Renal, ADH and Liver Passpoint questions:

A client presents with cirrhosis of the liver secondary to alcohol abuse. Which assessment findings would warrant immediate action by the nurse? ascites and hematemesis pulmonary edema jugular vein distension cramps and watery diarrhea

ascites and hematemesis

A nurse is caring for a client with advanced cirrhosis. Upon assessment, the nurse notes pallor with a distended and firm abdomen. What is the most likely cause? portal hypertension resulting in a sudden fluid shift and signs of hypovolemia ascites increasing significantly due to hypoalbuminemia development of a paralytic ileus associated with cirrhosis bleeding esophageal varices causing gastric distension

ascites increasing significantly due to hypoalbuminemia

A client with a history of alcohol abuse was admitted with bleeding esophageal varices. After several days of treatment, the client is ready for discharge. The nurse enters the client's room to review discharge instructions with the client when the client tells the nurse that they want help to quit drinking. How should the nurse respond? "Let me finish reviewing your discharge instructions then we can discuss your concerns." "I'll tell your family so they can make arrangements for you to enter an alcohol rehabilitation center." "I'll notify your physician and call the social worker so they can discuss treatment options with you." "I hope it isn't too late; you've already done a lot of damage to your liver."

"I'll notify your physician and call the social worker so they can discuss treatment options with you."

A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention? Discuss meals that include low-fat high-carbohydrate content. Discuss the importance of drinking at least 64 oz (1,920 mL) of water daily. Discuss meals that have a high-fiber, high-protein content. Discuss the importance of eliminating caffeine in the diet.

Discuss meals that include low-fat high-carbohydrate content.

Which condition may contribute to hyperparathyroidism? A. chronic renal failure B. thyroidectomy C. elevated serum calcium level D. steroid use

A. Chronic renal failure

The nurse is teaching a client with diabetes insipidus about using desmopressin nasal spray. The therapeutic effects of desmopressin nasal spray are obtained when the client no longer has which symptom? A. polydipsia B. nasal congestion C. headache D. blurred vision

A. polydipsia

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)> Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? A. restricting fluids to 800 mL/day B. administering vasopressin as ordered C. elevating the head of the client's bed to 90 degrees D. restricting sodium intake to 1 gm/day

A. restricting fluids to 800 mL/day

The nurse is caring for a postoperative client who has undergone a transsphenoidal hypophysectomy. Which assessments would be most important for this client? SELECT ALL THAT APPLY. A. urinary output B. psychological status C. fluid and electrolyte balance D. gastrointestinal status E. visual disturbances

A. urinary output C. fluid and electrolyte balance E. visual disturbances

A client scheduled for hemodialysis is prescribed an oral antihypertensive daily. What is the correct action by the nurse regarding the medication? Administer it prior to the hemodialysis treatment. Administer it after the hemodialysis treatment. Contact the health care provider for a prescription to hold it on dialysis days. Administer it during the hemodialysis treatment.

Administer it after the hemodialysis treatment.

A client with cirrhosis is receiving lactulose. The nurse notes the client is more confused and has asterixis. What should the nurse do next? Assess for gastrointestinal (GI) bleeding. Withhold the lactulose. Increase protein in the diet. Monitor serum bilirubin levels.

Assess for gastrointestinal (GI) bleeding.

An adult with diabetes insipidus is hospitalized for care. Which finding should the nurse report to the physician? A. urine output of 350 mL in 8 hours B. urine specific gravity of 1.001 C. potassium of 4.0 mEq D. weight gain

B. urine specific gravity of 1.001

After completion of peritoneal dialysis, for which symptom should the nurse assess the client? A. hematuria B. weight loss C. hypertension D. increased urine output

B. weight loss

A client is having peritoneal dialysis. During the exchange, the nurse observes that the solution draining from the client's abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. What clinical judgment should the nurse make about the blood-tinged drainage? It is expected with a permanent peritoneal catheter. It indicates abdominal blood vessel damage. It can indicate kidney damage. It is caused by too-rapid infusion of the dialysate.

It indicates abdominal blood vessel damage.

What are important nursing care measures for a client with diabetes who is admitted with end-stage renal failure? Prepare for temporary peritoneal dialysis or hemodialysis. Restrict sodium and potassium and restrict fluids as ordered. Provide a diet high in protein and restrict fluids as ordered. Monitor for hypotension and maintain accurate intake and output records.

Restrict sodium and potassium and restrict fluids as ordered.

The nurse is planning care with the parents of a child who requires continuous peritoneal dialysis. Which finding should be discussed with the health care provider (HCP)? The family lives a long distance from the medical facility. The child attends a large public school. The child reports having a previous surgery for a ruptured appendix. The family feels the child cannot self-regulate to wake at night and change bags.

The child reports having a previous surgery for a ruptured appendix.

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis disequilibrium syndrome causes: confusion, headache, and seizures. acute bone pain and confusion. weakness, tingling, and cardiac arrhythmias. hypotension, tachycardia, and tachypnea.

confusion, headache, and seizures.

