RSNG Spring 2018 Final review questions......questions 1-31 = AKI, CKD, Dialysis; Questions 32 on are from practice tests given in class

The nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse should be alert for which of the following? 1. Trousseau's sign 2. Cardiac arrhythmias 3. Constipation 4. Decreased clotting time 5. Drowsiness and lethargy 6. Fractures

1. Trousseau's sign 2. Cardiac arrhythmias 6. Fractures Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting times, anxiety, and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures.

The nurse is teaching the client about home blood glucose monitoring. Which blood glucose measurement indicates hypoglycemia? A. 59 B. 75 C. 108 D. 119

A. 59

Which condition most commonly results in coronary artery disease (CAD)? A. Atherosclerosis B. DM C. MI D. renal failure

A. Atherosclerosis

A client diagnosed with agoraphobia and who experiences panic attacks with a nurse about the progress made in treatment. Which client statement indicates a positive response to treatment? A. I went to the mall with my friend on Saturday B. I am still worried about having another panic attack C. I am still taking my medication to prevent the attacks D. I still find that it is difficult for me to do my everyday tasks

A. I went to the mall with my friend on Saturday

The nurse manager of a surgical unit observes a nurse providing colostomy care to a client without using any PPE. What is most appropriate response by the nurse manager in relation to the use of PPE? A. PPE should be used when you risk exposure to blood or bodily fluids B. If you are not using PPE, you need to be careful not to touch any of the drainage C. you should be aware that PPE is used when caring for any client in the hospital D. in the future, have the physician write an order for PPE for clients with colostomies

A. PPE should be used when you risk exposure to blood or bodily fluids

When assessing a client with an acute infection, the nurse would expect which laboratory results? A. WBC 14,000 B. serium calcium 7.6 C. serum thyroxine 12 D. platelet count 300,000

A. WBC 14,000 WBC normal range is 5-10,000 Calcium normal range is 8.5 - 10.2 serum thyroxine normal range is 4.6 - 12 (T4) platelet normal range is 150-400,000

A client developed cardiogenic shock after a severe myocardial infarction and has now developed acute renal failure. The client's family asks the nurse why the client has developed acute renal failure. The nurse should base the response on the knowledge that there was: A. a decrease in the blood flow through the kidneys B. an obstruction of urine flow from the kidneys C. a blood clot formed in the kidneys D. structural damage to the kidneys resulting in acute tubular necrosis

A. a decrease in the blood flow through the kidneys

The nurse is caring for an infant diagnosed with thrush. Which instruction would the nurse give to a client's mother who will be administering nystatin oral solution? A. administer the drug right after meals by swabbing the mouth B. administer the drug right before meals by using a guaze pad C. mix the drug with small amounts of formula in bottle D. administer half the dose before and half after feeding

A. administer the drug right after meals by swabbing the mouth

An adolescent client scheduled for an emergency appendectomy is to be transferred directly from the ER to the operating room. Which statement by the client should the nurse interpret as most significant? A. all of the sudden it does not hurt at all B. the pain is centered around my navel C. I feel like I am going to throw up D. it hurts when you press on my stomach

A. all of the sudden it does not hurt at all

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteriod therapy for this child is to: A. combat inflammation B. prevent infection C. prevent platelet aggregation D. diuresis

A. combat inflammation Corticosteroids lower immunity, can raise blood glucose

The nurse determines that interventions for decreasing fluid retention have been effective when the nurse makes which assessment in child with nephrotic syndrome? A. decreased abdominal girth B. increased caloric intake C. increased respiratory rate D. decreased heart rate

A. decreased abdominal girth

Which laboratory finding is present in nephrotic syndrome? A. decreased total serum protein B. hypercalcemia C. hyperglycemia D. decreased hematocrit

A. decreased total serum protein A decreased total serum protein occurs as extensive amounts of protein are excreted from the body through the urine. Clients may develop hypocalcemia. Hyperglycemia is not a finding related to nephrotic syndrome. A decreased hematocrit is not a finding related to nephrotic syndrome

A client is scheduled to have surgery to relieve an intestinal obstruction. Prior to surgery, the nurse should verify that the client has: A. discontinued use of blood thinners B. followed a low residue diet C. performed abdominal tightening exercises D. signed a last will and testament

A. discontinued use of blood thinners

A nurse is educating a client who is at risk for CAD. The nurse knows that the client needs more education when he states that the risk factors that can be controlled or modified include: A. gender, family hx, older age B. inactivity, stress, gender, smoking C. obesity, inactivity, diet, smoking D. stress, family hx, obesity

A. gender, family hx, older age

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? A. increase daily fluid intake to at least 2 to 3 L B. strain urine at home regularly C. eliminate dairy products from the diet D. follow measures to alkalinize the urine

A. increase daily fluid intake to at least 2 to 3 L

A client with peripheral vascular disease has poor circulation. The nurse should assess the client changes in: (select all) A. nail bed color B. fluid intake C. skin temp D. nausea E. pain in extremity

A. nail bed color C. skin temp E. pain in extremity

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? (select all) A. numbness B. aphasia C. tingling D. muscle twitching and spasms E. polyuria F. polydipsia

A. numbness C. tingling D. muscle twitching and spasms

A nurse is caring for an older adult client who is admitted with an electrolyte imbalance. Which laboratory values should be a priority concern for the nurse? (select all) A. pH 7.32 B. PaO2 90 mm Hg C. PaCO2 45 mm Hg D. sodium 140 mEq/L E. potassium 5.8 mEq/L

A. pH 7.32 E. potassium 5.8 mEq/L

A child is being discharged with albuterol nebulizer treatments. The nurse should instruct the parents to watch for: A. tachycardia B. bradypnea C. urine retention D. constipation

A. tachycardia

The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client? A. use the unaffected arm for blood pressure measurements B. draw blood from the cannula for routine laboratory work C. percuss the cannula for bruits each shift D. inject heparin into the cannula each shift

A. use the unaffected arm for blood pressure measurements

A HCP gives the nurse an order over the telephone. Which of the following is the appropriate nursing action? A. verify the order by repeating it back to the HCP B. no action is needed at this time C. request that a second healthcare provider repeat the order to the nurse over the telephone D. explain that the healthcare provider must sign the order within 1 hour

A. verify the order by repeating it back to the HCP

A client with heart failure will take oral furosemide at home. To help the client evaluate the effectiveness of furosemide therapy, the nurse should teach the client to: A. weigh daily B. take blood pressure daily C. keep a daily record of urine output D. have a serum potassium level drawn weekly

A. weigh daily

The client is to undergo a series of diagnostic tests to determine if the client's cognitive impairment is treatable. Which state can lead to nonreversible impairment? A. cerebral abscess B. Alzheimer's disease C. delirium D. electrolyte imbalance

B. Alzheimer's disease

A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching? A. I'll increase my intake of protein during exacerbations B. I should increase my intake of fresh fruits and vegetables during remissions C. I'll snack on nuts, olives and popcorn during flare ups D. I'll incorporate foods rich in omega 3 fatty acids into my diet

B. I should increase my intake of fresh fruits and vegetables during remissions

A nurse has completed discharge teaching for a client, which involves instructions for changing a leg dressing. Which statement would indicate that the teaching has been effective? A. I should change this dressing once a week when it starts to hurt B. I will report any signs of redness or drainage when I change the dressing C. The dressing should be changed next time I have an appointment with my physician D. I don't need to worry about this dressing because the home health nurse will change it

