladder condition causes inability to store urine. Incontinence would be a symptom of inability to store urine.

A client reports urinary incontinence, specifically not feeling the urge to urinate until the bladder voids uncontrollably. Client history shows type 1 diabetes of 40+ years and compliance with medication and diet. What is the most likely diagnosis? Incontinence caused by stress on the bladder Incontinence related to having large volumes stored in the bladder Incontinence caused by a physical block in the urethra Incontinence related to neuropathy causing overactive bladder

Incontinence related to neuropathy causing overactive bladder Explanation: Neural damage is brought about by chronic diabetes and can result in the loss of control of the detrusor muscle. Stress, urge, and functional incontinence are all caused by pressure or blockage.

The nurse is assessing a client who has a unilateral obstruction of the urinary tract. Which clinical finding by the nurse correlates to this diagnosis? Increase in blood pressure Excretion of dilute urine Increased urine output Inability to control urination

Increase in blood pressure Explanation: Hypertension is an occasional complication of urinary tract obstruction. It is more common in cases of unilateral obstruction in which renin secretion is enhanced, probably secondary to impaired renal blood flow. In these circumstances, removal of the obstruction often leads to a reduction in blood pressure. The urine output would be decreased and not diluted.

The client has a cast applied for a fractured tibia. Which physiologic response to the fracture places this client at risk for compartment syndrome? Inflammation causes increase in volume but cast limits compartment size Joint immobility due to the cast placement Muscle atrophy from lack of ability to exercise Extremity elevation on pillows makes it hard for blood to circulate

Inflammation causes increase in volume but cast limits compartment size Explanation: One of the most important causes of compartment syndrome is bleeding and edema caused by fractures and bone surgery. Compartment syndrome can result from a decrease in compartment size caused by constrictive dressings and casts; increased content volume caused by inflammation, swelling, bleeding, and venous obstruction; or a combination of the two factors. Muscle atrophy decreases volume of contents; casting (rather than immobility caused by the cast) can compress the compartment. Extremity elevation enhances venous return and decreases edema.

A client presents for follow-up with ongoing treatment for peptic ulcer disease. What is the most likely goal of this client's pharmacologic treatment? Inhibiting gastric acid production Promoting hypertrophy of the gastric mucosa Increasing the rate of gastric emptying Increasing muscle tone of the cardiac sphincter

Inhibiting gastric acid production Explanation: Current therapies for peptic ulcer disease are aimed at neutralization of gastric acid, inhibition of gastric acid (H2 antagonists and proton pump inhibitors), and promotion of mucosal protection. Growth of the mucosa itself, strengthening the gastrointestinal (GI) sphincters, and changing the rate of stomach emptying are not goals of the usual pharmacologic treatments for peptic ulcers.

A client with a history of peptic ulcer disease presents to the emergency department with the following symptoms: early satiety, feeling of epigastric fullness and heaviness after meals, weight loss, and vomiting. The nurse suspects that the peptic ulcer has caused which problem? Perforation Obstruction Penetration Obtrusion

Obstruction Explanation: Outlet obstruction is caused by edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas. The presentation of an obstruction is typically insidious, with symptoms of early satiety, feeling of epigastric fullness and heaviness after meals, gastroesophageal reflux, weight loss, and abdominal pain. With severe obstruction, there is vomiting of undigested food.

The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication? Obstruction of the renal tubules with myoglobin and damaged tubular cells Hypokalemia and metabolic acidosis Development of renal stones due to stasis Compartment syndrome in the lower extremities

Obstruction of the renal tubules with myoglobin and damaged tubular cells Myoglobin normally is not found in the serum or urine. It has a low molecular weight; if it escapes into the circulation, it is rapidly filtered in the glomerulus. A life-threatening condition known as rhabdomyolysis occurs when increasing myoglobinuria levels cause myoglobin to precipitate in the renal tubules, leading to obstruction and damage to surrounding tubular cells. Myoglobinuria most commonly results from muscle trauma but may result from exertion, hyperthermia, sepsis, prolonged seizures, and alcoholism or drug abuse. Rhabdomyolysis is not cured with anticoagulation administration nor does it cause kidney stones. Compartment syndrome occurs when there is insufficient blood supply to muscles and nerves due to increased pressure within one of the body's compartments. Myoglobinuria causes hyperkalemia, which may cause cardiac dysrhythmias, metabolic acidosis, hyperphosphatemia, early hypocalcemia, and late hypercalcemia.

Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)? Male client 2 days postoperative hip fracture repair whose Foley catheter was removed on postoperative day 1 Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month Woman who has just given birth and had a straight urinary catheter inserted prior to delivery Middle-aged male client admitted for dehydration due to strenuous exercise in hot weather

Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month Explanation: Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract. Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized clients. A catheter in place for 1 month places the client at greatest risk for a UTI.

Which substance would not be found in glomerular filtrate? Water Potassium Sodium Protein

Protein Explanation: The glomerular filtrate has a chemical composition similar to plasma (which contains sodium, potassium and water), but it contains no proteins because large molecules do not readily cross the glomerular wall.

A client with a closed reduction of a wrist fracture has a plaster cast applied. Which nursing intervention is the highest priority immediately after the procedure? Elevating the extremity on a pillow Performing a peripheral circulation assessment Immobilizing the arm in a sling Handling the cast with the palms of the hands

Performing a peripheral circulation assessment Explanation: Complications of fractures include compartment syndrome (when swelling after the injury impairs blood and nerve function), delayed healing, infection, and emboli. Of these conditions, compartment syndrome has the earliest onset and is monitored by peripheral circulation assessment. This includes capillary refill, temperature of the distal extremity, and sensation and the ability to move fingertips.

During assessment of a client with systemic lupus erythematosus (SLE), the nurse hears a friction rub when the stethoscope is placed over the heart. Which complication of SLE will the nurse document in the medical records and report to the health care provider? Pleural effusion Pericarditis Pneumonia Vasculitis

Pericarditis Explanation: A pericardial friction rub is pathognomonic for acute pericarditis; the rub has a scratching, grating sound similar to leather rubbing against leather. The inner and outer (visceral and parietal, respectively) layers are normally lubricated by a small amount of pericardial fluid, but the inflammation of pericardium causes the walls to rub against each other with audible friction. Pleural effusions are accumulation of fluids within the pleural space and are associated with symptoms of chest pain and shortness of breath. Pneumonia is an infection of the lungs caused by bacteria, viruses, or fungi. General symptoms of pneumonia include chest pain, fever, productive cough, and trouble breathing. Vasculitis is an inflammation of the blood vessels. It happens when the body's immune system attacks the blood vessel by mistake. Vasculitis can affect arteries, veins and capillaries so symptoms depend on the vessel involved.

While assessing a peritoneal dialysis client in the home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as: Peritonitis Bowel perforation Too much sugar in the dialysis solution Bladder erosion

Peritonitis Potential problems with peritoneal dialysis include infection, catheter malfunction, dehydration, hyperglycemia, and hernia. Bowel perforation can occur, but the fluid would be stool colored. The client may develop hyperglycemia; however, this will not cause the fluid to be cloudy. If bladder erosion had occurred, the fluid would look like urine and not be cloudy and white.

When teaching a group of nursing students about the liver, the nurse relates that Kupffer cells function to remove harmful substances or cells from the portal blood and venous sinusoids through which process? Ultrafiltration Osmosis Phagocytosis Cytotoxic action

Phagocytosis Explanation: Kupffer cells, which line the venous sinusoids, are reticuloendothelial cells that are capable of removing, engulfing, and phagocytizing old and defective blood cells, bacteria, and other foreign material from the portal blood as it flows through the sinusoid. This phagocytic action removes the enteric bacilli and other harmful substances that have filtered into the blood from the intestine. Kupffer cells do not have cytotoxic, osmotic, or ultrafiltration capabilities.

After several months of persistent heartburn, an adult client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to be prescribed for this client's GERD? Surgical correction of the incompetent pylorus and limiting physical exercise Anti-inflammatory medications; avoiding positions that exacerbate reflux; a soft-textured diet Weight loss and administration of calcium channel blocking medications Proton pump inhibitors; avoiding large meals; remaining upright after meals

Proton pump inhibitors; avoiding large meals; remaining upright after meals Explanation: Proton pump inhibitors block the final stage of gastric acid production, effectively controlling the root cause of the esophageal damage associated with GERD. The pylorus is not involved, and a soft diet is not indicated. Calcium channel blocking drugs would not address the problem.

