med surg exam 1 practice q

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first? 1. "Have you had any diarrhea?" 2. "Have you been constipated recently?" 3. "Have you had any abdominal discomfort?" 4. "Have you had an increased amount of flatulence?"

2. "Have you been constipated recently?"

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder? 1. Hypoglycemia 2. Diabetes mellitus 3. Coronary artery disease 4. Orthostatic hypotension

2. Diabetes mellitus (diabetes causes renal probs)

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. Peritonitis 2. Hyperglycemia 3. Hyperphosphatemia 4. Disequilibrium syndrome

2. Hyperglycemia

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4. Decreased central venous pressure

2. Hypertension

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse should expect to note which abnormal finding documented on the client's medical record? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4. Decreased central venous pressure

2. Hypertension

The nurse is caring for a client with acute kidney injury (AKI). The nurse should test the client's urine for proteinuria to determine which type of AKI? 1. Prerenal 2. Intrinsic 3. Atypical 4. Postrenal

2. Intrinsic

The nurse is caring for a client with acute kidney injury (AKI) experiencing metabolic acidosis. When performing an assessment, the nurse should expect to note which breathing pattern? 1. Apnea 2. Kussmaul respirations 3. Decreased respirations 4. Cheyne-Stokes respirations

2. Kussmaul respirations

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5°C (101.2°F). Which nursing action is most appropriate? 1. Encourage fluid intake. 2. Notify the health care provider. 3. Continue to monitor vital signs. 4. Monitor the site of the shunt for infection.

2. Notify the health care provider.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client? 1. Prevent fluid overload. 2. Prevent loss of electrolytes. 3. Promote the excretion of wastes. 4. Reduce the urine specific gravity.

2. Prevent loss of electrolytes.

The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply. 1. Milk 2. Prune juice 3. Apricot juice 4. Cranberry juice 5. Carbonated drinks

2. Prune juice 3. Apricot juice 4. Cranberry juice

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? 1.Sinus dysrhythmia 2.Sinus tachycardia 3.Sinus bradycardia 4.Normal sinus rhythm

2.Sinus tachycardia

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply. 1. "Sterile dialysate must be used." 2. "Dialysate contains metabolic waste products." 3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion."

3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion."

A client with prostatitis following kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that education was effective if the client makes which statement? 1. "I will stop antibiotic therapy when pain subsides." 2. "I will exercise as much as possible to stimulate circulation." 3. "I should use warm tub baths and analgesics to increase comfort." 4. "I will keep fluid intake to a minimum to decrease the need to void."

3. "I should use warm tub baths and analgesics to increase comfort."

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions? 1. Increase intake of dairy products. 2. Avoid citrus fruits and citrus juices. 3. Avoid green, leafy vegetables such as spinach. 4. Increase intake of meat, fish, plums, and cranberries.

3. Avoid green, leafy vegetables such as spinach. (theyre high in oxalate)

The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food? 1. Breads 2. Poultry 3. Chocolate 4. Prune juice

3. Chocolate (high in oxalate)

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1. Fever, diarrhea, groin pain, and ecchymosis 2. Nausea, painful scrotal edema, and ecchymosis 3. Fever, nausea, vomiting, and painful scrotal edema 4. Diarrhea, groin pain, testicular torsion, and scrotal edema

3. Fever, nausea, vomiting, and painful scrotal edema

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse should observe for which most common manifestation of this disorder? 1. Headache 2. Hypotension 3. Flank pain and hematuria 4. Complaints of low pelvic pain

3. Flank pain and hematuria

The nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse should base the response on knowing that which is the action of the glucose in the solution? 1. Decreases the risk of peritonitis 2. Prevents disequilibrium syndrome 3. Increases osmotic pressure to produce ultrafiltration 4. Prevents excess glucose from being removed from the client

3. Increases osmotic pressure to produce ultrafiltration

A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement? 1. The client has an accurate understanding of the procedure and aftercare. 2. The client does not realize how painful removal of the dialysis catheter will be. 3. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. 4. The client is not aware that the alternative access site is left in place prophylactically for 2 months.

3. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use.`

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition? 1. Pyelonephritis 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the client's family

3. Trauma to the bladder or abdomen (1& 2 would involve a fever. 4 would have flank pain instead of low abd pain)

A client has developed atrial fibrillation, with a ventricular rate of 150 beats/minute. The nurse should assess the client for which associated signs/symptoms? 1.Flat neck veins 2.Nausea and vomiting 3.Hypotension and dizziness 4.Hypertension and headache

3.Hypotension and dizziness

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. Which would be a correct interpretation based on these characteristics? 1.Sinus bradycardia 2.Sick sinus syndrome 3.Normal sinus rhythm 4.First-degree heart block

3.Normal sinus rhythm

The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. How should the nurse correctly interpret this rhythm? 1.Asystole 2.Atrial fibrillation 3.Ventricular fibrillation 4.Ventricular tachycardia

3.Ventricular fibrillation

The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 beats/minute. The nurse determines that the client is experiencing which dysrhythmia? 1.Sinus tachycardia 2.Ventricular fibrillation 3.Ventricular tachycardia 4.Premature ventricular contractions

3.Ventricular tachycardia

The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? 1. "I should try to maintain an acid ash diet." 2. "I should increase my fluid intake to 3 L per day." 3. "I should take my daily dose of vitamin C to acidify the urine." 4. "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."

4. "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include? 1. "It is acceptable to eat whatever you want on the day before hemodialysis." 2. "It is acceptable to exceed the fluid restriction on the day before hemodialysis." 3. "Medications should be double-dosed on the morning of hemodialysis because of potential loss." 4. "Several types of medications should be withheld on the day of dialysis until after the procedure."

4. "Several types of medications should be withheld on the day of dialysis until after the procedure."

The client with a crush injury to the leg has a highly positive urine myoglobin level. The nurse should assess this client carefully for signs and symptoms of which problem? 1. Brain attack 2. Respiratory failure 3. Myocardial infarction 4. Acute tubular necrosis

4. Acute tubular necrosis

A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? 1. Steak 2. Shrimp 3. Chicken liver 4. Cottage cheese

4. Cottage cheese

A client with chronic kidney disease (CKD) is prescribed aluminum hydroxide. Which information should the nurse include while instructing the client regarding the action of this medication? 1. It prevents ulcers. 2. It prevents constipation. 3. It promotes the elimination of potassium from the body. 4. It combines with phosphorus and helps eliminate phosphates from the body.

4. It combines with phosphorus and helps eliminate phosphates from the body.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1. Monitor the client. 2. Elevate the head of the bed. 3. Assess the fistula site and dressing. 4. Notify the health care provider (HCP).

4. Notify the health care provider (HCP). (signs of increased icp/disequilibrium synd)

The nurse is analyzing the posthemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? 1. Potassium 2. Creatinine 3. Phosphorus 4. Red blood cell (RBC) count

4. Red blood cell (RBC) count (you want dialysis to lower the others, blood loss isnt what u want)

A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. Based on these data, what food item does the nurse instruct the client to avoid? 1. Pasta 2. Lentils 3. Lettuce 4. Spinach

4. Spinach

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? 1. Soft and swollen prostate gland 2. Swollen, and boggy prostate gland 3. Tender and edematous prostate gland 4. Tender, indurated prostate gland that is warm to the touch

4. Tender, indurated prostate gland that is warm to the touch

Which patient below with acute kidney injury is in the oliguric stage of AKI: A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day. C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day. D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day.