B. I will report any signs of redness or drainage when I change the dressing

A staff nurse on a pediatric unit has four client assignments. Which child should the nurse assess first? A. an 8 year old child admitted from the postanesthesia care unit who's complaining of pain B. a 10 year old child with asthma whose oxygen saturation levels are dropping C. a 7 year old child whose mother is waiting for discharge instructions D. a 9 year old child with a broken leg who wants help moving from the bed to the chair

B. a 10 year old child with asthma whose oxygen saturation levels are dropping

A child, just been admitted to the ER, has the following chart entry: Progress notes 10/15/16 1800 Parents describe recent weight loss and lack of energy. Client's ears and cheeks are flushed; acetone-smelling breath noted. Blood glucose 324 mg/dl, BP 104/60, P 88, RR 16 breaths/min. What intervention would the nurse anticipate? A. subq administration of glucagon B. administration of IV regular insulin by continuous infusion pump C. administration of regular insulin subq Q4H as needed per sliding scale D. administration of IV fluids in boluses of 20 ml/kg

B. administration of IV regular insulin by continuous infusion pump

Which symptom would cause the nurse to suspect that the client is experiencing digitalis toxicity? A. abdominal cramping B. bradycardia C. polyuria D. hearing disturbances

B. bradycardia Furosemide and the myacins can cause hearing disturbances

Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? A. sodium phosphate B. calcium gluconate C. echothiophate iodid D. sodium bicarbonate

B. calcium gluconate

A client who is receiving a blood transfusion begins to have difficulty breathing. The nurse notes an elevated blood pressure and a cough. Based on these signs, the nurse should prepare to manage which complication? A. anaphylactic reaction B. circulatory overload C. sepsis D. acute hemolytic reaction

B. circulatory overload The symptoms of difficulty breathing, elevated blood pressure, and cough are indicative of circulatory overload. Circulatory overload occurs when blood is infused more rapidly than the circulatory system can accommodate. Anaphylactic reactions are manifested by urticaria, wheezing, and shock. Sepsis begins with a rapid onset of chills and fever. Acute hemolytic reaction is typically manifested by chills, fever, low back pain, and flushing.

When teaching a client with chronic renal failure who is taking antibiotics about signs and symptoms of potential nephrotoxicity to report, the nurse should encourage the client to promptly report which changes in the color of the urine? (select all that apply.) A. straw-colored B. cloudy C. smoky D. pink

B. cloudy C. smoky D. pink

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to: A. assess whether the client is a good candidate for surgery B. help the client cope with the anxiety associated with changes in body image C. assess suicidal risk postoperatively D. evaluate the client's need for mental health intervention

B. help the client cope with the anxiety associated with changes in body image

A 48 year old female client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? (select all that apply) A. high protein, high calorie diet B. high fiber, low calorie diet C. plan for thyroidectomy D. use of stool softeners E. thyroid hormone replacements F. review of the procedure for thyroid radiation therapy

B. high fiber, low calorie diet D. use of stool softeners E. thyroid hormone replacements

A hospitalized client with a fracture of the tibia and fibula of the left leg is reporting increased pain at the site. What signs must the nurse be alert to what would indicate compromised circulation to the leg? A. foul odor of the affected leg B. increased swelling of the toes and decreased distal pulses C. increased systemic body temperature D. purulent drainage from the incision site

B. increased swelling of the toes and decreased distal pulses

The client is shaking and is reporting a high degree of stress about hospitalization. Which of the following should be the nurse's first action? A. leave the room to provide privacy B. instruct the client to inhale and exhale slowly C. have the client choose a word to repeat for mediation D. encourage the client to listen to a music channel

B. instruct the client to inhale and exhale slowly

A client diagnosed with hypothyroidism (myxedema) is receiving levothyroxine. Which assessment findings would require a nursing intervention? (select all that apply) A. dysuria B. mild chest pain C. dysrhythmias D. heart rate of 132 beats/min E. adventitious breath sounds

B. mild chest pain C. dysrhythmias D. heart rate of 132 beats/min Levothyroxine (thyroid hormone replacement medication) increases cardiac demand, which can cause increased heart rate, palpitations, and chest pain. These clients are at risk for a myocardial infarction. Adventitious breath sounds are abnormal, extra sounds, but are not related to receiving levothyroxine. Dysuria means painful urination and is not a side effect of levothyroxine.

A nurse provides preoperative education to a client scheduled to undergo elective surgery. The nurse includes instructions about proper skin care. Which client statement indicates the need for further? A. I should begin to use an antibacterial soap a few days before my surgical procedure B. on the morning of the surgery, I can shave my surgical area at home to save time C. on the morning of surgery, I won't use lotions or cosmetics D. I'll shower before coming to the hospital on the day of the surgery

B. on the morning of the surgery, I can shave my surgical area at home to save time

The client with acute pyelonephritis wants to know the possibility of developing chronic pyelonephritis. The nurse's response is based on knowledge of which disorder that most commonly leads to chronic pyelonephritis? A. acute pyelonephritis B. recurrent UTIs C. acute renal failure D. glomerulonephritis

B. recurrent UTIs presents with flank pain, chills

A client with a large goiter is scheduled for a subtotal throidectomy to treat thyrotoxicosis. Saturated solution of potassium iodine (SSKI) is prescribed preoperatively for the client. The expected outcome of using this drug is that it helps: A. slow progression of exophthalmos B. reduce vascularity of the thyroid gland C. decrease the body's ability to store thyroxine D. increase the body's ability to excrete thyroxine

B. reduce vascularity of the thyroid gland Thyrotoxicosis means an excess of thyroid hormone in the body. Having this condition also means that you have a low level of thyroid stimulating hormone, TSH, in your bloodstream, because the pituitary gland senses that you have "enough" thyroid hormone. Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor)

A client has a dull headache, is dizzy, and has an increased pulse rate. The results of an ABG are: pH 7.26; partial pressure of carbon dioxide 50 mmHg; and bicarbonate 24 mEq/L. These findings indicate which acid base imbalance? A. respiratory alkalosis B. respiratory acidosis C. metabolic acidosis D. metabolic alkalosis

B. respiratory acidosis

A client's ABG analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which of the following? A. respiratory alkalosis B. respiratory acidosis C. metabolic acidosis D. metabolic alkalosis

B. respiratory acidosis An increased level of dissolved carbon dioxide (PaCO2) indicates respiratory acidosis. Metabolic acidosis and alkalosis are not correct because this is a respiratory issue, not a metabolic one. Respiratory alkalosis would have a PaCO2 deficit, not an increase.