The nurse recognizes that acute renal injury is characterized by which of the following? Rapid decline in renal function Irreversible damage to nephrons Decreased blood urea nitrogen (BUN) Low incidence of mortality

Rapid decline in renal function

An older adult client has been hospitalized for the treatment of acute pyelonephritis. Which characteristic of the client is most likely implicated in the etiology of this current health problem? Was diagnosed with type 2 diabetes several years earlier Takes a diuretic and an ACE inhibitor each day for the treatment of hypertension Recently had a urinary tract infection Has peripheral vascular disease

Recently had a urinary tract infection Explanation: There are two routes by which bacteria can gain access to the kidney: ascending infection from the lower urinary tract and through the bloodstream. Ascending infection from the lower urinary tract is the most important and common route by which bacteria reach the kidney, resulting in acute pyelonephritis. Diabetes, peripheral vascular disease, and hypertension controlled by a diuretic and an ACE inhibitor and are not associated with acute pyelonephritis.

The nurse is performing a physical assessment of the gastrointestinal tract. In which area does the nurse place the hands for palpation of the liver? Right upper quadrant Left upper quadrant Right lower quadrant Left upper quadrant

Right upper quadrant Explanation: The liver is the largest visceral organ in the body, located below the diaphragm in the right hypochondrium or right upper quadrant.

When teaching a group of nursing students about rheumatic disorders, a nurse emphasizes which important differences when caring for the older adult? Need for pain relief Stiffness in the morning Risk for falls Muscle weakness

Risk for falls Explanation: The pain, stiffness, and muscle weakness affect daily life, often threatening independence and quality of life. Symptoms of the rheumatic diseases can also have an indirect effect on and even threaten the duration of life for older adults. The weakness and gait disturbance that often accompany rheumatic diseases can contribute to the likelihood of falls and fractures.

Which meal choice is most likely to exacerbate an individual's celiac disease? Spaghetti with meatballs and garlic bread Stir-fried chicken and vegetables with rice Oatmeal with milk, brown sugar, and walnuts Barbecued steak and a baked potato with sour cream

Spaghetti with meatballs and garlic bread Explanation: Celiac disease is treated by the removal of wheat, barley, and rye from the diet, all of which contain gluten. Both spaghetti and garlic bread are wheat based and would exacerbate celiac disease. The other noted meals do not contain these grains.

The nurse teaches the client that which of these contributed to the development of acute cholelithiasis? Chronic pancreatitis Rapid elimination of bile Stasis of bile Excessive alcohol consumption

Stasis of bile Explanation: Two primary factors contribute to the formation of gallstones: abnormalities in the composition of bile and the stasis of bile (rather than rapid elimination). Inflammation of the gallbladder alters the absorptive characteristics of the mucosal layer, allowing excessive absorption of water and bile salts. Although a number of factors are associated with the development of acute pancreatitis, most cases result from gallstones (rather than cause gallstone formation) or alcohol use disorder. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct; alcohol intake is not a factor in the development of cholesterol or bilirubin stones.

The nurse is caring for a client with hypovolemic shock. Which of these does the nurse recognize is the liver's contribution to compensate for shock states? Stored blood in the liver can shift to general circulation to restore blood volume. The liver synthesizes ADH to retain water during periods of deficiency. The liver makes substances which constrict blood vessels to raise blood pressure. Kupffer cells are responsible for regulating blood volume and blood vessel tone.

Stored blood in the liver can shift to general circulation to restore blood volume. Explanation: The liver has the ability to store approximately 500 to 1000 mL of blood, which then can be shifted back into the general circulation during periods of hypovolemia and shock.

The client who has experienced third-degree burns is susceptible to which specific type of gastrointestinal (GI) ulceration? Peptic Gastric Duodenal Stress

Stress Explanation: Stress ulcers refer to GI ulcerations that develop in people with large-surface-area burns.

A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence? Overflow incontinence Urge incontinence Stress incontinence Mixed incontinence

Stress incontinence Explanation: Stress incontinence is commonly caused by weak pelvic floor muscles, which allow the angle between the bladder and the posterior proximal urethra to change so that the bladder and urethra are positioned for voiding when some activity increases intra-abdominal pressure. Overflow incontinence results when the bladder becomes distended and detrusor activity is absent. Urge incontinence is probably related to CNS control of bladder sensation and emptying or to the smooth muscle of the bladder. Mixed incontinence, a combination of stress and urge incontinence, probably has more than one cause.

