PREP U-- fluid/electrolyte

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37. The nurse suspects the client may be experiencing:

Metabolic alkalosis

A patient with hyperparathyroidism has hypercalcemia. Which of the following is a likely consequence?

Metastatic calcification

A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:

Microorganism transfer

A client experiencing vomiting and diarrhea for 2 days has a blood pressure of 88/56, a pulse rate of 122 beats/minute, and a respiratory rate of 28 breaths/minute. The nurse places the client in which position?

Modified Trendelenburg

A nurse is providing care to a client who has undergone a colonoscopy. What would be most appropriate for the nurse to do after the procedure?

Monitor for rectal bleeding

Which of the following would be appropriate nursing interventions for a client with hypokalemia? Select all that apply.

Monitor intake and output every shift. Offer a diet with fruit juices and citrus fruits. Hypokalemia is a potassium level less than 3.5 mEq/L. Nurses must have knowledge of this life-threatening imbalance. The nurse would complete appropriate interventions such as offering a diet containing sufficient potassium, which includes fruits and vegetables, and monitoring the intake and output. Approximately 40 mEq of potassium is lost for every liter of urine output.

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test?

Monitor the client for an allergy to iodine contrast material.

A patient arrives in the emergency department with complaints of chest pain radiating to the jaw. What medication does the nurse anticipate administering to reduce pain and anxiety as well as reducing oxygen consumption?

Morphine

A client presents to the emergency department with some vague symptoms. After history and physical exam, the physician is suspecting the client may have viral hepatitis. Which of the following clinical manifestations leads the nurse to suspect the client is in the prodromal period of viral hepatitis?

Muscle aches and pain along with fatigue

Magnesium levels are important indicators to a variety of bodily functions. What is severe hypermagnesemia associated with?

Muscle and respiratory paralysis

The nurse is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for:

Muscle weakness

The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. For which of the following clinical manifestations does the observe in this patient?

Muscular spasms and complaints of tingling in hands/feet.

The nurse is administering a unit of packed red blood cells to a patient and piggybacks the unit of blood through a solution of 0.9% NaCl. Blood cells placed in a solution of 0.9% saline will do which of the following?

Neither shrink nor swell

Both type 1 and type 2 diabetes mellitus can cause damage to the glomeruli of the kidneys. Which renal disease is diabetic nephropathy associated with?

Nephrotic syndrome

Following a motor vehicle collision, a client is admitted to the emergency department with a blood pressure of 88/46, pulse of 54 beats/min with a regular rhythm, and respirations of 20 breaths/min with clear lung sounds. The client's skin is dry and warm. The nurse assesses the client to be in which type of shock?

Neurogenic

Milliseconds.

Neurotransmitters like catecholamines (ex. dopamine and epinephrine) have a reaction time of:

A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle?

Nocturnal intermittent peritoneal dialysis (NIPD)

The nurse in the cardiac clinic is teaching a client about his antihypertensive medications when he mentions he has strained his back and is taking over the counter ibuprofen for relief. Which information does the nurse need to relate to this client?

Non steroidal anti-inflammatory drugs cause fluid retention and should be avoided in those with hypertension.

The client comes to the emergency department with skin burns and tells the practitioner that they were caused by a diathermy treatment. The practitioner understands that the burns were caused by which of the following?

Nonionizing radiation

The following foods are a part of a client's daily diet: high-fiber cereals, fruits, vegetables, 2,500 mL of fluids. What would the nurse tell the client to change?

Nothing; this is a good diet

The nurse is caring for a client whose blood type is B negative. Which donor blood type does the nurse confirm as compatible for this client?

O negative

Which enema solution lubricates the stool and intestinal mucosa without distending the intestine?

Oil

Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)?

Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month

The nurse at a long term care facility encourages the older adults to drink even though they may not feel thirsty at the time. Which of the following statements supports the nurse's action?

Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.

The term used to describe total urine output less than 0.5 mL/kg/hr is:

Oliguria

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer.

Omeprazole (Prilosec) Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected?

On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.

The nurse is evaluating a client in the intensive care unit to identify improvement in the client's condition. Which outcome does the nurse note as the result of inadequate compensatory mechanisms?

Organ damage

Hypothalamic sensory neurons that promote thirst when stimulated are called which of the following?

Osmoreceptors

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:

Osmosis

Pressure generated as water moves across a membrane is also known as which of the following?

Osmotic pressure

An elderly client asks the nurse what causes the functional decline that occurs with the process of aging. The best response would be:

Oxidative stress

A client experiences an acute myocardial infarction. Current blood pressure is 90/58, pulse is 118 beats/minute, and respirations are 30 breaths/minute. The nurse intervenes first by administering the following prescribed treatment:

Oxygen at 2 L/min by nasal cannula

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which of these descriptions?

Pain in the right upper quadrant referred to the same shoulder

The nurse knows that a patient with chronic kidney disease (CKD) may experience which of the following changes in skin integrity? Select all that apply.

Pale skin Brittle fingernails Decreased perspiration

A nurse is performing an abdominal assessment of a client before administering a large-volume cleansing enema. Which assessment technique would be performed last?

Palpation

Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?

Parathyroid hormone

- Stimulation of calcium reabsorption and phosphate excretion PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

Parathyroid hormone (PTH) has which effects on the kidney? - Stimulation of calcium reabsorption and phosphate excretion - Stimulation of phosphate reabsorption and calcium excretion - Increased absorption of vitamin D and excretion of vitamin E - Increased absorption of vitamin E and excretion of vitamin D

The nurse is caring for a patient with compensatory hyperplasia. Which of the following is the most likely cause of the hyperplasia?

Partial hepatectomy

A nurse is caring for a group of patients. Which one does the nurse plan to monitor for hyperkalemia?

Patient who has been admitted with metabolic acidosis

When providing teaching to a client who reports tension headaches, which of the following instructions would be most beneficial to prevent onset of symptoms?

Perform stretching exercises and frequent position change. Tension headaches are often associated with prolonged tensed muscles. Application of cool or warm cloths and avoidance of bright lights may help to reduce the headache after occurrence. Avoiding certain foods may prevent migraine headaches, but it is not likely to prevent tension headaches.

A patient with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which of the following conditions does the nurse suspect is common with this stage of kidney disease?

Pericarditis

During the physical examination of a client, the nurse monitors for signs that may indicate a urinary tract disorder. Which of the following would suggest that the client may have a urinary tract disorder?

Periorbital edema

The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration?

Phenazopyridine hydrochloride

A nurse is assessing the stoma of a client with a colostomy. Which finding would the nurse interpret as indicating that the stoma is healthy?

Pink color

Which one of the following is associated with hydrostatic edema?

Pits to finger pressure

The nurse and nursing student are caring for a client with a condition causing deficiency of ADH. The nurse recognizes that the student understands the origin of this process when the student states ADH is produced in which of these areas?

Pituitary gland

A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action?

Place emergency medical equipment in the procedure room.

The nurse is caring for a client who is developing hypovolemic shock from a duodenal ulcer bleed. What is the first intervention the nurse can provide to facilitate blood flow to the brain?

Place the client in a modified Trendelenburg position.

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?

Plasma proteins

A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system?

Plasmapheresis

A client is diagnosed with a tumor in the urinary bladder. The nurse will monitor the client for which of the following?

Postrenal failure

A patient has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which of the following types of renal failure should the nurse closely monitor for?

Postrenal failure

Retention of which electrolyte is the most life-threatening effect of renal failure?

Potassium

A 50-year-old client with hypertension is being treated with a diuretic. The client complains of muscle weakness and falls easily. The nurse should assess which electrolyte? a) Potassium b) Chloride c) Phosphorous d) Sodium

Potassium Explanation: Diuretics, commonly given to treat high blood pressure and heart failure, can cause an extracellular deficit or loss of electrolytes including potassium, calcium, and magnesium. (less) Reference: Taylor et al. Fundamentals of Nursing, 7th ed. Philadelphia:

The nurse is reviewing lab results of a client diagnosed with metabolic acidosis. The most important electrolyte for the nurse to assess would be:

Potassium (K+)

The nurse suspects a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes which of these abnormal laboratory results is consistent with this problem?

Potassium level of 2.8 mEq/L

A patient in renal failure has marked decrease in renal blood flow caused by hypovolemia, caused by gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which of the following forms of acute renal injury does this patient have?

Prerenal failure

The nurse caring for a bedridden client who has sacral edema plans care to prevent risk from what type of injury?

Pressure ulcers

A nursing student studying pharmacology is learning how angiotensin converting enzyme inhibitors (ACE) work. The student is correct when the student states the mechanism of action of ACE inhibitors is which of these?

Prevent conversion of angiotensin I to II

Mass spectrometry with liquid chromatography

Prior to running the marathon, an athlete is tested for the use of performance-enhancing agents. Which type of lab/diagnostic testing should the nurse review with this athlete?

In isotonic fluid volume deficit, changes in total body water are accompanied by:

Proportionate losses of sodium

The nurse is reviewing the diagnosis of four male clients. Select the diagnosis that places the clients at risk for developing postrenal kidney failure.

Prostatic hyperplasia

Which substance would not be found in glomerular filtrate?

Protein

Which of the following is the hallmark of the diagnosis of nephrotic syndrome?

Proteinuria

Which assessment finding would lead the nurse to suspect the client has developed nephrotic syndrome?

Proteinuria and generalized edema

The nurse is teaching a group of nursing students about the formation of urine in the nephron. Which of these components does the nurse teach are components of the nephron? Select all that apply.

Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting tubule

When teaching a pharmacology class the nurse relates that 65 percent of all reabsorptive and secretory processes that occur in the tubular system take place in which of these areas?

Proximal tubules

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram?

Pruritis

A patient with schizophrenia is admitted to the behavioral health department and is observed drinking copious amounts of water and voiding large amounts of dilute urine. The nurse recognizes this behavior is consistent with which of these problems?

Psychogenic polydipsia

Clinical manifestations of radiation injury result from acute cell injury, dose-dependent changes in the blood vessels that supply the irradiated tissues, and fibrotic tissue replacement. What are these clinical manifestations?

Radiation cystitis, dermatitis, and diarrhea from enteritis

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function

The renal control mechanism of restoring the acid-base balance is accomplished through which process?

Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms.

A nurse inadvertently partially dislodges a PICC line when changing the dressing. What would be the appropriate intervention in this situation? a) Set up a sonogram for the client to determine the end point of the line. b) Reapply the dressing and notify the physician for further instructions. c) Sedate the client, remove the PICC line, and then notify the physician. d) Swab the line with sterile saline and gently reinsert the line.

Reapply the dressing and notify the physician for further instructions. Explanation: When a PICC line is not all the way out, the nurse should notify the physician. The physician will most likely order a chest x-ray to determine where the end of the PICC line is. A dressing should be reapplied before the chest x-ray, to prevent further dislodgement.

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?

Recently had a urinary tract infection

The nurse reviews the lab results for a client who has advanced autosomal dominant polycystic kidney disease (ADPKD). The client 's hemoglobin is 8.8 g/dL (88 g/L). The nurse suspects this lab value is related to which cause?

Reduced production of erythropoietin

Morphine sulfate has which of the following effects on the body?

Reduces preload

A 72-year-old patient is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival?

Reduction in T-lymphocyte function

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:

Renal calculi

What is the most common cancer of the kidney?

Renal cell carcinoma

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?

Renin

The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level are consistent with which of these diagnoses?

Respiratory acidosis

The nurse enters a patient's hospital room and finds the patient breathing rapidly, stating, " I must be having a stroke, my fingers are tingling!" Which of the following acid-base balance disorders is this patient experiencing due to hyperventilation?

Respiratory alkalosis

Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two thirds suffer from what peripheral neuropathy?

Restless legs syndrome

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which would be the best instruction for the nurse to provide?

Restrict intake of dietary protein

The nurse is assessing a client who has just been admitted to the unit with a diagnosis of cholelithiasis. The nurse is aware that the client may manifest:

Right upper quadrant pain

A client is taking a diuretic that increases her urinary output. What would be an appropriate nursing diagnosis on which to base an educational plan?

Risk for Deficient Fluid Volume

A nurse is assisting a client when he is draining a continent ileostomy. The catheter suddenly becomes plugged with stool. Which action should the nurse take to rectify the problem?

Rotate the catheter tip inside the stoma

Amines and amino acids

Select the category of hormones that include norepinephrine and epinephrine.

Cortisol

Select the hormone that requires protein as a transport carrier.

Provide a better measure of hormone levels during a designated period.

Select the most accurate statement regarding measurements of urinary hormone:

Hormones function as modulators of cellular and systematic responses.

Select the most appropriate statement that describes the function of hormones.

Receptor binding

Select the process that allows hormones to exert influence upon some cells and not others.

Hormone receptors recognize a specific hormone and translate the signal into a cellular response.

Select the statement that best explains the function of hormone receptors.

The client exhibits a blood pressure of 110/68 mm Hg, pulse rate of 112 beats/min, temperature of 102°F with skin warm and flushed. Respirations are 30 breaths/min. The nurse assesses the client may be exhibiting the early stage of which shock?

Septic

The nurse anticipates that an immunosuppressed client is at greatest risk for which type of shock?

Septic

An elderly man is brought into the clinic by his daughter who states, "My father hasn't been himself lately. Now I think he looks a little yellow." What test would the nurse expect to have ordered to check this man's creatinine level?

Serum creatinine

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icteric period. The nurse would expect the client to manifest:

Severe pruritus and liver tenderness

You are assessing a 6-year-old little girl in the emergency department (ED) who was brought in by her mother. She was stung by a bee and is allergic to bee venom. The child is now having trouble breathing. She is vasodilated, hypotensive, and has broken out in hives. What do you suspect is wrong with this child?

She is having an allergic reaction and going into anaphylactic shock.

The nurse is teaching a client how to change an ostomy appliance. After removing the existing pouch, which action will the nurse teach next?

Shower, bathe, or wash peristomal area with mild soapy water

The nurse will place a client who is to receive a hypertonic enema solution into which position for ease of administration?

Sims

They are inactive in the bound state.

Since steroid hormones are bound to protein carriers for transport, this means:

The nurse is caring for an older adult client with diarrhea. Which assessment finding requires immediate nursing intervention?

Skin turgor response 5 seconds

A nurse caring for a client with a diagnosis of diabetes insipidus (DI) should prioritize the close monitoring of which of the following electrolyte levels?

Sodium

The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?

Sodium

When caring for patients with disorders of sodium balance, the nurse asks the provider which of the following findings are consistent with hypernatremia?

Sodium 158 mEq/L and serum osmolality of 320 mOsm/kg

The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop:

Sodium and water retention

The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L, PCO2 57mm Hg. What IV medication should the nurse expect to provide next?

Sodium bicarbonate

A client who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The nurse knows that which of the following statements listed below about potential risks of radiation is most accurate?

Some clients experience longer-term irritation of skin adjacent to the treatment site.

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is:

Specific gravity 1.035

Which of the following are alterations noted in Virchow's triad? Select all that apply

Stasis of blood Vessel wall injury Altered coagulation Three factors, known as Virchow's triad, are believed to play a significant role in the development of venous thrombosis. They are stasis of blood, vessel wall injury, and altered coagulation. Edema and tenderness are clinical manifestations of venous thrombosis, but are not part of the triad.

The nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include?

Suction equipment

Calcium

Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. Sodium Calcium Potassium Magnesium

Which is an effect of aging on upper and lower urinary tract function?

Susceptibility to develop hypernatremia

As a member of the stroke team, the nurse knows that thrombolytic therapy carries the potential for benefit and for harm. The nurse should be cognizant of what contraindications for thrombolytic therapy? Select all that apply.

Symptom onset greater than 3 hours prior to admission Recent intracranial pathology Current anticoagulation therapy Some of the absolute contraindications for thrombolytic therapy include symptom onset greater than 3 hours before admission, a client who is anticoagulated (with an INR above 1.7), or a client who has recently had any type of intracranial pathology (e.g., previous stroke, head injury, trauma).

A nurse is caring for a patient with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which of the following problems could the patient be diagnosed with?

Syndrome of inappropriate antidiuretic hormone (ADH)

A nurse is caring for a patient with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which of the following problems could the patient be diagnose with ?

Syndrome of inappropriate antidiuretic hormone (ADH)

When a client is in the compensatory stage of shock, which symptom occurs?

Tachycardia

A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply.

Tachycardia Fatigue Decreased myocardial oxygen

A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The nurse expects that the compensatory mechanisms associated with hypovolemia would cause what clinical manifestations? (Select all that apply.)

Tachypnea Oliguria Tachycardia Hypovolemia, or fluid volume deficit, is indicated by decreased, not increased, blood pressure (hypotension), oliguria, tachycardia (not bradycardia), and tachypnea.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.

Tall peaked T

Which of the following enzymes listed below are responsible for cancer cells ability to prevent aging of the cells and contributes to cellular immortality that is so characteristic of this disease process?

Telomerase

Which of the following enzymes listed below are responsible for cancer cells ability to prevent aging of the cells and contributes to cellular immortality that is so characteristic of this disease process?

Telomerase.

A client with anemia is showing signs of acidosis. How can a decline in red blood cells cause someone to be acidotic?

The RBCs are potent buffers and their loss results in less bicarbonate production.

D

The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? D C B E

Golgi complex

The anatomy instructor is presenting a lecture on hormone synthesis. The instructor determines that instruction was effective when students identify the site of prohormone to hormone conversion as the:

An expected outcome for the hemodialysis client is:

The client explains how to assess the venous access site.

A patient is admitted with an electrical burn and a fractured arm. Which of the following causes the fracture related to the burn?

The client had violent muscle contractions during the electrical injury.

A 68 year old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which of the following statements best captures an aspect of this client's condition?

The client has possibly undergone damage as a result of calcification following cellular injury.

The nurse is caring for a client with kidney disease who has an estimated glomerular filtration rate of 75 ml/minute. The nurse interprets this data in which of the following way?

The client has reduced glomerular filtration reflecting damage to the kidney.

You are talking with the family of a client who is in the irreversible stage of shock. They ask you why the physician has told the family that the client is going to die. What would you explain to this family?

The client is not responding to medical interventions.

Which nursing assessment finding indicates the client has not met expected outcomes?

The client voids 75 cc four hours post cystoscopy.

You are caring for a client with a stage IV leg ulcer. You are closely monitoring the client for sepsis. What would indicate that sepsis has occurred and that you should notify the physician of immediately?

The client's heart rate is greater than 90 beats per minute.

A nurse observes that a client's urine is cola colored and considers which factor as a possible reason?

The client's urine contains material from the degradation of red blood cells.

The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?

The costovertebral angle

The nurse is obtaining physician orders which include a pulse pressure. The nurse is most correct to report which of the following?

The difference between the systolic and diastolic pressure

Which of the following should be included in the teaching plan of care for the parents of a child diagnosed with Tay-Sachs disease?

The disorder involves accumulation of abnormal lipids.

Epinephrine

The endocrine system is closely linked with the nervous system. What neurotransmitter can also act as a hormone?

Potassium is the major cation in the body. It plays many important roles, including the excitability of nerves and muscles. Where is this action particularly important?

The heart

Negative feedback loop

The hormone levels in the body need to be kept within an appropriate range. How is this accomplished for many of the hormones in the body?

Hypophyseal portal system

The hypophysis is a unit formed by the pituitary and the hypothalamus. These two glands are connected by the blood flow in what system?

Stimulates calcium absorption from the intestine

The kidney produces 1,25-dihydroxyvitamin D. This form of vitamin D is responsible for which action in the body?

Which function of the kidneys helps to maintain the pH balance in the body?

The kidneys conserve base bicarbonate and eliminate hydrogen ions.

A client with primary hypertension comes to the clinic reporting a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what?

retinal blood vessel damage Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.

A diabetic patient is scheduled for surgery for repair of a detached retina that was caused by proliferative retinopathy. The nurse prepared the patient for surgery, aware that the type of detachment is most likely classified as which of the following?

rhegmatogenous Rhegmatogenous detachment is the most common form of retinal detachment. In this condition, a hole or tear develops in the sensory retina, allowing some of the liquid vitreous to seep through the sensory retina and detach it from the retinal pigment epithelium.

The nurse is caring for a client who has produced an average of 20 ml/hour for the previous day. The nurse recognizes this compares in which way to the normal urine output?

The kidneys should produce about 1.5 liters of urine each day.

A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact?

The left kidney usually is slightly higher than the right one.

Testosterone Aldosterone

The non-vesicle-mediated pathway has a role in synthesis and release of which of the following hormones? Select all that apply.

To decrease airway inflammation

The nurse administers a glucocorticoid medication to a client with pneumonia. Which of these does the nurse teach the client is the purpose of the medication?

To stimulate contraction of the uterus

The nurse explains to a client in labor who has demonstrated ineffective contractions impeding progression of labor that the health care provider has added oxytocin infusion to the orders. Which of these does the nurse teach the client is the purpose of oxytocin?

While reviewing the health history of an older adult experiencing hearing loss the nurse notes the client has had no trauma or loss of balance. What aspect of this client's health history is most likely to be linked to the client's hearing deficit?

routine use of quinine for management of leg cramps Long-term, regular use of quinine for management of leg cramps is associated with loss of hearing acuity. Radiation therapy for cancer should not affect hearing; however, hearing can be significantly compromised by chemotherapy. Allergy to hair products may be associated with otitis externa; however, it is not linked to hearing loss. An ear drum that perforates spontaneously due to the sudden drop in altitude associated with a high dive usually heals well and is not likely to become infected. Recurrent otitis media with perforation can affect hearing as a result of chronic inflammation of the ossicles in the middle ear.

- Hyperthyroidism Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism.SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.

The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? - Hypothyroidism - Hyperthyroidism - Syndrome of inappropriate antidiuretic hormone secretion (SIADH) - Diabetes insipidus (DI)

Action of releasing hormones from hypothalamus

The nurse is assessing a client with thyrotoxicosis and the nurse is explaining how the thyroid gland is stimulated to release thyroid hormones. The nurse should describe what process?

When caring for the client with a hyperkalemia, the nurse recognizes the body should respond in which of these ways?

secrete potassium in the distal tubules for excretion

Suppression of the client's hypothalamic-pituitary-target cell system

The nurse is caring for a client who has been diagnosed with severe chronic obstructive pulmonary disease and has been taking oral steroids for several years. The nurse is aware that the client is at risk for:

Reduction in ACTH

The nurse is caring for a client who is receiving exogenous corticosteroids for rheumatoid arthritis. Recognizing that hormone levels are regulated by negative feedback, which of these laboratory test results does the nurse anticipate uncovering when reviewing the medical record?

Positive anti-thyroid peroxidase antibodies

The nurse is caring for a client with a tentative diagnosis of Hashimoto thyroiditis. Which of these test results does the nurse anticipate will be present in autoimmune thyroiditis?

The drug level will be elevated as lack of protein allows more free drug to circulate.

The nurse is caring for a client with decreased serum protein levels secondary to liver failure. When administering medications that are highly protein bound, the nurse anticipates the resulting drug level will respond in which of these ways?

Which type of hearing loss is most likely to be caused by frequent ear infections?

sensorineural Sensorineural hearing loss includes such etiologies as atherosclerosis, a tumor of the vestibulocochlear nerve, infections, and drug toxicity. Conductive hearing loss is more commonly caused by obstructions. Tinnitus is a symptom, not a cause of hearing loss.

The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function?

serum creatinine 1.5

- Temperature of 102ºF Thyroid storm is characterized by the following: 1) high fever (hyperpyrexia), >38.5°C (>101.3°F); 2) extreme tachycardia (>130 bpm); 3) exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations); and 4) altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma.

The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? - Heart rate of 62 - Blood pressure 90/58 mm Hg - Oxygen saturation of 96% - Temperature of 102ºF

A 77 year-old female hospital patient has contracted Clostridium difficile during her stay, and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?

she is susceptible ti isotonic fluid volume deficit

The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose?

slows the progression of the disease Selegiline increases dopaminergic activity and slows the progression of the disease. Carbidopa-levodopa is a dopamine replacement drug. Anticholinergic drugs are used to reduce the symptoms of dyskinesia and other side effects.

The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop:

sodium and water retention

A child is brought into the clinic with symptoms of periorbital edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem?

sore throat 2 wks ago

- Gigantism When over secretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.

The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? - Gigantism - Dwarfism - Acromegaly - Simmonds' disease

The thyroid gland is responsible for increasing the metabolic rate.

The nurse is teaching a client who has been newly diagnosed with hypothyroidism about the function of the thyroid. Which of these does the nurse explain to the client is the role of the thyroid gland?

While assessing a patient with urosepsis, the ICU nurse notes the patient's BP is 80/54; HR 132; RR 24; pulse Ox 89% on 6 lpm O2. Over the last hour, the patients urine output is 15 mL. When explaining to a new graduate nurse, the nurse will emphasize that the patients status may relate to:

The patients sympathetic nervous system has been stimulated which has resulted in vasoconstriction of the afferent arteriole which causes a decrease in renal blood flow.

Hypothalamus

The physician is assessing a client with a preliminary diagnosis of endocrine disorder. Further assessment findings identify abnormalities with emotion, pain, body temperature, and neural input. The physician determines the need to further assess the:

Stimulation tests

The physician suspects a client may be experiencing hypofunction of an endocrine organ. Select the most appropriate test to determine organ function.

