53, 54, 31,, chapter 30 hematology, 55

The process of fibrinolysis is to

2. remove a blood clot.

A laboratory test used to best measure the effectiveness of warfarin sodium therapy is known as

4. international normalized ratio (INR).

13. The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the nurse assess for pain at the costovertebral angle?

C) At the lower border of the 12th rib and the spine

The nurse educator is reviewing the process of hemostasis. Place the steps of hemostasis in the order they occur. 1. Blood flow is further reduced 2. Platelets become sticky 3. Fibrin strands form 4. Platelets are attracted to the site 5. Vessel spasms

5, 2, 4, 1, 3

The nurse is managing care for a patient with cirrhosis of the liver. The nurse teaches the patient about how to avoid injury that may result in bleeding. The patient asks the nurse why he is at risk to start bleeding. What is the best response by the nurse?

3. "Because your liver is injured and cannot make clotting factors."

The nursing instructor is teaching student nurses about the process of hemostasis after an injury. What does the nursing instructor include as the initial event in this process?

3. The vessel spasms.

A woman brings her husband to the emergency department and tells the nurse that her husband just had a stroke. The physician verifies a thrombotic stroke occurred and plans to use alteplase (Activase). What priority assessment question will the nurse ask the wife?

4. "What time did your husband have the stroke?"

The patient receives warfarin (Coumadin). The nurse notes that the patient's morning international normalized ratio (INR) is 7-. What are the priority nursing interventions at this time?

4. Administer vitamin K and hold the next dose of warfarin (Coumadin).

The nurse is managing care for a patient with a DVT (deep vein thrombosis) of the right calf. The patient receives heparin intravenously (IV). What is the priority outcome for this patient?

4. The patient will not experience bleeding.

The most important food for a patient taking anticoagulants to avoid is

2. garlic

Anticoagulants are used to

2. prevent the formation of blood clots.

The physician orders pentoxifylline (Trental) for the patient with peripheral vascular disease. The nurse has completed medication education and determines that learning has occurred when the patient makes which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.

1, 2, 3

The patient has a deep vein thrombosis (DVT) and is admitted for initial heparin therapy. Which orders would the nurse want to validate with the physician? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Heparin 1000 units intravenous (IV) every 6 hours 2. Tylenol as needed (PRN) for headaches 3. Obtaining a daily weight on the patient 4. Advil as needed (PRN) for headaches 5. Low vitamin K diet

1, 4, 5

The patient receives an appropriate dose of warfarin (Coumadin), but the international normalized ratio (INR) is in the high range. The patient denies taking any aspirin products. What is the best assessment question to ask the patient at this time?

1. "Have you been eating much garlic?"

The patient is being discharged on an anticoagulant following a valve replacement. The nurse has completed medication education and determines that learning has occurred when the patient makes which statement?

1. "I should wear a MedicAlert bracelet that says I'm on an anticoagulant."

The patient receives warfarin (Coumadin). The nurse plans to teach the patient to avoid which foods that are served for lunch? 1. Tomato salad with kale and basil 2. Whole-wheat bread with margarine 3. Salt substitute 4. Fettuccine Alfredo

1. Tomato salad with kale and basil

Laboratory studies related to heparin therapy include

1. aPtt.

The patient receives enoxaparin (Lovenox) postoperatively. The nurse teaches the patient about this medication and evaluates that learning has occurred when he makes which statement?

2. "It increases the time it takes for me to form a clot."

The physician orders enoxaparin (Lovenox) for the postoperative patient. What is the best administration technique by the nurse?

2. Administer the medication in the abdomen, subcutaneously.

The patient receives heparin. During the morning assessment of the patient, the nurse notes that the patient's blood pressure and red blood cell (RBC) count are low. There is no evidence of bleeding on the bed linen or the patient's gown. What will the best assessment of this patient reveal?

2. The patient may be bleeding internally.

15. The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?

A) A vein and an artery in your arm will be attached surgically.

33. The nurse is caring for a patient who has returned to the postsurgical suite after post-anesthetic recovery from a nephrectomy. The nurses most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurses best response?

A) Assess the patient for signs of bleeding and inform the physician.