The nurse caring for clients who have bladder cancer identifies which treatments to be acceptable for this cancer? Select all that apply. Surgical removal Radiation therapy Hypnosis Chemotherapy Herbal therapy

Surgical removal Radiation therapy Chemotherapy

A nurse is caring for a client admitted with a malar rash on the nose and cheeks. The nurse recognizes that this rash is characteristic of which disease process? Rheumatoid arthritis (RA) Sarcoidosis Systemic lupus erythematosus (SLE) Scleroderma

Systemic lupus erythematosus (SLE) Explanation: In SLE, the acute skin lesions include the classic malar or "butterfly" rash on the nose and cheeks.

A client is diagnosed with choledocholithiasis and acute suppurative cholangitis and is being rushed to surgery to prevent which possible complication? The accumulation of purulent bile, which can cause sepsis. Hepatitis that can result from the distention of the bile duct. Impaired nutritional absorption Neurologic damage that can be caused by toxic bilirubinemia.

The accumulation of purulent bile, which can cause sepsis. Explanation: Complications of choledocholithiasis include acute suppurative cholangitis when purulent bile fills and distends bile ducts. It is characterized by the presence of an altered sensorium, lethargy, and septic shock. Bilirubinuria and malabsorption are not emergency situations. This situation is not part of the etiology of hepatitis.

A client has a motor vehicle accident and is diagnosed with a right hip dislocation. For which intervention should the nurse anticipate needing to prepare this client? The client can be discharged and can make an appointment in a few days to see the primary health care provider. The client will need emergency intervention to reduce the fracture and prevent complications. The client will be allowed to walk on the extremity for a few days before any treatment will be done. The fracture will be reduced in 12 hours, at which time the client can apply weight to the extremity.

The client will need emergency intervention to reduce the fracture and prevent complications. Explanation: Hip dislocation is an emergency. The disorder is typically accompanied by severe pain and inability to move the lower extremity. In the dislocated position, great tension is placed on the blood supply to the femoral head and avascular necrosis may result. To prevent this complication, early reduction is indicated. Weight bearing is usually limited after reduction to prevent the dislocation from reoccurring and allow healing to occur.

A busy 45-year-old female executive has been diagnosed with diverticulitis. Her primary treatment is an increase in the fiber content of her diet. What effect will the fiber have on the diverticula? The fiber cleans out the diverticula, allowing for a remittance of inflammation. The fiber pulls water into the colon, increasing the intraluminal pressure, ensuring that fecal material will not become stagnant. The fiber increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure . The fiber stimulates a myogenic muscle contraction in the wall of the intestines that will force the forward movement of fecal material, thereby preventing diverticula formation.

The fiber increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure. Explanation: The treatment for diverticulitis includes increasing the bulk in the diet and bowel retraining so that the person has at least one bowel movement each day. The increased bulk promotes regular defecation and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure. Increases in pressure will make the condition worse.

The older adult client tells the health care provider about experiencing incontinence ever since starting diuretic therapy 2 weeks ago. What term should the provider document in the medical record related to the type of incontinence? Transient Chronic Neurogenic Stress

Transient Explanation: The causes of incontinence can be divided into two categories: transient and chronic. Of particular importance is the role of pharmaceuticals as a cause of transient urinary incontinence. Numerous medications, such as long-acting sedatives and hypnotics, psychotropics, and diuretics, can induce incontinence. Chronic urinary incontinence occurs as a failure of the bladder to store urine (stress incontinence) or a failure to empty urine (neurogenic incontinence).

The nurse understands that medications, although very beneficial to clients, can have harmful effects. When working with older adult clients the nurse should recognize that which outcome is a common result of potent, fast-acting diuretics? Increased potassium levels Urge incontinence Decreased urine output No untoward effects

Urge incontinence Explanation: Medications prescribed for other health problems may prevent a healthy bladder from functioning properly. Potent, fast-acting diuretics are known for their ability to cause urge incontinence. They can decrease potassium levels and increase urine output. They do have untoward effects.

A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention? Urinary catheterization Increased oral fluids Administration of intravenous fluids Laxative administration

Urinary catheterization Explanation: The relief of lower urinary tract obstruction is directed toward relief of bladder distension through urinary catheterization. This is the primary intervention. The other interventions are not the priority.

