EXAM 4 Q's

The nurse should be alert for which manifestations n a patient receiving a loop diuretic? a. Restlessness and agitation b. Paresthesias and irritability c. Weak, irregular pulse and poor muscle tone d. Increased blood pressure and muscle spasms

c. Weak, irregular pulse and poor muscle tone

Patients with chronic KD experience an increased incidence of cardiovascular disease related to (select all that apply) a. HTN b. vascular calcifications c. a genetic predisposition d. hypeerinsulinemia causing dyslipidemia e. increased high density lipoprotein levels

a. HTN b. vascular calcifications d. hypeerinsulinemia causing dyslipidemia

Which description characterize acute kidney injury (select all that apply) a. primary cause of death is infection b. it almost always affects older people c. disease course is potentially reversible d. most common cause is diabetic nephropathy e. cardiovascular disease is most common cause of death

a. primary cause of death is infection c. disease course is potentially reversible

Nursing management of the patient with acute pancreatitis includes (select all that apply) a. checking for signs of hypocalcemia b. providing a diet low in carbs c. giving insulin based on a sliding scale d. observing stools for signs of steatorrhea e. monitoring for infection, particularly resp tract infection

a. checking for signs of hypocalcemia e. monitoring for infection, particularly resp tract infection

It is important for the nurse to assess for which clinical manifestations in a pt who has just undergone a total thyroidectomy (select all that apply)? a. confusion b. wt gain c. depressed reflexes d. circumoral numbness e. positive Chvostek's sign

a. confusion d. circumoral numbness e. positive Chvostek's sign

A patient is admitted to the hospital with chronic KD. The nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys b. a rapid decrease in urine output with an elevated BUN c. an increasing Cr clearance with a decrease in urine output d. prostration, somnolence, and confusion with coma and imminent death

a. progressive irreversible destruction of the kidneys

A pt with Hep A is in he acute phase. The nurse plans care for the pt baed on the knowledge that a. pruritus is a common problem w/ jaundice in this phase b. the pt is most likely to transmit the disease during this phase c. GI symptoms are not as severe in Hep A as they are in Hep B d. extrahepatic manifestations of glomerulonephritis and polyarterities are common in this phase

a. pruritus is a common problem w/ jaundice in this phase

An ESRD pt receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the pt to make a decision about tx, the nurse informs the pt that a. successful transplantation usually provides better quality of life than that offered by dialysis b. if rejection of the transplanted kidney occurs, no further tx for the renal failure is available c. hemodialysis replaces the normal fxs of the kidneys, and pts do not have to live with the continual fear of rejection d. the immunosuppressive therapy following transplantations makes the person ineligible to receive other forms to tx if the kidney fails

a. successful transplantation usually provides better quality of life than that offered by dialysis

The typical fluid replacement for the patient with a fluid volume deficit is: a. dextran b. 0.45% saline c. lactated Ringer's d. 5% dextrose in 0.45% saline

c. lactated Ringer's

The nurse teaches a patient with a hx of an upper GI bleed how to check for bloody stools. Which statement by the nurse is appropriate? a. "if vomiting of bright red blood occurs, stools will not be black and stick" b. "blood is never obvious in stools and must be detected by a lab test" c. "acute bleeding in your stomach will cause bright red blood in your stool" d. "stools that are black and tarry occur with slow bleeding from your stomach"

d. "stools that are black and tarry occur with slow bleeding from your stomach" (??)

A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with a. the structural support of the kidney. b. regulation of the concentration of urine. c. the entry and exit of blood vessels at the kidney. d. collection and drainage of urine from the kidney.

d. collection and drainage of urine from the kidney.

The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes a. hyperaldosteronism b. serotonin deficiency c. adrenal insufficiency d. hyperparathyroidm

d. hyperparathyroidism

The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to a. apply warm moist compresses to the insertion site. b. attempt to force 10 mL of normal saline into the device. c. place the patient on the left side with head-down position. d. instruct the patient to change positions, raise arm, and cough.