A client is having difficulty having a bowel movement on the bedpan. What is the physiologic reason for this problem?

The position does not facilitate downward pressure

Diagnostic testing of a client with a history of dyspepsia and abdominal pain has resulted in a diagnosis of gastric cancer. The nurse's anticipatory guidance should include what information?

The possibility of surgery, chemotherapy and radiotherapy Treatment of gastric cancer is usually multimodal, but does not necessitate a colostomy. Weight loss is not a goal during recovery; exercise is not a high priority and may be unrealistic. The prognosis for clients with gastric cancer is generally poor.

A client has impacted cerumen in the left ear. Which of the following would be appropriate to use to help dislodge the cerumen? Select all that apply.

tap water, half strength hydrogen peroxide, mineral oil To remove impacted cerumen, the external auditory ear canal can be irrigated gently with warmed tap water using the lowest effective pressure. Additionally, a few drops of warmed glycerin, mineral oil, or half-strength peroxide can be instilled into the canal for 30 minutes to soften cerumen before its removal. A moistened cotton-tipped applicator should not be used; it can push the cerumen further in the ear, become a foreign body, or cause trauma to the canal. Antibiotic solution is not necessary to remove impacted cerumen.

A nurse assessing a client with an ostomy appliance documents the condition "prolapse" in the client chart and notifies the physician. Which of statement describes this condition?

The stoma is protruding into the bag and may become twisted

Follicle-stimulating hormone Antidiuretic hormone Dopamine

The vesicle-mediated pathway has a role in synthesis and release of which of the following hormones? Select all that apply.

A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe?

There is possible obstruction in the urinary tract.

The nurse is teaching a group of nursing students about the mechanism of action of common diuretics. Which of these best reflects the mechanism of these drugs?

They block the reabsorption of sodium and chloride in the nephron.

Which diuretic acts by preventing the reabsorption of sodium chloride in the distal convoluted tubule?

Thiazide diuretics

The nurse is administering the diuretic furosemide (Lasix) to a client with heart failure. The nurse recognizes that this exerts its action in which of these areas in the kidney?

Thick ascending loop of Henle

Microscopic examination of tissue samples from a deceased client's liver reveal that the hepatocytes contain pathologic vacuoles of fat. The nurse should understand what significance of this finding?

This phenomenon may have been reversible if the client had undertaken lifestyle changes.

Which of the following describes how atrophied cells survive?

Through decreased oxygen consumption

Bile and urine

To prevent the accumulation of hormones in our bodies, the hormones are constantly being metabolized and excreted. Where are adrenal and gonadal steroid hormones excreted?

An intravenous hypertonic solution containing dextrose, proteins, vitamins, and minerals is known as a) Cellular hydration b) Total parenteral nutrition c) Blood transfusion therapy d) Volume expander

Total parenteral nutrition Explanation: Total parenteral nutrition is a hypertonic solution containing 20% to 50% dextrose, proteins, vitamins, and minerals that is administered into the venous system.

When planning the care of the patient in cardiogenic shock, what does the nurse understand is the primary treatment goal?

Treat the oxygenation needs of the heart muscle

- Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A positive Trousseau's sign is suggestive of latent tetany.

Trousseau's sign is elicited by which of the following? - Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. - A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. - After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. - The patient complains of pain in the calf when his foot is dorsiflexed.

Bruising of the skin is a manifestation of bleeding disorders in patients with CKD.

True

You are admitting a client with an acoustic neuroma to your unit. What would you include during the assessment of this client?

test for facial sensation The assessment of a client with an acoustic neuroma includes evaluating hearing function, observing the client's facial movements, and testing for facial sensation. The client's urine output, height and weight, and ability to sustain balance, though important, are not as essential as testing for facial sensation.

The nurse is caring for a client with symptoms of ototoxicity from aminoglycoside administration. On which structure does the medication produce the ototoxic effect?

the eighth cranial nerve Ototoxicity describes the detrimental effect of aminoglycosides on the eighth cranial nerve. Signs and symptoms include tinnitus and sensorineural hearing. The other options are not related to the ototoxic effects.

A client with a diagnosis of heart failure has begun showing signs of renal failure. This occurs because:

the kidneys receive a high proportion of cardiac output to maintain GFR and waste-product removal.

A client has developed ascites secondary to alcoholism. The client's abdominal girth is increased because:

the liver no longer produces enough plasma proteins to maintain osmotic pressure.

The nurse is assisting the physician with a colonoscopy for a patient with rectal bleeding. The physician requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure?

to relax the colonic musculature and reduce spasm Glucagon may be administered, if needed, to relax the colonic musculature and to reduce spasm during the colonoscopy.

A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?

urainary calici

The nurse is caring for a client diagnosed with hyperchloremia. Which are signs and symptoms of hyperchloremia? Select all that apply.

weakness, tachypnea, lethargy The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive ability; and hypertension occur. If untreated, hyperchloremia can lead to a decrease in cardiac output, dysrhythmias, and coma. A high chloride concentration is accompanied by a high sodium concentration and fluid retention.

A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following?

weight

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client:

will not undergo an acute kidney injury by decreasing renal blood flow.

Which diagnosis causes an increased risk of developing intrahepatic jaundice? Select all that apply.

• Hepatitis • Cirrhosis • Liver cancer

A nurse is providing care to a client who has been vomiting for the past 2 days. The nurse would assess this client for which imbalance? Select all that apply.

• Metabolic alkalosis • Hypokalemia

A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract?

Ureters

Gout and the development of kidney stones are often attributed to high levels of what compound?

Uric acid

The nurse is caring for a client who is diagnosed with gout. Which of these laboratory studies does the nurse monitor to monitor this condition?

Uric acid levels

The most frequent reason for admission to skilled care facilities includes which of the following?

Urinary incontinence

One of the most damaging effects of urinary obstruction on kidney structures is which effect?

Urinary stasis

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document?

Urinary urgency

The nurse caring for an older adult notes a marked decrease in mental acuity over a 24-hour period. What assessment indicates the most likely cause of this change?

Urine cloudy with strong odor

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

The nurse is teaching a client with a new ostomy about skin care to preserve tissue integrity at the stomal site. Which teaching will the nurse provide regarding cleansing the stoma?

Use water and mild soap

Which of the following is an example of physiologic hyperplasia?

Uterine enlargement in pregnancy

The nurse is assessing blood gas results for a patient with diabetes and ketoacidosis and notes a pH level of 7.15. Which of the following dysrhythmias should the nurse closely monitor while treating this patient?

Ventricular tachycardia

The nurse is reviewing diagnostic lab work of a client developing shock. Which laboratory result does the nurse note as a key in determining the type of shock?

WBC: 42,000/mm3

A nurse is assessing the stoma of a client with an ostomy. Which intervention should the nurse perform when providing peristomal care to the client to preserve skin integrity?

Wash it with a mild cleanser and water

A client is postoperative day 1 following gastrostomy. The nurse is planning interventions to address the nursing diagnosis of Risk for Infection Related to Presence of Wound and Tube. What intervention is most appropriate?

Wash the area around the tube with soap and water daily. Infection can be prevented by keeping the skin near the insertion site clean using soap and water. Hydrogen peroxide is not used, due to associated skin irritation. The skin around the site is not irrigated with normal saline and antibiotics are not given to prevent site infection.

A client has received nursing teaching about proper skin care at a stomal site. The nurse's teaching has been effective when the client identifies which solution is used to clean the stoma?

Water and mild soap

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?

Wear a mask when performing exchanges.

The nurse is assessing a client with fluid volume excess. The nurse anticipates the client would manifest:

Weight Gain

- Consume adequate amounts of fluid. The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss.

What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss? - Come to the clinic for IV fluid therapy daily. - Limit the fluid intake at night. - Consume adequate amounts of fluid. - Weigh daily.

Negative feedback

What is the most common mechanism of hormone control?

- a blood pressure of 176/88 mm Hg. Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: - a blood pressure of 130/70 mm Hg. - a blood glucose level of 130 mg/dl. - bradycardia. - a blood pressure of 176/88 mm Hg.

Dual-energy x-ray absorptiometry (DEXA)

When caring for a client who is being screened for osteoporosis, the nurse plans to evaluate the results of which of theses diagnostic tests?

Erythropoietin

When caring for a client with anemia and a decrease in red blood cells (RBCs), the nurse recognizes which of these hormones will stimulate the bone marrow to produce additional RBCs?

200 amino acids.

When explaining about structural classifications to a group of students, the instructor discusses the peptides and proteins. They talk about small hormones and hormones as large and complex as growth hormone (GH) which has approximately how many amino acids involved?

Autocrine and paracrine

When hormones act locally rather than being secreted into the bloodstream, their actions are termed what?

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present?

When the urine output is less than 30 mL/h

- Hypercalcemia Hypercalcemia is the hallmark of excess parathyroid hormone levels

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? - Hypocalcemia - Hypercalcemia - Hyperphosphatemia - Hypophosphaturia

- computed tomography scan A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor

Which diagnostic test is done to determine suspected pituitary tumor? - computed tomography scan - measurement of blood hormone levels - radioimmunoassay - radiographs of the abdomen

Decrease in secretion of thyroid stimulating hormone (TSH) Increased levels of thyroid hormone Stimulation of sensors in the anterior pituitary gland Stimulation of sensors in the hypothalamus

Which events are involved in the negative feedback mechanism that keeps the serum thyroid hormone level within appropriate range? Select all that apply.

Hypothalamus

Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland?

Pituitary

Which gland is often referred to as the master gland because it secretes many hormones?

Follicle-stimulating hormone (FSH)

Which hormone is secreted based on a cyclic rather than a diurnal manner?

- Vasopressin

Which hormone is secreted by the posterior pituitary? - Vasopressin - Calcitonin - Corticosteroids - Somatostatin

Estrogen

Which hormone triggers the positive feedback mechanism that controls the secretion of luteinizing hormone (LH) levels?

- Excessive thirst Urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.

Which is a clinical manifestation of diabetes insipidus? - Low urine output - Excessive thirst - Weight gain - Excessive activities

- Hypothyroidism

Which is a complication of hyperthyroidism? - Myxedema coma - Hypothyroidism - Addisonian crisis - Acromegaly

Epinephrine Norepinephrine

Which of the following are examples of amines? Select all that apply.

Much longer to reduce the concentration of the hormone by one half.

Which of the following best describes the half-life of a highly protein bound drug such as thyroxine (99% protein bound)? The half-life would be:

Lipolysis

Which of the following body functions is regulated by several hormones?

They bind to receptors.

Which of the following describes how water-soluble peptides such as parathyroid hormone, or glucagon, exert their effect on cells?

Aldosterone and testosterone

Which of the following hormones are derivatives of cholesterol?

Norepinephrine

Which of the following hormones will elicit a more rapid response than the others?

It does not require serum collection for an accurate reading.

Which of the following is an advantage of assessing hormone levels through collection of a 24-hour urine?

Somatostatin and thyroid-stimulating hormone Insulin and glucagon Calcium and parathyroid hormone Cortisol and adrenocorticotropic hormone

Which of the following is an example of a negative feedback system? Select all that apply.

Estradiol and follicle-stimulating hormone (FSH)

Which of the following is an example of a positive feedback system?

- Aldosterone Aldosterone is the primary hormone for the long-term regulation of sodium balance. Vasopressin (ADH) release will result in reabsorption of water into the bloodstream, rather than excretion by the kidneys.

Which of the following is the primary hormone for the long-term regulation of sodium balance? - Aldosterone - Antidiuretic hormone (ADH) - Calcitonin - Thyroxin

- Desmopressin (DDAVP) DDAVP is a synthetic vasopressin used to control fluid balance and prevent dehydration.

Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? - Desmopressin (DDAVP) - Thiazide diuretics - Ibuprofen - Diabinese

Magnetic resonance imaging (MRI) of the pituitary gland

Which of the following organ systems is matched with the preferred type of imaging?

Second messengers act as the intracellular signal that responds to the presence of a hormone.

Which of the following statements best captures the essence of a second messenger in the mechanisms of the endocrine system?

The hypothalamus receives input from numerous sources throughout the body and directs the pituitary to then control many target glands and cells.

Which of the following statements best captures the relationship between the hypothalamus and the pituitary gland as it relates to endocrine function?

Peptides are degraded by enzymes in cells.

Which of the following statements is accurate regarding how hormones are metabolized and excreted?

Prolactin is unbound. Insulin is unbound. Glucocorticoids are bound

Which of the following statements is correct about hormone transport? Select all that apply.

Dual energy x-ray absorptiometry (DEXA) scan

Which of the following types of imaging is preferred to evaluate the bone density of a patient with hyperparathyroidism?

- Myxedemic coma Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? - Thyroid storm - Myxedemic coma - Addison's disease - Acromegaly

Lipid-soluble steroid hormones

Which type of hormone is released as soon as they are synthesized?

- Positive Chvostek's sign If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward.

While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? - Positive Trousseau's sign - Positive Chvostek's sign - Hyperactive deep tendon reflex - Tetany

Following a meal that was high in carbohydrates, a person's blood glucose elevates, which stimulates the release of insulin from the pancreas.

While discussing the regulation of hormone levels, the instructor gives an example of hormones regulated by feedback mechanisms. Which example of this regulation is best?

Paracrine

While discussing the regulation of hormone levels, the instructor gives an example of hormones regulated by feedback mechanisms. Which example of this regulation is best?

Promote glucose uptake and increase the synthesis of certain proteins involved in fat metabolism, which reduces levels of certain types of lipids.

While reviewing the concept of nuclear receptors with a group of pathophysiology students, the instructor uses the example of clients with type 2 diabetes mellitus taking pioglitazone, a thiazolidinedione medication. Because of the peroxisome proliferator-activated receptors (PPARs), the drug has which effect on the clients' diabetes? Select the best answer.

sperm production.

While reviewing the major actions of follicle-stimulating hormone (FSH), the faculty points out that in males, this hormone is responsible for the:

A cytotechnologist is performing genetic testing on a series of tissues. One tissue comes back with the WT1 mutation, and it's mapped to chromosome 11. What disease will the client mostlikely develop?

Wilms tumor

The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as:

a streptococcal infection 7 to 12 days prior to onset.

The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as? a) 9.0 to 10.5 mg/dL b) 3.5 to 5.3 mg/dL c) 13.5 to 14.5 mg/dL d) 12.0 to 15.0 mg/dL

a) 9.0 to 10.5 mg/dL

Morbid obesity is defined as being how many pounds over the person's ideal body weight? a. 100 b. 90 c. 75 d. 50

a. 100

A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? a. Acromegaly b. Type 1 diabetes mellitus c. Hypothyroidism d. Deficient growth hormone

a. Acromegaly

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? a. Hypokalemia and hypoglycemia b. Hypocalcemia and hyperkalemia c. Hyperkalemia and hyperglycemia d. Hypernatremia and hypercalcemia

a. Hypokalemia and hypoglycemia

Which parenteral route of administration has the longest absorption time? a. Intradermal b. Intravenous c. Subcutaneous d. Intramuscular

a. Intradermal

A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy? a. Liver function b. Thyroid level c. White blood cell (WBC) count d. Cardiac enzymes

a. Liver function

Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome? a. Observe the color of stool. b. Monitor bowel patterns. c. Monitor vital signs every 4 hours. d. Observe urine output.

a. Observe the color of stool.

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? a. Regular insulin b. Lispro c. NPH d. Detemir

a. Regular insulin

The nurse is caring for a client with Cushing's disease. During change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply. a. Serum sodium level b. Hemoglobin and hematocrit c. Serum potassium level d. Blood glucose level e. White blood cell count f. Creatinine clearance total

a. Serum sodium level c. Serum potassium level d. Blood glucose level e. White blood cell count

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? a. Syndrome of inappropriate antidiuretic hormone b. Diabetes insipidus c. Hyposecretion of somatotropin d. Hypersecretion of somatotropin

a. Syndrome of inappropriate antidiuretic hormone

A nurse is teaching a client with diabetes mellitus about self-management. Which of the following would be correct about the administration of lispro insulin? a. Take the insulin at around the same time each day at a meal. b. Increase the insulin amount with the ingestion of alcohol. c. Take once daily in the evening. d. Can be mixed with regular insulin in the same syringe for injection.

a. Take the insulin at around the same time each day at a meal.

A nurse is caring for a child with intussusception. What is an expected outcome for a goal to relieve acute pain from abdominal cramping? a. The child exhibits no manifestations of discomfort. b. The child is very still. c. The child has a normal bowel movement. d. The child has not vomited in 3 hours.

a. The child exhibits no manifestations of discomfort.

Which indicates that the client with diabetes insipidus understands how to manage care? a. The client will maintain normal fluid and electrolyte balance. b. The client will select a diabetic diet correctly. c. The client will state dietary restrictions. d. The client will exhibit serum glucose level within normal range.

a. The client will maintain normal fluid and electrolyte balance.

A male client, aged 42, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? a. The client's consumption of carbohydrates b. History of radiographic contrast studies that used iodine c. The client's mental and emotional status d. The client's exercise routine

a. The client's consumption of carbohydrates

For a client with hyperthyroidism, treatment is most likely to include: a. a thyroid hormone antagonist. b. thyroid extract. c. a synthetic thyroid hormone. d. emollient lotions.

a. a thyroid hormone antagonist.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: a. cannot tolerate high-glucose concentration. b. are at risk for gallbladder contraction. c. are at risk for hepatic encephalopathy. d. can digest high-fat foods.

a. cannot tolerate high-glucose concentration.

The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is: a. decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. b. decreased TSH and increased T4 levels. c. decreased creatine phosphokinase levels. d. absence of antithyroid antibodies.

a. decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels.

How is pharmacodynamics best defined? a. the action that the drug has on body cells b. the method by which a drug is distributed through the body c. the time that elapses between absorption and excretion of a drug d. the way that the liver or kidneys alter the chemical structure of a drug

a. the action that the drug has on body cells

A client with diabetes is taking insulin lispro injections. The nurse should advise the client to eat: a. within 10 to 15 minutes after the injection. b. 1 hour after the injection. c. at any time because timing of meals with lispro injections is unnecessary. d. 2 hours before the injection.

a. within 10 to 15 minutes after the injection.

A client is admitted to hospital with fluid volume deficit. The nurse should be aware that compensatory mechanisms will include:

activation of the renin--angiotensin--aldosterone system.

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 give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed:

acute postinfectious glomerulonephritis.

The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains afterload to the student and then asks the student what nursing interventions might cause decreased afterload. The student correctly answers which of the following?

administration of a vasodilating drug (as ordered by the physician) Afterload is the amount of resistance to the ejection of blood from the ventricles. Anything that decreases this resistance will decrease afterload. Vasodilation will decrease systemic resistance. Antiembolytic stockings and keeping the client's legs elevated will increase resistance.

A client arrives in the emergency department semi-comatose. Her breath has a "fruity" smell. Their initial blood glucose level is >600. Her mouth and mucous membranes are dry. The healthcare providers suspect the client may be experiencing hyperglycemic hyperosmolar syndrome. In this situation, the nurse can expect the client's lab results to reflect:

an increase in glomerular filtration rate [GFR].

A client in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. The first activity of the nurse is to:

assess lung sounds bilaterally All these activities are things the nurse may do for a client with a foreign body in the esophagus. This client is at risk for esophageal perforation, and thus pneumothorax. By auscultating lung sounds the nurse will be able to assess if a pneumothorax is present. The client has little saliva in the oral cavity and does not need to be suctioned. A client may also report pain with a foreign body. However, ABCs (airway, breathing, circulation) take priority. The consent for the esophagogastroscopy may be obtained after the nurse has completed the client assessment.

The triage nurse in the ED is assessing a client with chronic heart failure who has presented with worsening symptoms. In reviewing the client's medical history, what is a potential primary cause of the client's heart failure?

atherosclerosis Atherosclerosis of the coronary arteries is the primary cause of heart failure. Pleural effusion, endocarditis, and an atrial-septal defect are not health problems that contribute to the etiology of heart failure.

When confronted with a decrease in work demands or adverse environmental conditions, most cells are able to revert to a smaller size and a lower, more efficient level of functioning that is compatible with survival. This decrease in cell size is known as:

atrophy

The nurse is providing discharge education for the client going home after a cardiac catheterization. Which of the following would be important information to give this client?

avoids tub baths, but shower as desired Guidelines for self-care after hospital discharge following a cardiac catheterization include shower as desired (no tub baths), avoid bending at the waist and lifting heavy objects, the physician will indicate when it is okay to return to work, and notify the physician right away if you have bleeding, new bruising, swelling, or pain at the puncture site.

A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? a. "You must lie flat for 24 hours after surgery." b. "You must avoid coughing, sneezing, and blowing your nose." c. "You must restrict your fluid intake." d. "You must report ringing in your ears immediately."

b. "You must avoid coughing, sneezing, and blowing your nose."

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? a. Pitting edema of the legs b. An irregular apical pulse c. Dry mucous membranes d. Frequent urination

b. An irregular apical pulse

The nurse is caring for a client with polydipsia and large amounts of urine with a specific gravity of 1.003. Which disorder is anticipated? a. Diabetes mellitus b. Diabetes insipidus c. Diabetic ketoacidosis d. SIADH secretion

b. Diabetes insipidus

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? a. Polyuria b. Hypoglycemia c. Blurred vision d. Polydipsia

b. Hypoglycemia

Production of melanin is controlled by a hormone secreted by which gland? a. Thyroid b. Hypothalamus c. Adrenal d. Parathyroid

b. Hypothalamus

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? a. Disturbed body image b. Impaired nutrition: less than body requirements c. Nausea d. Anxiety

b. Impaired nutrition: less than body requirements

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? a. Report the condition to the physician immediately. b. Measure abdominal girth according to a set routine. c. Provide the client with nonprescription laxatives. d. Ask the client about food intake.

b. Measure abdominal girth according to a set routine.

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? a. Increase calories. b. Restrict sodium. c. Restrict potassium. d. Reduce fat to 10%.

b. Restrict sodium.

The nurse is discussing diabetes mellitus with the family members of a client recently diagnosed. In order to promote the health of the family members, what would be the most important information for the nurse to include? a. Medications used to treat diabetes mellitus b. Risk factors and prevention of diabetes mellitus c. The severity of the client's disease d. The cellular metabolism of glucose

b. Risk factors and prevention of diabetes mellitus

Which method would be most appropriate for the nurse use to determine if a 2-year-old is obese? a. weight-for-length charts b. body mass index (BMI)-for-age c. abdominal girths d. skinfold thickness measurements

b. body mass index (BMI)-for-age

A 42-year-old female is interested in making dietary changes to reduce her risk of colon cancer. What dietary selections should the nurse suggest? a. croissant, granola and peanut butter squares, whole milk b. bran muffin, skim milk, stir-fried broccoli c. granola, bagel with cream cheese, cauliflower salad d. oatmeal-raisin cookies, baked potato with sour cream, turkey sandwich

b. bran muffin, skim milk, stir-fried broccoli

The nurse is assessing a client's nutritional status before surgery. Which observation would indicate poor nutrition in a 5-foot 7-inch (170 cm) female client who is 21 years of age? a. poor posture b. brittle nails c. dull expression d. weight of 128 lb (58.1 kg)

b. brittle nails

A client in cardiac rehabilitation would like to eat the right foods to ensure adequate endurance on the treadmill. Which nutrient is most helpful for promoting endurance during sustained activity? a. protein b. carbohydrate c. fat d. water

b. carbohydrate

Total parenteral nutrition (TPN) is prescribed for a client who has recently had a significant small and large bowel resection and is currently not taking anything by mouth. The nurse should: a. administer TPN through a nasogastric or gastrostomy tube. b. handle TPN using strict aseptic technique. c. auscultate for bowel sounds prior to administering TPN. d. designate a peripheral intravenous (IV) site for TPN administration.

b. handle TPN using strict aseptic technique.

Vasopressin is administered to the client with diabetes insipidus because it: a. decreases blood pressure. b. increases tubular reabsorption of water. c. increases release of insulin from the pancreas. d. decreases glucose production within the liver.

b. increases tubular reabsorption of water.

The nurse should instruct a client with heart disease to avoid which foods that contribute to increases in serum cholesterol? a. polyunsaturated fat b. saturated fat c. monounsaturated fat d. phospholipids

b. saturated fat

A client has extreme fatigue and is malnourished, and laboratory tests reveal a hemoglobin level of 8.5 g/dL (85 g/L). The nurse should specifically ask the client about the intake of food high in which nutrients? a. vitamins A, E, and C b. vitamins B6 and B12, folate, iron, and copper c. thiamine, riboflavin, and niacin d. vitamins A and B

b. vitamins B6 and B12, folate, iron, and copper

The nurse is reviewing the medication administration record of a client diagnosed with systolic heart failure. What medication should the nurse anticipate administering to this client? You Selected:

beta-adrenergic blocker Several medications are routinely prescribed for systolic heart failure, including ACE inhibitors, beta-blockers, diuretics, and digitalis. Calcium channel blockers, antiplatelet aggregators, and NSAIDs are not commonly prescribed.