A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. (output <400ml/day=oliguria)

A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply: A. Hypervolemia B. Hypokalemia C. Increased BUN level D. Decreased Creatinine level

A. Hypervolemia C. Increased BUN level

A 65 year old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys? A. Lisinopril B. Metoprolol C. Amlodipine D. Verapamil

A. Lisinopril (ace inhib/ARBs lower bp and protect kidneys)

A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a: A. Low protein, low sodium, low potassium, low phosphate diet B. High protein, low sodium, low potassium, high phosphate diet C. Low protein, high sodium, high potassium, high phosphate diet D. Low protein, low sodium, low potassium, high phosphate diet

A. Low protein, low sodium, low potassium, low phosphate diet

In patients who are experiencing acute glomerulonephritis, the glomerulus is permeable to what substances? A. Red blood cells and protein B. Protein and white blood cells C. Red blood cells, protein, and lipids D. Proteins

A. Red blood cells and protein

A 5 year-old male patient is experiencing acute glomerulonephritis. What signs and symptoms may you observe with this condition? select all that apply A. Swelling in the face B. Hyperlipidemia C. Tea-colored urine D. Elevated BUN and creatinine level E. >3 Grams of protein loss in the urine per day

A. Swelling in the face C. Tea-colored urine D. Elevated BUN and creatinine level

A patient with chest pain experiences a heart rate of 200 beats/minute and blood pressure of 80/50 mm Hg. The electrocardiogram shows absent P waves. The nurse expects that which intravenous medication will be prescribed? Digoxin Atropine Adenosine Vasopressin

Adenosine

The nurse is caring for a patient with monomorphic ventricular tachycardia that is clinically stable. What is appropriate to be included on the patient's treatment plan? Perform defibrillation Administer amiodarone Administer a vasopressor Initiate cardiopulmonary resuscitation

Administer amiodarone

The nurse responds to a cardiac monitor alarm and notes that atrial flutter has developed on a patient's electrocardiogram (ECG). The nurse visualizes the patient's room and notes that the patient is awake and talking. Which action should the nurse take? Assess the patient for dyspnea Initiate cardiopulmonary resuscitation (CPR) Prepare for synchronized cardioversion Place the patient in the Trendelenburg position

Assess the patient for dyspnea

The nurse finds that a patient has an atrial rate of 450 beats per minute and a ventricular rate of 150 beats per minute. What condition is the patient likely experiencing? Atrial flutter Atrial fibrillation Ventricular fibrillation Premature ventricular contractions

Atrial fibrillation

The nurse observing a telemetry monitor notes that a patient that was in sinus rhythm is now in a different rhythm. The electrocardiogram (ECG) now shows no P waves, fine and wavy lines between the QRS complexes, QRS complexes that measure 0.08 sec, and QRS complexes that occur irregularly with a rate of 120 beats/minute. The nurse correctly interprets this rhythm as what? Sinus tachycardia Atrial fibrillation Ventricular fibrillation Ventricular tachycardia

Atrial fibrillation

A patient's permanent pacemaker is failing to capture. The nurse recalls that the definition of failure to capture is when the electrical charge to the myocardium is insufficient to produce what cardiac activity? Spontaneous atrial activity Atrial or ventricular contraction Excitability during the cardiac cycle Spontaneous ventricular activity

Atrial or ventricular contraction (spike but no P if atrial or QRS ventricular)

A patient with CKD has a low erythropoietin (EPO) level. The patient is at risk for? A. Hypercalcemia B. Anemia C. Blood clots D. Hyperkalemia

B. Anemia

______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine. A. Urea B. Creatinine C. Potassium D. Magnesium

B. Creatinine

A 36 year old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply: A. Water intoxication B. Hypotension C. Low urine specific gravity D. Hypokalemia E. Normal GFR

B. Hypotension C. Low urine specific gravity D. Hypokalemia

You're developing a nursing care plan for a patient with a kidney stone. Which of the following nursing interventions will you include in the patient's plan of care? A. Restrict calcium intake B. Strain urine with every void C. Keep patient in supine position to alleviate pain D. Maintain fluid restriction of 1-2 Liter per day

B. Strain urine with every void

A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood? A. Calcium B. Urea C. Phosphate D. Erythropoietin

B. Urea (thats uremic frost)

Select all the patients below that are at risk for acute intra-renal injury? A. A 45 year old male with a renal calculus. B. A 65 year old male with benign prostatic hyperplasia. C. A 25 year old female receiving chemotherapy. D. A 36 year old female with renal artery stenosis. E. A 6 year old male with acute glomerulonephritis. F. An 87 year old male who is taking an aminoglycoside medication for an infection.