What are important nursing care measures for a client with diabetes who is admitted with end-stage renal failure? A. prepare for temporary peritoneal dialysis or hemodialysis B. restrict sodium and potassium and restrict fluids as ordered C. provide a diet high in protein and restrict fluids as ordered D. monitor for hypotension and maintain accurate intake and output records

B. restrict sodium and potassium and restrict fluids as ordered

A client with agoraphobia has been symptom free for 4 months. Classic s/s of phobias include: A. insomnia and an inability to concentrate B. severe anxiety and fear C. depression and weight loss D. withdrawal and failure to distinguish reality from fantasy

B. severe anxiety and fear

A client is being discharged after undergoing a thyroidectomy. Which discharge instructions are appropriate for this client? (select all that apply) A. report s/s of hypoglycemia B. take thyroid replacement medication as ordered C. watch for changes in body functioning, such as lethargy, restless, sensitivity to cold, and dry skin. Report these changes to the physician D. avoid all OTC medication E. carry injectible dexamethasone at all times

B. take thyroid replacement medication as ordered C. watch for changes in body functioning, such as lethargy, restless, sensitivity to cold, and dry skin. Report these changes to the physician Dexamethasone is a steroid

A client has type I diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subq. She awakens in 5 minutes. Why should her husband offer her a complex carb snack as soon as possible? A. to decrease the possibility of N/V B. to restore liver glycogen and prevent secondary hypoglycemia C. to stimulate her appetite D. to decrease the amount of glycogen in her system

B. to restore liver glycogen and prevent secondary hypoglycemia

Which clinical manifestations should the nurse expect to assess in a client diagnosed with an overdose of a cholinergic agent? (select all that apply) A. dry mucous membranes B. urinary incontinence C. CNS depression D. seizures E. skin rash

B. urinary incontinence C. CNS depression D. seizures dry mucous membranes are caused by anti-cholinergics Cholinergic drugs, any of various drugs that inhibit, enhance, or mimic the action of the neurotransmitter acetylcholine, the primary transmitter of nerve impulses within the parasympathetic nervous system—i.e., that part of the autonomic nervous system that contracts smooth muscles, dilates blood vessels, increases

A nurse is instructing a client with newly diagnosed hypo-parathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and: A. folic acid B. vitamin D C. potassium D. iron

B. vitamin D

A client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client's serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range? A. 2 to 5 B. 5 to 10 C. 10 to 20 D. 21 to 25

C. 10 to 20

A nurse is planning a group teaching session on the topic of UTI. Which of the following statements, if made by a group member, would indicate understanding of the teaching? A. to reduce urgency to urinate, I should decrease my intake of fluids B. I should take the medication ordered for the UTI until the symptoms subside C. I should notify the physician if urinary urgency, burning, frequency, or difficulty urinating occurs D. it does not matter what type of underwear I wear as long as I do not take tub baths

C. I should notify the physician if urinary urgency, burning, frequency, or difficulty urinating occurs

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which ABG value is most important? A. pH B. HCO3 C. PaO2 D. PaCO2

C. PaO2

During an initial shift assessment, a nurse finds a diabetic client who is lethargic and who has rapid, deep respirations. Which of the following actions should the nurse take? A. administer IV glucagon bolus as needed B. start oxygen at 2 L/min as needed C. administer a saline bolus as needed D. contact HCP

C. administer a saline bolus as needed Give fluid - dehydration is most important. Treat DKA first with saline.

The HCP prescribes risperdone for a client with Alzheimer's disease. The nurse anticipates administering this medication to help decrease which behavior? A. sleep disturbances B. concomitant depression C. agitation and assaultiveness D. confusion and withdrawal

C. agitation and assaultiveness Risperdone is an antipsychotic medication. It is mainly used to treat schizophrenia, bipolar disorder, and irritability in people with autism. It is taken either by mouth or by injection into a muscle. The injectable version is long acting and lasts for about two weeks.

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: A. oliguria B. polyuria C. anuria D. hematuria

C. anuria

The client asks the nurse, "Is it really possible to lead a normal life with an ileostomy?" Which action by the nurse would be most effective to address this question? A. Have the client talk with a member of the clergy about these concerns B. tell the client to worry about those concerns after surgery C. arrange for a person with an ostomy to visit the client preoperatively D. notify the surgeon of the client's question

C. arrange for a person with an ostomy to visit the client preoperatively

An elderly client with Alzheimer's disease begins supplemental tube feedings through a gastrostomy tube to provide adequate calorie intake. The nurse's priority should be the potential for: A. hyperglycemia B. fluid volume excess C. aspiration D. constipation

C. aspiration

A client undergoes a nephrectomy. In the immediate postoperative period, which nursing intervention has the highest priority? A. monitor blood pressure B. encourage the use of the incentive spirometer C. assess urine output hourly D. check the flank dressing for urine drainage

C. assess urine output hourly

A client is admitted to the hospital through the ED with chest pain. Which intervention is the priority? A. monitoring the platelet count B. assessing B-type natriuretic peptide levels C. assessing troponin 1 levels D. monitoring the WBC count

C. assessing troponin 1 levels

Which nursing measure will likely decrease the risk of a surgical wound infection in a client with an internal fixation and hip pinning? A. inserting an indwelling urinary catheter to prevent possible soiling of the dressing B. accurately measuring drainage from the surgical drainage tube C. changing the surgical dressings using sterile technique D. monitoring the incision for signs of redness, swelling, and warmth

C. changing the surgical dressings using sterile technique

The most significant sign of acute renal failure is: A. elevated body temp B. increased blood pressure C. decreased urine output D. increased urine specific gravity

C. decreased urine output

A child with a fractured left femur receives a cast. A short time later, the nurse notices that the toes of the child's left foot are edematous. Which nursing action would be most appropriate? A. applying ice to the foot B. massaging the toes C. elevating the foot of the bed D. placing the child on his right side

C. elevating the foot of the bed

A client with chronic renal failure is admitted with a heart rate of 122 beats/min, a resp rate of 32 breaths/min, a blood pressure of 190/110, neck vein distention, and bibasilar crackles. Which nursing diagnosis takes highest priority for this client? A. fear B. urinary retention C. excess fluid volume D. toileting self care deficit

C. excess fluid volume

The nurse is assigned to care for a client with early stage Alzheimer's disease. Which nursing interventions should be included in the client's care plan? (select all that apply) A. make frequent changes in the client's routine B. engage the client in complex to improve memory C. furnish the client's environment with familiar possessions D. assist the client with activities of daily living as necessary E. assign tasks in simple steps

C. furnish the client's environment with familiar possessions D. assist the client with activities of daily living as necessary E. assign tasks in simple steps

What instructions should the nurse give to the parents of an 8 year old child with asthma who is being switched from parental steroid therapy to a daily dose of oral prednisone? A. administer the dose before bedtime to minimize adverse effects B. give the medication according to the child's response C. have the child take the dose with meals to prevent gastric irritation D. make sure to give the pill intact to maintain the enteric coating

C. have the child take the dose with meals to prevent gastric irritation

The nurse should assess a client taking chlorpropamide for: A. dumping syndrome B. extrapyramidal symptoms C. hypoglycemia D. oral candidiasis

C. hypoglycemia chlorpropamide is a PO anti-diabetes med

Which medication is considered safe during pregnancy? A. aspirin B. magnesium hydroxide C. insulin D. oral antidiabetic agents

C. insulin

The nurse is assessing a client's abdominal incision 48 hours after surgery. Which finding indicates that the wound is inflamed? A. serous sanguineous drainage B. moderate amount of dried bloody drainage on the dressing C. localized warmth over the incision area D. the skin is slightly pink around the staples

C. localized warmth over the incision area

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? A. high carb, high protein B. high calcium, high potassium, high protein C. low protein, low sodium, low potassium D. low protein, high potassium

C. low protein, low sodium, low potassium

A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse be sure to cover? A. maintaining a low potassium diet B. skipping medication dose if dizziness occurs C. maintaining a low sodium diet D. receiving IV anti-hypertensive medications

C. maintaining a low sodium diet

A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life threatening complication? A. MI B. thyroid storm C. myxedema coma D. CHF

C. myxedema coma

The nurse has asked the UAP to help with admitting an elderly client who has been diagnosed with bacterial pneumonia. Which activity is appropriate for the nurse to ask the UAP to perform? A. assess the client's breath sounds B. collect nursing history and assessment data C. obtain the client's height and weight D. evaluate the client's respiratory status