The most reliable method for measuring body water or fluid volume increase is by assessing...

body weight change You have to weight a patient w/ renal failure to assess their fluid retention

A client has been prescribed a drug that is not removed quickly by renal filtration. The drug likely has this quality because it is:

bound to plasma proteins.

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?

breif hot showers

Eve, 2 years old, and her parents are at the office for a follow-up visit. She has had excessive hormone levels in her recent bloodwork and her parents question why this was not found sooner. What is the best response of the nurse? a. "It takes time to determine the level of functioning of endocrine glands." b. "Have there been signs and symptoms that you should have reported to the doctor?" c. "As endocrine functions become more stable throughout childhood, alterations become more apparent." d. "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."

c. "As endocrine functions become more stable throughout childhood, alterations become more apparent."

The nurse is teaching a new mother about the changes in her newborn's gastrointestinal tract. The nurse determines that additional teaching is needed when the mother makes which statement? a. "The newborn's gut is sterile at birth." b. "He needs to get food orally to make vitamin K." c. "His stomach can hold approximately 10 ounces." d. "The muscle opening that leads into of the stomach is not mature."

c. "His stomach can hold approximately 10 ounces."

After a school-age child with type 1 diabetes attends a teaching session about nutrition, the nurse determines that the teaching has been effective when the child makes which statement? a. "If I do not eat all my meal, I can make up the carbohydrates at the next meal." b. "If I am not hungry for a meal, I can eat the carbohydrates for a snack later." c. "When I do not finish a meal, I must make up the carbohydrates right then." d. "When I do not finish a meal, I just need to take more insulin."

c. "When I do not finish a meal, I must make up the carbohydrates right then."

After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true? a. Erectile dysfunction is unrelated to anxiety or depression. b. Erectile dysfunction is primarily a normal response to aging. c. Erectile dysfunction may be due to testosterone insufficiency. d. Erectile dysfunction rarely occurs in clients with diabetes mellitus.

c. Erectile dysfunction may be due to testosterone insufficiency.

Which would a nurse expect to assess in a client experiencing hyperthyroidism? a. Slow and deep tendon reflexes b. Bradycardia c. Flushed, warm skin d. Intolerance to cold

c. Flushed, warm skin

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? a. Fasting blood glucose level b. Glucose via a urine dipstick test c. Glycosylated hemoglobin level d. Glucose via an oral glucose tolerance test

c. Glycosylated hemoglobin level

A client is scheduled for a thyroid panel. The nurse understands that this test would involve which of the following? a. Radiograph of the neck b. Radioactive iodine uptake test c. Measurement of blood hormone levels d. Scan using an injected radioactive substance

c. Measurement of blood hormone levels

The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? a. Levothyroxine b. Spironolactone c. Propylthiouracil d. Propranolol

c. Propylthiouracil

A nurse is caring for a client who has a malabsorption disease. The nurse should understand that which structure in the gastrointestinal system absorbs the majority of digested food and minerals? a. Stomach b. Large intestine c. Small intestine d. Liver

c. Small intestine

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: a. Transport of potassium. b. Release of glucose. c. Synthesis of glucose from noncarbohydrate sources. d. Storage of glucose as glycogen in the liver.

c. Synthesis of glucose from noncarbohydrate sources.

A nurse is preparing to administer a prescribed drug to a client who has liver disease. The nurse expects a reduction in dosage based on the understanding that what might be altered? a. absorption b. distribution c. metabolism d. excretion

c. metabolism

A client who is suffering a myocardial infarction is transported to the ED by ambulance. This client is at greatest risk for developing which type of shock?

cardiogenic shock

A 45-year-old client presents to the ED reporting trouble speaking and numbness of the right arm and leg. The nurse suspects an ischemic stroke. Which insult or abnormality can cause an ischemic stroke?

cocaine use Two classifications of ischemic strokes are cryptogenic strokes, which have no known cause, and strokes from other causes, such as illicit drug use, coagulopathies, migraine, and spontaneous dissection of the carotid or vertebral arteries. Cocaine is a potent vasoconstrictor and may result in a life-threatening reaction, even with the individual's first use of the drug. Arteriovenous malformations, trauma, and intracerebral aneurysm are associated with hemorrhagic strokes.

The nurse is reviewing the results of a renal client's laboratory results. This client's urine specific gravity allows the nurse to assess the kidneys' ability to:

concentrate urine.

The nurse is caring for an adult client with heart failure who is prescribed digoxin. When assessing the client for adverse effects, the nurse should assess for which of the following signs and symptoms? Select all that apply.

confusion, bradycardia A key concern associated with digitalis therapy is digitalis toxicity. Symptoms include anorexia, nausea, visual disturbances, confusion, and bradycardia. The other listed signs and symptoms are not characteristic of digitalis toxicity.

The nurse is assessing a client with fluid volume excess. The nurse anticipates the client would manifest? a) decreased blood pressure b) weak, rapid pulse c) increased BUN d) weight gain

d) weight gain

A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder? a. Coagulation studies b. Magnetic resonance imaging c. Radioisotope liver scan d. Liver biopsy

d. Liver biopsy

For a client with Graves' disease, which nursing intervention promotes comfort? a. Restricting intake of oral fluids b. Placing extra blankets on the client's bed c. Limiting intake of high-carbohydrate foods d. Maintaining room temperature in the low-normal range

d. Maintaining room temperature in the low-normal range

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? a. Polyuria, headache, and fatigue b. Polyphagia and flushed, dry skin c. Polydipsia, pallor, and irritability d. Nervousness, diaphoresis, and confusion

d. Nervousness, diaphoresis, and confusion

A client has sustained a traumatic brain injury with involvement of the hypothalamus. The health care team is concerned about the complication of diabetes insipidus. Which of the following would be an appropriate nursing intervention to monitor for early signs of diabetes insipidus? a. Assess frequent vital signs. b. Reposition frequently. c. Assess for pupillary response frequently. d. Record intake and output.

d. Record intake and output.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? a. Blood urea nitrogen (BUN) level of 12 mg/dl (0.7 mmol/L) b. Blood glucose level of 90 mg/dl (4.9 mmol/L) c. Serum sodium level of 134 mEq/L (134 mmol/L) d. Serum potassium level of 5.8 mEq/L (5.8 mmol/L)

d. Serum potassium level of 5.8 mEq/L (5.8 mmol/L)

A client diagnosed with anxiety disorder is ordered buspirone. Teaching instructions for buspirone should include: a. a warning that immediate sedation can occur with a resultant drop in pulse. b. a reminder of the need to schedule blood work 1 week after initiating therapy to check blood levels of the drug. c. a warning about medication-related incidence of neuroleptic malignant syndrome. d. a warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days.

d. a warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days.

The nurse judges that the mother has understood the teaching about care of an infant with colic when the nurse observes the mother doing which action? a. holding the infant prone while feeding b. holding the infant in her lap to burp c. placing the infant prone after the feeding d. burping the infant during and after the feeding

d. burping the infant during and after the feeding

A client with chronic renal failure is undergoing hemodialysis. Postdialysis, the client weighs 59 kg. The nurse should teach the client to: a. increase sodium in the diet to 4 g/day. b. limit total calories consumed each day to 1,000. c. increase fluid intake to 3,000 mL each day. d. control the amount of protein intake to 59 to 70 g/day.

d. control the amount of protein intake to 59 to 70 g/day.

The most important intervention in the nutritional support of a client with a burn injury is to provide adequate nutrition and calories. The nurse recognizes this intervention is to promote a. increased metabolic rate. b. increased glucose demands. c. increased skeletal muscle breakdown. d. decreased catabolism.

d. decreased catabolism.

A nurse should encourage a client with a wound to consume foods high in vitamin C because this vitamin: a. restores the inflammatory response. b. enhances oxygen transport to tissues. c. reduces edema. d. enhances protein synthesis.

d. enhances protein synthesis.

A nurse is administering pain medication to an 80-year-old man. What altered drug response might be expected due to the client's age? a. decreased gastric pH causing stomach irritation b. increased possibility of drug toxicity due to increased distribution of water-soluble drugs c. increased excretion of drugs, leading to possible increased serum levels/toxicity d. increased possibility of drug toxicity due to higher drug plasma concentrations

d. increased possibility of drug toxicity due to higher drug plasma concentrations

Baroreceptors in the left atrium and in the carotid and aortic arches respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect?

decrease in glomerular filtration Sympathetic stimulation constricts renal arterioles; this decreases glomerular filtration, increases the release of aldosterone, and increases sodium and water reabsorption. None of the other listed options occurs with increased sympathetic stimulation.

A client with a history of renal insufficiency is experiencing a flare-up of his arthritis and he has increased his daily dose of ibprofen (an NSAID). Knowing the effect that ibprofen has on prostaglandin synthesis, the nurse should anticipate:

decrease renal blood flow resulting in decrease in urine output.

The nurse teaches the client with hyperparathyroidism he is at risk for which of these?

developing kidney stones

A patient diagnosed with IBS is advised to eat a diet that is:

diet high in fiber A high-fiber diet is prescribed to control diarrhea and constipation and is recommended for patients with IBS.

By which route do oxygen and carbon dioxide exchange in the lung?

diffusion

A woman age 76 years has informed the nurse that she has begun using over-the-counter laxatives because her friend told her it was imperative to have at least one bowel movement daily. How should the nurse best respond to this client's statement?

"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day"

A client has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds:

"All glomeruli and all parts of the glomeruli are involved."

A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following?

"Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney."

The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries?

dobutamine Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. Options A, B, and C would not dilate the coronary arteries.

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to:

drink liberal amounts of fluids.

A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client?

"Do you take multiple vitamin preparations?"

While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question?

"Do you urinate while sleeping?"

A nurse educator is orientating new nurses to a renal unit of the hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function?

"Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation."

The nurse is caring for a man who has experienced a spinal cord injury. Throughout his recovery, the client expects to gain control of his bowels. The nurse's best response to this client would be which of the following?

"Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact." The act of defecation is a spinal reflex involving the parasympathetic nerve fibers. Normally, the external anal sphincter is maintained in a state of tonic contraction. With a spinal cord injury, the client no longer has this nervous system control and is often incontinent.

The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions?

"I can resume my usual activities without restriction."

A client is taking home occult blood testing (FOBT) supplies. Which client statement requires nursing intervention?

"I like to eat beef, so this will be good for me before performing the test"

An adult client has been diagnosed with polycystic kidney disease. Which statement by the client demonstrates an accurate understanding of this diagnosis?

"I suppose I should be tested to see if my children might inherit this."

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse?

"I took my blood pressure medication with my morning coffee an hour ago."

The nurse is admitting a client who is to undergo an open renal biopsy. About which of the following comments by the client should the nurse be most concerned?

"I took my usual dose of Coumadin last night."

A client is prescribed sumatriptan for the treatment of migraine headache. Which client statement would indicate a need for additional teaching from the nurse?

"I use this to prevent migraines" Sumatriptan is a serotonin receptor agonist that stimulates serotonin receptors in the brain and causes vasoconstriction of the cerebral arteries and reduce/eliminate headaches and other symptoms associated with migraines. Sumatriptan is used during an attack and is not indicated for preventative migraine therapy.

The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective?

"I will feel a warm sensation as the dye is injected."

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?

"I will have to take vitamin B12 shots up to 1 year after surgery." After a total gastrectomy, a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia. Visiting clergy for emotional support is normal after receiving a cancer diagnosis. This action should be encouraged by the nurse. It's appropriate for the client to call the physician if he experiences signs and symptoms of intestinal blockage or obstruction, such as abdominal pain. Because a client with a total gastrectomy will receive enteral feedings or parenteral feedings, he should weigh himself each day and keep a record of the weights.

A 42 year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which statement by the client reflects an accurate understanding of the process of hemodialysis?

"I won't be able to go about my normal routine during treatment."

The nurse is explaining the steps for collecting a clean catch urine specimen to a client. Which statement by the client indicates effective teaching?

"I'll start to urinate for a few seconds and then start to collect the specimen."

A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?

"I'm feeling a bit under the weather these days and I'm a bit feverish."

Which of the following symptoms should the nurse expect to find as an early symptom of chronic heart failure?

fatigue Fatigue is commonly the earliest symptom of chronic heart failure; it is caused by decreased cardiac output and tissue oxygenation. Pedal edema and nocturia are symptoms of heart failure, but they occur later in the course of the condition. An irregular pulse can be a complication of heart failure, but it is not necessarily an early indication of the condition.

A nurse is documenting the appearance of feces from a client with a permanent ileostomy. Which scenario would she document?

"Ileostomy bag half filled with liquid feces"

An older adult client tells the nurse, "I give myself a mineral oil enema every day." What is the appropriate nursing response?

"Mineral oil enemas can interfere with absorption of fat-soluble vitamins"

A patient in a hospital is frustrated at the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine collection test. He asks the nurse why the test is necessary since he provided a single urine sample two days ago. How could the nurse best respond to the patient's question?

"Often why an abnormal substance shows up in urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine."

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions?

"See if rest relieves the chest pain before using the nitroglycerin."

A male patient with a history of heavy alcohol use has been admitted to hospital for malnutrition and suspected pancreatitis. The patient's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

"The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.

The nurse is caring for a motor vehicle accident client who is unresponsive on arrival to the emergency department. The client has numerous fractures, internal abdominal injuries, and large lacerations on the head and torso. The family arrives and seeks update on the client's condition. A family member asks, "What causes the body to go into shock?"Given the client's condition, which statement is most correct?

"The client is in shock because the blood volume has decreased in the system."

The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl (Renagel), a phosphate binder, with meals. How does the nurse explain the rationale for the timing of this medication?

"The medication should be taken at meal time to allow the binding of phosphate."

A nurse is preparing a client for a lumbar puncture and informs the client that the needle will be inserted into the subarachnoid space between L3 and L4 or L4 and L5. The client reports that she is worried about damage to her spinal cord. The appropriate response from the nurse is which of the following?

"The spinal cord ends at L1, so puncturing it is not possible." The needle is usually inserted into the subarachnoid space between the 3rd and 4th or 4th and 5th lumbar vertebrae. Because the spinal cord ends at the 1st lumbar vertebra, insertion of the needle below the level of the 3rd lumbar vertebra prevents puncture of the spinal cord.

The nurse has provided a client with fecal immunochemical test (FIT) testing supplies. Which client statement reflects understanding of the purpose of this test?

"This test can help indicate if I have colorectal cancer"

The nurse is teaching a client with rectal bleeding about fecal occult blood test (FOBT) testing supplies. What teaching will the nurse provide?

"This test detects heme, a type of iron compound in blood in the stool."

A client has been given fecal occult blood test (FOBT) testing supplies. What teaching will the nurse provide about the purpose for this test?

"This test detects heme, an iron compound in blood within the stool."

Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective?

"Ultrafiltration methods take much longer than hemodialysis."

A 51 year-old male professional is in the habit of consuming 6 to 8 rum and cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the client's statement?

"When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts."

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?

"You don't need to do any fasting before this noninvasive test."

A family physician is providing care for a 61 year-old obese male who has a history of diabetes and hypertension. Blood work has indicated that the man has a GFR of 51 mL/min with elevated serum creatinine levels. Which of the following statements will the physician most likely provide to the client in light of these results?

"Your chronic kidney disease has likely been caused by your diabetes and high blood pressure."

The nurse on the cardiac unit has noted that the client's potassium level is 6.1 mEq/L. The nurse has notified the physician and removed the banana from the client's meal tray. When explaining the nursing actions to the client, which of these statements is appropriate?

"Your potassium level is high so I need you let me know if you feel numbness, tingling or weakness"

A client with no significant medical history reports experiencing diarrhea over the past week. Which assessment question will the nurse ask? (Select all that apply.)

- "Have you started a new medication?" - "What are your normal bowel habits?" - "Do you use laxatives?"

The nurse has presented an educational in-service about caring for clients who have newly created ostomies. The nurse asks participants, "How will you know when a client begins to accept the altered body image?" Which responses by participants indicates a correct understanding of the material? Select all that apply.

- "The client is willing to look at the stoma." - "The client makes neutral or positive statements about the ostomy." - "The client expresses interest in learning self-care."

What can the nurse include in the plan of care to ensure early intervention along the continuum of shock to improve the patient's prognosis? (Select all that apply.)

- Assess the patient who is at risk for shock. - Administer intravenous fluids. - Monitor for changes in vital signs.

A heart failure client has gotten confused and took too many of his "water pills" (diuretics). On admission, his serum potassium level was 2.6 mEq/L. Of the following assessments, which correlate to this hypokalemia finding? Select all that apply.

- Constipation - Polyuria - Paresthesia with numbness of the lips/mouth

The nurse is evaluating stool characteristics of an adult client. Which of the following would describe a normal stool? Select all that apply

- Dark Brown - Light Brown

Stress ulcers occur frequently in acutely ill patient. Which of the following medications would be used to prevent ulcer formation? Select all that apply.

- Famotidine (Pepcid) - Ranitidine (Zantac) - Lansoprazole (Prevacid)

The nurse is caring for a client diagnosed with shock. During report, the nurse reports the results of which assessments that signal early signs of the decompensation stage? Select all that apply.

- Vital signs - Skin color - Urine output - Peripheral pulses

The risk for developing colorectal cancer during one's lifetime is 1 in 19. Nurses play an integral role in the promotion of colorectal cancer screening. What are risk factors for colorectal cancer? Select all that apply

- age 50 and older - a positive family history - a history of inflammatory bowel disease

Edema is an excess in the interstitial fluid volume. What mechanisms play a part in the formation of edema? (Select all that apply.)

-Mechanisms that increase capillary permeability - Mechanisms that increase capillary filtration pressure - Mechanisms that produce obstruction to the flow of lymph - Mechanisms that decrease capillary colloidal osmotic pressure

To calculate the H2CO3 content of the blood, the nurse needs to measure the Pco2 (partial pressure of CO2) by its solubility coefficient. What is the solubility coefficient of CO2?

0.03

A patient is admitted to the emergency department after being involved in an automobile accident with possible internal bleeding. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?

0.9% NaCl

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?

1,000mL OR 1 L

A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be:

1-2 L/day

D

1. The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? a. 250 mL b. 500 mL c. 750 mL d. 1,000 mL

The nurse is preparing to empty an open-ended colostomy pouch. Arrange the following steps in the correct order

1. Uncuff the end edge of the pouch 2. Empty contents into a measuring device 3. Wipe the lower 2 inches of the pouch with toilet tissue 4. Fold the end of the pouch upward like a cuff 5. Apply clamp

When fluid intake is normal, the specific gravity of urine should be which of the following?

1.010-1.025

B

10. The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a. Abdominal distention owing to reflex cessation of intestinal peristalsis b. Hypovolemic shock caused by hemorrhage c. Paralytic ileus caused by manipulation of the colon during surgery d. Pneumonia caused by shallow breathing because of severe incisional pain

A client is admitted to the emergency department after a motorcycle accident. Upon assessment, the client's vital signs reveal blood pressure of 80/60 mm Hg and heart rate of 145 beats per minute. The client's skin is cool and clammy. Which medical order for this client will the nurse complete first?

100% oxygen via a nonrebreather mask

A new client on hemodialysis is watching his blood being filtered through a dialyzer. He asks the nurse how much blood typically passes through the kidney every minute? The nurse responds:

1000-1300 mL/minute.

Which value represents a normal BUN-to-creatinine ratio?

10:1

C

11. A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? a. Performing the test without contrast b. Administering Garamycin (gentamicin) prophylactically c. Hydrating with saline intravenously before the test d. Administering sodium bicarbonate after the procedure

The nurse should assess the patient for signs of lethargy, increasing intracranial pressure, and seizures when the serum sodium reaches what level?

115 mEq/L Features of hyponatremia associated with sodium loss and water gain include anorexia, muscle cramps, and a feeling of exhaustion. The severity of symptoms increases with the degree of hyponatremia and the speed with which it develops. When the serum sodium level decreases to less than 115 mEq/L (115 mmol/L), signs of increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur.

D

12. The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? a. Administration of an insulin drip b. Administration of a loop diuretic c. Administration of sodium bicarbonate d. Administration of sodium polystyrene sulfonate [Kayexalate])

A

13. The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication? a. With food b. 2 hours before meals c. 2 hours after meals d. At bedtime with 8 ounces of fluid

D

14. A patient with ESKD is scheduled to have a arteriovenous fistula created. The nurse explains that the patient will have a temporary dialysis catheter because the fistula has to "mature." The nurse will explain that the patient will have to wait how long before using the fistula? a. 1 to 2 weeks b. 2 to 3 weeks c. 1 month d. 2 to 3 months

When vasoactive medications are administered, the nurse must monitor vital signs at least how often?

15 minutes

C

15. A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened? a. The dialysis was performed too rapidly. b. The patient is having an allergic reaction to the dialysate. c. The patient is experiencing a cerebral fluid shift. d. Too much fluid was pulled off during dialysis.

A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?

150

The nurse is teaching a healthy adult client about adequate hydration. How much average daily intake does the nurse recommend?

2,500 mL/day

Select the percentage of cardiac output that perfuses the kidneys.

20% to 25%

Which clients would be considered to have a significant risk of developing the prerenal form of acute renal failure? Select all that apply.

22 year-old male who has lost large amounts of blood following a workplace injury. 79 year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure. 80 year-old female who has been admitted for the treatment of dehydration and malnutrition.

The nurse is preparing to administer a large-volume enema to an adult client. How far should the nurse insert the tubing?

3 inches (7.5 cm)

During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?

3% sodium chloride.

A, C, D

3. The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? (Select all that apply.) a. Red blood cells in the urine b. Polyuria. c. Proteinuria d. White cell casts in the urine e. Hemoglobin of 12.8 g/dL

A patient is receiving continuous tube feedings via a small bore feeding tube. The nurse irrigates the tube after administering medication to maintain patency. Which size syringe would the nurse use?

30 mL When small-bore feeding tubes for continuous tube feedings are used and irrigated after administration of medications, a 30-mL or larger syringe is necessary, because the pressure generated by smaller syringes could rupture the tube.

The nurse received report on a hospitalized patient who was being evaluated for renal disease. The nurse was told that the patient had oliguria. Select the output record that would be consistent with that diagnosis.

350-500 mL/24 hr

C

4. The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output? a. 1.5 L b. 1.0 L c. Less than 400 mL d. Less than 50 mL

A nurse is asked to assess a patient's need for a hearing aid. The nurse knows that a general guideline to determine need would be a hearing loss of:

40 dB in the range of 500 to 2,000 Hz. A general guideline for assessing the patient's need for a hearing aid is a hearing loss exceeding 30 dB in the range of 500 to 2,000 Hz (units of cycles/second).

A client has been prescribed a protein intake of 0.6 g/kg of body weight. The client weighs 154 pounds. The nurse calculates the daily protein intake to be how many grams? Enter the correct number ONLY.

42

The nurse is checking the placement of a nasogastric tube and aspirates for gastric contents. The nurse checks the pH of the aspirate and determines that the tube is in the stomach when she gets which pH measurement?

5

The health care provider ordered an IV solution for a dehydrated patient with a head injury. Select the IV solution that the nurse knows would be contraindicated.

5% DW A solution of D5W is an isotonic IV solution that is contraindicated in head injury because it may increase intracranial pressure.

The nurse receives an order to administer a colloidal solution for a patient experiencing hypovolemic shock. What common colloidal solution will the nurse most likely administer?

5% albumin

B

5. The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium? a. Butter b. Citrus fruits c. Cooked white rice d. Salad oils

A nursing instructor is discussing the diagnosis of intermittent claudication with students. To determine whether the students understand the pathophysiology of the disease, the instructor asks, "What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?" What answer should the students give?

50 Typically, about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced.

The nurse is providing health teaching for four clients. Which client will the nurse teach that should consider a colonoscopy screening?

50-year-old client with a family history of polyps

The nurse works at an agency that automatically places certain clients on intake and output (I&O;). For which client will the nurse document all I&O;?

55-year old with congestive heart failure on furosemide

A patient is receiving a continuous tube feeding. The nurse notes that the feeding tube was last irrigated at 2 p.m. The nurse would plan to irrigate the tube again at which time?

6-8 pm The recommendation is to irrigate the feeding tube of patients receiving continuous tube feedings every 4 to 6 hours. For this patient, the nurse would irrigate the tube next at 6 p.m. to 8 p.m.

A

6. A patient has AKI with a negative nitrogen balance. How much weight does the nurse expect the patient to lose? a. 0.5 kg/day b. 1.0 kg/day c. 1.5 kg/day d. 2.0 kg/day

The nurse knows when the cardiovascular system becomes ineffective in maintaining an adequate mean arterial pressure (MAP). Select the reading below that indicates tissue hypoperfusion.

60 mm Hg

Body weight consists of which of the following percentages of body water?

60%

B

7. A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? a. A GFR of 90 mL/min/1.73 m2 b. A GFR of 30-59 mL/min/1.73 m2 c. A GFR of 120 mL/min/1.73 m2 d. A GFR of 85 mL/min/1.73 m2

The nurse is using continuous central venous oximetry (ScvO2) to monitor the blood oxygen saturation of a patient in shock. What value would the nurse document as normal for the patient?

