NUR 3262-3-4/Kahoot/ATI

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow?

1. Inspect vials for contaminants. 2. Roll NPH vial between palms of hands. 3. Inject air into the NPH. 4. Inject air into regular insulin vial 5. Withdraw short-acting insulin into syringe 6. Add intermediate insulin to syringe

Which patient is not at risk for developing CKD?

45-year-old female with PCOS

A nurse is calculating a client's fluid output for a 12hr period. It includes Jackson-Pratt (JP) drainage 35mL, NG suction 120mL, and incontinence pads weighing 240g, 310g, and 270g. The dry weight of the incontinence pads is 90g. The nurse should record how many mL of output on the client's record?

890 mL Step 1: Subtract 90 g (the weight of a dry incontinence pad) 240 - 90 = 150 g STEP 2: What is the unit of measurement to calculate? mL STEP 3: Set up an equation and solve for X. 1 g/1 mL = 150 g/X mL X = 150 mL Step 4: Reassess to determine whether the fluid volume makes sense. If 1 g = 1 mL, it makes sense that 150 g = 150 mL. Step 1: Subtract 90 g (the weight of a dry incontinence pad) 275 - 90 = 185 g STEP 2: What is the unit of measurement to calculate? mL STEP 3: Set up an equation and solve for X. 1 g/1 mL = 185 g/X mL X = 185 mL Step 4: Reassess to determine whether the fluid volume makes sense. If 1 g = 1 mL, it makes sense that 185 g = 150 mL. Step 1: Subtract 90 g (the weight of a dry incontinence pad) 310 - 90 = 220 g STEP 2: What is the unit of measurement to calculate? mL STEP 3: Set up an equation and solve for X. 1 g/1 mL = 220 g/X mL X = 220 mL Step 4: Reassess to determine whether the fluid volume makes sense. If 1 g = 1 mL, it makes sense that 220 g = 220 mL Step 1: Subtract 90 g (the weight of a dry incontinence pad) 270 - 90 = 180 g STEP 2: What is the unit of measurement to calculate? mL STEP 3: Set up an equation and solve for X. 1 g/1 mL = 180 g/X mL X = 180 mL Step 4: Reassess to determine whether the fluid volume makes sense. If 1 g = 1 mL, it makes sense that 180 g = 180 mL. After converting all fluid amounts to mL, add them to calculate the client's total fluid intake. 35 (JP drain) + 120 mL (suction) + 150 + 185 + 220 + 180 = 890 mL

A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make? A. "A low-protein diet reduces the risk for uremia." B. "A low-protein diet reduces the risk for edema." C. "A low -protein diet will reduce the risk for hyperkalemia." D. "A low-protein diet will increase the nitrogenous wastes in the blood."

A. "A low-protein diet reduces the risk for uremia." Rational: Urea is a waste product of protein breakdown and can accumulate in clients who have kidney failure, causing uremia.

A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching? A. "I will feel shaky." B. "I will be more thirsty than usual." C. "My skin will be warm and moist." D. "My appetite will be decreased."

A. "I will feel shaky." Rational: Manifestations of hypoglycemia include feeling shaky and nervous.

A nurse is caring for a client who will have blood sampling for a serum creatinine level and asks what this test shows. Which of the following responses should the nurse make? A. "This test will tell your doctor how your kidneys are functioning." B. "You'll have to ask your doctor." C. "This test will tell if you have severe renal impairment or a disease." D. "We'll find out if any medications, such as steroids, are interfering with your kidney function."

A. "This test will tell your doctor how your kidneys are functioning." Rational: This response is appropriate because it answers the client's question simply rather than avoiding it.

A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make? A. "a low-protein diet reduces the risk for uremia" B. "A low-protein diet reduces the risk for edema" C. "A low-protein diet will reduce the risk for hyperkalemia" D. "A low-protein diet will increase the nitrogenous wastes in the blood"

A. "a low-protein diet reduces the risk for uremia" Rational: Urea is a waste product of protein breakdown and can accumulate in clients who have kidney failure, causing uremia.

When checking a client's capillary refill, the nurse finds that the color returns in 10 seconds. The nurse should understand that this finding indicates which of the following? A. Arterial insufficiency B. Venous insufficiency C. Within the expected range D. Thrombus formation in the vein

A. Arterial insufficiency Rational: To test capillary refill, a nurse presses on the client's nail beds to produce blanching and then measures the time it takes for the color to return. With adequate arterial capillary perfusion, the color should return within 3 seconds. If the skin color takes longer than 3 seconds to return to normal, this indicates impaired arterial blood flow to the extremity.

A nurse is providing teaching to a client who has renal failure and an elevated phosphorus level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times a daily. For which of the following adverse effects should the nurse inform the client? A. Constipation B. Metallic taste C. Headache D. Muscle spasms

A. Constipation Rational: Constipation is a common side effect of aluminum-based antacids. The nurse should instruct the client to increase fiber intake and that stool softeners or laxatives may be needed.

A nurse is assessing a client who has chronic kidney disease for fluid volume increase. Which of the following provides a reliable measure of fluid retention? A. Daily weight B. Sodium level C. Tissue turgor D. Intake and output

A. Daily weight Rational: Obtaining a client's daily weight and comparing it to previous weights is a reliable method for measuring a client's fluid volume over time.

A nurse is having difficulty caring for a client due to variables affecting the communication process. Which of the following should the nurse identify as an interpersonal variable? A. Education B. Feedback C. Gender D. Perception E. Time

A. Education Rational: The educational background of the client is an interpersonal variable that affects the communication process. Other interpersonal variables are sociocultural background, health status, emotions, pain, and relationships. C. Gender Rational: Gender is an interpersonal variable that affects the communication process. Other interpersonal variables are sociocultural background, health status, emotions, pain, and relationships. D. Perception Rational: Perception provides a uniquely personal view to a client's experience and is an interpersonal variable that affects communication. Other interpersonal variables are sociocultural background, health status, emotions, pain, and relationships.

A nurse is caring for a client who has polycystic kidney disease (PKD). Which of the following findings should the nurse expect? A. Flank pain B. Hypotension C. Confusion D. Urinary retention

A. Flank pain Rational: Flank pain is a finding associated with PKD.

A nurse is caring for a client who is diabetic and reports a headache, restlessness, fatigue, and hunger. The nurse should identify that the client is likely experiencing which of the following conditions? A. Hypoglycemia B. Hyperglycemia C. Neuropathy D. Hypokalemia

A. Hypoglycemia Rational: Hypoglycemia is a complication of diabetes indicating a blood glucose level less than 70 mg/dL. It can occur when excessive insulin or oral hypoglycemic are administered, with excessive physical activity, or when too little food is consumed. The manifestations of hypoglycemia include sweating, tremor, tachycardia, palpitations, headache, fatigue, nervousness, and hunger.