C. 25 year old female receiving chemotherapy. E. A 6 year old male with acute glomerulonephritis. F. An 87 year old male who is taking an aminoglycoside medication for an infection. (a&b are postrenal, d is pre renal so theyre wrong) (chemo/aminoglycosides are nephtoxic & glomerulonephritis damage kidney aka intrarenal)

Which patient below is NOT at risk for developing chronic kidney disease? A. A 58 year old female with uncontrolled hypertension. B. A 69 year old male with diabetes mellitus. C. A 45 year old female with polycystic ovarian disease. D. A 78 year old female with an intrarenal injury.

C. A 45 year old female with polycystic ovarian disease. (HTN, diabetes, and renal damage are common causes of CKD)

A patient is diagnosed nephrotic syndrome. What signs and symptoms below are common in this condition? Select-all-that-apply: A. Hypertension B. Decreased Glomerular Filtration Rate C. Foamy, frothy urine D. Massive Proteinuria E. Hyperlipidemia F. Edema G. Hematuria H. Hypoalbuminemia

C. Foamy, frothy urine D. Massive Proteinuria E. Hyperlipidemia F. Edema H. Hypoalbuminemia

. A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient? A. Low-sodium, high-protein, and low-potassium B. High-protein, low-potassium, and low-sodium C. Low-protein, low-potassium, and low-sodium D. High-protein and high-potassium

C. Low-protein, low-potassium, and low-sodium

A patient is suspected of having nephrotic syndrome due to a health history of Lupus. As the nurse you know that what substance(s) will be present in the urine to confirm this diagnosis? A. Red blood cells and mild protein B. Massive red blood cells and moderate protein C. Massive protein D. Elevated potassium and sodium

C. Massive protein

A 55 year old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? A. Post-renal B. Intra-renal C. Pre-renal D. Intrinsic renal

C. Pre-renal

A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as? A. Stage 1 B. Stage 3 C. Stage 4 D. Stage 5

C. Stage 4

A patient with a kidney stone explains that the pain he is experiencing is intense, sharp, and wavelike that radiates to the scrotum. In addition, he explains it feels like he has to void but a small amount of urine is passed. Based on the patient's signs and symptoms, where may the kidney stone be located? A. Renal Calyx B. Renal Papilla C. Ureter D. Urethra

C. Ureter

The nurse is caring for a patient with valvular heart disease who experiences atrial dysrhythmias. The nurse anticipates a prescription for which type of medication? Nitrate Positive inotrope Calcium channel blocker Angiotensin-converting enzyme (ACE) inhibitor

Calcium channel blocker

A nurse provides care to a patient with atrial flutter that is clinically stable. The nurse anticipates a prescription for which types of medication? Select all that apply. Select all that apply Calcium channel blocker Antidysrhythmia medication β- blocker Anticoagulant Anticholinergic medication

Calcium channel blocker Antidysrhythmia medication β- blocker

The kidneys are responsible for performing all the following functions EXCEPT? A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production

D. Maintaining cortisol production

Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality? A. Phosphate 3.2 mg/dL B. Calcium 9.3 mg/dL C. Magnesium 2.2 mg/dL D. Potassium 7.1 mEq/L

D. Potassium 7.1 mEq/L (tall peaked t waves is cardinal sign of high k)

A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL. The patient's 24 hour urinary output is 1.75 Liters. Based on these findings, what stage of AKI is this patient in? A. Initiation B. Diuresis C. Oliguric D. Recovery

D. Recovery (labs are back to normal)

The nurse is caring for a patient and observes with a serum potassium of 2.8 mEq/L. What is the greatest risk for this patient that the nurse should monitor for? Dysrhythmias Acute renal failure Metabolic alkalosis Malignant hypertension

Dysrhythmias

A patient experienced sudden cardiac death (SCD) while hospitalized and survived. The nurse expects that what preventive treatment will be prescribed? External pacemaker An electrophysiologic study (EPS) Medications to prevent dysrhythmias Implantable cardioverter-defibrillator (ICD)

Implantable cardioverter-defibrillator (ICD)

The nurse provides information about side effects of digoxin to a nursing student. What should the nurse include? Select all that apply. Select all that apply It may cause toxicity. It increases the heart rate. It may result in dysrhythmias. It decreases myocardial contractility. It increases the risk of thrombus formation.