70%

A

8. A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this patient? a. Anemia b. Acidosis c. Hyperkalemia d. Pericarditis

B

9. At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? a. 0.5 lb b. 1.0 lb c. 1.5 lb d. 2 lb

A nurse observes peaked, narrow T waves on the electrocardiogram of a patient suffering from renal failure. The nurse suspects that the client is experiencing which of the following conditions?

9.0 to 10.5 mg/dL

Cerebral edema occurs with potentially severe neurologic impairment.

9.0 to 10.5 mg/dL

Which blood pressure (BP) reading would result in a pulse pressure indicative of shock?

90/70 mm Hg

Urine is a amber, light-yellow fluid that is 5% dissolved solid. What percent of it is water?

95

Stimulation test

A 21 year-old female is suspected of having inadequate function of her hypothalamic-pituitary-thyroid system. Her care provider is planning to inject thyrotropin-releasing hormone (TRH) and then measure her levels of TSH. Which of the following diagnostic tests is being performed?

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.

A 26-year-old female with anxiety who has been hyperventilating

Estrogen will continue to pass freely through the cellular membranes.

A 38-year-old woman takes clomiphene, an infertility drug that works by competing with, and thereby blocking, cellular receptors for estrogen. Which of the following statements is most likely to be true of this client?

Insufficient estrogen production within the smooth endoplasmic reticulum of the relevant cells.

A 51 year-old woman has been experiencing signs and symptoms of perimenopause and has sought help from her family physician. A deficiency in estrogen levels has been determined to be a contributing factor. Which of the following phenomena could potentially underlie the woman's health problem?

A geriatric nurse is caring for several clients. Which alterations in clients' health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years.

A patient has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels?

A BUN to creatinine level ratio of 20:1

Sleep-wake cycles

A client asks the nurse what causes the secretion of growth hormone (GH) and adrenocorticotrophic hormone (ACTH) to fluctuate. The best response by the nurse would be:

A suppression test

A client comes to a scheduled appointment in the endocrine clinic. The primary care physician referred the client, suspecting acromegaly. Knowing the usual testing involved, the nurse should educate the client about which lab/diagnostic procedure?

Hypotension Hypoventilation Hypothermia Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.

A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. - Hypothermia - Hypertension - Hypotension - Hypoventilation - Hyperventilation

Function of the thyroid gland Function of the gonads Growth and metabolism Glucocorticoid hormone levels

A client has developed a tumor of the anterior pituitary gland. The nurse is aware that the client is at risk for alterations of: Select all that apply.

Antidiuretic hormone (ADH) and oxytocin

A client has developed a tumor of the posterior pituitary gland. The client is at risk for problems with secretions of:

- Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? - Infusing IV fluids rapidly as ordered - Encouraging increased oral intake - Restricting fluids - Administering glucose-containing I.V. fluids as ordered

- Serum potassium level of 5.8 mEq/L Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? - Blood urea nitrogen (BUN) level of 12 mg/dl - Blood glucose level of 90 mg/dl - Serum sodium level of 134 mEq/L - Serum potassium level of 5.8 mEq/L

- Glucocorticoids Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens.

A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress? - Testosterone - Mineralocorticoids - Glucocorticoids - Estrogen

- Tracheostomy set After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.

A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? - Indwelling urinary catheter kit - Tracheostomy set - Cardiac monitor - Humidifier

whether the client is producing excessive hormone levels.

A client is scheduled for a suppression test as part of the diagnostic testing for his suspected endocrine disorder. The results of this test will help the care team determine:

- Magnetic resonance imaging (MRI) A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.

A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for? - Magnetic resonance imaging (MRI) - Radioactive iodine uptake tes - Radioimmunoassay - A nuclear scan

- Pineal gland, melatonin The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamicpituitary interaction.

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood? - Thymus gland, thymosin - Parathyroid glands, parathormone - Pineal gland, melatonin - Adrenal cortex, corticosteroids

The hypothalamic-pituitary-target cell system

A client who is referred to the endocrinologist's office for an evaluation of his hormone levels asks what regulates the hormone levels. The best response would be that hormone levels in the body are primarily regulated by:

Up-regulation has increased the sensitivity of the body to particular hormone levels.

A client with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which of the following processes would the client's care team most likely rule out first as a contributing factor?

With input from various sensors, hormone production and release are adjusted based on existing hormone levels.

A client with a new diagnosis of an endocrine disorder is unclear how the body can control the levels of different hormones over time. Which of the following statements most accurately underlies the dominant regulation process of hormone levels in the body?

- Pressure on the optic nerve Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.

A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? - Glaucoma - Corneal abrasions - Retinal detachment - Pressure on the optic nerve

- A pituitary tumor When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.

A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly? - A pituitary tumor - A decrease in release in the growth hormone - A decrease in the glucose level - An increase in cerebral edema

- "Maintain a moderate exercise program." Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise.

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? - "Maintain a moderate exercise program." - "Rest as much as possible." - "Lose weight." - "Jog at least 2 miles per day."

have negative feedback regulation.

A client with hyperthyroidism is being treated with medication that blocks the activity of thyroid-stimulating hormone. Her care team has determined that she has been overproducing TSH. This client will have lost her ability to:

Which of the following clients' diagnostic bloodwork is most suggestive of chronic kidney disease (CKD)?

A client with low vitamin D levels; low calcitrol levels and elevated parathyroid hormone (PTH) levels

A client is experiencing septic shock and infrequent bowel sounds. To ensure adequate nutrition, the nurse administers

A continuous infusion of total parenteral nutrition

A client is experiencing an increase in urinary output. The nurse determines this is a result of:

A decrease in antidiuretic hormone

A nurse is caring for a client with constipation. The incidence of constipation tends to be high among clients that follow which diet?

A diet lacking in fruits and vegetables

The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom?

A dull sound when percussing over the bladder

- Acromegaly Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea.

A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? - Acromegaly - Type 1 diabetes mellitus - Hypothyroidism - Deficient growth hormone

the fact that a lower pH of the body fluids (ketoacidosis) reduces insulin binding.

A homeless individual is brought to the emergency department (ED) after the police could not wake the person. The client's breath is fruity and others state that the client has been acting "different." Initial blood work identifies a blood glucose level of 642. The client is admitted to the ICU in ketoacidosis. The client is prescribed an insulin drip (IV infusion). The rationale for this is related to:

Of the following clients, which would be at highest risk for developing hyperkalemia?

A male admitted for acute renal failure following a drug overdose

Lack of follicle-stimulating hormone (FSH) Insufficient androgens

A male patient has been diagnosed with a low sperm count. Which of the following endocrine imbalances could contribute to this condition? Select all that apply.

- Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: - thyroiditis. - Graves' disease. - Hashimoto's thyroiditis. - multinodular goiter.

may take days for the full effect to occur, based on the mechanism of action.

A middle-aged female client has been diagnosed with thyroid condition. The nurse educates the client about the prescription and needed follow-up lab work, which will help regulate the dosage. The client asks, "Why do I not return to the clinic for weeks, since I am starting the medication tomorrow morning?" The nurse bases the answer on the knowledge that thyroid hormones:

The growth hormone level will not be suppressed following glucose load.

A middle-aged woman has acromegaly as a result of a pituitary adenoma that was found and removed when she was a teenager. The physician is suspecting that the tumor has returned and has ordered a diagnostic work-up. A glucose load is ordered. If the tumor has returned, the nurse would expect which of the following results?

Elevated atrial natriuretic hormone

A nurse examines the laboratory values of a patient in heart failure. Which of the following values indicates a compensatory hormone mechanism?

- T3, thyroxine (T4), and calcitonin. The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.

A nurse explains to a client with thyroid disease that the thyroid gland normally produces: - iodine and thyroid-stimulating hormone (TSH). - thyrotropin-releasing hormone (TRH) and TSH. - TSH, triiodothyronine (T3), and calcitonin. - T3, thyroxine (T4), and calcitonin.

Temperature Nutritional status Stress

A nurse has just completed an explanation of how hormones are normally regulated by feedback mechanisms to a client. The client asks if anything can alter the regulation. The best response by the nurse would be: Select all that apply.

- An irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician.

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? - Pitting edema of the legs - An irregular apical pulse - Dry mucous membranes - Frequent urination

- Decreased cardiac output An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse.

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? - Risk for infection - Decreased cardiac output - Impaired physical mobility - Imbalanced nutrition: Less than body requirements

- adrenal function

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? - adrenal function - thyroid function - thymus function - parathyroid function

- Explain that the client's physical changes are a result of excessive corticosteroids.

A nurse should perform which intervention for a client with Cushing's syndrome? - Offer clothing or bedding that's cool and comfortable. - Suggest a high-carbohydrate, low-protein diet. - Explain that the client's physical changes are a result of excessive corticosteroids. - Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.

"It's common for production of hormones to be far removed from the tissue where they ultimately exert their effect." "Sometimes hormones act locally on the area where they were produced, like in the case of paracrine and autocrine actions." "A single hormone can act on not only one process or organ, but often on several different locations or processes." "A bodily process can be the result of the combined effect of several different hormones from different sources."

A nurse who works in the office of an endocrinologist is orientating a new staff member. Which of the following teaching points is the nurse justified in including in the orientation? Select all that apply.

"A single hormone can act on not only one process or organ but often on several different locations or processes."

A nurse who works in the office of an endocrinologist is orienting a new staff member. Which teaching point should the nurse include in the orientation?

Paracrine

A nursing instructor is teaching a group of students about the action of hormones. The instructor determined that teaching was effective when the students' recognize the local action of hormones as:

The nurse is caring for a client with an acid base imbalance. Which of these does the nurse recognize is correct regarding compensatio

A pH moves toward the normal range

The nurse is caring for a client with an acid base imbalance. Which of these does the nurse recognize is correct regarding compensation?

A pH moves toward the normal range

Calcium

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has? a. Calcium b. Magnesium c. Phosphorus d. Sodium

Lack of parathyroid hormone

A patient develops hypocalcemia after thyroid surgery. Which of the following hormonal imbalances caused this complication?

A young female patient who has been trying to get pregnant.

A patient exhibiting problems with their thyroid has been scheduled for a radioactive scan. From the following list of patients, which would the nurse question as to whether this would be a safe procedure for this patient?

Decreased adrenocorticotropic hormone (ACTH)

A patient experiences an increase in cortisol as a result of Cushing's disease. Which of the following hormonal responses demonstrates the negative feedback mechanism?

Decreased thyroid-stimulating hormone (TSH)

A patient experiences an increase in thyroid hormone as a result of a thyroid tumor. Which of the following hormonal responses demonstrates the negative feedback mechanism?

Which of the following measurable urine output recorded indicates the patient is maintaining adequate fluid intake and balance?

A patient with a minimal urine output of 20 ml/hour

Diarrhea Tachycardia Hyperthermia

A patient with hyperthyroidism took aspirin for a headache. Which of the following complications could develop? Select all that apply.

Drinks carbonated sodas daily

A patient with osteoporosis is prescribed calcitonin (Miacalcin). Which of the following actions by the patient requires further instruction?

Prescribing a tapering dose of the medication over weeks

A patientreceives steroids for several months to treat an inflammatory condition. Which of the following actions by the primary healthcare provider indicates an understanding of the negative feedback mechanism when the patient no longer needs the medication?

You are the nurse caring for a client in septic shock. You know to closely monitor your client. What finding would you observe when the client's condition is in its initial stages?

A rapid, bounding pulse

A client is experiencing muscle atrophy following two weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the client's muscle cells?

A reduction of skeletal muscle use secondary to the traction treatment.

A patient has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit, the nurse will be assessing the patient for syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessments would alert the clinic nurse that the patient may be developing this complication?

A) Complaints that his urine output is decreased, no edema noted in ankles, and increasing headache

Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate?

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.

A client suffering from a previous myocardial infarction (MI) has symptomology indicating ineffective renal blood vessel dilation, resulting in increased sodium retention. Which hormone level may have been affected by the MI?

ANP

A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the following pathophysiologic processes contributes to this third spacing?

Abnormal increase in transcellular fluid volume

- Calcium gluconate Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate.

Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? - Calcium gluconate - Synthroid - Propylthiouracil (PTU) - Tapazole

When explaining to a class of nursing students enrolled in pathophysiology, the instructor states, "the majority of energy used by the kidney is for:

Active sodium transport mechanisms."

Which client is displaying manifestations of having a kidney stone?

Acute onset of colicky flank pain radiating to lower abdomen

While on tour, a 32 year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include temperature 46.8°C (101.8°F), blood pressure 89/48 mmHg and heart rate 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase and lipase are all elevated. Which of the following diagnoses would the care team suspect first?

Acute pancreatitis

A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis?

Acute pyelonephritis

You are caring for a client in shock who is deteriorating. You are infusing IV fluids and giving medications as ordered. What type of medications are you most likely giving to this client?

Adrenergic drugs

A client is admitted to the hospital with reports of chest pain. The nurse is monitoring the client and notifies the physician when the client exhibits

Adventitious breath sounds

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure?

After discarding the 8:00 am specimen

Cortisol, a glucocorticoid

After having a very stressful day in pathophysiology class, the student knows that which hormone (secreted by the adrenal cortex) will help decrease the effects of stress?

Which colloid is expensive but rapidly expands plasma volume?

Albumin

Which of the following is a condition that can cause decreased antidiuretic hormone (ADH) level or action?

Alcohol

Major control over the extracellular concentration of potassium within the human body is exerted by insulin and a) Progesterone b) Testosterone c) Albumin d) Aldosterone

Aldosterone Explanation: Two hormones exert major control over the extracellular concentration of potassium: insulin and aldosterone. Aldosterone enhances renal secretion of potassium.

A patient is admitted to a special critical care unit for the treatment of an arterial thrombus. The nurse is aware that the preferred drug of choice for clot removal, unless contraindicated, would be:

Alteplase

Which of the following medications is considered a thrombolytic?

Alteplase Alteplase is considered a thrombolytic, which lyses and dissolves thrombi. Thrombolytic therapy is most effective when given within the first 3 days after acute thrombosis. Heparin, Coumadin, and Lovenox do not lyse clots.

Nephrotoxicity can occur as a result of the use of aminoglycosides such as gentamicin. Select all of the following statements which are true.

Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity.

When assessing the client with acute pancreatitis, which of these diagnostic tests, consistent with the disease, does the nurse anticipate will be altered?

Amylase and lipase

Increased GH secretion

An adult patient is scheduled for testing of a suspected growth hormone (GH)- secreting tumor. Which of the following results from the glucose suppression test would confirm the condition?

No increase in TSH

An adult patient with suspected hypothyroidism is scheduled for a thyrotropin-releasing hormone (TRH) stimulation test to evaluate pituitary response. Which of the following test results would confirm secondary hypothyroidism?

The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume? Select all that apply.

An elevated hematocrit level Electrolyte imbalance Dehydration is a common primary or secondary diagnosis in health care. An elevated hematocrit level reflects low fluid level and a hemoconcentration. Electrolytes are in an imbalance as sodium and potassium levels are excreted together in client with dehydration. The urine specific gravity, due to concentrated particle level, is high. Protein is not a common sign of dehydration. Ketones are always present in the urine.

Red blood cells.

An example of a single hormone that can exert effects in different tissues, erythropoietin, made in the kidney stimulates the bone marrow to produce:

The nurse is caring for a patient who has been NPO for 2 days pending a diagnostic procedure that has been repeated cancelled. When evaluating this patient's urinalysis, what would the nurse anticipate?

An increased urine specific gravity

Increased estradiol production causes increased gonadotropin (FSH) production.

An instructor is teaching the class about positive feedback mechanism. The best example would be:

The nurse is caring for a toddler brought into the emergency department for suspected lead toxicity. Which of the following is the cardinal indicator of lead toxicity?

Anemia

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?

Angiography

Which of the following combinations of ions are most likely to bind, forming molecules?

Anion and cation

Nurses who care for diverse populations must be aware of patterns of disease that are more likely to affect certain ethnic or racial groups. Which examples accurately reflect these profiles? (Select all that apply.) a) Tuberculosis is 11 times more common in Asian Americans than the white population. b) Black American men are 30% more likely to die from heart disease than non-Hispanic white men. c) Hispanics have higher rates of obesity than non-Hispanic Caucasians. d) Black Americans have the highest mortality rate of any minority for most major cancers. e) American Indian/Alaska Natives have an infant mortality rate 75% higher than that of Caucasians. f) Black adults are diagnosed with diabetes and die from diabetes almost three times as often as white adults.

Answer" A. B. C. D. Rationale: Several examples reflect correct information about particular ethnic or racial groups. Black American men are 30% more likely to die from heart disease than non-Hispanic white men. Hispanics have higher rates of obesity than non-Hispanic Caucasians. Black adults are diagnosed with diabetes and die from diabetes almost three times as often as white adults. Tuberculosis is 11 times more common is Asian American that the white population. Several examples were incorrect. American Indian/Alaska Natives have an infant mortality rate 60%, not 75%, higher than that of Caucasians. Black adults are diagnosed with diabetes and die from diabetes almost two times, not three times, as often as white adults.

what should the nurse recommend to a client with blepharitis?

frequent washing of he face and hair Frequent washing of the face and hair is recommended in a client with blepharitis because seborrhea or excessive oiliness of the skin of the face and scalp is associated with blepharitis. Warm soaks would be included for treatment of a sty. There is no benefit to sleeping with the face parallel to the floor.

You are caring for a new client on your unit who is third-spacing fluid. You know to assess for what type of edema?

generalized There may be generalized edema in all the interstitial spaces, which sometimes is called brawny edema or anasarca.

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?

give kayexalate

The nurse cares for a client who receives continuous parenteral nutrition (PN) through a Hickman catheter and notices that the client's solution has run out. No PN solution is currently available from the pharmacy. What should the nurse do?

hang 10% dextrose and water If the parenteral nutrition (PN) solution runs out and no PN is available, the nurse should hang 10% dextrose and water until the PN becomes available.

The nurse is caring for a client with a traumatic brain injury and experiencing increased intracranial pressure. The nurse has administered mannitol, an osmotic diuretic, as ordered. This medication promotes the shift of fluid from the intracellular to the intravascular compartment. Therefore, it is necessary for the nurse to continually assess for which of the following?

heart failure It is possible for the client to have a fluid overload that creates such an increased workload for the heart that it fails.

A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states: a) "I need to try and go to bed and get up at the same time each night." b) "I should continue to take my sleep medication for as long as I need to." c) "I should avoid coffee, but tea is okay to drink before bed." d) "I should do some mild exercises about 2 hours before bedtime."

Answer: " I need to try to go to bed and get up at the same time each night." Rationale: Sleep measures include maintaining a routine, going to bed and getting up at the same time each night, avoiding exercise 3 to 4 hours before bed, using prescribed sleep medications only for the short-term (7 to 14 days), and avoiding alcohol, nicotine, and caffeine (which tea contains).

The nurse auscultates the abdomen to assess bowel sounds. She documents five to six sounds heard in less than 30 seconds. How does the nurse document the bowel sounds?

hyperactive Bowel sounds are assessed using the diaphragm of the stethoscope for high-pitched and gurgling sounds (Gu, Lim, & Moser, 2010). The frequency and character of the sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minute. The terms normal (sounds heard about every 5 to 20 seconds), hypoactive (one or two sounds in 2 minutes), hyperactive (5 to 6 sounds heard in less than 30 seconds), or absent (no sounds in 3 to 5 minutes) are frequently used in documentation, but these assessments are highly subjective (Li, Wang, & Ma,

A nurse is teaching an elderly client's family about the causes of mental impairment. The nurse sees that the teaching has been effective when the family says which of the following? a) "Alzheimer's disease (AD) is a reversible neurologic illness." b) "Delirium progressively affects cognitive function and is a chronic process." c) "Sundowning is a common problem of dementia." d) "Dementia is an acute process and develops suddenly."

Answer: "Sundowning is a common problem dementia." Rationale: A common problem in patients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. Dementia is chronic and usually develops gradually. AD is the most common degenerative illness and is irreversible. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment.

The nurse is caring for a client who has been admitted with a possible clotting disorder. The client is complaining of excessive bleeding and bruising without cause. The nurse knows to take extra care to check for signs of bruising or bleeding in what condition?

hypocalcemia Hypocalcemia or low serum calcium levels can affect clotting. Therefore, in this condition, the nurse should take extra care to check for bruising or bleeding. There is no such risk in dehydration, hypokalemia, or hypomagnesemia.

The nurse is assigned to care for a client age 87 years admitted to the medical unit for congestive heart failure. It is the fourth hospital day, and the response to treatment has been good. The client is no longer short of breath and the lung sounds are clearing. There is still a diet restriction of decreased sodium and fluids are limited to no more than 1000 mL per day. The nurse is preparing the client and family for discharge. The nurse's discharge education, in order to promote the older client's health, will include which instructions? Select all that apply. a) Do not use the salt shaker at meals. b) Gradually increase activities as tolerated. c) Increased stress may interfere with recovery. d) Take several naps during the day.

Answer: A, B, C Rationale: Promoting health for older adults includes ensuring adequate nutrition (e.g., low-fat diet, other diet modifications); balancing calories and activities; planning exercise as a daily activity; and educating the client that illness is a physical and emotional stress and increases the risk for complications. Taking naps will interfere with sleep at night

Which of the following conditions does the nurse need to confirm when he or she taps the facial nerve of a client who has dysphagia?

hypomagnesemia If there is a unilateral spasm of facial muscles when the nurse taps over the facial muscle, it is known as Chvostek's sign, which is a sign of hypocalcemia and hypomagnesemia. The additional symptom of dysphagia reinforces the possibility of hypomagnesemia rather than hypocalcemia. A positive Chvostek's sign does not apply to hypercalcemia, hypervolemia, or hypermagnesemia.

A client presents with muscle weakness, tremors, slow muscle movements, and vertigo. The following are the client's laboratory values: Na+ 134 mEq/L K+ 3.2 mEq/L Cl- 111 mEq/L Mg++ 1.1 mg/dL Ca++ 8.4 mg/dL

hypomagnesemia Magnesium, the second most abundant intracellular cation, plays a role in both carbohydrate and protein metabolism. The most common cause of this imbalance is loss in the gastrointestinal tract. Hypomagnesemia is a value less than 1.3 mg/dL. Signs and symptoms include muscle weakness, tremors, irregular movements, tetany, vertigo, focal seizures, and positive Chvostek's and Trousseau's signs.

A nurse is reading a journal article about mood disorders in the older adult population. Which information about these conditions would the nurse expect to find? Select all that apply. a) Symptoms often mimic those of other chronic comorbidities of the older adult. b) Suicide is the most serious consequence of depression. c) The stigma associated with depression is less for older adults. d) Depression is often misdiagnosed. e) Depression is considered a normal part of aging.

Answer: A, B, D Rationale: Mood disorders (especially depression) are often unrecognized or misdiagnosed in older adults partly due to the false belief that depression is a natural reaction to illness, advanced age, or life changes that occur with age. Therefore, depression is not viewed as something that needs to be treated in the older adult. Furthermore, symptoms of depression may include poor cognitive performance, sleep problems, and lack of initiative ? symptoms commonly seen in people with multiple chronic comorbidities (such as diabetes or heart failure) or in clients with dementia or delirium, causing it to be unrecognized. Although depression is not a normal part of aging, older adults are at an increased risk of experiencing depression due to chronic illness and other age-related changes. The older adult population is also less likely to report symptoms due to the stigma attached. Suicide is the most serious consequence of depression.

The nurse is caring for an older adult with hypertension. Based on the nurse's understanding of inappropriate medications for use in the older adult, the nurse would question an order for which drug as initial treatment for hypertension? Select all that apply. a) Clonidine b) Furosemide c) Methyldopa d) Quinapril e) Prazosin

Answer: A, C, E Rationale: Medications such as prazosin, clonidine, and methyldopa are not recommended for treatment of hypertension in the older adult due to the high risk for orthostatic hypotension; their use should be avoided. Furosemide and quinapril are appropriate for use in the older adult

A nurse is preparing a presentation for a group of older adults about promoting safety while maintaining their mobility. Based on the nurse's understanding of factors placing the older adult at risk for falls, which area would the nurse most likely address? Select all that apply. a) environmental hazards b) hearing loss c) medication use d) changes in bowel function e) diminished strength

Answer: A, C, E Rationale: Multiple factors place the older adult at risk for falls, including the use of medications affecting balance, thinking, memory, and elimination; impaired vision; environmental hazards (e.g., slippery floors, throw rugs, poor lighting); decreased strength; loss of bone mass; and neurological and musculoskeletal problems. Hearing loss and changes in bowel function are not associated with an increased risk for falling.

A nurse is screening for Alzheimer's disease (AD) in patients in a long-term care facility. Which facts regarding AD are accurate? (Select all that apply.) a) Nearly half of 85-year-old adults have A b) AD accounts for about one-third of the cases of dementia in the United States. c) AD affects brain cells and is characterized by patchy areas of the brain that degenerate. d) AD primarily affects young to middle adults. e) AD is a progressively serious but not a life- threatening disease. f) Scientists estimate that more than 5 million people have AD.