A nurse is caring for a client who has peripheral arterial disease (PAD). Which of the following symptoms should the nurse expect to find in the early stage of the disease? A. Intermittent claudication B. Dependent rubor C. Rest pain D. Foot ulcers

A. Intermittent claudication Rational: Intermittent claudication is ischemic pain that is precipitated by exercise, resolves with rest, and is reproducible. The pain associated with claudication arises when cellular oxygen demand exceeds supply. It occurs early in the disease course, and is typically the initial reason clients who have PAD seek medical attention.

A nurse is teaching a client who has CKD and a new prescription for epoetin alfa. the nurse should instruct the client to increase dietary intake of which of the following substances. A. Iron B. Protein C. Potassium D. Sodium

A. Iron Rational: Epoetin alfa is a synthetic form of erythropoietin, a substance produced by the kidneys that stimulates the bone marrow to produce red blood cells. Increased iron is needed for the production of hemoglobin and red blood cells by the bone marrow.

A nurse is assessing a school-aged child whose blood glucose level is 280. Which of the following findings should the nurse expect? A. Lethargy B. Pallor C. Tremors D. Shallow respirations

A. Lethargy Rational: A blood glucose of 280 mg/dL is above the expected reference range indicating hyperglycemia. The nurse should expect the child to appear lethargic, leading to a decreased level of consciousness and confusion.

A nurse is teaching a class of older adults about the expected physiologic changes of aging. Which of the following changes should the nurse include in the discussion? (Select all that apply.) A. More difficulty seeing due to a greater sensitivity to glare B. Decreased cough reflex C. Decreased bladder capacity D. Decreased systolic blood pressure E. Dehydration of intervertebral discs

A. More difficulty seeing due to a greater sensitivity to glare Rational: Older adults have an increased susceptibility to glare, greater difficulty in seeing at low levels of illumination, and alterations in color perception. B. Decreased cough reflex Rational: Older adults have a decreased cough reflex, increased airway resistance, fewer alveoli, and a greater risk for respiratory infections. C. Decreased bladder capacity Rational: Older adults have a decreased bladder capacity and a reduction in renal blood flow. E. Dehydration of intervertebral discs Rational: Older adults have dehydration of intervertebral discs, decreased muscle strength and mass, and decalcification of bones.

A nurse is caring for a client on a medical-surgical unit. Medical History: Day 1: Parkinson's disease Heart failure Medication Administration Record: Day 1: Furosemide 40 mg PO bid Carbidopa/levodopa 25 mg/100 mg po tid Vital Signs Day 1: Temperature 37.2° C (99° F) BP 128/56 mm Hg sitting, 92/40 mm Hg standing Heart rate 66/min Respiratory rate 18/min Pulse oximetry 96% on room air (95% to 100%) Diagnostic Results: Day 1: Hct 38% (37% to 47%) Hgb 13 g/dL (12 g/dL to 16 g/dL) WBC 6,500/mm3 (5,000 to 10,000/mm3) Potassium 3.5 mEq/L (3.5 mEq/L to 5 mEq/L) Day 2: Hct 39% (37% to 47%) Hgb 14 g/dL (12 g/dL to 16 g/dL) WBC 7,000/mm3 (5,000 to 10,000/mm3) Potassium 3.0 mEq/L (3.5 mEq/L to 5 mEq/L) A nurse is performing a fall risk assessment on a client. Which of the following findings indicates that the client is at increased risk for falls? (Select all that apply.) A. Potassium level on day 2 B. WBC count C. Orthostatic blood pressure D. Furosemide E. Parkinson's disease F. Temperature

A. Potassium level on day 2 Rational: The client's potassium level is below the expected reference range. Hypokalemia can cause muscle weakness, which places the client at increased risk for falls. C. Orthostatic blood pressure Rational: The client's has orthostatic hypotension, which can cause dizziness and increase the client's risk for falls D. Furosemide Rational: Furosemide is a loop diuretic which can cause urinary frequency and orthostatic hypotension. This can increase the client's risk for falls because they might need to frequently get out of bed to use the bathroom, and they might also experience dizziness due to orthostatic hypotension. E. Parkinson's disease Rational: Parkinson's disease is a chronic neurologic disorder that causes impaired mobility and cognition, which places the client at risk for a fall.

A nurse is providing dietary teaching to a client who has chronic kidney disease (CKD).The nurse should instruct the client to limit which of the following nutrients? (Select all that apply.) A. Protein B. Calcium C. Calories D. Phosphorous E. Sodium

A. Protein Rational: A client who has CKD should restrict protein intake to prevent uremia that can develop as a result of the kidneys' inability to remove the waste products of protein. D. Phosphorous Rational: A client who has CKD is at risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys. E. Sodium Rational: A client who has CKD is at risk for hypernatremia, edema, and hypertension due to sodium retention.

A nurse is caring for a 44-year-old client who was admitted with an elevated temperature and abdominal pain. Medical History: The client reports "not feeling well" for 3 days. The client reports decreased appetite and generalized abdominal pain with nausea. No reports of vomiting or diarrhea. The client has a history of stage IV chronic kidney disease. The client currently completes continuous ambulatory peritoneal dialysis (CAPD) four times per day. Client lives alone and has 4 cats. Other pertinent history includes hypertension, diabetes, and neuropathy. Noncompliant with health care provider visits and follow-up. 1000: Admitted from the clinic with generalized abdominal pain. Reports pain as an 8 on a scale of 0 to 10. Generalized abdominal tenderness noted upon palpation. Abdomen distended and rigid with decreased bowel sounds. Reports nausea but denies vomiting. Heart sounds distant and irregular. Respirations are labored with crackles throughout lung fields. Skin pale and cool with poor skin turgor. 3+ pitting edema to the lower extremities. The client states they have not completed any dialysis for the past 24 hr due to weakness. Temporal temperature 38.9º C (102º F) [36°C to 38°C (96.8°F to 100.4°F)] Pulse 110 /min; irregular (60 to 100/min) Respirations 28/min; labored (12 to 20/min) Blood pressure 108/60 mm Hg right arm (less than 120/80 mm Hg) Oxygen saturation 95% on room air (greater than or equal to 95%) Select the top 4 client findings that requires immediate follow up. A. WBC count 17,000/mm3 (Normal Finding: 5,000 to 10,000/mm³) B. Crackles throughout lungs C. Glucose 250 mg/dL D. Potassium 7.0 mEq/L (3.5 to 5 mEq/L) E. Nausea F. Hemoglobin 10 g/dL (12 to 18 g/dL) G. Creatinine 3.0 mg/dL (0.5 to 1.3 mg/dL) H. No dialysis for 24 hr I. Abdomen rigid with decreased bowel sounds

A. WBC count 17,000/mm3 (Normal Finding: 5,000 to 10,000/mm³) Rational: Clients who have chronic kidney disease have altered immunity and are prone to infection. One of the most common complications of peritoneal dialysis is peritonitis. Elevated temperature and increased WBC count is indicative of infection; therefore, this finding requires immediate follow-up. B. Crackles throughout lungs Rational: Clients who have chronic kidney disease are prone to fluid overload. This client has not had dialysis for 24 hr and is showing signs of fluid overload (crackles in lungs and 3+ edema of lower extremities); therefore, this finding requires immediate follow-up. D. Potassium 7.0 mEq/L (3.5 to 5 mEq/L) Rational: Elevated potassium levels can lead to life-threatening cardiac dysrhythmias; therefore, this finding requires immediate follow-up. H. No dialysis for 24 hr Rational: Continuous ambulatory peritoneal dialysis (CAPD) is performed by the client with the infusion of exchanges of dialysate into the peritoneal cavity four times per day, seven days a week. With each exchange the dialysate remains in the abdomen for 4 to 8 hr. Since the client has not had dialysis for the last 24 hr, this finding requires immediate follow-up. I. Abdomen rigid with decreased bowel sounds Rational: A rigid abdomen with decreased bowel sounds is indicative of peritonitis; therefore, this finding requires immediate follow-up.

