Unit 1

The nurse is caring for a client with cirrhosis. Which assessment findings correlate with expected laboratory findings in the​ client? ​(Select all that​ apply.) A: Peripheral edema B: Bruising easily C: Confusion D: Spider angiomas E: Frequent infections

Answer: A, B, C, E

Which condition is NOT a known cause of cirrhosis?* A. Obesity B. Alcohol consumption C. Blockage of the bile duct D. Hepatitis C E. All are known causes of cirrhosis

E

A nurse is assigned to care for a client with nephrotic syndrome. The nurse assesses which important parameter on a daily basis? a) weight b) albumin levels c) activity tolerance d) blood urea nitrogen (BUN) level

a) weight

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for _________________

rapid respirations.

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

infuse a bolus of normal saline.

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear.* True False

TRUE

2 ( Potassium is lost when a client is taking HCTZ, and potassium level should be monitored regularly. Focus: Prioritization)

22. Which blood test result would you be sure to monitor for the client taking HCTZ? 1. Sodium level 2. Potassium level 3. Chloride level 4. Calcium level

The nurse is performing an assessment on a client bein evaluated for viral hepatitis. Which symptom will the nurse most likely assess on this client? 1. Arthralgia 2. Excitability 3. Headache 4. Polyphagia

"ANSWER: 1 Rationale: arthralgia is common in clients with viral hepatitis. Other symptoms of viral hepatits include lethargy, flulike symptoms, anorexia, N/V, abdominal pain, diarrhea, constipation, and fever. The others are not symptoms of viral hepatitis."

The client diagnosed with a fluid and electrolyte disturbance in the emergency department is exhibiting packed T waves on the STAT electrocardiogram. Which interventions should the nurse implement? List in order of priority. A) Assess the client for leg and muscle cramps B) Check the serum potassium level C) Notify the health-care provider D) Arrange for a transfer to the telemetry floor E) Administer Kayexalate, a cation resin

1) Assess the client for leg and muscle cramps 2) Check the serum potassium level 3) Notify the health-care provider 4) Administer Kayexalate, a cation resin 5) Arrange for a transfer to the telemetry floor.

1 (Although cystectomy is a major surgery, it has a predictable course and no complications were identified. AFter removing the bladder, the client must have an ileal conduit. This is expected with this surgery and the new grad could be assigned. #2 A client on HD would require a nurse trained in this area, #3 Renal trauma is unpredictable and requires continuous assessment. #4 eviscerated wound is critically ill and not to a new grad)

14 The charge nurse is making assignments, Which client should the nurse assign to the graduate nurse who just finished orientation? 1. The client with a cystectomy who had a creation of an ileal conduit 2. The client on continuous hemodialysis who is awaiting a kidney transplant 3. The client with renal trauma secondary to a MVA 4. The client who has had abd surgery and whose wound has eviscerated

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

2. An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.

1 ( Providing oral care is within the scope of practice of the UAP. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skills of the RN. Focus: Assignment, delegation, supervision)

8. The charge nurse assigned the care of a client with acute kidney failure and hypernatremia to you, a newly-graduated RN. Which action can you delegate to the UAP? 1. Providing oral care every 3 to 4 hours 2. Monitoring for indications of dehydration 3. Administering 0.45% saline by IV line 4. Assessing daily weights for trends

*Possible exam question* The nurse provides dietary teaching to a client with CKD. Which food should the nurse inform the client about that contains protein of high biologic value? SATA A) Fish B) Poultry C) Milk D) Legumes E) Peanut Butter

A, B, C Fish, poultry, milk Rationale: Animal sources of protein​ are meat, poultry, fish, eggs, milk,​ cheese, and yogurt which are proteins of high biologic value.​ Plants, legumes, grains,​ nuts, seeds, and vegetables provide proteins of low biologic value

The nurse is performing an assessment for a client diagnosed with cirrhosis. Which finding should lead the nurse to determine that treatment is effective? SATA A) Stable liver function tests B) Increasing abdominal girth measurements C) Increasing serum albumin levels D) Decreasing BUN levels E) Absence of bruising or bleeding

A, C, E - Stable liver function - Increased albumin - No bruising or bleeding Rationale: For treatment to be​ effective, liver function tests should remain stable during treatment. The client should exhibit the absence of bruising or bleeding. Serum albumin levels should increase. Abdominal girth measurements should decrease. Blood urea nitrogen levels are used to diagnose kidney​ failure, not liver failure. OK

The nurse is caring for a client diagnosed iwth cirrhosis who has developed ascites. Which intervention should the nurse include in the plan of care? SATA A) Assess the client's urine specific gravity B) Encourage fluid consumption C) Measure abdominal girth weekly D) Weigh the client daily E) Monitor I&Os

A, D, E Rationale: Ascites occurs because of portal hypertension and hypoalbuminemia. For the client with​ ascites, measures to counteract fluid volume overload should be taken. These measures include monitoring intake and​ output, assessing the urine specific gravity​ (an indicator of hydration​ status), and weighing the client daily. Abdominal girth should also be measured​ daily, not​ weekly, and the client should be placed on a fluid restriction.

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." Rationale: Urea is a waste product of protein breakdown and can accumulate in clients who have kidney failure, causing uremia.

Your plan for care of a patient with AKI includes which goal of dietary management? A. Provide sufficient calories while preventing nitrogen excess. B. Deliver adequate calories while restricting fat and protein intake. C. Replace protein intake with enough fat intake to sustain metabolism. D. Restrict fluids, increase potassium intake, and regulate sodium intake.

A. Provide sufficient calories while preventing nitrogen excess. The challenge of nutrition management in AKI is to provide adequate calories to prevent catabolism despite the restrictions required to prevent electrolyte and fluid disorders and azotemia (accumulation of nitrogen and wastes in blood).

A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patient's presentation? A) "How many alcoholic drinks do you typically consume in a week?" B) "To the best of your knowledge, are your immunizations up to date?" C) "Have you ever worked in an occupation where you might have been exposed to toxins?" D) "Has anyone in your family ever experienced symptoms similar to yours?"

Ans: A Feedback: Signs or symptoms of hepatic dysfunction indicate a need to assess for alcohol use. Immunization status, occupational risks, and family history are also relevant considerations, but alcohol use is a more common etiologic factor in liver disease.

Which priority teaching information should the nurse discuss with the client to help prevent contracting hep. A? 1.Explain the importance of good hand washing. 2.Tell the client to take the hepatitis B vaccine in three (3) doses. 3.Tell the client not to ingest unsanitary food or water. 4.Discuss how to implement standard precautions.

Answer 1 would be appropriate for prevention of hepatitis A.

"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.

Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A ,b. hep b, C Hep C, D. Hep D

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

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.

Which priority teaching information should the nurse discuss with the client to help prevent contracting hep. B? A. Explain the importance of good hand washing. B. Tell the client to take the hepatitis B vaccine in three (3) doses. C. Tell the client not to ingest unsanitary food or water. D. Discuss how to implement standard precautions.

Answer B Tell the client to take the hepatitis B vaccine in three (3) doses.

The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention? A.Suggest that the client take warm showers. B.Add baby oil to the client's bath water. C.Apply powder to the client's skin. D.Suggest a hot-water rinse after bathing.

Answer B. Applying baby oil could help soothe the itchy skin. Answer A, C, and D would increase dryness and worsen the itching.

The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention? A.Suggest that the client take warm showers. B.Add baby oil to the client's bath water. C.Apply powder to the client's skin. D.Suggest a hot-water rinse after bathing.

Answer B. Applying baby oil could help soothe the itchy skin. Answer A, C, and D would increase dryness and worsen the itching.

The nurse is caring for a client with cirrhosis of the liver. Which dietary support does this client​ need? ​(Select all that​ apply.) A: Vitamin supplements ​B: High-fiber diet ​C: Fluid-restricted diet ​D: Sodium-restricted diet E: Regular diet

Answer: A, C, D

A client with​ end-stage cirrhosis is brought to the emergency department with declining functional status. Which treatment will relieve the client​'s symptoms of portal hypertension and reduce the onset of esophageal varices and​ ascites? A: Paracentesis ​B: Sengstaken-Blakemore tube C: Transjugular intrahepatic portosystemic shunt​ (TIPS) D: Minnesota tube

Answer: C

The nurse is planning care for a client with chronic kidney disease and osteoporosis. The nurse reviews the client's medical record and determines the priority nursing diagnosis to be: A) Anxiety B) Disturbed Body Image C) Risk for Injury D) Risk for Bleeding

Answer: C Explanation: C) The client with chronic kidney disease with significant osteodystrophy (osteoporosis, or calcium loss from the bones) is at high risk for fractures; therefore, preventing injury is the most appropriate outcome. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, it is specified that the client has significant osteoporosis. Anxiety is not related to osteoporosis.

The nurse is administering peritoneal dialysis on a client with acute renal failure. The nurse notes the presence of a cloudy dialysate return. Which action does the nurse initiate after notifying the physician? A) Measure abdominal girth. B) Document the cloudy dialysate. C) Culture the dialysate return. D) Increase dialysate instillation.

Answer: C Explanation: C) The return should be clear. The presence of cloudy drainage might indicate peritonitis, and the nurse should culture the return in order to help identify the presence and type of organism that could be causing the infection. Documenting the cloudy dialysate and nursing actions taken would be necessary, but is not the next-priority action. Measurement of abdominal girth is performed prior to the dialysis procedure, and although increased girth could indicate peritonitis, culturing the return is more important. The instillation part of the procedure is completed prior to the collection of the dialysate return, and the rate of the instillation has no relationship to the development of an infection.

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.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? A Adherence to therapy B Handwashing C Monitoring for low-grade fever D Strict clean technique

B Handwashing The most important infection control measure for the client receiving immune-suppressive therapy is handwashing. Adherence to therapy and monitoring for low-grade fever are important, but are not infection control measures. The nurse should practice aseptic technique for this client, not simply clean technique.

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? A Diltiazem (Cardizem) B Lisinopril (Zestril) C Clonidine (Catapres) D Doxazosin (Cardura)

B Lisinopril (Zestril) Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.

Select all the ways a person can become infected with Hepatitis B:* A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

B, C, E, and F

To prevent the spread of hepatitis A infections the nurse is especially careful when: A) Disposing of food trays B) Disposing of bed pan C) taking an oral temp D) Changing IV tubing

B. Rationale: 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."

A patient has an increased ammonia level associated with hepatic encephalopathy. What assessment finding does the nurse expect? a. Aphasia b. Asterixis c. Hyperactivity d. Acute dementia

B. Asterixis is a twitching spasm of the hands and wrists seen in patients with increased ammonia levels in conditions such as hepatic encephalopathy. Aphasia, hyperactivity, and acute dementia are manifestations not associated with hepatic encephalopathy. Besides asterixis, an increased serum ammonia level causes sedation and confusion that progress to a comatose state. Text Reference - p. 1021

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis? A. Hyperactive bowel sounds B. Nausea and vomiting C. Bradycardia D. Increased urinary output

B. Nausea and vomiting Rationale:Peritonitis is an inflammation of the peritoneum and is a potential complication of peritoneal dialysis. The nurse should monitor the client for manifestations such as abdominal tenderness or pain, anorexia, nausea, vomiting, restlessness, and confusion.

A young adult client receiving peritoneal dialysis feels fat and unattractive. Which action should the nurse use to help the client cope with a disturbed body image? A) Recommend speaking with adolescents who also have developed chronic renal failure B) Provide written information regarding the technical aspects of the dialysis procedure C) Encourage expression of feelings related to the disease and treatment and their impact on life D) Recommend increasing physical activity to manage weight

C) Encourage expression of feelings related to the disease and treatment and their impact on life Rationale: An appropriate intervention for a client with a disturbed body image is to encourage the expression of feelings related to the disease process and the treatments. While support groups are​ encouraged, the nurse would not recommend that the client speak to an adolescent client with chronic renal failure. While offering written information regarding treatment is​ important, this intervention is not appropriate for a client with disturbed body image. Telling the client to increase physical activity to avoid gaining weight is not therapeutic.

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

The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: a. during dialysis b. just before dialysis c. the day after dialysis d. on return form dialysis

D on return form dialysis

The nurse discusses the risk of developing CKD with a group of nursing students. Which population group should the nurse emphasize as being most at risk for developing this disorder? A) Hispanic Americans B) Caucasian Americans C) Asian Americans D) African Americans

D) African Americans Rationale: African Americans are nearly three times as likely to develop CKD as Caucasian Americans. This is much greater than the risk for Asian Americans and Hispanic Americans to develop the disease.

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a) Obstructive b) Nonobstructive c) Hepatocellular d) Hemolytic

D) Hemolytic Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease.

*Possible exam question* The nurse creates a plan of care for a client with end-stage renal disease. To what should the nurse pay particular attention when planning this care? A) Medication regimens and their side effects B) Daily weights C) Monitoring input and output D) Meal planning when dietary modifications are required

D) Meal planning when dietary modifications are required Rationale: The nurse should involve the client in meal planning if dietary modifications are required. The nurse can provide teaching about the medication​ regimen, but the client is not usually involved in planning these regimens. Weighing the client and monitoring input and output are interventions carried out by the​ nurse, with little involvement by the client.

When a patient who has had progressive chronic kidney disease (CKD) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching?

More protein will be allowed because of the removal of urea and creatinine by dialysis.

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change?* A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

The answer is A. When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

10. You're developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing diagnosis would you include in the care plan? A. Excess fluid volume B. Risk for electrolyte imbalance C. Urinary retention D. Acute pain

The answer is B. During the diuresis stage of AKI, the patient will be losing an excessive amount of urine (3-6 Liters/day) and is at risk for fluid volume deficient and electrolyte imbalance. The nurse must monitor the patient's electrolyte levels, especially potassium (hypokalemia).

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis?* A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

The answer is C. Hand hygiene can help prevent all types of viral hepatitis. However, not all types of viral Hepatitis have a vaccine available or are spread through needle sticks or blood/organs donations. Remember Hepatitis A and E are spread only via fecal-oral routes.

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is?* A. Antiviral medications B. Interferon C. Supportive care D. Hepatitis A vaccine

The answer is C. There is no current treatment for Hepatitis A but supportive care and rest. Treatments for the other types of Hepatitis such as B, C, and D include antiviral or interferon (mainly the chronic cases) along with rest.

A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this medication what route?* A. Oral B. Intramuscular C. Subcutaneous D. Intravenous

The answer is C. This medication is administered subq

8. True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not all patients will progress through the diuresis stage.

The answer is FALSE. Some patients will skip the oliguric stage of AKI and progress to the diuresis stage.

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply:* A. Water B. Food C. Semen D. Blood

The answers are C and D. The most common source for transmission of Hepatitis A is water and food.

d (rationale: Postrenal AKI is a result of any ureteral or urethral obstruction. Prerenal AKI is caused by any disorder that significantly decreases vascular volume, cardiac output, or systemic vascular resistance that can affect renal blood flow. Intrarenal (intrinsic) AKI is caused by diseases of the kidney itself.)

The nurse is caring for a patient with acute kidney injury (AKI) resulting from a urethral obstruction due to cancer. Which type of AKI is the patient experiencing? a. Intrinsic b. Prerenal c. Intrarenal d. Postrenal

3 A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment,and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal.

The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal? 1.The client will have a blood pressure within normal limits. 2.The client will show no protein in the urine. 3.The client will maintain normal renal function. 4.The client will have clear lung sounds.

The nurse discusses the risk of developing chronic kidney disease​ (CKD) with a group of nursing students. Which population group should the nurse emphasize as being most at risk for developing this​ disorder? A. Caucasian Americans B. Hispanic Americans C. Asian Americans D. African Americans

​African Americans Rationale: African Americans are nearly three times as likely to develop CKD as Caucasian Americans. This is much greater than the risk for Asian Americans and Hispanic Americans to develop the disease.

A client with chronic kidney disease​ (CKD) is experiencing Kussmaul respirations. Which acid-base imbalance should the nurse suspect the client is​ experiencing? A. Respiratory alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Metabolic alkalosis

​Metabolic acidosis Rationale: As renal failure​ advances, the kidney loses the ability to excrete hydrogen ions. The buffering action of the kidney becomes impaired. This leads to metabolic acidosis. Kussmaul respirations​ (increasing rate and​ depth) are the​ body's attempt to compensate for the acidosis. Metabolic alkalosis occurs with an increased excretion of hydrogen ions. Respiratory acidosis occurs with retention of carbon dioxide. Respiratory alkalosis occurs with an increased loss of carbon dioxide.

Which of the following the are early manifestations of liver cancer? Select all that apply. a) Fever b) Continuous aching in the back c) Vomiting d) Pain e) Increased appetite f) Jaundice

• Pain • Continuous aching in the back Explanation: Early manifestations of liver cancer include pain and continuous dull aching in the right upper quadrant epigastrium or back. Weight loss, anorexia, and anemia may occur. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever and vomiting are not associated manifestations.

The nurse is reviewing the medication list and appropriate dose adjustments made for a patient with CKD. The nurse would question the use and/or dosage adjustment of which type of medication? A) Antibiotics B) Magnesium antacids C) Oral antidiabetics D) Opioids

B) Magnesium antacids

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

A pt with hep B surface antigen (HBsAg) in the serum is being discharged w/ pain medication after knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic complications? a. Tramadol (ultram) b. hydromorphone (dilaudid) c. oxycodone with aspirin (percodan) d. hydrocodone with acetaminophen (vicodin)

D Pt is likely to have impaired liver function. Acetaminophen is not suitable b/c it is converted to a toxic metabolite in the liver after absorption, increasing risk of hepatocellular damage.

The pt with cirrhosis is being taught self care. which statement indicates the pt needs MORE teaching? a. if i notice a fast heart rate and irregular beats, this is normal for cirrhosis b. i need to take good care of my belly and ankle skin where it is swollen. c. a scrotal support may be more comfortable when i have scrotal edema d. i can use pillows to support my head to help me breathe when i am in bed.

A This may indicative of hypokalemia and should be reported to healthcare provider, this is not normal for cirrhosis.

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) A Restricted protein B Liberal sodium C Restricted fluids D Low potassium E Low fat

A Restricted protein C Restricted fluids D Low potassium Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

The nurse is planning care for a client diagnosed with acute kidney injury (AKI). The nurse plans the client's care based on the nursing diagnosis of Excess Fluid Volume. Which assessment data supports this nursing diagnosis? A) Pitting edema in the lower extremities B) Bowel sounds positive in four quadrants C) Wheezing in the lungs D) Generalized weakness

A) Pitting edema in the lower extremities Rationale: The client in acute kidney injury (AKI) will likely be edematous, because the kidneys are not producing urine. Wheezing in the lungs is an assessment consistent with asthma, not AKI. Bowel sounds in four quadrants is a normal assessment finding. Generalized weakness may be due to whatever disease process precipitated the kidney failure

After a liver transplant, evidence-based guidelines are implemented to prevent the development of what? A) VAP B) ESLD C) MELD D) OLT

ANS: A Evidence-based practice guidelines are implemented to prevent the development of VAP in the postoperative liver transplant recipient. ESLD means end-stage liver disease; MELD is model of end-stage liver disease; orthotopic liver transplantation is OLT.

For which complication should the nurse monitor a client with portal​ hypertension? A: Esophageal varices B: Steatohepatitis C: Hepatic encephalopathy D: Hepatitis C

Answer: A

3. This is usually the length of time clients need to wait prior to having sexual intercourse; this is the information the client wants to know.

The client who is postoperative TURP asks the nurse, "When will I know if I will be able to have sex after my TURP?" Which response is most appropriate by the nurse? 1."You seem anxious about your surgery." 2."Tell me about your fears of impotency." 3."Potency can return in six (6) to eight (8) weeks." 4."Did you ask your doctor about your concern?"

a (Rationale: If a client develops​ AKI, maintaining the fluid and electrolyte balance is a key goal in managing the condition. Drinking more fluids could place the client at risk for fluid overload. Diuretics may be ordered for a client who is retaining a significant amount of fluid. Increasing the amount of iron in the diet is necessary if the client is not getting the daily requirement in the foods they are consuming.)

The nurse is discussing management of acute kidney injury​ (AKI) with the client. Which would describe the key goal to managing this​ condition? A. Maintaining fluid and electrolyte balance B. Avoiding the use of diuretics C. Eating more vegetables that are low in iron D. Drinking more fluids

An increase in which electrolyte would indicate the use of sevelamer for a person with acute kidney injury? a. sodium b. phosphorous c. potassium d. calcium

b. phosphorous

The client in end-stage of renal failure had undergone kidney transplant. Which of the following assessment findings indicate kidney transplant rejection? a) increased urinary output, BUN = 15 mg/dL b) HCT = 50%, Hgb = 17 g/dl c) decreased urinary output, sudden weight gain d) decreased urinary output, sudden weight loss

c) decreased urinary output, sudden weight gain

Which of the following is NOT a role of the liver?* a. Removing hormones from the body b. Producing bile c. Absorbing water d. Producing albumin

c. Absorbing water

The lab work of a client with chronic kidney disease​ (CKD) shows an elevated serum potassium level. Which prescription should the nurse anticipate receiving from the healthcare​ provider? A. Intravenous glucose B. Oral vitamin D C. Intravenous potassium chloride D. Oral calcium carbonate

​Intravenous glucose Rationale: A method to lower blood potassium levels is to administer intravenous glucose and insulin. The insulin drives the glucose into body cells. The glucose takes the potassium with it into the​ cells, thereby lowering blood potassium levels. Potassium supplements would not be prescribed for a client with an elevated potassium level. Oral calcium carbonate is a​ phosphorus-binding agent and reduces the phosphate level in the blood. Vitamin D is given to increase the absorption of calcium.

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

2

Which medication would be given to promote elimination of ammonia in fecal matter and to treat hepatic encephalopathy in a patient with cirrhosis? 1. Furosemide (Lasix) 2. Lactulose (Cephulac) 3. Propranolol (Inderal) 4. Spironolactone (Aldactone)

2. Lactulose (Cephulac) Lactulose is used to help eliminate ammonia in feces and to prevent or treat hepatic encephalopathy. Furosemide is used for excretion of excess fluid. Propanolol reduces pressure in veins, decreasing the risk for bleeding. Spironolactone is used to decrease excess fluid.REF: p. 863

41. Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure? 1. Anuria 2. Diarrhea 3. Oliguria 4. Vomiting

41. Answer: 3. Oliguria Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.

3 (This is a private moment, the dressing change can wait)

42 The nurse is preparing to perform a dressing change on a f client with ESRD. The nurse notes the clients husband is silently holding the clients hand and praying. Which action should the nurse implement first? 1. Continue to prepare for the dressing change in the room 2. Call the chaplain to help the client and spouse pray 3. Quietly leave the room and come back later for the dressing change 4. Ask the husband whether or not he would like the nurse to join in prayer

A​ 63-year-old man is admitted with postrenal acute kidney injury​ (AKI) because of a kidney stone. Vascular volume and renal perfusion have been restored and he is on fluid restriction. During the past 24​ hours, he has voided 250 mL of urine. He has not had any other type of output. How much fluid should the client receive over the next 24​ hours? A. 750 mL B. 3000 mL C. 1250 mL D. 2750 mL

750ml ​Rationale: Once vascular and renal perfusion has been​ restored, fluid intake for clients with AKI is usually restricted because the kidneys cannot eliminate fluids normally. Fluid intake is calculated for these clients by adding the amount of output for the previous 24 hours to 500 mL to allow for insensible losses. The​ client's output for the past 24 hours was 250​ mL; added to 500​ mL, the fluid volume calculation equals 750 mL. A fluid intake of​ 1250, 2750, or 3000 mL would be too much fluid for the client and would put the client at risk for fluid overload.

2 ( Even after beginning HD, patients are still required to restrict fluid intake. In addition, patients on HD have nutritional restrictions (e.g., protein, potassium, phosphorus, sodium restrictions). All of the other patient statements indicate an appropriate understanding of HD. Focus: Prioritization)

8. After discussing renal replacement therapies with the health care provider and nurse, Ms. J is considering hemodialysis (HD). Which statement indicates that Ms. J needs additional teaching about HD? 1. "I will need surgery to create an access route for HD." 2. "I will be able to eat and drink what I want once I start dialysis." 3. "I will have a temporary dialysis catheter for a few months." 4. "I will be having dialysis three times every week."

3 ( Temporary dialysis lines are to be used only for HD. As supervising nurse, you should stop the new nurse before the temporary HD system is interrupted. Breaking into the system increases the risk for complications such as infection. The blood pressure should always be assessed on the nondialysis arm. Postoperative patients should always be monitored for bleeding. Oxycodone, when ordered by the provider, is an appropriate analgesic for moderate to moderately severe pain. Focus: Delegation, supervision)

9. You are supervising a new nurse on orientation to the unit who is providing care for Ms. J after her return from surgery to create a left forearm access for dialysis. Which action by the nurse requires that you intervene? 1. Monitoring the patient's operative site dressing for evidence of bleeding 2. Obtaining a blood pressure reading by placing the cuff on the right arm 3. Drawing blood for laboratory studies from the temporary dialysis line 4. Administering oxycodone (Roxicodone) PO for moderate postoperative pain

The nurse is caring for a woman recently diagnosed with viral hep A. which individual should the nurse refer for an immunoglobulin (IG) injection? a. a caregiver who lives in the same home with the pt b. a friend who delivers meals to the pt and family each wk c. a relative with a hx of hep A who visits the pt daily d. a child living in the home who received the hep A vaccine 3 months ago

A recommended for those who do not have the anti-HAV antibodies and exposed as of close contact with those who have HAV or foodborne exposure

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? A Increased blood urea nitrogen (BUN) B Increased creatinine level C Pale-colored urine D Decreased sodium level

A Increased blood urea nitrogen (BUN An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

Select all the types of viral Hepatitis that have preventive vaccines available in the United States?* A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A and B.

"Most people with hepatitis recover without any medication." Treatment for hepatitis is mostly supportive, and nearly all individuals with acute hepatitis recover fully without any medical treatment. There are medications available to prevent and treat postexposure hepatitis A and B, as well as chronic viral hepatitis. It is not accurate that medication is prohibitively expensive or experimental.

A patient with a new diagnosis of acute hepatitis asks the nurse, "Why am I not being given any medication?" How should the nurse reply? "Medical treatment for hepatitis is experimental and only reserved for very serious cases." "The medication to treat hepatitis is very expensive." "There is no medication available to treat hepatitis." "Most people with hepatitis recover without any medication."

a (rationale: A renal biopsy is done to differentiate between acute and chronic renal failure, so the nurse should provide education for this diagnostic test. It will also identify the underlying cause. A renal ultrasonogram identifies obstructive causes of renal failure and does not differentiate between acute and chronic renal failure. Therefore, the nurse should not provide education for this diagnostic test. A CT scan or an MRI evaluates kidney size and identifies possible obstructions, but it does not differentiate between acute and chronic renal failure; therefore, the nurse should not provide education for these diagnostic tests.)

A patient with renal failure is scheduled for a diagnostic test to differentiate between acute and chronic renal failure. For which diagnostic test should the nurse provide teaching? a. Renal biopsy b. Magnetic resonance imaging (MRI) c. Renal ultrasonography d. Computerized tomography (CT) scan

The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? (Select all that apply) A) Hemodialysis B) Peritoneal dialysis C) Kidney transplant D) Bilateral nephrectomy E) Intense immunosuppression therapy

A) Hemodialysis C) Kidney transplant D) Bilateral nephrectomy

Select all the signs and symptoms associated with Hepatitis?* A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

A, D, F, G, and H

How is Hepatitis E transmitted?* A. Fecal-oral B. Percutaneous C. Mucosal D. Body fluids

A. Fecal-oral

*Possible exam question* Which lab finding is suggestive of chronic kidney disease? A) Increase in creatinine clearance B) Decrease in serum sodium C) Increase in hematocrit D) Decrease in BUN

B) Decrease in serum sodium Rationale: Laboratory findings associated with chronic kidney disease include decreased creatinine clearance due to a decrease in the glomerular filtration rate; decreased serum sodium because of water retention; decreased hematocrit due to decreased red blood cell production, and increased BUN due to inability of the kidneys to eliminate nitrogenous waste products.

Acute renal failure is potentially reversible in the: A. convalescent phase. B. initiation phase. C. maintenance phase. D. recovery phase.

B, initiation phase

The nurse is caring for a patient diagnosed with prerenal acute kidney injury (AKI). Which condition should the nurse recognize as a cause for this disorder? A. Glomerulonephritis B. Sepsis C. Renal calculi D. Hyperkalemia

B. Sepsis Prerenal AKI results from conditions that affect renal blood flow and perfusion. Any disorder that significantly decreases vascular volume, cardiac output, or systemic vascular resistance can affect renal blood flow. Sepsis causes prerenal AKI because it causes altered vascular resistance. Renal calculi are the cause of postrenal failure. Fluid retention is not a cause of prerenal AKI. Glomerulonephritis is the cause of intrarenal AKI.

A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity? A. Omeprazole B. Vancomycin C. Ondansetron D. Diphenhydramine

B. Vancomycin Rationale: The nurse should identify that vancomycin, an antibiotic, to be associated with nephrotoxic adverse effects.

14. The nurse determines that which of the following types of antibiotics being prescribed for one or more of a group of clients is least likely to cause nephrotoxicity? a. A cephalosporin b. An aminoglycoside c. A penicillin d. A sulfonamide

C

The condition of the pt who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the pt has developed liver cancer? a. serum a-fetoprotein level b. ventilation/perfusion scan c. hepatic structure ultasound d. abdominal girth measurement

C

Which factor represents a sign or symptom of digoxin toxicity? A Serum digoxin level of 1.2 ng/mL B Polyphagia C Visual changes D Serum potassium of 5.0 mEq/L

C Visual changes Visual changes, anorexia, nausea, and vomiting are symptoms of digoxin toxicity. A digoxin level of 1.2 ng/mL is normal (0.5 to 2.0 ng/mL). Polyphagia is a symptom of diabetes. Although hypokalemia may predispose to digoxin toxicity, this represents a normal, not low, potassium value.

The patient in the oliguric phase of AKI excreted 300 mL of urine in addition to 100 mL of other losses during the past 24 hours. With appropriate calculations, you determine that for the next 24 hours the patient's fluid allocation is A. 600 mL. B. 800 mL. C. 1000 mL. D. 1200 mL.

C. 1000 mL. Fluid intake must be closely monitored during the oliguric phase. The rule for calculating the fluid restriction is to add all losses for the previous 24 hours to 600 mL for insensible losses.

The nurse is calculating the protein requirement for a client who is switching from peritoneal dialysis to hemodialysis. The client is 5'5" tall and weighs 140 pounds. How many grams of protein does this client need per day? a. 42 to 63 b. 51 to 62 c. 64 to 76 d. 76 to 96

C. 64 to 76 A client on hemodialysis requires 1.0 to 1.2 grams of protein per kilogram of body weight. The client weighs 64 kg so the requirement is 64 to 76.

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

The answer is A. During the oliguric stage of AKI the patient will have a urinary output of 400 mL/day or LESS. This is due to a decreased GRF (glomerular filtration rate), which will lead to increased amounts of waste in the blood (increased BUN/Creatinine), metabolic acidosis (decreased excretion of hydrogen ions), hyperkalemia, hypervolemia (edema/hypertension), and urinary output of <400 mL/day.

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

The answer is D. The adrenal glands are responsible for maintaining cortisol production not the kidneys.

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply:* A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. C. Prevention of Hepatitis D includes handwashing and the Hepatitis D vaccine. D. Hepatitis D is most commonly transmitted via the fecal-oral route.

The answers are A and B. These are true statements about Hepatitis D. Prevention for Hepatitis D includes handwashing and the Hepatitis B vaccine (since it occurs only with the Hepatitis B virus). It is transmitted via blood.

What is the biliary system?

The biliary tract, (biliary tree or biliary system) refers to the liver, gall bladder and bile ducts, and how they work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin.

3. Venison, sardines, goose, organ meats,and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent re-occurrence? 1.Beer and colas. 2.Asparagus and cabbage. 3.Venison and sardines. 4.Cheese and eggs.

What is venous hydrostatic pressure ?

The force of hydrostatic pressure means that as blood moves along the capillary, fluid moves out through its pores and into the interstitial space. This movement means that the pressure exerted by the blood will become lower, as the blood moves along the capillary, from the arterial to the venous end

c

The nurse is discussing the effect pregnancy can have on the kidneys with a patient. Which patient statement demonstrates effective teaching? a. "I should not drink more than 20 ounces of water per day." b. "If I feel a lot of pressure in my abdomen, that demonstrates stress on the kidneys." c. "If I have burning during urination, I should call my healthcare provider." d. "If I am not moving around daily, that stresses the kidneys."

3. The drainage bag should be kept below the level of the bladder to prevent reflux of urine into the renal system; it should not be placed on the bed.

The nurse is observing the UAP providing direct care to a client with an indwelling catheter. Which data warrant immediate intervention by the nurse? 1.The UAP secures the tubing to the client's leg with tape. 2.The UAP provides catheter care with the client's bath. 3.The UAP puts the collection bag on the client's bed. 4.The UAP cares for the catheter after washing the hands.

"Recovery times vary, but it may be up to 6 months." The convalescent, or recovery, phase of hepatitis B starts with a feeling of well-being after 2-3 weeks of feeling acutely ill. Complete recovery from hepatitis B can take up to 6 months.

The nurse is teaching a patient with hepatitis B about the recovery phase of the disease. Which statement should the nurse include? "Recovery from hepatitis can take several years." "Recovery can take up to 2 months after the acute illness." "There is no complete recovery from hepatitis B." "Recovery times vary, but it may be up to 6 months."

This disease is a risk factor for primary liver cancer. This disease is transmitted through infected blood and body fluids. Liver cells are damaged by the immune response. Hepatitis B is spread through infected blood and body fluids and increases the risk for primary liver cancer. In​ addition, damage to liver cells is caused by the immune response. Hepatitis B is common in the United States and must be present for hepatitis D to occur.

The nurse prepares a presentation on hepatitis B for new nurses. Which information should be​ included? (Select all that​ apply.) This disease is a risk factor for primary liver cancer. This disease is transmitted through infected blood and body fluids. Liver cells are damaged by the immune response. This disease is rare in the United States. Pathogens cause infection only in persons who are also infected with hepatitis D.

Hepatitis A Hepatitis A and hepatitis E are both transmitted through the fecal-oral route. It is important to practice diligent hand hygiene, especially before handling or preparing food and using the restroom. Hepatitis B, C, and D are transmitted through blood and body fluids.

The risk of which type of hepatitis virus is reduced through diligent hand washing before preparing or handling food? Hepatitis D Hepatitis A Hepatitis C Hepatitis B

4. The nephrostomy tube should never be clamped or have kinks because an obstruction can cause pyelonephritis.

Which intervention should the nurse implement when caring for the client with a nephrostomy tube? 1.Change the dressing only if soiled by urine. 2.Clean the end of the connecting tubing with Betadine. 3.Clean the drainage system every day with bleach and water. 4.Assess the tube for kinks to prevent obstruction.

4. This is a potentially life-threatening problem.

Which nursing diagnosis is priority for the client who has undergone a TURP? 1.Potential for sexual dysfunction. 2.Potential for an altered body image. 3.Potential for chronic infection. 4.Potential for hemorrhage.

Which of the following client responses shows a correct understanding of continuous ambulatory peritoneal dialysis (CAPD)? a) I am expected to perform the procedure at home b) the procedure lasts for one hour c) I have to sit and raise my legs during the procedure d) I have to go to the hospital for this procedure

a) I am expected to perform the procedure at home

Which of the following problems is expected in a client who is in end-stage renal failure? a) anemia b) thalassemia c) renal calculi d) hypotension

a) anemia

Which of the following should the nurse include in the nursing care plan of the client who is diagnosed to have renal failure, whose BUN is 32 mg/dl, serum creatinine is 4 mg/dl, hematocrit is 38%. He is complaining of fatigue and edema. a) low protein diet and fluid restriction b) high protein diet and fluid restriction c) low protein diet and increase in fiber d) high protein diet and potassium restriction

a) low protein diet and fluid restriction

The client has end-stage renal disease. He had undergone kidney transplant 5 days ago. Which of the following is the most important intervention for the client to prevent infection? a) observe asepsis b) increase fluid intake c) avoid clients with flu d) avoid crowded places

a) observe asepsis

A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's BP. c. Instruct the patient to avoid high-potassium foods. d. Call the lab and request a redraw of the lab to verify results.

a. Dysrhythmias may occur with an elevated potassium level and are potentially lethal. Monitor the rhythm while contacting physician or calling the rapid response team.

A patient with decompensated cirrhosis is at risk for which complications? Select all that apply. a. Jaundice b. Esophageal varices c. Coagulation defects d. Hepatitis A virus (HAV) e. Spontaneous bacterial peritonitis f. Ascites

a. Jaundice b. Esophageal varices c. Coagulation defects e. Spontaneous bacterial peritonitis f. Ascites

Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of a. ammonia synthesis b. excretion of sodium c. excretion of bicarbonate d. conservation of potassium

a. metabolic acidosis occurs in AKI because the kidneys cannot synthesize ammonia or excrete acid producgts of metabolism, resulting in an increased acid load. Bicarbonate is normally generated and reabsorbed by the functioning kidney to maintain acid-base balance.