10. The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?

A) Assessment of the quantity of the patients urine output

16. A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patients diet to maximize the therapeutic effect and minimize the risks of complications. The patients diet should include which of the following modifications? Select all that apply.

A) Decreased protein intake B) Decreased sodium intake D) Fluid restriction

12. Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it

A) Heart failure

1. The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?

A) Hematuria

7. A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?

A) Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

13. A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. What should the nurse teach the patient about hemodialysis?

A) Hemodialysis is a treatment option that is usually required three times a week.

A nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where?

A) In the ureteropelvic junction

37. A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed the patient that slight hematuria may occur after the testing is complete. The nurse should recommendwhat action to help resolve hematuria?

A) Increased fluid intake following the test

5. The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what?

A) Increased fluid intake to produce a full bladder

14. A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurses most appropriate action?

A) Inform the physician and assess the patient for signs of infection.

32. The nurse has identified the nursing diagnosis of risk for infection in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk?

A) Maintain aseptic technique when administering dialysate.

30.The nurse is caring for a patient status after a motor vehicle accident. The patient has developed AKI. What is the nurses role in caring for this patient? Select all that apply.

A) Providing emotional support for the family B) Monitoring for complications C) Participating in emergency treatment of fluid and electrolyte imbalances D) Providing nursing care for primary disorder (trauma)

37. The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patients output from surgical drains, the nurse should assess what parameters? Select all that apply.

A) Quantity of output B) Color of the output C) Visible characteristics of the output

38. The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply.

A) Specific gravity of the patients urine B) Testing for the presence of glucose in the patients urine C) Microscopic examination of urine sediment for RBCs D) Microscopic examination of urine sediment for casts

39. A nurse on the renal unit is caring for a patient who will soon begin peritoneal dialysis. The family of the patient asks for education about the peritoneal dialysis catheter that has been placed in the patients peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply.

A) The cuffs are made of Dacron polyester.B) The cuffs stabilize the catheter.C) The cuffs prevent the dialysate from leaking.D) The cuffs provide a barrier against microorganisms.

4. The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding?

A) The patients bladder is not completely empty.

33. A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe?

A) The right kidneys proximity to the pancreas, liver, and gallbladder

18. A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test?

A) Ultrasound

8. A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what

A) Urinary retention

4. The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what?

A) Wash hands carefully and frequently.

A patient is receiving a coagulation modifier to prevent a thromboembolic event. The nurse teaching the patient about his disease is using this figure. Indicate the point of origin of a thrombus that would cause a pulmonary embolism

An embolus from the right atrium will cause pulmonary emboli whereas an embolus from the left atrium will cause a stroke or an arterial infarction elsewhere in the body. Thrombi and emboli typically do not arise from ventricles.

19. The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.

B) Assess for the presence of peripheral edema. D) Assess the patients BP.

21. A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight hematuria during the first void after the procedure. What is the nurses most appropriate action?

B) Reassure the patient that this is not unexpected and then monitor the patient for further bleeding.

17. A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurses most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurses most appropriate response?

B) Recognize this as an expected finding.

12. The nurse caring for a patient with suspected renal dysfunction calculates that the patients weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid?

B) 2,300 mL of fluid in 24 hours

A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples?

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

9. The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD?

B) A patient with diabetes mellitus and poorly controlled hypertension

34. The critical care nurse is monitoring the patients urine output and drains following renal surgery. What should the nurse promptly report to the physician?

B) Absence of drain output

24. The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident. What patient preparation should the nurse most likely provide before this test?

B) Administration of a laxative

23. A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?

B) Excess fluid volume

31. A 71-year-old patient with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make?

B) Kidney transplants in patients your age are as successful as they are in younger patients.

28. A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this patient?

B) Managing postoperative pain

32. A patient is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply.

B) Pain C) Gastrointestinal symptoms D) Changes in voiding

8. A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?

B) Preprocedure hydration and administration of acetylcysteine

30. A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education should the nurse include?

B) Relaxation techniques to apply during the test

40. A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the patients abdomen is increasing in girth. What is the nurses most appropriate action?

B) Reposition the patient to facilitate drainage.

9. A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of renal failure for which the nurse should monitor the patient?