A patient with CKD has a low erythropoietin level. What is this patient at risk for?

Anemia

A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parents indicates an understanding of the teaching? A. "The onset of low blood glucose usually occurs slowly." B. "My son might complain of feeling shaky when he has a low blood glucose level." C. "Sweating can occur with hyperglycemia." D. "My son might have nausea and vomiting with hypoglycemia."

B. "My son might complain of feeling shaky when he has a low blood glucose level." Rational: A shaky feeling is a consistent finding of hypoglycemia.

A nurse is providing discharge teaching to a client who has peripheral arterial disease (PAD). Which of the following instructions should the nurse include in the teaching? A. Apply a heating pad on a low setting to help relieve leg pain. B. Adjust the thermostat so that the environment is warm. C. Wear antiembolic stockings during the day. D. Rest with the legs above heart level.

B. Adjust the thermostat so that the environment is warm. Rational: The client's instructions should include keeping the environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and socks will help prevent vasoconstriction.

A nurse is caring for a 44-year-old client who was admitted with an elevated temperature and abdominal pain. Medical History: The client reports "not feeling well" for 3 days. The client reports decreased appetite and generalized abdominal pain with nausea. No reports of vomiting or diarrhea. The client has a history of stage IV chronic kidney disease. The client currently completes continuous ambulatory peritoneal dialysis (CAPD) four times per day. Client lives alone and has 4 cats. Other pertinent history includes hypertension, diabetes, and neuropathy. Noncompliant with health care provider visits and follow-up. A. Creatinine 3.0 mg/dL (0.5 to 1.3 mg/dL) B. Crackles throughout lungs C. Nausea D. Glucose 250 mg/dL E. Hemoglobin 10 g/dL (12 to 18 g/dL) F. No dialysis for 24 hr G. Abdomen rigid with decreased bowel sounds H. Potassium 7.0 mEq/L (3.5 to 5 mEq/L) I. WBC count 17,000/mm3 (Normal Finding: 5,000 to 10,000/mm³)

B. Crackles throughout lungs Rational: Clients who have chronic kidney disease are prone to fluid overload. This client has not had dialysis for 24 hr and is showing signs of fluid overload (crackles in lungs and 3+ edema of lower extremities); therefore, this finding requires immediate follow-up. F. No dialysis for 24 hr. Rational: Continuous ambulatory peritoneal dialysis (CAPD) is performed by the client with the infusion of exchanges of dialysate into the peritoneal cavity four times per day, seven days a week. With each exchange the dialysate remains in the abdomen for 4 to 8 hr. Since the client has not had dialysis for the last 24 hr, this finding requires immediate follow-up. G. Abdomen rigid with decreased bowel sounds. Rational: A rigid abdomen with decreased bowel sounds is indicative of peritonitis; therefore, this finding requires immediate follow-up. H. Potassium 7.0 mEq/L. Rational: Elevated potassium levels can lead to life-threatening cardiac dysrhythmias; therefore, this finding requires immediate follow-up. I. WBC count 17,000/mm3. Rational: Clients who have chronic kidney disease have altered immunity and are prone to infection. One of the most common complications of peritoneal dialysis is peritonitis. Elevated temperature and increased WBC count is indicative of infection; therefore, this finding requires immediate follow-up.

A nurse is assessing a client who has chronic venous insufficiency. Which of the following findings should the nurse expect? A. Dependent rubor B. Edema C. Hair loss D. Thick, deformed toenails

B. Edema Rational: An increase in venous hydrostatic pressure, which develops when fluid accumulates in the veins, causes fluid to leak out into the tissues resulting in edema.

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client who has DM. When mixing the 2 types of insulin, which of the actions should the nurse take first? A. Inject 10 units of air into the regular insulin vial. B. Inject 20 units of air into the NPH insulin vial. C. Withdraw 10 units of insulin from the regular insulin vial. D. Replace the needle for withdrawal with a safety needle.

B. Inject 20 units of air into the NPH insulin vial. Rational: The first action the nurse should take is to inject 20 units of air into the NPH insulin vial because this insulin is the intermediate-acting insulin, which will be drawn up last in order to avoid contaminating the regular insulin with NPH insulin.

A nurse is assessing a client to identify risk factors for disease. Which of the following findings is a risk factor for metabolic syndrome? A. History of asthma B. Large waist size C. Hypotension D. Hypoglycemia

B. Large waist size Rational: Central obesity due to excessive abdominal fat is a risk factor for metabolic syndrome. Metabolic syndrome increases the risk for the development of diabetes and coronary artery disease.

A nurse is assessing a client to identify risk factors for disease. Which of the following findings is a risk factor for metabolic syndrome? A. History of asthma B. Large waist size C. Hypotension D. Hypoglycemia

B. Large waist size Rational: Central obesity due to excessive abdominal fat is a risk factor for metabolic syndrome. Metabolic syndrome increases the risk for the development of diabetes and coronary artery disease.

A nurse is providing teaching to a female client who has type 2 diabetes and a new prescription for pioglitazone. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Expect urine to be darkened. B. Monitor weight daily C. Increase calcium intake. D. Use oral contraceptives to avoid pregnancy. E. Take tablets whole.

B. Monitor weight daily. Rational: Pioglitazone may lead to fluid retention and worsen heart failure. Clients should monitor weight and report any rapid gains to the provider. C. Increase calcium intake. Rational: Pioglitazone increases the risk of fractures in women. Clients should be advised to exercise and ensure adequate intake of vitamin D and calcium to protect bone health.

A nurse is planning care for a client who has dehydration and is receiving a continuous IV infusion of 0.9% sodium chloride. which intervention should the nurse include in plan of care? A. Monitor the client's intake and output every 6 hr. B. Offer the client 240 mL (8 oz) of oral fluids every 4 hr. C. Check the client's IV infusion every 8 hr. D. Administer furosemide to the client.

B. Offer the client 240 mL (8 oz) of oral fluids every 4 hr. Rational: The nurse should offer 60 to 120 mL (2 to 4 oz) of fluids every 1 to 2 hr to manage the dehydration as well as prevent further dehydration.