C. obtain the client's height and weight

A client is admitted with severe abdominal pains and the diagnosis of acute pancreatitis. The nurse should develop a plan of care during the acute phase of pancreatitis that will involve interventions to manage: A. drug and alcohol abuse B. risk for injury C. severe pain D. ineffective airway clearance

C. severe pain

While talking to her husband, who is caring for their children, a 52 year old slams the phone down. She begins to cry and states that she is feeling guilty for being hospitalized. Which nursing action will best support the client emotionally? A. ask the client if she would like to speak with a grief counselor B. call the HCP and request an antidepressant C. sit with the client and help her acknowledge and discuss her feelings D. suggest the client call her husband when she is calmer

C. sit with the client and help her acknowledge and discuss her feelings

A client is having a blood transfusion reaction. What must the nurse do in order of priority from first to last? All options must be used. A. complete the appropriate transfusion reaction form(s) B. keep the IV open with normal saline infusion C. stop the transfusion D. notify the HCP and blood bank

C. stop the transfusion B. keep the IV open with normal saline infusion D. notify the HCP and blood bank A. complete the appropriate transfusion reaction form(s)

The client with first time bacterial cystitis is being treated with an antibiotic to be taken for 7 days. The nurse should instruct the client to: A. limit fluids to 1,000 mL/day B. notify the HCP when urine is clear C. take the entire prescription as ordered D. use condoms if having sex

C. take the entire prescription as ordered

Which concept refers to a professional nurse's role in client advocacy? A. the nurse makes decisions for clients who can't make decisions for themselves B. the nurse follows the basic standards of care and hospital policies and procedures for providing client care C. the nurse promotes and protects the client's interests and rights D. the nurse adopts a paternalistic approach to client care

C. the nurse promotes and protects the client's interests and rights

A client has polycystic kidney disease. The client asks the nurse, "How did I get these fluid-filled bubbles on my kidneys?" How should the nurse respond to help the client understand risk factors for this disease process? A. second hand smoke puts you at greater risk for developing cysts B. exposure to dyes used to color fruits and vegetables increases the risk of polycystic kidney disease C. there is a higher incidence of polycystic kidney disease among blood relatives D. drinking alcohol daily allows the kidneys to develop cysts

C. there is a higher incidence of polycystic kidney disease among blood relatives

When administering atropine sulfate preoperatively to a client scheduled for lung surgery, the nurse should tell the client? A. this medicine will make you drowsy B. this medicine will help you relax C. this medicine will make your mouth feel dry D. this medicine will reduce the risk of postoperative infection

C. this medicine will make your mouth feel dry

A client presents to the ER, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? A. Metabolic acidosis and hyperkalemia B. Metabolic acidosis and hypokalemia C. Metabolic alkalosis and hyperkalemia D. Metabolic alkalosis and hypokalemia

D. Metabolic alkalosis and hypokalemia Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia.

A client with a history of asthma is admitted to the ER. The nurse notes that the client is dyspneic, with respiratory rate of 35 breaths/min, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. What should the nurse do first? A. initiate oxygen therapy as prescribed, and reassess the client in 10 minutes B. draw blood for an arterial blood gas C. encourage the client to relax and breathe slowly through the mouth D. administer bronchodilators as precribed

D. administer bronchodilators as precribed

A client scheduled for cardiac catherization tells the nurse she's nervous because she's heard of people dying during this procedure.. Based on this statement, which nursing diagnosis is most appropriate? A. impaired health maintenance B. activity intolerance C. complicated grieving D. anxiety

D. anxiety Ask the patient to explain how she is feeling so you can understand.

The client with Alzheimer's disease has been prescribed donepezil 5 mg at bedtime. Which instruction should the nurse give to the client's daughter? A. take her mother to the clinic next week for blood work B. give her mother an extra dose if needed at night C. observe her mother for signs of constipation D. avoid suddenly stopping the medication

D. avoid suddenly stopping the medication

A client with chronic renal failure has a serum potassium level of 6.8. What should the nurse assess first? A. blood pressure B. respiration C. temperature D. cardiac rhythm

D. cardiac rhythm

A client with chronic renal failure is undergoing hemodialysis. Postdialysis, the client weight 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 Hemodialysis clients have their protein requirements individually tailored according to their postdialysis weight. The protein requirement is 1.0 to 1.2 g/kg body weight per day. Hence, for a 59-kg weight, the amount of protein will be 59 to 70 g/day. Sodium should be restricted to 3 g/day. The client should obtain sufficient calories; if calories are not supplied in adequate amount, the body will use tissue protein for energy, which will lead to a negative nitrogen balance and malnutrition. Fluid intake needs to be restricted. The fluid amount is restricted to 500 to 700 mL plus the urine output.

A client hospitalized with heart failure, is receiving digoxin and furosemide intravenously and now has continuous ringing in the ears. What is the appropriate action for the nurse to take at this time.? A. obtain a digoxin level to check for toxicity B. note the observation in the medical record and plan to reassess in 2 hours C. ask the client about taking aspirin in addition to other medications D. discontinue the furosemide and notify the HCP

D. discontinue the furosemide and notify the HCP

A client in the ER reports that he has been vomiting excessively for the past 2 days. His ABG analysis shows pH of 7.50, partial pressure of arterial carbon dioxide of 43 mmHg, partial pressure of arterial oxygen of 75 mmHg, and bicarbonate of 42 mEq/L. The nurse documents that the client is experiencing which type of acid-base imbalance? A. respiratory alkalosis B. respiratory acidosis C. metabolic acidosis D. metabolic alkalosis

D. metabolic alkalosis

The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addison's crisis following surgery? A. prednisone orally B. fludrocortisone subcutaneously C. spironolactone intramuscularly D. methylprenisolone sodium succinate intravenously

D. methylprenisolone sodium succinate intravenously IV because it is after surgery

After a client has had a bronchoscopy under local anesthesia, the nurse should: A. irrigate the nasogastric tube with 30 mL of normal saline every 2 hours B. offer 200 mL of oral fluids every hour to liquefy lung secretions C. observe the abdomen for s/s of distention and board-like rigidity D. restrict oral intake until the gag reflex returns

D. restrict oral intake until the gag reflex returns

A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury? A. bend over the object you're lifting B. narrow the stance when lifting C. push or pull an object using your arms D. stand close to the object you're lifting

D. stand close to the object you're lifting

A client with chronic pancreatitis is discharged with a prescription for pancrelipase. Which instruction must the nurse include when providing discharge instructions regarding this medication? A. store this medication in the refrigerator B. take this medication before going to bed C. dissolve the medication in a full glass of water D. swallow this medication whole and do not chew it

D. swallow this medication whole and do not chew it Pancreatic enzymes also known as pancrelipase and pancreatin, are commercial mixtures of amylase, lipase, and protease. They are used to treat malabsorption syndrome due to pancreatic problems. It should be taken with each meal.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? A. the head of your bed must remain flat for 24 hours after surgery B. you should avoid deep breathing and coughing after surgery C. you won't be able to swallow for the first day or two D. you must avoid hyperextending your neck after surgery

D. you must avoid hyperextending your neck after surgery

14. The nurse caring for a patient with suspected renal dysfunction is assessing ankle and sacral edema and the presence of crackles in the bases of the lungs bilaterally. A daily weight indicates that the patient's weight has increased by 5 pounds in the past 24 hours. The nurse notes that evaluation of the patient's intake and output records for the prior 24 hours indicate greater fluid intake than urine output. Based upon the assessment findings and the daily weight information, the nurse estimates that the patient has retained how much fluid? a) 2273 mL of fluid in 24 hours b) 1258 mL of fluid in 24 hours c) 2500 mL of fluid in 24 hours d) 5000 mL of fluid in 24 hours

a) 2273 mL of fluid in 24 hours 1 Liter of fluid= 1 kg or 2.2 pounds: need to know

29. Patient education regarding a fistulae or graft includes which of the following? (Select all that apply) a) Avoid compression of the site. b) No IV or blood pressure taken on extremity with dialysis access. c) Cleanse site b.i.d. d) No tight clothing. e) Check daily for thrill and bruit.

a) Avoid compression of the site. b) No IV or blood pressure taken on extremity with dialysis access. d) No tight clothing. e) Check daily for thrill and bruit.