It may cause toxicity. It may result in dysrhythmias.

The nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury? 1. "The increase in urine output indicates the return of some renal function." 2. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days. "3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 4. "The blood urea nitrogen and creatinine levels will continue to rise during the first few days of diuresis."

"3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." (longer than 24h)

A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? 1. The client washes hands at least once per day. 2. The client's temperature remains lower than 101°F (38.3°C). 3. The client avoids blood pressure (BP) measurement in the left arm. 4. The client's white blood cell (WBC) count remains within normal limits.

.4. The client's white blood cell (WBC) count remains within normal limits. (best indicator of infection)

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option? 1. A client with severe heart failure 2. A client with a history of ruptured diverticula 3. A client with a history of herniated lumbar disk 4. A client with a history of 3 previous abdominal surgeries

1. A client with severe heart failure

A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply. 1. Agitation 2. Euphoria 3. Depression 4. Withdrawal 5. Labile emotions

1. Agitation 3. Depression 4. Withdrawal 5. Labile emotions (def not gonna be happy/euphoric??)

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? 1. Blood pressure 2. Apical heart rate 3. Jugular vein distention 4. Level of consciousness

1. Blood pressure

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 3. Contact the health care provider (HCP). 4. Place the client in good body alignment 5. Check the peritoneal dialysis system for kinks 6. Increase the flow rate of the peritoneal dialysis solution.

1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 4. Place the client in good body alignment 5. Check the peritoneal dialysis system for kinks

A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder? 1. Diabetes mellitus 2. Orthostatic hypotension 3. Coronary artery disease 4. Intravenous (IV) contrast medium

1. Diabetes mellitus

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Increased number of white blood cells in the urine

1. Elevated creatinine level (creat is most specific to kidney, could have 2 or 3 for other reasons)

The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation? 1. Fever 2. Fatigue 3. Clear dialysate output 4. Leaking around the catheter site

1. Fever

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? 1. Fish 2. Plum juice 3. Fruit juice 4. Cranberries

1. Fish

The nurse has taught the client with polycystic kidney disease about management of the disorder and prevention and recognition of complications. The nurse should determine that the client understands the instructions if the client states that which should be reported to the health care provider (HCP)? Select all that apply. 1. Frequent urination 2. Burning on urination 3. A temperature of 100.6°F (38.1°C) 4. New-onset shortness of breath 5. A blood pressure of 105/68 mm Hg

1. Frequent urination 2. Burning on urination 3. A temperature of 100.6°F (38.1°C) 4. New-onset shortness of breath

the nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? Select all that apply. 1. Hemodialysis 2. Peritoneal dialysis 3. Kidney transplant 4. Bilateral nephrectomy 5. Intense immunosuppression therapy

1. Hemodialysis 3. Kidney transplant 4. Bilateral nephrectomy

The nurse is performing assessment on a client with acute kidney injury who is in the oliguric phase. Which should the nurse expect to note? Select all that apply. 1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 4. A urine output of 600 to 800 mL in a 24-hour period 5. Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)

1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 5. Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)

The nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? 1. Maintain strict aseptic technique .2. Add heparin to the dialysate solution. 3. Change the catheter site dressing daily. 4. Monitor the client's level of consciousness.

1. Maintain strict aseptic technique

The nurse is creating a plan of care for a client with a diagnosis of nephrotic syndrome whose glomerular filtration rate (GFR) is normal. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor daily weight. 2. Maintain sodium restrictions. 3. Maintain a diet low in protein. 4. Monitor intake and output (I&O). 5. Maintain bed rest when edema is severe.