A nurse is caring for a client who is confused and has pulled out her peripheral IV catheter 3 times. Which of the following actions should the nurse consider? A. Administer a mild sedative to the client. B. Place mitten restraints on the client's hands. C. Reorient the client to time, place, and person. D. Move the client close to the nurses' station.

B. Place mitten restraints on the client's hands. Rational: The nurse should consider placing mitten restraints on the client's hands to prevent pulling out the IV catheter. The nurse should obtain a prescription from the provider to apply these restraints.

A nurse is reviewing a client's admission record. The nurse notes that there are prescriptions for several medications. Which of the following factors should the nurse recognize is of primary consideration when determining the schedule of administration? A. Institutional policies regarding routine medication administration times B. Specific characteristics of the medications C. Schedule of administration that the client follows at home D. Time at which the medication can be available from the pharmacy

B. Specific characteristics of the medications Rational: Evidence-based practice indicates that the specific characteristics of the medications be the primary consideration of scheduling administration times. The characteristics of each medication, including the indication, onset, durations of action, and potential adverse effects and interactions, primarily determine the schedule of administration. Although an institutional policy may require that all once daily medications be administered at 0800, the nurse should be aware that some classifications of medications should only be given at bedtime or should only be given with food. Likewise, the client's preferences, as well as the availability of each medication from the pharmacy, play important but smaller roles in determining the schedule of administration.

A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. which of the following foods should the nurse instruct the client to avoid? A. Green Beans B. Tomatoes C. Bananas D. Asparagus E. Raisins

B. Tomatoes Rational: Tomatoes are high in potassium and should be avoided by a client who is on a potassium- restricted diet. C. Bananas Rational: Bananas are high in potassium and should be avoided by a client who is on a potassium-restricted diet. E. Raisins Rational: Raisins are high in potassium and should be avoided by a client who is on a potassium-restricted diet.

A nurse is developing a plan of care for a client who is to begin receiving peritoneal dialysis. Which of the following intervention should the nurse implement to ensure proper dialysate exchange? A. Monitor vital signs every 2 hr during the procedure. B. Warm the dialysate solution prior to instillation. C. Place the drainage bag above the level of the client's abdomen. D. Maintain the client in a left lateral position during dialysis.

B. Warm the dialysate solution prior to instillation. Rational: Pain during inflow of the dialysate is a common adverse effect when clients begin peritoneal dialysis. Warming the solution decreases discomfort.

A nurse is teaching a client who has pre-dialysis end-stage kidney disease about diet. What instructions should the nurse include? A. "Increase intake of dietary phosphorous." B. "Eliminate foods high in protein from your diet." C. "Reduce intake of foods high in potassium." D. "Increase intake of sodium-containing food."

C. "Reduce intake of foods high in potassium." Rational: The client should reduce foods high in potassium because potassium clearance is impaired in the client who has end-stage kidney disease.

A nurse is teaching a client about self-administered peritoneal dialysis. Which of the following statements by the client indicates a need for further teaching? A. "The fluid from my abdomen will be clear or slightly yellow." B. "The catheter can become infected even with sterile precautions." C. "The microwave in my kitchen can warm the solution before I use it." D. "The volume of the output solution should be greater than the input solution."

C. "The microwave in my kitchen can warm the solution before I use it." Rational: It is dangerous to use a microwave to heat dialysate because microwaves heat unevenly, and the dialysate can be much hotter than it initially appears. It is recommended that dialysate be warmed using dry heat, such as a heating pad. Warming the dialysate in water is also discouraged as this can introduce non-sterile water into the ports of the dialysate bag.

A nurse is providing discharge teaching for a client who is to perform peritoneal dialysis at home. What information should the nurse include? A. "You should avoid foods high in fiber." B. "You should expect redness at the catheter exit site." C. "You should anticipate pain the first week during the inflow of dialysate." D. "You should warm the dialysate in a microwave oven before instillation."

C. "You should anticipate pain the first week during the inflow of dialysate." Rational: Abdominal pain is expected during inflow of the dialysate during the first few weeks of therapy.

A nurse is providing care for four clients on a medical-surgical unit. which of the following client should the nurse identify as being at risk for the development of pressure ulcers? A. A client who is ambulatory following a cardiac catheterization 4 hr ago B. A client who has type1 diabetes mellitus and is hyperglycemic C. A client who has protein calorie malnutrition D. A client who has right-sided heart failure and 4+ edema to the lower extremities E. A client who has postoperative delirium

C. A client who has protein calorie malnutrition Rational: A client who has poor nutritional status is at risk for the development of pressure ulcers. D. A client who has right-sided heart failure and 4+ edema to the lower extremities Rational: A client who has poor skin perfusion resulting from a condition such as peripheral edema is at risk for the development of pressure ulcers. E. A client who has postoperative delirium Rational: A client who has a decreased level of consciousness, such as delirium, is at risk for the development of pressure ulcers.

A nurse is reviewing the medical record of a client who reports drinking three to four glasses of wine each night and taking 3,000 mg of acetaminophen daily. Which of the following laboratory values is the priority for the nurse to assess? A. Amylase B. Creatinine C. Aspartate aminotransferase (AST) D. Antidiuretic hormone (ADH)

C. Aspartate aminotransferase (AST) Rational: The greatest risk to this client is liver injury from the combined adverse effects of alcohol and acetaminophen. Therefore, the priority laboratory value for the nurse to evaluate is AST because an elevated level is an indication of liver damage.

A nurse is caring for a client who has a new arteriovenous graft in his left forearm. which of the following techniques should the nurse use to assess the patency of this graft? A. Measure the client's blood pressure to ensure it is higher in the left arm than the right. B. Check the brachial and radial pulses of the left arm simultaneously. C. Auscultate the site for a bruit. D. Auscultate the antecubital fossa using a Doppler stethoscope.

C. Auscultate the site for a bruit. Rational: The nurse should auscultate the AV graft site for the presence of a bruit or palpate the site for a thrill every 4 hr to assess for blood flow.

A nurse is teaching a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CAPD). Which of the following information should the nurse include in the teaching? A. CAPD filters the client's blood through an artificial device called a dialyzer. B. CAPD is the dialysis treatment of choice for clients who have a history of abdominal surgery. C. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires. D. CAPD requires a rigid schedule of exchange times.

C. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires. Rationale: CAPD's advantages include fewer dietary and fluid restrictions as compared to hemodialysis.

A nurse is developing a teaching a plan for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Establish short-term, realistic goals for the client. B. Give the client access to a video about diabetes. C. Determine what the client knows about managing diabetes. D. Evaluate the effectiveness of the client's admission teaching plan.

C. Determine what the client knows about managing diabetes. Rational: The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should find out what the client knows before proceeding with the plan.

