PN 140 Test 4 Practice Questions

In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and bladder. The nurse should assess the client further for signs of: 1. Nephritis. 2. Referred pain. 3. Urine retention. 4. Additional stone formation.

2. The pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients and to the testicles in male clients. Nausea, vomiting, abdominal cramping, and diarrhea may also be present. Nephritis or urine retention is an unlikely cause of the referred pain. The type of pain described in this situation is unlikely to be caused by additional stone formation.

A client is admitted to the hospital with a diagnosis of renal calculi. The client is experiencing severe flank pain and nausea; the temperature is 100.6 ° F (38.1 ° C). Which of the following would be a priority outcome for this client? 1. Prevention of urinary tract complications. 2. Alleviation of nausea. 3. Alleviation of pain. 4. Maintenance of fluid and electrolyte balance.

3. The priority nursing goal for this client is to alleviate the pain, which can be excruciating. Prevention of urinary tract complications and alleviation of nausea are appropriate throughout the client's hospitalization, but relief of the severe pain is a priority. The client is at little risk for fluid and electrolyte imbalance.

The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. To prepare the client for this procedure, the nurse should explain to the client that: 1. Fluid and food will be withheld the morning of the examination. 2. A tranquilizer will be given before the examination. 3. An enema will be given before the examination. 4. No special preparation is required for the examination.

4. A KUB radiographic examination ordinarily requires no preparation. It is usually done while the client lies supine and does not involve the use of radiopaque substances.

A client who was tested for human immunodeficiency virus (HIV) after a recent exposure had a negative result. During the post-test counseling session, the nurse tells the client which of the following? a) the test should be repeated in 6 months b) this ensures that the client is not infected with the HIV virus c) the client no longer needs to protect himself from sexual partners d) the client probably has immunity to the acquired immunodeficiency virus

A A negative test result indicates that no HIV antibodies were detected in the blood sample. A repeated test in 6 months is recommended because false-negative test results have occurred early in the infection. Options B, C, and D are incorrect.

During the past 6 months, a client diagnosed with acquired immunodeficiency syndrome has had chronic diarrhea and has lost 18 pounds. Additional assessment findings include tented skin turgor, dry mucous membranes, and listleness. Which nursing diagnosis focuses attention on the client's most immediate problem? A. Deficient fluid volume related to diarrhea and abnormal fluid loss B. Imbalanced nutrition: less than body requirements related to nausea and vomiting C. Disturbed thought processes related to central nervous system effects of disease D. Diarrhea related to the disease process and acute infection

A Based on the client's assessment findings, the most immediate problem is dehydration because of chronic diarrhea. The nursing diagnosis of deficient fluid volume is the priority, and interventions are geared to improving the client's fluid status. Although imbalanced nutrition, disturbed thought processes, and diarrhea are involved, they assume a lower priority at this time.

A client is diagnosed with human immunodeficiency virus (HIV) infection. The nurse prepares a care plan for the client, knowing that HIV is primarily a condition in which: a) immunosuppression occurs and is indicated by a CD4 count of less than 200/mm3 b) bacterial infection occurs, causing weakness c) fungal infection occurs, causing a rash and pruritus d) protozoan infection occurs, causing a fever and nonproductive cough

A HIV infection causes immunosuppression and is indicated by a CD4 count of less than 200/mm3. Although bacterial, fungal, and protozoal infection can occur, these occur as opportunistic infections as a result of the immunosuppression.

A client with acquired immunodeficiency syndrome (AIDS) is experiencing shortness of breath related to Pneumocystis jiroveci pneumonia. Which measure should the nurse include in the plan of care to assist the client in performing activities of daily living? a) provide supportive care with hygiene needs b) provide meals and snacks with high-protein, high calorie, and high-nutritional value c) provide small, frequent meals d) instruct patient to wash hands before eating

A Providing supportive care with hygiene needs as needed reduces the client's physical and emotional energy demands and conserves energy resources for other functions such as breathing. Options B, C, and D are important interventions for the client with AIDS but do not address the subject of activities of daily living. Option B will assist the client in maintaining appropriate weight and proper nutrition. Option C will assist the client in tolerating meals better. Option D will decrease the client's risk of infection.

Which member of the health care team demonstrates reducing the risk for infection for the client with acquired immunodeficiency syndrome (AIDS)? A) The dietary worker hands the disposable meal trays to the LPN assigned to the client. B) The social worker encourages the client to verbalize about stressors at home. C) Housekeeping thoroughly cleans and disinfects the hallways near the client's room. D) Health care provider orders vital signs including temperature every 8 hours.

A) The dietary worker hands the disposable meal trays to the LPN assigned to the client. Rationale: This limits the number of health care personnel entering the room. Incorrect: B) The social worker encourages the client to verbalize about stressors at home. Rationale: Verbalizing stressors does not reduce the risk for infection. C) Housekeeping thoroughly cleans and disinfects the hallways near the client's room. Rationale: Bathrooms, not hallways, that are cleaned at least once daily by housekeeping reduces infection. D) Health care provider orders vital signs including temperature every 8 hours. Rationale Vital signs, including temperature, should be taken every 4 hours to detect potential infection.

When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. "I will need to isolate any tissues I use so as not to infect my family." B. "I will notify all of my sexual partners so they can get tested for HIV." C. "Unprotected sexual contact is the most common mode of transmission." D. "I do not need to worry about spreading this virus to others by sweating at the gym."