The client had been diagnosed to have chronic renal failure. He had undergone hemodialysis for the first time. What signs and symptoms when experienced by the client suggest that he is experiencing disequilibrium syndrome? a) restlessness, hypotension, headache b) nausea and vomiting, hypertension, dizziness c) lethargy, hypotension, dizziness d) thachycardia, hypotension, headache

b) nausea and vomiting, hypertension, dizziness disequilibrium syndrome is caused by more rapid removal of waste products from the blood from the brain. This is due to the presence of blood-brain barrier. This causes increased intracranial pressure.

The nurse is teaching a patient with cirrhosis about nutrition therapy. Which statement by the patient indicates teaching has been effective? a. "I will only use table salt with my dinner meal." b. "I will read the sodium content labels on all food and beverages." c. "I will avoid the use of vinegar." d. "I will not take vitamin supplements."

b. "I will read the sodium content labels on all food and beverages."

A patient with AKI has a serum potassium level of 6.7 mEq/L and the following ABG results: ph 7.28, PaCo2 30, PaO2 86, HCO3- 18. the nurse recognizes that treatment of the acid-base problem with sodium bicarobnate would cause a decrease in with value? a. pH b. potassium level c. bicarbonate level d. carbon dixoide level

b. During acidosis, potassium moves out of the cell in exchange for H+ ions, increasing the serum potassium level. Correction of the acidosis with sodium bicarbonate will help to shift the potassium back into the cells. A dcrease in pH and the bicarbonate and PaCo2 levels would indicate worsening acidosis.

A patient is scheduled for a procedure to place a stent in the biliary tract. For which procedure does the nurse provide patient teaching? a. Esophagogastroduodenoscopy (EGD) b. Endoscopic retrograde cholangiopancreatography (ERCP) c. Upper gastrointestinal (GI) series d. Cholangiogram

b. Endoscopic retrograde cholangiopancreatography (ERCP)

Which type of dialysis can remove fluids and wastes from the system more quickly? a. peritoneal dialysis b. hemodialysis c. both can remove waste quickly d. none of the above

b. hemodialysis

A renal diet would include which restriction? a. decreased fats b. c. decreased potassium d.

c. decreased potassium

What is the main ingredient of dialysate for most patients undergoing peritoneal dialysis? a. hypertonic solution b. protein c. glucose d. hypotonic saline

c. glucose

During assessment of a pt with obstructive jaundice, the nurse would expect to find: clay colored stools dark urine and stool pyrexia and pruritis elevated urinary urobilinogen

clay colored stool

In the oliguric phase of renal failure, what is the most appropriate nursing diagnosis? a) fluid volume deficit b) activity intolerance c) ineffective breathing pattern d) fluid volume excess

d) fluid volume excess

Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. patient with DM. b. a patient with HTN crisis c. patient who tried to overdose on acetaminophen d. patient with major surgery who required a blood transfusion

d. ATN is primarily the result of ischemia, nephrotoxins, or sepsis. DM, HTN, and acetaminophen overdose will not contribute to ATN.

________ reside in the liver and help remove bacteria, debris, and old red blood cells.* a. Hepatocytes b. Langerhan cells c. Enterocytes d. Kupffer cells

d. Kupffer cells

How is the patency of an AV fistula checked? a. flush with saline b. take an x-ray c. aspirate blood return d. auscultate bruit

d. auscultate bruit

Which medication is used to treat the acid base imbalance common in persons with acute kidney injury? a. calcium carbonate b. aluminum hydroxide c. magnesium oxide d. sodium bicarbonate

d. sodium bicarbonate

What is cholecystitis?

inflammation of the gallbladder

"The school nurse is discussing ways to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important intervention that the school nurse must explain to the school teachers? "1.Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands."

"Answer is 4. 1.Eating after each other should be discouraged,but it is not the most important intervention. 2.Only bottled water should be consumed in Third World countries, but that precaution is not necessary in American high schools. 3.Hepatitis B and C, not hepatitis A, are transmitted by sexual activity. 4.Hepatitis A is transmitted via the fecal-oral route. Good hand washing helps to prevent its spread."

"A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will: A. Prevent the absorption of ammonia from the bowel. B. Prevent hypoglycemia. C. Remove bilirubin from the blood. D. Mobilize iron stores from the liver"

"Correct Answer: A Rationale: Lactulose helps prevent the absorption of ammonia from the bowel because it will cause frequent bowel movements, which facilitates the removal of ammonia from the intestines."

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 1)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 2)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 3) This is the expected color of urine. 4) Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines.

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.

"The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate?" A. "The hepatitis vaccine will provide immunity from this exposure and future exposures." B. "I am afraid there is nothing you can do since the patient was infectious before admission." C. "You will need to be tested first to make sure you don't have the virus before we can treat you." D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure.""

Correct C "Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

"A client is admitted with ongoing sypmtoms of the flu. There are no other obvious signs of illness. This client should be tested for hepatitis because: "A. She has a blood pressure of 90/50 B. whe has an allergy to shellfish C. She could have anicteric hepatitis, which means no jaundice D. She was living with a roommate who had similar symptoms"

Correct C Rationale: Only about 25 percet of people with acute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised liver function that is overlooked due to lack of jaundice. A roommate with the same symptoms could mean a communicable disease such as the flu.

A colleges student is required to be inoculated for hepatits before beginning college. The nurse relaizes this client will be inocualted to prevent the development of: 1. Hepatitis C 2. Hepatitis E 3. hepatitis B 4. Hepatitis D

Correct answer Hepatitis B Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

The home care nurse is visiting a client during an icteric phase of hepatitis of unknown etiology. The nurse would be MOST concerned if the client made which of the following comments? "1. "I must not share eating utensils with my family."" 2. ""I must use my own bath towel."" 3. ""I'm glad that my husband and I can continue to have intimate relations."" 4. ""I must eat small, frequent feedings."""

Correct: 3 3. ""I'm glad my husband..."" - CORRECT: avoid sexual contact until serologic indicators return to normal

A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness? http://www.rnpedia.com/home/exams/nclex-exam/nclex-rn-practice-questions-6 "1. Prilosec (omeprazole) 2. Synthroid (levothyroxine) 3. Premarin (conjugated estrogens) 4. Lipitor (atorvastatin)

Correct: 4 Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level B.. Elevated serum bilirubin level c. Elevated blood urea nitrogen leveld. d. Decreased erythrocycle sedimentation rate

Correct: B Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis

A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B?* A. Positive IgG B. Positive HBsAg C. Positive IgM D. Positive anti-HBs

D

A young school-age client is in the hospital with an acute kidney injury diagnosis following a streptococcus infection. The client's parents primarily speak Spanish but have a limited ability to understand English. Through an interpreter, the parents ask the nurse what mistake they made that caused their child to be so sick. Which response by the nurse is the most appropriate? A) "Your child does not eat enough dietary protein." B) "Your child has a congenital defect that led to renal failure." C) "Your child's renal failure has been caused by a low calcium level." D) "Your child's recent infection may have caused the renal failure."

D) "Your child's recent infection may have caused the renal failure." Rationale: Clients with streptococcus are at risk for kidney and cardiac sequelae. In this case, the child has no evidence of a congenital defect leading to acute kidney injury (AKI). A low-protein or low-calcium diet will not lead to AKI.

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)

Increased BUN and creatinine, hyperkalemia, and hypernatremia are all characteristics of which stage of kidney disease? A) Stage 1 CKD B) Mild CKD C) Moderate CKD D) ESKD

D) ESKD

The nurse is caring for a client suspected of having hepatorenal syndrome. Which assessment finding leads the nurse to determine this is correct? A) Esophageal varices B) Fever C) Asterixis D) Sodium retention

D) Sodium retention Rationale: Hepatorenal syndrome causes sodium​ retention, oliguria, and hypotension. Asterixis develops with portal systemic​ encephalopathy, and fever occurs with bacterial peritonitis. Esophageal varices are a complication of cirrhosis.

When collecting an admission history, the nurse identifies that the client prefers fish and crustaceans over other sources of protein. When planning discharge teaching for this client the nurse should include the fact that the cooked food most likely to remain contaminated by the virus that causes Hep A is A) canned tuna B) broiled shrimp C) baked haddock D) steamed lobster

D) Steamed lobster. The temperature during steaming is never high enough or sustained long enough to kill organisms

A 45-year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because? A: the liver cells are removing too much estrogen from the body which causes the testicles to produce excessive amounts of estrogen, and this leads to gynecomastia B: the liver is producing too much estrogen due to the damage to the liver cells, which causes the level to increase in the body, and this leads to gynecomastia C: the liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia D: the liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

D: The liver cells are failing to remove the hormone estrogen properly to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

21.Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI) (select all that apply.)? 1. Dehydration 2. Hypokalemia 3. Hypernatremia 4. BUN increases 5. Urine output increases 6. Serum creatinine increases

Dehydration Hypokalemia 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 nurse is caring for a​ critically-ill client who experienced significant blood loss during surgery. Which concern related to the​ client's risk for prerenal acute kidney injury​ (AKI) should the nurse consider the priority​? A. Hyperperfusion B. Diminished cardiac output C. Urinary obstruction D. Fluid overload

Diminished cardiac output Rationale: Prerenal AKI results from conditions that affect renal blood flow and perfusion. Any disorder that significantly decreases vascular​ volume, cardiac​ output, or systemic vascular resistance can affect renal blood flow. Prerenal AKI is​ common, particularly in clients who experience trauma or surgery or are critically ill. The kidneys normally receive 20-​25% of the cardiac output to maintain the glomerular filtration rate​ (GFR), the rate at which fluid is filtered through the kidneys. A drop in renal blood flow to less than​ 20% of normal causes the GFR to fall.​ Hypoperfusion, not​ hyperperfusion, would be a concern. Obstruction is a concern with postrenal​ AKI, not prerenal. Dehydration due to fluid loss would be the​ concern, not fluid overload.

Which condition is NOT a known cause of cirrhosis? A: Obesity B: Alcohol consumption C: Blockage of the bile duct D: Hepatitis C E: All are known causes of cirrhosis

E. All of these conditions can cause cirrhosis.

The mode of transmission of hepatitis A virus (HAV) includes which of the following? a) Fecal-oral b) Blood c) Semen d) Saliva

Fecal-oral Explanation: The mode of transmission of hepatitis A virus (HAV) occurs through fecal-oral route, primarily through person to person contact and/or ingestion of fecal contaminated food or water. Hepatitis B virus (HBV) is transmitted primarily through blood. HBV can be found in blood, saliva, semen, and can be transmitted through mucous membranes and breaks in the skin.

True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not all patients will progress through the diuresis stage. True False

Flase

The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?

Joint pain

Which laboratory test is prescribed for a client with suspected​ cirrhosis? O2 level CO2 level WBC count Liver biopsy

Liver biopsy Liver biopsy helps distinguish cirrhosis from other forms of liver disease. The O2 ​level, CO2 ​level, and WBC count are not relevant to establishing the diagnosis of cirrhosis.

The nurse observes a distinct change in the Mr.​ Dontay's level of consciousness during a routine assessment during a scheduled physical examination. Mr. Dontay is 55 years​ old, a recovering​ alcoholic, and has a primary diagnosis of cirrhosis. Which intervention is appropriate for Mr. Dontay while providing​ care? Encouraging large meals Measuring abdominal girth Providing a diet high in sodium Using hot water for bathing

Measuring abdominal girth The client with cirrhosis is at risk for​ ascites; therefore it is important to measure the​ client's abdominal girth while providing care. The nurse should encourage small​ meals, provide a diet low in​ sodium, and use warm water for bathing.

2 (The access is compromised, therefore this client warrants intervention, cant do HD)

Mr RAy is preparing to perform hemodialysis on the client with ESRD Which data warrants immediate intervention from Mr. Ray? 1. A Hgb of 9.8 and hct of 30% 2. Inability to palpate a thrill or auscultate a bruit 3. Complaints of being exhausted and unable to sleep 4. No urine output in the past 12 hrs

A pt with hep 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 wks b. use a condom during sex c. have family get injection of immunoglobulin d. follow low protein, moderate carb and moderate fat diet

B use a condom Hep B transmitted mucosally from infected blood or body fluid. sexually transmitted.

When teaching a client with chronic renal failure who is taking antibiotics about signs and symptoms of potential nephrotoxicity to report, the nurse should encourage the client to promptly report which changes in the color of the urine? (Select all that apply) A) Straw colored B) Cloudy C) Smoky D) Pink

B) Cloudy C) Smoky D) Pink

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply:* A. A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

B, C, and D

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply:* A. Frothy light-colored urine B. Dark brown urine C. Yellowing of the sclera D. Dark brown stool E. Jaundice of the skin F. Bluish mucous membranes

B, C, and E

A pt has developed hepatitis A after eating contaminated oysters. The nurse assesses the pt for which expected assessment finding? Malaise Dark Stools Weight gain Left upper quadrant discomfort

Malaise

11. While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last? A. 1-2 weeks B. 1-3 days C. Few hours to 2 weeks D. 12 months

The answer is A. The oliguric stage can last 1-2 weeks. Regarding the other stages of AKI: Initiation: few hours to several days, diuresis: 1-3 weeks, and recovery: 12 months or more.

While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last? A. 1-2 weeks B. 1-3 days C. Few hours to 2 weeks D. 12 months

The answer is A. The oliguric stage can last 1-2 weeks. Regarding the other stages of AKI: Initiation: few hours to several days, diuresis: 1-3 weeks, and recovery: 12 months or more.

The liver receives blood from two sources. The _____ is responsible for pumping blood rich nutrients into the liver. A. hepatic iliac vein B. hepatic portal vein C. mesenteric artery D. hepatic artery

The answer is B. The liver receives blood from two sources. The hepatic portal vein is responsible for pumping blood rich in nutrients to the liver.

3. Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products.

The client diagnosed with ARF is admitted to the intensive care unit and placed on a therapeutic diet. Which diet is most appropriate for the client? 1.A high-potassium and low-calcium diet. 2.A low-fat and low-cholesterol diet. 3.A high-carbohydrate and restricted-protein diet. 4.A regular diet with six (6) small feedings a day.

Hepatitis A Hepatitis B There are currently vaccinations against Hepatitis A and Hepatitis B. There are no developed vaccinations against Hepatitis​ C, D, or E.

The nurse should encourage all clients to receive vaccinations against which type of​ hepatitis? (Select all that​ apply.) Hepatitis E Hepatitis C Hepatitis A Hepatitis B Hepatitis D

a pt with CKD has a low EPO level. The pt is at risk for? a. hypercalcemia b. anemia c. blood clots d. hyperkalemia

b

The liver receives its blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen.* a. hepatic artery, low, high b. hepatic portal vein, high, low c. hepatic lobule, high, low d. hepatic vein, low, high

b. hepatic portal vein, high, low

90. The public health nurse is discussing hepatitis B with a group in the community. Which health promotion activities should the nurse discuss with the group? Select all that apply. 1. Do not share needles or equipment. 2. Use barrier protection during sex. 3. Get the hepatitis B vaccines. 4. Obtain immune globulin injections. 5. Avoid any type of hepatotoxic medications.

1,2,3

2 ( Suspect hypokalemia and check the client's potassium level. Common ECG changes with hypokalemia include ST-segment depression, inverted T waves, and prominent U waves. Clients with hypokalemia may also develop heart block. Focus: Prioritization)

5. You have been floated to the telemetry unit for the day. The monitor watcher informs you that the client has developed prominent U waves. Which laboratory value should you check immediately? 1. Sodium 2. Potassium 3. Magnesium 4. Calcium

27. The nurse would monitor which of the following laboratory values to monitor the effect of epoetin alpha being given to a client with chronic renal failure? a. Hematocrit b. BUN c. Leukocyte count d. Serum Creatinine

A

A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client's status after dialysis? a. Vital signs and weight. b. Potassium level and weight. c. Vital signs and BUN. d. BUN and creatinine levels.

A Following dialysis, the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.

Chronic hepatitis Chronic hepatitis is the primary cause of liver damage leading to​ cirrhosis, and liver cancer and can also cause liver failure. Autoimmune hepatitis causes persistent inflammation and​ necrosis, causing fibrosis with​ scarring, but does not cause liver failure. Neither Hepatitis B nor Hepatitis A causes liver failure.

A client presents to the emergency department with symptoms of right upper quadrant​ pain, fatigue,​ nausea, and vomiting. Laboratory work is completed and indicates that the client is in liver failure. Which condition should the nurse expect to find in the​ client's history? Hepatitis B Hepatitis A Chronic hepatitis Autoimmune hepatitis

Hepatitis C Hepatitis B Hepatitis B and hepatitis C can be passed to an unborn child through an infected mother. The nurse should recommend testing for these two conditions so that treatment can be initiated quickly after birth if an active infection is present.

A nurse is caring for a pregnant woman and offers testing for which types of hepatitis to prevent vertical​ transmission? (Select all that​ apply.) Hepatitis C Hepatitis E Hepatitis D Hepatitis B Hepatitis A

1,2,3 (The nurse should provide a high protein diet due to the high rate of protein breakdown that occurs with acute kidney injury. The nurse should assess the urine for blood, stones, and particles indicating a obstruction of the urinary structures that leave the kidney. The nurse should assess for intermittent anuria due to obstruction or damage to the kidney or urinary structures.. The nurse should weigh the client DAILY to monitor for fluid retention. The nurse SHOULD NOT admin NSAIDS which are toxic to the nephrons in the kidney)

A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a serum creatinine of 5. Which of the following interventions should the nurse include in the plan ? SATA 1 Provide a high protein diet 2. Assess the urine for blood 3. monitor the intermittent anuria 4. Weigh the client once per week 5 provide NSAIDS for pain

The nurse is caring for a client diagnosed with cirrhosis. The client asks the nurse, "Why does my skin itch so much?" How should the nurse respond? A) "Your skin itches because your liver cannot eliminate bile salts." B) "Your skin itches because you have been bleeding internally." C) "Your skin itches because your fluid levels are low." D) "Your skin itches because your protein levels are low."

A) "Your skin itches because your liver cannot eliminate bile salts." Rationale: In liver​ disease, the client becomes jaundiced with bile salts being deposited on the skin. This causes pruritus.​ Bleeding, low fluid​ levels, and low protein levels do not cause itching.

The nurse reviews the complications of CKD with a group of new graduate nurses. Which complication should the nurse include in the teaching? SATA A) Uremic encephalopathy B) Celiac disease C) Anemia D) Osteodystrophy E) Diabetes insipidus

A, C, D - Uremic encephalopathy - Anemia, - osteodystrophy Rationale: In​ CKD, the kidneys produce less​ erythropoietin, which results in anemia. The kidney loses the ability to excrete metabolic waste​ products, so they build up in the blood​ (uremia). These waste products cause changes in the central nervous system known as uremic encephalopathy. Decreased vitamin D synthesis and decreased calcium absorption leads to bone resorption and remodeling that leads to osteodystrophy. Diabetes insipidus and celiac disease are not complications of CKD.

The nurse is caring for a patient with cancer of the liver. The patient has a percutaneous biliary drainage system. What assessments should the nurse record in the patient's chart? A) Amount and color of drainage B) Temperature of drainage C) Odor of drainage D) Consistency of drainage

ANS: A The percutaneous biliary system is open to external drainage. The bile is observed closely for the amount, color, and presence of blood and debris. The nurse would not record the temperature, odor, and consistency of the drainage.

A nurse practitioner is teaching a health class in the local high school. The nurse practitioner informs the class about hepatitis B. What occupation does the nurse practitioner inform the class is at the greatest risk for contracting hepatitis B? A) Flight attendants B) Health care workers C) Fire fighters D) Educators

ANS: B People who are at high risk, including nurses and other health care personnel exposed to blood or blood products, should receive active immunization. Health care workers who have had frequent contact with blood are screened for anti-HBs to determine whether immunity is already present from previous exposure. Flight attendants, fire fighters and educators are not at high risk for hepatitis B.

4. A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine output b. Calcium level c. Cardiac rhythm d. Neurologic status

ANS: C The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.

A nurse is caring for a client with cirrhosis. Which assessment finding warrants immediate​ attention? Pulse of 60 bpm Oxygen saturation of​ 92% Blood pressure of​ 110/72 mmHg Abdominal distention

Abdominal distention Rationale Abdominal​ distention, which is an imbalance of fluid within the portal​ system, might mean ascites in a client with cirrhosis. The vital signs are all within normal limits.

33. A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patient's fluid volume excess? Select all that apply. A) Administering diuretics B) Administering calcium channel blockers C) Implementing fluid restrictions D) Implementing a 1500 kcal/day restriction E) Enhancing patient positioning

Ans: A, C, E Feedback: Administering diuretics, implementing fluid restrictions, and enhancing patient positioning can optimize the management of fluid volume excess. Calcium channel blockers and calorie restriction do not address this problem.

A patient who has been on continuous ambulatory peritoneal dialysis (CAPD) is hospitalized and is receiving CAPD with four exchanges a day. During the dialysate inflow, the patient complains of having abdominal pain and pain in the right shoulder. The nurse should a. massage the patient's abdomen and back. b. decrease the rate of dialysate infusion. c. stop the infusion and notify the health care provider. d. administer the PRN acetaminophen (Tylenol).

Answer: B Rationale: Abdominal pain and referred shoulder pain can be caused by a rapid infusion of dialysate; the nurse should slow the rate of the infusion. Massage and administration of acetaminophen (Tylenol) would not address the reason for the pain. There is no need to notify the health care provider.

A college student is required to be inoculated for hepatitis before entering college. The nurse reognizes that this client will be inoculated to prevent the development of...? "1. Hepatits D 2. Hepatits B 3, Hepatitis C 4.Hepatits E"

"Answer: 2 - Hepatits B Ratioinale: Sexually transmitted and is seen in all age groups. There is a vaccine for this type of Hepatitis

3 (The clients apical pulse and BP indicate the client is hemorrhaging)

50. A client with open surgery of the kidney has an AP 118 BP 88/58 Which intervention should the nurse implement first? 1. Obtain the pulse oximeter reading 2. check the clients last hgb and hct 3. Notify the surgeon immed 4. Monitor the clients urine output

3 (It is within the LPNs scope to change the ileal conduit drainage bag, this is the most appropriate assignment)

6 The charge nurse is making shift assignments to the surgical staff. Which consists of two nurses , two LPNs and 2 UAPs, Which assignment would be most appropriate for the charge nurse to make? 1. Instruct the nurse to admin all the PRNS 2. Instruct the UAP to clean the recently vacated room 3. Assign the LPN to change the clients ileal conduit bag 4. Request the LPN to complete the admission interview for a new client

3 ( SIADH causes a relative sodium deficit due to excessive retention of water. Focus: Prioritization)

7. A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). For which electrolyte abnormality would you be sure to monitor? 1. Hypokalemia 2. Hyperkalemia 3. Hyponatremia 4. Hypernatremia

12. The enterostomal therapist is consulting with the surgeon regarding placement of a urinary stoma. Which of the following locations should be suggested? a. Lower abdominal quadrants b. Pubic area c. Rib margins d. Umbilical area

A

30. Clients are monitored consistently throughout the peritoneal dialysis procedure for all the following except: a. Increased appetite b. Color of dialysate c. Chvostek's sign d. Low potassium

A

The nurse reviews the stages of CKD before caring for a client with the disorder. Which stage of CKD should the nurse identify as occurring when the kidneys are unable to excrete metabolic waste and maintain fluid and electrolyte balance adequately? A) End-stage renal disease B) Renal insufficiency C) Corneal failure D) Decreasing renal reserve

A) End-stage renal disease Rationale: Chronic renal disease​ (CKD) progresses slowly. Loss of function may not be recognized for many years.​ End-stage renal​ disease, or stage​ 5, is the stage where the kidneys are finally unable to excrete metabolic wastes and to regulate fluid and electrolyte balance adequately.

A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on knowledge that A) Milk thistle may affect liver enzymes and thus alter drug metabolism. B) Milk thistle is generally safe in recommended doses for up to 10 years. C) There is unclear scientific evidence for the use of milk thistle in treating cirrhosis. D) Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.

A) Milk thistle may affect liver enzymes and thus alter drug metabolism There is good scientific evidence for the use of milk thistle as an antioxidant to protect the liver cells from toxic damage in the treatment of cirrhosis. It is noted to be safe for up to 6 years, not 10 years, and it may lower, not elevate, blood glucose levels. It does affect liver enzymes and thus could alter drug metabolism. Therefore patients will need to be monitored for drug interactions.

Which characteristics are associated with ESKD? (Select all that apply) A) Severe fluid overload B) Renal osteodystrophy C) Nephrons compensate D) Dialysis or transplant needed to maintain homeostasis E) Excessive waste products

A) Severe fluid overload B) Renal osteodystrophy D) Dialysis or transplant needed to maintain homeostasis E) Excessive waste products

12. A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a. is much less likely to clot. b. increases patient mobility. c. can accommodate larger needles. d. can be used sooner after surgery.

ANS: A AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.

16. When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation? a. The patient has metastatic lung cancer. b. The patient has poorly controlled type 1 diabetes. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with the human immunodeficiency virus.

ANS: A Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.

13. When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? a. Check the fistula site for a bruit and thrill. b. Assess the rate and quality of the left radial pulse. c. Compare blood pressures in the left and right arms. d. Irrigate the fistula site with saline every 8 to 12 hours.

ANS: A The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.

5. A patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which of these orders for the patient will the nurse question? a. NPO for 6 hours before IVP procedure b. Normal saline 500 mL IV before procedure c. Ibuprofen (Advil) 400 mg PO PRN for pain d. Dulcolax suppository 4 hours before IVP procedure

ANS: C The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure.

Which nursing diagnosis supports a medical diagnosis of​ cirrhosis? A: Fatigue B: Increased risk for acute confusion C: Anxiety D: Activity intolerance

Answer: B

10. What is the most common complication of peritoneal dialysis? a. Urinary retension b. Peritonitis c. Abdominal pain d. Infiltration

B

"What type of precautions should the nurse implement to protect from being exposed to any of the hepatitis viruses? "1. Airborne precautions 2. Standard precautions 3. Droplet precautions 4. Exposure precautions"

Correct 2 2. Standard precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood

"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 college student is required to be inculated for hepatitis before starting college. The nurse recognizes that he will be inoculated for: 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

Correct Answer 2 Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

A college student is required to be inculated for hepatitis before starting college. The nurse recognizes that he will be inoculated for: 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

Correct Answer 2 Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

"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"

13. The nurse would anticipate that a client with rhabdomyolysis would exhibit which of the following manifestations? a. Gross hematuria b. Clear yellow urine c. Dark amber urine d. Brown-tinged urine

D

15. Mrs. K is in the diuretic phase of acute renal failure. During this phase, the client is assessed for signs of: a. Hyperkalemia b. Metabolic acidosis c. Hypertension d. Hypovolemia

D

A nurse is analyzing the posthemodialysis lab test results for a client with chronic renal failure (CRF). The nurse interprets that the dialysis is having an expected but nontherapeutic effect if the results indicate a decreased: a. Phosphorus. b. Creatinine. c. Potassium. d. Red blood cell count

D Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia, because RBCs are lost in dialysis from blood sampling and anticoagulation during the procedure, and from residual blood that is left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process.

The nurse is explaining to the client the most common causes of AKI. Which cause should the nurse present? SATA A) Fluid overload B) Dehydration C) Chemical imbalance D) Insufficient blood supply E) Exposure to nephrotoxins

D, E - Insufficient blood supply - Exposure to nephrotoxins Rationale: The most common causes of acute kidney injury​ (AKI) are ischemia​ (insufficient blood​ supply) and exposure to nephrotoxins​ (substances that damage nerves or nerve​ tissue). Because of the amount of blood that passes through​ them, the kidneys are particularly vulnerable to these factors. A fall in blood pressure or volume can cause ischemia of kidney tissues. Nephrotoxins in the blood damage renal tissue directly. Other causes of AKI include major​ surgery, sepsis, and severe pneumonia.

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

Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Palpation of abdomen for a fluid shift b) Measurement of abdominal girth c) Foul-smelling breath d) Weight

Foul-smelling breath Explanation: Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.

The nurse is caring for a client with acute kidney injury​ (AKI). Which condition should the nurse recognize as a possible cause for this​ disease? (Select all that​ apply.) A. Cerebrovascular disease B. Hemorrhage C. Severe heart failure D. Major trauma E. Radiologic contrast media

Hemorrhage Severe heart failure Major trauma Radiologic contrast media Rationale: Major​ trauma, heart​ failure, and hemorrhage are all possible risks and causes for AKI because they can reduce blood flow to the kidneys. Radiologic contrast media can be nephrotoxic and cause AKI. Cerebrovascular disease is not a risk factor for AKI because it does not reduce blood flow to the kidneys and it does not cause nephrotoxicity.

10.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? 1. Hypokalemia 2. Hyponatremia 3. Large urine output 4. Leukocytosis with cloudy urine output

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

The nurse is discussing management of acute kidney injury​ (AKI) with the client. Which would describe the key goal to managing this​ condition? A. Drinking more fluids B. Avoiding the use of diuretics C. Eating more vegetables that are low in iron D. Maintaining fluid and electrolyte balance

Maintaining fluid and electrolyte balance Rationale: If a client develops​ AKI, maintaining the fluid and electrolyte balance is a key goal in managing the condition. Drinking more fluids could place the client at risk for fluid overload. Diuretics may be ordered for a client who is retaining a significant amount of fluid. Increasing the amount of iron in the diet is necessary if the client is not getting the daily requirement in the foods they are consuming.

6.The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? 1. Sodium 2. Potassium 3. Magnesium 4. Phosphorus

Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not have an effect on sodium, potassium, or magnesium levels

To determine a blood and tissue type match between donor and recipient in kidney​ transplants, human leukocyte antigens are compared. How many antigens should the nurse expect to be reported for a donor to be a​ "perfect" match? A. Four B. Five C. Seven D. Six

Six ​Rationale: Six antigens are considered a perfect match in blood and tissue typing for kidney transplantation.

A nurse is caring for a client with ascites secondary to cirrhosis. Which medication is the treatment of​ choice? Spironolactone​ (Aldactone) Neomycin sulfate Oxazepam​ (Serax) Furosemide​ (Lasix)

Spironolactone​ (Aldactone) Diuretics are used to reduce fluid retention and ascites. While furosemide​ (Lasix) may be​ used, the drug of choice is spironolactone​ (Aldactone) because it is also an Aldosterone Antagonist. Neomycin sulfate reduces the number of​ ammonia-forming bacteria in the​ bowel, and oxazepam​ (Serax) is used for acute agitation.

2. These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost.

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1.Have the assistant apply a moisture barrier cream to the skin. 2.Instruct the UAP to bathe the client in cool water. 3.Tell the UAP not to turn the client in this condition. 4.Explain this is normal and do not do anything for the client.

Select all the signs and symptoms associated with Hepatitis?* A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

The answers are A, D, F, G, and H. The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 15-45 mcg/dL.

1. An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct.

The client asks, "What does an elevated PSA test mean?" On which scientific rationale should the nurse base the response? 1.An elevated PSA can result from several different causes. 2.An elevated PSA can be only from prostate cancer. 3.An elevated PSA can be diagnostic for testicular cancer. 4.An elevated PSA is the only test used to diagnose BPH.

Which of the following is the most effective strategy to prevent hepatitis B infection? a) Vaccine b) Barrier protection during intercourse c) Avoid sharing toothbrushes d) Covering open sores

Vaccine Explanation: The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it a priority to monitor the patient for signs and symptoms of? Select all that apply:* a. Thrombocytopenia b. Vision changes c. Increased PT/INR d. Leukopenia

a. Thrombocytopenia c. Increased PT/INR d. Leukopenia

What is most likely to be elevated in the urine for a person with acute kidney injury? a. albumin b. ketones c. nitrates d. calcium

a. albumin

A patient has been diagnosed with renal osteodystrophy. What is priority concern of the nurse? a. bone fracture b. muscle weakness c. tetany d. dysrhthymias

a. bone fracture

You are receiving a shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply:* a. Frothy light-colored urine b. Dark brown urine c. Yellowing of the sclera d. Dark brown stool e. Jaundice of the skin f. Bluish mucous membranes

b. Dark brown urine c. Yellowing of the sclera e. Jaundice of the skin

The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrate the medication is working effectively? Select all that apply:* a. Decrease albumin levels b. Decrease in Fetor Hepaticus c. Patient is stuporous. d. Decreased ammonia blood level e. Presence of asterixis

b. Decrease in Fetor Hepaticus d. Decreased ammonia blood level

What is a serious side effect to monitor for when a person is taking anti-rejection medication after a kidney transplant? a. cardiac dysrhythmias b. infection c. anemia d. decreased cardiac output

b. infection

your pt with CKD disease is scheduled for dialysis in the morning. While examining the pt's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel. what result from the BMP confirms the EKG abnormality? a. phosphate 3.2mg/dL b. calcium 9.3mg/dL c. magnesium 2.2mg/dL d. potassium 7.1mEq/L

d

In a patient with AKI, which laboratory urinalysis result indicates tubular damage? a. urine testing reveals a low specific gravity b. causative factor is malignant hyptertension c. urine testing reveals a high sodium concentration d. reversal of oliguria occurs with fluid replacement

d. In prerenal oliguria, the oliguria is caused by a decrease in circulating blood volume and there is no damage yet to the renal tissue.

What is the action of calcitrol? a. decrease renal secretion of calcium b. increase calcium production in bones c. decreases serum calcium levels d. increases absorption calcium from gut

d. increases absorption calcium from gut

Which type of dialysis is able to remove protein from the blood? a. neither type b. hemodialysis c. both types d. peritoneal dialysis

d. peritoneal dialysis

A client with liver cirrhosis begins to drain bright red blood through the nasogastric tube. Which should the nurse prepare to administer to this client? A) Vitamin K B) Ferrous sulfate C) Platelets D) Folic acid

C) Platelets Rationale: Ferrous sulfate and folic acid are given as indicated to treat anemia. Vitamin K may be ordered to reduce the risk of bleeding. When bleeding is acute, packed RBCs, fresh frozen plasma, or platelets may be administered to restore blood components and promote hemostasis.

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

The answer is A. The patient should follow this type of diet because protein breaks down into urea (remember patient will have increased urea levels), low sodium to prevent fluid excess, low potassium to prevent hyperkalemia (remember glomerulus isn't filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia.

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: The hepatitis A virus is in the stool of infected people up to two (2) weeks beforesymptoms develop.

________ reside in the liver and help remove bacteria, debris, and old red blood cells.* A. Hepatocytes B. Langerhan cells C. Enterocytes D. Kupffer cells

D

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this pt by assessing what? a. relief of constipation b. relief of ab pain c. decreased liver enzymes d. decreased ammonia levels

D hepatic encephalopathy is associated with elevated ammonia levels. Lactulose traps ammonia in the intestinal tract. It's laxative effect then expels ammonia from the colon, resulting in decreased ammonia levels, correcting hepatic encephalopathy.

The client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. The priority nurse action would be to: a. Check the shunt for the presence of bruit and thrill. b. Observe the site once as time permits during the shift. c. Check the results of the prothrombin times as they are determined. d. Ensure that small clamps are attached to the arteriovenous shunt dressing.

D An arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours.

1) The nurse is concerned that a client with potential hepatic failure is at risk for developing ascites. Which assessment finding supports the development of liver failure as manifested by ascites? A) Increased abdominal girth B) Gallbladder pain C) Yellow-tinged skin D) Bleeding and bruising easily

a

95. Which statement by the client diagnosed with hepatitis would warrant 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 that 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."

4

How is Hepatitis E transmitted?* A. Fecal-oral B. Percutaneous C. Mucosal D. Body fluids

A

What is the most serious electrolyte disorder associated with kidney disease? A) Hypocalcemia B) Hyperkalemia C) Hyponatremia D) Hypermagnesemia

B) Hyperkalemia

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis?* A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

C

The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 100.2F. Which of the following is the appropriate nursing action? a. Encourage fluids. b. Notify the physician. c. Continue to monitor vital signs. d. Monitor the site of the shunt for infection.

C The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity determinations.

The nurse is caring for a patient with acute kidney injury (AKI) resulting from a urethral obstruction due to cancer. Which type of AKI is the patient experiencing? A. Prerenal B. Intrinsic C. Postrenal D. Intrarenal

C. Postrenal Postrenal AKI is a result of any ureteral or urethral obstruction. Prerenal AKI is caused by any disorder that significantly decreases vascular volume, cardiac output, or systemic vascular resistance that can affect renal blood flow. Intrarenal (intrinsic) AKI is caused by diseases of the kidney itself.

Signs and symptoms of acute renal failure include: A. bradycardia, with decreased respiration, low serum bicarbonate, and elevated pH. B. lethargy, tachypnea, and elevated serum bicarbonate. C. slowed respirations and low pH. D. tachypnea, low pH, and low serum bicarbonate.

D. tachypnea, low pH, and low serum bicarbonate.

"A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission? A. Sexual contact with an infected partner. B. Contaminated food. C. Blood transfusion. D. Illegal drug use.

Correct answer: B" Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B, C, and D are transmitted through infected bodily fluids.