d. instruct the patient to change positions, raise arm, and cough

In planning care for a patient with metastatic liver cancer, the nurse should include interventions that a. focus primarily on symptomatic and comfort measures b. reassure the pt that chemotherapy offers a good prognosis c. promote the pt's confidence that surgical excision of the tumor will be successful d. provide information necessary for the pt to make decisions regarding liver transplantation

a. focus primarily on symptomatic and comfort measures

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply) a. nonpalpable left kidney b. auscultation of renal artery bruit c. CVA tenderness elicited by a kidney punch d. no CVA tenderness elicited by a kidney punch e. palpable bladder to the level of the pubic symphysis

a. nonpalpable left kidney

A pt has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease. the nursing teaching plan should include a. having genetic testing done b. recommending a heart healthy diet c. the necessity to reduce wt rapidly d. avoiding alc until liver enzymes return to normal

b. recommending a heart healthy diet

A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? a. assess temp and initiate workup to rule out infection b. reassure the pt that this is common after transplantation c. provide warm cover for the pt and give 1 g acetaminophen orally d. notify the nephrologist that the pt has developed symptoms of acute rejection

a. assess temp and initiate workup to rule out infection

A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history? a.Gallstones b.Hypolipidemia c.COPD d.Diabetes mellitus

a. Gallstones

A major advantage of peritoneal dialysis is a. the diet is less restricted and dialysis can be performed at home b. the dialysate is biocompatible and causes no long term consequences c. high glucose concentrations of the dialysate cause a reduction in appetite, promoting wt loss d. no meds are required b/c of the enhanced efficiency of the peritoneal membrane in removing toxins

a. the diet is less restricted and dialysis can be performed at home

An older woman was admitted to the medical unit with dehydration. Clinical indications of this problem are (select all that apply): a. weight loss b. dry oral mucosa c. full bounding pulse d. engorged neck veins e. decreased central venous pressure

a. weight loss b. dry oral mucosa e. decreased central venous pressure

During the oliguric phase of AKI, the nurse monitors for (select all that apply) a. hypotension b. ECG changes c. hypernatremia d. pulm edema e. urine with high specific gravity

b. ECG changes d. pulm edema

The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of: a. Antibiotics. b. NPO status. c. Antispasmodics. d. H2R blockers or proton pump inhibitors.

b. NPO status

A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate? a. Initiate a low-reside diet b. Pantoprazole 80mg IV bolus twice daily c. Ambulate twice daily d. Pancrealipase 500units/kg PO three times daily with meals

b. Pantoprazole 80mg IV bolus twice daily

A pt w. acute Hep B is being discharge in 2 days. The discharge teaching plan should include instructions to a. avoid alc for the 1st 3 weeks b. use a condom during sex c. have family members get an injection of immunoglobulin d. follow a low protein, moderate carb, moderate fat diet

b. use a condom during sex

A nurse is providing discharge teaching for a client who has chronic pancreatitis. Which of the following statements should the nurse make? a. "You should decrease your caloric intake when abdominal pain is present." b. "You should increase fat intake when experiencing loose stools." c. "You should increase your daily intake of protein." d. "You should limit alcohol intake to 2-3 drinks per week."

c. "You should increase your daily intake of protein."

A dx study that indicates renal blood flow, glomerular filtration, tubular fx, and excretion is a a. IVP b. VCUG c. renal scan d. loopogram

c. renal scan

during physical assessment of the urinary system, the nurse a. cannot palpate the left kidney b. palpates an empty bladder as a small nodule c. finds a dull percussion sound when 100 mL of urine is present in the bladder d. palpates above the symphysis pubis to determine the level of urine in the bladder

a. cannot palpate the left kidney

Nutritional support and management are essential across the entire continuum of CKD. Which statements would be considered true related to nutritional therapy (select all that apply) a. fluid is not usually restricted for pts receiving peritoneal dialysis b. sodium and potassium may be restricted in someone with advanced CKD c. decreased fluid intake and a low potassium diet are hallmarks of the diet for a pt receiving hemodialysis d. decreased fluid intake and a low potassium diet are hallmarks of the diet for a pt receiving peritoneal dialysis e. decreased fluid intake and a diet with phosphate rich foods are hallmarks of a diet for a pt receiving hemodialysis

a. fluid is not usually restricted for pts receiving peritoneal dialysis b. sodium and potassium may be restricted in someone with advanced CKD c. decreased fluid intake and a low potassium diet are hallmarks of the diet for a pt receiving hemodialysis

The nursing care for a pt w/ hyponatremia and fluid volume excess includes a. fluid restriction b. admin of hypotonic IV fluids c. admin of a cation exchange resin d. placement of an indwelling urinary catheter

a. fluid restriction

The lungs act as an acid-base buffer by: a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. d. decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load.

a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load.