A. "I will need to isolate any tissues I use so as not to infect my family." HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? A. Delaying disease progression B. Preventing disease transmission C. Helping to cure the HIV infection D. Enabling an increase in self-care activities

A. Delaying disease progression These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities

A patient who has tested positive for the human immunodeficiency virus (HIV) arrives at the clinic with a report of fever, nonproductive cough, and fatigue. The patient's CD4 count is 184 cells/mcL. How should the healthcare provider interpret these findings? Please choose from one of the following options. A. The patient is diagnosed with acquired immunodeficiency syndrome (AIDS). B.The patient is now in the latent stages of HIV infection C.These findings provide evidence that the patient has seroconverted. D. This is an expected finding because the patient has tested positive for HIV.

A. The patient is diagnosed with acquired immunodeficiency syndrome (AIDS).

A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

ANS: A After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

ANS: A Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.

ANS: C After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. blood in the urine. b. lower back or hip pain. c. erectile dysfunction (ED). d. strength of the urinary stream.

ANS: D The American Urological Association (AUA) Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms of BPH.

Several children at a daycare center have been infected with hepatitis A virus. Which instruction by the nurse would reduce the risk of hepatitis A to the other children and staff members? 1. Hand washing after diaper changes 2. Isolation of the sick children 3. Use of masks during contact with the children 4. Sterilization of all eating utensils"

Answer 1 Rationale: children in day care centers are at risk for hepatits A infection which is transmitted via fecal-oral route due to poor hand hygeine practices and poor sanitation. Isolation of sick children, use of mask during contact, and sterilization of all eating utensils would not be useful in breaking the chain of infection.

The physican has determine the client with Hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

Answer 1: Hepatitis A is the correct answer because it is transmitted by the oral-fecal route, via contaminated food or food handlers. B, C, and D are transmitted most commonly via infected body fluids

The nurse sticks herself with a dirty needle. Which action should the nurse implement first? 1.Notify the infection control nurse. 2.Cleanse the area with soap and water. 3.Request post-exposure prophylaxis. 4.Check the hepatitis status of the client.

Answer 2. The nurse should first clean the needle stick with soap and water to help remove any virus that is on the skin

The LPN is providing discharge information to a client with hep B. The LPN instructs the client to prevent transmission via: a. airborne pathogens 2. blood and body secretions 3. skin contact 4. fecal and oral routes

Answer 2: Hep b is transmitted via blood and body secretions. The LPN instructs the client to prevent transmission through correct use of latex condoms, and by not sharing personal care items that may have blood on them. Diseases such as pneumonia are spread by airborne pathogens, hep A is spread by fecal and oral routes. Hep B is not transmitted by skin contact.

Which statement by the client diagnosed with hepatitis warrants immediate intervention by the clinic nurse? 1) I will not drink any type of beer or mixed drink. 2)I will get adequate rest so I don't get exhausted. 3) I had a big hearty breakfast this morning. 4) I took some cough syrup for this nasty head cold.

Answer 4: Rationale: 1) The client should avoid all alcohol to prevent further liver damage and promote healing. 2) Rest is needed for healing of the liver and to promote optimum immune function. 3) Clients with hepatitis need increased caloric intake so this is a good statement. 4)The client needs to understand some types of cough syrup have alcohol and all alcohol must be avoided to prevent further injury to the liver; therefore, this statement requires intervention"

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? a. "You may have eaten contaminated restaurant food." b. "You could have gotten it by using I.V. drugs." c. "You must have received an infected blood transfusion." d. "You probably got it by engaging in unprotected sex.""

Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex."

Nurse Jaja is giving an injection to Ms. X. After giving an injection, the nurse accidentally stuck her finger with the needle when the client became very agitated. To determine if the nurse became infected with HIV when is the best time to test her for HIV antibodies? a. Immediately and repeat the test after 12 weeks b. Immediately and repeat the test after 4 weeks c. After a week and repeat the test in 4 months d. After a weeks and repeat the test in 6 months

Answer A. Keyword: BEST TIME. Rationale: To determine if a preexisting infection is present a test should be done immediately and is repeated again in 3 months time (12 weeks) to detect seroconversion as a result of the needle stick.

A client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? a. Select foods high in fat b. Increase intake of fluids, including juices. c. Eat a good supper when anorexia is not as severe. d. Eat less often, preferably only three large meals daily."

Answer B : Although no special diet is required to treat viral hepatitis, it is generally recommended that clients consume a low-fat diet because fat may be tolerated poorly because of decreased bile production. Small frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morining, so it is easier to eat a good breakfast. An adequated fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.

The blood test first used to identify a response to HIV infection is: a. Western blot b. ELISA test c. CD4+ T-cell count d. CBC

Answer B. Keyword: FIRST. Rationale: The ELISA test is the first screening test for HIV. A Western blot test confirms a positive ELISA test. Other blood tests that support the diagnosis of HIV include CD4+ and CD8 + counts, CBC, immunoglobulin levels, p24 antigen assay, and quantitative ribonucleic acid assays.

What is the main reason why it is difficult to develop a vaccine against HIV? a. HIV is still unknown to human b. HIV mutates easily c. HIV spreads rapidly throughout the body d. HIV matures easily

Answer B. Keyword: MAIN REASON. Rationale: HIV was identified in 1983, thus, A is incorrect. By 1988 two strains of HIV existed, HIV-1 and HIV-2. Viruses spread rapidly and mature easily but these factors don't affect the potential for development against HIV. Mutating too easily makes it hard to create a vaccine against it.

The nurse observes precaution in caring for Mr. X as HIV is most easily transmitted in: a. Vaginal secretions and urine b. Breast milk and tears c. Feces and saliva d. Blood and semen

Answer D. Keyword: MOST EASILY. Rationale: HIV is MOST EASILY transmitted in blood, semen and vaginal secretions. However, it has been noted to be found in fecal materials, urine, saliva, tears and breast milk.