To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when: A) Disposing of food trays B) Emptying the bed pan C)Taking an oral temperature D) changing IV tubing

Correct: B.... Rationale: 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

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is?* A. Blood B. Percutaneous C. Mucosal D. Fecal-oral

D

What is the MOST common transmission route of Hepatitis C?* A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

D

The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is priority for the client? A) Low self-esteem B) Knowledge deficit C) Activity intolerance D) Excess fluid volume

D) Excess fluid volume

The nurse is providing education to the caregivers of a client with cirrhosis of the liver. The caregivers indicate that they've heard of portal hypertension, but they aren't sure which symptoms could indicate that their loved one is experiencing this condition. Which symptoms of portal hypertension should the nurse discuss with the caregivers? A) Muscle wasting B) Hypothermia C) Bleeding gums D) Hemorrhoids

D) Hemorrhoids Rationale: Obstruction to portal blood flow causes a rise in portal venous pressure, resulting in splenomegaly, ascites, and engorgement of veins in the esophagus, rectum, and abdomen. Bleeding gums indicate insufficient vitamin K production in the liver. Muscle wasting is commonly associated with the poor nutritional intake seen in clients with cirrhosis. Hypothermia is an unrelated finding.

You are preparing to administer a dose of PhosLo to a patient with chronic kidney disease (CKD). This medication should have a beneficial effect on which laboratory value? A. Sodium B. Potassium C. Magnesium D. Phosphorus

D. Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen in CKD.

The nurse is completing a health history on a client admitted with acute renal failure. Which information should the nurse​ collect? (Select all that​ apply.) A. Reports of anorexia B. Reports of weight loss C. Previous transfusion reactions D. Recent exposure to nephrotoxic medications E. Chronic diseases

Reports of anorexia Previous transfusion reactions Recent exposure to nephrotoxic medications Chronic diseases Rationale: When completing a health history on a client with acute renal​ failure, the nurse needs to collect information on recent exposure to nephrotoxic medications​ (e.g., nonsteroidal​ anti-inflammatory drugs​ [NSAIDs] and some chemotherapeutic​ drugs); previous transfusion​ reactions; chronic diseases such as diabetes​ mellitus, heart​ failure, and kidney​ disease; and reports of anorexia. The nurse needs to collect information on reports of weight​ gain, not weight loss.

​"I have recently been​ overseas." Hepatitis A is most commonly spread through contaminated food and water in developing countries with high rates of hepatitis A. To prevent hepatitis​ A, travelers in developing countries should boil​ water, cook food​ thoroughly, and peel raw vegetables and fruits.

Which statement suggests that a client is at risk for contracting viral hepatitis​ A? ​"I am a healthcare​ worker." ​"I had a blood transfusion​ recently." ​"I have recently been​ overseas." ​"I have renal failure and receive hemodialysis three times a​ week."

Use of contact precautions Hepatitis A is transmitted through the fecal-oral route. If a patient with this condition is also experiencing fecal incontinence, contact isolation is required to prevent transmission of infection to other patients and staff members.

While working with a patient with hepatitis A, which is the most appropriate action by the nurse? Initiating droplet precautions Use of a mask when entering the room Use of standard precautions Use of contact precautions

4 ( The treatment for hyperacute rejection is immediate removal of the transplanted kidney and return to dialysis. Increased doses of immunosuppressant drugs are used to treat acute rejection, conservative management is used for chronic rejection, and IV antibiotics are administered for infections. Focus: Prioritization)

You are caring for Ms. J 1 day postoperatively. On assessment, her temperature is 100.4° F (38o C), her blood pressure is 168/92 mm Hg, and the patient tells you she has pain around the transplant site. 14. What intervention is required at this time? 1. Increased doses of immunosuppressive drugs 2. IV antibiotics 3. Conservative management including dialysis 4. Immediate removal of the transplanted kidney

The client is in end-stage renal failure (ESRD). Which of the following foods may be allowed for the client? a) banana b) apple c) carrot cake d) cantaloupe

b) apple APPLES ARE LOW IN POTASSIUM

A client has been diagnosed to have chronic renal failure. Sodium polysterene sulfonate (exchange resin kayexalate) is prescribed. The action of the medication is that it releases a) bicarbonate in exchange for primarily sodium ions b) sodium ions in exchange for primarily bicarbonate ions c) sodium ions in exchange for primarily potassium ions d) potassium ions in exchange for primarily sodium ions

c) sodium ions in exchange for primarily potassium ions

What is the most common complication of peritoneal dialysis? a. hyperglycemia b. fluid retention c. peritonitis d. confusion

c. peritonitis

Which lab is most indicative of kidney damage? a. increased BUN b. decreased potassium c. decreased sodium d. increased creatinine

d. increased creatinine

The nurse preceptor is teaching a new graduate about conditions that can cause damage to the renal parenchyma and nephrons resulting in acute kidney injury​ (AKI). Which condition should the nurse preceptor​ include? (Select all that​ apply.) A. Vasculitis B. Hypertension C. Hemolysis D. Glomerulonephritis E. Dehydration

​Vasculitis Hypertension Hemolysis Glomerulonephritis Rationale: Hypertension,​ hemolysis, glomerulonephritis, and vasculitis cause acute damage to the renal parenchyma and​ nephrons, leading to intrarenal AKI. Dehydration causes prerenal AKI and does not cause damage to the renal parenchyma and nephrons.

"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"

The nurse knows that which are the functions of bile? Select all that apply. 1. Emulsifies fat 2. Removes some toxins 3. Neutralizes alkalytic chime 4. Helps absorb fat-soluble vitamins 5. Converts urobilinogen to bilirubin 6. Produced in the gallbladder, aids the liver

1. Emulsifies fat 2. Removes some toxins 4. Helps absorb fat-soluble vitamins Bile emulsifies fat, breaking it into small particles that can be absorbed. Bile is responsible for removing some toxins. In addition, bile plays a role in the absorption of fat-soluble vitamins. Bile neutralizes acidic rather than alkalytic chime as it leaves the stomach. In the large intestine, bile is converted to urobilinogen and then stercobilin, not bilirubin. Bile is produced in the liver and stored in the gallbladder.REF: p. 848

The nurse is teaching a health promotion class. The participants should be told that they can reduce the risk of pancreatic cancer by: (select all that apply) 1. Smoking cessation 2. Increased dietary protein 3. Regular exercise 4. Stress reduction activities

1. Smoking cessation 4. Stress reduction activities Among the risk factors for pancreatic cancer are chronic pancreatitis and smoking. Other probable risk factors are a high-fat diet and exposure to certain toxic chemicals. Tumors may develop in the head, body, or tail of the pancreas. Chronic pancreatitis is often related to alcohol abuse, so stress reduction exercises are needed. Nursing care of the patient with pancreatitis addresses anxiety along with acute pain; deficient fluid volume; risk for infection; impaired gas exchange; imbalanced nutrition: less than body requirements; and deficient knowledge. Increased dietary protein is not an intervention needed to reduce one's risk of pancreatic cancer. Regular exercise is not as important as interventions to relieve stress.

4 ( Epoetin alfa is used to treat anemia and is given two to three times a week. It is given by either the IV or subcutaneous route. Most commonly epoetin alfa is given subcutaneously. All of the other statements about CKD patient medications are accurate. Focus: Delegation, supervision)

12. Ms. J (hemodialysis pt) is preparing for discharge. You are supervising a student nurse, who is teaching the patient about her discharge medications. For which statement by the student nurse will you intervene? 1. "Sevelamer prevents your body from absorbing phosphorus." 2. "Take your folic acid after dialysis on dialysis days." 3. "The docusate is to prevent constipation that may be caused by ferrous sulfate." 4. "You must take the epoetin alfa three times a week by mouth to treat anemia."

94. The client diagnosed with liver problems asks the nurse, "Why are my stools claycolored?" On which scientific rationale should the nurse base the response? 1. There is an increase in serum ammonia level. 2. The liver is unable to excrete bilirubin. 3. The liver is unable to metabolize fatty foods. 4. A damaged liver cannot detoxify vitamins.

2

4 (fosamax, should be administered with a full glass of water on an empty stomach to promote absorption. The client should remain upright for 30 mins to prevent regurgitation into the esophagus and esophageal erosion.)

21 The elderly client with osteoporosis is dx and prescribed the biphosphate med alendronate (Fosamax) Which intervention is priority when administering this medication? 1. Admin first thing in the am 2. Ask the client about a Hx of peptic ulcer disease 3 Encourage the client to walk for at least 30 min 4. Have the client remain upright for 30 mins after med admin

4 (Tylenol first, due in 5 mins, administered for mild to mod pain)

24 The nurse is preparing to admin medications. Which medication should the nurse admin first? 1. digoxin a cardiac glycoside due at 0900 2. Furosemide due at 0800 3. Propoxyphene, an analgesic due in 2 hrs 4. Acetaminophen due in 5 mins

3. A nurse is caring for a client who has just returned to the nursing unit after an intravenous pyelogram (IVP). The nurse determines that which of the following is important in the postprocedure care of this client? a) encouraging increased intake of oral fluids b) ambulating the client in the hallway c) encouraging the client to try to avoid frequently d) maintaining the client on bedrest

3) A - Following an IVP, the client should take in increased fluids to aid in the clearance of the dye used for the procedure. It is unnecessary to void frequently after the procedure. The client is usually allowed activity as tolerated without any specific activity guidelines.

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) A Obtain the client's pre-hemodialysis weight. Correct B Check the arteriovenous (AV) fistula for a thrill and bruit. C Document the amount the client drinks throughout the shift. Correct D Auscultate the client's lung sounds every 4 hours. E Explain the components of a low-sodium diet.

A Obtain the client's pre-hemodialysis weight. C Document the amount the client drinks throughout the shift. Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

Which statements are INCORRECT regarding the anatomy and physiology of the liver? Select all that apply:* A. The liver has 3 lobes and 8 segments. B. The liver produces bile which is released into the small intestine to help digest fats. C. The liver turns urea, a by-product of protein breakdown, into ammonia. D. The liver plays an important role in the coagulation process.

A and C.

3 (orthostat hypotension is an adverse effect of captopril. This results in a change in blood flow to the kidneys after the initial dose. WRONG: #1 assess for hypotensive effect of antihypertensive. #2 increase the clients fluids can help resolve hypotension effects of med. #4 The client is at risk for falls due to the hypotensive effect of the med. The nurse would encourage the client to remain in bed)

A nurse administered captopril to a client during a renal scan. Which of the following actions should the nurse take? 1. assess for HTN 2. Limit the clients fluid intake 3. Monitor for orthostatic hypotension 4. encourage early ambulation

Standard immune globulin Postexposure prophylaxis for hepatitis A must be administered within 2 weeks of exposure. Hepatitis A immune globulin would be administered to promote passive immunity to the virus. HepaGam B is the immune globulin for hepatitis B virus. Hepatitis A vaccine is given to prevent infection before exposure. Roferon-A is an interferon to treat the actual infection.

A woman presents to the clinic after learning that she was exposed to hepatitis A in a restaurant that she went to last week. Which treatment does the nurse anticipate will be ordered for this patient? HepaGam B Standard immune globulin Hepatitis A vaccine Roferon-A

A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk? a) Increase intake of potassium-rich food. b) Avoid intake of sodium-rich food. c) Abstain from drinking alcohol. d) Use aspirin at least once a day.

Abstain from drinking alcohol. Explanation: A soft diet and elimination of alcohol, aspirin, and other locally irritating substances minimize the risk for developing esophageal varices. Intake of sodium- or potassium-rich food has no effect on the formation of varices.

An 87-year-old client is in the ICU where you practice nursing. He was admitted for critical care due to his esophageal varices and his precarious physical condition. Which of the following could result in causing his varices to hemorrhage? a) All options are correct b) Little protective tissue to protect fragile veins c) Chemical irritation d) Rough food

All options are correct Explanation: Esophageal varices overfill as a result of portal hypertension. They are especially vulnerable to bleeding because they lie superficially in the mucosa, contain little protective elastic tissue, and are easily traumatized by rough food or chemical irritation.

The nurse is reviewing the record of a client with a dx of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? Dorsiflex the foot Measure abdominal girth Ask pt to extend the arms Instruct pt to lean forward

Ask the pt to extend the arms Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, with the palms down, wrists bent up, and fingers spread. It is the most common and reliable sign that hepati encephalopathy is developing.

9.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? 1. Level of consciousness 2. Blood pressure and fluid balance 3. Temperature, heart rate, and blood pressure 4. Assessment for signs and symptoms of infection

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 afte

18. Which of the following electrolyte imbalances tends to occur in the earlier stages of chronic renal failure? a. Hypokalemia b. Hypercalcemia c. Hyponatremia d. Hypocalcemia

C

19. Which of the following clients with chronic renal failure would not be a candidate for peritoneal dialysis? a. A 50 year old man with cardiovascular disease b. A 45 year old woman with diabetes mellitus c. A 10 year old child with congenital urethral strictures d. A 70 year old woman with tuberculosis.

C

6. How often must hemodialysis be performed in order to be effective? a. Every day b. Twice a week c. Three times a week d. Four times a week and prn

C

A 56-year-old woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. The nurse should assess the patient for: A) Fatigue B) Flank tenderness C) Cardiac dysrhythmias D) Elevated triglycerides

C) Cardiac dysrhythmias

Which of the following is NOT a role of the liver? A: removing hormones from the body B: producing bile C: absorbing water D: producing albumin

C: absorbing water. The liver does not absorb water. The intestines are responsible for this function.

Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?

Calculated glomerular filtration rate (GFR)

3.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? 1. Fatigue 2. Hypoglycemia 3. Cardiac dysrhythmias 4. Elevated triglycerides

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.

After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first?

Check the chart for the most recent blood potassium level.

A client who received a kidney transplant 18 months ago is demonstrating progressive​ azotemia, proteinuria, and hypertension. Which disorder should the nurse suspect the client is​ experiencing? A. Acute rejection of the kidney B. Pyelonephritis C. Chronic rejection of the kidney D. Glomerulonephritis

Chronic rejection of the kidney Rationale: The symptoms described are those of progressive renal failure. This means that the transplanted kidney is failing. Acute rejection develops within months of the transplant. Chronic rejection occurs months or years after the transplant. Glomerulonephritis and pyelonephritis are infections of the kidney.

The nurse is providing care to a client diagnosed with chronic renal failure. Which assessment finding should the nurse expect if uremia is​ present? (Select all that​ apply.) A. Bruising on upper extremities B. Crystals noted on the skin surface C. Pruritus D. Moist skin E. Yellow color on the sclera

Crystals noted on the skin surface Pruritus Rationale: High levels of urea mixing with sweat can result in uremic​ frost, crystallized deposits of urea on the skin. The condition will cause pruritus. Bruising is a common manifestation of chronic renal​ failure, but this manifestation is caused by impaired platelet function. Clients with​ end-stage renal disease​ (ESRD) may develop a yellowish tinge to the skin because of retained pigmented​ metabolites, but a yellowed sclera is significant of other disease processes. Dry skin with poor turgor is a common dermatologic assessment in clients with ESRD.

20. During peritoneal dialysis. Mrs. H's dialysate white blood cell count is 150/mm and neutrophils are 60%. This would indicate that the client has developed a. Anemia b. Pylenephritis c. Bowel perforation d. Peritonitis

D

4. Hemodialysis rids the body of harmful waste. What else does hemodialysis remove? a. Extra protein and fat b. Extra sodium and potassium c. Extra insulin d. Extra water and sodium

D

Which stage of chronic kidney disease is characterized by hypertension, anemia, malnutrition, altered bone metabolism, metabolic acidosis, and a severely decreased glomerular filtration rate? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

D) Stage 4 Rationale: Clients in stage 1 of chronic kidney disease (CKD) are asymptomatic and have a normal or increased glomerular filtration rate (GFR). During stage 2, the GFR mildly decreases and hypertension may develop. In stage 3, there is a moderate GFR decrease, as well as hypertension, possible anemia and fatigue, anorexia, possible malnutrition, and bone pain. Stage 4 involves a severely decreased GFR as well as hypertension, anemia, malnutrition, altered bone metabolism, edema, metabolic acidosis, hypercalcemia, possible uremia, and azotemia.

17.During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? 1. Administer hypertonic saline. 2. Administer a blood transfusion. 3. Decrease the rate of fluid removal. 4. Administer antiemetic medications.

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

11.Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? 1. IV tobramycin 2. Incompatible blood transfusion 3. Poststreptococcal glomerulonephritis 4. Dissecting abdominal aortic aneurysm

Dissecting abdominal aortic aneurysm A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and post-streptococcal glomerulonephritis are intrarenal causes of AKI

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a) Hepatocellular b) Nonobstructive c) Obstructive d) Hemolytic

Hemolytic Explanation: Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Bradycardia b) Warm moist skin c) Hypotension d) Polyuria

Hypotension Explanation: Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a) Serum sodium level of 135 mEq/L b) Blood pH of 7.25 c) Serum potassium level of 3.5 mEq/L d) Loss of 2.2 lb (1 kg) in 24 hours

Loss of 2.2 lb (1 kg) in 24 hours Explanation: Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

4 (There should be at least 30 mL/hr, must assess to ensure the stents placed in ureters have not become dislodged or to ensure that edema of ureters is not occurring)

Ms Brenda is making rounds on clients. Which client should be assessed first? 1. The client with ESRD on hemodialysis with palpable bruit 2. Client with acute glomerulonephritis who has hematuria and proteinuria 3. The client with bladder cancer who has painless urination with bright red urine 4. The client with an ileal conduit who has not had any drainage in the drainage bag

For which manifestation should the nurse assess in a client with hepatorenal​ syndrome? Fever Esophageal varices Sodium retention Asterixis

Sodium retention Hepatorenal syndrome causes sodium​ retention, oliguria, and hypotension. Asterixis develops with hepatic​ encephalopathy, and fever with bacterial peritonitis. Esophageal varices are a complication of cirrhosis.

Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension? a) Kanamycin (Kantrex) b) Cyclosporine (Sandimmune) c) Spironolactone (Aldactone) d) Lactulose (Cephulac)

Spironolactone (Aldactone) Explanation: For portal hypertension, a diuretic usually an aldosterone antagonist such as spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to treat hepatic encephalopathy to destroy intestinal microorganisms and decrease ammonia production. Lactulose would be used to reduce serum ammonia concentration in a client with hepatic encephalopathy. Cyclosporine (Sandimmune) would be used to prevent graft rejection after a transplant.

The nurse is planning care for a client with chronic kidney disease​ (CKD). Which precautions should the nurse implement for this​ client? A. Droplet B. Airborne C. Standard D. Contact

Standard Rationale: Because a client with chronic renal failure is at risk of​ infection, healthcare providers should use standard precautions to provide care. The other types of precautions are not appropriate for a client with chronic renal failure.

The nurse is providing care to a client diagnosed with chronic renal failure. Which cardiovascular assessment finding should the nurse identify that supports this diagnosis? A. Anemia B. Systemic hypertension C. Hyperkalemia D. Decreased white blood cell count

Systemic hypertension Rationale: The cardiovascular assessment finding that supports the diagnosis of chronic renal failure is systemic hypertension. Anemia is a hematologic symptom of chronic renal failure. A decreased white blood cell count is a manifestation of chronic renal failure that affects the immune system. Hyperkalemia occurs as the result of the effects of chronic renal failure on fluids and electrolytes.

3. Regular insulin, along with glucose, will drive potassium into the cells,thereby lowering serum potassium levels temporarily.

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1.Erythropoietin. 2.Calcium gluconate. 3.Regular insulin. 4.Osmotic diuretic.

1. Clients who have urinary incontinenceare often embarrassed, so it is the responsibility of the nurse to approach this subject with respect and consideration.

The elderly client being seen in the clinic has complaints of urinary frequency,urgency, and "leaking." Which priority intervention should the nurse implement when interviewing the client? 1.Ensure communication is nonjudgmental and respectful. 2.Set the temperature for comfort in the examination room. 3.Speak loudly to ensure the client understands the nurse. 4.Ensure the examining room has adequate lighting.

What is the main issue in cirrhosis?

The hepatocytes, which are the main functional unit of the liver, are being destroyed. Repeated destruction of hepatic cells causes SCAR TISSUE to form on the liver ----- irreversible damage.

When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation?

The patient has metastatic lung cancer.

The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which information should be reported immediately to the health care provider?

The patient's peritoneal effluent appears cloudy.

1. A client with a peaked T wave could be experiencing hyperkalemia. Changes in potassium levels can initiate cardiac dysrhythmias and instability.

The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first? 1.The client in normal sinus rhythm with a peaked T wave. 2.The client diagnosed with atrial fibrillation with a rate of 100. 3.The client diagnosed with a myocardial infarction who has occasional PVCs. 4.The client with a first-degree atrioventricular block and a rate of 92.

A patient diagnosed with hepatitis develops splenomegaly. When reviewing the laboratory report, which of the following results will the healthcare provider anticipate?

Thrombocytopenia Thrombocytopenia is the most common hematological abnormality encountered in patients with chronic liver disease (CLD),1 occurring in 64%-84% of patients with cirrhosis or fibrosi

The nurse assesses for which item during the health history for a client with​ cirrhosis? Skin color Mental status Weight loss Vital signs

Weight loss For a client with​ cirrhosis, the nurse assesses recent weight loss during the heath history portion of the nursing assessment. Vital​ signs, mental​ status, and skin color are assessed during the physical examination portion of the nursing assessment.

One who is living with an infected person Risk factors for hepatitis A include male-to-male sexual contact, illicit drug use and sharing needles, drinking contaminated water or eating undercooked food, traveling in areas with high rates of infection, having HIV positive status, and living with an infected individual.

Which patient is at greatest risk for developing hepatitis A? One who is on high doses of acetaminophen One who has a history of autoimmune disorder One who suffers from alcoholism One who is living with an infected person

A client has acute liver failure. The nurse would assess for which skin changes? Select all that apply. Poor wound healing Dark-brownish discolorations on the chest Pale mucous membranes Presence of pruritus Presence of petechiae

Your Answers: Pale mucous membranes Presence of petechiae Presence of pruritus Bleeding may result in pale mucous membranes. Problems with coagulation can result in presence of petechiae. Pruritus is a common finding associated with acute or chronic liver failure.

10) Restricted blood flow through the liver results in which condition? A) Portal hypertension B) Cirrhosis C) Jaundice D) Biliary atresia

a

14) The nurse is assessing a school-age child who complains of severe itching, bruising easily, restlessness, and involuntary jerking of the hands. When considering these manifestations collectively, which organ or system should the nurse anticipate needing to assess further? A) The liver B) The nervous system C) The gastrointestinal tract D) The urinary system

a

What effect does kidney disease have on a person's blood pressure? a. raises it b. does not affect it c. lowers it d. none of the above

a. raises it

9) A client with liver disease presents to the hospital with severe ascites. What pathophysiologic changes does the nurse recognize as contributing to the development of ascites? Select all that apply. A) Presence of portal hypertension B) Presence of hyperalbuminemia C) Increased colloidal osmotic pressure D) Sodium and water retention E) Presence of hypoaldosteronism

ad

What GFR classifies a person to be in end-stage-renal-disease? a. less than 30 mL/min b. less than 60 mL/min c. less than 15 mL/min d. less than 50 mL/min

c. less than 15 mL/min

The kidneys are responsible for performing all the following functions EXCEPT? a. activating vit D b. secreting Renin c. security EPO d. maintaining cortisol production

d

A client is scheduled for computed tomography (CT) of the kidneys to rule out renal disease. As an essential preprocedure component of the nursing assessment, the nurse plans to ask the client about a history of: a) familial renal disease b) frequent antibiotic use c) long-term diuretic therapy d) allergy to shellfish or iodine

d) allergy to shellfish or iodine

The nurse develops a post-procedure plan of care for a client who had a renal biopsy. The nurse avoids documenting which intervention in the plan? a) administering analgesics as needed b) encouraging fluids to at least 3L in the first 24 hours c) testing serial urine samples with dipstick for occult blood d) ambulating the client in the room and hall for short distances

d) ambulating the client in the room and hall for short distances

Your focused assessment of a patient with hepatitis reveals jaundice, light-colored stools, and dark urine. These findings are typical of which phase of hepatitis?

icteric phase The icteric phase is characterized by jaundice, light- or clay-colored stools, and dark urine typical of impaired bile production and secretion. Bile salts accumulate under the skin and can cause pruritus. Gastrointestinal symptoms from the preicteric phase often persist. The icteric phase lasts 2 to 4 weeks. Hepatitis patients who do not develop jaundice are said to have anicteric hepatitis.

Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check the laboratory value for _______________

serum phosphate.

The nurse reviews the results of diagnostic tests performed on a client with suspected chronic kidney disease (CKD). Which stage of the disease should the nurse suspect the client is experiencing when the glomerular filtration rate (GFR) is mildly decreased? A. Stage 3 B. Stage 2 C. Stage 1 D. Stage 4

stage 2 Rationale: A client with mildly decreased GFR is diagnosed with stage 2 chronic kidney disease. GFR in stage 1 is increased. GFR in stage 3 is moderately decreased. GFR in stage 4 is severely decreased.

What is the peritoneum?

the mucus membrane covering the abdominal cavity

The nurse is preparing a care plan for a patient with hepatic cirrhosis. Which of the following nursing diagnoses are appropriate? Select all that apply. a) Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort b) Altered nutrition, more than body requirements, related to decreased activity and bed rest c) Risk for injury related to altered clotting mechanisms d) Disturbed body image related to changes in appearance, sexual dysfunction, and role function e) Urinary incontinence related to general debility and muscle wasting

• Risk for injury related to altered clotting mechanisms • Disturbed body image related to changes in appearance, sexual dysfunction, and role function • Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Correct Explanation: Risks for injury, activity intolerance, and disturbed body image are priority nursing diagnoses. The appropriate nursing diagnosis related to nutrition would be altered nutrition, less than body requirements, related to chronic gastritis, decreased GI motility, and anorexia. Urinary incontinence is not generally a concern with hepatic cirrhosis.

Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective?

"I will measure my urinary output each day to help calculate the amount I can drink."

5.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? 1. "Drain time is faster if I rub my abdomen." 2. "The fluid draining from the catheter is cloudy." 3. "The drainage is bloody when I have my period." 4. "I wash around the catheter with soap and water."

"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

A nurse is leading an education class on the various types of hepatitis for newly hired certified nurse assistants (CNAs). Which statement best describes hepatitis A? 1. Infectious hepatitis is the most common type and is rarely fatal. 2. Serum hepatitis is found in body fluids and is of particular concern to health care workers. 3. This type of hepatitis is most likely to result in the person becoming a chronic carrier of the virus. 4. Chronic forms of this type do not exist and are considered to be very rare in the United States.

1. Infectious hepatitis is the most common type and is rarely fatal. Hepatitis A is called infectious or epidemic and is transmitted from one person to another through contaminated food, water, or medical equipment. It is the most common type and is rarely fatal. Serum hepatitis is also known as hepatitis B and is found in body fluids and medical equipment that is contaminated. Persons with hepatitis C are more likely to become chronic carriers of the virus. Hepatitis E is similar to hepatitis A; however, it is rarely seen in the United States.REF: p. 856

A patient is having blood drawn for suspected liver disease. The PT is 12, and the INR is 1. The laboratory has called the nurse with the results. What is the nurse's best action? 1. Place the results in the chart. 2. Call the care provider immediately. 3. Prepare for assisting with a liver biopsy. 4. Institute safety precautions because of an increased risk for bleeding.

1. Place the results in the chart. The PT of 11.0 to 12.6 seconds and the INR of 1 to 1.2 are within normal limits, so no further action is needed unless the care provider has specifically instructed to do so. The patient's results are not indicative of a prolonged clotting time or evidence of liver disease, so a liver biopsy may not be done. The results of the PT and INR do not demonstrate increased risk for bleeding.REF: p. 853

1 ( Measuring vital signs and weighing the patient are within the education and scope of practice of the UAP. The UAP could remind the patient to request assistance when getting out of bed after the RN has instructed to patient to do so. Assessing the HD access site for bleeding, bruit, and thrill require additional education and skill and are appropriately performed by a licensed nurse. Focus: Delegation, supervision)

11. Six months later, Ms. J is readmitted to the unit. She has just returned from HD. Which nursing care action should you delegate to the UAP? 1. Measuring vital signs and postdialysis weight 2. Assessing the HD access site for bruit and thrill 3. Checking the access site dressing for bleeding 4. Instructing the patient to request assistance getting out of bed

Which factors predispose a patient to disorders of the gallbladder? Select all that apply. 1. Male 2. 40 years of age 3. Obesity 4. Fertile 5. Sedentary 6. Family history

2. 40 years of age 3. Obesity 4. Fertile 5. Sedentary 6. Family history The age of 40 years is one of the five factors used to describe persons at risk for gallbladder disorders. Obesity or being overweight is a factor, as is being fertile. A sedentary lifestyle is also a risk factor. Family history can show a tendency toward gallbladder issues. Being female is a greater risk factor than being male.REF: p. 871

A nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which of the following statements if made by the client indicates an accurate understanding of CAPD? 1. A portable hemodialysis machine is used so that I will be able to ambulate during the treatment. 2. A cycling machine is used so the risk for infection is minimized. 3. No machinery is involved, and I can pursue my usual activities. 4. The drainage system can be used once during the day and a cycling machine for 3 cycles at night.

3. CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.

A patient with cirrhosis has esophageal varices and hemorrhoids. The nurse understands that varices and hemorrhoids are caused by: 1. Blood vessels weakened by malnutrition 2. Inability to conjugate and excrete bilirubin 3. Elevated pressure in GI blood vessels 4. Fluid retention associated with excess aldosterone

3. Elevated pressure in GI blood vessels Distended, engorged vessels in the esophagus are called esophageal varices. They are fragile and bleed easily, with the potential for fatal hemorrhage. Circumstances that may trigger bleeding in the esophageal varices and hemorrhoids include irritation and increased intraabdominal pressure.

The patient is scheduled for a q12h dose of lactulose 30 grams orally. Available is an oral solution containing 5 g/10 mL. How much solution should be poured into the medication cup to give the required dose? 15 mL 30 mL 45 mL 60 mL

60mL Using the medication-calculation equation of dose desired (30 grams) divided by dose on hand (5 grams) and multipled by the quantity (10 mL), the answer is 60 mL.

42. Which cause of hypertension is the most common in acute renal failure? 1. Pulmonary edema 2. Hypervolemia 3. Hypovolemia 4. Anemia

42. Answer: 2. Hypervolemia Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of renin. Therefore, hypervolemia causes hypertension.

24. The nurse is providing instructions to a client about continuous ambulatory peritoneal dialysis (CAPD). Which of the following information would be included in discussions with this client? a. There are four daily cycles with an 8 hour dwell for one cycle during the night. b. A small, lightweight pump must be carried in a pocket or on a belt. c. This eliminates the need for strict aseptic technique when handling the catheter. d. The procedure involves instilling 250-500 ml of fluid into the abdomen at a time.

A

A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient?* A. Beef tips and broccoli rabe B. Pasta noodles and bread C. Cucumber sandwich with a side of grapes D. Fresh salad with chopped water chestnuts

A

A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of Hepatitis?* A. Icteric B. Posticteric C. Preicteric D. Convalescent

A

A patient diagnosed with viral hepatitis is prescribed ribavirin and interferon alfa-2a. The patient calls the clinic to report shortness of breath and increasing fatigue over the past week. Which of the following responses would be most appropriate for the healthcare provider to make? A "Do you have any other symptoms such as a headache or rash?" B "Please come to the clinic so we can send some of your blood to the lab' C "How many hours of sleep do you usually get each night?" D "These symptoms are very common in patients diagnosed with hepatitis.'

A Although it's true these symptoms are associated with hepatitis, the healthcare provider will want to assess for serious problems associated with the prescribed medications. Think about other physiological problems besides hepatitis that can cause these symptoms. Ribavirin toxicity can cause hemolytic anemia, and interferon alpha-2a can cause bone marrow depression. This can lead to decreased oxygen-carrying capacity of the blood resulting in fatigue and shortness of breath.

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply:* A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. C. Prevention of Hepatitis D includes handwashing and the Hepatitis D vaccine. D. Hepatitis D is most commonly transmitted via the fecal-oral route.

A and B

You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply:* A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A and E

A nurse is planning care for a client who has stage 4 chronic kidney disease. Which of the following should the nurse include in the plan of care? (Select all that apply) A) Assess for jugular vein distention B) Provide frequent mouth rinses C) Auscultate for a pleural friction rub D) Assess using the Glasgow Coma Scale E) Monitor for dysrhythmias

A) Assess for jugular vein distention B) Provide frequent mouth rinses C) Auscultate for a pleural friction rub E) Monitor for dysrhythmias

3,4,5 (A manifestation of prerenal AKI is reduced urine output, elevated serum creatinine, and reduced calcium level. The BUN would be ELEVATED. And elevated cardiac enzymes is a manifestation of cardiac tissue injury not AKI)

A nurse is assessing a client who has prerenal AKI Which of the following findings should the nurse expect? SATA 1. reduced BUN 2. elevated cardiac enzymes 3. reduced urine output 4. elevated serum creatinine 5. reduced serum Ca

d (rationale: The nurse should provide frequent mouth care and encourage use of hard candies to decrease thirst. Providing frequent mouth care keeps the mucous membrane moist and helps decrease the patient's desire to consume fluids. The proportion of solids in a meal has no connection to fluid restriction. Intake and output should be monitored daily for a patient on fluid restriction. Loss of extra weight affects the overall health of the patient, but it is not an indicator for fluid restriction. Nutrition and dietary interventions include: Fluid restriction. Monitor food intake: type and amount. Daily weights. Dietitian consult. Meal planning with patient and family. Frequent, small meals with between-meal snacks. Mouth care before meals. Antiemetics as needed. Frequent mouth care.)

A patient with acute kidney injury (AKI) is on fluid restriction. Which statement by the nurse indicates an appropriate intervention? a. "I should order extra solids with their meals." b. "I should encourage the patient to lose weight." c. "I should monitor weekly intake and output." d. "I should provide frequent mouth care."

Obtain and review the​ child's vaccination records. Before planning the next​ steps, the nurse should review the​ child's vaccination records to see if the child has been vaccinated or started the vaccine series before coming to the United States. If the child has not been​ vaccinated, then the nurse can suggest that the child undergo testing to look for immunity or offer the vaccine as necessary.

A school nurse was notified that a new student will be joining the school. The student is a refugee from South America and the nurse becomes concerned about the risk of hepatitis B to the other students in the school. Which should the nurse do​ first? Send the child for a hepatitis B titer. Have the​ child's parents sign a waiver of refusal to vaccinate. Vaccinate the child before school starts. Obtain and review the​ child's vaccination records.

A physician has ordered a liver biopsy for a client whose condition is deteriorating. Which of the following places the client at high risk due to her altered liver function during the biopsy? a) Low platelet count b) Low hemoglobin c) Decreased prothrombin time d) Low sodium level

A) Low platelet count Certain blood tests provide information about liver function. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.

The nurse is providing discharge teaching to the client diagnosed with polycystic kidney disease. Which statement made by the client indicates the teaching has been effective? A) "I need to avoid any activity causing a risk for injury to my kidney." B) "I should avoid taking medications for high blood pressure." C) "When I urinate there may be blood streaks in my urine." D) "I may have occasional burning when I urinate with the disease."

A) "I need to avoid any activity causing a risk for injury to my kidney."

A client with CKD has hypertension. Which class of medications should the nurse expect to be prescribed for the client? A) ACE inhibitor B) Beta blocker C) Vasodilator D) Calcium channel blocker

A) ACE inhibitor Rationale: ACE inhibitors are the treatment of choice for hypertension associated with chronic kidney disease. They suppress the​ renin-angiotensin-aldosterone system and slow the progress of renal disease. Calcium channel​ blockers, beta​ blockers, and vasodilators are other classes of medications that are used to treat hypertension.

The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? A) Twitching B) Hypoactive bowel sounds C) Negative Trousseau's sign D) Hypoactive deep tendon reflexes

A) Twitching

The nurse is caring for a client with AKI. Which condition should the nurse recognize as a possible cause for this disease? SATA A) Severe heart failure B) Major trauma C) Cerebrovascular disease D) Radiologic contrast media E) Hemorrhage

A, B, D, E Rationale: Major​ trauma, heart​ failure, and hemorrhage are all possible risks and causes for AKI because they can reduce blood flow to the kidneys. Radiologic contrast media can be nephrotoxic and cause AKI. Cerebrovascular disease is not a risk factor for AKI because it does not reduce blood flow to the kidneys and it does not cause nephrotoxicity.

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply:* A. Thrombocytopenia B. Vision changes C. Increased PT/INR D. Leukopenia

A, C, and D

A kidney transplant recipient complains of fever, chills, and dysuria over the past 2 days. What is the first action that you should take? A. Assess temperature and initiate a workup to rule out infection. B. Provide warm covers for the patient and give 1 gram of acetaminophen orally. C. Reassure the patient and let him know this is common after transplantation. D. Notify the nephrologist that the patient has developed symptoms of acute rejection.

A. Assess temperature and initiate a workup to rule out infection. You must be astute in the observation and assessment of kidney transplant recipients, because prompt diagnosis and treatment of infections can improve patient outcomes. Fever, chills, and dysuria indicate a possible infection. The temperature should be assessed, and the patient should have diagnostic tests to identify or rule out an infection.

Nurses need to educate patients at risk for CKD. Which individuals are considered to be at increased risk (select all that apply)? A. Older African Americans B. Individuals older than 60 years C. Those with a history of pancreatitis D. Those with a history of hypertension E. Those with a history of type 2 diabetes

A. Older African Americans B. Individuals older than 60 years D. Those with a history of hypertension E. Those with a history of type 2 diabetes Risk factors for CKD include diabetes mellitus, hypertension, age older than 60 years, cardiovascular disease, family history of CKD, exposure to nephrotoxic drugs, and ethnic minorities (e.g., African American, Native American).