20. A nurse is caring for a renal patient in the diuresis period of ARF. What must the patient be observed closely for during this phase? a) Dehydration b) Hypervolemia c) Hyperkalemia d) Hypocalcemia

a) Dehydration

19. A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? a) Diuresis b) Restored glomerular function c) Acute tubular necrosis d) Oliguria

a) Diuresis

28. Which phase of acute renal failure signals that glomerular filtration has started to recover? a) Diuretic b) Recovery c) Oliguric d) Initiation

a) Diuretic

6. A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute renal failure b) Acute glomerulonephritis c) Chronic renal failure d) Nephrotic syndrome

b) Acute glomerulonephritis

21. Which of the following would a nurse classify as a prerenal cause of acute renal failure? a) Ureteral stricture b) Cardiogenic shock c) Polycystic disease d) Prostatic hypertrophy

b) Cardiogenic shock

5. A patient presents at the walk-in clinic complaining of edema around the eyes and flank tenderness bilaterally. Acute glomerular inflammation is suspected. What tests would the nurse expect to be ordered to confirm the diagnosis? a) BUN b) Creatinine c) Urinalysis d) CBC

b) Creatinine

24. A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? a) Keep the AV fistula wrapped in gauze. b) Keep the AV fistula site dry. c) Assess the AV fistula for a bruit and thrill. d) Take the client's blood pressure in the left arm.

c) Assess the AV fistula for a bruit and thrill.

18. When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? a) Add the prescribed drug to the dialysate. b) Warm the solution to body temperature. c) Check for thrill or bruit over the access site. d) Inspect the catheter insertion site for infection.

c) Check for thrill or bruit over the access site.

3. Which of the following causes should the nurse suspect in a client that is diagnosed with intrarenal failure? a) Ureteral calculus b) Hypovolemia c) Dysrhythmia d) Glomerulonephritis

d) Glomerulonephritis

1. Which term best describes a total urine output of less than 500 mL in 24 hours? a) Polyuria b) Nocturia c) Dysuria d) Oliguria

d) Oliguria

23. You are caring for a patient with acute renal failure. What is the most common clinical manifestation of acute renal failure? a) Decrease in serum creatinine b) Decrease in BUN c) Anuria d) Oliguria

d) Oliguria

22. A patient is receiving patient education prior to beginning continuous ambulatory peritoneal dialysis. What would the nurse teach the patient that the most common complication associated with this procedure is? a) Dehydration b) Constipation c) Blood loss d) Peritonitis

d) Peritonitis

30. Retention of which electrolyte is the most life-threatening effect of renal failure? a) Phosphorous b) Calcium c) Sodium d) Potassium

d) Potassium

27. A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Temperature of 99.2° F (37.3° C) b) Serum potassium level of 4.9 mEq/L c) Serum sodium level of 135 mEq/L d) Urine output of 20 ml/hour

d) Urine output of 20 ml/hour

The nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: 1. hypernatremia. 2. hypokalemia. 3. hyperkalemia. 4. hypercalcemia.

3. hyperkalemia. Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

Which infections require contact precautions? (select all that apply) A. Cdiff B. TB C. MRSA D. measles E. pertussis

A. Cdiff C. MRSA

Two family members are visiting their father who is experiencing acute delirium. They are upset that their father is so disoriented. "He knows who we are, but that is about it. We do not know what to say to him".(select all that apply) A. answer his questions simply, honestly, slowly and clearly B. correct him when he is hearing and seeing things that are not there C. occasionally remind him of the time, day, and place when he does not remember D. include him in your conversation, instead of talking about him while he is present E. raise your voice a bit so you are sure he hears you

A. answer his questions simply, honestly, slowly and clearly C. occasionally remind him of the time, day, and place when he does not remember D. include him in your conversation, instead of talking about him while he is present

What should a nurse do when administering pilocarpine? A. apply pressure on the inner canthus to prevent systemic absorption B. administer at bedtime to prevent night blindness C. apply pressure on the outer canthus to prevent adverse reactions D. flush the client's eye with normal saline solution to prevent burning

A. apply pressure on the inner canthus to prevent systemic absorptio

A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage, and finds it to be cooler and paler than the left lower leg. What should the nurse do next? A. assess the distal pulses B. elevate the extremity C. lower the head of the bed to 30 degrees or less D. notify the attending physician of the finding

A. assess the distal pulses

A client with bladder cancer has gross hematuria. The client's hemoglobin is 8.0 g/dL and the HCP prescribes a unit of packed blood cells. The client has an existing intravenous infusion of normal saline using a 19 g needle. To administer the packed red blood cells, the nurse should: A. attached the packed cells to the existing 19g IV of normal saline solution using Y tubing B. start an additional 22g IV site because the packed blood cells must be given in a separate line C. attach the packed blood cells to the existing 22g IV of 5% dextrose using Y tubing D. start an additional IV access device with a 22g intravenous cannulation device

A. attached the packed cells to the existing 19g IV of normal saline solution using Y tubing

A client is being discharged to home 3 days after a resection of the prostate (TURP). What should the nurse instruct the client to do? (select all that apply) A. drink at least 3,000 mL of water per day B. increase caloric intake by eating six small meals a day C. report bright red bleeding to the health care provider D. take deep breaths and cough every 2 hours E. report a temperature over 99 degrees

A. drink at least 3,000 mL of water per day C. report bright red bleeding to the health care provider E. report a temperature over 99 degrees The nurse should instruct the client to drink a large amount of fluids (about 3,000 mL/day) to keep the urine clear. The urine should be almost without color. About 2 weeks after TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the emergency department if at any time the urine turns bright red. The nurse should also instruct the client to report signs of infection such as a temperature over 99° F (37.2° C). The client is not specifically at risk for nutritional problems after TURP and can resume a diet as tolerated. The client is not specifically at risk for airway problems because the procedure is done under spinal anesthesia and the client does not need to take deep breaths and cough.