A patient scheduled for a transurethral resection of the prostate (TURP) for BPH tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur. b. information about penile implants used for ED is available if he is interested. c. there are many methods of sexual expression that can be alternatives to sexual intercourse. d. sterility will not be a problem after surgery because sperm production will not be affected.

Answer: A Rationale: Erectile problems are rare, but retrograde ejaculation may occur after TURP. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.

You are administering erythropoietin to the patient with CKF. Which of the following would be a sign of adverse reaction? SATA A) Seizure B) Hypertension C) Decreased u/o D) Improved exercise tolerance E) Headache

Answer: A, B, and E. Seizures, Hypertension, HA, arthralgia, nausea, increased clotting of vascular access sites, seizures, and depletion of body iron stores are adverse effects of administering erythropoietin. Decreased u/o is a symptom of the disease process. Improved exercise tolerance would be a benefit of this medication.

The nurse is performing peritoneal dialysis and infuses 2 L of fluid into the patient. The drainage is measured to be only 1800 ml. What is the nurse's priority action? A) Raise the head of the bed B) Administer 02 C) Call the doctor D) Infuse 200 ml

Answer: A. Repositioning the patient, often by sitting the client up, can help facilitate draining. The nurse can also turn the patient from side to side. The patency of the catheter should be inspected by looking for kinks, closed clamps, or an air lock. If none of these methods help pull off the extra fluid the doctor should be notified. Administering O2 is not needed unless the patient shows signs of difficulty breathing. Infusing extra fluid would make the situation worse

During an admission assessment, the nurse notes a client with hepatitis exhibits all of the following signs or symptoms. Which one is not related to hepatitis? A. Anorexia B. Bloody stools C. Dark urine D. Yellow sclera

Answer: B RATIONALE (A) Anorexia is an expected assessment finding with hepatitis. (B) Rectal bleeding is not related to hepatitis. Further assessment 358 Clinical Specialties: Content Reviews and Testsis needed to identify the cause. (C) Dark urine is an expected assessment finding with hepatitis and is a result of increased serum bilirubin being excreted by the kidneys. (D) Yellow sclera is a sign of jaundice and is an expected assessment finding with hepatitis. Jaundice is caused by increased serum bilirubin

The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate? a. "The bladder irrigation is needed to stop the postoperative bleeding in the bladder." b. "The irrigation is needed to keep the catheter from being occluded by blood clots." c. "Normal production of urine is maintained with the irrigations until healing occurs." d. "Antibiotics are being administered into the bladder with the irrigation solution."

Answer: B Rationale: The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or maintain urine production. Antibiotics are given by the IV route, not through the bladder irrigation.

The patient with ESRD arrives to the clinic ready for his peritoneal dialysis. He says "I am not very happy about being here today" This patient has a history of severe hypertension, heart failure, pulmonary edema, diabetes, A-fib, hyperlipidemia, CAD and has recently been diagnosed with osteoporosis. His vitals today are BP 145/70, HR 99, T 99.7 O2 94%. Which piece of patient data does the nurse need to pay most attention to right before beginning dialysis? A) The patient's anxiety B) Hx of diabetes C) BP 145/70 D) Hx of A-fib

Answer: B. It is important for the nurse to closely monitor the patient's glucose level because peritoneal dialysis uses solutions containing glucose. Insulin will probably need to be administered

Nurse Heather is looking over the patient chart and is preparing to administer erythropoietin to the patient with CKF. Which of the following pieces of information in the chart would cause Nurse Heather to question this order? A) Hgb of 9 B) Hx of uncontrolled HTN C) Pt. complains of fatigue D) Ferric Gluconate (Ferrlecit) is also ordered

Answer: B. Erythropoietin is used to treat anemia associated with chronic kidney disease. Uncontrolled HTN is a contraindication to this therapy because erythropoietin can severely raise BP. HGB of 9 is considered to be low, and would be an indication for the use of this medication. The HGB should not exceed 12. Fatigue is treated with this medication. Iron supplementation, ferric gluconate, is often ordered alongside erythropoietin to provide an adequate response.

The nurse is performing peritoneal dialysis exchange on the patient with CKF. This is the first peritoneal dialysis treatment. The nurse inspects the drainage. Which should the nurse report to the physician immediately? A) Bloody drainage B) More than 2 L of drainage C) Cloudy drainage D) Glucose in drainage

Answer: C. Cloudy drainage is abnormal as the drainage after peritoneal dialysis should be clear and colorless. Having bloody drainage after the insertion of a new catheter is normal and is expected on the first few exchanges. Having more than 2 L of drainage and have glucose in the drainage is to be expected.

You are working at a dialysis center and are taking care of Ms. Hector. She has a history of diabetes, CKF, and HTN. She says "I hate having to come here all the time. Can't I just do this stuff at home?" What is the nurse's best response? A) "Yes, home hemodialysis is an option for you. In fact, we can start setting you up within the next week" B) "In order to have hemodialysis you need to have friends or family to help you. Do you even have any friends?" C) "Home hemodialysis is a possibility but it will be necessary to inspect your home" D) "Because of your preexisting conditions, you would not be a good candidate for home dialysis"

Answer: C. Home dialysis is an option for some people, but requires extensive training, home inspection, and support system. It would not be feasible to set up Ms. Hector with home hemodialysis within the next week. Although she does have preexisting conditions, none of the ones listed would be a barrier to her performing home hemodialysis. Asking her if she has any friends is just plain mean.