Answer: A, C, F Rationale: The following facts about Alzheimer's disease (AD) are correct. Scientists estimate that more than 5 million people have AD. Nearly half of 85-year-old adults have AD. AD affects the brain cells and is characterized by patchy areas of the brain that degenerate. The first indications of AD usually occur after 60 years of age. AD is a progressively serious and ultimately fatal disorder.

The nurse is caring for an older adult client who is confused and agitated. When the client's family comes to visit the nurse asks how long the client has been confused. The family states that the client has been confused for a long time and the confusion is getting worse. The client is subsequently diagnosed with dementia. What is the most common cause of dementia in an older adult client? a) Depression b) Alzheimer's disease c) Delirium d) Excessive drug use

Answer: Alzheimer's disease Rationale: Alzheimer's disease is the most common cause of dementia in older adults. Approximately 10% of people over age 65 have Alzheimer's disease; about 50% of people over age 85 have the disease. Delirium, or acute confusion, is caused by an underlying disease and is not itself a cause of dementia. Depression is common in older adults but, in many cases, manifests itself in apathy, self-deprecation, or inertia — not dementia. Excessive drug use, commonly stemming from the client seeing multiple physicians who are unaware of drugs that other physicians have prescribed, can cause dementia. Although it is a problem among older adults, it is not as common as Alzheimer's disease.

After obtaining the health history from an older adult client, the nurse develops a plan of care and identifies a nursing diagnosis of Risk for Impaired Physical Mobility. A history of which condition would support this nursing diagnosis? Select all that apply a) Glaucoma b) Hip fracture c) Diverticulitis d) Arthritis e) Stroke

Answer: B, D, E Rationale: Some chronic conditions such as walking, driving, shopping, and exercise can negatively affect aspects of mobility. Arthritis, gait and balance disorders (caused by musculoskeletal or neurologic conditions), and cataracts are among the many health conditions that cause mobility problems.

An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition? a) Disorientation b) Dementia c) Delirium d) Depression

Answer: Delirium Rationale: Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause.

A 78-year-old woman is status post right hip fracture after a fall. She has stopped going to her church over the past few months. She has also asked her neighbor to help her and do her gardening, an activity she previously loved. The client tells the nurse "I just don't enjoy gardening like I used to. I am always worried about falling." What would most concern the nurse regarding the client? a) Realistic caution b) Depression c) Generalized anxiety disorder d) Bipolar disorder

Answer: Depression Rationale: One sign of depression is a lack of interest in previously enjoyable activities. Further investigation is necessary to make a formal diagnosis

The nurse understands that when caring for the older adult it is important to assist in maintaining independence and self-esteem. Assisting the client to adjust to a walker or wheelchair is an example of supporting which of Erikson's developmental tasks of the older adult? a) Ego integrity and coping with reality of limitations b) Adaptation to age and preservation of self c) Functional adaptation and self-awareness d) Prevention of injury and safety in navigation

Answer: Ego integrity and coping with reality of limitations Rationale: Age does affect the older adult due to many different physiological changes, as evidenced by a decrease of cardiac output, peripheral circulation, oxygenation of blood, decreased ability to control temperature, and a slower heart rate. Ego integrity is the task of the older adult, according to Erikson, including "wholeness," emotional integration, and acceptance of physical decline. The others are not developmental tasks described by Erikson.

Erikson identified ego integrity versus despair and disgust as the last stage of human development, which begins at about 60 years of age. Which intervention would best foster older patients' ego integrity? a) Encouraging life review b) Promoting independent living c) Distracting the patient d) Praising the patient

Answer: Encourage life review Rationale: The intervention that would best foster older clients' ego integrity would be encouraging life review. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified world-wide. In a sense, this is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Integrity versus despair and disgust would not be fostered by distracting the client, praising the client, or promoting independent living.

Gould viewed the middle years as a time when adults increase their feelings of self-satisfaction, value their spouse as a companion, and become more concerned with health. Which nursing action best facilitates this process? a) Counseling a patient who complains of being depressed b) Providing entertainment for a patient on bedrest c) Arranging for social services to assist with meals for a homebound patient d) Encouraging a patient to have regular checkups

Answer: Encouraging a patient have regular checkups Rationale: Gould viewed the middle years as a time when adults look inward (ages 35 to 43); accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community (ages 43 to 50); and increase their feelings of self-satisfaction, value spouse as a companion, and become more concerned with health (ages 50 to 60). The nursing action that best facilitates this process would be encouraging a client to have regular checkups.

A nurse is making a home visit to an older adult with multiple chronic health problems. The client is alert and oriented and his cognition is intact. While talking with the client, he reveals that he thinks his son is stealing his social security checks to buy his beer and eat out all the time. The nurse interprets this statement as possibly suggesting which type of elder abuse? a) Abandonment b) Exploitation c) Emotional d) Physical

Answer: Exploitation Rationale: Exploitation involves illegally taking or misusing the funds, property, or assets of a vulnerable older adult. Physical abuse involves the infliction of pain/injury on a vulnerable older adult, the threat of inflicting such pain or injury, or depriving them of basic needs. Emotional/psychological abuse involves verbal or nonverbal actions causing mental pain, anguish, or distress on the older adult. Abandonment involves desertion of a vulnerable adult by anyone who has assumed responsibility for his care.

A nurse knows that the major clinical use of dobutamine (Dobutrex) is to:

increase cardiac output.

A client is having a blood urea nitrogen (BUN) test. BUN level is:

increased in renal disease and urinary obstruction.

The client has been taking famotidine (Pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily to achieve which of the following?

inhibit gastric acid secretions Famotidine is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion.

A 35-year-old male client presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary provider, what intervention should the nurse prioritize?

insertion of a nasogastric tube Decompression of the bowel through a nasogastric tube is necessary for all clients with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories, and laxatives are not indicated if an obstruction is present.

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of

intestinal malabsorption Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel. Large, greasy stools suggest intestinal malabsorption, and the presence of mucus and pus in the stools suggests inflammatory enteritis or colitis.

A critical care nurse is documenting the assessment of a client. The client is status postresection of a brain tumor. The nurse documents that the client is flaccid on the left. This means that the client:

is not responding to stimuli

A 40 year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) one year ago and now has chronic viral hepatitis. Which of the following statements by the client to his care provider would warrant correction by the nurse?

it is at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?

its approp to warm in the dialstat in micro wave

Which of the following is used to decrease potassium level seen in acute renal failure?

kayexalate

A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process?

kidneys

Which of the following types of diuretic is the first-line treatment for those diagnosed with heart failure (HF)?

loop Loop diuretics such as furosemide, bumetanide, and torsemide are the preferred first-line diuretics because of their efficacy in patients with and without renal impairment. Diuretics should never be used alone to treat HF because they don't prevent further myocardial damage.

Which of the following best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?

mEq/L

The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg HCO3: 18 mEq/L The nurse would interpret this as? a) metabolic alkalosis b) respiratory alkalosis c) metabolic acidosis d) respiratory acidosis

metabolic acidosis

Your client's lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap?

metabolic acidosis The anion gap is the difference between sodium and potassium cations and the sum of chloride and bicarbonate anions. An anion gap that exceeds 16 mEq/L indicates metabolic acidosis. In this case, the anion gap is (166 + 5) minus (115 + 35), yielding 21 mEq/L, which suggests metabolic acidosis. Anion gap is not used to check for respiratory alkalosis, metabolic alkalosis, or respiratory acidosis.

The nurse is providing discharge teaching to a client who had hypophosphatemia during his time in hospital. The client has a diet prescribed that is high in phosphate. What foods should you teach this client to include in his diet? Select all that apply.

milk, poultry, liver If the client experiences mild hypophosphatemia, foods such as milk and milk products, organ meats, nuts, fish, poultry, and whole grains should be encouraged.

When caring for older adults, nurses must be aware of common conditions found in this population. Which statements accurately describe these conditions? (Select all that apply.) a) Polypharmacy is a term that is used to describe the habit of older adults to use many pharmacies to obtain their prescription drugs. b) Delirium is a permanent state of confusion occurring in older adulthood. c) Depression is a prolonged or extreme state of sadness occurring in many older adults. d) A significant percentage of older adults limit their activities because of fear of falling that might result in serious health consequences. e) As many as 50% of adults 65 years and older experience an episode of delirium during a hospitalization. f) Sundowning syndrome is a condition in which an older adult habitually becomes confused, restless, and agitated after dark.

Answer: F, C, D Rationale: Several of the statements listed are true statements. Sundowning syndrome is a condition in which an older adult habitually becomes confused, restless, and agitated after dark. Depression is a prolonged or extreme state of sadness occurring in many older adults. A significant percentage of older adults limit their activities because of fear of falling that might result in serious health consequences. There were three statements that were not true. First, delirium is not a permanent state of confusion occurring in older adulthood. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment. Polypharmacy does not look at the number of pharmacies used to obtain prescriptions but the amount of drugs prescribed by health care providers for a variety of medical conditions. Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults. Complicated regimens need careful review to minimize risks and complications and maximize benefits.

Which of the following health promotion measures should occur most frequently in older adult women? a) Tetanus booster b) Fecal occult blood test c) Colonoscopy d) Pelvic and Papanicolaou (Pap) exam

Answer: Fecal occult blood test Rationale: Fecal occult blood tests are recommended annually for older adults. Pap exams and pelvic exams are recommended at least every 3 years. Colonoscopy or sigmoidoscopy should be performed every 3 to 5 years, and a tetanus booster is only necessary every 10 years.

The middle adult is sometimes called the "sandwich generation". According to Erikson, the developmental task of the middle adult is what? a) Initiative versus guilt b) Ego-integrity versus despair c) Generativity versus stagnation d) Goal attainment versus crisis

Answer: Generativity versus stagnation Rationale: The developmental task of the middle adult is "generativity versus stagnation." They are in a stage of guiding the next generation, accepting their own changes and adjusting to need of aging parents, as well as evaluating their own goals and accomplishments. "Initiative versus guilt" is the developmental task for toddlers. "Ego integrity versus despair" is the developmental task for older adults. "Goal attainment versus crisis" is not a developmental task.

An older adult client is prescribed a sleep medication. When explaining the medication to the client, the nurse would emphasize which aspect of therapy? a) rare occurrences of confusion b) need for follow-up laboratory tests c) greatest effectiveness with short term use d) minimal risk of adverse effects

Answer: Greatest effectiveness with short term use Rationale: Sleep medications may be used, but these drugs are most effective when limited to short-term use (7 to 14 days); otherwise, the medications may actually interfere with sleep and cause other adverse outcomes such as falls, confusion, and constipation. The risks for adverse effects depend on the drug prescribed. There is no need for follow up laboratory tests.

Based on Havighurst's theory of human development, which nursing intervention would best facilitate the accomplishment of a developmental task of older adulthood? a) Helping a patient become established in the community b) Helping a patient accept a move to live with a daughter c) Helping a patient move independently using a walker d) Helping a patient cope with living alone after the death of a spouse

Answer: Helping a patient move independently using a walker Rationale: According to Havighurst, the major tasks of old age are primarily concerned with the maintenance of social contacts and relationships. Successful aging depends on a person's ability to be flexible and adapt to new age-related roles. The person must find new and meaningful roles in old age while being reasonably comfortable with the social customs of the times. The only nursing intervention that addresses this theory would be helping a client move independently using a walker.

A nurse encourages residents of a long-term care facility to continue a similar pattern of behavior and activity that existed in their middle adulthood years to ensure healthy aging. This intervention is based on which aging theory? a) Disengagement theory b) Identity-continuity theory c) Life review theory d) Activity theory

Answer: Identity-continuity theory Rationale: The identity-continuity theory assumes that healthy aging is related to the older adult's ability to continue similar patterns of behavior from young and middle adulthood. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified world- wide. Disengagement theory, maintained that older adults often withdraw from usual roles and become more introspective and self-focused. This withdrawal was theorized as intrinsic and inevitable, necessary for successful aging, and beneficial for both the person and for society.

The nurse practitioner is examining a 55-year-old female client. Which of the following findings would be uncommon for this age group? a) Presbyopia occurs b) Lower extremity pulses are weak c) Agility gradually decreases d) Menopause occurs

Answer: Lower extremity pulses are weak. Rationale: Normal physiologic changes of the middle-aged adult do not include peripheral pulses becoming weak and not always palpable. The other options can be seen in a middle-aged adult.

A nurse is preparing a presentation for families who are caring for older adults at home. Which information would the nurse most likely include about an older adult's cognition? a) Delirium is more common in middle-age adults. b) Dementia is considered a normal part of aging. c) Many older adults retain full cognitive function into advanced age. d) Aging normally leads to impairments in judgment and insight.

Answer: Many older adults retain full cognitive function into advance age. Rationale: Many older adults retain full cognitive (thinking) function into advanced age. Dementia is not a normal part of aging. Older adults experience higher rates of delirium as compared to younger adults. Although some older adults may experience impairments in judgment and insight, this is not a normal change.

A nurse is preparing a presentation for families who are caring for older adults at home. Which information would the nurse most likely include about an older adult's cognition? a) Delirium is more common in middle-age adults. b) Many older adults retain full cognitive function into advanced age. c) Aging normally leads to impairments in judgment and insight. d) Dementia is considered a normal part of aging.

Answer: Many older adults retain full cognitive function into advanced age. Rationale: Many older adults retain full cognitive (thinking) function into advanced age. Dementia is not a normal part of aging. Older adults experience higher rates of delirium as compared to younger adults. Although some older adults may experience impairments in judgment and insight, this is not a normal change.

The nurse is administering a unit of packed red blood cells to a patient and piggybacks the unit of blood through a solution of 0.9% NaCl. Blood cells placed in a solution of 0.9% saline will do which of the following?

neither shrink nor swell

A male client reports chronic insomnia. Which medication would the nurse not want to administer to the client? a) Nasal decongestant for an upper respiratory infection b) Beta blocker for blood pressure control c) Diuretic in the morning for hypertension d) Acetaminophen for postoperative pain

Answer: Nasal decongestant for an upper respiratory infection Rationale: Decongestants can worsen insomnia in the older adult.

A nurse is providing care at an ambulatory care center to a wide range of older adults from diverse racial and ethnic groups. Based on recent statistics, which group would the nurse most likely identify as projected to be the largest? a) Asians b) Hispanics c) African Americans d) Non-Hispanic whites

Answer: Non-Hispanic Whites Rationale: In 2012, 21% of people 65 and over were members of racial or ethnic minority populations. Racial and ethnic minority groups have increased from 6.1 million in 2002 (17% of the older population) to 8.9 million in 2012 (21% of the older population) and are projected to increase to 20.2 million in 2030 (28%% of the older population). Between 2012 and 2030, the white non-Hispanic population 65 years or older is projected to increase by 54%, compared with 123.5% for older racial and ethnic minorities, including Hispanics (155%); African Americans (104%); American Indian and Native Alaskans (116%); and Asians (119%).

An 80-year-old client tells the nurse that he has been dizzy since starting to take an herbal remedy for arthritis in addition to prescribed medications. The nurse recognizes that the client may be experiencing the effects of which of the following? a) Fluid volume overload b) Polypharmacy c) Cascade iatrogenesis d) Sleep disorder

Answer: Polypharmacy Rationale: Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults. Alternative therapies, such as herbal remedies, have the potential to interact with prescribed drugs. Fluid volume overload and sleep disorders are not the cause of dizziness. Cascade iatrogenesis is a sequence of adverse events in a frail, older adult.

A 45-year-old Caucasian woman is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:

nephrotoxic acute tubular necrosis.

A client with a history of depression is brought to the ED after overdosing on Valium. This client is at risk for developing which type of distributive shock?

neurogenic shock

A client is experiencing vomiting and diarrhea for 2 days. Blood pressure is 88/56, pulse rate is 122 beats/minute, and respirations are 28 breaths/minute. The nurse starts intravenous fluids. Which of the following prescribed prn mediciations would the nurse administer next?

ondansetron (Zofran)

An 85-year-old client's daughter calls the nurse and states her father is recently having periods of confusion, is unable to dress himself, and is having periods of incontinence. Which of the following should the nurse do first? a) Make arrangements for the client to move to an extended-care facility b) Perform a SPICES assessment c) Teach the daughter how to use reminiscence as a therapy d) Schedule an appointment for a physical examination

Answer: Schedule an appointment for a physical examination Rationale: Drug interactions, circulatory or metabolic problems, nutritional deficiencies, or a worsening illness are likely causes for confusion and changes in function, thus a physical examination is indicated. Moving to an extended-care facility is premature until physical causes have been examined. Reminiscence therapy, a way for older adults to facilitate adaptation by reliving past experiences, is used for psychosocial development. A SPICES (sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown) assessment is used to identify problems that can lead to negative outcomes in the elderly client. Although it may be useful in this client, the priority is finding the cause for the physical changes

In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client? a) Sleep deprivation b) Grieving c) Social isolation d) Noncompliance

Answer: Sleep deprivation Rationale: A common problem in clients with dementia is sundowning syndrome in which an older adult habitually becomes confused, restless, and agitated after dark and does not sleep. Implementing the nursing diagnosis of sleep deprivation will help the client obtain adequate sleep at night and awaken refreshed. Social isolation, grieving, and noncompliance are diagnoses that could be related to dementia but not sundowning.

In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client? a) Sleep deprivation b) Noncompliance c) Grieving d) Social isolation

Answer: Sleep deprivation Rationale: A common problem in clients with dementia is sundowning syndrome in which an older adult habitually becomes confused, restless, and agitated after dark and does not sleep. Implementing the nursing diagnosis of sleep deprivation will help the client obtain adequate sleep at night and awaken refreshed. Social isolation, grieving, and noncompliance are diagnoses that could be related to dementia but not sundowning.

The nurse is preparing to administer fluid replacement to a client. Which action related to intravenous therapy does the nurse identify as out of scope nursing practice?

ordering type of solution, additive, amount of infusion, and duration

There is an 86-year-old female on the medical inpatient unit. She explains that the hospital is quite noisy and that she is having difficulty sleeping. Which is not true regarding sleep in the older adult? a) Deep sleep declines in the older adult. b) Chronic cardiovascular or respiratory illness can interfere with sleep. c) Stage 1 sleep increases in the older adult. d) Sleep medications are usually the first choice in treating sleep disturbance.

Answer: Sleep medications are usually the first choice in treating sleep disturbance. Rationale: Medications are typically the last choice for treating sleep disturbance because they can interact with other medications or have paradoxical effects on the older adult.

There is an 86-year-old female on the medical inpatient unit. She explains that the hospital is quite noisy and that she is having difficulty sleeping. Which is not true regarding sleep in the older adult? a) Deep sleep declines in the older adult. b) Stage 1 sleep increases in the older adult. c) Chronic cardiovascular or respiratory illness can interfere with sleep. d) Sleep medications are usually the first choice in treating sleep disturbance.

Answer: Sleep medications are usually the first choice in treating sleep disturbance. Rationale: Medications are typically the last choice for treating sleep disturbance because they can interact with other medications or have paradoxical effects on the older adult.

An older adult female client tells the nurse, "Whenever I sneeze or cough, I urinate a little bit. It's very embarrassing." The nurse interprets the client's statement as indicating which type of incontinence? a) Functional b) Urge c) Overflow d) Stress

Answer: Stress Rationale: Stress incontinence is caused by pelvic floor muscle weakness or urethral hypermobility. Urge incontinence is caused by an overactive detrusor muscle causing involuntary bladder contraction. Overflow incontinence occurs when the bladder muscle distends and urine is forced out. Functional incontinence occurs when a physical or psychological impairment impedes continence despite a competent urinary system.

An older adult female client tells the nurse, "Whenever I sneeze or cough, I urinate a little bit. It's very embarrassing." The nurse interprets the client's statement as indicating which type of incontinence? a) Urge b) Stress c) Functional d) Overflow

Answer: Stress Rationale: Stress incontinence is caused by pelvic floor muscle weakness or urethral hypermobility. Urge incontinence is caused by an overactive detrusor muscle causing involuntary bladder contraction. Overflow incontinence occurs when the bladder muscle distends and urine is forced out. Functional incontinence occurs when a physical or psychological impairment impedes continence despite a competent urinary system.

When providing nursing care to the elderly, it is most important to provide comfort due to which of the following changes? a) Dementia b) Isolation c) Thermoregulation d) Sexuality

Answer: Thermoregulation Rationale: The body can adapt to environmental temperatures within broad limits, but age and health status greatly affect this capacity. Thus, in the provision of nursing care that focuses on comfort, the nurse must be aware of changes in thermoregulation

A 90-year-old woman is admitted to a nurse's unit status post CVA. The client is alert and oriented to person, place, and time but has limited mobility and hemiparesis of the left side of her body. She is experiencing urinary incontinence. What is the most appropriate nursing action? a) Insert a Foley catheter to prevent incontinence. b) Assist the client once per shift to use the commode. c) Use disposable padding (Chux) to keep the bedding dry. d) Use the Braden scale to assess for pressure ulcers.

Answer: Use the Braden scale to assess for pressure ulcers. Rationale: The Braden scale is an evidence-based tool used to assess for pressure ulcers. Pressure ulcers can result from urinary incontinence, particularly if the skin is moist and skin integrity is impaired. The client would likely require assistance every time she uses the toilet. A Foley catheter is an extreme solution to this problem.

A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as: a) emotional abuse. b) neglect. c) abandonment. d) exploitation.

Answer: abandonment Rationale: The client is alone and without any support or caregivers. Therefore, abandonment, which is the desertion or a vulnerable older adult by anyone who has assumed responsibility for that adult's care, would apply. Exploitation involves illegally taking or misusing funds, property, or assets of a vulnerable older adult. Neglect involves refusal or failure by those responsible to provide food, shelter, protection, or health care for a vulnerable older adult. Emotional abuse involves verbally or nonverbally causing mental pain, anguish or distress on the older adult.

A 76-year-old man is recovering from a myocardial infarction. In regards to his recovery, it is important for the nurse to: a) have a male counterpart address sexuality. b) instruct him to eliminate sex for 1 month. c) address any questions about sexuality. d) refer the client to a therapist.

Answer: address any questions about sexuality Rationale: With regard to sexuality, the nurse should spend time with the older adult; use clear, easy-to-understand language; help the client feel more comfortable talking about sex; be open minded and talk openly; listen, and encourage discussion; give advice or suggestions as needed; and understand that sex is not just for the young.

A nurse is providing care to an older adult who is experiencing delirium. Which risk factors would the nurse identify as being most common? Select all that apply. a) poor nutrition b) trauma c) sleep deprivation d) advanced age e) pre-existing cognitive impairment

Answer: advanced age; pre-existing cognitive impairment Rationale: Although trauma, poor nutrition, and sleep deprivation are risk factors for delirium, advanced age and preexisting cognitive impairment are the most common.

A nurse is preparing a presentation for a group of families who are providing care to their older adult parents. One of the family members asks the nurse, "How common is Alzheimer's disease?" The nurse responds by telling the group that after age 65, the prevalence of Alzheimer's disease: a) decreases by 10 for every year. b) triples every year. c) doubles every 5 years. d) declines but the rate is unknown.

Answer: doubles every year Answer: According to the Alzheimer's Association, the prevalence of Alzheimer's disease doubles every 5 years beyond age 65.

An elderly patient has come in to the clinic for her yearly physical. The patient tells the nurse that she is having difficulty with bowel movements. What intervention could the nurse suggest? a) Increasing caloric intake b) Adequate privacy c) Stress reduction d) Increasing intake of water

Answer: increasing intake of water Rationale: Age-related changes, as well as additional risk factors such as disease and the effects of medications, can result in a negative impact on function. Constipation is a common problem in aged people. The nurse should assess the patient for frequent laxative and antacid use, which is associated with constipation. The patient should eat high-fiber foods, drink eight to 10 glasses of water daily, and establish regular bowel habits. Interventions the nurse would not suggest are stress reduction, eating more, or insuring adequate privacy.

The nurse is assessing an older adult client who has suffered injury to his nervous system. The client has a history of chronic pain and currently reports pain on a scale of 8 out of 10. The nurse identifies this type of pain as most likely: a) central pain. b) postherpetic neuralgia. c) phantom limb pain. d) neuropathic pain.

Answer: neuropathic pain Rationale: Chronic pain is most commonly caused by osteoarthritis. Other conditions causing chronic pain include neuropathic pain (chronic pain resulting from an injury to the nervous system), central or neuropathic pain after stroke, postherpetic neuralgia (result of damage to nerve fibers caused by the herpes zoster virus, commonly known as shingles), and phantom limb pain after amputation.

While assessing an older adult, the client reports pain resulting from shingles. The nurse identifies this as which type of pain? a) Phantom limb pain b) Chronic pain c) Neuropathic pain d) Postherpetic neuralgia

Answer: postherpetic neuralgia Rationale: Chronic pain is most commonly caused by osteoarthritis. Other conditions causing chronic pain include neuropathic pain (chronic pain resulting from an injury to the nervous system), central or neuropathic pain after stroke, postherpetic neuralgia (result of damage to nerve fibers caused by the herpes zoster virus, commonly known as shingles), and phantom limb pain after amputation.

The nurse is assessing an older adult client who is having difficulty with mobility. Assessment reveals that the client has stiff and awkward muscle movements. The nurse identifies this as: a) spasticity. b) ataxia. c) disequilibrium. d) hemiparesis.