The nurse is taking a nursing history from a client prior to surgery. Which information in a client's history would have a significant impact on the client's recovery postoperatively? The client: A. has smoked one pack of cigarettes a day for 12 years B. had a cold 6 weeks ago C. drinks two beers a week on a regular basis D. is 10 lbs overweight

A. has smoked one pack of cigarettes a day for 12 years (causes vasoconstriction, lowers respiratory)

A client is newly diagnosed with Alzheimer's disease. When planning this client's care, the nurse should include which aspects of care? (select all that apply) A. help the client organize his room B. schedule physical therapy sessions twice per day C. provide a safe environment D. instruct the family regarding the disease progression E. assess the client's nutritional status

A. help the client organize his room C. provide a safe environment D. instruct the family regarding the disease progression E. assess the client's nutritional status

Which information should be included in the teaching plan for a client with osteoporosis? (select all that apply) A. maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals B. choose good calcium sources, such as figs, broccoli, and almonds C. use alcohol in moderation because a moderate intake has no known negative effects D. try swimming as a good exercise to maintain bone mass E. avoid high fat foods, such as avocados, salad dressings and fried foods

A. maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals B. choose good calcium sources, such as figs, broccoli, and almonds C. use alcohol in moderation because a moderate intake has no know negative effects

The nurse is caring for an elderly client with a possible diagnosis of pneumonia who has just been admitted to the hospital. The client is slightly confused and is experiencing difficulty breathing. Which activities would be appropriate for the nurse to delegate to the UAP? (select all that apply) A. obtain vital signs B. initiate oxygen therapy as needed C. apply antiembolic stockings D. assess the client's breath sounds E. keep the client oriented

A. obtain vital signs C. apply antiembolic stockings E. keep the client oriented

A nurse is teaching a client about taking antihistamines. Which information should the nurse include in the teaching plan? (select all that apply) A. operating machinery and driving may be dangerous while taking antihistamines. B. continue taking antihistamines even if nasal infection develops C. the effect of antihistamines is not felt until a day later D. do not us alcohol with antihistamines E. increase fluid intake to 2000 mL/day

A. operating machinery and driving may be dangerous while taking antihistamines. D. do not us alcohol with antihistamines E. increase fluid intake to 2000 mL/day

A toddler is admitted to the facility with nephrotic syndrome. The nurse carefully monitors the toddler's fluid intake and output and checks urine specimens regularly with a reagent strip. Which finding is the nurse most likely to see? A. proteinuria B. glycosuria C. ketonuria D. polyuria

A. proteinuria People with proteinuria have urine containing an abnormal amount of protein. The condition is often a sign of kidney disease. ... But filters damaged by kidney disease may let proteins such as albumin leak from the blood into the urine. Proteinuria can also be a result of overproduction of proteins by the body.

The nurse is caring for a client with Cdiff. Upon entering the room, which of the following steps should the nurse take? A. put on an isolation gown and gloves B. wear a face mask and goggles C. take antiseptic wipes into the room D. use sterile gloves and foot protection

A. put on an isolation gown and gloves

The nurse is obtaining vital signs from a client receiving an intravenous antibiotic for the first time. Which observation made by the nurse requires immediate intervention? (select all that apply) A. rash on skin of face, chest, and arms B. reports sever itching all over C. inspiratory wheezes D. heart rate of 85 E. reports mouth is dry

A. rash on skin of face, chest, and arms B. reports sever itching all over C. inspiratory wheezes

When taking a telephone order from a physician, the nurse verifies that he/she understands the order by: A. repeating the order back to the physician B. faxing the written order to the physician's office C. asking the physician to summarize the orders given D. confirming the order with the nurse manager

A. repeating the order back to the physician

A client admitted with acute anxiety has the following ABG values: pH 7.55; partial pressure of arterial oxygen 90 mmHg; partial pressure of arterial carbon dioxide 27mmHg; and bicarbonate 24 mEq/L. Based on these values, the nurse suspects: A. respiratory alkalosis B. respiratory acidosis C. metabolic acidosis D. metabolic alkalosis

A. respiratory alkalosis. This client's above-normal pH value indicates alkalosis. The below-normal PaCO2 value indicates acid loss via hyperventilation; this type of acid loss occurs only in respiratory alkalosis. These ABG values wouldn't occur in metabolic acidosis, respiratory acidosis, or metabolic alkalosis. losis

A client was treated for streptococcal throat infection 2 weeks ago. The client now has been diagnosed with acute poststreptococcal glomerulonephritis. The client asks the nurse how he could have prevented this condition. What should the nurse tell the client? A. see your HCP for an early diagnosis and treatment of a sore throat B. as long as you do not have a fever, it is sufficient to gargle daily with an antibacterial mouthwash C. you may continue to utilize the previously prescribed antibiotics until they are gone D. unscented bar soap may be used in showers

A. see your HCP for an early diagnosis and treatment of a sore throat

A nurse enters the room of a female client and finds her crying. The client has just been told that her breast cancer has recurred. The client says, "I do not know why God is punishing me like this." When responding to the client, which action would be most appropriate at this time. A. tell the client that her belief in God will get her through this B. Allow the client to continue to verbalize her feelings C. ask the client is she would like to pray with you D. remind the client that her faith is strong

B. Allow the client to continue to verbalize her feelings

On a medical surgical floor, a nurse is caring for a cluster of clients with DM. Which client should the nurse assess first? A. a 20 year old with a BP of 70 B. a 55 year old complaining of chest pressure C. a 60 year old client experiencing N/V D. a 80 year old with a blood glucose level of 350

B. a 55 year old complaining of chest pressure This may be an MI

The nurse is assessing a client who has been admitted with impaired arterial circulation in the lower extremities due to DM. Which of the following would be expected findings? A. capillary refill in toes within 3 seconds B. absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet C. edema and coolness in the ankles and feet D. redness, inflammation, and sharp pain with calf muscle contraction

B. absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet

A physician orders triamcinolone and salmetrol for a client with a history of asthma. What action should the nurse take when administering these drugs? A. administer the triamcinolone and then the salmeterol B. administer the salmeterol and then the traimcinolone C. allow the client to choose the order in which the drugs are administered D. monitor the client's theophylline level before administering the medications

B. administer the salmeterol and then the traimcinolone Triamcinolone is an intermediate-acting synthetic glucocorticoid given by inhalation. Salmeterol is a bronchodilator. It can treat COPD, including chronic bronchitis and emphysema. theophylline is a bronchodilator

The nurse receives preoperative blood work report for a client who is scheduled to undergo surgery. Which laboratory finding should be reported to the surgeon and anesthesiologist? A. red blood cells, 4.5 B. creatinine 2.6 C. hemoglobin 12.2 D. blood urea nitrogen 15

B. creatinine 2.6 Normal creatinine is 0.5 - 1.2 normal RBC 4.2 - 6.1 normal Hgb 12.0 - 17.5 normal BUN 7-20

A 34 year old female is diagnosed with hypothyroidism. What should the nurse assess the client for? (select all) A. rapid pulse B. decreased energy and fatigue C. weight gain of 10 lb D. fine, thin hair with hair loss E. constipation F. menorrhagia

B. decreased energy and fatigue C. weight gain of 10 lb E. constipation F. menorrhagia

A child has just received a dose of theophylline IV for asthma. What assessment finding should the nurse expect? A. increased coughing because of postnasal drip B. decreased pulmonary wheezing C. stridor D. white blood cell count of 12,000

B. decreased pulmonary wheezing Theophylline is a bronchodilator used to prevent and treat wheezing, shortness of breath, and chest tightness caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe.