A patient with CKF arrives for his dialysis treatment complaining of muscle aches and digestive upset. He also says "my skin has been feeling itchy and gets red if I scratch too much" The patients vitals are BP 146/73 HR 89 RR 24 T 99.5 Spo2 94%. The nurse suspects which of the following? A) The patient is experiencing adverse reaction from his erythropoietin B) Most likely a clot has formed at the dialysis access, broken off, and spread systemically C) These signs indicate worsening CKF. Dialysis treatment may need to be adjusted D) The patient is experiencing a rejection reaction from the dialysis procedures

Answer: C. The patient's symptoms are indicative of rising uric acid levels in the blood stream, indicating that the dialysis treatment may need to be adjusted. These s/s are not indicative of erythropoietin adverse effects or emboli formation. Oh and I just made up rejection reaction so I'm pretty sure that's not a thing.

You are teaching the patient starting hemodialysis. Which statement, if made by the patient, indicates the need for further teaching? A) "To protect my fistula I shouldn't wear tight fitting clothing on that side" B) "If I see any redness or swelling on the site I should call my doctor" C) "I shouldn't sleep on my side with the graft but it's ok to take a blood pressure on that arm" D) "I need to wait to take my medications until after my dialysis treatment"

Answer: C. It is not ok to take a blood pressure on the side with the dialysis site. The patient should also be taught to avoid tight fitting clothes, blood draws, iv insertions, carrying bags/pocketbooks, or sleeping on the affected side. Redness and swelling are signs of infection that should be reported to the doctor. Because hemodialysis can cause medication accumulation and toxicity patients are advised to take daily medications after dialysis treatment.

A patient undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The patient is complaining of painful bladder spasms. The most appropriate action by the nurse is to a. administer the ordered IV morphine sulfate, 4 mg. b. increase the flow rate of the continuous bladder irrigation. c. give the ordered the belladonna and opium suppository. d. manually instill 50 ml of saline and try to remove the clots.

Answer: D Rationale: The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.

The nurse is taking care of the patient with chronic kidney disease. Which of the following meal trays would be the best for this patient? A) Whole grain roll with baked chicken and pea soup and milk B) Sandwich with smoked salmon lunchmeat, green beans, and banana pudding C) Baked ham, mashed potatoes, tomato soup and peanut butter cookies D) Low-sodium chicken noodle soup, apple slices, white-wheat roll, and rice

Answer: D. This tray contains a small amount of protein and an adequate amount of carbohydrates that are low in sodium and potassium. Although a whole-grain roll would be appropriate with baked chicken. Pea soup and the milk would be high in potassium and protein. Smoked meats are often high in sodium. Tomato soup and peanut butter would add extra potassium and protein to this patient's diet

After the first injection of an immunotherapy program, the nurse notices a large, red wheal on the client's arm, coughing, and expiratory wheezing. Which intervention should the nurse implement first? A. Notifying the health care provider immediately B. Administering I.M. epinephrine per protocol C. Beginning oxygen by way of nasal cannula D. Starting an I.V. line for medication administration

B Immediately on noticing the client's sign and symptoms, the nurse would determine that the client is experiencing anaphylaxis to the injection. The first action is to give 0.2 to 0.5 ml of 1:1,000 epinephrine I.M. Notifying the health care provider, beginning oxygen administration, and starting an I.V. line follow after the initial injection of epinephrine is administered.

Which client problem relating to altered nutrition is a consequence of AIDS? A. Increased appetite B. Decreased protein absorption C. Increased secretions of digestive juices D. Decreased gastrointestinal absorption

B Often the complications of the acquired immunodeficiency syndrome (AIDS) have a negative impact on nutritional status. Weight loss and protein depletion are commonly seen among the AIDS population.

To prevent the spread of hepatitis A virus, the nurse is especially careful when A. Disposing of food trays B. Emptying bed pans C. Taking an oral temperature D. Changing IV

B HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A.

The home health nurse is making an initial home visit to the client currently living with family members after being hospitalized with pneumonia and newly diagnosed with AIDS. Which statement by the nurse best acknowledges the client's fear of discovery by his family? A) ''Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?'' B) ''Is there somewhere private in the home we can go and talk?'' C) ''I hope that all of your family members know about your disease and how you need to be protected, since you have been so sick.'' D) ''It is your duty to protect your family members from getting AIDS.''

B) ''Is there somewhere private in the home we can go and talk?'' Rationale: A nonthreatening approach initially to find out whether the client has informed family members or desires privacy is very important. Incorrect: A) ''Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?'' Rationale: The client has a right to privacy and can make the decision whether to post handwashing signs. Caution signs invade the client's right to privacy. C) ''I hope that all of your family members know about your disease and how you need to be protected, since you have been so sick.'' Rationale: Protection from infection is important, but this approach is not respectful of the client's right to privacy. D) ''It is your duty to protect your family members from getting AIDS.'' Rationale: This statement by the nurse is rather intimidating. It is the client's right whether he wants to make the decision to inform or not inform family members about their illness. However, this ''nonaction'' could be grounds for a lawsuit if the client were to infect someone inadvertently.

Which statement made to the nurse by a health care worker assigned to care for the client with HIV indicates a breach of confidentiality and requires further education by the nurse? A) ''I told the family members they needed to wash their hands when they enter and leave the room.'' B) ''The other health care worker and I were out in the hallway discussing how we were concerned about getting HIV from our client, so no one could hear us in the client's room.'' C) ''Yes, I understand the reasons why I have to wear gloves when I bathe my client.'' D) ''The client's spouse told me she got HIV from a blood transfusion.