Answer: spasticity Rationale: Spasticity refers to stiff or awkward muscle movements. Hemiparesis refers to weakness on one side of the body. Ataxia refers to impaired muscle coordination. Disequilibrium would lead to balance problems.

A client is in the postoperative phase of an abdominal resection and colostomy. When educating the client on ostomy care by providing educational materials to read, it is important to assess the client's: a) gait. b) vision. c) hearing. d) social support.

Answer: vision Rationale: The nurse must ensure that the client's vision allows for reading. Social support and gait do not relate to the provision of written education materials.

A client tells the nurse she takes vitamin E and vitamin C daily. She further explains that the purpose is to inhibit the reactions of reactive oxygen species (ROS) with biological structures and prevent the uncontrolled formation of ROS. The nurse identifies this process as a function of:

Antioxidants

A nurse is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the nurse's advice?

Antioxidants inhibit the actions of reactive oxygen species.

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as:

Anuria

A client admitted with a massive myocardial infarction rapidly develops cardiogenic shock. Ideally, the physician would use the intra-aortic balloon pump (IABP) to support the injured myocardium. However, this client has a history of unstable angina pectoris, aortic insufficiency, hypertension, and diabetes mellitus. Which condition is a contraindication for IABP use?

Aortic insufficiency

The nurse is providing care for a client with a diagnosis of amyotrophic lateral sclerosis (ALS). The nurse recognizes which of the following mechanisms are suspected to play a role in the cellular death associated with ALS?

Apoptosis

What is the lab test commonly used in the assessment and treatment of acid-base balance?

Arterial blood gas

A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response?

Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age.

A patient has been diagnosed with a fungal infection causing external otitis. What is the most common fungal infection in the ear?

Aspergillus The most common bacterial pathogens associated with external otitis are Staphylococcus aureus and Pseudomonas species. The most common fungus isolated in both normal and infected ears is Aspergillus

After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first?

Assess peripheral pulses in the left leg

A patient had a renal angiography and is being brought back to the hospital room. What nursing interventions should the nurse carry out after the procedure to detect complications? Select all that apply.

Assess peripheral pulses, compare color and temperature between the involved and uninvolved extremities, examine the puncture site for swelling and hematoma formation.

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse?

Assess the patient's back and shoulder areas for signs of internal bleeding.

Which of the following processes can cause cells adapt to changes in threats to survival? Select all that apply.

Atrophy Hypertrophy Hyperplasia

During the inspection of a client's abdomen, the nurse notes that it is visibly distended. The nurse should proceed with the client's abdominal assessment by next performing:

Auscultation

The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as:

Autosomal recessive

The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which disorder?

Autosomal recessive polycystic kidney disease (ARPD)

Which of the following should a nurse stress when teaching patients to avoid exposure to lead in the environment? Select all that apply.

Avoid flaking paint. Lead can contaminate soil. Root vegetables can contain more lead than other vegetables.

A client is preparing for a fecal occult blood test. What teaching will the nurse provide regarding vitamin C 3 days before testing?

Avoid more than 250 mg

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed?

osmosis

Which of the following assessment results is considered a major risk factor for PAD?

BP of 160/110 mm Hg Hypertension is considered a major risk factor for PAD. Blood pressure should be less than 130/90 mm Hg. The other laboratory results are within the recommended range of normal to high normal.

A client is having a blood urea nitrogen (BUN) test.

BUN level is: increased in renal disease and urinary obstruction.

Acute pyelonephritis is a result of:

Bacterial infection

The nurse is caring for a patient who has had acute blood loss from ruptured esophageal varices. Which of the following does the nurse recognize is an early sign of prerenal failure?

Baseline urine output of 50 mL/hr that is now 10 mL/hr

- in 1 to 2 weeks. Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol (Inderal).

Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside: - in a few days. - in 3 to 4 months. - immediately. - in 1 to 2 weeks.

The nurse is performing palpation of the kidney during assessment of the client on the urology unit. The nurse plans to palpate in which of these areas?

Between the 12th thoracic and 3rd lumbar vertebrae

Pressure generated as water moves across a membrane is also known as which of the following?

osmotic pressure

As women age, many experience an increased sense of urgency to void, as well as an increased risk of incontinence. This is usually the result of age-related changes in which part of the renal system?

Bladder

The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following?

Bleeding

When caring for a client with dehydration, the nurse anticipates the client will have an alteration in which of these substances in the blood?

Blood urea nitrogen

The nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur?

Blood-tinged urine

At which of the following locations in the nephron would a health care professional first expect blood to be largely free of plasma proteins?

Bowman's space

During preshock, the compensatory stage of shock, the body, through sympathetic nervous system stimulation, will release catecholamines to shunt blood from one organ to another. Which of the following organs will always be protected?

Brain

The nurse is caring for an older adult client who is frail in appearance. The client has been diagnosed with glaucoma and will be started on eye drops for the condition. Which medication would cause the nurse to call the health care provider before administering the first dose?

Brimonidine (Alphagan-P) Brimonidine should be used with caution in frail elderly clients because it may cause confusion.

The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder?

pH 7.20, PaCO2 36, HCO3 14-

A client with chronic obstructive pulmonary disease (COPD) receives oxygen in the emergency department at a rate of 4 L/min for acute respiratory distress. Later, the nurse finds the client unresponsive with a respiratory rate of 8/minute. What ABG values would the nurse expect to obtain?

pH 7.29, pCO2 67mm Hg, HCO3- 26 mEq/L, pO2 64mm Hg

Which arterial blood gas (ABG) values tell the nurse a client is in respiratory alkalosis? Select all that apply.

pH 7.52 pCO2 of 27 mm Hg

The nurse caring for a client with respiratory alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory alkalosis is improving?

pH has decreased

The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic acidosis is improving?

pH has increased

The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?

pH of 7.50 and HCO3 of 45 mEq/L

When assessing the impact of medications on the etiology of ARF, the nurse recognizes which of the following as the drug that is not nephrotoxic?

penicillin

Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply. A. A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa B. A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia C. An 81-year-old man with right-sided heart failure and hypothyroidism D. A 34-year-old industrial worker who has suffered extensive burns in a job-related accident E. A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus

C. An 81-year-old man with right-sided heart failure and hypothyroidism D. A 34-year-old industrial worker who has suffered extensive burns in a job-related accident A. A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa

The nurse caring for a client with respiratory acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory acidosis is improving?

CO2 has decreased

A client who has had an intestinal bypass has developed a kidney stone. Which type of kidney stone does the nurse recognize that this client will most likely be treated for?

Calcium

Serum phosphorus level has a reciprocal relationship with which of the following serum electrolytes?

Calcium

The nurse is caring for a patient with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which of the following medications will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?

Calcium carbonate

Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia?

Calcium carbonate.

Protein-dependent forces that promote fluid movement into the intravascular space are known as which of the following pressures?

Capillary osmotic

When explaining how carbon dioxide combines with water to form carbonic acid as part of acid-base lecture, the faculty instructor emphasized that which enzyme is needed as a catalysis for this reaction?

Carbonic anhydrase.

The nurse is caring for a male client who has a diagnosis of heart failure. Today's laboratory results show a serum potassium of 3.2 mEq/L. For what complications should the nurse be aware, related to the potassium level?

Cardiac dysrhythmias

Which of the following assessments should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L?

Cardiac monitoring looking for prolonged PR interval and flattening of the T wave

Older adults are more likely to develop which type of shock?

Cardiogenic shock

When caring for a patient with hyperkalemia, the nurse prioritizes assessment of which of the following body systems?

Cardiovascular

Hospitalized neonates are at greatest risk of developing septicemia related to which procedure?

Catheter-associated bacteriuria

A student nurse studying human anatomy knows that a structure of the large intestine is the:

Cecum

Normal physiologic process involves the necessary removal of irreversibly damaged cells .Select the option that best describes this process.

Cell death

Which of the following can the nurse tell family members to best explain muscle atrophy of a family member who has been in a persistent coma?

Cell size decreases as workload declines

A client's ECG reveals that he is suffering from a myocardial infarction. Prompt interventions are chosen to minimize further myocardial harm. What damage is the care team trying to prevent?

Cellular hypoxia

The student is reviewing the aging process. One group of theories of aging involves the shortening of telomeres until a critical minimal length is attained and then senescence ensues. These theories are known as which of the following?

Cellular theories

In a person with fluid volume deficit, there is a dehydration of brain and nerve cells. What can occur if fluid volume deficit is corrected too rapidly?

Cerebral edema occurs with potentially severe neurologic impairment.

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing post-procedure care, the nurse should:

Check the client's pedal pulses frequently.

A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions?

Check the patient's urine for hematuria.

The body regulates the pH of its fluids by what mechanism? (Select all that apply.)

Chemical buffer systems, of the body fluids, the lungs, and the kidneys

Which of the following is an anion?

Chloride

The nurse is caring for a client with a history of sickle cell anemia. The nurse understands that this predisposes the client to which renal or urologic disorder?

Chronic kidney disease

A client is diagnosed with decreased gomerular filtration rate but has no renal damage. The nurse recognizes this can occur with which disease process? Select all that apply.

Cirrhosis Heart failure Removal of one kidney Dehydration

A client scheduled for a colonoscopy is scheduled to receive a hypertonic enema prior to the procedure. A hypertonic enema is classified as which type of enema?

Cleansing enema

Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes?

Client reports increasing fatigue

A client with chronic kidney disease has developed cardiac calcification. On admission the priority assessment would be for the nurse to:

place on a heart monitor to watch for arrhythmias.

The nurse is caring for a patient brought to the emergency department by emergency medical personnel after choking on a peanut and collapsing. The emergency personnel were able to partially clear the obstruction, but the patient experience prolonged hypoxia. The nurse anticipates that the resulting cerebral infarction will lead to which of the following?

Coagulation necrosis

A client develops interstitial edema as a result of decreased:

Colloidal osmotic pressure

The nurse obtains a blood pressure of 120/78 mm Hg from a patient in hypovolemic shock. Since the blood pressure is within normal range for this patient, what stage of shock does the nurse realize this patient is experiencing?

Compensatory stage

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? Confusion and seizures Sunken eyeballs and spasticity Flaccidity and thirst Tetany and increased blood urea nitrogen (BUN) levels

Confusion and seizures Explanation: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.

Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor?

Congenital anomalies, usually of the genitourinary system

The nursing instructor informs a student nurse that a client she is caring for has a chronic neurologic condition that decreases the client's peristalsis. What nursing diagnosis is the most likely risk for this client?

Constipation

A vasoactive medication is prescribed for a patient in shock to help maintain MAP and hemodynamic stability. A medication that acts on the alpha-adrenergic receptors of the SNS is ordered. Its purpose is to:

Constrict blood vessels in the cardiorespiratory system.

A client who experienced shock remains unstable. Enteral nutritional supplements have been prescribed to prevent muscle wasting. The nurse

Consults with the physician about subsituting lansoprazole (Prevacid) for the prescribed dose of pantoprazole (Protonix)

Select the action of renin in the renin-angiotensin-aldosterone mechanism.

Converts angiotensin to angiotensin I

What is the rate of administration for packed red blood cells? a) 1 unit over 2 to 3 hours, no longer than 4 hours b) IV push over 3 minutes c) As fast as the patient can tolerate d) 200 mL/hr

Correct response: 1 unit over 2 to 3 hours, no longer than 4 hours Explanation: Packed red blood cells are administered 1 unit over 2 to 3 hours for no longer than 4 hours. Answer A describes platelets, answer C represents cryoprecipitate, and answer D describes fresh-frozen plasma.

The physician writes an order for intravenous fluids to infuse at 150 mL per hour. If the drop factor of the tubing is 10, at how many drops per minute should the fluid infuse?

Correct response: 25 Explanation: 150 (mL) x 60 (minutes) / 10 (drop factor) = 25 drops per minute

Which of the following fluids should be administered slowly to prevent circulatory overload? a) 5% NaCl b) 0.9% NaCl c) 0.45% NaCl d) Dextrose 5%

Correct response: 5% NaCl Explanation: When a hypertonic solution is infused, it raises serum osmolarity, pulling fluid from the cells and the interstitial tissues into the vascular space. Examples of hypertonic solutions include 3% (NaCl) and 5% saline (NaCl).

A physician orders an infusion of 250 mL of NS in 100 minutes. The set is 20 gtt/mL. What is the flow rate? a) 40 gtt/min b) 50 gtt/min c) 30 gtt/min d) 20 gtt/min

Correct response: 50 gtt/min Explanation: The flow rate (gtt/min) equals the volume (mL) times the drop factor (gtt/mL) divided by the time in minutes.

The oncoming nurse is assigned to the following patients. Which patient should the nurse assess first? a) A newly admitted 88-year-old with a two-day history of vomiting and loose stools b) A 20-year-old, 2 days post-operative open appendectomy who refuses to ambulate today c) A 47-year-old who had a colon resection yesterday and is complaining of pain d) A 60-year-old who is 3 days post-myocardial infarction and has been stable

Correct response: A newly admitted 88-year-old with a two-day history of vomiting and loose stools Explanation: Young children, elderly people, and people who are ill are especially at risk for hypovolemia. Fluid volume deficit can rapidly result in a weight loss of 5% in adults and 10% in infants. A 5% weight loss is considered a pronounced fluid deficit; an 8% loss or more is considered severe. A 15% weight loss caused by fluid deficiency usually is life threatening. It is important to ambulate after surgery, but this can be addressed after assessment of the 88-year-old. The stable MI patient presents no emergent needs at the present. The pain is important to address and should be addressed next or simultaneously (asking a colleague to give pain med)

Which client will have more adipose tissue and less fluid? a) A man b) A child c) A woman d) An infant

Correct response: A woman Explanation: Women have a lower fluid content because they have more adipose tissue then men.

A client with a diagnosis of colon cancer has opted for a treatment plan that will include several rounds of chemotherapy. What vascular access device is most likely to meet this client's needs? a) A peripheral venous catheter inserted to the cephalic vein b) A midline peripheral catheter c) An implanted central venous access device (CVAD) d) A peripheral venous catheter inserted to the antecubital fossa

Correct response: An implanted central venous access device (CVAD) Explanation: Implanted CVADs are ideal for long-term uses such as chemotherapy. The short-term nature of peripheral IVs, and the fact that they are sited in small-diameter vessels, makes them inappropriate for the administration of chemotherapy.

When caring for a client who is on intravenous therapy, the nurse observes that the client has developed redness, warmth, and discomfort along the vein. Which of the following interventions should the nurse perform for this complication? a) Elevate the client's head. b) Position the client on the left side. c) Apply a warm compress. d) Apply antiseptic and a dressing.

Correct response: Apply a warm compress. Explanation: Prolonged use of the same vein can cause phlebitis; the nurse should apply a warm compress after restarting the IV. The nurse need not elevate the client's head, position the client on the left side, or apply antiseptic and a dressing. The client's head is elevated if the client exhibits symptoms of circulatory overload. The client is positioned on the left side if exhibiting signs of air embolism. The nurse applies antiseptic and a dressing to an IV site in the event of an infection.

A home care nurse is teaching a client and family about the importance of a balanced diet. The nurse determines that the education was successful when the client identifies which of the following as a rich source of potassium? a) Dairy products b) Apricots c) Processed meat d) Bread products

Correct response: Apricots Explanation: Apricots are a rich source of potassium. Dairy products are rich sources of calcium. Processed meat and bread products provide sodium.

What is the lab test commonly used in the assessment and treatment of acid-base balance? a) Urinalysis b) Arterial blood gas c) Complete blood count d) Chemistry I

Correct response: Arterial blood gas Explanation: ABGs are used to assess acid-base balance. The pH of plasma indicates balance or impending acidosis or alkalosis. The complete blood cell count measures the components of the blood focusing on the red and white blood cells. The urinalysis assesses the components of the urine

A home care nurse is visiting a client with renal failure who is on fluid restriction. The client tells the nurse, "I get thirsty very often. What might help?" Which of the following would the nurse include as a suggestion for this client? a) Use regular gum and hard candy. b) Avoid salty or excessively sweet fluids. c) Eat crackers and bread. d) Use an alcohol-based mouthwash to moisten your mouth.

Correct response: Avoid salty or excessively sweet fluids. Explanation: To minimize thirst in a client on fluid restriction, the nurse should suggest the avoidance of salty or excessively sweet fluids. Gum and hard candy may temporarily relieve thirst by drawing fluid into the oral cavity because the sugar content increases oral tonicity. Fifteen to 30 minutes later, however, oral membranes may be even drier than before. Dry foods, such as crackers and bread, also may increase the client's feeling of thirst. Allowing the client to rinse the mouth frequently may decrease thirst, but this should be done with water, not alcohol-based, mouthwashes, which would have a drying effect.

Potassium is needed for neural, muscle, and a) Auditory function b) Optic function c) Skeletal function d) Cardiac function

Correct response: Cardiac function Explanation: Potassium is essential for normal cardiac, neural, and muscle function and contractility of all muscles.

A client's most recent blood work indicates a K+ level of 7.2 mEq/L, a finding that constitutes hyperkalemia. For what signs and symptoms should the nurse vigilantly monitor? a) Metabolic acidosis b) Increased intracranial pressure (ICP) c) Cardiac irregularities d) Muscle weakness

Correct response: Cardiac irregularities Explanation: Hyperkalemia compromises the normal functioning of the sodium-potassium pump and action potentials. The most serious consequence of this alteration in homeostasis is the risk for potentially fatal cardiac dysrhythmias.

The client in the ED has just had a diagnostic lumbar puncture. To reduce the incidence of a postlumbar puncture headache, what is the nurse's most appropriate action?

position the client to prone The lumbar puncture headache may be avoided if a small-gauge needle is used and if the client remains prone after the procedure. Acetaminophen is not given as a preventative measure for postlumbar puncture headaches.

Assessment of a client reveals the following findings: elevated body temperature, dry skin, low urinary output, and increased pulse rate. The client 's health record indicates that he is taking diuretics. Which nursing diagnosis would be most appropriate for the client? a) Water excess b) Impaired skin integrity c) Risk for injury d) ECF deficient fluid volume

Correct response: ECF deficient fluid volume Explanation: The most appropriate nursing diagnosis is ECF deficient fluid volume deficit because the client has the defining characteristics of the diagnosis. Impaired skin integrity is associated with edema and diarrhea. Risk for injury can occur if electrolyte or fluid imbalances cause postural hypotension, loss of consciousness, or impaired cognition. Water excess is characterized by symptoms like weight gain, headache, and delirium.

A nurse is required to initiate IV therapy for a client. Which of the following should the nurse consider before starting the IV? a) Use half-instilled IV solutions before infusing a new one. b) Select a primary tubing of about 37 inches (94 cm) long. c) Avoid replacing IV solution every 24 hours. d) Ensure that the prescribed solution is clear and transparent.

Correct response: Ensure that the prescribed solution is clear and transparent. Explanation: Before preparing the solution, the nurse should inspect the container and determine that the solution is clear and transparent, the expiration date has not elapsed, no leaks are apparent, and a separate label is attached. The primary tubing should be approximately 110 inches (2.8 m) long and the secondary tubing should be about 37 inches (94 cm) long. To reduce the potential for infection, IV solutions are replaced every 24 hours even if the total volume has not been completely instilled.

The client is admitted to the nurse's unit with a diagnosis of heart failure. His heart is not pumping effectively, which is resulting in edema and coarse crackles in his lungs. The term for this condition is which of the following? a) Fluid volume deficit b) Myocardial Infarction c) Fluid volume excess d) Atelectasis

Correct response: Fluid volume excess Explanation: A common cause of fluid volume excess is failure of the heart to function as a pump, resulting in accumulation of fluid in the lungs and dependent parts of the body. Fluid volume deficit does not manifest itself as edema and abnormal lung sounds, but results in poor skin turgor, sunken eyes, and dry mucous membranes. Atelectasis is a collapse of the lung and does not have to do with fluid abnormalities. Myocardial infarction results from a blocked coronary artery and may result in heart failure, but is not a term for fluid volume excess.

A nurse assessing the IV site of a client observes swelling and pallor around the site, and notes a significant decrease in the flow rate. The client complains of coldness around the infusion site. What IV complication does this describe? a) Speed shock b) Infiltration c) Thrombus d) Sepsis

Correct response: Infiltration Explanation: Infiltration is the escape of fluid into the subcutaneous tissue due to a dislodged needle that has penetrated a vessel wall. Signs and symptoms include swelling, pallor, coldness, or pain around the infusion site, and significant decrease in the flow rate. The signs of sepsis include red and tender insertion site, fever, malaise, and other vital sign changes. The symptoms of thrombus are local, acute tenderness; redness, warmth, and slight edema of the vein above the insertion site. The signs of speed shock are pounding headache, fainting, rapid pulse rate, apprehension, chills, back pains, and dyspnea.

A severely malnourished client has been admitted to a health care facility. The nurse is preparing to administer total parenteral nutrition (TPN) to the client. How should the nurse administer the TPN solution? a) It is administered in a peripheral vein with its tip terminating in the jugular vein. b) It is administered in a vein distant from the heart through peripheral veins. c) It is administered in a peripheral vein with its tip terminating in the superior vena cava. d) It is administered in a peripheral vein in a lower limb.

Correct response: It is administered in a peripheral vein with its tip terminating in the superior vena cava. Explanation: TPN solution should be administered through a catheter inserted into the subclavian or jugular vein; the tip terminates in the superior vena cava. Sometimes a peripherally inserted central catheter is used; this long catheter is inserted in a peripheral arm vein but its tip terminates in the superior vena cava as well. Total parenteral nutrition is a hypertonic solution of nutrients designed to meet almost all caloric and nutritional needs. It is preferred for clients who are severely malnourished or may not be able to consume food or liquids for a long period. A TPN solution is not infused in a peripheral vein with its tip terminating in the jugular vein.

A nurse is conducting health screening with a diverse group of clients. Which client likely has the most risk factors for developing hemorrhoids?

pregnant women at 28 weeks gestation Hemorrhoids commonly affect 50% of clients after the age of 50. Pregnancy may initiate hemorrhoids or aggravate existing ones. This is due to increased constipation during pregnancy. The significance of pregnancy is greater than that of standing, lifting, or stress in the development of hemorrhoids.

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. Which of the following is an accurate guideline for IV management that the nurse should consider? a) It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order. b) As one bag is infusing, the nurse should prepare the next bag so it is ready for a change when less than 10 mL of fluid remains in the original container. c) The nurse should use new tubing when attaching additional IV solutions. d) Generally, the nurse should change the administration sets of simple IV solutions every 24 hours.

Correct response: It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order. Explanation: The nurse's ongoing verification of the IV solution and the infusion rate with the physician's order is essential. If more than one IV solution or medication is ordered, the nurse should make sure the additional IV solution can be attached to the existing tubing. As one bag is infusing, the nurse should prepare the next bag so it is ready for a change when less than 50 mL of fluid remains in the original container. Every 72 hours is recommended for changing the administration sets of simple IV solutions

A nurse monitoring a client's IV infusion auscultates the client's lung sounds and finds crackles in the bases of lungs that were previously clear. What would be the appropriate intervention in this situation? a) Check all clamps on the tubing and check tubing for any kinking. b) Notify the primary care provider immediately because these are signs of speed shock. c) Notify the primary care provider immediately for possible fluid overload. d) No intervention is necessary as this is a normal finding with IV infusion.

Correct response: Notify the primary care provider immediately for possible fluid overload. Explanation: If the client's lung sounds were previously clear, but now some crackles in the bases are auscultated, notify the primary care provider immediately. The client may be exhibiting signs of fluid overload. Be prepared to tell the health care provider what the past intake and output totals were, as well as the vital signs and pulse oximetry findings of the client.

Upon assessment of a client's peripheral intravenous site, the nurse notices the area is red and warm. The client complains of pain when the nurse gently palpates the area. These signs and symptoms indicative of what? a) A systemic blood infection b) Phlebitis c) Rapid fluid administration d) An infiltration

Correct response: Phlebitis Explanation: Phlebitis is a local infection at the site of an intravenous catheter. Signs and symptoms include redness, pus, warmth, induration, and pain. A systemic infection includes manifestations such as chills, fever, tachycardia, and hypotension. An infiltration involves manifestations such as swelling, coolness, and pallor at the catheter insertion site. Rapid fluid administration can result in fluid overload, and manifestations may include an elevated blood pressure, edema in the tissues, and crackles in the lungs.

A decrease in arterial blood pressure will result in the release of a) Thrombus b) Insulin c) Renin d) Protein

Correct response: Renin Explanation: Decreased arterial blood pressure, decreased renal blood flow, increased sympathetic nerve activity, and/or low-salt diet can stimulate renin release

A woman age 58 years is suffering from food poisoning after eating at a local restaurant. She has had nausea, vomiting, and diarrhea for the past 12 hours. Her blood pressure is 88/50 and she is diaphoretic. She requires what? a) An access route to replace fluids in combination with blood products b) Replacement of fluids for those lost from vomiting and diarrhea c) Intravenous fluids to be administered on an outpatient basis d) An access route to administer medications intravenously

Correct response: Replacement of fluids for those lost from vomiting and diarrhea Explanation: The therapeutic goal may be maintenance, replacement, treatment, diagnosis, monitoring, palliation, or a combination. This client requires intravenous fluids for replacement of those lost from vomiting and diarrhea.