For the patient with AKI, which laboratory result would cause you the greatest concern? A. Potassium level of 5.9 mEq/L B. BUN level of 25 mg/dL C. Sodium level of 144 mEq/L D. pH of 7.5

A. Potassium level of 5.9 mEq/L Hyperkalemia is one of the most serious complications in AKI because it can cause life-threatening cardiac dysrhythmias.

A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient? A: beef tips with broccoli rabe B: pasta noodles and bread C: cucumber sandwich with a side of grapes D: Fresh salad with chopped water chestnuts

A: beef tips with broccoli rabe. Patients who are experiencing hepatic encephalopathy are having issues with toxin build up in the body, specifically ammonia. Remember that ammonia is the byproduct of protein breakdown, and normally the liver can take the ammonia from the protein breakdown and turn it into urea (but if the cirrhosis is severe enough this can't happen). Therefore, the patient should consume foods LOW in protein until the encephalopathy subsides.

A client with chronic kidney disease​ (CKD) has hypertension. Which class of medications should the nurse expect to be prescribed for this​ client? A. Vasodilator B. Calcium channel blocker C. ACE inhibitor D. Beta blocker

ACE inhibitor ​Rationale: ACE inhibitors are the treatment of choice for hypertension associated with chronic kidney disease. They suppress the​ renin-angiotensin-aldosterone system and slow the progress of renal disease. Calcium channel​ blockers, beta​ blockers, and vasodilators are other classes of medications that are used to treat hypertension.

The nurse is educating a client who recently had a kidney transplant about the dietary changes that will be necessary. Which of the following statements could the nurse make to the client? Select all that apply. a. additional calcium may be needed b. carbohydrates may be restricted c. extra protein may be needed d. fats may be limited e. protein may be restricted f. sodium may be restricted

ALL--> A, B, C, D, E, F After kidney transplant, there may be a need for extra protein or for the restriction of protein. Carbohydrate and sodium may be restricted. The appropriate amounts of these nutrients will depend largely on the medications given at the time. Additional calcium and phosphorus may be necessary if there was substantial bone loss before the transplant. There may be an increased appetite after transplant, so fats and simple carbohydrates may be limited to prevent excessive weight gain.

17. The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid? a. Joint pain b. Tachycardia c. Postural hypotension d. Increase in creatinine level

ANS: A Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.

The nursing instructor is talking about hepatitis with her clinical group. What would the instructor teach the students is the best method to prevent the transmission of the hepatitis E virus? A) Following proper hand-washing techniques B) Avoiding chemicals that are toxic to the liver C) Wearing a condom during sexual relations D) Isolating yourself from your family members

ANS: A Avoiding contact with the hepatitis E virus through good hygiene, including hand-washing, is the major method of prevention. Hepatitis E is transmitted by the fecal-oral route, principally through contaminated water in areas with poor sanitation. It is not necessary for the patient to isolate himself or herself from family members. Condom use is advised for patients with blood-borne hepatitis, such as hepatitis B, C, and D. Nonviral hepatitis is caused by the toxic effects of certain chemicals on the body and does not require transmission precautions.

The triage nurse in the emergency department is assessing a patient who presented with complaints of not feeling well. The patient has ascites and an enlarged liver. The patient reports a history of drinking a 12 pack of beer every evening for the past 15 years. The nurse is aware that the patient is at risk for which disease? A) Cirrhosis B) Renal failure C) Hepatitis D) Cardiovascular disease

ANS: A Cirrhosis is a chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver. There are three types of cirrhosis or scarring of the liver. This is most frequently due to chronic alcoholism. This patient's history does not put him or her at risk for renal failure, hepatitis, or cardiovascular disease.

A patient with a liver mass is undergoing a percutaneous liver biopsy. After the procedure the nurse assists the physician in positioning the patient. What position should they position the patient in? A) On the right side with a pillow under the costal margin B) Supine position C) On the left side with a pillow under the knees D) Trendelenberg position

ANS: A Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin. Instruct the patient to remain in this position, recumbent and immobile, for several hours. The patient will not be placed in the supine or the Trendelenberg position. Option C is incorrect.

A patient with a history of postnecrotic cirrhosis is being cared for on your unit. What is this type of cirrhosis often the result of? A) A previous bout of acute viral hepatitis B) Chronic alcoholism C) Bilary obstruction D) Cholangitis

ANS: A Postnecrotic cirrhosis involves broad bands of scar tissue and is the result of a previous bout of acute viral hepatitis. Alcoholic cirrhosis is most frequently due to chronic alcoholism. Biliary cirrhosis usually results from chronic biliary obstruction and infection (cholangitis).

A patient with liver cancer is undergoing radiation therapy. The patient asks the nurse if the radiation therapy is going to cure the cancer. What is the best answer the nurse could give? A) "The radiation therapy will hopefully prolong your life, but the major effect is palliative." B) "The radiation therapy is going to give you a second chance at life." C) "The radiation therapy will cure your cancer." D) "The radiation therapy will take away your pain and discomfort."

ANS: A Radiation therapy and chemotherapy have been used to treat cancer of the liver with varying degrees of success. Although these therapies may prolong survival and improve quality of life by reducing pain and discomfort, their major effect is palliative. The only complete answer is option

9. The nurse has instructed a patient who is receiving hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful? a. Scrambled eggs, English muffin, and apple juice b. Oatmeal with cream, half a banana, and herbal tea c. Split-pea soup, whole-wheat toast, and nonfat milk d. Cheese sandwich, tomato soup, and cranberry juice

ANS: A Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.

The nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment the nurse notes that the patient has a flapping tremor of the hands. What will the nurse document this condition as in the patient's chart? A) Asterixis B) Constructional apraxia C) Fetor hepaticus D) Palmar erythema

ANS: A The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but is not a flapping tremor.

23. In a patient with acute kidney injury (AKI) who requires hemodialysis, a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which intervention will be included in the plan of care? a. Place the patient on bed rest. b. Start continuous pulse oximetry. c. Discontinue the retention catheter. d. Restrict the patients oral protein intake.

ANS: A The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.

5. What is the filter called that functions as an artificial kidney in hemodialysis? a. Hemolyzer b. Dialyzer c. Nephrolyzer d. Kidneyzer

B

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as?* A. The patient has an active infection of Hepatitis A. B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. C. The patient is in the preicetric phase of viral Hepatitis. D. The patient is in the icteric phase of viral Hepatitis.

B

In end-stage liver disease, hypervolemia is always a problem. What nursing interventions would be most appropriate when caring for these patients? (Mark all that apply.) A) Administering diuretics B) Giving pain medications C) Implementing fluid restrictions D) Teaching nutrition E) Enhancing patient positioning

ANS: A, C, E Pulmonary compromise, which is always a potential complication of ESLD because of plasma volume excess, makes prevention of pulmonary complications an important role for the nurse. Administering diuretics, implementing fluid restrictions, and enhancing patient positioning can optimize pulmonary function.

A patient with bleeding esophageal varices is brought to the emergency department by the paramedics. An immediate endoscopy is performed. What nursing intervention is appropriate? A) Keep patient NPO until results of test are known. B) Keep patient NPO until gag reflex returns. C) Give anesthetic gargles until post-procedure soreness goes away. D) Give anesthetic lozenges 10 minutes before meals.

ANS: B After the examination, fluids are not given until the patient's gag reflex returns. Lozenges and gargles may be used to relieve throat discomfort if the patient's physical condition and mental status permit. Appropriate nursing interventions do not include option A, as the result of the test is known immediately; anesthetic gargles and lozenges are contraindicated until the gag reflex returns.

A patient with liver cancer is at the clinic to talk with the physician. The physician tells the patient that it is to risky to do surgery on their hepatic tumor. The patient asks the nurse why surgery is so risky for them. The nurse explains that while surgical resection of the liver tumor is possible in some patients, the risks associated with this procedure increase when the patient has a history of what? A) Oral contraceptive use B) Cirrhosis C) Hypertension D) Prior abdominal surgery

ANS: B Although surgical resection of the liver tumor is possible in some patients, the underlying cirrhosis is so prevalent in cancer of the liver that it increases the risks associated with surgery. Oral contraceptive use is associated with benign liver tumors not malignant tumors. Prior abdominal surgery may have resulted in abdominal scar tissue formation, but poses minor if any risk to the patient. Hypertension can be controlled by use of anti-hypertensive drugs and again, poses a minor risk to the patient.

20. A patient with hypertension and stage 2 chronic kidney disease (CKD) is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patients a. glucose. b. potassium. c. creatinine. d. phosphate.

ANS: B Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values also would be monitored in patients with CKD but would not affect whether the captopril was given or not.

31. The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which information should be reported immediately to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patients peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient complains of feeling bloated after the inflow.

ANS: B Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

19. A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required? a. Multivitamin with iron b. Milk of magnesia 30 mL c. Calcium phosphate (PhosLo) d. Acetaminophen (Tylenol) 650 mg

ANS: B Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.

You are caring for a patient with advanced cirrhosis. You know that the most significant source of bleeding in a patient with cirrhosis is what? A) Portal hypertension B) Esophageal varices C) Hemolytic jaundice D) Ascites

ANS: B Once esophageal varices form, they are increase in size and eventually bleed; in cirrhosis, they are the most significant source of bleeding. Portal hypertension, hemolytic jaundice, and ascites are not sources of bleeding.

A patient with esophageal varices has medication ordered to decrease portal pressure and aid in preventing a first bleeding episode. What type of drug would the physician order? A) Antihypertensive agents B) Beta-blocking agents C) Calcium channel blockers D) Histamine-2 antagonists

ANS: B Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in patients with known varices and to prevent rebleeding. This makes options A, C, and D incorrect.

Toxic hepatitis has a poor prognosis if there is a prolonged period between the exposure to the toxin and the onset of symptoms. There are no effective antidotes. What is the clinical course of toxic hepatitis? 1. Fever rises. 2. Hematemisis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma. A) 12543 B) 12345 C) 23145 D) 31254

ANS: B Recovery from acute toxic hepatitis is rapid if the hepatotoxin is identified early and removed or if exposure to the agent has been limited. Recovery is unlikely if there is a prolonged period between exposure and onset of symptoms. There are no effective antidotes. The fever rises; the patient becomes toxic and prostrated. Vomiting may be persistent, with the emesis containing blood. Clotting abnormalities may be severe, and hemorrhages may appear under the skin. The severe GI symptoms may lead to vascular collapse. Delirium, coma, and seizures develop, and within a few days the patient may die of fulminant hepatic failure (discussed later) unless he or she receives a liver transplant.

28. When caring for a dehydrated patient with acute kidney injury who is oliguric, anemic, and hyperkalemic, which of the following prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).

ANS: B Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output, but does not correct the cause of the renal failure.

18. Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse? a. The blood glucose is 144 mg/dL. b. The patients blood pressure is 150/92. c. There is a nontender lump in the axilla. d. The patient has a round, moonlike face.

ANS: C A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The elevated glucose, moon face, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.

A client, newly diagnosed with chronic renal failure, has recently begun hemodialysis. The nurse, establishing the client's plan of care, includes monitoring the client for disequilibrium syndrome. Which of the following symptoms will the nurse assess the client for? a. Headache, nausea, vomiting, altered level of consciousness, and hypotension. b. Headache, nausea, vomiting, altered level of consciousness and hypertension. c. Muscle cramps, seizure activity d. Chills, fever, shortness of breath and discolored urine

B

30. The RN observes an LPN/LVN carrying out all of the following actions while caring for a patient with stage 2 chronic kidney disease. Which action requires the RN to intervene? a. The LPN/LVN administers erythropoietin subcutaneously. b. The LPN/LVN assists the patient to ambulate in the hallway. c. The LPN/LVN gives the iron supplement and phosphate binder with lunch. d. The LPN/LVN carries a tray containing low-protein foods into the patients room.

ANS: C Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency.

The nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep, has rigid extremities, and shows EEG abnormalities. Based upon these clinical findings, what is the patient's stage of hepatic encephalopathy? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

ANS: C Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous; difficult to arouse; sleeps most of the time; exhibits marked confusion; incoherent in speech; asterixis; increased deep tendon reflexes; rigidity of extremities; marked EEG abnormalities. Patients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as found in stage 3, and patients in stage 4 are comatose. In stage 4, there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.

The nursing instructor is teaching the senior nursing students about liver disease. What would the instructor teach the students is the most common surgical procedure for liver cancer? A) Cryosurgery B) Liver transplantation C) A lobectomy D) Laser hyperthermia

ANS: C Removal of a lobe of the liver (lobectomy) is the most common surgical procedure for excising a liver tumor. While liver transplantation and cryosurgery are other surgical options for management of liver cancer, these procedures are not performed at the same frequency as a lobectomy. Laser hyperthermia is a nonsurgical treatment for liver cancer.

8. Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the a. blood urea nitrogen (BUN) and creatinine. b. blood glucose level. c. patients bowel sounds. d. level of consciousness (LOC).

ANS: C Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurses decision to give the medication.

32. Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider? a. The urine output is 900 to 1100 mL/hr. b. The blood urea nitrogen (BUN) and creatinine levels are elevated. c. The patients central venous pressure (CVP) is decreased. d. The patient has level 8 (on a 10-point scale) incisional pain.

ANS: C The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.

26. Which information about a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration will be most important for the nurse to report to the health care provider? a. The blood urea nitrogen (BUN) level is 67 mg/dL. b. The creatinine level is 3.0 mg/dL. c. Urine output over an 8-hour period is 2500 mL. d. The glomerular filtration rate is <30 mL/min/1.73m2.

ANS: C The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.

A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective.* A. 2 weeks B. 24 hours C. 1 month D. 7 days

B

The nursing instructor is teaching the beginning nursing students how to palpate a liver. What technique will the student nurse use to palpate a patient's liver? A) Place hand under left lower rib cage and press down lightly with the other hand. B) Place the left hand over the abdomen and behind the left side at the 11th rib. C) Place hand under right lower rib cage and press down lightly with the other hand. D) Hold hand 90 degrees to abdomen and push down firmly.

ANS: C To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. Therefore options A, B, and D are incorrect.

A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL. What is this patient at risk for? A) Chronic jaundice B) Pigment stones in portal circulation C) Brainstem damage D) Hepatomegaly

ANS: C Brainstem damage Prolonged jaundice, even if mild, predisposes to the formation of pigment stones in the gallbladder, and extremely severe jaundice (levels of free bilirubin exceeding 20 to 25 mg/dL) poses a risk for brainstem damage.

10. Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check the laboratory value for a. creatinine. b. potassium. c. total cholesterol. d. serum phosphate.

ANS: D If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a) Albumin b) Creatinine c) Urobilinogen d) Chloride

Albumin Explanation: Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

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 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

While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as:* A. Metallic Hepatico B. Fetor Hepaticus C. Hepaticoacidosis D. Asterixis

B

A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment? A) Destruction of the patient's liver tumor B) Restoration of portal vein patency C) Destruction of a liver abscess D) Reversal of metastasis

Ans: A Feedback: Using radiofrequency ablation, a tumor up to 5 cm in size can be destroyed in one treatment session. This technique does not address circulatory function or abscess formation. It does not allow for the reversal of metastasis.

A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform? A) Keep patient NPO until the results of test are known. B) Keep patient NPO until the patient's gag reflex returns. C) Administer analgesia until post-procedure tenderness is relieved. D) Give the patient a cold beverage to promote swallowing ability.

Ans: B Feedback: After the examination, fluids are not given until the patient's gag reflex returns. Lozenges and gargles may be used to relieve throat discomfort if the patient's physical condition and mental status permit. The result of the test is known immediately. Food and fluids are contraindicated until the gag reflex returns.

20.Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD) (select all that apply.)? 1. Anemia 2. Dehydration 3. Hypertension 4. Hypercalcemia 5. Increased risk for fractures 6. Elevated white blood cells

Anemia Hypertension 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 nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patient's plan of care? A) Measurement of abdominal girth and body weight B) Assessment for variceal bleeding C) Assessment for signs and symptoms of jaundice D) Monitoring of results of liver function testing

Ans: B Feedback: Esophageal varices are a major cause of mortality in patients with uncompensated cirrhosis. Consequently, this should be a focus of the nurse's assessments and should be prioritized over the other listed assessments, even though each should be performed.

During evaluation of a patient at an outpatient clinic, the nurse determines that administration of hepatitis B vaccine has been effective when a specimen of the patient's blood reveals: a. HBsAg. b. anti-HBs c. anti-HBc IgM. d. anti-HBc IgG"

Answer B: The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV

The nurse is caring for a client who has been diagnosed with acute renal failure. The nurse is reviewing the client's most recent laboratory data. Which lab result is an indicator to the nurse that a client with acute renal failure has met the expected outcomes? Select all that apply. A) Decreasing serum creatinine B) Decreasing blood urea nitrogen (BUN) levels C) Decreasing neutrophil count D) Decreasing lymphocyte count E) Decreasing erythrocyte count

Answer: A, B Explanation: A) Creatinine is the metabolic end product of creatine phosphate and is excreted via the kidneys in relatively constant amounts. BUN, a measurement of the nitrogen portion of urea, is also excreted in urine and is a good indicator of renal function. Neutrophils, lymphocytes, and erythrocytes are not used to monitor the return of renal function.

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) Head ache

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 physician has determined that 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"

Correct 1 Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers.

During a home visit, the nurse is concerned that an older client is developing renal failure. The client has no history of cardiovascular disease. What did the nurse assess in this client? Select all that apply. A) Progressive edema B) Complaints of hip joint pain C) New onset of hypertension D) Recent increase in hunger and thirst E) Warm moist skin

Answer: A, C Explanation: A) The manifestations of renal failure often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of renal failure in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not renal failure in the older client. A client with renal failure will have pale dry skin with poor turgor.

The nurse is assessing a patient who is receiving peritoneal dialysis with 2-L inflows. Which information should be reported immediately to the health care provider? a. The patient complains of feeling bloated after the inflow. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient has an outflow volume of 1600 ml.

Answer: B Rationale: Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

14.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? 1. Apple, green beans, and a roast beef sandwich 2. Granola made with dried fruits, nuts, and seeds 3. Watermelon and ice cream with chocolate sauce 4. Bran cereal with ½ banana and milk and orange juice

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

2.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? Assess skin turgor to determine hydration status. Insert a urinary catheter for the expected diuresis. Evaluate the patient's lower extremities for edema. Check the patient's urine for the presence of ketones.

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.

11. What dietary regime would the nurse encourage clients who are receiving peritoneal dialysis to engage in? a. High carbohydrate diet b. High protein intake c. Low fat, low sodium diet d. High fat, high carbohydrate diet.

B

16. Mrs. V is a client with oliguric acute renal failure. Which of the following clinical manifestations would be consistent with that diagnosis? a. Urine specific gravity of 1.001 b. BUN :Creatinine ratio of 30:1. c. Proteinuria d. Hematuria

B

A female patient expresses her concern about becoming pregnant while her partner is on ribavirin therapy for chronic hepatitis C. What should the nurse advise the patient? a. She can plan pregnancy now. b. She should avoid getting pregnant now. c. She should not get pregnant with this partner ever. d. She should avoid any sexual intercourse after conception.

B Any woman who is on ribavirin or whose male partner is on is on ribavirin should avoid pregnancy during treatment. The pregnancy can be planned after the treatment is complete. She can get pregnant with this partner, but not while on treatment. Avoiding intercourse after conception is not necessary. Text Reference - p. 1013

A client undergoing hemodialysis has an arteriovenous (AV) fistula in the left arm. A related nursing diagnosis for the client is risk for infection. The nurse should formulate which of the following outcome goals as most appropriate for this nursing diagnosis? a. The client's temperature remains less than 101F b. The client's WBC count remains within normal limits. c. The client washes hands at least once per day. d. The client states to avoid blood pressure measurement in the left arm.

B General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand-washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the nursing diagnosis risk for injury.

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) A Check brachial pulses daily. B Auscultate for a bruit every 8 hours. Correct C Teach the client to palpate for a thrill over the site. Correct D Elevate the arm above heart level. E Ensure that no blood pressures are taken in that arm.

B Auscultate for a bruit every 8 hours. C Teach the client to palpate for a thrill over the site. E Ensure that no blood pressures are taken in that arm. A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

*Possible exam question* The nurse is discussing risk factors for cirrhosis with a group of community members. Which risk factor should the nurse include in the discussion? SATA A) Obesity B) Injection drug use C) Excessive alcohol use D) Hepatitis C Infection E) Smoking

B, C, D - Injection drug use - Excessive alcohol - Hep C Rationale: The leading risk factor for cirrhosis is excessive alcohol use. The use of injected drugs puts the client at risk of contracting viral hepatitis​ (B, C, or​ D). Obesity and smoking are not known risk factors for cirrhosis.

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply:* A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

B, C, and E

The nurse is performing discharge teaching to a patient recovering from an acute kidney injury (AKI). Which patient statement indicates a need for further teaching on how to manage AKI after discharge? A. "I will monitor my blood pressure." B. "I need to avoid NSAIDs for 1 month." C. "I need to avoid life stressors." D. "I will monitor for symptoms of possible relapse."

B. "I need to avoid NSAIDs for 1 month." A patient recovering from AKI needs to avoid nephrotoxic drugs for up to 1 year, not 1 month. The patient will need to continue monitoring blood pressure and symptoms of possible relapse after discharge, as well as avoid life stressors, which can slow healing.

A nurse is teaching a client who has acute kidney disease about fluid restrictions. Which of the following statements by the client should the nurse identify as understanding of the teaching? A. "I should consume most of the fluid during the evening." B. "I will make a list of my favorite beverages." C. "I will put beverages in large containers to give the appearance of drinking a lot." D. "I will not add ice cream to the amount of fluid intake."

B. "I will make a list of my favorite beverages." Rationale: The nurse should work with the client to develop a schedule for fluid restrictions, and should attempt to include the client's favorite beverages when possible to promote satisfaction.

A patient with a history of end-stage renal disease (ESRD) resulting from diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessment should you prioritize before, during, and after his 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, the nature of the procedure indicates a particular need to monitor blood pressure and fluid balance.

The nurse is assessing an otherwise healthy client with renal disease. The client is taking several supplements that are not indicated for clients who have renal disease. Which of the following will the nurse think should be discontinued? Select all that apply. a. iron b. vitamin A c. vitamin C d. vitamin D e. vitamin E f. vitamin K

B. Vitamin A E. Vitamin E F. Vitamin K Renal clients often have an increased need for vitamins B, C, and D, and supplements are often given. Vitamin A should not be given because the blood level of vitamin A tends to be elevated in uremia. If a client is receiving antibiotics, a vitamin K supplement may be given. Otherwise, supplements of vitamins E and K are not necessary.

The nurse provides discharge instructions for a 64 y.o. women with ascites and peripheral edema related to cirrhosis. Which statement, if made by the pt, indicates teaching WAS effective? a. it is safe to take acetaminophen up to four times a day for pain b. lactulose (cephulac) should be taken everyday to prevent constipation c. herbs and other spices should be used to season my foods instead of salt d. i will eat foods high in potassium while taking spironolactone (aldactone)

C low sodium diet is indicated for pt with ascites and edema related to cirrhosis

9. In peritoneal dialysis, which anatomic area acts as the filter for this method of dialysis? a. The lining of the stomach b. The lining of the small intestine c. The lining of the peritoneum d. The lining of the abdomen

C

Which of the following is NOT a role of the liver?* A. Removing hormones from the body B. Producing bile C. Absorbing water D. Producing albumin

C

A patient is admitted to the medical unit with a diagnosis of hepatitis. When preparing to administer intravenous medications, the healthcare provider understands that the patient's diagnosis primarily impacts which phase of pharmacokinetics? A. Absorption B Distribution C. Metabolism D Excretion

C A medication is said to be absorbed when it enters the bloodstream. Medications are primarily excreted via the renal system and the biliary system. The liver is the primary site of drug metabolism, so alterations in liver function can affect the metabolism of medications. Liver function can also affect excretion to a lesser degree if the liver's ability to make medications water-soluble is compromised.

When caring for a patient diagnosed with viral hepatitis, the healthcare provider experiences a needlestick with a contaminated needle. Which of the following actions should the healthcare provider do first? A. Make an appointment with the infection control department B. Put the needle in a biohazard bag for testing C Wash the area thoroughly with soap and water D Report to the emergency department

C The healthcare provider will follow the facility-specific protocol for when a needlestick occurs. The initial action is aimed at reducing the possibility of infection. The puncture site and skin should be washed thoroughly with soap and water. Then the healthcare provider will follow the next steps in the facility protocol.

The nurse at the dialysis clinic notes when she reviews a client's labs that the labs indicated hyperkalemia. She makes a note to make sure the client is adhering to all dietary restrictions. Of the following possibilities, which might the nurse ask about? a. fiber supplements b. intake of whole grains c. salt substitutes d. sugar substitutes

C . Salt Substitutes Potassium may be restricted in some clients because hyperkalemia tends to occur in end-stage renal disease. Excess potassium can cause cardiac arrest. Because of this danger, renal clients should not use salt substitutes or low-sodium milk because the sodium in these products is replaced with potassium.

"What type of precautions should the nurse implement to protect from being exposed to any of the hepatitis viruses? 1. Airborne precautions 2. Standard precautions 3. Droplet precautions 4. Exposure precautions"

Correct 2 2. Standard precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood

19.The physician has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? 1. Hemodialysis (HD) three times per week 2. Automated peritoneal dialysis (APD) 3. Continuous venovenous hemofiltration (CVVH) 4. Continuous ambulatory peritoneal dialysis (CAPD)

Continuous venovenous hemofiltration (CVVH) CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection. HD three times per week would not be used for this patient because fluid and solutes build up and then are rapidly removed. With APD (used at night instead of during the day) fluid and solutes build up during the day and would not benefit this patient as much. CAPD will not as rapidly remove large amounts of fluid as CVVH can do

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 1 "1.The hepatitis A virus is in the stool of infected people up to two (2) weeks beforesymptoms develop. 2.Hepatitis B virus is spread through contact with infected blood and body fluids.3.Hepatitis C virus is transmitted throughinfected blood and body fluids.4.Hepatitis D virus only causes infection inpeople who are also infected with hepatitis Bor C"

"A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that: A. pruritus is a common problem with jaundice in this phase. B. the patient is most likley to transmit the disease during this phase. C. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. D. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase."

Correct: A The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

"A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission? "A. Sexual contact with an infected partner. B. Contaminated food. C. Blood transfusion. D. Illegal drug use.

Correct answer: B" Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B, C, and D are transmitted through infected bodily fluids.

"A client is admitted with ongoing symptoms of the flu. There are no other obvious signs of illness. This client should be tested for hepatitis because: "a) She has an allergy to shellfish. b) She could have anicteric hepatitis, which means no jaundice. c) She was living with a roommate who had similar symptoms. d)She has a blood pressure of 90/50.

Correct answer: B" Only about 25 percent of people with acute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised liver function that is overlooked due to lack of jaundice.

The home care nurse is visiting a client with a diagnosis of hepatitis of unknown etiology. The nurse knows that teaching has been successful if the patient makes which on of the following statements? 1. ""I am so sad that I am not able to hold my baby."" 2."" I will eat after my family eats."" 3. ""I will make sure that my children don't eat or drink after me."" 4. ""I'm glad that I don't have to get help taking care of my children."""

Correct: 3 "1. not spread by casual contact 2. can eat together, but not share utensils 3. to prevent transmission - do not share eating utensils or drinking glasses, wash hands before eating and after using toilet 4. alternate rest/activity to promote hepatic healing, mother of young children will need help"

The home care nurse is visiting a client with a diagnosis of hepatitis of unknown etiology. The nurse knows that teaching has been successful if the patient makes which on of the following statements? "1. ""I am so sad that I am not able to hold my baby."" 2."" I will eat after my family eats."" 3. ""I will make sure that my children don't eat or drink after me."" 4. ""I'm glad that I don't have to get help taking care of my children."""

Correct: 3 "1. not spread by casual contact 2. can eat together, but not share utensils 3. to prevent transmission - do not share eating utensils or drinking glasses, wash hands before eating and after using toilet 4. alternate rest/activity to promote hepatic healing, mother of young children will need help"

The home care nurse is visiting a client during an icteric phase of hepatitis of unknown etiology. The nurse would be MOST concerned if the client made which of the following comments? 1. ""I must not share eating utensils with my family."" 2. ""I must use my own bath towel."" 3. ""I'm glad that my husband and I can continue to have intimate relations."" 4. ""I must eat small, frequent feedings."""

Correct: 3 3. ""I'm glad my husband..."" - CORRECT: avoid sexual contact until serologic indicators return to normal

23. Mr. U is a client recently receiving hemodialysis treatments. Following a treatment, the client complains of a severe headache and he appears somewhat confused. Which of the following initial actions by the nurse is most appropriate? a. Check the client's blood pressure b. Administer oxygen c. Encourage the client to drink fluids d. Notify the physician immediately

D

The pt with a hx of lung cancer and hep C has developed live failure and is considering liver transplantation. After comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation? a. has completed a college education b. has been able to stop smoking cigarettes c. has well-controlled type 1 DM d. the chest x-ray showed another lung cancer lesion

D - contraindications include severe extra-hepatic disease, advanced hepatocellular carcinoma or other cancer, ongoing drug/alcohol abuse, and inability to comprehend with rigorous transplant course.

When teaching the pt with acute hep C, the pt demonstrates understanding when the pt makes which statement? a. I will sue care when kissing my wife to prevent giving it to her. b. I will need to take adofevir (hepsera) to prevent chronic HCV. c. now that i have HCV, I will have immunity and not get it again. d. I will need to be checked for chronic HCV and other liver problems

D - transmitted via sharing needles and risky sex - treatment focus on rest and nutrition. - treated with pegylated interferon with ribivan

The family of a pt newly dx with hep A asks the nurse what they can do to prevent becoming ill themselves. Which response is most appropriate? a. The hep vaccine will provide immunity from this exposure and future exposures. b. I am afraid there is nothing you can do since the pt was infectious before admission. c. You will need to be tested first to make sure you don't have the virus before we can treat you. d. an injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure.

D Immunoglobulin provides temporary (1-2 month) passive immunity and is effective for preventing hep A if given within 2 wks after exposure.

When planning care for a pt with cirrhosis, the nurse will give highest priority to which nursing diagnosis? a. impaired skin integrity related to edema, ascites, and pruritis b. imbalanced nutrition: less than body requirements related to anorexia c. excess fluid volume related to portal hypertension and hyperaldosteronism d. ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

D airway and breathing are always highest priority.

A patient with chronic kidney disease (CKD) is started on hemodialysis, and after the first treatment, the patient complains of nausea and a headache. The nurse notes mild jerking and twitching of the patient's extremities. The nurse will anticipate the need to a. increase the time for the next dialysis to remove wastes more completely. b. switch to continuous renal replacement therapy (CRRT) to improve dialysis efficiency. c. administer medications to control these symptoms before the next dialysis. d. slow the rate for the next dialysis to decrease the speed of solute removal.

D Rationale: The patient has symptoms of disequilibrium syndrome, which can be prevented by slowing the rate of dialysis so that fewer solutes are removed during the dialysis. Increasing the time of the dialysis to remove wastes more completely will increase the risk for disequilibrium syndrome. CRRT is a less efficient means of removing wastes and, because it is continuous, would not be used for a patient with CKD. Administration of medications to control the symptoms is not an appropriate action; rather, the disequilibrium syndrome should be avoided.

The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for: a. Hypertension, tachycardia, and fever. b. Hypotension, bradycardia, and hypothermia. c. Restlessness, irritability, and generalized weakness. d. Headache, deteriorating level of consciousness, and twitching.

D Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? A History of hiatal hernia B Presence of diabetes and glycosylated hemoglobin of 6.8% C History of basal cell carcinoma on the nose 5 years ago D Presence of tuberculosis

D Presence of tuberculosis Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.

The nurse is reviewing discharge instructions with a client with acute renal injury​ (AKI). Which diet instruction should the nurse​ include? (Select all that​ apply.) A. Eat foods low in potassium. B. Eat foods high in potassium. C. Eat​ high-calcium foods. D. Eat foods low in saturated fat. E. Eat​ low-phosphorus foods.

Eat foods low in potassium. Eat​ high-calcium foods. Eat foods low in saturated fat. Eat​ low-phosphorus foods. Rationale: Clients with AKI experience electrolyte imbalances. The client with AKI is at particular risk for hyperkalemia caused by impaired potassium excretion and hyperphosphatemia. Calcium and phosphate have a reciprocal relationship in the​ body; as the level of one​ rises, the level of the other falls.​ Therefore, the client should eat foods high in calcium and low in phosphate. Saturated fats are known to raise the levels of cholesterol and therefore should be eaten in moderation.

Which type of deficiency results in macrocytic anemia? a) Folic acid b) Vitamin A c) Vitamin C d) Vitamin K

Folic acid Explanation: Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.

A client diagnosed with liver cirrhosis is being treated for an infection. For which complication should the nurse monitor the​ client? Portal hypertension Hepatic encephalopathy Esophageal varices Wilson disease

Hepatic encephalopathy Hepatic encephalopathy may be aggravated by sepsis secondary to​ infection, due to increased buildup of toxic​ substances, in clients with cirrhosis. Portal​ hypertension, esophageal​ varices, and Wilson disease (an inherited disorder that causes too much copper to accumulate in the organs) are not caused or aggravated by infection.

Which nursing diagnosis supports a medical diagnosis of​ cirrhosis? Increased risk for acute confusion Anxiety Activity intolerance Fatigue

Increased risk for acute confusion Clients with cirrhosis deal with a variety of​ problems, but​ fatigue, activity​ intolerance, and anxiety are not among them. A few nursing diagnoses that are appropriate include impaired skin​ integrity, increased risk for acute​ confusion, diminished​ protection, increased fluid​ volume, and reduced​ nutrition, less than body requirements.

16.Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis? 1. Increasing the pressure gradient 2. Increasing osmolality of the dialysate 3. Decreasing the glucose in the dialysate 4. Decreasing the concentration of the dialysate

Increasing osmolality of the dialysate Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis, the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream

What is thrombocytopenia?

Low Platelet count (less than 50,000?) Normal = 150,000 - 400,000 Low platelet count (easy bruising & bleeding), nursing considerations bleeding, soft bristle tooth brush and no jumping or sharp toys. Thrombocytopenia is a condition in which you have a low blood platelet count. Platelets (thrombocytes) are colorless blood cells that help blood clot. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.

The nurse is reviewing the lab results for a pt with cirrhosis and notes that the ammonia level is elevated. Which diet does the nurse anticipate to be presribed for this pt? Low-protein High-protein Moderate-fat High-carb

Low-protein diet Protein provided by the diet is transported to the liver via the portal vein. The liver breaks down protein, which results in the formation of ammonia.

Which data should the nurse collect when completing a physical examination on a client experiencing acute kidney injury​ (AKI)? (Select all that​ apply.) A. Reports of edema B. History of diabetes mellitus C. Lung sounds D. Weight E. Skin color

Lung sounds Weight Skin color Rationale: When completing a physical examination on a client experiencing acute renal​ failure, the nurse needs to note the​ client's weight, skin​ color, and lung​ sounds, which may indicate fluid volume excess. Reports of edema and having a history of diabetes mellitus are information collected when obtaining a​ client's health history.

The nurse creates a plan of care for a client with​ end-stage renal disease​ (ESRD). To what should the nurse pay particular attention when planning this​ care? A. Meal planning when dietary modifications are required B. Medication regimens and their side effects C. Monitoring input and output D. Daily weights

Meal planning when dietary modifications are required Rationale: The nurse should involve the client in meal planning if dietary modifications are required. The nurse can provide teaching about the medication​ regimen, but the client is not usually involved in planning these regimens. Weighing the client and monitoring input and output are interventions carried out by the​ nurse, with little involvement by the client.

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? a) Ask the client about food intake. b) Report the condition to the physician immediately. c) Provide the client with nonprescription laxatives. d) Measure abdominal girth according to a set routine.

Measure abdominal girth according to a set routine. Explanation: If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

A client is at risk for infectious sepsis through which portals of​ entry? ​(Select all that​ apply.) Peptic ulcerations Surgical wounds Sexually transmitted infections Pulse oximetry monitoring Intravenous catheters

Peptic ulcerations Surgical wounds Sexually transmitted infections Intravenous catheters Portals of entry for infection that may lead to sepsis​ include, but are not limited​ to, intravenous​ catheters, surgical​ wounds, sexually transmitted​ infections, and peptic ulcerations. Pulse oximetry is not an invasive procedure and is not a portal of entry for infectious sepsis.

What is creatinine?

Product of muscle breakdown, measurement of kidney function

Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?

The patient cleans the catheter while taking a bath every day.

7. When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? 1. Weigh patient three times weekly. 2. Increase dietary sodium and potassium. 3. Provide a low-protein, high-carbohydrate diet. 4. Restrict fluids according to previous daily loss.

Restrict fluids according to previous daily loss. Patients in the oliguric phase of AKI will have fluid volume excess with potassium and sodium retention. Therefore, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week

The nurse reviews findings from the assessment of a client with​ end-stage renal disease​ (ESRD). Which finding should the nurse identify as the most common cardiac complication of this​ disease? A. Systemic hypertension B. Cardiomyopathy C. Hypolipidemia D. Tetralogy of Fallot

Systemic hypertension Rationale: Hypertension results from excess fluid​ volume, increased​ renin-angiotensin activity, and increased peripheral vascular resistance.​ Hyperlipidemia, not​ hypolipidemia, often occurs with ESRD. Heart​ failure, not​ cardiomyopathy, results from ESRD. Tetralogy of Fallot is a congenital heart abnormality not caused by ESRD.