You suspect kidney transplant rejection when the patient shows which symptoms? A. Pain in the incision, general malaise, and hypotension B. Pain in the incision, general malaise, and depression C. Fever, weight gain, and diminished urine output D. Diminished urine output and hypotension

C. Fever, weight gain, and diminished urine output

A nurse is caring for a client who has type 1 diabetes mellitus. Which of the following should the nurse recommend to the client as an appropriate sweetener? A. Corn syrup B. Natural honey C. Nonnutritive sugar substitute D. Guava nectar

C. Nonnutritive sugar substitute Rational: Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Nonnutritive sugar substitutes allow the client to sweeten the taste of foods without increasing carbohydrate intake.

A nurse is assessing a client who is 2 weeks postoperative following a kidney transplant. Which of the following manifestations should the nurse identify as possible organ rejection? A. Temperature 36.1° C (97.0° F) B. Insomnia C. Oliguria D. Weight loss

C. Oliguria Rational: The nurse should identify little to no urine output as possible manifestations of kidney rejection.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? A. Cimetidine B. Dextromethorphan C. Prednisone D. Atorvastatin

C. Prednisone Rational: Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication.

A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect? A. Hyperactive bowel sounds B. Increased urinary output C. Rigid abdomen D. Frequent bowel movements

C. Rigid abdomen Rational: A rigid, boardlike abdomen is a manifestation of peritonitis.

A school nurse is assessing an adolescent who reports feeling shaky and is having difficulty speaking and concentrating on the questions the nurse is asking. The nurse checks the adolescent's Blood glucose level and identifies a value of 55 mg/dL. Which of the following findings should the nurse expect? A. Dry, flushed skin B. Deep, rapid respirations C. Tachycardia D. Polyuria

C. Tachycardia Rational: A blood glucose level of 55 mg/dL is below the expected reference range and an adolescent with this blood glucose level is likely to have tachycardia due to increased circulating catecholamines and increased adrenergic activity.

Which information is most important to communicate to the MD 2 hours after a kidney transplant?

Central venous pressure decreased

A nurse is caring for a client in the emergency department (ED). Vital Signs: 1500: Temperature 37.3° C (99.1° F) BP 154/64 mm Hg Heart rate 105/min Respiratory rate 26/min Oxygen saturation 93% on room air Medical History Cirrhosis Hypertension, controlled with metoprolol therapy Type 2 diabetes mellitus, controlled with glipizide therapy Physical Examination 1500: Client presents with decreased level of consciousness, slurred speech, and impaired concentration. Client is lethargic, does not respond to questions or simple commands. Pupils round, reactive to light and accommodation. Partner states client has been sleeping during the day and remains awake at night. Skin is dry and jaundiced with petechiae present to arms and legs. S1 S2 heard on auscultation. +1 pulses on bilateral radial and pedal pulses. Peripheral edema +3 present in bilateral lower extremities. Crackles auscultated in bilateral lower lobes. Abdomen distended with ascites. Hypoactive bowel sounds present in all four quadrants. Partner reports no knowledge of rectal bleeding, states client has been tolerating diet with no nausea or vomiting. Client placed in semi-Fowler's position at 45°, feet elevated. Bed in low position. Partner remains at client's bedside. Diagnostic Results 1700: Albumin 2.9 g/dL (3.5 to 5 g/dL) Ammonia 250 mcg/dL (10 to 80 mcg/dL) Sodium 138 mEq/L (136 to 145 mEq/L) Potassium 4.8 mEq/L (3.5 to 5 mEq/L) Fasting glucose 148 mg/dL (70 to 110 mg/dL) BUN 18 mg/dL (10 to 20 mg/dL) Creatinine 0.8 mg/dL (0.5 to 1 mg/dL) Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client is exhibiting manifestations of (Condition)________________ due to the client's (Finding)___________________.

Condition Encephalopathy is correct. Rational: The client is experiencing alterations in their level of consciousness and has an elevated ammonia level. Encephalopathy is indicative of liver failure due to cirrhosis. Finding Ammonia level is correct. Rational: The client is experiencing encephalopathy which can be a result of an elevated ammonia level. An elevated ammonia level is indicative of liver failure due to cirrhosis.

A nurse is caring for a client in the emergency department (ED). Vital Signs: 1500: Temperature 37.3° C (99.1° F) BP 154/64 mm Hg Heart rate 105/min Respiratory rate 26/min Oxygen saturation 93% on room air Medical History: Cirrhosis Hypertension, controlled with metoprolol therapy Type 2 diabetes mellitus, controlled with glipizide therapy Physical Examination 1500: Client presents with decreased level of consciousness, slurred speech, and impaired concentration. Client is lethargic, does not respond to questions or simple commands. Pupils round, reactive to light and accommodation. Partner states client has been sleeping during the day and remains awake at night. Skin is dry and jaundiced with petechiae present to arms and legs. S1 S2 heard on auscultation. +1 pulses on bilateral radial and pedal pulses. Peripheral edema +3 present in bilateral lower extremities. Crackles auscultated in bilateral lower lobes. Abdomen distended with ascites. Hypoactive bowel sounds present in all four quadrants. Partner reports no knowledge of rectal bleeding, states client has been tolerating diet with no nausea or vomiting. Client placed in semi-Fowler's position at 45°, feet elevated. Bed in low position. Partner remains at client's bedside. Diagnostic Results: 1700: Albumin 2.9 g/dL (3.5 to 5 g/dL) Ammonia 250 mcg/dL (10 to 80 mcg/dL) Sodium 138 mEq/L (136 to 145 mEq/L) Potassium 4.8 mEq/L (3.5 to 5 mEq/L) Fasting glucose 148 mg/dL (70 to 110 mg/dL) BUN 18 mg/dL (10 to 20 mg/dL) Creatinine 0.8 mg/dL (0.5 to 1 mg/dL) Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client is exhibiting manifestations of (Condition)______________ due to the client's (Finding)__________________.

Condition Encephalopathy is correct. The client is experiencing alterations in their level of consciousness and has an elevated ammonia level. Encephalopathy is indicative of liver failure due to cirrhosis. Finding Ammonia level is correct. The client is experiencing encephalopathy which can be a result of an elevated ammonia level. An elevated ammonia level is indicative of liver failure due to cirrhosis.

A nurse is assessing a client who has output of 250 mL in 24-hour period. Which of the following descriptive terms should the nurse place in the client's electronic record? A. Enuresis B. Anuria C. Nocturia D. Oliguria

D. Oliguria Rational: The nurse should document the client has oliguria, which is urine output between 100 mL and 400 mL of urine in 24 hr.

A nurse is preparing to obtain a daily weight from a client who has chronic kidney disease. Which of the following actions should the nurse implement? A. Use any available scale to weigh the client. B. Balance the scale at minus two before weighing the client. C. Obtain the weight each day at a time most convenient for the client. D. Weigh the client after he has voided.

D. Weigh the client after he has voided. Rational: The nurse should have the client void before obtaining a daily weight.

A nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via and external insulin pump. Which of the following statements by the client indicates a need for further teaching? A. "I will change the needle every 3 days." B. "I should store all unused insulin in the refrigerator." C. "If I skip lunch, I will skip my mealtime dose of insulin." D. "I will use insulin glargine in my insulin pump."