Clients with which medical history will have an increased risk for developing urinary tract infections? Select all that apply. Urinary obstruction Neurogenic disorders Elderly Prostate disease Not sexually active A premenopausal woman

Urinary obstruction Neurogenic disorders Elderly Prostate disease

An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should focus assessment on which aspects? Weight and nutritional status Cognition and coping skills Sodium and potassium levels Oxygenation and respiratory status

Weight and nutritional status Explanation: Anorexia is a common extra-articular symptom of rheumatoid arthritis. Consequently, there is a need to monitor the client's nutritional status and intake. Cognition, respiratory status, and electrolytes are not typically affected.

Which clinical manifestations would tell a nurse that a client is having progressive decompensation related to obstruction of urinary outflow? Client complains of waking up several times in the night to void. When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized. Client states that he or she is incontinent. Client complains of urinary urgency.

When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized. Explanation: When compensatory mechanisms are no longer effective, signs of decompensation begin to appear. The period of detrusor muscle contraction becomes too short to expel the urine completely, and residual urine remains in the bladder. At this point, symptoms of obstruction become pronounced. These symptoms include frequency of urination, hesitancy, need to strain to initiate urination, a weak and small stream, and termination of the stream before the bladder is completely emptied. With progressive decompensation, the bladder may become severely overstretched with a residual urine volume of 1000 to 3000 mL. Urinary urgency is a compensatory mechanism. Incontinence may be caused by many different factors and does not indicate decompensation.

A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called: Zollinger-Ellison syndrome Creutzfeldt-Jakob disease Sickle cell anemia Stevens-Johnson syndrome

Zollinger-Ellison syndrome Explanation: Zollinger-Ellison syndrome is a rare condition caused by a gastrin-secreting tumor (gastrinoma).

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents: a need to increase water intake. that the kidneys are functioning normally. a loss of over half the client's normal kidney function. concentrated urine.

a loss of over half the client's normal kidney function. In clinical practice, GFR is usually estimated using the serum creatinine concentration. A GFR below 60 mL/minute/1.73 m2 represents a loss of one half or more of the level of normal adult kidney function. The GFR is not diagnostic for concentrated urine or the need to drink more water.

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby: activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. the pancreas is irreversibly damaged and will not recover to normal functioning (chronic). the pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction. stones will develop in the common bile duct, resulting in acute jaundice.

activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. Explanation: Acute pancreatitis is associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues. These enzymes cause fat necrosis, or autodigestion, of the pancreas. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct, rather than bowel obstruction. The pancreas is irreversibly damaged and will not recover to normal functioning results from chronic pancreatitis. Acute pancreatitis also is associated with viral infections. The pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction occurring with cancer of the pancreas. Presence of stones in the common bile duct with jaundice is primarily a result of gallstones.

If a client with a kidney stone has the "classic" ureteral colic, the client will describe the pain as: Select all that apply. acute and intermittent. diffuse over the entire lower back and legs. excruciating. in the flank and upper outer quadrant of the abdomen.

acute and intermittent. excruciating. in the flank and upper outer quadrant of the abdomen. The symptoms of renal colic are caused by stones 1 to 5 mm in diameter that can move into the ureter and obstruct flow. Classic ureteral colic is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in the man. The pain is usually not described as diffuse and over the entire low back and legs.

A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to gave antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed which complication? acute kidney injury kidney stones acute postinfectious glomerulonephritis nephrotic syndrome

acute postinfectious glomerulonephritis Explanation: The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days: the time needed for the development of antibodies. The primary infection usually involves the pharynx (pharyngitis), but it can also result from a skin infection (impetigo). Oliguria, which develops as the glomular filtration rate decreases, is one of the first symptoms.

The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal kidney injury? baseline blood pressure of 150/90 mm Hg that is now 130/80 mm Hg baseline heart rate of 100 beats/min that has increased to 120 beats/min baseline urine output of 50 ml/hr that is now 10 mlk/hr foul-smelling, cloudy urine

baseline urine output of 50 ml/hr that is now 10 mlk/hr Explanation: The kidneys normally respond to a decrease in the glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal kidney injury is a sharp decrease in urine output.