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

The answer is A. During the oliguric stage of AKI the patient will have a urinary output of 400 mL/day or LESS. This is due to a decreased GRF (glomerular filtration rate), which will lead to increased amounts of waste in the blood (increased BUN/Creatinine), metabolic acidosis (decreased excretion of hydrogen ions), hyperkalemia, hypervolemia (edema/hypertension), and urinary output of <400 mL/day.

Which patient below is at MOST risk for developing a complication related to a Hepatitis E infection?* A. A 45-year-old male with diabetes. B. A 26-year-old female in the 3rd trimester of pregnancy. C. A 12-year-old female with a ventricle septal defect. D. A 63-year-old male with cardiovascular disease.

The answer is B. Patients who are in the 3rd trimester of pregnancy are at a HIGH risk of developing a complication related to a Hepatitis E infection.

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

The answer is B. This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this.

1. Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal sub-stance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure.

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most significant for diagnosing ARF? 1.BUN and creatinine. 2.WBC and hemoglobin. 3.Potassium and sodium. 4.Bilirubin and ammonia level.

4. Normal potassium level is 3.5 to5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-careprovider order, so it is a collaborative intervention.

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1.Administer a phosphate binder. 2.Type and crossmatch for whole blood. 3.Assess the client for leg cramps. 4.Prepare the client for dialysis.

2. Bed rest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine).

The client diagnosed with ARF is placed on bed rest. The client asks the nurse, "Why do I have to stay in bed? I don't feel bad." Which scientific rationale supports the nurse's response? 1.Bed rest helps increase the blood return to the renal circulation. 2.Bed rest reduces the metabolic rate during the acute stage. 3.Bed rest decreases the workload of the left side of the heart. 4.Bed rest aids in reduction of peripheral and sacral edema.

1, 3, 4 The nurse should assess the drain postoperatively. The head of the bed should be lowered and the foot should be elevated to shunt blood to the central circulating system. The surgeon needs to be notified of the change in condition.

The client returned from surgery after having a TURP and has a P 110, R 24, BP90/40, and cool and clammy skin. Which interventions should the nurse implement?Select all that apply. 1.Assess the urine in the continuous irrigation drainage bag. 2.Decrease the irrigation fluid in the continuous irrigation catheter. 3.Lower the head of the bed while raising the foot of the bed. 4.Contact the surgeon to give an update on the client's condition. 5.Check the client's postoperative creatinine and BUN.

4. The nurse should always assess any complaint before dismissing it as a commonly occurring problem.

The client with a TURP who has a continuous irrigation catheter complains of the need to urinate. Which intervention should the nurse implement first? 1.Call the surgeon to inform the HCP of the client's complaint. 2.Administer the client a narcotic medication for pain. 3.Explain to the client this sensation happens frequently. 4.Assess the continuous irrigation catheter for patency.

4. Use of the bladder training drill is helpful in stress incontinence. The client is instructed to void at scheduled intervals. After consistently being dry, the interval is increased by 15 minutes until the client reaches an acceptable interval.

The elderly client recovering from a prostatectomy has been experiencing stress incontinence. Which independent nursing intervention should the nurse discuss with the client? 1.Establish a set voiding frequency of every two (2) hours while awake. 2.Encourage a family member to assist the client to the bathroom to void. 3.Apply a transurethral electrical stimulator to relieve symptoms of urinary urgency. 4.Discuss the use of a "bladder drill," including a timed voiding schedule.

"Hepatitis A can spread through a daycare center where children are in diapers or potty training." Hepatitis A is commonly spread at daycare centers, where children are in diapers or being potty trained. Vaccination against this virus is the best way to prevent transmission of the disease. The parents should also ensure that there are strict handwashing protocols in place at the daycare.

The nurse informs the parents of 1-year-old child the hepatitis A vaccine is scheduled to be given. The parents ask why it would be necessary to vaccinate their baby against a disease like hepatitis. Which is the best reply by the nurse? "Hepatitis A can spread through a daycare center where children are in diapers or potty training." "Hepatitis A can be transmitted when being in close proximity with someone else who has the disease." "It is good to vaccinate your child before they start high school and becomes sexually active." "Hepatitis A can be spread if a child gets hurt and bleeds on the floor or other surfaces."

What is plasma oncotic pressure?

The hydrostatic pressure drives the material out of the capillary, while the osmotic pressure brings the material back to the capillary. Hydrostatic pressure is more than osmotic pressure at the artery side, so overall things get out of the capillary. Low albumin means lower oncotic pressure, because water will follow albumin Oncotic pressure remains constant, because it is due to the protein (albumin) concentration in the blood. But, hydrotatic pressure will be higher on the arterial end, as it relates to blood pressure Hydrostatic = Filtration -----pushing liquid out of the BVs Oncotic = obsorption into the BVs

2. Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of pre-renal failure(before the kidney).

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? 1.Diabetes mellitus. 2.Hypotension. 3.Aminoglycosides. 4.Benign prostatic hypertrophy

a (rationale: Impaired potassium excretion leads to hyperkalemia, which causes electrocardiographic changes. Hypotension, constipation, and weight gain are not manifestations of hyperkalemia. Actions for a patient with acute kidney injury (AKI) who is experiencing hyperkalemia include: Removal of potassium from IV fluids. A low-potassium diet. Administration of glucose and insulin to drive potassium into the cell. Potassium-absorbing enemas. Dialysis.)

The nurse identifies that a patient with acute kidney injury (AKI) is experiencing hyperkalemia. The nurse should monitor the patient for which manifestation? a. Electrocardiographic changes b. Hypotension c. Weight gain d. Constipation

2. This client's dialysis access is compromised and he or she should be assessed first.

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1.The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%. 2.The client who does not have a palpable thrill or auscultated bruit. 3.The client who is complaining of being exhausted and is sleeping. 4.The client who did not take antihypertensive medication this morning.

a (Rationale: Turning the client frequently and providing good skin care help to avoid skin breakdown. Edema decreases tissue perfusion and increases the risk of skin​ breakdown, especially in clients who are older or debilitated. Frequent repositioning has no bearing on bone fractures. The client should be kept dry to assist in avoiding skin breakdown. Repositioning is not done to disturb or keep the client awake.)

The nurse notes that the plan of care for a client with acute kidney injury​ (AKI) instructs them to reposition the client every 2 hours while in bed. Which is the rationale behind this​ instruction? A. To avoid skin breakdown B. To keep skin dry C. To avoid bone fractures D. To keep the client awake

d (rationale: An increasing serum potassium level is an indication for hemodialysis because of its arrhythmogenic effects. Although anemia (decreased red blood cells) and low serum sodium are associated with AKI, they can be managed with therapies other than hemodialysis. Cell casts in the urine are a sign of acute tubular necrosis and cannot be reversed with hemodialysis. Teaching regarding complementary and alternative medicine and acute kidney injury (AKI) includes: Avoiding herbal supplements. Discussing the use of any complementary health approaches with the healthcare provider. Discussing the list of foods that help increase kidney function. Using unsweetened cranberry juice, because it maintains the acid level in the urine.)

The nurse reviews laboratory data for a patient with acute kidney injury (AKI). For which laboratory value should the nurse expect hemodialysis to be ordered? a. Low serum sodium b. Decreased red blood cells c. Cell casts in urine d. Increasing serum potassium level

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear.* True False

True

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses? a) Angiography b) Ultrasonography c) Electroencephalogram d) Magnetic resonance imaging

Ultrasonography Explanation: A ultrasonography will show the size of the abdominal organs and the presence of masses. Magnetic resonance imaging is used to detect hepatic neoplasms. An angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An electroencephalogram is used to detect abnormalities that occur with hepatic coma.

The nurse realizes that as chronic kidney disease​ (CKD) progresses, the kidney loses the ability to eliminate metabolic wastes. Which way should the nurse expect a client with this disease to eliminate wastes other than through the​ kidneys? A. Via respirations B. Via the bowel C. Via tears D. Via the skin

Via the skin Rationale: Metabolic wastes that accumulate in the blood may be eliminated through the skin in the form of uremic frost. The​ bowel, tears, and respirations cannot eliminate metabolic waste.

Which of the following indicates an overdose of lactulose? a) Constipation b) Watery diarrhea c) Hypoactive bowel sounds d) Fecal impaction

Watery diarrhea Explanation: The patient receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.

A patient with hepatitis E and fecal incontinence The use of contact precautions is needed only when a patient has hepatitis A or hepatitis E and fecal incontinence due to the risk of transmission. A patient with a new diagnosis of Hepatitis B, who is in the icterus phase of hepatitis C, or who is recovering from hepatitis A (without fecal incontinence) does not require contact precautions.

Which patient requires contact precautions? A patient with hepatitis E and fecal incontinence A patient with a new diagnosis of Active Hepatitis B A patient who is recovering from hepatitis A A patient in the icterus phase of hepatitis C

c (rationale: A patient in the maintenance phase will experience azotemia, which is more severe in a patient with oliguria. Clinical manifestations for acute kidney injury (AKI) include: Anemia. Fluid volume excess. Hyperkalemia. Edema. Hyperphosphatemia. Hypocalcemia. Metabolic acidosis. Confusion. Hyperreflexia. Seizures or coma. Anorexia. Nausea and vomiting. Uremic syndrome if prolonged.)

Which statement is accurate regarding the development of azotemia as it relates to oliguria? a. Azotemia is not affected by oliguria. b. Azotemia is less severe when oliguria is present. c. Azotemia is more severe when oliguria is present. d. Oliguria is constant in a patient with renal failure.

a 65yo male pt has a GFR of 55mL/min. The pt has a history of uncontrolled HTN and CAD. youre assessing the new medication orders received for this pt. Which medication ordered by the physician will help treat the pt's HTN along with providing a protective mechanism to the kidneys? a. lisinopril b. metoprolol c. amlodipine d. verapamil

a

Prevention of AKI is important because of high mortality rate. Which patient patients are at increased risk for AKI (select all that apply)? a. An 86 year old woman scheduled for a cardiac catheterization b. A 48 year old man with multiple injuries from a MVA c. A 32 year old woman following a c-section delivery for abruptio placentae d. A 64 year old woman with CHF admitted with bloody stools e. A 58 year old man with prostate cancer undergoing preoperative workup for prostatectomy

a, b, c, d, e. High-risk patients include those exposed to nephrotoxic agents and advanced age, massive trauma, prolonged hypovolemia or hypotension, obstetric complications, cardiac failure, preexisting chronic kidney disease, extensive burns or sepsis. Patients with prostate cancer may have obstruction of the outflow tract, which increases risk of postrenal AKI.

When preparing a patient for a paracentesis, what does the nurse do? Select all that apply. a. Ask the patient to void prior to the procedure. b. Place the patient in the supine position. c. Weigh the patient before the procedure. d. Obtain the patient's heart rate e. Assess the patient's respiratory rate. f. Obtain the patient's blood pressure.

a. Ask the patient to void prior to the procedure. c. Weigh the patient before the procedure.c d. Obtains the patient's heart rate. e. Assess the patient's respiratory rate. f. Obtain the patient's blood pressure.

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply* a. Excessive coughing b. Sleeping on the back c. Drinking juice d. Alcohol consumption e. Straining during a bowel movement f. Vomiting

a. Excessive coughing d. Alcohol consumption e. Straining during a bowel movement f. Vomiting

6) The nurse is caring for a client recovering from a liver transplant necessitated by cirrhosis of the liver. Which postoperative outcome would be a priority for this client? A) Moist membranes of the mouth B) Normal serum bilirubin levels C) Ability to move the legs D) Normal pupil reaction

b

A patient diagnosed with chronic hepatitis has developed hepatic encephalopathy. When assessing the patient, the healthcare provider looks for which of the following clinical manifestations characteristic of this condition Choose all answers that apply: Choose all answers that apply: A Retroperitoneal bleeding B Involuntary hand tremor C Bloody emesis D Shortened attention span E Hypersomnia F Slurred speech

b,d,e,f Hepatic encephalopathy is a result of hepatic dysfunction and portal hypertension. Hepatic encephalopathy is characterized by neuropsychiatric abnormalities secondary to increased serum ammonia levels. Hepatic encephalopathy characterized by progressive cognitive deficits and impaired neuromuscular function, so the healthcare provider would anticipate assessing symptoms such as sleep disturbances, confusion, impaired attention span, slurred speech, and asterixis (flapping tremor). Esophageal varices often result in bloody emesis, and retroperitoneal bleeding is a symptom of pancreatitis.

A 68 year-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2mEq/l (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum HCO3- is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. loop diuretics b. renal replacement therapy c. insulin and sodium bicarbonate d. sodium polystyrene sulfonate (Kayexalate)

b. This patient has a t least three of six common indications for RRT, including high potassium level, metabolic acidosis and changed mental status. The other indications are volume overload, resulting in compromised cardiac status (this patient has a history of HTN), BUN greater than 120 mg/dL, and pericarditis, pericardial effusion, or cardiac tamponade.

Why must ACE inhibitors be monitored if given to a patient with acute kidney injury? a. can increase the risk of bleeding b. can cause increased potassium levels c. can increase the risk of respiratory infection d. can cause decreased calcium levels

b. can cause increased potassium levels

What is a major risk factor of end-stage-renal disease? a. hyponatremia b. hypertension c. hypoglycemia d. hypercalcemia

b. hypertension

What is the most common complication of hemodialysis? a. hypokalemia b. hypotension c. pulmonary embolus d. bleeding

b. hypotension

13) A new mother brings her 2-week-old infant in for a checkup because he looks jaundiced and his stools are white. The provider suspects the infant might have biliary atresia. What findings does the nurse anticipate upon assessment of the infant? A) Above average weight gain B) Increased urine output C) Abdominal distention D) Reduced rooting reflex

c

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.

5) The nurse is providing education to the caregivers of a client with cirrhosis of the liver. The caregivers indicate that they've heard of portal hypertension, but they aren't sure which symptoms could indicate that their loved one is experiencing this condition. Which symptoms of portal hypertension should the nurse discuss with the caregivers? A) Muscle wasting B) Hypothermia C) Bleeding gums D) Hemorrhoids

d

What is the common cause for Laennec's cirrhosis? a. Hepatitis C virus (HPC) b. Chronic biliary obstruction c. Autoimmune disorders d. Chronic alcoholism

d. Chronic alcoholism

While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify the HCP? a. urine output is 300 ml/ b. edema occurs in the feet, legs, and sacral area c. cardiac monitor reveals a depressed T wave and elevated ST segment d. the patient experiences increasing muscle weakness and abdominal cramping

d. Hyperkalemia is potentially life-threatening complication of AKI in the oliguric phase. Hyperkalemia can cause the cardiac conduction abnormalities of peaked T wave, prolonged PR interval, prolonged QRS interval, and depressed ST segment.

Which condition is NOT a known cause of cirrhosis?* a. Obesity b. Alcohol consumption c. Blockage of the bile duct d. Hepatitis C e. All are known causes of cirrhosis

e. All are known causes of cirrhosis

92. The nurse writes the problem "imbalanced nutrition: less than body requirements" for the client diagnosed with hepatitis. Which intervention should the nurse include in the plan of care? 1. Provide a high-calorie intake diet. 2. Discuss total parenteral nutrition (TPN). 3. Instruct the client to decrease salt intake. 4. Encourage the client to increase water intake.

1

A nurse is developing an informational session about hepatitis B infection. Which information should the nurse include? Select all that apply. 1. A vaccination against hepatitis B is available. 2. Hepatitis B is rarely seen in middle-aged adults. 3. Hepatitis B can be considered a sexually transmitted infection. 4. Hepatitis B is spread by contaminated food or water. 5. Hepatitis B is endemic in the United States.

1 3

A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this medication what route?* A. Oral B. Intramuscular C. Subcutaneous D. Intravenous

C

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is?* A. Antiviral medications B. Interferon C. Supportive care D. Hepatitis A vaccine

C

1. A client with glomerulonephritis is at risk of developing acute renal failure. The nurse monitors the client for which sign of this complication? a) bradycardia b) hypertension c) decreased cardiac output d) decreased central venous pressure

1) B - Acute renal failure caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of acute renal failure is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. Acute renal failure from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for renal failure.

87. Which type of precaution should the nurse implement to protect from being exposed to any of the hepatitis viruses? 1. Airborne precautions. 2. Standard precautions. 3. Droplet precautions. 4. Exposure precautions.

2

89. Which instruction should the nurse discuss with the client who is in the icteric phase of hepatitis C? 1. Decrease alcohol intake. 2. Encourage rest periods. 3. Eat a large evening meal. 4. Drink diet drinks and juices.

2

1 ( Gentamicin can be a highly nephrotoxic substance. You would monitor creatinine and blood urea nitrogen levels for elevations indicating possible nephrotoxicity. All of the other measures are important but are not specific to gentamicin therapy. Focus: Prioritization)

22. Your patient is receiving IV piggyback doses of gentamicin (Garamycin) every 12 hours. Which would be your priority for monitoring during the period that the patient is receiving this drug? 1. Serum creatinine and blood urea nitrogen levels 2. Patient weight every morning 3. Intake and output every shift 4. Temperature

1 (therapeutic PTT level should be 1.5 to 2 times the normal PTT of 39 seconds. The therapeutic levels of heparin are 58-78. with a PTT of 92 the client is at risk for bleeding. and the heparin drip should be held. The nurse should assess this client first)

23 The nurse on the medical unit has just received the evening shift report. Which client should the nurse assess first? 1. The client with renal vein thrombosis who has a heparin drip infusion and a PTT of 92 2. The client on peritoneal dialysis who has clear dialysate draining from the abdomen 3. The client on hemodialysis whose right upper arm fistula has an audible bruit 4. The client dx with cystitis who is complaining of burning on urination

2. A nurse provides home care instructions to a client hospitalized for a transurethral resection of the prostate (TURP). Which statement by the client indicates a need for further instructions? a) I need to avoid strenuous activity for 4 to 6 weeks b) I need to maintain a daily intake of 6 to 8 glasses of water daily c) I need to avoid lifting items greater than 30 pounds d) I need to include prune juice in my diet

2) C - The client needs to be advised to avoid strenuous activity for 4 to 6 weeks and to avoid lifting items weighing greater than 20 pounds. The client needs to consume an intake of at least 6 to 8 glasses daily of nonalcoholic fluids to minimize clot formation. Straining during defecation for at least 6 weeks after surgery is avoided to prevent bleeding. Prune juice is a satisfactory bowel stimulant.

2 ( Patients with acute kidney failure usually go through a diuretic phase 2 to 6 weeks after the onset of the oliguric phase. The diuresis can result in an output of up to 10 L/day of dilute urine. During this phase it is important to monitor for electrolyte and fluid imbalances. This is followed by the recovery phase. A patient with acute kidney failure caused by hypovolemia would receive IV fluids to correct the problem; however, this would not necessarily lead to the onset of diuresis. Focus: Supervision)

23. A patient in whom acute kidney failure has been diagnosed has had a urine output of 1560 mL for the past 8 hours. The LPN/LVN who is caring for this patient, under your supervision, asks you how a patient with kidney failure can have such a large urine output. What is your best response? 1. "The patient's kidney failure was due to hypovolemia and we have given him IV fluids to correct the problem." 2. "Acute kidney failure patients go through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day." 3. "With that much urine output, there must have been a mistake in the patient's diagnosis." 4. "An increase in urine output like this is an indicator that the patient is entering the recovery phase of acute kidney failure."

4 ( A patient with dehydration due to deficient ADH would have diluted urine with a decreased urine specific gravity. Normal urine specific gravity ranges from 1.003 to 1.030. A specific gravity of 1.035 would indicate urine that is concentrated. Focus: Prioritization)

25. You are caring for a patient admitted with dehydration secondary to deficient antidiuretic hormone (ADH). Which specific gravity value supports this diagnosis? 1. 1.010 2. 1.035 3. 1.020 4. 1.002

1 (The client in pain is priority, None of the other clients have life threatening conditions. Routine antibiotics are not the priority)

4. The nurse is administering meds to clients on a surgical unit. Which medication should the nurse administer first? 1. The narc analgesic morphine IV infusion to the client who is 8 hrs postop and is complaining of pain rating it as a 7 on a 1-10 pain scale 2. The aminoglycoside antibiotic vancomycin IVPB to the client with an infected abd wound 3. The PPI IVPB to the client who is at risk for developing a stress ulcer 4. The loop diuretic Lasix IVP to a client who has undergone surgical debridement of the RLE

The nurse is assigned to observe a patient immediately after a needle biopsy of the liver is performed. Which nursing action would be most appropriate? 1. Monitor vital signs every 15 minutes for 1 hour and then hourly. Position the patient on the left side. 2. Monitor vital signs every 30 minutes for 2 hours and then hourly. Position the patient in the right side-lying position. 3. Monitor vital signs every 15 minutes four times and then every 30 minutes two times. Position the patient on the right side. 4. Monitor vital signs every 15 minutes for 1 hour followed by every 30 minutes for the next hour. Position the patient on the left side.

3. Monitor vital signs every 15 minutes four times and then every 30 minutes two times. Position the patient on the right side. Vital signs should be monitored every 15 minutes for the first hour, then every 30 minutes for the next hour, and then hourly. While assessing vital signs, the pressure dressing should be assessed for bleeding. The patient is placed on the right side for at least 2 hours. The patient would be placed on the right side rather than the left side to maintain pressure on the puncture site.REF: p. 855

4 ( Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other orders are important, but are not urgent. Focus: Prioritization)

4. The health care provider has written all of these orders for a client with a diagnosis of Excess Fluid Volume. The client's morning assessment reveals bounding peripheral pulses, weight gain of 2 lb, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time? 1. Weigh the client every morning. 2. Maintain accurate intake and output records. 3. Restrict fluids to 1500 mL/day. 4. Administer furosemide (Lasix) 40 mg IV push.

4. A nurse has collected nutritional data from a client with a diagnosis of cystitis. The nurse determines that which beverage needs to be eliminated from the client's diet to minimize the recurrence of cystitis? a) fruit juice b) tea c) water d) lemonade

4) B - Caffeine and alcohol can irritate the bladder. Therefore, alcohol and caffeine-containing beverages such as coffee, tea, and cocoa are avoided to minimize the risk. Water helps flush bacteria out of the bladder, and an intake of six to eight glasses per day is encouraged. Lemonade and fruit juice are acceptable items to drink.

A nurse is giving general instructions to a client receiving hemodialysis. Which of the following statements would be appropriate for the nurse to include? a. Several types of medications should be withheld on the day of dialysis until after the procedure. b. Medications should be double-dosed on the morning of hemodialysis to prevent loss. c. It's acceptable to exceed the fluid restriction on the day before hemodialysis. d. It's acceptable to eat whatever you want on the day before hemodialysis.

A Many medications are dialyzable, which means they are extracted from the bloodstream during dialysis. Therefore, many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be "double-dosed," because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.

b (rationale: Children with renal insufficiency (decrease in the kidneys' ability to conserve sodium and concentrate the urine) are at greatest risk for developing dehydration and acute kidney injury from acute gastrointestinal illness. Therefore, the nurse needs to further question the patient's parents about recent acute gastrointestinal illnesses. Major surgery, infections, and certain medications that are nephrotoxic can increase the risk for AKI in older adult patients. Risk factors for acute kidney injury include: Major trauma. Surgical infections. Hemorrhage. Severe heart failure. Severe liver disease. Lower urinary tract obstruction. Drugs and radiographic contrast that are nephrotoxic. Advancing age.)

A 6-year-old child presents with a history of renal insufficiency. Which question should the nurse ask the parents to assist with the diagnosis of acute kidney injury (AKI)? a. "Can you tell me about your child's past infections?" b. "Has your child had a recent acute gastrointestinal illness?" c. "How much protein does your child consume each day?" d. "Which previous major surgeries has your child had?"

2 (The greatest risk following surgery is hemorrhage from lack of clotting at the puncture site. WRONG: #1 is at risk for infection but not the highest priority. #3 is at risk for hematuria, but not highest priority. #4 is at risk for pain but not highest priority)

A nurse is monitoring a client who had a kidney biopsy for postop complications. Which of the following complications should the nurse ID as causing the greatest risk to the client? 1. infection 2. hemorrhage 3. hematuria 4. pain

The hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse assesses this client for which of the following manifestations? a. Warmth, redness, and pain in the left hand. b. Pallor, diminished pulse, and pain in the left hand. c. Edema and reddish discoloration of the left arm. d. Aching pain, pallor, and edema of the left arm.

B Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth, redness, and pain probably would characterize a problem with infection. The manifestations described in options 3 and 4 are incorrect.

A client with chronic renal failure is about to begin hemodialysis therapy. The client asks the nurse about the frequency and scheduling of hemodialysis treatments. The nurse's response is based on an understanding that the typical schedule is: a. 5 hours of treatment 2 days per week. b. 3 to 4 hours of treatment 3 days per week c. 2 to 3 hours of treatment 5 days per week d. 2 hours of treatment 6 days per week

B The typical schedule for hemodialysis is 3 to 4 hours of treatment three days per week. Individual adjustments may be made according to variables such as the size of the client, type of dialyzer, the rate of blood flow, personal client preferences, and others.

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? A "Should we filter air circulation?" B "Can we use less radiographic contrast dye?" C "Should we add low-dose dobutamine?" D "Should we decrease IV rates?"

B "Can we use less radiographic contrast dye?" Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? A "I'll talk to the health care provider and have your name removed from the waiting list." B "You sound frustrated with the situation." C "You're right, the wait is endless for some people." D "I'm sure you'll get a phone call soon that a kidney is available."

B "You sound frustrated with the situation." Acknowledging the client's frustration reflects the feelings the client is having and offers assistance and support. Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs; the nurse should not offer false hope by suggesting that the client will get a phone call soon.

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? A Consuming a low-calcium diet Incorrect B Avoiding peas, nuts, and legumes C Drinking cola beverages only once daily D Increasing dairy products enriched with vitamin D

B Avoiding peas, nuts, and legumes Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) A Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL B Crackles in the lung fields Correct C Temperature of 98.8° F (37.1° C) D Blood pressure of 164/98 mm Hg Correct E 3+ edema of the lower extremities

B Crackles in the lung fields D Blood pressure of 164/98 mm Hg E 3+ edema of the lower extremities Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrates the medication is working effectively? Select all that apply:* A. Decrease albumin levels B. Decrease in Fetor Hepaticus C. Patient is stuporous. D. Decreased ammonia blood level E. Presence of asterixis

B and D

Which metabolic effect should the nurse expect to find in the client with liver disease? SATA A0 Increased plasma oncotic pressure B) Impaired clotting factor production C) Increased blood flow to the liver D) Disrupted glucose metabolism E) Impaired bilirubin conversion

B, D, E Rationale: Liver disease causes many metabolic effects. Impaired clotting factor production results in bleeding and bruising. Disrupted glucose metabolism results in either hyperglycemia or hypoglycemia. Impaired bilirubin conversion and excretion result in jaundice. Other effects of liver disease include disrupted blood flow to the liver resulting in portal hypertension and decreased plasma oncotic pressure from impaired protein metabolism. This results in edema and ascites.

While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as: A: metallic hepatic B: rector hepaticus C: hepaticoacidosis D: asterisks

B: fedora hepaticus

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful?* A. Bilirubin <1 mg/dL B. ALT 8 U/L C. Ammonia 16 mcg/dL D. AST 10 U/L

C

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? A "I can stop my medications when my kidney function returns to normal." B "If my urine output is decreased, I should increase my fluids." C "The anti-rejection medications will be taken for life." D "I will drink 8 ounces of water with my medications."

C "The anti-rejection medications will be taken for life." Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply:* A. Water B. Food C. Semen D. Blood

C and D

Which of the following indicates an overdose of lactulose? a) Hypoactive bowel sounds b) Constipation c) Watery diarrhea d) Fecal impaction

C) Watery diarrhea The patient receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.

A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?

Cardiac rhythm

During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first?

Check the patient's blood pressure.

A patient with hepatitis A infection is being discharged from the hospital. What is the most important instruction that the nurse should include in the discharge teaching? a. Do not share razors or toothbrushes. b. Isolate the patient from other family members. c. Take acetaminophen every four hours if fever persists. d. Wash hands carefully after bowel movements

D The mode of transmission of hepatitis A infection is the fecal-oral route. Therefore, it is very important to maintain personal and environmental hygiene. The nurse should teach the patient and the family members about careful hand washing immediately after bowel movements and before eating to prevent outbreaks of hepatitis A viral infection. Not sharing toothbrushes and razors is a concern for the prevention of hepatitis B and C, because they are transferred through blood contact. There is no need to isolate the patient with hepatitis A unless he or she is incontinent or maintains poor personal hygiene. Acetaminophen may cause liver damage and should be avoided in hepatic viral infection. Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice. Text Reference - p. 1014

A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? A "All of this is new. What can't you do?" B "Are you afraid of dying?" C "How are you doing this morning?" D "What concerns do you have about your kidney disease?"

D "What concerns do you have about your kidney disease?" Asking the client about any concerns is open-ended and specific to the client's concerns. Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

The nurse is assessing a dialysis patient who is asking to receive continuous ambulatory peritoneal dialysis (CAPD) instead of hemodialysis. Which of the following complications of CAPD will the nurse review with the client? a. hypercalcemia b. hypertension c. hyponatremia d. hypotension

D. hypotension Clients on CAPD have a more normal lifestyle than do clients on either hemodialysis or peritoneal dialysis. Complications associated with CAPD include peritonitis, hypotension, and weight gain.

The nurse provides dietary teaching to a client with chronic kidney disease. Which food should the nurse inform the client about that contains protein of high biologic​ value? (Select all that​ apply.) A. Milk B. Fish C. Legumes D. Peanut butter E. Poultry

Milk Fish Poultry Rationale: Animal sources of protein​ are meat, poultry, fish, eggs, milk,​ cheese, and yogurt which are proteins of high biologic value.​ Plants, legumes, grains,​ nuts, seeds, and vegetables provide proteins of low biologic value.

A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required?

Milk of magnesia 30 mL

What is proteinuria?

Protein in the urine; indication of kidney disease Healthy kidneys do not allow a significant amount of protein to pass through their filters. But filters damaged by kidney disease may let proteins such as albumin leak from the blood into the urine. Proteinuria can also be a result of overproduction of proteins by the body. Kidney disease often has no early symptoms. One of its first signs may be proteinuria that's discovered by a urine test done during a routine physical exam. Blood tests will then be done to see how well the kidneys are working. Risk Factors for Proteinuria The two most common risk factors for proteinuria are: 1. Diabetes 2. High blood pressure (hypertension) Both diabetes and high blood pressure can cause damage to the kidneys, which leads to proteinuria.

A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient?* A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative. B. The patient is now recovered from a previous Hepatitis B infection and is now immune. C. The patient is not a candidate from antiviral or interferon medications. D. The patient is less likely to develop a chronic infection.

The answer is A. A positive HBsAg (hepatitis B surface antigen) indicates an active Hepatitis B infection. Therefore, the patient should avoid sexual intercourse and other forms of intimacy until their HBsAg is negative.

3. Dehydration results in concentrated serum, causing laboratory values to increase because the blood has normal constituents but not enough volume to dilute the values to within normal range or possibly lower.

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition is a cause for these findings? 1.Overhydration. 2.Anemia. 3.Dehydration. 4.Renal failure.

a, b, d, e (rationale: Hypertension,​ hemolysis, glomerulonephritis, and vasculitis cause acute damage to the renal parenchyma and​ nephrons, leading to intrarenal AKI. Dehydration causes prerenal AKI and does not cause damage to the renal parenchyma and nephrons.)

The nurse preceptor is teaching a new graduate about conditions that can cause damage to the renal parenchyma and nephrons resulting in acute kidney injury​ (AKI). Which condition should the nurse preceptor​ include? (Select all that​ apply.) A. Glomerulonephritis B. Hemolysis C. Dehydration D. Hypertension E. Vasculitis

A pt with stage 4 CKD asks what type of diet they should follow. You explain the pt should follow a a. low protein, low sodium, low K, low phosphate diet b. high protein, low Na, low K, high P diet c. low protein, high Na, high K, high P diet d. low protein, low Na, low K, high P diet

a

The nurse plans to preserve renal perfusion in a client with chronic kidney disease​ (CKD). Which intervention should the nurse implement for this​ client? A. Monitor white blood cell count. B. Monitor protein intake. C. Administer an​ angiotensin-converting enzyme inhibitor as prescribed. D. Assess the arteriovenous fistula on every shift.

​Administer an​ angiotensin-converting enzyme inhibitor as prescribed. Rationale: Administering an​ angiotensin-converting enzyme​ (ACE) inhibitor will reduce systemic hypertension and preserve renal function. Assessing the arteriovenous fistula is an important nursing intervention to preserve the patency of the fistula and reduce the risk of​ infection, not to preserve renal perfusion. The kidney with chronic disease is unable to excrete protein​ by-products, causing the multisystemic effects of uremia. Monitoring the​ client's protein intake will address these effects but does not directly preserve renal perfusion. An increase in white blood cells can indicate infection but does not directly affect renal perfusion.

The nurse is describing to a colleague how the accumulation of metabolites in the blood from renal failure affects the body. Which effect should the nurse​ include? A. Altered electrolyte balance B. Bradycardia C. Decreased levels of nitrogenous wastes in blood D. Increased pain

​Altered electrolyte balance Rationale: Renal failure is a condition in which the kidneys are unable to remove accumulated metabolites from the​ blood, resulting in altered fluid and electrolyte balance and acid-base balance. Increased pain in a client with renal failure would not cause an alteration in the amount of metabolites. Heart palpitations are caused by​ stress, physical​ exertion, too much​ caffeine, and the use of stimulants. Decreased blood volume is usually caused by bleeding or dehydration.

7. What is a common side effect for hemodialysis? a. Muscle cramps b. Dizziness and weakness, hypotension c. Nausea and vomiting d. All of the above.

D

a 55yo Male pt is diagnosed with CKD. the its recent GFR was 25mL/min. what stage of CKD is this known as? a. 1 b. 3 c. 4 d. 5

c

"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 a condom during sexual intercourse. c. have family members get an injection of immunoglobulin. d. follow a low-protein, moderate-carbohydrate, moderate-fat diet."

"3. Correct answer: b Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B."

The nurse is performing an assessment on a client bein evaluated for viral hepatitis. Which symptom will the nurse most likely assess on this client? 1. Arthralgia 2. Excitability 3. Headache 4. Polyphagia

"ANSWER: 1 Rationale: arthralgia is common in clients with viral hepatitis. Other symptoms of viral hepatits include lethargy, flulike symptoms, anorexia, N/V, abdominal pain, diarrhea, constipation, and fever. The others are not symptoms of viral hepatitis."

The nurse is performing an assessment on a client being evaluated for viral hepatitis. Which symptom will the nurse most likely assess on this client? 1. Arthralgia 2. Excitability 3. Headache 4. Polyphagia

"ANSWER: 1 Rationale: arthralgia is common in clients with viral hepatitis. Other symptoms of viral hepatits include lethargy, flulike symptoms, anorexia, N/V, abdominal pain, diarrhea, constipation, and fever. The others are not symptoms of viral hepatitis."

"A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal... a. hepatitis B surface antigen (HBsAg). b. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."

"ANSWER: D Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."

"A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal... a. hepatitis B surface antigen (HBsAg). b. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."

"ANSWER: D Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."

"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."

A cllient with chronic renal failure has been prescribed calcium carbonate. What is the rationale for this particular medication? 1) Diminishes incidence of gastric ulcer formation 2) Alleviates constipation 3) Binds with phosphorus to lower concentration 4) Increase tubular reabsorption of sodium

3: Clients with ARF have hyperphosphatemia. Clients are prescribed calcium-based phosphate binders to improve excretion of phosphorus.

A patient who has hepatitis reports that she is itching and cannot resist scratching. Which measures should help to control the itching? (Select all that apply) 1. Apply lubricating lotion 2. Administer prescribed antihistamine 3. Use tepid water for bathing 4. Vigourously massage affected areas 5. Administer prescribed antibiotics

1. Apply lubricating lotion 2. Administer prescribed antihistamine 3. Use tepid water for bathing Moisturizing lotions protect the skin and can help relieve itching associated with jaundice. The patient should bathe in tepid water, and pat dry. Mild soap is used unless it seems to increase symptoms. Lubricating lotions or topical antipruritics can be applied. Use light strokes in the direction of the heart. Select older, soft sheets. Gently pat the skin instead of scratching to reduce the itching sensation. Vigorous massage can further irritate the skin. If a patient is confused, trim the fingernails as agency policy permits. Mittens may be needed to prevent skin injury. If conservative measures are not effective, consult the physician about ordering an antihistamine. If the event that the patient is having an allergic reaction to antibiotics, contact the physician before continuing the medications.