B) Retention of potassium

26. A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acidbase balance?

B) Returning bicarbonate to the bodys circulation

25. A patient on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurses care of this patient?

B) The patients disease is incurable and the nurses interventions will be supportive.

39. Dipstick testing of an older adult patients urine indicates the presence of protein. Which of the following statements is true of this assessment finding? Select all that apply.

B) This finding is a risk factor for urinary incontinence. C) This finding is likely the result of an age-related physiologic change. D) This result confirms that the patient has diabetes.

15. The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesnt seem to be a great deal of urine flow. What would the nurse expect this patients physical assessment to reveal?

B) Urine retention

14. The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated?

C) A 42-year-old patient with morbid obesity

22. An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment. The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patient may contribute to AKI? Select all that apply.

C) Age-related physiologic changes D) Chronic systemic disease

22. A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?

C) Apply moist heat to the patients lower abdomen.

20. A patient is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the patient develops acute kidney injury. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patients hypervolemia and hyperkalemia. Which of the following therapies will the patients hemodynamic status best tolerate?

C) Continuous venovenous hemodialysis (CVVHD)

29. A nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the patient for what complication during this phase?

C) Dehydration

25. Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem?

C) Diabetes mellitus

11. The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?

C) Glucose and protein

11. The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?

C) Hyperkalemia

35. The nurse is creating an education plan for a patient who underwent a nephrectomy for the treatment of a renaltumor. What should the nurse include in the teaching plan?

C) Inspection and care of the incision

38. The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should the nurse evaluate?

C) Level of consciousness

29. A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?

C) Remember to drink frequently, even if you dont feel thirsty.30. A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education should the nurse include?

26. The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants risks of renal carcinoma?

C) Smoking cessation

6.A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the patients chronic kidney disease is at what stage?

C) Stage 3

5. The nurse is caring for a patient receiving hemodialysis three times weekly. 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?

C) Taking a BP reading on the affected arm can damage the fistula.

20. The nurse is caring for a patient who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the physician?

C) Temperature 100.2F orally

2. The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)?

C) The patients average urine output has been 10 mL/hr for several hours.

31. Results of a patients 24-hour urine sample indicate osmolality of 510 mOsm/kg, which is within reference range. What conclusion can the nurse draw from this assessment finding?

C) The patients kidneys can produce sufficiently concentrated urine.

19. A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location?

C) Ureter

21. A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the patient about what topic?

D) Current medication use

10. A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurses best response?

D) A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.

6. The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patients urinalysis results, what should the nurse anticipate?

D) An increased urine specific gravity

36. A patient with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care?

D) Assess for a thrill or bruit over the vascular access site each shift.

40. What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of the renal-urologic system?

D) Assess the patients understanding of the test results after their completion.

7. A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse should be aware of what age-related change affecting the renal or urinary system?

D) Decreased glomerular filtration rate

A patient admitted with nephrotic syndrome is being cared for on the medical unit. When writing this patients care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include?

D) Excess fluid volume related to generalized edema

36. A patient with a history of incontinence will undergo urodynamic testing in the physicians office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action?

D) Help the patient to relax before and during the test.

23. The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure?

D) Keep the patient NPO prior to the procedure.

27. The nurse performing the health interview of a patient with a new onset of periorbital edema has completed a genogram, noting the health history of the patients siblings, parents, and grandparents. This assessment addresses the patients risk of what kidney disorder?

D) Polycystic kidney disease (PKD)

28. A patient has experienced excessive losses of bicarbonate and has subsequently developed an acidbase imbalance. How will this lost bicarbonate be replaced?

D) Renal tubular cells will generate new bicarbonate.

24. A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event?

D) Streptococcal infection

27. A patients most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding?

D) The patient is likely to have increased serum creatinine levels.

1. The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations?

D) When about 80% of the nephrons are no longer functioning

3. The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorus-binding medication at what time?

D) With each mea

16. The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurses assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patients kidneys will compensate by secreting what substance?

Renin

17. A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patients care, the nurse should be aware of the consequent risk of what complication?

Urinary tract infection

35. The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse reads that the physician assessed the patients deep tendon reflexes. What condition of the urinary/renal system does this assessment address?

bladder dysfunction

34. A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value?

hemoglobin