The nurse is reviewing the medical history of four clients. Which client is at highest risk for developing peptic ulcer disease? client with a prior diagnosis of Helicobacter pylori who refused treatment client diagnosed with arthritis who takes acetaminophen twice per day client who has a history of a ruptured appendix client who eats excessive amounts of carbohydrates

client with a prior diagnosis of Helicobacter pylori who refused treatment Explanation: The two most important risk factors for peptic ulcer disease (PUD) are infection with the bacteria H. pylori and use of aspirin and/or nonsterioidal anti-inflammatory drugs (NSAIDs). Acetaminophen is not an NSAID, so it does not place the client at risk increased risk for PUD. A history of a ruptured appendix will not cause PUD. A high fat intake can be linked to increased risk for gastritis, but a diet high in carbohydrates is not linked to increased risk for PUD.

The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney injury? client with prostatic hyperplasia client with intratubular obstruction client with severe hypovolemia client with acute pyelonephritis

client with prostatic hyperplasia Explanation: The most common cause of postrenal kidney injury is prostatic hyperplasia. Postrenal kigney injury results from conditions that obstruct urine outflow. The obstruction can occur in the ureter, bladder, or urethra. Intratubular obstruction and acute pyelonephritis are intrarenal causes of kidney injury and severe hypovolemia is a prerenal cause

Several urine tests can be useful in establishing a diagnosis of acute kidney injury (AKI). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug? sulfonylureas calcium channel blockers diuretics beta-adrenergic blockers (beta-blockers)

diuretics Explanation: Diuretics, which directly affect renal excretion of sodium, can alter the fractional excretion of sodium. The other drug types listed do not affect this parameter of renal function.

Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)? elevated anti-nuclear antibodies (ANA) abnormal serum SLE assay decreased rheumatoid factor low red blood cell (RBC) count

elevated anti-nuclear antibodies (ANA) Explanation: There is no single diagnostic test that is used to diagnose SLE, such as an "SLE assay." However, the most common laboratory test performed is the immunofluorescence test for ANA, because 95% of people eventually diagnosed with the disease have elevated ANA levels. Rheumatoid factor is relevant to the diagnosis of rheumatoid arthritis, but is not among the diagnostic criteria for SLE. SLE can cause anemia, characterized by a low RBC count, but this finding is not specific to SLE to the same degree as elevated ANA.

A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media? having the client take nothing by mouth increasing the normal saline intravenous infusion rate prior to the exam administering one unit of packed red blood cells administering ibuprofen 600 mg prior to the procedure

increasing the normal saline intravenous infusion rate prior to the exam Explanation: Some drugs such as high-molecular-weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and nonsteroidal anti-inflammatory drugs can cause acute prerenal failure by decreasing renal blood flow. Administering intravenous saline can improve hydration and renal perfusion to decrease the toxic effects of the radiocontrast media.

A 16-year-old adolescent suffered a fracture of the ulna. The fracture does not protrude through the skin and there are several pieces of broken bone evident on the x-ray. Which term should the nurse use to describe this fracture? closed comminuted fracture closed greenstick fracture open spiral fracture transverse fracture

losed comminuted fracture Explanation: The fracture would be described as closed because it does not break through the skin. It is comminuted because it broke into more than two pieces. A closed greenstick fracture is a fracture that is a partial break in bone continuity, common in young children whose bones are not yet fully ossified. An open spiral fracture is a fracture that breaks through the skin. A transverse fracture is a single break straight across the bone.

A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, "I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body." The nurse should tell the client that the liver: is responsible for the absorption of most dietary nutrients, as well as the production of growth hormones. contributes to the metabolism of ingested food and provides the fluids that the GI tract requires. metabolizes most components of food and also cleans the blood of bacteria and drugs. maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals, and vitamins.

metabolizes most components of food and also cleans the blood of bacteria and drugs. Explanation: Protein, carbohydrate, and fat metabolism are performed by the liver. As well, it metabolizes drugs and removes bacteria by Kupffer cells. Absorption of nutrients takes place in the intestines. The liver does not produce the bulk of fluids secreted in the GI tract. The liver does not have a primary role in the maintenance of acid-base or electrolyte balance.