B) ''The other health care worker and I were out in the hallway discussing how we were concerned about getting HIV from our client, so no one could hear us in the client's room.'' Rationale: Discussing this client's illness outside the client's room is a breach of confidentiality. Incorrect: A) ''I told the family members they needed to wash their hands when they enter and leave the room.'' Rationale: Instruction on handwashing to family members or friends is not a breach of confidentiality. C) ''Yes, I understand the reasons why I have to wear gloves when I bathe my client.'' Rationale: This recognizes standard precautions in direct care, and is not a breach of confidentiality. D) ''The client's spouse told me she got HIV from a blood transfusion.'' Rationale: The health care worker assigned is relaying the conversation to the nurse. This is not a breach of confidentiality

The patient is admitted to the ED with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply)? A. Assessment of lung sounds B. Assessment of sexual behavior C. Assessment of living conditions D. Assessment of drug and syringe use E. Assessment of exposure to an ill person

B. Assessment of sexual behavior D. Assessment of drug and syringe use With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the HIV virus should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB).

The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manage

B. Combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time? A. Report hematuria to the physician B. Strain the urine carefully C. Administer meperidine (Demerol) every 3 hours D. Apply warm compresses to the flank area

B. Strain the urine carefully Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessened.

A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? A. Together they will cure HIV. B. Viral replication will be inhibited. C. They will decrease CD4+ T cell counts. D. It will prevent interaction with other drugs

B. Viral replication will be inhibited. The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

Which intervention should the nurse implement when caring for a client diagnosed with Pneumocystis carinii pneumonia related to acquired immunodeficiency syndrome who is crying over the loss of friends and family members because they will not talk to him anymore? A. Advising the client not to worry, and telling him everything will be alright B. Asking the health care provider for a psychiatric consult to assess the client's mental functioning C. Sitting down and listening to the client's concerns and frustrations D. Telling the client that the friends probably were not true friends anyway

C Crying is evidence that the client is beginning to express concerns to the nurse. In response, active, nonjudgmental listening would most appropriate because is aids in the development of a trusting relationship. Advising the client not to worry or saying that everything will be alright provides false reassurance, which does not help the client cope. Further assessment is needed to determine whether a psychiatric consult should be considered. Telling the client that the friends were not true friends discounts the client's feeling and hinders the development of a therapeutic relationship.

A client is diagnosed with late stage human immunodeficiency virus (HIV), and the client and family are extremely upset about the diagnosis. The priority psychosocial nursing intervention for the client and family is to: a) tell the client and family to stop smoking because it will predispose the client to respiratory infections b) tell the client and family that raw or improperly washed foods can produce microbes c) encourage the client and family to discuss their feelings about the disease d) advise the client to avoid becoming pregnant because of the risk of transmission of the infection

C The priority psychosocial nursing intervention for the client and family is to encourage the client and family to discuss their feelings about the disease. Options A, B, and D identify physiological not psychosocial concerns.

A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. "The baby will probably be infected with HIV." B. "Only an abortion will keep your baby from having HIV." C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.

The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count

C. A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

The woman is afraid she may get HIV from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis (select all that apply)? A. Take fluconazole (Diflucan). B. Take amphotericin B (Fungizone). C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband.

C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband. Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly has shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associate with HIV infection

The nurse instructs a client diagnosed with hepatitis A about untoward signs and symptoms related to hepatitis that may develop. The one that should be reported to the practitioner is: 1)Fatigue 2)Anorexia 3)Yellow urine 4)Clay-covered stools

Correct 4 Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines.

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following? 1. Malaise 2. Dark stools 3. Weight gain 4. Left upper quadrant discomfort"

Correct Answer 1 Rationale: Hepatitis causes GI symptoms such as anorexia, nausea, right upper quadrant discomfort and weight loss. Fatigue and malaise are common. Stools will be light or clay colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis ? A.Elevate hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreased erythrocyte sedimentation rate

Correct Answer B Laboratory indicator of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels.Thinking about the organ that is involved in hepatitis should assist in directing to choose option B liver function test.

What type of precaution should the nurse implement to protect from being exposed to any of the hepatitis viruses? A. Airborne Precautions. B. Standard Precautions. C. Droplet Precautions. D. Exposure Precautions.

Correct Answer B: Standard precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood. Airborne Precautions are only for airborne droplet nuclei or dust particles, Droplet precaution involves large particle droplets in the mucus membranes, and Exposure precaution is not a designated isolation category.

A health care provider who has not been immunized for hepatitis B is exposed to the hepatitis B virus (HBV) through a needle stick from an infected patient. The infection control nurse informs the individual that treatment for the exposure should include: a. baseline hepatitis B antibody testing now and in 2 months. b. active immunization with hepatitis B vaccine. c. hepatitis B immune globulin (HBIG) injection. d. both the hepatitis B vaccine and HBIG injection.

Correct D The recommended treatment for exposure to hepatitis B in unvaccinated individuals is to receive both HBIG and the hepatitis B vaccine, which would provide temporary passive immunity and promote active immunity. Antibody testing may also be done, but this would not provide protection from the exposure.

Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

Correct answer: 1 Rationale: 1. The hepatitis A virus is in the stool of infected people for up to 2 weeks before symptoms develop 2. Hepatitis B is spread through contact with infected blood and body fluids 3. Hepatitis C is transmitted through contact with infected blood and body fluids 4. Hepatitis D infection only causes infection in people who are also infected with Hepatitis B or C

A diagnosis of AIDS is made when an HIV-infected patient has a. a CD4+ T cell count below 200/µL. b. a high level of HIV in the blood and saliva. c. lipodystrophy with metabolic abnormalities. d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.

Correct answer: A Rationale: AIDS is diagnosed when an individual with HIV infection meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/L. Other criteria are listed in Table 15-9.