For the past 24 hours, a client with dry skin and dry mucous membranes has had a urine output of 600 mL and a fluid intake of 800 mL. The client's urine is dark amber. These findings indicate which nursing diagnosis? A. impaired urinary elimination B. deficient fluid volume C. imbalanced nutrition: less than body requirement D. excess fluid volume

B. deficient fluid volume

A client is scheduled for an intravenous pyelogram. In preparation for the procedure, what should the nurse ask the client? A. have you ever had an IVP before B. do you have any allergies C. when was your last bowel movement D. have you ever experienced urinary incontinence

B. do you have any allergies

UTI is a potential problem after spinal cord injury. To prevent a UTI, the nurse should encourage the client to: A. drink a glass of citrus fruit juice at every meal B. drink at least 2000 mL of fluid daily C. add extra protein to the diet D. wash hands frequently

B. drink at least 2000 mL of fluid daily

A nurse is planning care for a client with a diagnosis of acute anxiety. What is the best approach? A. place the client in a day room with others to utilize distraction B. encourage the client to verbalize his feelings and concerns C. encourage the client to make choices and decisions about concerns D. give information in detail about what is available in the area

B. encourage the client to verbalize his feelings and concerns

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin level of 7. The most therapeutic pharmacologic intervention would be to administer: A. ferrous sulfate B. epoetin alfa C. filgrastin D. enoxaparin

B. epoetin alfa Epoetin alfa is a man-made form of a protein that helps your body produce red blood cells. The amount of this protein in your body may be reduced when you have kidney failure or use certain medications. When fewer red blood cells are produced, you can develop a condition called anemia. Filgrastin is a medication that can help the body make white blood cells after receiving cancer medications. It can also improve survival in people who have been exposed to radiation.

A client is scheduled to undergo a bronchoscopy. Which nursing interventions would be included in the care plan? (select all that apply) A feed the client immediately after the procedure B. keep suction equipment available C. instruct that the client will be awake during the procedure D. assess cough and gag reflexes after the procedure E. explain to the client that a tube will be inserted through the nose into the stomach F. report hemoptysis, stridor or dyspnea immediately

B. keep suction equipment available D. assess cough and gag reflexes after the procedure F. report hemoptysis, stridor or dyspnea immediately

Which is not a risk factor for the development of atherosclerosis? A. family hx of early heart attack B. late onset of puberty C. total blood cholesterol level greater than 200 D. elevated fasting blood glucose concentration

B. late onset of puberty

The correct landmark for obtaining an apical pulse is the: A. left fifth intercostal space, midaxillary line B. left fifth intercostal space, midclavicular line C. left second intercostal space, midclavicular line D. left seventh intercostal space, midclavicular line

B. left fifth intercostal space, midclavicular line

A mother brings her newborn in for a well child checkup. During the visit, the mother tells the nurse that she is concerned about having her baby vaccinated because she heard that vaccinations can cause autism. Which response by the nurse would be most appropriate? A. you have a valid concern about vaccines B. let us talk about your concerns C. I have never heard of any cases occurring D. I will tell your pediatrician about your wishes

B. let us talk about your concerns

A nurse asks a client to sign consent for surgery. Which of the following is an appropriate situation for giving valid consent? A. The client still has further questions about the surgery, but the nurse encourages the consent to be signed and will attach a note to the chart for the physician. B. the client has cognitive capacity to make decisions C. the client tells the nurse that the physician is capable and signs without reading the information on the consent D. the client has his/her spouse sign because the client is in too much pain from the condition

B. the client has cognitive capacity to make decisions

Before administering a tube feeding to a toddler, which method should the nurse use to check the placement of a nasogastric tube? A. abdominal xrays B. injection of a small amount of air while listening with a stethoscope over the abdominal area C. A check of the pH of fluid aspirated from the tube D. visualization of the measurement mark on the tube made at the time of insertion

C. A check of the pH of fluid aspirated from the tube Use litmus paper - this is the nationwide confirmation

A client is admitted to the ED with crushing chest injuries sustained in a car accident. Which sign indicates pneumothorax? A. Cheyne-Stokes respirations B. increased fremitus C. dimished or absent breath sounds on the affected side D. decreased sensation on the affected side

C. dimished or absent breath sounds on the affected side Cheyne-Stokes respirations indicates abnormal neural function. Fremitus is vibration in the lungs.

A client in a general hospital is to undergo surgery in 2 days. He is experiencing moderate anxiety about the procedure and its outcome. To help the client reduce his anxiety, the nurse should: A. tell the client to distract himself with games and television B. reassure the client that he will come through surgery without incident C. explain the surgical procedure to the client and what happens before and after surgery D. ask the surgeon to refer the client to a psychiatrist who can work with the client to diminish his anxiety

C. explain the surgical procedure to the client and what happens before and after surgery The RN can do this because the client has moderate anxiety

The nurse is preparing to administer a preoperative medication that includes a sedative to a client who is having abdominal surgery. The nurse should first: A. have the family present B. ensure that the operative area has been shaved C. have the client empty the bladder D. make sure the client is covered with a warm blanket

C. have the client empty the bladder

A client's serum ammonia level is elevated, and the HCP prescribes 30 mL of lactulose. Which effect is common for this drug? A. increased urine output B. improved LOC C. increased bowel movements D. N/V

C. increased bowel movements

A client undergoes extracorporeal shock wave lithotripsy (ESWL) to break up and remove calculi. Which nursing measure is appropriate for the postoperative care of this client? A. maintain the client on strict bed rest for 48 hours after the procedure B. instruct the client to anticipate a decrease in urine output C. instruct the client to anticipate hematuria for about 24 hours after the procedure D. limit fluid intake to 1,000 mL/day until all stone fragments have been passed

C. instruct the client to anticipate hematuria for about 24 hours after the procedure

An 11 year old is admitted for treatment of an asthma attack. Which finding indicates immediate intervention is needed? A. thin, copious mucous secretions B. productive cough C. intercostal retractions D. respiratory rate of 20 breaths

C. intercostal retractions Intercostal retractions are due to reduced air pressure inside your chest. This can happen if the upper airway (trachea) or small airways of the lungs (bronchioles) become partially blocked. As a result, the intercostal muscles are sucked inward, between the ribs, when you breathe

A client with type I diabetes has a highly elevated A1C test result. In discussing the result with the client, the nurse is most accurate in stating: A. the test must be repeated following a 12 hour fast B. it looks like you aren't following the ordered diabetic diet C. it tells us about your sugar control for the last 3 months D. your insulin regimen must be altered significantly

C. it tells us about your sugar control for the last 3 months

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? A. encouraging coughing and deep breathing B. promoting carbohydrate intake C. limiting fluid intake D. providing pain relief measures

C. limiting fluid intake Oliguric phase is urine output of less than 400 mL/day.

A nurse is assessing a client two days after surgery for infection. Which s/s is most indicative if infection? A. the presence of pain at the incision site B. rectal temp of 100 C. red, warm, swollen, tender incision with foul drainage D. wbc count of 8,000

C. red, warm, swollen, tender incision with foul drainage

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? A. impaired urinary elimination B. toileting self care deficit C. risk for infection D. activity intolerance

C. risk for infection

Following surgery, to evaluate the effectiveness of the client's use of an incentive spirometer, the nurse should determine if the client: A. has increased circulation in the extremities B. is ready to ambulate without pain C. has stronger abdominal muscles D. can breathe more easily

D. can breathe more easily

A client has been diagnosed with hypothyroidism and started on synthetic levothyroxine for thyroid replacement therapy. Which of the following is the most important effect to report to the physician? A. increased temperature and metabolic rate B. insomnia and loss of weight C. increased energy level and reduction of edema D. palpitations and chest pain on exertion

D. palpitations and chest pain on exertion

A parent of a 9 year old child scheduled to have surgery expresses concern about the potential for postoperative infection. A nurse provides the parent with information about the measures taken to maintain surgical asepsis. Typical surgical asepsis involves: A using sterile surgical scrubs B. preoperative cleansing of jewelry worn by the surgical team C. applying bandages to cover any wounds surgical team members have D. performing a preoperative surgical scrub for a least 3 to 5 minutes