D. "I will use insulin glargine in my insulin pump." Rational: The client should use a short-acting insulin in the insulin pump. The insulin pump is designed to administer rapid-acting or short-acting insulin 24 hr a day. Insulin glargine is classified as a long-acting insulin and is administered at the same time each day to maintain stable blood glucose concentration for a 24-hr period.

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? A. "Have an eye examination once per year." B. "Examine your feet carefully every day." C. "Wear compression stockings daily." D. "Maintain stable blood glucose levels."

D. "Maintain stable blood glucose levels." Rational: Keeping blood glucose under control is the client's best protection against long-term complications of diabetes, since increased blood sugar contributes to neuropathic disease, and microvascular complications such as retinopathy and nephropathy, as well as to macrovascular complications.

A nurse is providing teaching to a client about completing a creatinine clearance test. Which of the following instructions should the nurse include in the teaching? A. "You will need to collect all of your urine for the next 12 hours." B. "You will need to store the urine container in a dark location." C. "You will need to start the collection time with your first urine specimen of the day." D. "You will need to avoid rigorous exercise during the test."

D. "You will need to avoid rigorous exercise during the test." Rational: The nurse should instruct the client to avoid exercising during the testing time because it can cause an increase in the creatinine values.

A nurse is assessing four female clients for obesity. Which of the following clients have manifestations of obesity? A. A client who has a body fat of 22% B. A client who has a BMI of 28 C. A client who has a waist circumference of 81.3 cm (32 in) D. A client who weighs 28% above ideal body weight

D. A client who weighs 28% above ideal body weight Rational: For a female client, obesity is classified as a weight 20% greater than ideal weight. A client whose weight is 28% above ideal body weight is classified as obese.

A nurse is discussing kidney transplant with a client who has end-stage renal disease (ESRD). Which of the following should the nurse identify as a contraindication for this treatment? A. Breast cancer survivor for 8 years B. Pacemaker C. 65-years of age D. Alcohol use disorder

D. Alcohol use disorder Rational: The nurse should identify that a substance use disorder is a contraindication for kidney transplant.

A nurse is reviewing the BUN and creatinine levels of an older adult client who has chronic kidney disease. The nurse should expect which of the following findings? A. BUN 10 mg/dL and creatinine 0.3 mg/dL B. BUN 23 mg/dL and creatinine 1.0 mg/dL C. BUN 8 mg/dL and creatinine 0.7 mg/dL D. BUN 45 mg/dL and creatinine 8 mg/dL

D. BUN 45 mg/dL and creatinine 8 mg/dL Rationale: An elevation of both BUN and creatinine is an expected finding of chronic kidney disease

A nurse is discussing lab values associated with the renal system with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the values? A. Potassium levels are increased in clients who have polyuria. B. Specific gravity is decreased in clients who have hypovolemia. C. BUN is decreased in clients who have dehydration. D. Creatinine levels are increased in clients who have acute kidney injury.

D. Creatinine levels are increased in clients who have acute kidney injury. Rational: Increased creatinine levels are associated with renal failure.

Which serum laboratory value indicates to the nurse that the patient's CKD is getting worse? a. Decreased BUN b. Decreased sodium c. Decreased creatinine d. Decreased calculated glomerular filtration rate (GFR)

D. Decreased calculated glomerular filtration rate (GFR)

A nurse is admitting a client who has partial hearing loss. Which of the following is the priority action by the nurse? A. Speak using his usual tone of voice. B. Stand directly in front of the client C. Rephrase statements the client does not hear. D. Determine if the client uses hearing aids.

D. Determine if the client uses hearing aids. Rational: The first action the nurse should take using the nursing process is to assess the client. The nurse should find out if the client has hearing aids and whether they are in place and functioning.

A nurse is preparing to administer medications to a client who states, "I don't want to take those drugs." Which of the following actions should the nurse take? A. Tell the client the physician wants him to take the medications. B. Ask the client why he is refusing to take the medications. C. Explain the purpose for the medications. D. Document that the client refuses the medications.

D. Document that the client refuses the medications. Rational: The client has the right to refuse the medication. It is appropriate for the nurse to document the client's refusal of the medications. The nurse should then inform the provider of the client's refusal.

A nurse in a public clinic is planning a health fair for older adult clients in the community. In teaching medication safety, which of the following foods should the nurse advise the clients to avoid when taking their prescriptions? A. Carbonated beverage B. Milk C. Orange juice D. Grapefruit juice

D. Grapefruit juice Rational: There is a high rate of food-drug interactions between grapefruit juice and many medications frequently taken by older adults, especially lipid-lowering agents. It is thought that one or more of the chemicals (most likely flavonoids) in grapefruit juice alter the activity of specific enzymes (such as CYP3A4 and CYP1A2) in the intestinal tract. These enzymes decrease the rate at which medications enter the systemic circulation. This could allow a larger amount of these drugs to reach the bloodstream, resulting in increased drug levels and possibly toxicity.

A nurse is caring for a client who is undergoing initial peritoneal dialysis. Which of the following should the nurse report immediately to the provider? A. Report of discomfort during dialysate inflow B. Blood-tinged dialysate outflow C. Dialysate leakage during inflow D. Purulent dialysate outflow

D. Purulent dialysate outflow Rational: Peritonitis is an inflammation of the peritoneum and a major complication of peritoneal dialysis. Manifestations of peritonitis include cloudy dialysate outflow, fever, nausea, and vomiting. If untreated, the client can become severely ill, progressing to bacterial septicemia and hypovolemic shock. Peritonitis can be prevented with meticulous site care. The nurse and client should wear a mask when accessing the catheter. Strict aseptic technique should be used when connecting and disconnecting the catheter.

A nurse is caring for a client receiving hemodialysis. Medical History: Client has a history of type 2 diabetes mellitus, chronic kidney disease, and hemodialysis with Arteriovenous fistula. A nurse is caring for a client who has received hemodialysis. Which of the following assessment findings require follow-up? A. Vital signs B. Weight C. Blood glucose level D. Presence of bruit and thrill E. Lung sounds F. AV fistula site assessment

E. Lung sounds F. AV fistula site assessment Rational: When analyzing cues, it is appropriate to follow up with the lung and AV fistula site assessments. There has been in a change in the client's lung sounds accompanied by a non-productive cough. The client experienced an episode of nausea with emesis at 1600 the evening prior and could have aspirated or may be retaining fluid related to decreased kidney function. The nurse should assess the site further for evidence of bleeding due to the use of anticoagulants during dialysis.

Which statement by the patient with CKD5 indicates that the teaching has been effective?

I will measure my UO daily to help calculate the amount I can drink.

Which statement correctly distinguishes renal failure from prerenal failure?

In prerenal failure, an IV isotonic saline infusion increases urine output

A patient complaints of leg cramps during hemodialysis. The nurse should first

Infuse bolus of normal saline

A patient with CKD4 asks what type of diet they should follow. You explain the patient should follow:

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

Which of the following is not a function of the kidneys?