Transmission of HIV from an infected individual to another most commonly occurs as a result of a. unprotected anal or vaginal sexual intercourse. b. low levels of virus in the blood and high levels of CD4+ T cells. c. transmission from mother to infant during labor and delivery and breastfeeding. d. sharing of drug-using equipment, including pipes and straws

Correct answer: A Rationale: Unprotected sexual contact (semen, vaginal secretions, or blood) with a partner

During HIV infection a. the virus replicates mainly in B-cells before spreading to CD4+ T cells. b. infection of monocytes may occur, but antibodies quickly destroy these cells. c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication

Correct answer: C Rationale: Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes)

Antiretroviral drugs are used to a. cure acute HIV infection. b. decrease viral RNA levels. c. treat opportunistic diseases. d. decrease pain and symptoms in terminal disease.

Correct answer: b Rationale: The goals of drug therapy in HIV infection are to (1) decrease the viral load, (2) maintain or raise CD4+ T cell counts, and (3) delay onset of HIV infection-related symptoms and opportunistic diseases.

Opportunistic diseases in HIV infection a. are usually benign. b. are generally slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.

Correct answer: c Rationale: Management of HIV infection is complicated by the many opportunistic diseases that can develop as the immune system deteriorates.

Screening for HIV infection generally involves a. laboratory analysis of blood to detect HIV antigen. b. electrophoretic analysis for HIV antigen in plasma. c. laboratory analysis of blood to detect HIV antibodies. d. analysis of lymph tissues for the presence of HIV RNA.

Correct answer: c Rationale: The most useful screening tests for HIV detect HIV-specific antibodies

Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low

Correct answers: a, b, c Rationale: The typical course of untreated HIV infection follows a predictable pattern. However, treatment can significantly alter this pattern, and disease progression is highly individualized. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.

Which statement about metabolic side effects of ART is true (select all that apply)? a. These are annoying symptoms that are ultimately harmless. b. ART-related body changes include central fat accumulation and peripheral wasting. c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. e. Compared to uninfected people, insulin resistance and hyperlipidemia are more difficult

Correct answers: b, c, d Rationale: Some HIV-infected patients, especially those who have been infected and have received ART for a long time, develop a set of metabolic disorders that include changes in body shape (e.g., fat deposits in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face) as a result of lipodystrophy, hyperlipidemia (i.e., elevated triglyceride levels and decreases in high-density lipoprotein levels), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease.

A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to: A. Avoid alcohol for the first 3 weeks B.use condoms during sexual intercourse C. have family members get an injection of immunoglobulin D. follow low protein, moderate carb, moderate fat diet"

Correct: B B. is the correct answer as it is important to instruct the patient they this disease can be spread through sexual contact

The decision to begin antiretroviral therapy is based on: A. The CD4 cell count B. The plasma viral load C. The intensity of the patient's clinical symptoms D. All of the above

D A person's CD4 count is an important factor in the decision to start ART. A low or falling CD4 count indicates that HIV is advancing and damaging the immune system. A rapidly decreasing CD4 count increases the urgency to start ART. Regardless of CD4 count, there is greater urgency to start ART when a person has a high viral load or any of the following conditions: pregnancy, AIDS, and certain HIV-related illnesses and co infections.

For a male client who has acquired immunodeficiency syndrome with chronic diarrhea, anorexia, a history of oral candidiasis, and weight loss, which dietary instruction would be included in the teaching plan? A. "Follow a low-protein, high-carbohydrate diet." B. "Eat three large meals per day." C. "Include unpasteurized dairy products in the diet." D. "Follow a high-protein, high-calorie diet.

D Dietary instructions should include the need for a high-protein, high-calorie diet. The patient should be taught to eat small, frequent meals and include low-microbial foods, such as pasteurized dairy products, washed and peeled fruits and vegetables, and well-cooked meats.

As a knowledgeable nurse, you know that the primary goals of antiretroviral therapy (ART) include all, EXCEPT: A. Reduce HIV-associated morbidity and prolong the duration and quality of survival B. Restore and preserve immunologic function C. Maximally and durably suppress plasma HIV viral load D. Elimination of HIV entirely from the body

D Eradication of HIV infection cannot be achieved with available antiretroviral (ARV) regimens even when new, potent drugs are added to a regimen that is already suppressing plasma viral load below the limits of detection of commercially available assays.

A client with acquired immunodeficiency syndrome (AIDS) has a nursing diagnosis of Imbalanced nutrition: less than body requirements. The nurse plans which of the following goals with this client? a) consume foods and beverages that are high in glucose b) plan large menus and cook meals in advance c) eat low-calorie snacks between meals d) eat small, frequent meals throughout the day

D The client should eat small, frequent meals throughout the day. The client also should take in nutrient-dense and high-calorie meals and snacks rather than those that are high in glucose only. The client is encouraged to eat favorite foods to keep intake up and plan meals that are easy to prepare. The client can also avoid taking fluids with meals to increase food intake before satiety sets in.

Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD)? Select all that apply. a. Anemia b. Dehydration c. Hypertension d. Hypercalcemia e. Increased risk for fractures f. Elevated white blood cells

a. Anemia c. Hypertension e. Increased risk for fractures When the kidney fails, erythropoietin in not excreted, so anemia is expected. Hypocalcemia from chronic renal disease stimulates the parathyroid to release parathyroid hormone, causing calcium liberation from bones increasing the risk of pathological fracture. Dehydration and hypercalcemia are not expected in chronic renal disease. Fluid volume overload and hypocalcemia are expected. Although impaired immune function should be expected, elevated white blood cells would indicate inflammation or infection not associated with chronic renal failure itself but a complication.

A 78-yr-old patient has stage 3 CKD and is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? a. Apple, green beans, and a roast beef sandwich b. Granola made with dried fruits, nuts, and seeds c. Watermelon and ice cream with chocolate sauce d. Bran cereal with ½ banana and milk and orange juice

a. Apple, green beans, and a roast beef sandwich When the patient selects an apple, green beans, and a roast beef sandwich, the patient demonstrates understanding of the low-potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have elevated levels of potassium, at or above 200 mg per 1/2 cup.