2 ( All of these findings are important, but only the presence of crackles in both lungs is urgent, because it signifies fluid-filled alveoli and interruption of adequate gas exchange and oxygenation, possibly pulmonary edema. The patient's peripheral edema is not new. The faint pulses are most likely due to the presence of peripheral edema. The dry and peeling skin is a result of chronic diabetes and merits careful monitoring to prevent infection. Focus: Prioritization)

1. During admission assessment, Ms. J has all of these findings. For which finding should you notify the health care provider immediately? 1. Bilateral pitting ankle and calf edema rated 2+ 2. Crackles in both lower and middle lobes 3. Dry and peeling skin on both feet 4. Faint but palpable pedal and post-tibial pulses

Nursing interventions for cirrhosis

1. Elevate HOB to help breathing 2.High protein diet + vitamins (unless there is edema and ascites or signs of impending coma) 3. Provide vitamns: B, A, C, K + folic acid and thiamine 4. Sodium and fluid restrictions 5. Diuretics for ascites 6. Monitor I and O 7. Daily weight + abdominal girth 8. Monitor LOC 9.Monitor for asterixis 10. Monitor for fetor hepaticus 11. Monitor coagulation lab results: give vitamin K if needed 12. Be aware of meds they are taking and how these may affect the liver 13. Educate with regard to alcohol

A patient returns from surgery for an incisional cholecystectomy with a T-tube. The nurse understands that the purpose of the T-Tube is to: 1. Maintain bile flow in the common bile duct 2. Relieve pressure on the liver 3. Divert intestinal contents from the surgical site 4. Prevent bile leakage into the abdomen

1. Maintain bile flow in the common bile duct A T-tube is placed in the common bile duct to maintain bile flow until swelling in the duct subsides. One part of the tubing is brought through the patient's skin and connected to a closed-gravity drainage receptacle. A T-tube does not relieve pressure on the liver, or divert intestinal contents, or prevent bile from leaking on the abdomen.

1 ( Hyperacute rejection occurs within 48 hours after transplant surgery. Increased temperature, increased blood pressure, and pain at the transplant site are manifestations. Focus: Prioritization)

13. You are caring for Ms. J 1 day postoperatively. (kidney transplant) On assessment, her temperature is 100.4° F (38o C), her blood pressure is 168/92 mm Hg, and the patient tells you she has pain around the transplant site. What is the best interpretation of these findings? 1. Hyperacute rejection 2. Acute rejection 3. Chronic rejection 4. Transplant site infection

4 ( Risk factors for acid-base imbalances in the older adult include chronic kidney disease and pulmonary disease. Occasional antacid use will not cause imbalances, although antacid abuse is a risk factor for metabolic alkalosis. Focus: Prioritization)

16. You are admitting an older adult client to the medical unit. Which assessment factor alerts you that this client has a risk for acid-base imbalances? 1. History of myocardial infarction 1 year ago 2. Antacid use for occasional indigestion 3. Shortness of breath with extreme exertion 4. Chronic renal insufficiency

A client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse?

167 drops/min 20 gtt × 500 mL = 10,000/60 min = 167 drops/min

4 (The client with acute pyelonephritis an inflammation of the renal parenchyma and collecting system is not expected to get dehydrated, therefore assess this client first. The other S/s are expected. Even with polycystic being the most common life threat genetic disease in the world, the s/s are expected.)

18. The nurse is caring for clients on a surgical unit. Which client should the nurse assess first after shift report? 1. The client Dx with polycystic kidney disease who has a BP of 170/100 2. The client dx with bladder cancer who has gross painless hematuria 3. The client Dx with renal calculi who thinks he passed the stone 4. The client with acute pyelonephritis who has NV and is dehydrated

1, 2, 4, 6 ( Administering oral medications is appropriate to the scope of practice for an LPN/LVN or RN. Assessing breath sounds requires additional education and skill development and is most appropriately within the scope of practice of an RN, but it may be part of the observations of an experienced and competent LPN/LVN. All other actions are within the educational preparation and scope of practice of an experienced UAP. Focus: Delegation, supervision)

19. You are providing nursing care for a patient with acute kidney failure for whom a nursing diagnosis of Excess Fluid Volume related to compromised regulatory mechanisms has been identified. Which actions should you delegate to an experienced UAP? (Select all that apply.) 1. Measuring and recording vital sign values every 4 hours 2. Weighing the patient every morning using a standing scale 3. Administering furosemide (Lasix) 40 mg orally twice a day 4. Reminding the patient to save all urine for intake and output measurement 5. Assessing breath sounds every 4 hours 6. Ensuring that the patient's urinal is within reach

The nurse monitoring a client receiving peritoneal dialysis notes that the clietn's outflow is less than the inflow. Select all nursing actions in the situation that apply. 1. Contact the physician. 2. Check the level of the drainage bag. 3. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.

2, 3, 4, 5. If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the physician. Increasing the flow rate is an inappropriate action and is not associated with the amount of outflow solution.

The nurse is providing instructions for a patient who will be having a percutaneous transhepatic cholangiography in 2 days. Which statement by the patient indicates understanding of this procedure? 1. "I will be able to leave the facility as soon as the procedure is finished." 2. "The nurses will monitor the puncture site and check my blood pressure frequently." 3. "This procedure requires that I be on bed rest for a minimum of 12 hours afterward." 4. "Results of the test will be discussed with my family while I am recovering from the procedure."

2. "The nurses will monitor the puncture site and check my blood pressure frequently." The percutaneous transhepatic cholangiography is an invasive procedure performed while a needle is inserted into the liver and dye injected. The nurse must closely monitor the puncture site for bleeding and must also monitor vital signs frequently. The patient will be maintained on bed rest for a minimum of 8 hours and will stay at the facility while this is accomplished. The results of the test will be discussed with the patient after the procedure.REF: p. 853

2 ( A nurse from the surgical ICU will be thoroughly familiar with the care of patients who have just undergone surgery. The patient scheduled for lithotripsy may need education about the procedure. The newly-admitted patient needs an in-depth admission assessment, and the patient with chronic kidney failure needs teaching about peritoneal dialysis. All of these interventions would best be accomplished by an experienced nurse with expertise in the care of patients with kidney problems. Focus: Assignment)

21. You are the charge nurse. Which patient will you assign to a nurse floated to your unit from the surgical intensive care unit (ICU)? 1. Patient with kidney stones scheduled for lithotripsy this morning 2. Patient who has just undergone surgery for renal stent placement 3. Newly-admitted patient with an acute UTI 4. Patient with chronic kidney failure who needs teaching on peritoneal dialysis

1 ( CAVH is a continuous renal replacement therapy that is prescribed for patients with kidney failure who are critically ill and do not tolerate the rapid shifts in fluids and electrolytes that are associated with hemodialysis. A teaching plan is not urgent at this time. A patient must have a mean arterial pressure (MAP) of at least 60 mm Hg or more for CAVH to be of use. The physician should be notified about this patient's MAP; it is a priority, but not the highest priority. When a patient urgently needs a procedure, morning care does not take priority and may be deferred until later in the day. Focus: Prioritization)

24. A patient on the medical-surgical unit with acute kidney failure is to begin continuous arteriovenous hemofiltration (CAVH) as soon as possible. What is the priority action at this time? 1. Call the charge nurse and transfer the patient to the ICU. 2. Develop a teaching plan for the patient that focuses on CAVH. 3. Assist the patient with morning bath and mouth care before transfer. 4. Notify the physician that the patient's mean arterial pressure is 68 mm Hg.

1 ( The risk for contrast-induced kidney failure is greatest in patients who are older or dehydrated. If possible, arrange for the patient to have this procedure early in the day to prevent dehydration. The purpose of this procedure is to assess kidney function and identify anomalies. The administration of drugs that affect the gag reflex is not done during this procedure. Focus: Supervision, prioritization)

26. You are supervising a senior nursing student who is caring for a 78-year-old scheduled for an intravenous pyelography. What information would you be sure to stress about this procedure to the nursing student? 1. "After the procedure, monitor urine output because the contrast dye increases the risk for kidney failure in older adults." 2. "The purpose of this procedure is to measure kidney size." 3. "Because this procedure assesses kidney function, there is no need for a bowel prep." 4. "Keep the patient NPO after the procedure because during the procedure the patient will receive drugs that affect the gag reflex."

28. Which sign indicated the second phase of acute renal failure? 1. Daily doubling of urine output (4 to 5 L/day) 2. Urine output less than 400 ml/day 3. Urine output less than 100 ml/day 4. Stabilization of renal function

28. Answer: 1. Daily doubling of urine output (4 to 5 L/day) Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.

96. Which task is *most appropriate* for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Draw the serum liver function test. 2. Evaluate the client's intake and output. 3. Perform the bedside glucometer check. 4. Help the ward clerk transcribe orders.

3

1 ( A patient with a serum potassium level of 7 to 8 mmol/L or higher is at risk for electrocardiographic changes and fatal dysrhythmias. The health care provider should be notified immediately about this potassium level. Although the serum creatinine and blood urea nitrogen levels are quite high, these levels are commonly reached before patients experience symptoms of CKD. The serum calcium level is low, but not life threatening. Keep in mind that there is an inverse relationship between calcium and phosphorus, so when calcium is low, expect phosphorus to be high. Focus: Prioritization)

3. You review Ms. J's laboratory results. Which laboratory finding is of most concern? 1. Serum potassium level of 7.1 mmol/L 2. Serum creatinine level of 15 mg/dL 3. Blood urea nitrogen level of 180 mg/dL 4. Serum calcium level of 7.8 mg/dL

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

3. Increasing the glucose concentration makes the solution more hypertonic. The more hypertonic the solution, the higher the osmotic pressure for ultrafiltration and thus the greater the amount of fluid removed from the client during an exchange. Options 1, 2, and 4 do not identify the purpose of the glucose.

A client with acute renal failure develops sever hyperkalemia. What would the nurse anticipate to be used to treat this imbalance? 1) Furosemide (Lasix) 2) Amphojel (aluminum hydroxide) 3) 50% glucose and regular insulin 4) Epoetin (Procrit)

3: Hyperkalemia can develop into an emergency situation (Cardia Arrest). It is important to quickly move the potassium back into the cells by administering 50% glucose and regular insulin, usually in conjunction with some type of base to correct the acidosis, such as sodium bicarbonate or calcium gluconate given IV. Insulin assists in the movement of potassium into the cells and helps to reduce the serum potassium level. Amphojel is used for the treatment of hyperphosphatemia that occurs with ARF. Procrit is used for the treatment of anemia caused by a decrease in erythropoietin production by the kidneys. A diuretic, such as Lasix, may lead to a loss of potassium, but the rate is too slow.

A client with chronic renal failure has an internal venous access site for hemodialysis on her left forearm. What action will the nurse take to protect this access site? 1) Irrigate with heparin and NS q8 hrs 2) Apply warm moist packs to the area after hemodialysis 3) Do not use the left arm to take blood pressure readings. 4) Keep the arm elevated above the level of the heart.

3: Protect the arm with the functioning shunt. No blood pressure readings should be taken from that arm, and there should be no needle sticks. The access is not irrigated with Heparin.

85. The client is in the preicteric phase of hepatitis. Which signs/symptoms should the nurse expect the client to exhibit during this phase? 1. Clay-colored stools and jaundice 2. Normal appetite and pruritus 3. Being afebrile and left upper quadrant pain 4. Complaints of fatigue and diarrhea

4

88. The school nurse is discussing methods to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important to teach the high school teachers? 1. Do not allow students to eat or drink after each other. 2. Drink bottled water as much as possible. 3. Encourage protected sexual activity. 4. Sing the happy birthday song while washing hands.

4

In preparation for hemodialysis, a patient has an AV native fistula created in the left forearm. When caring for the fistula postoperatively, the nurse should a. check the fistula site for a bruit and thrill. b. assess the rate and quality of the left radial pulse. c. compare blood pressures in the left and right arms. d. irrigate the fistula site daily with low-dose heparin.

A Rationale: The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.

A patient comes to the clinic for follow-up 1 month after liver transplantation. Which of the following assessment findings would concern you most? 1. Heartburn 2. Constipation 3. Pale urine 4. Fever

4. Fever The most concerning transplant rejection finding is fever. Fever is sometimes the only sign of rejection. Other assessment findings that would alert the nurse are anorexia, depression, vague abdominal pain, muscle aches, and joint pain. Rejection may be treated with corticosteroids or other immunosuppressant medications. If this treatment is unsuccessful, then retransplantation may be needed. Heartburn, constipation, and pale urine are not complaints or signs that might signal transplant rejection.

A client newly diagnosed with renal failure has just been started on peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is appropriate? 1. Stop the dialysis. 2. Slow the infusion. 3. Decrease the amount to be infused. 4. Explain that the pain will subside after the first few exchanges.

4. Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.

The school nurse is discussing ways to prevent an outbreak of hepatitis A with a groupof high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? "1.Do not allow students to eat or drink after each other.2.Drink bottled water as much as possible.3.Encourage protected sexual activity.4.Thoroughly wash hands."

4. Thoroughly wash hands.

3 (NS infusion increases the amt of volume in the bloodstream, which will decrease the dizziness)

56 the client receiving dialysis complaining of being dizzy and light-headed. Which priority intervention should the nurse implement? 1. Place the client reverse Trendelenburg 2. Decrease the volume of blood being removed from the client 3. Bolus the client 300 mL of NS 4. Notify the HCP ASAP

A registered nurse is instructing a new nursing graduate about hemodialysis. Which statement if made by the new nursing graduate would indicate an inaccurate understanding of the procedure for hemodialysis? a. Sterile dialysate must be used. b. Warming the dialysate increases the efficiency of diffusion. c. Heparin sodium is administered during dialysis. d. Dialysis cleanses the blood from accumulated waste products.

A Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore, the dialysate does not need to be sterile. The dialysate is warmed to approximately 100° F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Heparin sodium inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis.

A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which of the following lab tests? a. Partial thromboplastin time (PTT) b. Prothrombin time (PT) c. Thrombin time (TT) d. Bleeding time

A Heparin is the anticoagulant used most often during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by checking the PTT, which is the appropriate measure of heparin effect. The PT is used to monitor the effect of warfarin (Coumadin) therapy. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities.

The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The priority action for the nurse is to: a. Discontinue dialysis and notify the physician. b. Monitor vital signs every 15 minutes for the next hour. c. Continue dialysis at a slower rate after checking the lines for air. d. Bolus the client with 500 mL of normal saline to break up the embolus.

A If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed. Options 2, 3, and 4 are incorrect.

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching? a. "If I notice a fast heart rate or irregular beats, it is normal for cirrhosis." b. "I need to take good care of my belly and ankle skin where it is swollen." c. "A scrotal support may be more comfortable when I have scrotal edema." d. "I can use pillows to support my head to help me breathe when I am in bed."

A If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider, because this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. A scrotal support may improve comfort if there is scrotal edema. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency. Text Reference - p. 1024

15.Which patient has the most significant risk factors for CKD? 1. A 50-yr-old white woman with hypertension 2. A 61-yr-old Native American man with diabetes 3. A 40-yr-old Hispanic woman with cardiovascular disease 4. A 28-yr-old African American woman with a urinary tract infection

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 (rationale: Etiology of AKI in older adults includes sepsis and the presence of polypharmacy, especially nephrotoxic drugs such as NSAIDs. The drug classification for ibuprofen is an NSAID, so this should be avoided. The patient should be educated to take all of their medication as prescribed, and not alter their schedule. Resuming their vitamin schedule does not have an effect on the diagnosis of AKI. Older adults should review their medication list frequently with their healthcare provider to avoid issues associated with polypharmacy. The conversation should also include over-the-counter medications or dietary supplements.)

A 65-year-old patient with acute kidney injury (AKI) is meeting with the nurse to review their medication regimen at home. Which teaching should the nurse include? a. Avoiding the use of NSAIDs b. Taking vitamins daily c. Taking all prescribed medications in the morning d. Utilizing only ibuprofen for any pain

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? A Abrupt decrease in urine output B Blood-tinged urine C Incisional pain D Increase in urine output

A Abrupt decrease in urine output An abrupt decrease in urine output may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation.

A nurse is caring for a client with ascites secondary to cirrhosis. Which medication is the treatment of​ choice? A: Spironolactone​ (Aldactone) B: Furosemide​ (Lasix) C: Oxazepam​ (Serax) D: Neomycin sulfate

Answer: A

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

B Ascites is accumulation of serious fluid in peritoneal cavity. With portal hypertension, protein shifts from the blood into the lymph. When the lymph system is unable to carry excess, it leaks thru the liver into the peritoneal cavity. osmotic pressure of the proteins pulls additional fluid into cavity. Second mechanism of ascites if hypoalbuminemia from the liver unable to synthesize albumin, resulting in decreased colloidal oncotic pressure.

A member of the clinic housekeeping staff experiences a needlestick by a contaminated needle. Which of the following should be administered by the healthcare provider to provide the patient with passive immunity against the hepatitis B virus? A. Antiviral medication B Hepatitis B immune globulin (HBIG) C Hepatitis B vaccine D Interferon

B Eliminate the options that interfere with viral replication, since this is not a characteristic of passive immunity. Vaccines stimulate the immune system to make antibodies. HBIG contains IgG antibodies specific to hepatitis B, providing passive immunity (which means that a person is given antibodies to a disease instead of producing them through his or her own immune system). HBIG is used for prophylaxis after exposure to the hepatitis B virus.

Assessment findings for a patient diagnosed with alcoholic hepatitis and portal hypertension include oliguria and increasing blood urea nitrogen (BUN). Which additional assessment finding would be consistent with a diagnosis of hepatorenal syndrome? A Increased urine sodium B Increased serum creatinine C Flank pain and proteinuria D Hypotension and pallor

B Hepatorenal syndrome is characterized by reduced renal perfusion secondary to hepatic disease. The patient's portal hypertension sets off a chain of events throughout the body, including an increase in splanchnic nitric oxide production. Nitric oxide causes vasodilation of the splanchnic vasculature, which in turn causes decreased renal perfusion. Increasing serum creatinine levels are an indication of decreasing renal perfusion. There are no systemic signs of shock, but the renin-angiotensin-aldosterone system (RAAS) is stimulated, which decreases the amount of sodium in the urine.

A pt has been told she has NAFLD. The nursing teaching plan should include a. having genetic testing done b. recommend a heart healthy diet c. the necessity to reduce weight rapidly d. avoiding alcohol until liver enzymes return to normal

B NAFLD can progress to cirrhosis. NO definitive treatment; therapy directed at reducing risk like diabetes, body weight, and harmful medications.

When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? A Mild discomfort at the insertion site B Temperature 100.8° F C 1+ ankle edema D Anorexia

B Temperature 100.8° F Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed. Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

During the posticteric phase of Hepatitis the nurse would expect to find? Select all that apply:* A. Increased ALT and AST levels along with an increased bilirubin level B. Decreased liver enzymes and bilirubin level C. Flu-like symptoms D. Resolved jaundice and dark urine

B and D.

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

B is the correct answer. 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 nurse is caring for a client admitted with a diagnosis of acute kidney injury (AKI). The client asks the nurse, "Are my kidneys failing? Will I need a kidney transplant?" Which response by the nurse is the most appropriate? A) "No, don't think that. You're going to be fine." B) "In most cases, your condition can be reversed with prompt treatment and usually will not destroy the kidneys." C) "Kidney transplantation is highly likely, so it would be a good idea to start talking to your family members about organ donation." D) "When the doctor comes to see you, we can talk about whether you will need a transplant."

B) "In most cases, your condition can be reversed with prompt treatment and usually will not destroy the kidneys." Rationale: Acute kidney injury (AKI) is often resolved without the need for transplant if treatment is initiated quickly. There is no need to start lining up donors or wait for the provider to arrive to explore options. Telling the client that everything will be fine is condescending, provides no information, and is not within the nurse's ability to know.

*Possible exam question* What is the most frequent complication during hemodialysis? A) Hemorrhage B) Hypotension C) Localized infection D) Hypertension

B) Hypotension Rationale: Hypotension is the most frequent complication during hemodialysis. It may result from changes in serum osmolality, rapid removal of fluid from the vascular compartment, vasodilation, and other factors. Bleeding is another possible complication, although it does not occur as often as hypotension. Infection is also commonly associated with hemodialysis, although it occurs following treatment rather than during dialysis.

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply:* A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

B, C, and E

A patient begins hemodialysis after having had conservative management of chronic kidney disease. The nurse explains that one dietary regulation that will be changed when hemodialysis is started is that a. unlimited fluids are allowed since retained fluid is removed during dialysis. b. increased calories are needed because glucose is lost during hemodialysis. c. more protein will be allowed because of the removal of urea and creatinine by dialysis. d. dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.

C Rationale: Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is allowed. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

A patient with acute renal failure (ARF) requires hemodialysis and temporary vascular access is obtained by placing a catheter in the left femoral vein. The nurse will plan to a. restrict the patient's oral protein intake. b. discontinue the retention catheter. c. place the patient on bed rest. d. start continuous pulse oximetry.

C Rationale: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.

A nurse is working with the client newly diagnosed with chronic renal failure (CRF) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse assesses that the client is exhibiting: a. Withdrawal b. Depression c. Anger d. Projection

C Psychosocial reactions to CRF and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems. The client in this question is exhibiting anger. The client has not projected blame on the nurse, nor does the client statement reflect withdrawal or depression.

A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? A Blood pressure of 118/78 mm Hg B Weight loss of 3 pounds during hospitalization C Dyspnea and anxiety at rest D Central venous pressure (CVP) of 6 mm Hg

C Dyspnea and anxiety at rest Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply:* A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

C and D

A college student is required to be inoculated for hepatitis before beginning college. The nurse realizes this client will be inoculated to prevent the development of: "A) Hep B B) Hep D C) Hep C D) Hep E"

Correct A: Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis

The client is in the preicteric phase of hepatitis. Which signs/symptoms would thenurse expect the client to exhibit during this phase? 1.Clay-colored stools and jaundice. 2.Normal appetite and pruritus. 3.Being afebrile and left upper quadrant pain. 4.Complaints of fatigue and diarrhea.

Correct Answer 4 "Flu-like" symptoms are the first com-plaints of the client in the preicteric phase of hepatitis, which is the initial phase and may begin abruptly or insidiously

26. The nurse would encourage the client receiving peritoneal dialysis to do which of the following to manage low back pain associated with increased weight in the abdomen? a. Lying down as much as possible b. Walking on surfaces with gradual inclines c. Reducing voluntary fluid intake d. Performing specified exercises

D

8. Which dietary mineral must be limited for a person on hemodialysis? a. Iron b. Zinc c. Sodium d. Potassium

D

A client with chronic renal failure who is not receiving dialysis is suffering from uremia. What nutrient will the nurse tell this client to limit in an attempt to control the uremia? a. carbohydrate c. potassium b. magnesium d. protein

D . Protein Uremia is a condition in which protein wastes that should normally have been excreted are instead circulating in the blood. The diet may limit protein to as little as 40 grams a day for predialysis clients.

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? A Hematocrit of 26.7% B Potassium within normal range C Absence of spontaneous fractures D Less fatigue

D Less fatigue Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.

A frail 72-year-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 medication should the nurse teach the patient to avoid? A) Aspirin B) Acetaminophen C) Diphenhydramine D) Aluminum hydroxide

D) Aluminum hydroxide

2. Increasing the irrigation fluid will flush out the clots and blood.

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the client who is one (1) day postoperative TURP. Which intervention should the nurse implement? 1.Remove the indwelling catheter. 2.Titrate the NS irrigation to run faster. 3.Administer protamine sulfate IVP. 4.Administer vitamin K slowly.

A client is being discharged following the placement of an AV fistula. The nurse is providing discharge instructions to the client regarding the fistula. Which should the nurse share during this​ session? A. ​"The fistula will heal within a​ week." B. ​"The fistula will not be functional for dialysis for a​ month." C. ​"This fistula is created by joining two arteries​ together." D. ​"This is temporary access for​ dialysis."

​"The fistula will not be functional for dialysis for a​ month." Rationale: For​ longer-term vascular​ access, an arteriovenous​ (AV) fistula​ (an artificial connection between a vein and an​ artery) is created. In preparation for fistula​ formation, the nondominant arm is not used for venipuncture or blood pressure measurement during renal failure. The fistula is created by surgical anastomosis of an artery and​ vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used.

A client with​ end-stage renal disease​ (ESRD) is experiencing uremia. Which prescription should the nurse expect to receive from the healthcare​ provider? (Select all that​ apply.) A. Arterial blood gas monitoring B. Increased fluids C. Serum electrolytes D. Physical therapy care consult E. Begin dialysis

​Arterial blood gas monitoring Serum electrolytes Begin dialysis Rationale: Uremia is a manifestation of ESRD that occurs when metabolic wastes build up in the blood. Dialysis is often the only option for treatment. ABGs and serum electrolytes are monitored to assess for complications of uremia. Fluids should be​ restricted, not increased. A dietary consult might be​ necessary, but not a physical therapy consult at this time.

"The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate? A. The hepatitis vaccine will provide immunity from this exposure and future exposures. B. I am afraid there is nothing you can do since the paitent was infectious before admission C. You will need to be tested first to make sure you don't have the virus before we treat you D. An injection of immunoglobin will need to be given to minimize or prevent the effects of this exposure"

"Answer: D. Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which of the following responses by the nurse is most appropriate? A) The hepatitis vaccine will provide immunity from this exposure and future exposures."" B) I am afraid there is nothing you can do since the patient was infectious before admission."" C) You will need to be tested first to make sure you don't have the virus before we can treat you."" D) An injection of immunoglobulin will need to be given to prevent or minimize the effects of this exposure."""

"Correct Answer: D Rationale: Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks of exposure. It may not prevent an infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which of the following responses by the nurse is most appropriate? "A) The hepatitis vaccine will provide immunity from this exposure and future exposures."" B) I am afraid there is nothing you can do since the patient was infectious before admission."" C) You will need to be tested first to make sure you don't have the virus before we can treat you."" D) An injection of immunoglobulin will need to be given to prevent or minimize the effects of this exposure."""

"Correct Answer: D Rationale: Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks of exposure. It may not prevent an infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

"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"

"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 patient with hepatitis A is in the acute phase. The nurse plans care for the pateint based on the knowledge that: "a. pruritus is a common problem with jaundice in this phase. b. the pateint is most likely to transmit the disease during this phase. c. gastrointestinal symptoms are not severe in hepatitis A they are in hepatitis B. d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase."

"Correct answer: a Rationale: The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin."

8.Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? 1. "Maintain a daily written record of blood pressure and weight." 2. "It is essential that you maintain aseptic technique to prevent peritonitis." 3. "You will be allowed a more liberal protein diet once you complete CAPD." 4. "Continue regular medical and nursing follow-up visits while performing CAPD."

"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 nurse describes the increased risk of gastrointestinal bleeding to a client with AKI. Which factor should the nurse inform the client about with regard to​ medication? (Select all that​ apply.) A. ​"Take antacids at​ bedtime." B. ​"Regular doses of antacids are​ indicated." C. ​"Avoid magnesium-based​ antacids." D. ​"Drink milk to coat the stomach prior to taking​ medication." E. ​Over-the-counter calcium carbonate​ (Tums) is​ helpful."

"Regular doses of antacids are​ indicated." ​"Avoid magnesium-based​ antacids." Rationale: The client with AKI has an increased risk of GI​ bleeding, probably related to the stress response and impaired platelet function. Regular doses of antacids​ (although not ones that are magnesium​ based), histamine​ H2-receptor antagonists​ (e.g., famotidine,​ ranitidine), or a proton pump inhibitor​ (e.g., omeprazole​ [Prilosec]) are often ordered to prevent GI hemorrhage. All​ medications, including​ over-the-counter medications, should be discussed with the healthcare provider to see if they are contraindicated in their medical condition. Milk will not coat the stomach or protect the gastric mucosa.

86. The public health nurse is teaching day-care workers. 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.

1

The nurse identifies that a patient with CKD is at risk for fractures because of alterations in calcium and phosphorus metabolism. What is the pathologic process directly related to the increased risk of fractures? Number the processes beginning with 1 and ending with 6. A) Bone remodeling causes weakened bone matrix B) Bone demineralization for calcium and phosphate release C) Decalcification of the bone and replacement of bone tissue with fibrous tissue D) Impaired vitamin D activation resulting in decreased GI absorption of calcium E) Increased release of parathyroid hormone in response to decreased calcium levels F) Hyperphosphatemia decreases serum calcium levels and reduces kidney's vitamin D activation

1 ) Impaired vitamin D activation resulting in decreased GI absorption of calcium 2) Increased release of parathyroid hormone in response to decreased calcium levels 3) Bone demineralization for calcium and phosphate release 4) Hyperphosphatemia decreases serum calcium levels and reduces kidney's vitamin D activation 5) Bone remodeling causes weakened bone matrix 6) Decalcification of the bone and replacement of bone tissue with fibrous tissue

What complications can develop from cirrhosis?

1. Portal hypertension: Due to obstruction of blood flow 2. Ascites: Low albumin= fluid leak, capillary congestion = fluid leak 3. Esophageal varices 4. Decreased bile = less absorption of vitamins 5. Decreased Vitamin K + reduced clotting factors (2,5,9,10) increased bleeding chances 6. Jaundice: liver can't metabolize bilirubin 7. Portal system encephalopathy

The endocrine functions of the pancreas include which of the following? (Select all that apply) 1. Storage and secretion of insulin in response to high blood glucose levels 2. Conversion of excess blood glucose to glycogen for storage 3. Breakdown of excessive fats and carbohydrates in the intestine 4. Production and secretion of digestive enzymes into the duodenum through a duct 5. Manufacture and storage of bile

1. Storage and secretion of insulin in response to high blood glucose levels 2. Conversion of excess blood glucose to glycogen for storage The endocrine function of the pancreas is carried out by clusters of specialized cells scattered throughout the pancreas. These cells are called islets of Langerhans. The islets contain alpha, beta, delta, and PP cells. Alpha cells produce and secrete glucagon. Beta cells produce and secrete insulin. Insulin is secreted when the blood glucose rises, as after a meal. It stimulates the use of glucose by the cells so that a normal blood glucose level is maintained. Glucagon is secreted when the blood glucose level falls. It stimulates the liver to convert glycogen into glucose. Pancreatic fluid is part of the exocrine function of the pancreas. This fluid contains enzymes needed for the digestion of proteins, fats, and carbohydrates. It is secreted into the duodenum through the pancreatic duct. The manufacture and storage of bile is not an endocrine function of the pancreas. Bile is produced in the liver, stored in the gallbladder, and delivered to the intestine, where it is essential for emulsification and digestion of fats. When fats enter the duodenum, the gallbladder contracts and delivers bile to the intestine through the common bile duct.

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

1. The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option 3 may assist in preventing infection, this option relates to an external site. Options 2 and 4 are unrelated to the major complication of peritoneal dialysis.

2 (The nurse would not expect the client with BPH to have oozing blood from the IV site. This may indicate DIC. Which is potentially life threatening. WRong: #1 expected to have oliguria and peritorbital edema with acute glomerulonephritis, its a disorder of the glomeruli or small blood vessels of the kidneys. #3 pain comes with stones, expected. #4 protein in urine and and low protein in blood expected with nephrotic syndrome, the kidneys are damaged causing them to leak large amounts of protein into the urine)

1. The nurse is caring fro the following clients on a medical unit. Which client should the nurse assess first? 1. The client with glomerulonephritis who has oliguria and periorbital edema 2. The client with BPH who has blood oozing from the IV site 3. The client with renal calculi who is complaining of flank pain rated as a 5 on a scale of 1-10 4. The client with nephrotic syndrome who has proteinuria and hypoalbumenia

3 ( Changes in level of consciousness during or after HD can signal dialysis disequilibrium syndrome, a life-threatening situation that requires early recognition and treatment with anticonvulsants. Decreases in weight and blood pressure are to be expected as a result of dialysis therapy. A small amount of drainage is common after HD. Focus: Prioritization)

10. Assessment of Ms. J after dialysis reveals all of these findings. Which assessment finding necessitates immediate action? 1. Weight decrease of 4.5 lb 2. Systolic blood pressure decrease of 14 mm Hg 3. Decreased level of consciousness 4. Small blood spot near the center of the dressing

3 ( A musculoskeletal manifestation of low phosphorus levels is generalized muscle weakness, which may lead to acute muscle breakdown (rhabdomyolysis). Phosphate is necessary for energy production in the form of ATP, and when not produced, leads to generalized muscle weakness. Although the other statements are true, they do not answer the UAP's question. Focus: Delegation, supervision)

11. The UAP asks you why the client with a chronically low phosphorus level needs so much assistance with activities of daily living. What is your best response? 1. "The client's low phosphorus is probably due to malnutrition." 2. "The client is just worn out from not getting enough rest." 3. "The client's skeletal muscles are weak because of the low phosphorus." 4. "The client will do more for himself when his phosphorus level is normal."

4 (Nephrolithiasis is kidney stones, characterized by pain and hematuria. The nurse must assess the pain to determine whether a complication has occurred or it is the expected routine pain. Pain is the common priority of these 4 clients. The other S/s are expected for the conditions)

11. The nurse is caring for clients on a renal unit and making assignments for the day shift. Which client should the nurse assess first? 1. The client Dx with interstitial cystitis who has urinary urgency and pain in the bladder 2. The client with acute post strep glomerulonephritis who has hematuria with a smoky appearance 3. The client Dx with Goodpasture syndrome who has pallor, anemia, and renal failure 4. The client Dx with nephrolithiasis who has hematuria and is complaining of pain, rating it as a 9 on a 1-10 scale.

13. For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures

13. Answer C. During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

2 ( The client with COPD, although ventilator dependent, is in the most stable condition of the clients in this group. Clients with acid-base imbalances often require frequent laboratory assessment and changes in therapy to correct their disorders. In addition, the client with diabetic ketoacidosis is a new admission and will require an in-depth admission assessment. All three of these clients need care from an experienced critical care nurse. Focus: Assignment)

13. As the charge nurse, you would assign which client to the step-down unit nurse floated to the intensive care unit for the day? 1. 68-year-old on a ventilator with acute respiratory failure and respiratory acidosis 2. 72-year-old with chronic obstructive pulmonary disease (COPD) and normal blood gas values who is ventilator dependent 3. Newly-admitted 56-year-old with diabetic ketoacidosis receiving an insulin drip 4. 38-year-old on a ventilator with narcotic overdose and respiratory alkalosis

What nursing measure would be included in the plan of care for a client with acute renal failure? 1) Observe for signs of a secondary infection 2) Provide a high protein, low carbohydrate diet 3) In and out catheterization for residual urine 4) Encourage fluids to 2000 mL in 24 hours

1: Secondary infections are the cause of death in 50-90% of clients with acute renal failure. A low protein diet is most often offered. Catheterizations are avoided. Fluids may be limited if the client is in ARF.

91. The client with hepatitis asks the nurse, "I went to an herbalist, who recommended I take milk thistle. What do you think about that?" Which statement is the nurse's best response? 1. "You are concerned about taking an herb." 2. "The herb has been used to treat liver disease." 3. "I would not take anything that is not prescribed." 4. "Why would you want to take any herbs?"

2

The nurse is providing discharge instructions that include education for a patient who was recently diagnosed with hepatitis B. Which information should be included in the teaching plan for this patient? 1. The diet should be regular with added vitamin and mineral supplements. 2. Activity levels will depend on the patient's signs and symptoms and liver function test results. 3. When the patient has completed an antiviral medication, he or she will no longer be contagious. 4. It is important to take a medication such as diphenhydramine (Benadryl) around the clock to prevent severe itching.

2. Activity levels will depend on the patient's signs and symptoms and liver function test results. Activity levels depend on the individual patient's signs and symptoms. The diet for a patient who has hepatitis should be high-calorie, high-carbohydrate, moderate- to high-protein, and moderate- to low-fat with supplementary vitamins. Antiviral medications may help to lessen symptoms; however, the patient may still be contagious. Benadryl is helpful for itching when it occurs; however, there is no need to take it routinely.REF: p. 858

The nurse is caring for a patient who is returning to the unit after a liver biopsy. Which intervention implemented by the nurse is appropriate during the postintervention care of this patient? 1. Maintain the patient on the left side for at least 2 hours after the procedure. 2. Check vital signs every 15 minutes for the first hour and then according to protocol. 3. Encourage the patient to keep the right arm above the head and to take frequent deep breaths. 4. Change the pressure dressing every 30 minutes for the first 2 hours and assess the puncture site.

2. Check vital signs every 15 minutes for the first hour and then according to protocol. To monitor for potential complications after a liver biopsy, vital signs are checked every 15 minutes for the first hour and then according to protocol. The patient must remain on the right side for at least 2 hours to maintain pressure on the puncture site. The patient is encouraged to keep the right arm above the head and to take frequent deep breaths during the actual procedure, not postprocedure. The pressure dressing should be checked for bleeding every 15 minutes for the first hour and then every 30 minutes during the second hour; however, the dressing should not be removed or changed.REF: p. 855

Which of the following structures comprise the common bile duct? (Select all that apply) 1. Duodenum 2. Cystic duct 3. Hepatic bile ducts 4. Main pancreatic duct 5. Ductus arteriosis

2. Cystic duct 3. Hepatic bile ducts The common hepatic bile duct joins the cystic duct to form the common bile duct. The cystic duct leads to the gallbladder, a saclike organ beneath the liver. Bile flows from the liver to the gallbladder, where it is stored and concentrated. The duodenum, main pancreatic duct, and ductus arteriosus are not components of the common bile duct.

A patient with chronic pancreatitis is taking pancreatic enzyme tablets. To assess the effectiveness of the tablets, the nurse should: 1. Monitor daily weights 2. Examine the stools for steatorrhea 3. Record intake and output 4. Ask whether pain is relieved

2. Examine the stools for steatorrhea The patient with chronic pancreatitis is likely to need to take pancreatic enzymes to digest food. The enzymes can be taken with meals or snacks. The effect of the enzymes can be determined by examining the stools for steatorrhea: a high fat content caused by inadequate enzymes. Monitoring daily weights, recording intake and output, and checking for pain relief are not assessments related to pancreatic enzyme tablets.