1. Monitor daily weight. 2. Maintain sodium restrictions. 4. Monitor intake and output (I&O). 5. Maintain bed rest when edema is severe.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula 2. Presence of a radial pulse in the left wrist 3. Visualization of enlarged blood vessels at the fistula site 4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand

1. Palpation of a thrill over the fistula

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 3. Put the client on NPO (nothing by mouth) status except for ice chips. 4. Review the client's medications to determine if any contain or retain potassium. 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 4. Review the client's medications to determine if any contain or retain potassium.

The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply. 1. Proteinuria 2. Hematuria 3. Positive ketones 4. A low specific gravity 5. A dark and smoky appearance of the urine

1. Proteinuria 2. Hematuria 5. A dark and smoky appearance of the urine

A client with chronic kidney disease (CKD) is being managed by continuous ambulatory peritoneal dialysis (CAPD). During outflow, the nurse notes that only half of the 2-L dialysate has returned and the flow has stopped. Which interventions should the nurse take to enhance the outflow? Select all that apply. 1. Reposition the client. 2. Encourage a low-fiber diet. 3. Make sure the peritoneal catheter is not kinked. 4. Slide the peritoneal catheter farther into the abdomen. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated.

1. Reposition the client. 3. Make sure the peritoneal catheter is not kinked. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated.

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory studies? 1. Serum potassium, serum calcium 2. Urinalysis, hematocrit, hemoglobin 3. Culture and sensitivity testing, serum sodium 4. Urine specific gravity, intravenous pyelogram

1. Serum potassium, serum calcium

A client is diagnosed with epididymitis. The nurse checks the health care provider's prescriptions and expects that which measures will be prescribed? Select all that apply. 1. Sitz bath 2. Antibiotics 3. Scrotal elevation 4. Use of a heating pad 5. Bed rest with bathroom privileges

1. Sitz bath 2. Antibiotics 3. Scrotal elevation 5. Bed rest with bathroom privileges

The nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that education was effective if the client chooses which selections from a diet menu? 1. Spinach salad, milk, and a banana 2. Chicken, potatoes, and cranberries 3. Peanut butter sandwich, milk, and prunes 4. Linguini with shrimp, tossed salad, and a plum

1. Spinach salad, milk, and a banana

A client with chronic kidney disease has completed a hemodialysis treatment. The nurse should use which standard indicators to evaluate the client's status after dialysis? 1. Vital signs and weight 2. Potassium level and weight 3. Vital signs and blood urea nitrogen level 4. Blood urea nitrogen and creatinine levels

1. Vital signs and weight

The nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse correctly interpret the client's heart rhythm? 1.Atrial fibrillation 2.Sinus tachycardia 3.Ventricular fibrillation 4.Ventricular tachycardia

1.Atrial fibrillation

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? 1.It can develop into ventricular fibrillation at any time. 2.It is almost impossible to convert to a normal rhythm. 3.It is uncomfortable for the client, giving a sense of impending doom. 4.It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.

1.It can develop into ventricular fibrillation at any time.

When computing a heart rate on a patient's ECG tracing, the nurse counts 15 small blocks between an R-R interval. The rhythm is regular. What should the nurse document as the patient's heart rate? 60 beats/minute 75 beats/minute 100 beats/minute 150 beats/minute

100 beats/minute (small blocks represent 0.04 seconds so 1500 of these blocks represent 1 min. divide 1500 by the # of small blocks (15 in this case) and you get 100)

The electrocardiogram (ECG) of a patient indicates P waves that are hidden in the preceding T waves and normal QRS complexes. The nurse recognizes that the patient is experiencing what condition? Ventricular fibrillation Junctional dysrhythmia Premature atrial contractions Premature ventricular contractions

Premature atrial contractions

The nurse reviews a patient's electrocardiogram (ECG) tracing and notes a heart rate of 82 and an irregular rhythm. How should the nurse interpret the findings? Sinus tachycardia Junctional dysrhythmia Premature atrial contractions Paroxysmal supraventricular tachycardia