A nurse is assessing for the presence of edema in a client who is confined to bed after fracturing her femur. The nurse would pay particular attention to which area? a) Sacral area b) Hands c) Legs d) Abdomen

Correct response: Sacral area Explanation: The nurse should assess the sacral area in the client when determining the presence of edema. Edema is most noticeable in dependent areas of the body. When the client is sitting or standing, the edema can be assessed in the legs. The edema cannot be assessed in the hands and abdomen, as these are not dependent areas.

The passageways of the kidney permit the urine to flow to the bladder and a) Surround the Bowman's capsule, which is where the formation of urine begins b) Selectively reabsorb or secrete substance to maintain fluids and electrolytes c) Control external sphincter of the urethra and permit the control of urination d) Act as a valve that covers the junction between the ureters and the bladder

Correct response: Selectively reabsorb or secrete substance to maintain fluids and electrolytes Explanation: The capillaries of the glomerulus are porous, and, as the blood passes through the glomerular capillaries, some constituents of the blood are filtered out

Which of the following statements accurately describes the role of antidiuretic hormone in the regulation of body fluids? When antidiuretic hormone is present, a) The frequency of voiding increases b) Urine output is increased and diluted c) The renal tubules become permeable to water d) The renal tubules become impermeable to water

Correct response: The renal tubules become permeable to water Explanation: When antidiuretic hormone is present, the distal tubule of the nephron becomes more permeable to water.

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse's best response?

Corticosteroids

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find?

Costovertebal angle tenderness

Which value does the nurse recognize as the best clinical measure of renal function?

Creatinine clearance

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for?

Creatinine clearance level

The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator?

Creatinine clearance level

A nurse is evaluating a patient's morning laboratory values. Which of the following results requires that the nurse notify the health care provider?

Creatinine: 10.6 mg/dL

The nurse is completing a cardiac assessment on a patient. The patient has a blood pressure (BP) reading of 126/80. The nurse would identify this blood pressure reading as which of the following?

prehypertensive A systolic BP of 128 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is Stage I hypertension. A systolic BP of greater than or equal to 160 is classified as Stage 2 hypertension.

The nurse is providing teaching to a student nurse about how antidiuretic hormone (ADH) plays a central role in the reabsorption of water by the kidneys. The nursing student is correct to place the following components of the homeostatic action of ADH in the correct sequence. Use all the options.

D, B, E, A, C A) Stored ADH is released into circulation. B) ADH is transported along a neural pathway to the posterior pituitary gland. C) Aquaporins are inserted into tubular cell membranes. D) ADH is synthesized by cells in the supraoptic and paraventricular nuclei of the hypothalamus. E) Serum osmolality increases.

A client's recent diagnosis of colorectal cancer has required a hemicolectomy (removal of part of the bowel) and the creation of a colostomy. The nurse would recognize that the client's stoma is healthy when it appears what color?

Dark pink & moist

Which of the following occurrences is most likely to cause increased urination?

Decrease in anti-diuretic hormone

A client has an increase in respiratory rate. What assessment findings does the nurse expect?

Decreased PCO2

The nurse caring for the client with respiratory alkalosis and renal compensation determines which of these diagnostic findings is consistent with this disorder?

Decreased PCO2 and HCO3, and increased pH

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes which of these altered diagnostic tests is consistent with development of edema?

Decreased albumin

The nurse assesses the patient for the negative effect of IV nitroglycerin (Tridil) for shock management which is:

Decreased blood pressure.

A client who is NPO prior to surgery is complaining of thirst. What is the physiologic process that drives the thirst factor? a) Increased blood volume and intracellular dehydration b) Decreased blood volume and intracellular dehydration c) Decreased blood volume and extracellular overhydration d) Increased blood volume and extracellular overhydration

Decreased blood volume and intracellular dehydration Explanation: Located within the hypothalamus, the thirst control center is stimulated by intracellular dehydration and decreased blood volume.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition?

Decreased fluid intake

A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect?

Decreased pH below 7.35

A nurse is reviewing laboratory values for an elderly patient admitted for changes in mental status. The laboratory values are a urine-serum ratio of 4:1 and urine osmolality of 1100 mOsm/kg H2O. Based on these lab results, the nurse anticipates treatment for which of the following problems?

Dehydration

Which of the following is the preferred drug for treating chronic diabetes insipidus?

Desmopressin acetate(DDAVP)

An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?

Detects calculi, cysts, or tumors

A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. What treatment should the nurse anticipate?

Dialysis

A client who is postoperative day 1 following a total thyroidectomy is reporting "twitchy" muscles and tingling in his fingertips and around his lips. The nurse's assessment reveals a positive Chvostek sign. The nurse should:

prepare to administer IV calcium gluconate, as ordered.

A nurse is assessing a patient receiving tube feedings and suspects dumping syndrome. Which of the following would lead the nurse to suspect this? Select all that apply.

Diaphoresis Tachycardia Diarrhea Dumping syndrome is manifested by hypotension, diarrhea, tachycardia, and diaphoresis. The patient often reports a feeling of fullness, nausea, and vomiting. Because of the rapid movement of water to the stomach and intestines, bowel sounds would most likely be increased.

A client with chronic kidney disease (CKD) is starting hemodialysis. Which diet will the dialysis nurse likely recommend?

Diet low in proteins but including eggs and lean meat

The nurse is instructing a patient with advanced kidney disease (AKD) about a dietary regimen. Which of the following restrictions should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?

Dietary protein

The nurse is caring for a patient who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which of the following best describe this process?

Diffusion

Which statement best explains why digital removal of stool is considered a last resort after other methods of bowel evacuation have been unsuccessful?

Digital removal of stool may cause parasympathetic stimulation

A pregnant woman in the third trimester reports burning and pain on urination. Which physiologic changes during pregnancy increase the risk for urinary tract infection (UTI)? Select all that apply.

Dilation of the renal calyces, pelvis, and ureters Muscle-relaxing effects of progesterone-like hormones Mechanical obstruction from the enlarged uterus

The nurse is preparing to auscultate the bowel sounds of a client with a nasogastric tube in place set to low intermittent suction. How shall the nurse approach the assessment of bowel sounds and manage the nasogastric tube?

Disconnect the nasogastric tube from suction during the assessment of bowel sounds

When administering a thiazide diuretic the nurse recognizes these medications exert their effects in which of these areas of the kidney?

Distal and collecting tubules

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is which of the following?

Dorsiflexion of hands and feet

A nurse is providing discharge instructions for a client with a new colostomy. Which is a recommended guideline for long-term ostomy care?

Drink at least 2 quarts (1.9 L) of fluids, preferably water, daily

A client has a full bladder. Which sound would the nurse expect to hear on percussion?

Dullness

phosphorus PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: - sodium. - potassium. - magnesium. - phosphorus.

rapidly degraded by enzymes in circulation and at the tissue.

During a near-miss accident while cycling, a client marvels at how fast he was able to react. He attributes this to his fight/flight response but then wonders why it lasts for only a short period. The client had a short burst of catecholamine activity because catecholamines are:

- Detecting evidence of hormone hypersecretion.

During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? - Detecting evidence of hormone hypersecretion. - Detecting information about possible tumor growth. - Determining the presence or absence of testosterone levels. - Determining the size of the organs and location.

- "You must avoid hyperextending your neck after surgery."

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? - "The head of your bed must remain flat for 24 hours after surgery." - "You should avoid deep breathing and coughing after surgery." - "You won't be able to swallow for the first day or two." - "You must avoid hyperextending your neck after surgery."

A patient's lab report returns and a nurse is explaining to the patient the significance of the changes. The nurse states that the finding is implicated as a precursor of cancer. Which of the following finding was most likely on the lab report?

Dysplasia

A nurse practitioner is preparing to perform a client's Papanicolaou (Pap) smear and is answering the client's questions about the clinical rationale for the procedure. The nurse should describe what phenomenon?

Dysplasia of the cervical epithelium is associated with a high risk of cancer.

The cardiologist examines a client's echocardiogram and determines that the client has aortic stenosis. The cardiologist explains that a frequent cause of this valve disease is which of the following?

Dystrophic calcification

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which gastrointestinal signs and symptoms? Select all that apply.

Early morning nausea Gastrointestinal ulceration Metallic taste Anorexia

The community health nurse finds the client collapsed outdoors. The nurse assesses that the client is shallow breathing and has a weak pulse. A neighbor calls 911. Which nursing action is helpful while waiting for the ambulance?

Elevate the legs higher than the heart.

A nurse reviews the results of an electrocardiogram (ECG) for a patient who is being assessed for hypokalemia. Which of the following would the nurse notice as the most significant diagnostic indicator?

Elevated U wave An elevated U wave is specific for hypokalemia. Flat or inverted T waves may also be present. The other tracings are consistent with hyperkalemia.

The nurse is caring for a client with Addision's disease. For which of these complications does the nurse monitor?

Elevations in potassium levels

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:

Encourage high fluid intake

The nurse is caring for a client who is scheduled for an esophagogastroduodenoscopy (EGD). What action would the nurse take to prepare the client for this procedure?

Ensure that the client fasts 6 to 12 hours before the test as per policy

The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group?

Enuresis

A patient presents to the emergency department after being stung by a bee, complaining of difficulty breathing. What vasoconstrictive medication should be given at this time?

Epinephrine

A patient visits a health clinic because of urticaria and shortness of breath after being stung by several wasps. The nurse practitioner immediately administers which medication to reduce bronchospasm?

Epinephrine

Which substance stimulates the bone marrow to produce red blood cells?

Erythropoietin

A patient staggers into the emergency department with his son who states that his father has not been well for a couple of weeks. The patient's heart rate is 120 and lung sounds reveal crackles and a respiratory rate of 30. The patient also complains of right flank pain. The son says that his mother has been acting strangely and thinks she might be poisoning her husband. Which of the following clinical manifestations indicate the type of poisoning involved?

Ethylene glycol (antifreeze)

- Bulging forehead Oversecretion of growth hormone in an adult results in acromegaly, manifested by coarse features, a huge lower jaw, thick lips, thickened tongue, a bulging forehead, bulbous nose, and large hands and feet. Excessive urine output, weight loss, and constant thirst are associated with diabetes insipidus.

Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find? - Excessive urine output - Weight loss - Bulging forehead - Constant thirst

Hypokalemia can cause which symptom to occur?

Excessive thirst If prolonged, hypokalemia can lead to an inability of the kidneys to concentrate urine, causing dilute urine and excessive thirst. Potassium depletion depresses the release of insulin and results in glucose intolerance. Decreased sensitivity to digitalis does not occur with hypokalemia.

Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys? Excreting protein

Excreting protein

A physician writes an order to "force fluids." What will be the first action the nurse will take in implementing this order?

Explain to the client why this is needed.

Mr Powell, a dehydrated 35 year old has intravenous fluid running at 250 cc/h. for rapid rehydration. He is complaining of burning at the site. You see no redness, swelling, heat, or coolness upon inspection. You suspect a) Infiltration b) That the fluid is infusing too rapidly for comfort c) That something is wrong with the IV fluid d) Phlebitis

Explanation: The fluid is infusing too rapidly. You should slow the infusion to 200 cc/h.

When a client age 80 years who takes diuretics for management of hypertension informs the nurse that she takes laxatives daily to promote bowel movements, the nurse assesses the client for possible symptoms of what? a) Hypothyroidism b) Hypoglycemia c) Hypokalemia d) Hypocalcemia

Explanation: The frequent use of laxatives and diuretics promotes the excretion of potassium and magnesium from the body, increasing the risk for fluid and electrolyte deficits.

The primary extracellular electrolytes are: a) Sodium, chloride, and bicarbonate b) Phosphorous, calcium, and phosphate c) Magnesium, sulfate, and carbon d) Potassium, phosphate, and sulfate

Explanation: The primary extracellular electrolytes are sodium, chloride, and bicarbonate.

Which of the following statements is an appropriate nursing diagnosis for an client 80 years of age diagnosed with congestive heart failure, with symptoms of edema, orthopnea, and confusion? a) Fluid volume deficit related to congestive heart failure, as evidenced by shortness of breath b) Fluid volume excess related to loss of sodium and potassium c) Extracellular volume excess related to heart failure, as evidenced by edema and orthopnea d) Congestive heart failure related to edema

Extracellular volume excess related to heart failure, as evidenced by edema and orthopnea Explanation: Extracellular volume excess is the state in which a person experiences an excess of vascular and interstitial fluid.

Which procedure is a nonsurgical method of treatment for renal calculi (kidney stones)?

Extracorporeal shock wave lithotripsy (ESWL)

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?

FEVER

True or False: More patients experience hyperthyroidism than hypothyroidism.

False

A nurse is scheduling diagnostic studies for a client. Which test would be performed first?

Fecal occult blood test

Select the option that identifies the function of the kidneys in maintaining normal composition of internal body fluids.

Filtration and reabsorption of physiologically essential substances

The nurse is caring for a patient with a tumor obstructing the lymphatic system. For which of the following consequences does the nurse assess?

Fluid accumulating in the interstitial spaces distal to the tumor

A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient's most likely diagnosis?

Fluid volume excess

Adjustment according to the level of the substance a hormone regulates

Following a meal, a woman's blood glucose level has increased. In addition, her pancreas has increased the amount of insulin produced and released. Which of the following phenomena has occurred?

A 14-year-old boy, appearing to be intoxicated, is brought to the emergency room by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy's room.

Fomepizole

- a thyroid hormone antagonist. Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

For a client with hyperthyroidism, treatment is most likely to include: - a thyroid hormone antagonist. - thyroid extract. - a synthetic thyroid hormone. - emollient lotions.

Graves' disease Type 1 diabetes mellitus Hypoparathyroidism Addison's disease

For which of the following endocrine disorders would autoimmune antibody testing be appropriate? Select all that apply.

When the bladder contains 400 to 500 mL of urine, this is referred to as:

Functional capacity

The nurse is caring for a comatose patient and administering gastrostomy feedings. What does the nurse understand is the reason that gastrostomy feedings are preferred to nasogastric (NG) feedings in the comatose patient?

Gastroesophageal sphincter is intact, lessening the possibility of regurgitation. Gastrostomy is preferred over NG feedings in the patient who is comatose because the gastroesophageal sphincter remains intact, making regurgitation and aspiration less likely.

The nurse volunteering in the medical tent for a road race on a hot, humid day is asked to see a runner who has collapsed on the road. The nurse notes he has sunken eyes, a temperature of 100 degrees Fahrenheit, and dizziness. These are signs of a fluid volume deficit. Recognizing fluid volume deficit, which of these interventions does the nurse carry out first?

Give him an electrolyte solution by mouth.

The health care provider is reviewing lab results of a client. Select the test that is the best measurement of overall kidney function?

Glomerular filtration rate (GFR)

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine?

Glucose

Biologic agents differ from other injurious agents in that they are able to replicate and can continue to produce their injurious effects. How do Gram-negative bacteria cause harm to the cell?

Gram-negative bacilli release endotoxins that cause cell injury and increased capillary permeability.

Which of the following is as integumentary manifestation of chronic renal failure?

Gray brown skin color

The nurse is aware that the major role of the kidneys is regulated acid-base balance is to increase the production of?

HCO3-

The nurse caring for a client with metabolic alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic alkalosis is improving?

HCO3- has decreased

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:

HCO3−

A client tells the nurse that he takes laxatives every day but is still constipated. The nurse's response is based on which reasoning?

Habitual laxative use is the most common cause of chronic constipation

What are two essential techniques when collecting a stool specimen?

Hand hygiene and wearing gloves

A nurse is assisting with the orientation of a newly hired graduate. Which of the following behaviors of the graduate nurse would the other nurse identify as not adhering to strict infection control practices?

Hanging tape on the bedside table when changing a wet-to-dry sterile dressing

Elevating the patient's legs slightly to improve cerebral circulation is contraindicated in which of the following disease processes?

Head injury

The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? Select all that apply.

Heart failure Hypertension Pericarditis

Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma?

Hematuria

To assess circulating oxygen concentration, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which diagnostic test?

Hemoglobin

Which of the following assessments supports the finding of lead toxicity?

Hemoglobin 9 g/dL

A 7 year old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the client's diagnosis?

Hemoglobin 9.9 g/dL

The physician suspects a client may have developed pancreatitis, and the physician has ordered laboratory blood work. Diagnosis-confirming results would identify:

High serum amylase and lipase

A nurse is caring for an 85-year-old patient. The nurse offers oral fluids to the patient every 2 hours understanding that older adults may experience hypodipsia despite which of the following?

Higher plasma sodium and higher osmolality levels

Androgens and estrogens

Hormones can be synthesized by both vesicle-mediated pathways and non-vesicle-mediated pathways. What hormones are synthesized by non-vesicle-mediated pathways?

25 minutes

How long is the half-life of the hormone aldosterone, which is only 15% protein bound?

Receptors in each cell will increase.

How will cell receptors change in the absence of a particular hormone?

The nurse is caring for a patient who takes lithium to manage his bipolar disorder. The nurse carefully observes the patient for which of the following electrolyte imbalance?

Hypercalcemia

A nurse observes peaked, narrow T waves on the electrocardiogram of a patient suffering from renal failure. The nurse suspects that the client is experiencing which of the following conditions?

Hyperkalemia

A nurse working with a pregnant woman explains that breast size increases as a result of which of the following physiological manifestations?

Hyperplasia

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

Hypertension

Which of the following have the potential to cause chronic kidney disease? (Select all that apply.)

Hypertension Diabetes Glomerulonephritis

A nurse is discussing cardiac hemodynamics with a nursing student and explains the concept of afterload. The student asks what medical conditions might cause increased afterload. The nurse correctly answers which of the following?

Hypertension and aortic valve stenosis Major factors that determine afterload are the diameter and distensibility of the great vessels (aorta and pulmonary artery) and the opening and competence of the semilunar valves (pulmonic and aortic valves). If the client has significant vasoconstriction, hypertension, or a narrowed vavular opening, resistance or afterload increases. Diabetes mellitus and mitral valve stenosis do not directly affect afterload.

A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is:

proton pump inhibitors Proton pump inhibitors are the strongest inhibitors of acid secretions. The H2-receptor antagonists are the next most powerful.

Respiratory alkalosis is caused by hyperventilation, which is recognized as a respiratory rate in excess of that which maintains normal plasma Pco2 levels. What is a common cause of respiratory alkalosis?

Hyperventilation

A nurse is caring for a patient with hypoparathyroidism. Which of the following is a major concern for the patient?

Hypocalcemia

The nurse is caring for a patient who is 1 day postoperative for a thyroidectomy. The patient complains of tingling of the hands and feet and around his mouth. The nurse suspects these symptoms are a manifestation of which electrolyte disturbance?

Hypocalcemia

A nurse working on a cardiac unit knows that monitoring magnesium levels is important for which of the following reasons?

Hypomagnesemia causes intracellular potassium depletion, creating risk for cardiac arrhythmias.

A community health nurse who is attending a marathon recognizes which of the following types of hypotonic hyponatremia is likely when a patient reports muscle weakness, cramping, and general fatigue in spite of adequate water hydration during the run?

Hypovolemic

The nurse and nursing student are caring for a client with kidney dysfunction who requires a test to determine glomerular filtration rate. The nurse recognizes that the student understands the test when the student states which of these?

I will need to start a 24-hour urine collection.

A nurse is caring for a patient whose serum potassium level is 2.6 mEq/L. The nurse anticipates which of the following interventions will be prescribed?

IV infusion of 10 mEq potassium chloride in 100-mL normal saline solution over 1 hour times three doses

Thyroid scan

Imaging has proven useful in both the diagnosis and follow-up of endocrine disorders. Two types of imaging studies are useful when dealing with endocrine disorders: Isotopic imaging and nonisotopic imaging. What is an example of isotopic imaging?

A client diagnosed with CKD has begun to experience periods of epistaxis and developed bruising of skin and subcutaneous tissues. The nurse recognizes these manifestations as:

Impaired platelet function

When caring for the client with Laennec's cirrhosis, the nurse recognizes which of these is an expected etiology of jaundice?

Impaired uptake of billirubin

A GH suppression test

In an adult with acromegaly, a growth hormone (GH)-secreting tumor is suspected. What diagnostic test would be used for this client?

The nurse is conducting a lecture on the difference between hypovolemia and dehydration. When completing a verbal comparison, which point needs clarified?

In dehydration, only extracellular is depleted In clients diagnosed with dehydration, all fluid compartments including the intracellular and extracellular compartment are reduced. The other options are correct. Both states can be from similar disease process such as vomiting, fever, diarrhea and difficulty swallowing and also have abnormal lab work. It is correct that hypovolemia relates to low blood volume.

The nurse is caring for a patient with ketoacidosis, who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which of the following phenomena is most likely occurring?

In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids

A nurse is caring for a client with primary constipation. Which factor is responsible for primary constipation?

Inadequate intake of liquid

A client with ethylene glycol toxicity is restless, and stating he has flank pain. What intervention should the nurse perform to minimize complications?

Increase IV fluids

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

The nurse is admitting to the hospital a 45-year-old woman with a presumptive diagnosis of diabetes mellitus. While taking her history, she mentions that she has been eating a lot of sweets lately. How would the nurse expect this diet to impact her renal system?

Increase renal blood flow

The nurse is administering a medication to the client with a positive inotropic effect. Which action of the medication does the nurse anticipate?

Increase the force of myocardial contraction

A nurse advises a client with recurring UTIs to drink large amounts of water. What normal protective action is the nurse telling the client to utilize?

Increase washout of urine

The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?

Increased blood pressure

Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which manifestation?

Increased blood pressure

A client was stranded when his automobile broke down while traveling in the mountains. The client had to walk 15 miles to the nearest gas station, and the outside temperature was 20 degrees. The client was at risk for

Increased blood viscosity and vasoconstriction

The edema of venous thrombosis (thrombophlebitis) is related to which of the following?

Increased capillary pressure

Which of the following lab results would be associated with abnormalities in kidney function? Select all that apply:

Increased creatinine levels Detectable levels of glucose in a urine sample Elevated cystatin-C level.

A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which measures should the client integrate into his or her lifestyle to reduce the risk of recurrence?

Increased fluid intake and dietary changes

When teaching the client with gout about the cause of the disease, which of these should the nurse relate?

Increased levels of uric acid in the blood cause gout.

Which of the following data would a clinician consider as most indicative of acute renal failure?

Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR).

The nurse is reviewing lab results of a client who has liver failure. The nurse determines that the client is at an increased risk for bleeding when the results include:

Increased prothrombin time

When caring for the client with hepatic failure, the nurse recognizes which of these problems places the client at increased risk for bleeding?

Increased prothrombin time

A nurse is teaching a client about the effects of UV radiation. Exposure to UV radiation would place the client at greatest risk for:

Increased risk of cancer

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find?

Increased serum creatinine

Which of the following would help a nurse best describe a finding of hypertrophy on a lab report?

Increased size of the cell

You are caring for a client in the compensation stage of shock. You know that in this stage of shock adrenaline and noradrenaline are released into the circulation. What positive effect does this have on your client?

Increases myocardial contractility

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect?

Infection

What is the usual cause of acute pyelonephritis?

Infection

An adult client has the following results of his morning blood work: Potassium: 2.5 mmol/l Sodium: 136 mmol/l Calcium: 2.3 mmol/l Magnesium: 1.01 mmol/l How should the nurse best respond to these values?

Inform the care provider and monitor the client's cardiac status.

A client is brought to the emergency department semicomatose and a blood glucose reading of 673. He is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29 and HCO3− level 19 mEq/dL; PCO2 level 32 mm Hg. The nurse should anticipate that which of the following orders may correct this diabetic ketosis?

Initiating an insulin IV infusion along with fluid replacement

Which of the following interventions is a priority for the nurse when caring for a patient with hypokalemia?

Initiating cardiac monitoring

A patient sustained acute tubular injury approximately 2 hours ago. Which of the following phases of this disorder does the nurse recognize that the patient is in at this time?

Initiating phase

A client has developed dystrophic calcification as a result of macroscopic deposition of calcium salts. The tissue that would be most affected would be:

Injured tissue

A nurse is caring for a patient receiving parenteral nutrition at home. The patient was discharged from the acute care facility 4 days ago. Which of the following would the nurse include in the patient's plan of care? Select all that apply.

Intake and output monitoring Calorie counts for oral nutrients Daily weights For the patient receiving parenteral nutrition at home, the nurse would obtain daily weights initially, decreasing them to two to three times per week once the patient is stable. Intake and output monitoring also is necessary to evaluate fluid status. Calorie counts of oral nutrients are used to provide additional information about the patient's nutritional status. Transparent dressings are changed weekly. Activity is encouraged based on the patient's ability to maintain muscle tone. Strict bedrest is not appropriate.

The nurse observes that the client's urine is orange. Which additional assessment would be important for this client?

Intake of medications such as phenytoin

A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL. While performing an assessment, the nurse should focus on which of the following clinical manifestations associated with this calcium level?

Intermittent muscle spasms and complaints of numbness around her mouth

Lymph fluid arises directly from which one of the following spaces?