Nursing students are required to have certain immunizations. Vaccination for which of the following is required because health care providers are often in contact with body fluids? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

2. Hepatitis B Health care providers should be vaccinated against hepatitis B because it can be spread through contact with body fluids. Hepatitis A is also called infectious hepatitis and epidemic hepatitis. It is caused by the hepatitis A virus (HAV), which is transmitted from one person to another by way of water, food, or medical equipment that has been contaminated with infected fecal matter. Hepatitis A is the most common type of viral hepatitis. Fortunately, it is rarely fatal and infected persons do not become asymptomatic carriers. Hepatitis C is transmitted by contact with contaminated blood or medical equipment or by contact with infected body fluids. Like hepatitis B, it can be transmitted from an infected mother to her baby during birth; however, that is rare. Whereas some individuals recover completely from acute hepatitis C, a significant proportion of people with hepatitis C develop chronic infections and become carriers. Many of these will develop cirrhosis or cancer of the liver. Hepatitis D is caused by a virus known as the delta agent, which is a defective ribonucleic acid (RNA) virus that can survive only in the company of hepatitis B virus (HBV). Hepatitis D is transmitted percutaneously (through the skin or mucous membranes) with or following HBV infection. The presence of hepatitis D greatly increases the risk that the patient will progress to chronic hepatitis and possible liver failure.

1 ( During the oliguric phase of acute kidney failure, a patient's urine output is greatly reduced. Fluid boluses and diuretics do not work well. This phase usually lasts from 8 to 15 days. Although there are frequent omissions in recording intake and output, this is probably not the cause of the patient's decreased urine output. Retention of sodium and water is the rationale for giving furosemide, not the reason that it is ineffective. Nitrogenous wastes build up as a result of the kidneys' inability to perform their elimination function. Focus: Prioritization, supervision)

20. A UAP reports to you that a patient with acute kidney failure has had a urine output of 350 mL over the past 24 hours after receiving furosemide 40 mg IV push. The UAP asks you how this can happen. What is your best response? 1. "During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics." 2. "There must be some sort of error. Someone must have failed to record the urine output." 3. "A patient with acute kidney failure retains sodium and water, which counteracts the action of the furosemide." 4. "The gradual accumulation of nitrogenous waste products results in the retention of water and sodium.

1, 4, 5 ( HCTZ is a thiazide diuretic. It should not be taken at night because it will cause the client to wake up to urinate. This type of diuretic causes a loss of potassium, so you should teach the client about eating foods rich in potassium. Weight gain and increased edema should not occur while the client is taking this drug, so these should be reported to the prescriber. Focus: Prioritization)

21. The client has an order for hydrochlorothiazide (HCTZ, Microzide) 10 mg orally every day. What should you be sure to include in a teaching plan for this drug? (Select all that apply.) 1. "Take this medication in the morning." 2. "This medication should be taken in 2 divided doses when you get up and when you go to bed." 3. "Eat foods with extra sodium every day." 4. "Inform your prescriber if you notice weight gain or increased swelling." 5. "You should expect your urine output to increase."

A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient?* A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative. B. The patient is now recovered from a previous Hepatitis B infection and is now immune. C. The patient is not a candidate from antiviral or interferon medications. D. The patient is less likely to develop a chronic infection.

A

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change?* A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

A

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

A The acute phase of jaundice may be icetric or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice and is a result of accumulated bile salts beneath skin.

A pt with type 2 diabetes and cirrhosis asks if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge? a. milk thistle may affect liver enzymes and thus alter drug metabolism b. milk thistle is generally safe in recommended doses for up to 10 yrs c. there is unclear scientific evidence for the use of milk thistle in treating cirrhosis d. milk thislte may elevate the serum glucose level and is thus contraindicated in diabetes.

A There is evidence that there is no real benefit from using milk thistle to protect liver enzyme from toxic damage. Milk thistle does affect liver enzyme and could alter drug metabolism. Pt will need to be monitored for drug interactions. It is dafe for up to 6 yrs not 10, and it may lower, not elevate, blood glucose levels.

1 (The NCSBN NCLEX RN test blue print includes referrals under Management of Care. The client is in spiritual distress and the chaplain is the member of the team to address this)

41 The HH nurse admitting a F client Dx with ESRD who refuses to be placed on hemodialysis. The client is ready to die but verbalizes having so many regrets in her life. Which intervention would be the most appropriate for the nurse? 1. Contact the agency chaplain to come talk to the client 2. Call her church pastor and discuss her concerns 3. Ask the client whether or not she would like to pray with the nurse 4 Determine whether or not the client has an advance directive.

4 (Dulcolax is a stimulant laxative, overuse can cause laxative dependency and colon obstruction. The nurse should contact the HCP to arrange for a bulk laxative if the client requires a daily laxative. The other meds require assessment and monitoring of the client but the question shows no contraindications)

47 The nurse is on the day shift at a LTC facility. Which medication should the nurse question administering to the 85 y/o with chronic pyelonephritis and HF? 1. Lanoxin 0.125 mg PO qd 2. Lasix 40 mg PO qd 3. K Dur 20 mEq PO bid 4. Dulcolax 5mg PO qd

3,4,5

49 Which interventions should the nurse delegate to the UAP when caring for the client 2 days post op open surgery of the kidney? SATA 1. Explain the procedure for using the PCA pump 2. Check the clients flank surgical dressing for drainage 3. Take and record the VS and pulse ox reading 4. Empty the clients indwelling cath bag at the end of shift 5. Assist the client to ambulate in the hall 3-4 times per shift

5. A client with pyelonephritis is being discharged from the hospital, and the nurse provides instructions to the client to prevent recurrence. The nurse determines that the cleint understands the information that was given if hte client states an intention to: a) increase fluids for 2 days if signs and symptoms of a urinary tract infection develop b) take the prescribed antibiotics until all symptoms subside c) return to the physician's office for scheduled follow-up urine cultures d) decrease fluid intake if frequent urination occurs

5) C - The client with pyelonephritis should take the full course of antibiotic therapy that has been prescribed and return to the physician's office for follow-up urine cultures if so instructed. The client should learn the signs and symptoms of a urinary tract infection, and report them immediately if they occur. The client should also drink 3 L of fluid per day.

4 (HARD RIGID ABDOMEN IS ALWAYS THE FIRST)

52. The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1. The client with a hbg of 9.0 and hct of 26% 2 The client who does not have a palpable thrill or auscultated bruit 3. The client reporting a 3.6 kg weight gain and refusing dialysis 4. The client on peritoneal dialysis who is complaining of hard rigid abdomen

3 (elevated BP after admin )

53. The male client with chronic kidney disease has received the initial dose of erythropoietin, a biological response modifier, 1 week ago. Which data warrants the nurse to notify the HCP? 1. The clients pulse ox 95% 2. The client has a plt count of 155000 3. The client has a BP of 184/102 4. The client has a tympanic temp of 99.8

1 ( The client's potassium level is high (normal range is 3.5 to 5 mEq/L). Kayexalate removes potassium from the body through the gastrointestinal system. Spironolactone is a potassium-sparing diuretic that may cause the client's potassium level to go even higher. The beginning nursing student does not have the skill to assess ECG strips. Focus: Delegation, supervision)

6. A client's potassium level is 6.7 mEq/L. Which intervention should you delegate to the first-year student nurse whom you are supervising? 1. Administer sodium polystyrene sulfonate (Kayexalate) 15 g orally. 2. Administer spironolactone (Aldactone) 25 mg orally. 3. Assess the electrocardiogram (ECG) strip for tall T waves. 4. Administer potassium 10 mEq orally.

1 (The most experienced RN should be assigned to the client requiring discharge teaching. Post op complications can occur)

7. The charge nurse is making assignments in the day surgery center Which client should be assigned to the most experienced nurse? 1. The 24 yo client who had a circumcision and is being prepped for discharge 2. The client scheduled for a cystectomy who is crying about the surgery 3. The client Dx with kidney cancer who is receiving two units of blood 4. The client who has ESRD and had an arteriovenous fistula created

A patient diagnosed with hepatitis and cirrhosis has developed ascites. When assessing the patient, the healthcare provider notes an increased temperature and a decreased level of consciousness. What assessment should the healthcare provider perform next? A. Palpate the abdomen for tenderness B Obtain a urine sample for laboratory analysis C Auscultate the patient's lung sounds D Measure the patient's abdominal girth

A Think about the pathophysiology of ascites and some of the potential complications of the disorder. Ascites can alter the intestinal mucosal barrier, causing increased intestinal permeability. The increased intestinal permeability can cause bacteria to cross the intestinal lumen and cause bacterial peritonitis. Clinical manifestations of bacterial peritonitis include fever, altered mental status, and abdominal pain and tenderness.

The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful? a. Scrambled eggs, English muffin, and apple juice b. Cheese sandwich, tomato soup, and cranberry juice c. Split-pea soup, whole-wheat toast, and nonfat milk d. Oatmeal with cream, half a banana, and herbal tea

A Rationale: Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.

The nurse instructs a client with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the menu? a. Cream of wheat, blueberries, coffee b. Sausage and eggs, banana, orange juice. c. Bacon, cantaloupe melon, tomato juice. d. Cured pork, grits, strawberries, orange juice.

A The diet for a client with renal failure who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids. Options 2, 3, and 4 are high in sodium, phosphorus and potassium.

A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? a. Palpation of a thrill over the fistula. b. Presence of a radial pulse in the left wrist. c. Absence of a bruit on auscultation of the fistula. d. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand.

A The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill shorter than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A Auscultate for pericardial friction rub. B Assess for crackles. Incorrect C Monitor for decreased peripheral pulses. D Determine if the client is able to ambulate.

A Auscultate for pericardial friction rub. The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? A Avoiding venipuncture and blood pressure measurements in the affected arm B Modifications to allow for complete rest of the affected arm C How to assess for a bruit in the affected arm D How to practice proper nutrition

A Avoiding venipuncture and blood pressure measurements in the affected arm Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? A Client with chronic kidney failure who was just admitted with shortness of breath B Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted C Client with azotemia whose blood urea nitrogen and creatinine are increasing D Client receiving peritoneal dialysis who needs help changing the dialysate bag

A Client with chronic kidney failure who was just admitted with shortness of breath The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? A Construction worker B Office secretary C Schoolteacher D Taxicab driver

A Construction worker Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? A Eggs B Ham C Eggplant D Macaroni

A Eggs Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) A Football player in preseason practice Correct B Client who underwent contrast dye radiology Correct C Accident victim recovering from a severe hemorrhage Correct D Accountant with diabetes E Client in the intensive care unit on high doses of antibiotics Correct F Client recovering from gastrointestinal influenza

A Football player in preseason practice B Client who underwent contrast dye radiology C Accident victim recovering from a severe hemorrhage E Client in the intensive care unit on high doses of antibiotics F Client recovering from gastrointestinal influenza To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.

The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? A Nonsteroidal anti-inflammatory drugs (NSAIDs) B Angiotensin-converting enzyme (ACE) inhibitors C Opiates D Calcium channel blockers

A Nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

c (rationale: Initial emergency treatment of children with fluid depletion associated with AKI focuses on rapid fluid replacement with 20 mL/kg of 0.9% saline or lactated Ringer's solution given over 5 to 10 minutes and repeated as needed. This ensures renal perfusion and stabilizes blood pressure. Potassium and phosphorous would not be administered because the electrolytes would be expected to be elevated. A diuretic would not be administered because dehydration would be present due to fluid depletion. AKI in children and adolescents characteristically begins with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. Symptoms may include any combination of the following: Nausea Vomiting Lethargy Edema Gross hematuria (blood in the urine) Oliguria Hypertension Manifestations result from electrolyte imbalances, uremia (excessive amounts of urea in the blood), and fluid overload. The child appears pale and lethargic. The family should be made aware of the following: If oliguria persists after restoration of adequate fluid volume, intrinsic renal damage is suspected. Parents should monitor for signs of fluid depletion, such as paleness and lethargy. Parents should keep a log of intake and output and report any extremes to the healthcare provider.)

A child is admitted to the hospital with nausea, vomiting, lethargy, and oliguria, and the healthcare provider suspects fluid depletion associated with acute kidney injury (AKI). Which prescribed order should the nurse consider appropriate for this patient? a. Low doses of a diuretic b. Phosphorous supplement c. Isotonic saline solution d. Potassium supplement

b, c, d, e (​Rationale: The nurse should anticipate that calcium​ chloride, sodium​ bicarbonate, insulin, and glucose would be prescribed to treat the​ client's hyperkalemia. Calcium​ chloride, sodium​ bicarbonate, and insulin can be used to reduce serum potassium levels by moving potassium into the cells. Calcium is also administered to correct hypocalcemia and reduce hyperphosphatemia.​ (Calcium and phosphate have a reciprocal relationship in the​ body; as the level of one​ rises, the level of the other​ falls.) An ACE inhibitor is used to treat​ hypertension, not hyperkalemia.)

A client diagnosed with acute kidney injury​ (AKI) is experiencing hyperkalemia. Which medication should the nurse anticipate being prescribed to this​ client? (Select all that​ apply.) A. ​Angiotensin-converting enzyme​ (ACE) inhibitors B. Glucose C. Insulin D. Sodium bicarbonate E. Calcium chloride

c (​Rationale: Glucose and insulin are administered to the client with hyperkalemia to help drive potassium back into the intracellular​ fluid, reducing the amount of potassium in the blood. Potassium supplements would only increase the​ client's potassium levels. Insulin is used to control the blood glucose rate in a diabetic client. Insulin is not known to draw fluid from the cells or act as an anticoagulant.)

A client experiencing hyperkalemia is scheduled for dialysis. The nurse anticipates an order for insulin to help lower the serum potassium level. Which beneficial action does this medication have for this​ client? A. Pulls fluid from the cells B. Lowers the blood glucose rate C. Drives the potassium back into the cells D. Acts as an anticoagulant

Prodromal The prodromal phase occurs between exposure to the virus and onset of​ jaundice, and tends to occur about 2 weeks after exposure. Clinical manifestations include​ nausea, vomiting,​ fatigue, joint​ pain, and loss of appetite. During the icteric​ phase, the client will develop darkening urine and​ clay-colored stools, and may become jaundiced. During the​ convalescent, or​ recovery, phase, the client starts to feel better as symptoms start to ease.

A client exposed to hepatitis presents to a community clinic with complaints of​ nausea, vomiting,​ fatigue, joint​ pain, and loss of appetite. The nurse suspects that the client is in which stage of hepatitis​ infection? Icteric Recovery Convalescent Prodromal

Hepatitis C Illicit drug​ use, tattooing,​ piercing, and blood products received before 1987 are risk factors for hepatitis C. Risk factors for hepatitis D include​ male-to-male sexual​ contact, and illicit drug use and sharing of needles. Risk factors for hepatitis E include drinking contaminated water or eating undercooked​ food, and traveling to areas with high rates of infection. Risk factors for hepatitis B include​ male-to-male sexual contact and living with an affected individual.

A client has a history that includes illicit drug​ use, tattooing,​ piercing, and receiving blood products before 1987. For which type of hepatitis is the client at​ risk? Hepatitis C Hepatitis E Hepatitis D Hepatitis B

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply* A. Excessive coughing B. Sleeping on the back C. Drinking juice D. Alcohol consumption E. Straining during a bowel movement F. Vomiting

A, D, E, and F

a (​Rationale: For​ longer-term vascular​ access, an arteriovenous​ (AV) fistula​ (an artificial connection between a vein and an​ artery) is created. In preparation for fistula​ formation, the nondominant arm is not used for venipuncture or blood pressure measurement during renal failure. The fistula is created by surgical anastomosis of an artery and​ vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used.)

A client is being discharged following the placement of an AV fistula. The nurse is providing discharge instructions to the client regarding the fistula. Which should the nurse share during this​ session? A. ​"The fistula will not be functional for dialysis for a​ month." B. "The fistula will heal within a​ week." C. "This is temporary access for​ dialysis." D. "This fistula is created by joining two arteries​ together."

1,2,3,4 (A client older than 70 is at increased risk for complications from surgery, lifelong immunosuppression and organ rejection., A client who is morbidly obese is at increased risk for the same things. A client who requires NPH for type I Diabetes is at risk for the same things, And a client with a Hx of cancer such as lymphoma is at increased risk for the same reasons. WRONG: 5; BP is wnl. )

A client scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the clients risk of surgery? SATA 1. Age older than 70 2. BMI of 41 3. Administering NPH insulin each morning 4. Past Hx of lymphoma 5. BP avg 120/70

3 (The nurse should assess the LOC A change in urea levels can cause ICP. Subsequently the clients LOC decreases. WRONG #1: An altered LOC is a manifestation of disequilibrium syndrome. The nurse SHOULD NOT admin a opioid med. The provider may prescribe a med to decrease seizure activity. #2 The nurse should monitor for HYPOtension due to rapid change in F&E causing disequilibrium syndrome. #4 The nurse should DECREASE the dialysis exchange rate to slow the rapid changes in F&E status when a client develops disequilibrium syndrome)

A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? 1 admin an opioid med 2. Monitor for HTN 3 Assess LOC 4. Increase the dialysis exchange rate

1,2,3,5 (1; Anuria is a manifestation of ESRD, 2; marked azotemia is elevated BUN and serum creatinine, is a manifestation of ESRD 3; Crackles in lungs can indicate the client has pulmonary edema, caused from hypervolemia due to ESRD. 5; Proteinuria is a manifestation of ESRD WRONG: #4 Ca levels are decreased due to increased serum phosphate levels when the client has ESRD)

A nurse is caring for a client who has end stage kidney disease. Which of the following findings should the nurse expect? SATA 1. Anuria 2. Marked azotemia 3. Crackles in the lungs 4. Increase Ca levels 5. Proteinuria

​Anti-HAV IgM Anti-HAV IgM is the antibody that is found in the serum during an acute illness and would be most appropriate for the provider to order.​ AST/ALT and bilirubin are used to determine the extent of liver damage.​ Anti-HAV IgG is found in the blood during recovery and indicates immunity to the virus. Presence of this antibody does not indicate active infection.

A nurse is caring for a client who presented to the emergency department after exposure to hepatitis A at a local restaurant last week. Which serum testing should the nurse anticipate that the healthcare provider will​ order? ​Anti-HAV IgM ​AST/ALT ​Anti-HAV IgG Bilirubin

1,2,3,5 (Check allergies, #2 Metformin increases risk for lactic acidosis from the contrast dye with iodine given during the procedure. #3 Yes they get an enema to remove fecal contents, fluid and gas from the colon for a more clear visual. #5 clients who have asthma are at higher risk of exacerbation as an allergic response to the contrast dye used in the procedure. WRONG #4 A serum coagulation panel is essential for a client PRIOR to a kidney biopsy because of risk of hemorrhage from the procedure)

A nurse is caring for a client with DM type II and who will have excretory urography. Prior to the procedure which of the following actions should the nurse take? SATA 1. ID allergy to seafood 2. Withhold metformin for 24 hrs 3. admin an enema 4. Obtain a serum coagulation panel 5. Assess for asthma

b (rationale: A renal biopsy is the procedure used to extract kidney tissue for laboratory analysis. This can be used to check why the patient has blood in the urine. It demonstrates correct understanding of the process Laboratory testing for acute kidney injury (AKI) includes: Urinalysis. Serum creatinine. Blood urea nitrogen (BUN). Serum electrolytes. Arterial blood gases. Complete blood count (CBC).)

A nurse is providing teaching to a patient scheduled for a renal biopsy. Which statement demonstrates that the teaching has been effective? a. "They are taking some tissue from my kidneys to see if it is causing my blood pressure to increase." b. "They are taking a piece of tissue from my kidney to see why I have blood in my urine." c. "They are going to operate on my kidneys." d. "They are going to check the medication level in my system."

a, d, e (rationale: During​ pregnancy, glomerular filtration rate increases​ significantly, perhaps by as much as​ 50%. This leads to a decrease in baseline serum creatinine and other changes associated with the increased blood volume that pregnancy brings. AKI in pregnant women is often related to the same etiologies as are identified in the general population.​ However, there are unique etiologies that manifest themselves throughout the pregnancy cycle. Over​ 90% of women develop a physiologic hydronephrosis of​ pregnancy, and this can promote urinary​ stasis, lead to urinary tract​ infection, and ultimately lead to AKI. In​ addition, in the first​ trimester, hyperemesis gravidarum and placenta previa may lead to​ AKI, and as pregnancy​ progresses, pregnancy-induced​ hypertension, preeclampsia, and eclampsia stress the​ kidneys, leading to​ proteinuria, hydronephrosis, and AKI.)

A nurse is caring for a pregnant woman. Which physiologic condition may occur during pregnancy and is related to the development of acute kidney injury​ (AKI) that should concern the​ nurse? (Select all that​ apply.) A. Preeclampsia B. Hypoglycemia C. Hypertension D. Hyperemesis gravidarum E. Hydronephrosis

The last 24 hours Hepatitis B prophylaxis must be administered within 24 hours of exposure to the virus. It is administered intramuscularly into a large​ muscle, and the client should also begin the hepatitis B vaccine series concurrently.

A nurse is caring for a young woman who was exposed to hepatitis B by a previous sexual partner. Before administration of​ prophylaxis, the nurse should verify that exposure occurred within which time​ frame? The last 2 months The last month The last 24 hours The last 2 weeks

1,2,3,5 (Watch for JVD which = FVE. Provide freq mouth rinses because of uremic halitosis caused by uremic waste in the blood. Auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalances and fluid retention. The nurse SHOULD monitor for dysrhythmias related to increased serum K caused by Stage 4 chronic kidney disease.)

A nurse is planning care for a client who has Stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? SATA 1, Assess for JVD 2. Provide freq mouth rinses 3. Auscultate for a pleural friction rub 4, Provide a high sodium diet 5. Monitor for dysrhythmias

3 (The nurse should plan to administer a fluid challenge for hypovolemia, which is indicated by the clients low urinary output and BP WRONG 1: contrast dye is contraindicated for a client with possible acute kidney injury. 2: Nitro is a rapid acting vasodilator used to rapidly reduce BP for client in a hypertensive crisis, no hypotension. 4; the client should be put in REVERSE trendelenburg with the head down and feet up to tx hypotension)

A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hrs. and BP is 92/58. The nurse should anticipate which of the following interventions? 1 prepare the client for a CT scan with contrast dye 2. Plan to admin nitroprusside 3. Prepare to admin a fluid challenge 4. Plan to position the client in Trendelenburg

1,2,4,5 (1: monitor glucose because the dialysate contains glucose. 2: cloudy dialysate indicates an infection. Clear light yellow solution is typical during the outflow process. 4; The nurse should assess for SOB which could indicate an inability to tolerate a large volume of dialysate. 5; The nurse should check the access site dressing fro wetness and look for kinking, pulling, clamping, or twisting of the tubing which can increase the risk for exit site infections. WRONG #3. The nurse should NOT warm the dialysate in a microwave because of uneven heating of the solution. # 6 The nurse should maintain SURGICAL not medical asepsis when accessing the catheter insertion site to prevent infection from contamination)

A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? 1. Monitor serum glucose levels 2. Report cloudy dialysate return 3. Warm the dialysate in the microwave oven 4. Assess for SOB 5. Check the access site dressing for wetness 6. Maintain medical asepsis when accessing the catheter insertion site

1,2,3,5 (Daily weights are obtained to tell fluid status. 2 drainage on the dressing is assessed to monitor for hemorrhage and hematoma. 3 Hourly urine output replaced with IV fluid is monitored to detect abrupt decrease in urine output, which can indicate rejection or other serious conditions of the transplant kidney. 5 serum electrolytes is monitored because electrolytes loss can occur with post op diuresis. WRONG: 4: oliguria could indicate ischemia, acute kidney injury, rejection or hypovolemia. REport oliguria immediately to the provider)

A nurse is planning postoperative care for a client following a kidney transplant surgery Which of the following actions should the nurse include in the plan of care (SATA) 1. Obtain daily weights 2. Assess dressings for bloody drainage 3 .REplace hourly urine output with IV fluids 4. Expect oliguria in the first 4 hrs 5. monitor serum electrolytes

1,2,3,4 (1: The nurse should check the BUN and serum creatinine levels to determine the presence and degree of uremia or waste products that remain following dialysis. 2: The nurse should withhold meds the treatment can partially dialyze. After the Tx the nurse should admin the meds. 3: The client who is post dialysis is at risk for hypovolemia due to a rapid decrease in fluid volume. 4: The nurse should assess the site for bleeding because the client receives heparin during the procedure to prevent clotting of the blood. WRONG: #5 the nurse should NEVER measure the BP on the extremity that has the AV fistula because it can cause collapse of the AV fistula or graft)

A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? SATA 1. Check BUN and serum creatinine levels 2. Admin meds the nurse held prior to dialysis 3. Observe for signs hypovolemia 4. Assess the access site for bleeding 5. Evaluate BP on the arm with AV access

1,3,4 ( Immediate removal of the donor kidney IS a Tx for hyperacute rejection. Fever IS a manifestation of acute rejection. Fluid retention IS a manifestation of acute rejection. WRONG: 2: Dialysis can be required as a conservative Tx to monitor the clients kidney function for the progression of chronic kidney failure following kidney transplant. 5 Immunosuppressants are INCREASED to treat an ACUTE rejection)

A nurse is preop teaching a client who is scheduled for a kidney transplant about rejection of a transplanted kidney. Which of the following statements should the nurse include in the teaching? SATA 1. expect an immediate removal of the donor kidney for a hyperacute rejection 2. You may need to begin dialysis to monitor your kidney function for a hyperacute reaction 3. A fever is a manifestation of an acute rejection 4. Fluid retention is a manifestation of acute rejection 5. Your provider will increase your immunosuppressive medications for a chronic rejection

3 (The nurse should obtain a clean catch urine specimen for culture and sensitivity. The test will id which antibiotic will be most effective for treating the clients UTI )

A nurse is reviewing the results of a clients urinalysis. The findings indicate the urine is positive for leukocyte esterase and nitrites. Which of the following actions should the nurse take? 1. repeat the test early the next morning 2. Start a 24 hr urine collection for creatinine clearance 3. OBtain a clean catch urine specimen for culture and sensitivity 4. Insert an indwelling cath to collect a urine specimen

4 (Hemodialysis restores electrolyte balance by removing excess Na, K, fluids and waste products and also restores acid base balance. WRONG: #1 it does not restore kidney function, but is does sustain the life of a client with kidney disease. #2 It does not replace hormonal function of the renal system due to tissue damage causing dysfunction of the renin angiotensin aldosterone system. #3 It does not allow an unrestricted diet. It requires a diet high in folate, and more protein than predialysis restrictions allowed and low in Na, K and Ph.)

A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching? 1. Hemodialysis restores kidney function 2. Hemodialysis replaces hormonal function of the renal system 3. Hemodialysis allows an unrestricted diet 4. Hemodialysis returns a balance to serum electrolytes

4 (the nurse should explain to the client that a KUB can id renal calculi, strictures, calcium deposits, and obstruction of the urinary system. WRONG 1: clients do not receive dye for this procedure as they would for excretory urography. 2: no enema 3: will lie supine not prone)

A nurse is teaching a client who will have a x ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include in the teaching? 1. You will receive contrast dye during the procedure 2. An enema is necessary before the procedure 3. You will need to lie in a prone position during the procedure 4. The procedure determines whether you have a kidney stone

1,2,4,5 (1: By reviewing the meds the client currently takes the nurse can determine which meds to withhold until after dialysis. 2: Assessing the AV fistula for a bruit determines the patency of the fistula for dialysis. 4: Measuring the clients weight before dialysis is essential for comparing it with the clients weight after dialysis. 5: checking the serum electrolytes helps determine the need for dialysis. WRONG: 3: The clients hourly output can vary with the remaining kidney function and does not determine the need for dialysis. 6: The nurse should never use the access site for venipuncture because compression from a tourniquet can cause loss of the vascular access.)

A nurse preparing to initiate hemodialysis for a client who has acute kidney injury. Which of the following actions should the nurse take? SATA 1. review the medications the client currently takes 2. Assess the AV fistula for a bruit 3. Calculate the clients hourly urine output 4. Measure the clients weight 5. check the serum electrolytes 6. Use the access site area for venipuncture

2 (The GFR is severely decreased to approx 20 mL/min which is indicative of stage 4 chronic kidney disease WRONG 1 ; With stage 4 the BUN would be about 10-20 times the BUN finding. 3; In stage 4 chronic kidney disease the creatinine level can be as high as 15-30. 4; in stage 4 chronic kidney disease the K level would be higher than 5.0)

A nurse reviewing client lab data. The nurse should recognize that which of the following findings is expected for a client who has Stage 4 chronic kidney disease? 1. BUN 15 2. GFR 20 3. Serum creatinine 1.1 4. Serum K 5.0

3 (The client should report any manifestation of an infection because this med causes immunosuppression. WRONG: ! The client should NOT decrease protein rich foods in the diet, they promote healing and rebuild muscle. There are no restrictions post transplant on protein for a pt taking cyclosporine. 2: The client should NOT drink grapefruit juice which can reduce cyclosporine metabolism and cause increased cyclosporine levels. 4; The client should REPORT manifestations of hepatoxicity such as jaundice or abd pain)

A nurse teaching a client who is post op following a kidney transplant and is taking cyclosporine, Which of the following instructions should the nurse include? 1. Decrease your protein rich food intake 2. Take this med with grapefruit juice 3. Monitor for and report a sore throat to your provider 4. Expect your skin to turn yellow

d (rationale: When a patient is prescribed a loop diuretic such as furosemide (Lasix), the nurse should assess weight and vital signs for baseline data. The loop diuretics, named for their primary site of action in the loop of Henle, are high-ceiling diuretics (the response increases with increasing doses). These are highly effective diuretics used in early AKI to reestablish urine flow and convert oliguric renal failure to nonoliguric renal failure. Assessing breath sounds would be appropriate for a patient who presents with a heart or respiratory issue. Assessing the response of pupils to light would be done to identify neurologic conditions. The nurse would assess for bruising as an indication of bleeding beneath the skin. Medications commonly used for AKI include: Loop diuretics. Osmotic diuretics. Electrolytes. Electrolyte modifiers.)

A patient admitted for complications from acute kidney injury (AKI) has been prescribed furosemide (Lasix) 80 mg twice daily. Which is most important for the nurse to assess accurately in this patient? a. Bruising b. Response of pupils to light c. Breath sounds d. Initial weight

a (rationale: Obstructive causes of AKI are classified as postrenal. Any condition that prevents urine excretion can lead to postrenal AKI. Benign prostatic hypertrophy is the most common precipitating factor, but this occurs primarily in older men. Other causes include renal or urinary tract calculi and tumors. Ischemia is the deficiency of blood in one or both kidneys. Renal injury is serious but not of the obstructive nature because it generally includes a bruised, torn, or vascular injury. Renal surgery would not be the cause of an obstruction, which is a classic sign of postrenal injury.)

A patient is admitted to the medical unit with the diagnosis of postrenal acute kidney injury (AKI). Which should the nurse suspect as a possible cause? a. Urinary tract calculi b. Surgery c. Ischemia d. Trauma

Which symptom suggests that a client is entering the maintenance phase of acute kidney injury (AKI)? A) Onset of metabolic acidosis B) Onset of diuresis C) Increase in glomerular filtration rate D) Decrease in serum potassium levels

A) Onset of metabolic acidosis Rationale: The maintenance phase of AKI is characterized by a significant fall in glomerular filtration rate (GFR) and tubular necrosis. Oliguria, azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis may all develop. Also during this phase, impaired potassium excretion leads to hyperkalemia, or increased serum potassium levels. Onset of diuresis and an increasing glomerular filtration rate are suggestive of the recovery phase, not the maintenance phase.

c (rationale: A diagnostic test used to assess kidney function is serum creatinine level. In AKI, serum creatinine levels increase rapidly, within 24-48 hours of onset. Hemoglobin and hematocrit are used to assess hemoconcentration in the blood. Serum osmolality is the number of particles dissolved per unit of water in the serum. Serum osmolarity is the measure of the concentration of particles in the serum.)

A patient is diagnosed with acute kidney injury (AKI). The patient asks how the function of the kidneys can be assessed. Which statement by the nurse provides an appropriate answer? a. "Serum osmolality concentrations can provide that information to your healthcare provider." b. "We monitor the hemoglobin level in the blood." c. "A serum creatinine blood level will be obtained." d. "The healthcare provider assesses serial hematocrit values."

d (rationale: Postrenal AKI is caused by ureteral or urethral obstruction. However, BPH causes enlargement of the prostate, which can cause urethral obstruction. There is no evidence of ureteral obstruction because an enlarged prostate does not affect this structure. Loss of a kidney is not connected to prostatic enlargement. Glomuleronephritis is characterized by an inflammation of glomeruli or the small vessels of the kidneys and has no connection to prostate issues. **Postrenal AKI complications include: Ureteral obstruction - Calculi -Cancer -External compression **Urethral obstruction **Prostatic enlargement -Calculi -Cancer -Stricture -Blood clot.)

A patient is diagnosed with postrenal acute kidney injury (AKI) and benign prostatic hyperplasia (BPH). Which condition should the nurse suspect caused the AKI? a. Loss of a kidney b. Glomerulonephritis c. Ureteral obstruction d. Urethral obstruction

c (rationale: A patient in the maintenance phase of AKI with oliguria will experience azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis more severely than a patient with nonoliguric AKI, thereby leading to a poorer prognosis. Muscle weakness, anemia, and dehydration typically are not more severe when experiencing oliguria.)

A patient is in the maintenance phase of acute kidney injury (AKI) and is experiencing oliguria. Which manifestation should the nurse anticipate will increase in severity when compared to a patient with nonoliguric AKI? a. Muscle weakness b. Anemia c. Azotemia d. Dehydration

"Drink and use only bottled water, do not eat raw fruits and vegetables, and wash your hands before eating anything." Hepatitis A is transmitted by the fecal-oral route through contaminated food, water, shellfish, and direct contact. Using and consuming only bottled water and not eating any raw food reduces the possibility of contracting the disease. Hand washing before eating is very important. Although the onset is abrupt, the virus is in the body of the infected person for about 2 weeks before symptoms appear. Another form of hepatitis is not a precursor to hepatitis A.

A patient planning travel to South American to volunteer at a health clinic asks the nurse, "I heard hepatitis A is common there. How can I avoid it? " Which is the nurse's best response to the patient? "Hepatitis A is contagious only if you are infected with hepatitis B, and you have been immunized for hepatitis B." "Wash your hands after contact with a patient and before eating." "Drink and use only bottled water, do not eat raw fruits and vegetables, and wash your hands before eating anything." "Be sure to wash your hands whenever you come in contact with a patient."

Icteric The icteric phase of hepatitis occurs with the onset of clinical manifestations such as jaundice. It begins around 5-10 days after exposure to the virus and can be insidious or rapid. Early symptoms often mimic those of the flu. The prodromal phase begins between exposure to the virus and the appearance of clinical manifestations, such as jaundice. The recovery or convalescent phase begins around 2-3 weeks after the acute illness begins, as patients begin to feel better.

A patient presents to the emergency department with a new onset of jaundice that has developed over the last few days. The nurse understands that this means that the patient is in which phase of hepatitis? Prodromal Active Icteric Recovery

c (rationale: Peritoneal dialysis uses the peritoneal membrane as the dialyzing surface. Metabolic wastes and excess electrolytes diffuse into the dialysate in the abdomen, and an osmotic gradient pulls excess fluid from the blood. Hemodialysis is the process in which the blood volume is filtered through an external filter to remove toxins and excess fluid from the blood. The dialysate fluid does not diffuse into the bloodstream, but remains in the peritoneal space. Fluid is not exchanged in peritoneal dialysis. The same fluid that infuses into the abdomen is what is drained several hours later. Peritoneal dialysis is contraindicated in the following situations: Recent abdominal surgery Significant lung disease Peritonitis)

A patient receiving peritoneal dialysis asks the nurse how it works. Which response by the nurse is accurate? a. "Your blood is filtered through an external filter that will pull excess fluid and toxins out of your blood." b. "Your body exchanges the fluid in the bloodstream with the clean fluid in the abdomen, and then the fluid with the toxins drains out." c. "The fluid that infuses into your abdomen will pull fluid and toxins from the bloodstream, and then the waste products will drain from your abdomen." d. "The fluid that infuses into your abdomen diffuses into the blood and dilutes the toxins."

Interferon alfa Interferon alfa is used to reduce the risk of chronic hepatitis in patients with acute hepatitis C. Lamivudine, adefovir, and entecavir are used to treat severe acute hepatitis B.