Nurses must teach patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply) a. older African Americans b. pts more than 60 y/o c. those with a history of pancreatitis d. those with a history of hypertension e. those with a history of type 2 diabetes

a. older African Americans b. pts more than 60 y/o d. those with a history of hypertension e. those with a history of type 2 diabetes

During admin of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is a. osmosis b. diffusion c. active transport d. facilitated diffusion

a. osmosis

The nurse expects the long-term treatment of a patient with hyperphosphatemia secondary to renal failure will include a. fluid restriction. b. calcium supplements. c. magnesium supplements. d. increased intake of dairy products.

b. calcium supplements

A pt with kidney disease has oliguria and a Cr clearance of 40. These findings most directly reflect abnormal function of a. tubular secretion b. glomerular filtration c. capillary permeability d. concentration of filtrate

b. glomerular filtration

the pt with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that a. a lack of clotting factors promotes the collection of blood in the abdominal cavity b. portal HTN and hypoalbuminemia cause a fluid shift into the peritoneal space c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid

b. portal HTN and hypoalbuminemia cause a fluid shift into the peritoneal space

Teaching in relation to home management after a laparoscopic cholecystectomy should include a. keeping the bandages on the puncture sites for 48 hours. b. reporting any bile-colored drainage or pus from any incision. c. using over-the-counter antiemetics if nausea and vomiting occur. d. emptying and measuring the contents of the bile bag from the T tube every day. (Lewis 1042)

b. reporting any bile-colored drainage or pus from any incision.

Which pt is at greatest risk for developing hypermagnesemia a. 83 y/o man w/ lung cancer and HTN b. 65 y/o woman w/ HTN taking beta adrenergic blockers c. 42 y/o woman w/ systemic lupus erythematosus and renal failure d. 50 y/o man w/ benign prostatic hyperplasia and a UTI

c. 42 y/o woman w/ systemic lupus erythematosus and renal failure

The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (select all that apply) a. Limiting alcohol intake to one serving per day b. Only taking aspirin with milk or bread products c. Avoiding taking aspirin and drugs containing aspirin d. Only taking drugs prescribed by the health care provider e. Taking all drugs one hour before mealtime to prevent further bleeding

c. Avoiding taking aspirin and drugs containing aspirin d. Only taking drugs prescribed by the health care provider

Diminished ability to concentrate urine, associated with aging of the urinary system, is attributed to a. a decrease in bladder sensory receptors. b. a decrease in the number of functioning nephrons. c. decreased function of the loop of Henle and tubules. d. thickening of the basement membrane of Bowman's capsule.

c. decreased function of the loop of Henle and tubules.

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances a. hyperkalemia and hyponatremia b. hyperkalemia and hypernatremia c. hypokalemia and hyponatremia d. hypokalmeia and hypernatremia

c. hypokalemia and hyponatremia

To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should: (select all that apply) a. monitor the BP in the affected arm b. irrigate the graft daily with low dose heparin c. palpate the area of the graft to feel a normal thrill d. listen with a stethoscope over the graft for presence of a bruit e. frequently monitor the pulses and neurovascular status distal to the graft

c. palpate the area of the graft to feel a normal thrill d. listen with a stethoscope over the graft for presence of a bruit e. frequently monitor the pulses and neurovascular status distal to the graft

A pt with pancreatic cancer is admitted to the hospital for evaluation of possible tx options. The pt asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the info that a Whipple procedure involves a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum c. removal of part of the pancreas, part of the stomach, the duodenum , and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum

c. removal of part of the pancreas, part of the stomach, the duodenum , and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum

The nursing management of the pt with cholecystitis associated with cholelithiasis is based on the knowledge that a. shock wave therapy should be tried initially b. once gallstones are removed, they tend not to recur c. the disorder can be successfully treated with oral bile salts that dissolve gallstones d. laparoscopic cholecystectomy is the tx of choice in most pts who are symptomatic

d. laparoscopic cholecystectomy is the tx of choice in most pts who are symptomatic

A patient has the following arterial blood gas results: pH 7.52, PaCO2 30, HCO3 24. The nurse determines that these results indicate a. metabolic acidosis b. metabolic alkalosis c. resp acidosis d. resp alkalosis

d. resp alkalosis

RIFLE defines three stages of AKI based on changes in: A. blood pressure and urine osmolality B. fractional excretion of urinary sodium C. estimation of GFR with the MDRD equation D. serum creatinine or urine output from baseline

d. serum creatinine or urine output from baseline

During the postoperative care of a 76-year-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because: a. older adults have an impaired thirst mechanism and need reminding to drink fluids b. water accounts for a greater percentage of body weight in the older adult than in younger adults c. older adults are more likely than younger adults to lose extracellular fluid during surgical procedures d. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults

d. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find a. a pH of 8.4 b. RBCs of 4/hpf c. color: yellow, cloudy d. specific gravity of 1.035

d. specific gravity of 1.035