Maintaining cortisol production

A patient with CKD needs further teaching if they are taking which medication?

Milk of Magnesia

Which information is needed to determine the effectiveness of calcium carbonate for a patient with CKD?

Phosphate level

A patient with HTN and CKD takes captopril. Before administering this medication, the RN will check which of the following?

Potassium

You develop a care plan to reduce infection for your patient that received a kidney transplant. A goal for this patient is to:

Remain afebrile and have negative cultures

A 55-year-old male patient is diagnosed with CKD. The most recent GFR was 25 mL/min. What stage of CKD is this known as?

Stage 4

A nurse in an emergency department is caring for a 52-year-old male client. Nurses' Notes: The client reports new onset of thirst and increased hunger. Client states they need to urinate frequently during the day and wake up 2 to 3 times during the night to urinate. 1 cm (0.4 in) stage 2 pressure injury noted on plantar area of left foot. Client states pressure injury has been present for 2 weeks and is not healing. Client's BMI is 30 Diagnostic Results: HbA1c 6.6% (4% to 5.9%) Fasting blood glucose 120 mg/dL (70 mg/dL to 110 mg/dL) HDL 25 mg/dL (greater than 45 mg/dL) Triglyceride 275 mg/dL (40 mg/dL to 160 mg/dL) Prostate-specific antigen (PSA) 2.4 ng/mL (0 ng/mL to 2.5 ng/mL) Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

The nurse should request a referral with a registered dietician and request a prescription for an insulin stimulator because the client is most likely experiencing type 2 diabetes mellitus. The nurse should monitor the client's serum glucose and glycosylated hemoglobin assay to regulate the client's glucose level and assess the client's progress.

A nurse is preparing to care for an 84-year-old male client who is being admitted to a medical unit from a provider's office. The nurse reviews the client's medical records to prepare the client's plan of care. Diagnostic Results: HbA1C 6.2% (less than 7%) Blood glucose 102 mg/dL (82 to 115 mg/dL) Hemoglobin 14.2 g/dL (14.2 to 18 g/dL) Hematocrit 42.6% (42% to 52%) Total WBC count 6,000/mm3 (5,000 to 10,000/mm3) HDL 35 mg/dL (greater than 45 mg/dL) LDL 142 mg/dL (less than 130 mg/dL) Brain natriuretic peptide (BNP) 352 pg/mL (less than 100 pg/mL) Chest x-ray: Shows cardiomegaly and bibasilar pleural congestion. Medication Administration Record: Metformin 850 mg PO q am Digoxin 0.25 mg PO q am Carvedilol 25 mg PO bid Furosemide 40 mg IV bolus once now Vital Signs: BP 146/98 mm Hg Temperature 36.8º C (98.2º F) Pulse rate 106/min Respirations 24/minO2 saturation 94% on 2 L/min nasal cannula Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

The nurse should elevate the head of the bed and encourage an intake of a low-sodium diet because the client is most likely experiencing heart failure because the BNP level, blood pressure, pulse, and respiratory rate are elevated, and the chest x-ray indicates an enlarged heart and bibasilar fluid accumulation in the lungs. The nurse should monitor urinary output and blood pressure because the administration of furosemide should result in diuresis/increased urinary output and might lower blood pressure. Teaching the client signs of hyperglycemia, assessing feet for sensation, and encouraging a diet that includes iron-rich foods do not address the condition the client is most likely experiencing, which is congestive heart failure. White blood cell count, fingerstick blood glucose, and hemoglobin are not necessary for the nurse to monitor because they do not directly affect congestive heart failure.

A nurse is preparing to care for an 84-year-old male client who is being admitted to a medical unit from a provider's office. The nurse reviews the client's medical records to prepare the client's plan of care. Diagnostic Results: HbA1C 6.2% (less than 7%) Blood glucose 102 mg/dL (82 to 115 mg/dL) Hemoglobin 14.2 g/dL (14.2 to 18 g/dL) Hematocrit 42.6% (42% to 52%) Total WBC count 6,000/mm3 (5,000 to 10,000/mm3) HDL 35 mg/dL (greater than 45 mg/dL) LDL 142 mg/dL (less than 130 mg/dL) Brain natriuretic peptide (BNP) 352 pg/mL (less than 100 pg/mL) Chest x-ray: Shows cardiomegaly and bibasilar pleural congestion. Medication Administration Record: Metformin 850 mg PO q am Digoxin 0.25 mg PO q am Carvedilol 25 mg PO bid Furosemide 40 mg IV bolus once now Vital Signs BP 146/98 mm Hg Temperature 36.8º C (98.2º F) Pulse rate 106/min Respirations 24/min O2 saturation 94% on 2 L/min nasal cannula Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

The nurse should elevate the head of the bed and encourage an intake of a low-sodium diet because the client is most likely experiencing heart failure because the BNP level, blood pressure, pulse, and respiratory rate are elevated, and the chest x-ray indicates an enlarged heart and bibasilar fluid accumulation in the lungs. The nurse should monitor urinary output and blood pressure because the administration of furosemide should result in diuresis/increased urinary output and might lower blood pressure. Teaching the client signs of hyperglycemia, assessing feet for sensation, and encouraging a diet that includes iron-rich foods do not address the condition the client is most likely experiencing, which is congestive heart failure. White blood cell count, fingerstick blood glucose, and hemoglobin are not necessary for the nurse to monitor because they do not directly affect congestive heart failure.

A nurse is caring for a newly admitted client. Medical History: Cirrhosis Type 2 diabetes mellitus Hypertension Partner reports client drinks 12 cans of beer daily Diagnostic Results: 0700: Hemoglobin 11 g/dL (12 to 16 g/dL) Hematocrit 34% (37% to 47%) Aspartate aminotransferase (AST) 135 units/L (0 to 35 units/L) Alanine aminotransferase (ALT) 150 units/L (4 to 36 units/L) Alkaline phosphatase (ALP) 301 units/L (30 to 120 units/L) Ammonia 236 mcg/dL (10 to 80 mcg/dL) Total bilirubin 9.7 mg/dL (0.3 to 1.0 mg/dL) Albumin 2.5 g/dL (3.5 to 5 g/dL) Total protein 5.0 g/dL (6.4 to 8.3 g/dL) Prothrombin time 12.4 seconds (11.0 to 12.5 seconds) Glucose 180 mg/dL (74 to 106 mg/dL) Vital Signs: 0800: Temperature 37.2o C (98.9o F) Heart rate 92/min Respiratory rate 22/min Blood pressure 140/92 mm Hg SaO2 94% on 2 L oxygen via nasal cannula Physical Examination: 0800: Client is difficult to arouse and is disoriented to person, place, and time Lung sounds clear, no shortness of breath noted Bowel sounds active in all 4 quadrants, abdomen soft and slightly distended Skin intact, no petechiae or bruising noted. 2+ edema to legs bilaterally Jaundice to sclerae bilaterally Client denies pain Nurse's Notes: 0830: Client refuses breakfast; is agitated and disoriented. Assisted to commode. Had large soft stool, urine is dark yellow. A nurse notes the client's condition and initiates the following action. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

The nurse should identify that the client is most likely experiencing encephalopathy related to cirrhosis. Encephalopathy can lead to seizures and coma and is life-threatening if not treated. Increased ammonia levels lead to encephalopathy, which can cause alterations in mental status and motor disturbances, including asterixis, an involuntary flapping of hands. Lactulose is given to decrease ammonia by expelling it in the stool. The nurse should expect two to three soft stools per day from the lactulose and should notify the provider if liquid stools develop. The nurse should frequently monitor the client's neurological status to promptly recognize any further progression of confusion. The nurse should also ensure appropriate safety measures are in place to keep the client safe from injury.