The nurse is teaching about prevention of hepatitis A. Which group does the nurse suggest will benefit from this vaccine? people who have recently been exposed to hepatitis A all children as part of childhood immunization people who live in or travel to areas with high rates of hepatitis A infections people with liver disease or who are immunocompromised

people who live in or travel to areas with high rates of hepatitis A infections Explanation: Hepatitis A vaccine is suggested for anyone visiting or living in areas with high rates of hepatitis A infections. Hepatitis B is part of standard childhood immunization schedules, not hepatitis A. Hepatitis B is also recommended for unvaccinated adults who have liver disease or who are immunocompromised. The vaccine is of little benefit in prevention of hepatitis for people with known hepatitis A exposure, so IgG is recommended for these people.

An older adult client presents with a perforation of a peptic ulcer. The nurse will monitor for signs and symptoms of which priority complication? fecal impaction peritonitis diarrhea vomiting

peritonitis Explanation: Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. With perforation, gastrointestinal contents enter the peritoneum and cause peritonitis. Although the client may experience vomiting or diarrhea, these are not the priority compared to peritonitis.

A client in acute kidney injury has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of acute kidney injujry can be reversed if the bleeding is under control. Which form of acute kidney injury does this client have? prerenal kidney injury intrarenal kidney injury postrenal kidney injury chronic kidney disease

prerenal kidney injury Prerenal kidney injury, the most common form of acute kidney injury, is characterized by a marked decrease in renal blood flow. It is reversible if the cause of the decreased renal blood flow can be identified and corrected before kidney damage occurs.

The nurse is reviewing the lab results of a client with suspected nephrotic syndrome. The nurse anticipates the results to include: protein in the urine. decreased triglycerides. abnormal blood clotting factors. decreased LDL serum hyperalbuminemia.

protein in the urine. Explanation: In a person with nephrotic syndrome there is massive proteinuria (protein in the urine), serum hypoalbuminemia, generalized edema, and hyperlipidemia.

A major complication of prolonged bed rest is an increased risk of kidney stones. The nurse knows that this is most likely related to: saturation of urine with calcium salts. a limited access to fluids while hospitalized. increased urine levels of citrate. frequency of urination.

saturation of urine with calcium salts. Explanation: Prolonged immobility leads to bone resorption and an elevation in serum calcium which can cause the development of calcium-containing kidney stones. Elevated urine levels of citrate are a prominent inhibitor of calcium stone formation. Fluid intake is not likely to be limited but regardless, it would not contribute to kidney stone formation. Urinary frequency is not a factor in kidney stone formation.

A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icterus period. The nurse would expect the client to manifest: severe pruritus and liver tenderness. severe anorexia. disappearance of jaundice. chills and fever.

severe pruritus and liver tenderness. Explanation: Severe pruritus and liver tenderness are common during the icterus period. Chills, fever, and severe anorexia occur during the prodromal period. The disappearance of jaundice occurs in the convalescent phase.

An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after they curtailed their fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal kidney failure. The nurse should be assessing this client for which early sign of prerenal kidney injury? sharp decrease in urine output excessive voiding of clear urine acute hypertensive crisis intermittent periods of confusion

sharp decrease in urine output Explanation: Dehydration and its consequent hypovolemia can result in acute kidney injury that is prerenal in etiology. The kidney normally responds to a decrease in glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal injury is a sharp decrease in urine output. Postrenal kidney injury is obstructive in etiology, and intrinsic (or intrarenal) kidney injury is reflective of deficits in the function of the kidneys themselves.

The nurse is caring for a client with chronic kidney disease (CKD). The nurse suspects the client may have developed uremic pericarditis based on which sign(s) or symptom(s)? Select all that apply. substernal discomfort chest pain that is worse on inspiration abnormal heart sounds abdominal distension purpuric rash on the torso

substernal discomfort chest pain that is worse on inspiration abnormal heart sounds The manifestations of uremic pericarditis include mild to severe chest pain made worse when the client takes a deep breath. The nurse may also auscultate a pericardial friction rub when listening to heart sounds. Pericarditis can result in the accumulation of fluid in the pericardial space (pericardial effusion). If this fluid accumulates rapidly, or results in a large volume of fluid, cardiac tamponade may develop, which leads to hemodynamic instability. Abdominal distension is not associated with pericarditis. A purpuric rash is one that results from blood being released into the integument and may be evidence of a coagulopathy, but is not associated with pericarditis.