The nurse teaches a client about care of an arteriovenous (AV) access site. Which statement should the nurse include? Select all that apply. The incision should be kept dry until it is healed and the sutures are removed. The scabs that form around needle insertion site should be loosened daily. Dressings should be kept on access site for several hours after dialysis. The arm with the AV access should be kept elevated 4 hours after dialysis. Notify the healthcare provider of any redness, swelling, or drainage at AV access site.

The incision should be kept dry until it is healed and the sutures are removed. Dressings should be kept on access site for several hours after dialysis. Notify the healthcare provider of any redness, swelling, or drainage at AV access site.

The client is having peritoneal dialysis. During the exchange, the nurse observes that the flow of dialysate stops before all the solution has drained out. What should the nurse do next? Have the client sit in a chair. Turn the client from side to side. Reposition the peritoneal catheter. Have the client walk.

Turn the client from side to side.

A client is to receive peritoneal dialysis. What should the nurse do to prepare the client for the procedure? Assess the dialysis access for a bruit and thrill. Insert an indwelling urinary catheter and drain all urine from the bladder. Ask the client to turn toward the left side. Warm the dialysis solution in the warmer.

Warm the dialysis solution in the warmer

A client who is likely to become a candidate for dialysis treatment tells the nurse, "I must talk to my family." Recognizing the cultural preferences and beliefs of the client, what question must the nurse first answer before disclosing health care information? How many people does the client actually define as family? What is the appropriate client information to tell the family? Who is responsible for making client treatment decisions? Will the family protect the client from hearing bad news?

Who is responsible for making client treatment decisions?

The nurse is caring for a client with esophageal varices. The nurse should discuss which laboratory report finding with the health care provider (HCP)? normal serum albumin decreased ammonia slightly decreased levels of calcium elevated PT/INR

elevated PT/INR

A nurse is performing an admission assessment on a client diagnosed with diabetes insipidus. Which findings does the nurse anticipate during the assessment? Select all that apply. extreme polyuria excessive thirst elevated systolic blood pressure low urine specific gravity bradycardia elevated serum potassium level

extreme polyuria excessive thirst low urine specific gravity

A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis? capillary blood glucose test fluid deprivation test serum ketone test urine glucose test

fluid deprivation test

The nurse is assessing a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). What findings does the nurse attribute to complications of this condition? tetany and thirst jugular vein distention and confusion weight loss and cardiac arrhythmia polyuria and laryngeal spasms

jugular vein distention and confusion

Which assessment finding would advise the nurse of a need to change from the prescribed intranasal route to an injection of desmopressin acetate for a child with diabetes insipidus? mucous membrane irritation severe coughing occasional nosebleeds pneumonia

mucous membrane irritation

The client with cirrhosis who has ascites receives 100 mL of 25% serum albumin I.V. Which finding would best indicate that the albumin is having its desired effect? reduced ascites increased serum albumin level decreased anorexia increased ease of breathing

reduced ascites

A child is diagnosed with pituitary dwarfism. Which pituitary agent will the primary care provider most likely order to treat this condition? synthetic ACTH somatotropin desmopressin acetate vasopressin

somatotropin

Which treatment is the best therapy for a stable client with digoxin toxicity? activated charcoal time and symptomatic treatment hemodialysis atropine

time and symptomatic treatment

A physician prescribes several drugs for a client admitted to the emergency department with Laennec's cirrhosis. Which drug order should the nurse question? folic acid ketorolac warfarin vitamin K

warfarin

The nurse is caring for a neonate diagnosed with diabetes insipidus. Which assessment finding would warrant an immediate intervention? Edema Increased head circumference Increased feeding Weight loss

weight loss

A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. 36 hours later, the client's urine output suddenly rises above 200 mL/hr, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? A. above normal urine and serum osmolality levels B. below normal urine and serum osmolality levels C. above normal osmolality level, below normal serum osmolality level D. below normal urine osmolality level, above normal serum osmolality level

D. below normal urine osmolality level, above normal serum osmolality level

The nurse is caring for a client on hemodialysis who has an arteriovenous (AV) fistula in the right arm. When managing a client's plan of care, which instructions would the nurse determine as a priority for being completed? Select all that apply. maintaining the right arm above the heart utilizing a splint to maintain the right arm in an extended position avoiding all blood pressure readings and trauma to the right arm assessing the shunt by auscultating a bruit completing arm and finger exercises wearing snug-fitted shirts

avoiding all blood pressure readings and trauma to the right arm Assessing the shunt by auscultating a bruit completing arm and finger exercises

A client requires hemodialysis. Which type of drug should be withheld before this procedure? phosphate binders insulin antibiotics cardiac glycosides

cardiac glycosides

A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology? the client with diabetes mellitus the client with diabetes insipidus the client with diabetic ketoacidosis the client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion

the client with diabetes insipidus

A graduate nurse is asking for information about chronic renal failure. Which statement by the nurse would be most accurate when providing teaching? A. "it is most commonly caused by pyelonephritis." B. "it results in an increase in erythropoietin, leading to chronic anemia and fatigue" C. "it results in an inability of the kidneys to convert waste products to creatinine and BUN" D. "It is characterized by azotemia, fluid volume excess and hyperkalemia."

D. "It is characterized by azotemia, fluid volume excess and hyperkalemia."`