Interstitial

Which of the following volumes represents the greatest percentage of water in the extracellular compartment?

Interstitial

A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which of the following treatments should the nurse prepare to give?

Intravenous administration of a KCl solution.

A patient is in the progressive stage of shock with lung decompensation. What treatment does the nurse anticipate assisting with?

Intubation and mechanical ventilation

The nurse is performing an assessment for a patient that is experiencing shortness of breath. The nurse notes a full and bounding pulse, crackles in the lung fields, and jugular vein distention. The nurse recognizes symptoms of which of these problems?

Isotonic fluid volume excess

A client has an increase in her anion gap (AG). What does the nurse determine is the significance of this finding?

It indicates the client has metabolic acidosis.

Which type of nephron is primarily responsible for concentrating urine?

Juxtamedullary nephrons

A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following?

Kayexolate

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following?

Kidney stones

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding vitamin D is correct?

Kidneys convert inactive vitamin D to its active form, calcitriol.

The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood?

Kupffer cells

The nurse is aware that fluid replacement is a hallmark treatment for shock. Which of the following is the crystalloid fluid that helps treat acidosis?

Lactated Ringer's

A client has these arterial blood gas values: anion gap 20 mEq/L, pH 7.29, pCO2 37mm Hg, HCO3- 11 mEq/L, base excess -6 mEq/L. With what condition do these values correspond?

Lactic acidosis

The nurse is reviewing laboratory data for the client with an anion gap of 17. The nurse recognizes which of these conditions are associated with an increased anion gap mEq/L?

Lactic acidosis

Wilms tumor is a tumor of childhood. It is usually an encapsulated mass occurring in any part of the kidney. What are the common presenting signs of a Wilms tumor?

Large asymptomatic abdominal mass and hypertension

Which conditions increase the risk for respiratory alkalosis? Select all that apply.

Last trimester of pregnancy Salicylate toxicity Anxiety

The nurse is providing dietary instruction for a client with chronic kidney disease who is on hemodialysis. Which would the nurse encourage the client to restrict?

Lean meats

A client's last bowel movement was 4 days ago and oral laxatives and dietary changes have failed to prompt a bowel movement. How should the nurse position the client in anticipation of administering a cleansing enema?

Left side-lying

The nurse is teaching the client with Meniere's disease about controlling symptoms through diet. Which of the following would the nurse emphasize? Select all that apply.

Limit intake of caffeinated beverages. Maintain hydration. Read labels carefully for sodium content. Avoid foods high in sugar Most clients with Meniere's disease can be successfully treated through nutritional measures, such as adhering to a low-sodium diet to assist in regulating the delicate balance between the endolymph and perilymph in the inner ear. Therefore, the nurse should encourage the client to limit the amount of canned, frozen, and processed foods, substituting fresh fruits, fresh vegetables, and whole grains. Hydration is important, so the client should drink water, milk, and low-sugar fruit juices, avoiding caffeinated fluids because of the diuretic effect of caffeine. Clients also should limit foods high in sugar and read labels carefully to identify foods with hidden salts and sugars.

A yellow-brown pigment that accumulates in neurons and may be a sign of cellular stress is

Lipofuscin

There are two types of diabetes insipidus (DI): neurogenic and nephrogenic. In nephrogenic DI, there is an inability of the kidney to concentrate urine and to conserve free water. Nephrogenic DI can be either genetic or acquired. What are the causes of nephrogenic DI?

Lithium and hypokalemia

The nurse is administering the medications to a patient on the cardiac unit. Giving which of the following medications causes the nurse to be alert for hypokalemia?

Loop Diuretics

The nurse is administering the medications to a patient on the cardiac unit. Giving which of the following medications causes the nurse to be alert for hypokalemia?

Loop diuretic

The nurse recognizes that ADH, antidiuretic hormone, exerts its effects in which of these locations?

Loop of Henle

The nurse assessing a renal failure patient for encephalopathy caused by uremia may observe which of the following clinical manifestations?

Loss of recent memory and inattention.

Which one of the following is a cause of osmotic edema?

Low blood levels of albumin

A client has experienced hypovolemic shock and is being treated with 2 liters of lactated Ringer's solution. It is now most important for the nurse to assess

Lung sounds

Intracellular buildup of substances that can be either normal or toxic occurs in which of the following areas of the cell?

Lysosome

A nurse educator is explaining the importance of maintaining GFR for the maintenance of homeostasis. Which play an essential role in maintaining a constant GFR?

Macula densa

Which of the following is a cofactor in ATP synthesis?

Magnesium

Radioimmunoassay methods

Many hormones are measured for diagnostic reasons by using the plasma levels of the hormones. What is used today to measure plasma hormone levels?

A nurse is caring for a client diagnosed with nephrotic syndrome. The nurse is aware that the client may manifest which of the following? Select all that apply.

Massive proteinuria (>3.5 g/day) Lipiduria Generalized edema Hyperlipidemia

The nurse is caring for a client newly diagnosed with sepsis. The client has a serum lactate concentration of 6 mmol/L and fluid resuscitation has been initiated. Which value indicates that the client has received adequate fluid resuscitation?

Mean arterial pressure of 70 mm Hg

When caring for a patient with diabetes insipidus (DI), the nurse plans to evaluate which of the following laboratory studies?

Measurement of antidiuretic hormone (ADH) and plasma/urine osmolality

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate?

Mechanical ventilation

A child accidentally consumes a container of wood alcohol. The ED physician knows that the child is at risk of developing which of the following?

Metabolic acidosis

The nurse is caring for a client who has excessive diarrhea. Which of these acid base disturbances does the nurse anticipate uncovering during evaluation of the arterial blood gas?

Metabolic acidosis

The nurse is caring for a client with renal failure experiencing shortness of breath and increased respiratory rate. The arterial blood gas reflects a pH of 7.10 and a HCO3 level of 18 mEq/L. How does the nurse interpret these findings?

Metabolic acidosis

The student nurse asks, "what it interstitial fluid?" What is the appropriate nursing response?

"Fluid in the tissue space between and around cells."

The nurse working at the blood bank is speaking with potential blood donor clients. Which client statement requires nursing intervention?

"I received a blood transfusion in the United Kingdom."

The nurse is caring for a client who will be undergoing surgery in several weeks. The client states, "I would like to give my own blood to be used in case I need it during surgery." What is the appropriate nursing response?

"Let me refer you to the blood bank so they can provide you with information."

A client in hospital is frustrated at the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine-collection test. The client asks the nurse why the test is necessary since the client provided a single urine sample two days prior. How could the nurse best respond?

"Often when an abnormal substance shows up in a urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine."

The nurse is teaching a nursing student how to record strict I&O;for a client who wears adult absorbent undergarments. Which nursing teaching is appropriate?

"Weigh the wet undergarment, subtract the weight of a similar dry item, and fluid loss is based on the equivalent of 1 lb (0.47 kg) = 1 pint (475 mL)."

Which IV solutions would the nurse expect to be ordered for a client who has hypovolemia? Select all that apply.

0.9% NaCl (normal saline) • Lactated Ringer's solution • 5% dextrose in 0.9% NaCl

A nurse is reviewing the arterial blood gas results of a client. Which pH value would the nurse document as indicating acidosis?

7.30

Which nursing diagnosis would the nurse make based on the effects of fluid and electrolyte imbalance on human functioning?

Acute Confusion related to cerebral edema

Following an automobile accident where the patient had a traumatic amputation of their lower leg and lost >40% of their blood volume, they are currently not producing any urine output. The nurse bases this phenomena on which of the following humoral substances responsible for causing severe vasoconstriction of the renal vessels?

Angiotensin II and ADH.

A home care nurse is visiting a client with renal failure who is on fluid restriction. The client tells the nurse, "I get thirsty very often. What might help?" What would the nurse include as a suggestion for this client?

Avoid salty or excessively sweet fluids.

An adult has a serum sample taken to evaluate the BUN-creatinine ratio. Select the result that indicates a normal test.

BUN 10 mg/dL to creatinine 1 mg/dL

The nurse reviews the laboratory test results of a client and notes that the client's potassium level is elevated. What would the nurse expect to find when assessing the client's gastrointestinal system?

Diarrhea

A nurse is teaching a client about the functions of the kidney. Which would be the most appropriate information for the nurse to provide? Select all that apply.

Eliminates metabolic wastes Regulates calcium and phosphorus conservation and elimination Regulates blood pressure through the renin-aldosterone mechanism Regulates pH of body fluids through reabsorption and conservation

A nurse is reviewing the client's serum electrolyte levels which are as follows: Sodium: 138 mEq/L Potassium: 3.2 mEq/L Calcium: 4.4 mEq/L Magnesium: 1.6 mEq/L Chloride: 100 mEq/L Phosphate: 1.8 mEq/L Based on these levels, the nurse would identify which imbalance?

Hypokalemia

To treat enuresis in a young girl, her pediatrician prescribes desmopressin, an antidiuretic hormone (ADH) nasal spray, before bedtime. Which rationale for this treatment is the most likely?

It removes water from the filtrate and returns it to the vascular compartment.

The health care provider has prescribed a diuretic to inhibit the Na+/K+/2Cl− cotransporters for a client. The nurse recognizes the medication as a:

Loop diuretic

The nurse is caring for a 5-year-old child who had a hernia repair 1 day ago. The child is vomiting, has a nasogastric (NG) tube to low intermittent suction, and has diarrhea. Which of the following laboratory results would be the immediate priority for the nurse to assess? Potassium level Calcium level Magnesium level Chloride level

Potassium level Explanation: Vomiting, diarrhea, and NG suction are all common causes of hypokalemia.

The anemia that occurs with end-stage kidney disease is often caused by the kidneys themselves. What loss of function in the kidney results in anemia of end-stage kidney disease?

Produce erythropoietin

The nursing instructor hears students discussing fluid and electrolyte balance. Which statement would warrant further instruction?

The kidneys store and release antidiuretic hormone to increase water retention."

Which of the following is not true regarding magnesium?

The liver regulates magnesium levels by breaking down the ion when serum levels are low.

The nurse administers the drug vasopressin to a patient with a pituitary disorder. Based on knowledge of pathophysiology, the nurse anticipates the client will react in which of these ways?

Water will be retained and decreased urine output will result.

The client with chronic kidney disease asks the nurse why he must take active vitamin D (calcitriol) as a medication. Which of these is the most appropriate response by the nurse?

With renal disease vitamin D is unable to be transformed to its active form.

The oncoming nurse is assigned to the following clients. Which client should the nurse assess first?

a newly admitted 88-year-old with a 2-day history of vomiting and loose stools

The nurse is caring for a client who had a parathyroidectomy. Upon evaluation of the client's laboratory studies, the nurse would expect to see imbalances in which electrolytes related to the removal of the parathyroid gland?

calcium and phosphorus

A client's most recent blood work indicates a K+ level of 7.2 mEq/L, a finding that constitutes hyperkalemia. For what signs and symptoms should the nurse vigilantly monitor?

cardiac irregularities

Which adverse effects occur when there is too rapid an infusion of TPN solution? negative nitrogen balance circulatory overload hypoglycemia hypokalemia

circulatory overload Explanation: Too rapid infusion of a TPN solution can lead to circulatory overload. The client should be assessed carefully for indications of excessive fluid volume. A negative nitrogen balance occurs in nutritionally depleted individuals, not when TPN fluids are administered in excess. When TPN is administered too rapidly, the client is at risk for receiving an excess of dextrose and electrolytes. Therefore, the client is at risk for hyperglycemia and hyperkalemia.

Clients who are receiving total parenteral nutrition (TPN) are at risk for development of which complication

fluid imbalances Explanation: Clients receiving TPN are at risk for a number of complications, including fluid imbalances such as fluid overload and hyperosmolar diuresis. Other common complications include hyperglycemia, sepsis, pneumothorax, and air embolism. Hypostatic pneumonia, pulmonary hypertension, and orthostatic hypotension are not complications of TPN.

The client is admitted to the nurse's unit with a diagnosis of heart failure. His heart is not pumping effectively, which is resulting in edema and coarse crackles in his lungs. The term for this condition is:

fluid volume excess

For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate: hypocalcemia. hypercalcemia. hypokalemia. hyperkalemia.

hypocalcemia. Explanation: A client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal of or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

A client is diagnosed with metabolic acidosis. The nurse develops a plan of care for this client based on the understanding that the body compensates for this condition by:

increasing ventilation through the lungs.

In the emergency department, a client arrives following a car accident. His pulse is 122; BP 88/60; respiration is 18 bpm. Urine output is 4 mL over the first hour on arrival. When in shock, this lower urine output is primarily due to:

innervation of the sympathetic nervous system causing constriction of the afferent arteriole.

A client has had a nasogastric tube connected to low intermittent suction. The client is at risk for: confusion. muscle cramping. edema. tremors.

muscle cramping. Explanation: Muscle cramping is a sign of hypokalemia. Potassium is an electrolyte lost with nasogastric suctioning. Confusion is seen with hypercalcemia. Edema is seen with protein deficit or fluid volume overload. Tremors are seen with hypomagnesemia.

A client has been admitted to the hospital with a diagnosis of acute renal failure, a health problem that necessitates vigilant monitoring of the client's fluid balance. What is the most accurate way that the care team can achieve this assessment goal?

weighing the client once per day

The nurse is monitoring intake and output (I&O;) for a client who recently had surgery. Which client actions will the nurse document on the I&O;record? (Select all that apply.)

• drinking milk • urination • vomiting • infusion of intravenous solution

The nurse is caring for a client who was found after spending 2 days without food or water in the desert and was admitted through the emergency department. The client is severely dehydrated. What are reasons why the human body requires fluid? Select all that apply.

• facilitates cellular metabolism • helps maintain normal body temperature • acts as a solvent for electrolytes

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Urine output of 400 ml in 8 hours Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Blood pressure of 120/64 to 130/72 mm Hg Sodium level of [142 mEq/L (142 mmol/L)]

Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Explanation: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

A client with uncontrolled diabetes develops hypophosphatemia. Which finding would the nurse most likely assess? Select all that apply.

• respiratory muscle weakness • confusion • ventricular dysrhythmia

Which serum electrolytes findings should the nurse expect to find in an infant with persistent vomiting? K+, 3.2; Cl-, 92; Na+, 120 K+, 3.4; Cl-, 120; Na+, 140 K+, 3.5; Cl-, 90; Na+, 145 K+, 5.5; Cl-, 110; Na+, 130

K+, 3.2; Cl-, 92; Na+, 120 Explanation: Chloride and sodium function together to maintain fluid and electrolyte balance. With vomiting, sodium chloride and water are lost in gastric fluid. As dehydration occurs, potassium moves into the extracellular fluid. For these reasons, persistent vomiting can lead to hypokalemia, hypochloremia, and hyponatremia. The normal potassium level is 3.5 to 5.5, the normal chloride level is 98 to 106, and the normal sodium level is 135 to 145. The values of 3.2, 92, and 120, respectively, are consistent with persistent vomiting. Each of the other options includes at least two serum electrolyte levels that are normal or high. These are not consistent with persistent vomiting.

A client who is n.p.o. prior to surgery reports feeling thirsty. What is the physiologic process that drives the thirst factor?

decreased blood volume and intracellular dehydration

A nurse who has diagnosed a client as having "fluid volume excess" related to compromised regulatory mechanism (kidneys) may have been alerted by what symptom?

distended neck veins

Edema happens when there is which fluid volume imbalance?

extracellular fluid volume excess

A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client: retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level

retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. Explanation: Sodium polystyrene sulfonate is a sodium-exchange resin. Thus, the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, sodium polystyrene sulfonate must be in contact with the bowel for at least 30 minutes. Sorbitol in the sodium polystyrene sulfonate enema causes diarrhea, which increases potassium loss and decreases the potential for sodium polystyrene sulfonate retention.

A client is prescribed a diuretic as part of the treatment plan for heart failure. The nurse educates the client about the drug and dietary measures to prevent complications. The nurse determines that the client needs more education when he states that he will increase his consumption of:

spinach

A 4-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. The nurse should suspect that the child's I.V. fluid intake is excessive if assessment reveals: worsening dyspnea. gastric distention. nausea and vomiting. a temperature of 102° F (38.9° C).

worsening dyspnea. Explanation: Dyspnea and other signs of respiratory distress signify fluid volume overload, which can occur quickly in a child as fluid shifts rapidly between the intracellular and extracellular compartments. Gastric distention suggests excessive oral (not I.V.) fluid intake or infection. Nausea and vomiting or an elevated temperature may indicate a fluid volume deficit, not an excess.

A client is diagnosed with body fluid hypoosmolality. Treatment involves restricting his intake of free water. Which fluids would the nurse most likely restrict? Select all that apply.

• Apple juice • Tea

A nurse is providing care to a client with an ECF volume deficit. The nurse suspects that the deficit involves a decrease in vascular volume based on which finding? Select all that apply.

• orthostatic hypotension • decreased urine output • slow-filling peripheral veins

A nurse is preparing a presentation for a group of older adults at a local senior center about the importance of fluid intake. As part of the presentation, the nurse plans to discuss how the intake and output of fluids is typically balanced each day. When describing the normal daily output of fluids, which component would the nurse identify as accounting for the smallest amount of fluid output?

Perspiration

A patient is scheduled for a creatinine clearance test to measure the glomerular filtration rate (GFR). The patient asks the nurse what this test is used for. Which of the following is the nurse's best response?

"This test provides a gauge of renal function."

A client with marked oliguria is ordered a test dose of 0.2 g/kg of 15% mannitol solution intravenously over 5 minutes. The client weighs 132 lb. How many grams would the nurse administer? Record your answer as a whole number.

12 Explanation: First, convert the client's weight from pounds to kilograms: 132 lb ÷ 2.2 lb/kg = 60 kg. Then, to calculate the number of grams to administer, multiply the ordered number of grams by the client's weight in kilograms: 0.2g/kg X 60 kg = 12 g.

Which substance, released by the atria, causes vasodilation of the afferent and efferent arterioles, which results in an increase in renal blood flow and glomerular filtration rate (GFR)?

Atrial natriuretic peptide (ANP)

Which food should the nurse teach a client with heart failure to limit when following a 2-gram sodium diet? apples canned tomato juice whole wheat bread beef tenderloin

Canned foods and juices such as tomato juice are typically high in sodium and should be avoided in a sodium-restricted diet. Canned foods and juices in which sodium has been removed or limited are available. The client should be taught to read labels carefully. Apples and whole wheat breads are not high in sodium. Beef tenderloin would have less sodium than canned foods or tomato juice.

Which is a common anion?

Chloride

Which is not a primary intracellular electrolyte?

Chloride

The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which of these findings does the nurse anticipate?

Excessive urine output

Urine specific gravity is normally 1.010 to 1.025 with adequate hydration. When there is loss of renal concentrating ability due to impaired renal function, low concentration levels are exhibited. When would the nurse consider the low levels of concentration to be significant?

First void in morning

When caring for the client with proteinuria, the nurse recognizes dysfunction in which of these structures of the kidney allows protein to leak into the urine?

Glomerulus

Which of the following statements most accurately captures the function of the ascending loop of Henle?

Impermeability to water and absorption of solutes yields highly dilute filtrate.

A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan? Increase daily fluid intake to at least 2 to 3 L. Strain urine at home regularly. Eliminate dairy products from the diet. Follow measures to alkalinize the urine.

Increase daily fluid intake to at least 2 to 3 L. Explanation: A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly.

Based on knowledge of total body fluids, a nurse is especially watchful for a fluid volume deficit in an infant. Why would the nurse do this?

Infants have more total body fluid and ECF than adults

A medical client's routine urinalysis includes the following data: Casts: positive Red blood cells: negative Crystals: negative White blood cells: negative Epithelial cells: few Which interpretation of these findings is the most plausible?

The client's urine contains excessive protein

The nurse teaches the client with end-stage kidney disease who has developed anemia that the reason anemia has developed is which of these?

The damaged kidney is unable to produce erythropoietin.

Which statement most accurately describes the process of osmosis?

Water moves from an area of lower solute concentration to an area of higher solute concentration.

The nurse determines that interventions for decreasing fluid retention have been effective when the nurse makes which assessment in child with nephrotic syndrome? decreased abdominal girth increased caloric intake increased respiratory rate decreased heart rate

decreased abdominal girth Explanation: Fluid accumulates in the abdomen and interstitial spaces owing to hydrostatic pressure changes. Increased abdominal fluid is evidenced by an increase in abdominal girth. Therefore, decreased abdominal girth is a sign of reduced fluid in the third spaces and tissues. When fluid accumulates in the abdomen and interstitial spaces, the child does not feel hungry and does not eat well. Although increased caloric intake may indicate decreased intestinal edema, it is not the best and most accurate indicator of fluid retention. Increased respiratory rate may be an indication of increasing fluid in the abdomen (ascites) causing pressure on the diaphragm. Heart rate usually stays in the normal range even with excessive fluid volume.

A client loses consciousness after strenuous exercise and needs to be admitted to a health care facility. The client is diagnosed with dehydration. The nurse knows that the client needs restoration of:

electrolytes.

Endurance athletes who exercise for long periods of time and consume only water may experience a sodium deficit in their extracellular fluid. This electrolyte imbalance is known as:

hyponatremia.

A nurse is preparing an education plan for a client with heart failure who is experiencing edema. As part of the plan, the nurse wants to describe the underlying mechanism for why the edema develops. Which mechanism would the nurse most likely address?

increased hydrostatic pressure

Which body fluid is the fluid within the cells, constituting about 70% of the total body water?

intracellular fluid (ICF)

A healthy client eats a regular, balanced diet and drinks 3,000 mL of liquids during a 24-hour period. In evaluating this client's urine output for the same 24-hour period, the nurse realizes that it should total approximately how many mL?

3,000

A client is brought to the emergency department with abdominal trauma following an automobile accident. The vital signs are as follows: heart rate, 132 bpm; respirations, 28 breaths/min; blood pressure, 84/58 mm Hg; temperature, 97.0° F (36.1° C); oxygen saturation 89% on room air. Which prescription should the nurse implement first? Administer 1 liter 0.9% saline IV. Draw a complete blood count (CBC) with hematocrit and hemoglobin. Obtain an abdominal x-ray. Insert an indwelling urinary catheter.

Administer 1 liter 0.9% saline IV. Explanation: The client is demonstrating vital signs consistent with fluid volume deficit, likely due to bleeding and/or hypovolemic shock as a result of the automobile accident. The client will need intravenous fluid volume replacement using an isotonic fluid (e.g., 0.9% normal saline) to expand or replace blood volume and normalize vital signs. The other prescriptions can be implemented once the intravenous fluids have been initiated.

It is known that high levels of uric acid in the blood can cause gout, while high levels in the urine can cause kidney stones. What medication competes with uric acid for secretion in to the tubular fluid, thereby reducing uric acid secretion?

Aspirin

A nurse is reviewing the dietary intake of a client prescribed a potassium-sparing diuretic. The client tells the nurse that he had a banana, yogurt, and bran cereal for breakfast and a turkey sandwich with a glass of milk for lunch. The intake of which food would be a cause for concern?

Banana

A client has just been admitted to the emergency department after sustaining severe injuries and massive blood loss following a motor vehicle accident. The nurse predicts that the client's glomerular filtration rate will:

Decrease

A client has been diagnosed with right-sided heart failure. The nurse should assess the client further for: Intermittent claudication. Dyspnea. Dependent edema. Crackles.

Dependent edema. Explanation: Right-sided heart failure causes venous congestion resulting in such symptoms as peripheral (dependent) edema, splenomegaly, hepatomegaly, and neck vein distention. Intermittent claudication is associated with arterial occlusion. Dyspnea and crackles are associated with pulmonary edema, which occurs in left-sided heart failure.

The nurse is caring for a client with suspected dehydration. Which of these results does the nurse recognize will help confirm this diagnosis?

Elevated urine specific gravity

The nurse is instructing a client on the procedure for obtaining a voided urine specimen to bring the laboratory for analysis. Which is the most important information for the nurse to tell the client?

Obtain the first-voided morning specimen.

In an industrial accident, a client who weighs 155 lb (70 kg) sustained full-thickness burns over 40% of his body. He's in the burn unit receiving fluid resuscitation. Which finding shows that the fluid resuscitation is benefiting the client? A urine output consistently above 40 ml/hour (40 mL/hour) A weight gain of 4 lb (2 kg) in 24 hours Body temperature readings all within normal limits An electrocardiogram (ECG) showing no arrhythmias

A urine output consistently above 40 ml/hour (40 mL/hour) Explanation: In a client with burns, the goal of fluid resuscitation is to maintain a mean arterial blood pressure that provides adequate perfusion of vital structures. If the kidneys are adequately perfused, they will produce an acceptable urine output of at least 0.5 ml/kg/hour. Thus, the expected urine output of a 155-lb (70 kg) client is 35 ml/hour, and a urine output consistently above 40 ml/hour is adequate. Weight gain from fluid resuscitation isn't a goal. In fact, a 4-lb (2 kg) weight gain in 24 hours suggests third spacing. Body temperature readings and ECG interpretations may demonstrate secondary benefits of fluid resuscitation but aren't primary indicators.