D. performing a preoperative surgical scrub for a least 3 to 5 minutes

The nurse collects data on a client shortly after kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? A. serum potassium level of 4.9 B. serum sodium level of 135 C. temperature of 99.2 D. urine output of 20 mL/hr

D. urine output of 20 mL/hr

A client admitted with a gunshot wound to the abdomen is transferred to the ICU after an exploratory laparotomy. IV fluid is being infused at 150 mL/hr. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? A. blood urea nitrogen (BUN) level of 22 B. serum creatinine level of 1.2 C. temp 100.2 D. urine output of 250 mL/24 hrs (oliguria)

D. urine output of 250 mL/24 hrs BUN normal is 7-20 Creatinine normal is 0.5-1.2

Match the following conditions and characteristics with their associated etiologies of AKI _____a. Decreased cardiac output _____b. Mechanical outflow obstruction _____c. Initial cause of most acute renal failure _____d. Prostate cancer _____e. Tubular obstruction by Myoglobin _____f. Hypovolemia _____g. Renal stones _____h. Nephrotoxic drugs _____i. Bladder cancer _____J. Renal vascular obstruction _____K. Acute glomerularnephritis _____L. Anaphylaxis 1. Pre-renal 2. Intrarenal 3. Postrenal

___1__ a. Decreased cardiac output ___3__ b. Mechanical outflow obstruction __1___ c. Initial cause of most acute renal failure ___3__ d. Prostate cancer __2___ e. Tubular obstruction by Myoglobin __1___ f. Hypovolemia __3___ g. Renal stones __2___ h. Nephrotoxic drugs __3___ i. Bladder cancer __1/2___ J. Renal vascular obstruction ___2__ K. Acute glomerularnephritis ___1__ L. Anaphylaxis 1. Pre-renal 2. Intrarenal 3. Postrenal

Indicate whether the following characteristics are associated with peritoneal dialysis (PD) or hemodialysis (HD) _____ a. Requires vascular access ______ b. Increased hyperlipidemia ______ c. Lowers serum triglycerides ______ d. Portable system ______ e. Less cardiovascular stress ______ f. More protein loss ______ g. Intensifies anemia (blood loss) ______ h. Rapid fluid and creatinine loss ______ i. Requires fewer dietary restrictions ______ J. Potential exit site infection ______ k. Potential access thrombus complication ______ l. More hypotension, dizziness and muscle cramps ______ m. Less risk of hepatitis P = peritoneal dialysis H = hemodialysis

___H__ a. Requires vascular access __P___ b. Increased hyperlipidemia ___H__ c. Lowers serum triglycerides __P___ d. Portable system ___P__ e. Less cardiovascular stress _P____ f. More protein loss ___H__ g. Intensifies anemia (blood loss) ___H__ h. Rapid fluid and creatinine loss __P___ i. Requires fewer dietary restrictions __P___ J. Potential exit site infection __H___ k. Potential access thrombus complication ___H__ l. More hypotension, dizziness and muscle cramps ___P__ m. Less risk of hepatitis P = peritoneal dialysis H = hemodialysis

7. Which of the following substances stimulate the bone marrow to produced red blood cells? a) Erythropoietin b) Renin c) Prostaglandin E d) Prostacyclin

a) Erythropoietin

17. A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a) Previous episode of acute pyelonephritis b) Recent history of streptococcal infection c) History of hyperparathyroidism d) History of osteoporosis

b) Recent history of streptococcal infection

8. In starting your new job as a nurse with a group of renal specialists, you begin your orientation with a thorough review of renal function. While the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which of the following is NOT a function of the kidneys? a) Stimulating RBC production b) Excreting nitrogen waste products c) Excreting protein d) Regulating blood pressure

c) Excreting protein

31. Which of the following is used to decrease potassium level seen in acute renal failure? a) IV dextrose 50% b) Calcium supplements c) Kayexalate d) Sorbitol

c) Kayexalate

25. A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Temperature of 100.2° F (37.8° C) b) Blood urea nitrogen (BUN) level of 22 mg/dl c) Urine output of 250 ml/24 hours d) Serum creatinine level of 1.2 mg/dl

c) Urine output of 250 ml/24 hours

4. 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: a) oliguria. b) polyuria. c) anuria d) hematuria

c) anuria

16. A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a) metabolic alkalosis secondary to retention of hydrogen ions. b) a decreased serum phosphate level secondary to kidney failure. c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. d) an increased serum calcium level secondary to kidney failure.

c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

2. The most accurate indicator of fluid loss or gain in an acutely ill patient is: a) blood pressure. b) pulse rate. c) weight. d) edema.

c) weight

13. A patient with renal insufficiency has been hospitalized on your unit. The patient knows that renal function depends upon the functional status of nephrons. The patient asks you when she will need to start dialysis based upon loss of nephron function. What would you respond? a) "When about 50% of the nephrons are no longer functioning." b) "When about 60% of the nephrons are no longer functioning." c) "When about 70% of the nephrons are no longer functioning." d) "When about 80% of the nephrons are no longer functioning."

d) "When about 80% of the nephrons are no longer functioning."

9. A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse is aware that the specimens needed for the calculation of the patient's creatinine clearance will include what? a) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values b) A fasting serum potassium level and a random urine sample c) A blood, urea, nitrogen level, and serum creatinine level on three consecutive mornings d) A 24-hour urine specimen collection and a serum creatinine level midway through the urine collection process

d) A 24-hour urine specimen collection and a serum creatinine level midway through the urine collection process

15. A 45-year-old man with diabetic nephropathy has end-stage renal failure and is starting dialysis. He asks for information about hemodialysis. What would the nurse include in the teaching for this patient? a) You will have surgery and a catheter will need to be inserted into the abdomen. b) Hemodialysis is a treatment option that is required daily. c) Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again. d) Hemodialysis is a treatment option that is required three times a week

d) Hemodialysis is a treatment option that is required three times a week

26. The nurse is caring for a patient receiving hemodialysis treatments. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient? a) The patient feels best immediately after the dialysis treatment. b) The patient shouldn't feel pain during initiation of dialysis. c) Using a stethoscope for auscultating the fistula is contraindicated. d) Taking a blood pressure reading on the affected arm can cause clotting of the fistula

d) Taking a blood pressure reading on the affected arm can cause clotting of the fistula

The QRS waveform represents: A. atrial depolarization B. ventricular depolarization C. ventricular repolarization D. relative refractory period

B. ventricular depolarization ventricular depolarization is contraction atrial depolarization is the P wave ventricular repolarization is the T wave

The nurse is caring for a client who is in status asthmaticus. What is the nurse's priority action? A. call the HCP B. administer magnesium sulfate IV C. administer albuterol D. place the client on oxygen

D. place the client on oxygen Status asthmaticus is repeated asthma attacks.

A client admitted to the hospital with peptic ulcer disease tells the nurse about having black, tarry stools. The nurse should: A. encourage the client to increase fluid intake B. advise the client to avoid iron-rich foods C. place the client on contact precautions D. report the finding to the HCP

D. report the finding to the HCP The client may have melena - blood in the stool.

10. As glomerular filtration decreases, which of the following occurs? (Select all that apply.) a) Blood urea nitrogen (BUN) increases b) Creatinine clearance decreases c) BUN decreases d) Serum creatinine increases e) Serum creatinine decreases

a) Blood urea nitrogen (BUN) increases b) Creatinine clearance decreases d) Serum creatinine increases

12. A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a) Decreased blood urea nitrogen (BUN) b) Decreased potassium c) Increased serum creatinine d) Increased serum albumin

c) Increased serum creatinine