A 52-yr-old man with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which priority action should the nurse perform? a. Assess skin turgor to determine hydration status. b. Insert a urinary catheter for the expected diuresis. c. Evaluate the patient's lower extremities for edema. d. Check the patient's urine for the presence of ketones.

a. Assess skin turgor to determine hydration status. Preexisting kidney disease is the most important risk factor for the development of contrast-associated nephropathy and nephrotoxic injury. If contrast media must be administered to a high-risk patient, the patient needs to have optimal hydration. The nurse should assess the hydration status of the patient before the procedure is performed. Indwelling catheter use should be avoided whenever possible to decrease the risk of infection.

Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI)? Select all that apply. a. Dehydration b. Hypokalemia c. Hypernatremia d. BUN increases e. Urine output increases f. Serum creatinine increases

a. Dehydration b. Hypokalemia e. Urine output increases The hallmark of entering the diuretic phase is the production of copious amounts of urine. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Serum BUN and serum creatinine levels begin to decrease.

The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? a. Monitor the patient's cardiac status. b. Teach the patient about hand washing. c. Obtain a serum specimen for electrolytes. d. Increase direct observation of the patient.

a. Monitor the patient's cardiac status. The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as ordered by the health care provider.

A 62-year-old patient has acquired immunodeficiency syndrome (AIDS), and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? a. The patient has the virus present and can transmit the infection to others. b. The patient is not able to transmit the virus to others through sexual contact. c. The patient will be prescribed lower doses of antiretroviral medications for 2 months. d. The syndrome has been cured, and the patient will be able to discontinue all medications.

a. The patient has the virus present and can transmit the infection to others. In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" does not mean that the virus has been eliminated from the body

Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? a. "Maintain a daily written record of blood pressure and weight." b. "It is essential that you maintain aseptic technique to prevent peritonitis." c. "You will be allowed a more liberal protein diet once you complete CAPD." d. "Continue regular medical and nursing follow-up visits while performing CAPD."

b. "It is essential that you maintain aseptic technique to prevent peritonitis." Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of prevention. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality that peritonitis does.

The home care nurse visits a 34-yr-old woman receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? a. "Drain time is faster if I rub my abdomen." b. "The fluid draining from the catheter is cloudy." c. "The drainage is bloody when I have my period." d. "I wash around the catheter with soap and water."

b. "The fluid draining from the catheter is cloudy." The primary clinical manifestation of peritonitis is a cloudy peritoneal effluent. Blood may be present in the effluent of women who are menstruating, and no intervention is indicated. Daily catheter care may include washing around the catheter with soap and water. Drain time may be facilitated by gently massaging the abdomen.

Which patient has the most significant risk factors for CKD? a. A 50-yr-old white woman with hypertension b. A 61-yr-old Native American man with diabetes c. A 40-yr-old Hispanic woman with cardiovascular disease d. A 28-yr-old African American woman with a urinary tract infection

b. A 61-yr-old Native American man with diabetes The nurse identifies the 61-yr-old Native American with diabetes as the most at risk. Diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD six times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. African Americans have the highest rate of CKD because hypertension is significantly increased in African Americans. A UTI will not cause CKD unless it is not treated or UTIs occur recurrently.

A patient with end-stage renal disease (ESRD) secondary to diabetes mellitus has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? a. Level of consciousness b. Blood pressure and fluid balance c. Temperature, heart rate, and blood pressure d. Assessment for signs and symptoms of infection

b. Blood pressure and fluid balance Although all of the assessments are relevant to the care of a patient receiving hemodialysis, fluid removal during the procedure will require monitoring blood pressure and fluid balance prior, during, and after.

An 83 year old female patient was found lying on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medicine or eat or drink anything since then. What conditions could be causing prerenal AKI in the patient(select all that apply)? a. anaphlyaxis b. renal calculi c. hypovolemia d. nephrotoxic drugs e. decreased cardiac output

c,e. Because the patient has had nothing to eat or drink for 2 days, she is probably dehydrated and hypovolemic. Decreased cardiac output is most likely because she is older and takes heart medicine, wich is probably for heart failure or HTN.

A 56-yr-old woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which finding will the nurse monitor for? a. Fatigue b. Hypoglycemia c. Cardiac dysrhythmias d. Elevated triglycerides

c. Cardiac dysrhythmias Hyperkalemia is the most serious electrolyte disorder associated with kidney disease. Fatal dysrhythmias can occur when the serum potassium level reaches 7 to 8 mEq/L. Fatigue and hypertriglyceridemia may be present but do not require urgent intervention. Hypoglycemia is a complication related to diabetes control, not hyperkalemia. However, administration of insulin and dextrose is an emergency treatment for hyperkalemia.

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? a. Administer hypertonic saline. b. Administer a blood transfusion. c. Decrease the rate of fluid removal. d. Administer antiemetic medications.

c. Decrease the rate of fluid removal. The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.

The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a 56-year-old man with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications have been effective? a. Increased viral load b. Decreased neutrophil count c. Increased CD4+ T cell count d. Decreased white blood cell count

c. Increased CD4+ T cell count Antiretroviral therapy is effective if there are decreased viral loads and increased CD4+ T cell counts.

A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? a. Hypokalemia b. Hyponatremia c. Large urine output d. Leukocytosis with cloudy urine output

c. Large urine output Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

What are intrarenal causes of AKI (select all that apply)? a. anaphylaxis b. renal stones c. bladder cancer d. nephrotoxic drugs e. acute glomerulonephritis f. tubular obstruction by myoglobin

d, e, f. Intrarenal causes of AKI includes conditions that cause direct damage to the kidney tissue, including nephrotoxic drugs, acute glomerulonephritis, and tubular obstruction by myoglobin, or prolonged ischemia.