A nurse is caring for a newly admitted client. Medical History: Cirrhosis Type 2 diabetes mellitus Hypertension Partner reports client drinks 12 cans of beer daily Diagnostic Results: 0700: Hemoglobin 11 g/dL (12 to 16 g/dL) Hematocrit 34% (37% to 47%) Aspartate aminotransferase (AST) 135 units/L (0 to 35 units/L) Alanine aminotransferase (ALT) 150 units/L (4 to 36 units/L) Alkaline phosphatase (ALP) 301 units/L (30 to 120 units/L) Ammonia 236 mcg/dL (10 to 80 mcg/dL) Total bilirubin 9.7 mg/dL (0.3 to 1.0 mg/dL) Albumin 2.5 g/dL (3.5 to 5 g/dL) Total protein 5.0 g/dL (6.4 to 8.3 g/dL) Prothrombin time 12.4 seconds (11.0 to 12.5 seconds) Glucose 180 mg/dL (74 to 106 mg/dL) Vital Signs: 0800: Temperature 37.2o C (98.9o F) Heart rate 92/min Respiratory rate 22/min Blood pressure 140/92 mm Hg SaO2 94% on 2 L oxygen via nasal cannula Physical Examination: 0800: Client is difficult to arouse and is disoriented to person, place, and time Lung sounds clear, no shortness of breath noted Bowel sounds active in all 4 quadrants, abdomen soft and slightly distended Skin intact, no petechiae or bruising noted. 2+ edema to legs bilaterally Jaundice to sclerae bilaterally Client denies pain Nurse's Notes: 0830: Client refuses breakfast; is agitated and disoriented. Assisted to commode. Had large soft stool, urine is dark yellow. A nurse notes the client's condition and initiates the following action. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

The nurse should identify that the client is most likely experiencing encephalopathy related to cirrhosis. Encephalopathy can lead to seizures and coma and is life-threatening if not treated. Increased ammonia levels lead to encephalopathy, which can cause alterations in mental status and motor disturbances, including asterixis, an involuntary flapping of hands. Lactulose is given to decrease ammonia by expelling it in the stool. The nurse should expect two to three soft stools per day from the lactulose and should notify the provider if liquid stools develop. The nurse should frequently monitor the client's neurological status to promptly recognize any further progression of confusion. The nurse should also ensure appropriate safety measures are in place to keep the client safe from injury.

A nurse in an emergency department is caring for a 52-year-old male client. Nurses' Notes: The client reports new onset of thirst and increased hunger. Client states they need to urinate frequently during the day and wake up 2 to 3 times during the night to urinate. 1 cm (0.4 in) stage 2 pressure injury noted on plantar area of left foot. Client states pressure injury has been present for 2 weeks and is not healing. Client's BMI is 30 Diagnostic Results: HbA1c 6.6% (4% to 5.9%) Fasting blood glucose 120 mg/dL (70 mg/dL to 110 mg/dL) HDL 25 mg/dL (greater than 45 mg/dL) Triglyceride 275 mg/dL (40 mg/dL to 160 mg/dL) Prostate-specific antigen (PSA) 2.4 ng/mL (0 ng/mL to 2.5 ng/mL) Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

The nurse should request a referral with a registered dietician and request a prescription for an insulin stimulator because the client is most likely experiencing type 2 diabetes mellitus. The nurse should monitor the client's serum glucose and glycosylated hemoglobin assay to regulate the client's glucose level and assess the client's progress.

A nurse is caring for a client who is being admitted to the medical-surgical unit from the emergency department. The nurse is reviewing the client's medical records. Diagnostic Results: HbA1c 8.4% (less than 7% for diabetics) Blood glucose 235 mg/dL (74 to 106 mg/dL) Hemoglobin 14.2 g/dL (12 to 18 g/dL) Hematocrit 42.6% (37 to 52%) Total WBC count 6000/mm3 (5000 to 10,000/mm3) HDL 75 mg/dL (greater than 55 mg/dL) LDL 124 mg/dL (less than 130 mg/dL) BNP 52 pg/ml (less than 100 pg/mL) Chest x-ray: Clear. No evidence of infiltrates. Medication Administration Record: Glargine U 100 25 units subcutaneous at bedtime Fingerstick/random blood glucose before breakfast & bedtime with regular insulin subcutaneous sliding scale coverage: Less than 160 mg/dL: no coverage160 to 220 mg/dL: 2 units221 to 280 mg/dL: 3 units281 to 340 mg/dL: 6 units341to 400 mg/dL: 8 unit Greater than 400: call physician Aldactone 50 mg PO twice daily Digoxin 0.25 mg PO every morning Carvedilol 25 mg PO twice daily Vital Signs BP 120/72 mm Hg Temperature 36.8º C (98.2º F) Pulse rate 88/min Respirations 20/min Nurses' Notes: Client received to emergency department from home via private vehicle. Reports fatigue, blurred vision, dizziness, and headache x 2 days. Reports running out of blood glucose strips and Humulin regular insulin due to lack of financial means. States that they are afraid of possible falls from fatigue and dizziness. Lives at home alone. Orders received; will increase glargine from 20 units to 25 units at bedtime. Other meds taken at home remain the same at this time. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

The nurse should teach the client signs of hyperglycemia and assess their feet for sensation because the client is most likely experience type 1 diabetes mellitus because the HgA1c is elevated to a level indicating only fair diabetic control and the fingerstick blood glucose level is high, which is indicative of diabetes. The nurse will need to assess for the potential diabetic complication of peripheral neuropathy in the feet. The nurse should monitor urinary output and fingerstick blood glucose. This will allow the nurse to determine whether the medication and diet are effective in controlling the client's glucose levels.

A patient with CKD is brought to the ER with Kussmaul respirations. What does the RN know about CKD that could cause this?

They are caused by respiratory compensation for metabolic acidosis

To prevent the most common serious complication of PD, what is important for the nurse to do? a. Infuse the dialysate slowly. b. Use strict aseptic technique in the dialysis procedures. c. Have the patient empty the bowel before the inflow phase. d. Reposition the patient frequently and promote deep breathing.

b. Use strict aseptic technique in the dialysis procedures.