Premature atrial contractions

The nurse is monitoring a patient on a wireless electrocardiogram (ECG) monitor. Which observation is a cause for concern? Upright P wave Flat ST segment Prolonged QT interval Upright T wave

Prolonged QT interval (the rest are normal)

A patient's electrocardiogram (ECG) shows a heart rate of 150 beats/minute and a normal P wave preceding each QRS complex. How should the nurse interpret the finding? Atrial fibrillation Sinus tachycardia Ventricular fibrillation Premature atrial contractions

Sinus tachycardia

The nurse assesses a patient and notes a temperature of 101.6° F. Which type of dysrhythmia is associated with a fever? Fibrillation Sinus tachycardia Sinus bradycardia Junctional tachycardia

Sinus tachycardia

A patient develops atrial flutter with a rapid ventricular response. The nurse anticipates that what treatment will be prescribed? Defibrillation Synchronized cardioversion Automatic external defibrillator (AED) Implantable cardioverter-defibrillator (ICD)

Synchronized cardioversion

A patient with paroxysmal supraventricular tachycardia (PSVT) that is receiving intravenous adenosine becomes hemodynamically unstable. The nurse expects what to be included in the patient's immediate treatment plan? β-adrenergic blocker Calcium channel blocker Catheter ablation therapy Synchronized cardioversion

Synchronized cardioversion

The nurse understands that a pacemaker is used for which type of dysrhythmia? Atrial fibrillation Ventricular fibrillation Ventricular tachycardia Third-degree AV block

Third-degree AV block

The nurse provides education to a group of nursing students about cardiac conditions that are common causes of dysrhythmias. What should the nurse include in the teaching? Select all that apply. Valve disease Emotional crisis Conduction defects Accessory pathways Electrolyte imbalances

Valve disease Conduction defects Accessory pathways

Defibrillation is indicated for which dysrhythmia? Ventricular fibrillation Third-degree atrioventricular (AV) block Uncontrolled atrial fibrillation Ventricular tachycardia with a pulse

Ventricular fibrillation

The nurse recognizes that which cardiac dysrhythmia is life-threatening and necessitates immediate intervention? Sinus tachycardia Atrial fibrillation Junctional tachycardia Ventricular fibrillation

Ventricular fibrillation

youre teaching a pt how to prevent a UTI, what statement by the pt would require further investigation a. i can go all day without emptying my bladder b. i drink 2l of fluid every day c. i dont use bubble bath d. i drink cranberry juice daily

a. i can go all day without emptying my bladder

youre instructing a pt w CKD on the appropriate diet, which statement shows the teaching was effective? a. i love grilling red bell peppers b. my spouse makes the best pork chops c. i have a cheese sandwich for lunch every day d. i eat yogurt for breakfast almost every day

a. i love grilling red bell peppers (want low protein/k/na/phos diet- the others are high in protein)

youre teaching a pt w urolithiasis how to prevent calcium calculi. what statement by the pt will indicate teaching was successful a. ill drink at least 3000(3l) of fld daily b. ill eat 2 servings of meat/cheese daily c. ill drink at least 2 glasses of cranberry juice daily d. ill eat a large amount of citrus daily

a. ill drink at least 3000(3l) of fld daily

a pts admitted w an AKI, the nurse understand which explanation is the most accurate description of the pts condition a. sudden loss of kidney fxn due to failure of the renal syst circulation or to glomerular or tubular damage b. progressive deterioration of kidney fxn that ends fatally when uremia develops c. inflammation of kidney pelvis/tubules/interstitial tissues of one or both kidneys d. inflammatory process precipitated by chemical changes in the glomeruli of both kidneys

a. sudden loss of kidney fxn due to failure of the renal syst circulation or to glomerular or tubular damage b is CKD c/d are glomerulonephritis

the nurse is teaching a patient who recently had an episode of urolithiasis with calcium oxalate stones about diet therapy. what instructions should the nuse include? select all that apply a. increase intake of milk b. limit consumption of colas c. increase consumption of coffee d. drink at least 3L of fluids daily e. limit intake of dried fruits and nuts