In caring for the patient with AKI, what should the nurse be aware of? a. The most common cause of death in AKI is irreversible metabolic acidosis. b. During the oliguric phase of AKI, daily fluid intake is limited to 1000 ml plus the prior day's measured fluid loss c. dietary sodium and potassium during the oliguric phase of AKI are manage according to the patient's urinary output. d. One of the most important nursing measures in managing fluid balance in the patient with AKI in taking accurate daily weights

d. Measuring daily weights with the same scale at the same time each day allows for the evaluation and detection of excessive body fluid gains or losses.

What indicates to the nurse a patient with AKI is the recovery phase? a. a return to normal weight b. a urine output of 3700 ml/day c. decreasing sodium and potassium levels d. decreasing blood urea nitrogen and creatinine levels

d. The BUN and creatinine levels remain high during oliguric and diuretic phrases of AKI. The recovery phase begins when the glomerular filtration returns to a rate at which BUN and creatinine stabilize and then decrease. Urinary output of 305 L/day, decreasing sodium and potassium levels, and fluid weight loss are characteristic of the diuretic phase of AKI

A frail 72-yr-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? a. Aspirin b. Acetaminophen c. Diphenhydramine d. Aluminum hydroxide

d. Aluminum hydroxide Antacids (that contain magnesium and aluminum) should be avoided because patients with kidney disease are unable to excrete these substances. Also, some antacids contain high levels of sodium that further increase blood pressure. Acetaminophen and aspirin (if taken for a short period of time) are usually safe for patients with kidney disease. Antihistamines may be used, but combination drugs that contain pseudoephedrine may increase blood pressure and should be avoided.

A patient with a 25-year history of type 1 diabetes mellitus is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood sugars. Which diagnostic study is most indicative of chronic kidney disease (CKD)? a. Serum creatinine b. Serum potassium c. Microalbuminuria d. Calculated glomerular filtration rate (GFR)

d. Calculated glomerular filtration rate (GFR) The best study to determine kidney function or CKD that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for 3 months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.

A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? a. Cough, diarrhea, headaches, blurred vision, muscle fatigue b. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy c. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lympadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

The nurse presents a seminar on HIV testing to a group of seniors and their caregivers in an assisted living facility. Which responses fit the Centers for Disease Control and Prevention's (CDC's) recommendations for HIV testing? (Select all that apply.) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' B) ''In 1974, I received a transfusion of platelets.'' C) ''Seven years ago, I was released from prison.'' D) ''I used to smoke marijuana 30 years ago, but I have not done any drugs since.'' E) ''I had sex with a man with a disreputable past from New York back in the late 1960s, but I have been happily married since 1971.'' F) ''At 68, I am going to get married for the fourth time.'' G) ''Downtown was where I picked up the best hookers back in the 1950s.'

(A, C, F) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' Rationale: People who have had sexually transmitted diseases should be tested for HIV. C) ''Seven years ago, I was released from prison.'' Rationale: HIV testing is recommended for people who are or have been in jails or prisons. F) ''At 68, I am going to get married for the fourth time.'' Rationale: People who are planning to get married should be tested for HIV. Incorrect: B) ''In 1974, I received a transfusion of platelets.'' Rationale: People who received blood transfusions between 1978 and 1985 should be tested for HIV. D) ''I used to smoke marijuana 30 years ago, but I have not done any drugs since.'' Rationale: HIV testing is recommended for injection drug users. E) ''I had sex with a man with a disreputable past from New York back in the late 1960s, but I have been happily married since 1971.'' Rationale: AIDS cases were extremely rare prior to the 1970s. G) ''Downtown was where I picked up the best hookers back in the 1950s.'' Rationale: The current AIDS pandemic started in the mid to late 1970s.

A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan? 1. Increase daily fluid intake to at least 2 to 3 L. 2. Strain urine at home regularly. 3. Eliminate dairy products from the diet. 4. Follow measures to alkalinize the urine.

1. A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly.

Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic? 1. Applying moist heat to the flank area. 2. Administering meperidine (Demerol). 3. Encouraging high fluid intake. 4. Maintaining complete bed rest.

2. During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics to control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.

Human Immunodeficiency virus belongs to which classifications? a. Rhabdovirus b. Rhinovirus c. Retrovirus d. Rotavirus

Answer C. Rationale: HIV is a retrovirus that has a ribonucleic acid dependent reverse transcriptase.

The patient undergoing peritoneal dialysis complains of abdominal pain. The nurse notes the drainage to be cloudy. She also palpates rebound tenderness. Which complication does the nurse suspect? A) Leakage around catheter B) Internal Bleeding C) Hypertriglycerdemia D) Peritonitis

Answer: D. Peritonitis is the most serious complication of PD. It's symtpoms include rebound tendernece, cloudy drainage, low grade fever, abdominal pain, and rebound tenderness.

What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. "Set up" a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that the side effects of the drugs are bad but that they go away after a while. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.

Correct answer: d Rationale: The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life.

The nurse is providing postoperative care for a 30-year-old female patient after an appendectomy. The patient has tested positive for human immunodeficiency virus (HIV). What type of precautions should the nurse observe to prevent the transmission of this disease? a. Droplet precautions b. Contact precautions c. Airborne precautions d. Standard precautions

d. Standard precautions Standard precautions are indicated for prevention of transmission of HIV to the health care worker. HIV is not transmitted by casual contact or respiratory droplets. HIV may be transmitted through sexual intercourse with an infected partner, exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or though breastfeeding.