b. limit consumption of colas d. drink at least 3L of fluids daily e. limit intake of dried fruits and nuts

a nurse is providing care for a pt with sudden onset of severe R flank pain. theyre diagnosed w urinary calculi. what intervention has the HIGHEST priority a. keep pt NPO b. relieve pain c. strain urine d. obtain mid stream urine specimen

b. relieve pain

a pts being prepared for peritoneal dialysis, what do you do FIRST a. assess for bruit b. warm the dialysate c. position pt on left side d. insert foley

b. warm the dialysate

The health care provider requests arterial blood gases (ABGs) for a patient. While performing the test, what should the nurse tell the patient about the test? Select all that apply. Select all that apply a.The test is done by using pulse oximetry. b.The test is done to assess changes in acid-base balance. c.The test is done to assess changes in arterial oxygen (PaO 2). d.The test is done to assess changes in arterial carbon dioxide (PaCO 2). e.The test is done to assess changes in blood urea nitrogen and serum creatinine.

b.The test is done to assess changes in acid-base balance. c.The test is done to assess changes in arterial oxygen (PaO 2). d.The test is done to assess changes in arterial carbon dioxide (PaCO 2).

which urine output best indicates the pts kidneys are functioning normally a. 555ml in 2h b. 30ml in 1h c. 1500 ml in 24h d. 800ml in 24h

c. 1500 ml in 24h

pH 7.37 paCo2 33 HCO3 17 what is it?

compensated metabolic acidosis

pH 7.39 paCo2 48 HCO3 28 what is it?

compensated respiratory acidosis

pH 7.41 paCo2 26 HCO3 17 what is it?

compensated respiratory alkalosis

a pt w a hx of kidney disease is reporting weakness/lethargy. the EKG shows sinus brady w a prolonged PR interval. what lab would you expect to see a. K 3.0 b. K 3.5 c. K 5 d. K 8.5

d. K 8.5 (signs of hyperkalemia, also pointy/peaked T)

a pt is diagnosed w CKD, what finding is expected a. hematuria b. polyuria c. dysuria d. oliguria

d. oliguria (hematuria is w glomerulonephritis, polyuria is opposite, dysuria is w UTI)

a pt w CKD is perscribed a low protein diet. what is the reason for this? a. decreases fld retention b. increases diaphoresis c. prevents hypovolemic shock d. preserves renal function

d. preserves renal function

TRUE OR FALSE: The R waves in atrial fibrillation are regular

false (super irregular)

TRUE OR FALSE: Atrial fibrillation is characetized by random p-waves on the EKG

false (theres no p waves w a fib)

The nurse is assigned to care for an 83-year-old patient with an acute asthma exacerbation. Which arterial blood gas (ABG) result would prompt the nurse to notify the provider immediately? pH 7.32, PaO 2 75 mm Hg, PaCO 2 42 mm Hg pH 7.30, PaO 2 74 mm Hg, PaCO 2 65 mm Hg pH 7.48, PaO 2 79 mm Hg, PaCO 2 43 mm Hg pH 7.40, PaO 2 65 mm Hg, PaCO 2 38 mm Hg

pH 7.30, PaO 2 74 mm Hg, PaCO 2 65 mm Hg

pH 7.31 paCo2 34 HCO3 21 what is it?

partially compensated metabolic acidosis

pH 7.56 paCo2 20 HCO3 20 what is it?

partially compensated respiratory alkalosis

TRUE OR FALSE: P-waves are absent in atrial flutter

true

pH 7.23 paCo2 37 HCO3 18 what is it?

uncompensated metabolic acidosis

pH 7.30 paCo2 36 HCO3 16 what is it?

uncompensated metabolic acidosis

pH 7.22 paCo2 49 HCO3 24 what is it?

uncompensated respiratory acidosis

pH 7.50 paCo2 32 HCO3 24 what is it?

uncompensated respiratory alkalosis