A patient with hepatitis C is admitted to a medical-surgical unit. Which medication should the nurse anticipate will be ordered for this patient to reduce the risk of chronic hepatitis? Adefovir Entecavir Lamivudine Interferon alfa

*Possible exam question* The nurse is caring for a client experiencing severe ascites. Which collaborative intervention should the nurse expect? A) Paracentesis B) Gastric lavage C) Transjugular intrahepatic portosystemic shunt (TIPS) D) Insertion of Sengstaken-Blakemore tube

A) Paracentesis Rationale: For severe​ ascites, the treatment of choice is​ paracentesis, which is removal of fluid from the peritoneal cavity. The goal of this treatment is to reduce respiratory distress. A​ Sengstaken-Blakemore tube is used to treat bleeding esophageal varices. Gastric​ lavage, irrigation of the stomach with large quantities of normal​ saline, is performed to improve visualization of the stomach. The TIPS procedure is performed to relieve portal hypertension.

c (rationale: Over 90% of women develop a physiological hydronephrosis of pregnancy, which can promote urinary stasis, leading to urinary tract infection and ultimately acute kidney injury (AKI). Hyperkalemia is an electrolyte imbalance that causes a high level of potassium in the blood. Hyperphosphatemia is another electrolyte imbalance that causes an abnormally high level of phosphate in the blood. Acute tubular necrosis is the death of the tubular cells and is usually caused by low blood pressure or nephrotoxic drugs. The patient should be alerted to the following signs of an UTI and should be encouraged to report them immediately to their healthcare provider: Burning upon urination Frequency Pain in the back or abdomen Cloudy, dark, or foul-smelling urine Fever or chills)

A pregnant patient is in the first trimester of pregnancy and has been having a lot of burning and discomfort upon urination and is diagnosed with a urinary tract infection. Which condition should the nurse suspect as a possible cause for this infection? a. Hyperphosphatemia b. Acute tubular necrosis c. Physiological hydronephrosis d. Hyperkalemia

A client diagnosed with acute kidney injury (AKI) will be discharged to home in the next few days. When conducting dietary instruction, the nurse should teach the client to choose proteins that are high in biological value. Which client statement indicates that this teaching has been effective? A) "I will be sure to include eggs in my diet." B) "I should include vegetables at every meal." C) "Legumes should be included in my diet, because they are complete proteins." D) "I will eat nuts daily because they are high in protein."

A) "I will be sure to include eggs in my diet." Rationale: Eggs are an excellent source of essential amino acids and are recommended as part of the diet for a client with acute kidney injury (AKI) who is on a protein-restricted diet. Legumes, nuts, and vegetables do contain protein, but they are incomplete proteins and thus not as good a protein source as eggs.

The nurse is preparing to discharge a client diagnosed with chronic kidney disease (CKD). The nurse is teaching the client and family about administering calcium acetate tablets by mouth with each meal at home. Which explanation about this medication is most appropriate for the nurse to include? A) "The calcium acetate will lower your serum phosphate levels." B) "The calcium acetate helps neutralize your gastric acids." C) "The calcium acetate will help stimulate your appetite." D) "The calcium acetate will decrease your serum creatinine levels."

A) "The calcium acetate will lower your serum phosphate levels." Rationale: The client with CKD has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with CKD. This medication has no effect on appetite stimulation.

A client is being discharged following the placement of an AV fistula. The nurse is providing discharge instructions to the client regarding the fistula. Which should the nurse share during this session? A) "The fistula will not be functional for dialysis for a month." B) "The fistula will heal within a week." C) "This fistula is created by joining two arteries together." D) "This is temporary access for dialysis."

A) "The fistula will not be functional for dialysis for a month." Rationale: For​ longer-term vascular​ access, an arteriovenous​ (AV) fistula​ (an artificial connection between a vein and an​ artery) is created. In preparation for fistula​ formation, the nondominant arm is not used for venipuncture or blood pressure measurement during renal failure. The fistula is created by surgical anastomosis of an artery and​ vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used.

A client with liver failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a) Albumin b) Chloride c) Urobilinogen d) Creatinine

A) Albumin Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

A 52-year-old man with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which action should the nurse take? 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 ketones

A) Assess skin turgor to determine hydration status

The nurse is discussing medications with a client with AKI upon discharge. Which should be included in the teaching? A) Avoid taking NSAIDs B) Avoid taking iron supplementation C) Avoid taking Acetaminophen (Tylenol) D) Avoid taking blood pressure meds at night

A) Avoid taking NSAIDs Rationale: All drugs that either are directly nephrotoxic or may interfere with renal perfusion​ (e.g., potent​ vasoconstrictors) should be avoided.​ NSAIDs, nephrotoxic​ antibiotics, and other potentially harmful drugs are avoided throughout the course of AKI. Iron supplementation can be continued if the client is not receiving the required amount in the foods they consume. Acetaminophen can be taken for​ discomfort, as it does not contain the same chemical​ make-up as the NSAIDS. The client should take their blood pressure medication as ordered by the healthcare provider.

The nurse is caring for a critically-ill client who experienced significant blood loss during surgery. Which concern related to the client's risk for pre-renal AKI should the nurse consider the priority? A) Diminished cardiac output B) Urinary obstruction C) Hyperperfusion D) Fluid overload

A) Diminished cardiac output Rationale: Prerenal AKI results from conditions that affect renal blood flow and perfusion. Any disorder that significantly decreases vascular​ volume, cardiac​ output, or systemic vascular resistance can affect renal blood flow. Prerenal AKI is​ common, particularly in clients who experience trauma or surgery or are critically ill. The kidneys normally receive 20-​25% of the cardiac output to maintain the glomerular filtration rate​ (GFR), the rate at which fluid is filtered through the kidneys. A drop in renal blood flow to less than​ 20% of normal causes the GFR to fall.​ Hypoperfusion, not​ hyperperfusion, would be a concern. Obstruction is a concern with postrenal​ AKI, not prerenal. Dehydration due to fluid loss would be the​ concern, not fluid overload

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would expect to not which finding? A) Elevated creatinine level B) Decreased hemoglobin level C) Decreased red blood cell count D) Increased number of white blood cells in the urine

A) Elevated creatinine level

The nurse is caring for a client diagnosed with portal hypertension. For which complication should the nurse monitor? A) Esophageal varices B) Hepatitis C C) Hepatic encephalopathy D) Fatty liver

A) Esophageal varices Rationale: In portal​ hypertension, the venous drainage of the gastrointestinal tract becomes​ congested, leading to esophageal varices. Hepatitis C is caused by a viral infection. Hepatic​ (portal systemic) encephalopathy is due to the accumulation of toxic substances in the​ bloodstream, related to liver failure.​ Steatohepatitis, also known as fatty​ liver, is a condition in which fat cells build up in the​ liver, leading to liver enlargement and cirrhosis

A nurse is caring for a client who was recently admitted for treatment of cirrhosis. The client is currently experiencing ascites, +3 pitting edema, and oliguria. Which nursing diagnosis should the nurse select as a priority for this client? A) Excess Fluid Volume B) Ineffective Peripheral Tissue Perfusion C) Deficient Fluid Volume D) Impaired Skin Integrity

A) Excess Fluid Volume Rationale: The client experiencing ascites, edema, and oliguria should have a care plan for fluid volume excess. Hypotension and dry mucous membranes are associated with deficient fluid volume. Ineffective Tissue Perfusion would be the appropriate diagnosis for a client experiencing cyanosis or tissue necrosis. Edema can cause an alteration in skin integrity, but there is no evidence of such problems with this client.

The nurse is reviewing urinalysis results for a patient who is in the early stages of CKD. What results might the nurse expect to see? A) Excessive protein, glucose, red blood cells, and white blood cells B) Increased specific gravity with a dark amber discoloration C) Dramatically increased urine osmolarity D) Pink-tinged urine with obvious small blood clots

A) Excessive protein, glucose, red blood cells, and white blood cells

*Possible exam question* It has been determined that a client with hepatitis has contracted the infection from contaminated food. Which type of hepatitis is this client likely experiencing? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D

A) Hepatitis A Rationale: Hep A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hep B, C, and D are most commonly transmitted via infected blood or body fluids.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Hypotension b) Bradycardia c) Polyuria d) Warm moist skin

A) Hypotension Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

The nurse is concerned that a client with potential hepatic failure is at risk for developing ascites. Which assessment finding supports the development of liver failure as manifested by ascites? A) Increased abdominal girth B) Gallbladder pain C) Yellow-tinged skin D) Bleeding and bruising easily

A) Increased abdominal girth Rationale: Ascites is the accumulation of the fluid in the abdomen and is a result of liver failure. The client with ascites would have an increased abdominal girth. Jaundice is manifested as yellow-tinged skin and is the result of hepatic disorders. The client experiencing hepatic problems might have bleeding and bruising issues due to inadequate vitamin K. Obstructed biliary flow could be the cause of gallbladder pain.

Why is development of Kussmaul respirations problematic in a client with chronic kidney disease (CKD)? A) It suggests the client is experiencing metabolic acidosis. B) It suggests the client is dehydrated. C) It suggests the client is hypotensive. D) It suggests the client is experiencing proteinuria.

A) It suggests the client is experiencing metabolic acidosis. Rationale: Kussmaul respirations involve an increase in respiratory rate and depth. Clients with CKD may exhibit these respirations when they are experiencing metabolic acidosis related to impaired hydrogen ion excretion and buffer production. Clients with CKD typically experience fluid retention and hypertension rather than dehydration and hypotension. Proteinuria is common among clients with CKD and does not contribute to Kussmaul respirations.

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a) Loss of 2.2 lb (1 kg) in 24 hours b) Serum potassium level of 3.5 mEq/L c) Blood pH of 7.25 d) Serum sodium level of 135 mEq/L

A) Loss of 2.2 lb (1 kg) in 24 hours Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

*Possible exam question* Restricted blood flow through the liver results in which condition? A) Portal hypertension B) Cirrhosis C) Jaundice D) Biliary atresia

A) Portal hypertension Rationale: Restricted blood flow through the liver results in portal hypertension, or increased pressure in the portal venous system. Jaundice results from impaired bilirubin conversion and excretion. Cirrhosis results when functional liver tissue is destroyed and replaced by fibrous scar tissue. Biliary atresia is a disorder of the bile ducts that causes backup of bile into the liver, resulting in tissue damage.

The most common cause of esophageal varices includes which of the following? a) Portal hypertension b) Asterixis c) Jaundice d) Ascites

A) Portal hypertension Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

A client with acute kidney failure is complaining of a metallic taste in the mouth and has no appetite. Based on this data, which intervention by the nurse is the most appropriate? A) Provide mouth care before meals. B) Administer an antiemetic as prescribed. C) Restrict fluids. D) Encourage the intake of protein, salt, and potassium.

A) Provide mouth are before meals Rationale: A metallic taste in the mouth is due to uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic would be prescribed for nausea. Restricting fluids would not reduce the metallic taste in the mouth. Encouraging intake of protein, salt, and potassium would exacerbate the uremia that is causing the metallic taste in the mouth.

*Possible exam question* The nurse reviews the results of diagnostic tests performed on a client with suspected chronic kidney disease (CKD). Which stage of the disease should the nurse suspect the client is experiencing when the GFR is mildly decreased? A) Stage 2 B) Stage 4 C) Stage 3 D) Stage 1

A) Stage 2 Rationale: A client with mildly decreased GFR is diagnosed with stage 2 chronic kidney disease. GFR in stage 1 is increased. GFR in stage 3 is moderately decreased. GFR in stage 4 is severely decreased.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a) subnormal serum glucose and elevated serum ammonia levels. b) subnormal clotting factors and platelet count. c) elevated liver enzymes and low serum protein level. d) elevated blood urea nitrogen and creatinine levels and hyperglycemia.

A) Subnormal serum glucose and elevated serum ammonia levels In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

The nurse is assessing a school-age child who complains of severe itching, bruising easily, restlessness, and involuntary jerking of the hands. When considering these manifestations collectively, which organ or system should the nurse anticipate needing to assess further? A) The liver B) The nervous system C) The gastrointestinal tract D) The urinary system

A) The liver Rationale: Severe itching (pruritus) is common in children with liver cirrhosis. Bruising easily indicates a decreased clotting ability, which could be related to the inability of the liver to produce clotting factors. Restlessness and involuntary jerking of the hands (asterixis) are both signs of portal systemic encephalopathy. All of these symptoms relate to liver disease, particularly cirrhosis. Therefore, a history of infection or disease with liver involvement will be most important to obtain from this client. Infections or diseases with neural, gastrointestinal, or urinary involvement would not produce these symptoms.

The nurse notes that the plan of care for a client with AKI instructs them to reposition the client every 2 hours while in bed. Which is the rationale behind this instruction? A) To avoid skin breakdown B) To keep the client awake C) To keep skin dry D) To avoid bone fractures

A) To avoid skin breakdown Rationale: Turning the client frequently and providing good skin care help to avoid skin breakdown. Edema decreases tissue perfusion and increases the risk of skin​ breakdown, especially in clients who are older or debilitated. Frequent repositioning has no bearing on bone fractures. The client should be kept dry to assist in avoiding skin breakdown. Repositioning is not done to disturb or keep the client awake.

The nurse knows which of the following body systems is responsible for the production of erythropoietin? A) Urinary system B) Cardiovascular system C) Lymphatic system D) Endocrine system

A) Urinary system

The nurse is caring for a client diagnosed with acute kidney injury (AKI). When reviewing the client's laboratory data, which findings should indicate to the nurse that the client has met the expected outcomes? Select all that apply. A) Decreasing serum creatinine B) Decreasing blood urea nitrogen (BUN) C) Decreasing neutrophil count D) Decreasing lymphocyte count E) Decreasing erythrocyte count

A, B Rationale: - Decreasing CREA, BUN Rationale: Creatinine is the metabolic end product of creatine phosphate and is excreted via the kidneys in relatively constant amounts. BUN, a measurement of the nitrogen portion of urea, is also excreted in urine and is a good indicator of renal function. Neutrophils, lymphocytes, and erythrocytes are not used to monitor the return of renal function.

35. Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation? a. Heart rate b. Blood urea nitrogen (BUN) level c. Urine output d. Creatinine clearance

ANS: C Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.

The pt with cirrhosis has increased ab girth from ascites. The nurse should know that this fluid gathers in the ad for which reasons? Select all that apply. a. there is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. b. hyperaldosteronsim related to damaged hepatocytes increases sodium and fluid retention c. portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity d. osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluid orally e. overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.

A, B, C Ascites related to cirrhosis is caused by decreased colloid oncotic pressure from the lack of albumin form liver inability to synthesize it and the portal hypertension shifts protein into peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention.

The healthcare provider is teaching a patient diagnosed with hepatitis C about the disease. Which of these statements made by the patient indicate that the patient has an understanding of the teaching? Choose all answers that apply: A "I should get vaccinated for hepatitis A and hepatitis B." B "It's important for me to use barrier protection when I have sex." C "I should not drink any wine, beer or other alcoholic beverages." D "I'll plan to do all my activities in the morning when I'm most rested." E "I should avoid sharing drinking cups and eating utensils with my family." F "Acetaminophen is the best medication for me if I have a headache."

A, B, C Hepatitis C is a parenterally transmitted virus. Inflammation caused by the hepatitis C virus can result in cirrhosis and liver cancer, so the patient will want to take steps to avoid further damage to the liver Patients infected with the hepatitis C virus should avoid alcohol, avoid acetaminophen, and get vaccinated for hepatitis A and B. Barrier protection should be used during sex, but casual household contact is not a risk factor for transmission. Fatigue is best managed by spacing activities throughout the day and taking rest periods as needed.

The nurse is concerned that an older adult client is at risk for developing acute kidney injury (AKI). Which data in the client's history supports the nurse's concern? SATA A) Diagnosed with hypotension B) Recent aortic valve replacement surgery C) Prescribed high doses of intravenous antibiotics D) Total hip replacement surgery 5 years ago E) Taking medication for type 2 diabetes mellitus

A, B, C Rationale: Older adults develop acute kidney injury more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for acute kidney injury. Hypotension, aortic valve replacement surgery, and receipt of high doses of intravenous antibiotics increase this client's risk for developing acute kidney injury. A previous history of hip replacement surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute kidney injury.

The nurse preceptor is teaching a new graduate about conditions that can cause damage to the renal parenchyma and nephrons resulting in AKI. Which condition should the nurse preceptor include? SATA A) Vasculitis B) Hypertension C) Hemodialysis D) Glomerulonephritis E) Dehydration

A, B, C, D -Vasculitis - HTN - Hemolysis - Glomerulonephritis Rationale: Hypertension,​ hemolysis, glomerulonephritis, and vasculitis cause acute damage to the renal parenchyma and​ nephrons, leading to intrarenal AKI. Dehydration causes prerenal AKI and does not cause damage to the renal parenchyma and nephrons.

When caring for a pt with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome? Select all that apply. a. use smallest gauge needle possible when giving injections or drawing blood. b. teach pt to avoid straining at stool, vigorous blowing of nose, and coughing c. advise pt to use soft-bristle toothbrush and avoid ingestion of irritating food. d. apply gentle pressure for the shortest possible time period after performing venipuncture e. instruct pt to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

A, B, C, E - small gauge minimize risk of bleeding into tissues. - avoiding strain reduces hemorrhage - soft bristle reduce injury to highly vascular mucous membranes - apply gentle but prolonged pressure to venipuncture - aspirin and NSAIDs should not be used in pt with liver disease b/c they interfere w/ platelet aggregation, increasing bleeding risk

*Possible exam question* A client diagnosed with AKI is experiencing hyperkalemia. Which medication should the nurse anticipate being prescribed to this client? SATA A) Calcium chloride B) Insulin C) Glucose D) Angiotensin-converting enzyme (ACE) inhibitors E) Sodium bicarbonate

A, B, C, E Rationale: The nurse should anticipate that calcium​ chloride, sodium​ bicarbonate, insulin, and glucose would be prescribed to treat the​ client's hyperkalemia. Calcium​ chloride, sodium​ bicarbonate, and insulin can be used to reduce serum potassium levels by moving potassium into the cells. Calcium is also administered to correct hypocalcemia and reduce hyperphosphatemia.​ (Calcium and phosphate have a reciprocal relationship in the​ body; as the level of one​ rises, the level of the other​ falls.) An ACE inhibitor is used to treat​ hypertension, not hyperkalemia.

The nurse is completing a health hx on a client admitted with acute renal failure. Which information should the nurse collect? SATA A) Recent exposure to nephrotoxic medications B) Chronic diseases C) Previous transfusion reactions D) Reports of weight loss E) Reports of anorexia

A, B, C, E Rationale: When completing a health history on a client with acute renal​ failure, the nurse needs to collect information on recent exposure to nephrotoxic medications​ (e.g., nonsteroidal​ anti-inflammatory drugs​ [NSAIDs] and some chemotherapeutic​ drugs); previous transfusion​ reactions; chronic diseases such as diabetes​ mellitus, heart​ failure, and kidney​ disease; and reports of anorexia. The nurse needs to collect information on reports of weight​ gain, not weight loss.

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct? Select all that apply. A: excessive coughing B: sleeping on the back C: drinking juice D: alcohol consumption E; straining during a bowel movement F: vomiting

A, D, E, F Excessive coughing, alcohol consumption, straining during a bowel movement, vomiting. Esophageal varices are dilated vessels that are connected from the throat to the stomach. They can become enlarged due to portal hypertension in cirrhosis and can rupture. The patient should avoid activities that could rupture these vessels, such as excessive cough, vomiting, drinking alcohol, and constipation.

*Kind of shit question alert* A nurse is caring for a pregnant woman. Which physiologic condition may occur during pregnancy and is related to the development of AKI that should concern the nurse? SATA A) Hydronephrosis B) Hyperemesis gravidarum C) Hypertension D) Preeclampsia E) Hypoglycemia

A, B, D -Hydronephrosis - Hyperemesis gravidarum - Preeclampsia Rationale: During​ pregnancy, glomerular filtration rate increases​ significantly, perhaps by as much as​ 50%. This leads to a decrease in baseline serum creatinine and other changes associated with the increased blood volume that pregnancy brings. AKI in pregnant women is often related to the same etiologies as are identified in the general population.​ However, there are unique etiologies that manifest themselves throughout the pregnancy cycle. Over​ 90% of women develop a physiologic hydronephrosis of​ pregnancy, and this can promote urinary​ stasis, lead to urinary tract​ infection, and ultimately lead to AKI. In​ addition, in the first​ trimester, hyperemesis gravidarum and placenta previa may lead to​ AKI, and as pregnancy​ progresses, pregnancy-induced​ hypertension, preeclampsia, and eclampsia stress the​ kidneys, leading to​ proteinuria, hydronephrosis, and AKI.

The nurse is reviewing the lab results for a client suspected of having cirrhosis. Which result suggests to the nurse that the suspicion is correct? SATA A) Decreased sodium levels B) Elevated serum ammonia levels C) Increased albumin levels D) Decreased bilirubin levels E) Prolonged prothrombin time.

A, B, E - Decreased sodium - Elevated ammonia - Prolonged prothrombin time Rationale: In​ cirrhosis, prothrombin times are prolonged because the liver is unable to manufacture clotting factors. Serum ammonia levels are elevated because the liver lacks the ability to efficiently convert ammonia to ammonium for excretion as urea by the kidneys. Sodium levels are decreased because of hemodilution due to fluid retention. In​ cirrhosis, bilirubin levels are​ increased, and albumin levels are decreased.

A client diagnosed with frequent urinary tract infections is seen in the urology clinic. The nurse reviews the client's medical history and determines that the client is at risk for acute kidney injury. Which items in the client's history support this conclusion? Select all that apply. A) Dehydration B) Renal calculi C) Ineffective wound healing D) Low serum albumin E) Hypertension

A, B, E -Dehydration - Renal calculi - HTN Rationale: Dehydration, renal calculi, and hypertension can all precipitate acute kidney injury (AKI). Ineffective wound healing has not been shown to cause renal failure unless the infection becomes systemic. A low serum albumin does not cause AKI.

During a home visit, the nurse is concerned that an older adult client is developing chronic kidney disease (CKD). The client has no history of cardiovascular disease. Which data in the client's assessment caused the nurse to have this concern? Select all that apply. A) Progressive edema B) Complaints of hip joint pain C) New onset of hypertension D) Recent increase in hunger and thirst E) Warm moist skin

A, C Rationale: The manifestations of chronic kidney disease (CKD) often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of CKD in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not CKD in the older client. A client with CKD will have pale dry skin with poor turgor.

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply: A: thrombocytopenia B: vision changes C: increased PT/INR D: leukopenia

A, C, D. Thrombocytopenia, increased PT/INR, leukopenia. A patient with an enlarged spleen due to cirrhosis can experience thrombocytopenia, increased PT/INR and leukopenia. The spleen stores platelets and WBCs. An enlarged spleen can develop due to portal hypertension, which causes the platelets and WBCs to become stuck inside the spleen due to the increased pressure in the hepatic vein (hence lowering the count and the body's access to these important cells for survival.)

The nurse describes the increased risk of GI bleeding to a client with AKI. Which factor should the nurse inform the client with regard to medication? SATA A) "Avoid magnesium-based antacids." B) "Drink milk to coat the stomach prior to taking medication." C) "OTC calcium carbonate (Tums) is helpful." D) "Regular doses of antacids are indicated." E) "Take antacids at bedtime."

A, D Rationale: The client with AKI has an increased risk of GI​ bleeding, probably related to the stress response and impaired platelet function. Regular doses of antacids​ (although not ones that are magnesium​ based), histamine​ H2-receptor antagonists​ (e.g., famotidine,​ ranitidine), or a proton pump inhibitor​ (e.g., omeprazole​ [Prilosec]) are often ordered to prevent GI hemorrhage. All​ medications, including​ over-the-counter medications, should be discussed with the healthcare provider to see if they are contraindicated in their medical condition. Milk will not coat the stomach or protect the gastric mucosa.

A client with liver disease presents to the hospital with severe ascites. What pathophysiologic changes does the nurse recognize as contributing to the development of ascites? SATA A) Presence of portal hypertension B) Presence of hyperalbuminemia C) Increased colloidal osmotic pressure D) Sodium and water retention E) Presence of hypoaldosteronism

A, D - Portal HTN - Sodium and water retention Rationale: Ascites is the accumulation of plasma-rich fluid in the abdominal cavity. Although portal hypertension is the primary cause of ascites, decreased serum proteins and increased aldosterone also contribute to the fluid accumulation. Hypoalbuminemia (low serum albumin) decreases the colloidal osmotic pressure of plasma. This pressure normally holds fluid in the intravascular compartment, but when the plasma colloidal osmotic pressure decreases, fluid escapes into extravascular compartments. Hyperaldosteronism (an increase in aldosterone) causes sodium and water retention, contributing to ascites and generalized edema.

The community nurse visits the home of a young child who is home from school because of sudden onset of nausea, vomiting, and lethargy. The nurse suspects acute kidney injury (AKI). Which clinical manifestations support the nurse's suspicions? SATA A) Elevated blood pressure B) Postural hypotension C) Wheezing D) Edema E) Hematuria

A, D, E - Elevated BP, Edema, Hematuria Rationale: Pediatric manifestations of acute kidney injury characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute kidney injury in an older person. Wheezing is not a manifestation of acute kidney injury.

The nurse is preparing to administer a hemodialysis treatment for a client diagnosed with chronic kidney disease (CKD). Which laboratory values should the nurse anticipate prior to the client's treatment? Select all that apply. A) Increased blood urea nitrogen (BUN) B) Decreased potassium C) Decreased phosphorus D) Increased urine osmolality E) Increased creatinine

A, E Increased BUN Increased CREA Rationale: The damaged kidney is unable to excrete waste products, including creatinine, so creatinine levels will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which of the following vitamin supplements (select all that apply)? A) Vitamin A B) Vitamin D C) Vitamin E D) Vitamin K E) Vitamin B

A,B,C,D Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat soluble and thus would need to be supplemented in a patient with biliary obstruction.

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which of the following nursing interventions would be appropriate to achieve this outcome (select all that apply)? A) Use smallest gauge possible when giving injections or drawing blood. B) Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C) Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. D) Apply gentle pressure for the shortest possible time period after performing venipuncture. E) Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

A,B,C,E Using the smallest gauge for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding.

A patient diagnosed with chronic hepatitis is admitted to the medical unit with ascites. Which of the following mechanisms will the healthcare provider identify as contributing to the development of ascites in this patient? Choose all answers that apply: A Increased serum aldosterone B Increased liver fibrosis C Decreased production of vitamin K D Decreased venous hydrostatic pressure E Decreased serum albumin

A. B E Ascites is an accumulation of fluid in the peritoneal cavity.Ascites is an accumulation of fluid in the peritoneal cavity. Ascites is a complication of portal hypertension (in normal portal circulation, venous blood flows from the abdominal organs to the liver). Portal hypertension is a result of increased resistance to portal blood flow. As fluid accumulates in the peritoneal cavity, the circulating blood volume decreases. Ascites is a result of increased venous hydrostatic pressure (portal hypertension secondary to liver fibrosis) and decreased plasma oncotic pressure (the impaired liver does not synthesize adequate albumin). In addition, an increase in aldosterone (the RAAS system is activated because of the low circulating volume, plus the impaired liver does not metabolize aldosterone normally) causes sodium and water retention, which contributes to the ascites.

The nurse preceptor is working with a new graduate nurse to provide care for a patient with fluid volume overload due to acute kidney injury (AKI). Which statement indicates that the new graduate nurse needs further teaching about interventions that should be implemented for this patient? A. "I need to administer potassium replacements." B. "I need to limit fluid intake." C. "I need to weigh the patient daily." D. "I need to place the patient in a semi-Fowler position."

A. "I need to administer potassium replacements." Patients with AKI have hyperkalemia and should not be given potassium supplements. Nursing care for patients with fluid volume overload caused by AKI includes maintaining intake and output measurements and daily weighing to assist in tracking fluid balance. Liberal fluid intake is contraindicated in patients with AKI because of their inability to excrete excess fluid. The semi-Fowler position helps improve respiratory excursion of the patient with fluid overload.

The nurse is teaching a patient with acute kidney injury (AKI) how to diminish lower leg edema. Which patient statement demonstrates effective teaching? A. "I should prop my legs up as frequently as possible." B. "I should not drink alcohol." C. "I should drink more fluid to help move the excess water through my body." D. "I should only drink one glass of water a day while my legs are swollen."

A. "I should prop my legs up as frequently as possible." In kidney disease, extra fluid and sodium in the circulation can pool and cause edema in the lower legs and around the eyes. It is important to teach the patient that elevating their legs can decrease the edema. The patient will be on fluid restriction, which should be followed.

Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) is of highest priority when teaching a patient new to this procedure? A. "It is essential that you maintain aseptic technique to prevent peritonitis." B. "You will be allowed a more liberal protein diet after you complete CAPD." C. "It is important for you to maintain a daily written record of blood pressure and weight." D. "You must continue regular medical and nursing follow-up visits while performing CAPD."

A. "It is essential that you maintain aseptic technique to prevent peritonitis." Peritonitis is a potentially fatal complication of peritoneal dialysis, and it is imperative to teach the patient methods to prevent it from occurring. Although the other teaching statements are accurate, they do not address the potential for mortality by peritonitis, making that nursing action the highest priority.

A patient receiving peritoneal dialysis asks the nurse how it works. Which response by the nurse is accurate? A. "The fluid that infuses into your abdomen will pull fluid and toxins from the bloodstream, and then the waste products will drain from your abdomen." B. "The fluid that infuses into your abdomen diffuses into the blood and dilutes the toxins." C. "Your blood is filtered through an external filter that will pull excess fluid and toxins out of your blood." D. "Your body exchanges the fluid in the bloodstream with the clean fluid in the abdomen, and then the fluid with the toxins drains out."

A. "The fluid that infuses into your abdomen will pull fluid and toxins from the bloodstream, and then the waste products will drain from your abdomen." Peritoneal dialysis uses the peritoneal membrane as the dialyzing surface. Metabolic wastes and excess electrolytes diffuse into the dialysate in the abdomen, and an osmotic gradient pulls excess fluid from the blood. Hemodialysis is the process in which the blood volume is filtered through an external filter to remove toxins and excess fluid from the blood. The dialysate fluid does not diffuse into the bloodstream, but remains in the peritoneal space. Fluid is not exchanged in peritoneal dialysis. The same fluid that infuses into the abdomen is what is drained several hours later.

A nurse is caring for a client following his first hemodialysis treatment. The client reports a headache, nausea, and restlessness. The nurse should identify these findings as manifestations of which of the following complications? A. Dialysis disequilibrium B. Air embolism C. Peritonitis D. Septicemia

A. Dialysis disequilibrium Rationale: Dialysis disequilibrium syndrome can develop during or after hemodialysis. The syndrome is caused by the rapid decrease in fluid volume and BUN levels during dialysis. The change in urea levels can cause cerebral edema and increased intracranial pressure. Manifestations include headache, nausea, vomiting, restlessness, seizures, and coma.

During evaluation of a patient at an outpatient clinic, the nurse determines that administration of hepatitis B vaccine has been effective when a specimen of the patient's blood reveals: a. HBsAg. b. anti-HBs c. anti-HBc IgM. d. anti-HBc IgG"

Answer B: The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV

What characterizes AKI (select all that apply)? A. Primary cause of death is infection. B. It usually affects older people. C. The disease course is potentially reversible. D. The most common cause is diabetic nephropathy. E. Cardiovascular disease is the most common cause of death.

A. Primary cause of death is infection. C. The disease course is potentially reversible. AKI is potentially reversible. It has a high mortality rate, and the primary cause of death is infection; the primary cause of death for chronic kidney failure is cardiovascular disease. AKI commonly follows severe, prolonged hypotension or hypovolemia or exposure to a nephrotoxic agent. Although it can occur at any age, the older adult is more susceptible to AKI because the number of functioning nephrons decreases with age.

A patient is admitted to the hospital with CKD. You understand that this condition is characterized by A. Progressive irreversible destruction of the kidneys B. A rapid decrease in urinary output with an elevated BUN level C. Increasing creatinine clearance with a decrease in urinary output D. Prostration, somnolence, and confusion with coma and imminent death

A. Progressive irreversible destruction of the kidneys CKD involves progressive, irreversible loss of kidney function.

A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload? A. The client has a 5 lb weight gain since yesterday. B. Flattened neck veins C. Oxygen saturation 93% D. Return of skin to previous position when the client's shin is palpated

A. The client has a 5 lb weight gain since yesterday. Rationale: The nurse should identify that a gain of 2 lb per day is stable. A gain of more than 2 lb per day or 5 lb per week is an indication of fluid overload.

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 D. Phosphorous E. Sodium Rationale: Protein is correct. 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.Calcium is incorrect. A client who has CKD is at risk for hypocalcemia due to an alteration in the conversion of vitamin D by the kidneys.Calories is incorrect. A client who has CKD requires adequate calories to meet metabolic needs.Phosphorous is correct. A client who has CKD is at risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys.Sodium is correct. A client who has CKD is at risk for hypernatremia, edema, and hypertension due to sodium retention

A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply). A. Slurred speech B. Bone pain C. Bradypnea. D. Pruritus E. Hypotension

A. Slurred speech B. Bone pain D. Pruritus Rationale:Slurred speech is correct. Slurred speech is an expected finding of ESKD.Bone pain is correct. Bone pain is an expected finding of ESKD.Bradypnea is incorrect. Tachypnea, rather than bradypnea, is an expected finding of ESKD.Pruritus is correct. Pruritus is an expected finding of ESKD. Hypotension is incorrect. Hypertension, rather than hypotension, is an expected finding of EKRD.

How do you determine that a patient's oliguria is associated with acute renal failure (ARF)? A. Specific gravity of urine at 3 different times is 1.010. B. The serum creatinine level is normal. C. The blood urea nitrogen (BUN) level is normal or below. D. Hypokalemia is identified.

A. Specific gravity of urine at 3 different times is 1.010. A urinalysis may show casts, red blood cells (RBCs), white blood cells (WBCs), a specific gravity fixed at about 1.010, and urine osmolality at about 300 mOsm/kg.

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, what do you tell the patient? A. Successful transplantation usually provides better quality of life than that offered by dialysis. B. If rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. C. The immunosuppressive therapy that is required after transplantation causes fatal malignancies in many patients. D. Hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection.

A. Successful transplantation usually provides better quality of life than that offered by dialysis. Kidney transplantation is extremely successful, with 1-year graft survival rates of about 90% for deceased donor transplants and 95% for live donor transplants. An advantage of kidney transplantation compared with dialysis is that it reverses many of the pathophysiologic changes associated with renal failure when normal kidney function is restored. It also eliminates the dependence on dialysis and the accompanying dietary and lifestyle restrictions. Transplantation is also less expensive than dialysis after the first year.

Which patient has the greatest risk for prerenal AKI? A. The patient is hypovolemic because of hemorrhage. B. The patient relates a history of chronic urinary tract obstruction. C. The patient has vascular changes related to coagulopathies. D. The patient is receiving antibiotics such as gentamicin.

A. The patient is hypovolemic because of hemorrhage. Prerenal causes of AKI are factors external to the kidneys. These factors reduce systemic circulation, causing a reduction in renal blood flow, and they lead to decreased glomerular perfusion and filtration of the kidneys.

Important nursing interventions for the patient with AKI are (select all that apply) A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. D. increase intake of vitamin A and D. E. frequent mouth care.

A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. E. frequent mouth care. You have an important role in managing fluid and electrolyte balance during the oliguric and diuretic phases of AKI. Observing and recording accurate intake and output are essential. Measure daily weights with the same scale at the same time each day to assess excessive gains or losses of body fluids. Mouth care is important to prevent stomatitis, which develops when ammonia (produced by bacterial breakdown of urea) in saliva irritates the mucous membrane.

During the oliguric phase of AKI, you monitor the patient for (select all that apply) A. hypertension. B. electrocardiographic (ECG) changes. C. hypernatremia. D. pulmonary edema. E. urine with high specific gravity.

A. hypertension. B. electrocardiographic (ECG) changes. D. pulmonary edema. You monitor the patient in the oliguric phase of AKI for hypertension and pulmonary edema. When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (anuria and oliguria), the neck veins may become distended and have a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure, pulmonary edema, and pericardial and pleural effusions. The patient is monitored for hyponatremia. Damaged tubules cannot conserve sodium, and the urinary excretion of sodium may increase, resulting in normal or below-normal levels of serum sodium. Monitoring may reveal ECG changes and hyperkalemia. Initially, clinical signs of hyperkalemia are apparent on electrocardiogram, which demonstrate peaked T waves, widening of the QRS complex, and ST-segment depression. Urinary specific gravity is fixed at about 1.010.

Patients with CKD have an increased incidence of cardiovascular disease related to (select all that apply) A. hypertension. B. vascular calcifications. C. a genetic predisposition. D. hyperinsulinemia causing dyslipidemia. E. increased high-density lipoproteins levels.

A. hypertension. B. vascular calcifications. D. hyperinsulinemia causing dyslipidemia. Traditional cardiovascular risk factors, such as hypertension and elevated lipid levels, are common in CKD patients. Hyperinsulinemia stimulates hepatic production of triglycerides. Most patients with uremia develop dyslipidemia. Much of the cardiovascular disease may be related to nontraditional risk factors such as vascular calcification and arterial stiffness. Vascular calcification and arterial stiffness are major contributors to cardiovascular disease in CKD. Calcium deposits in the vascular medial layer are associated with stiffening of the blood vessels. The mechanisms involved are multifactorial and incompletely understood, but they include (1) vascular smooth muscle cells that change into a chondrocyte or osteoblast-like cell, (2) high total body calcium and phosphate levels due to abnormal bone metabolism, (3) impaired renal excretion, and (4) drug therapies to treat the bone disease (e.g., calcium phosphate binders).

The advantage of continuous replacement therapy over hemodialysis is its ability to A. remove fluid without the use of a dialysate. B. remove fluid in less than 24 hours. C. allow the patient to receive the therapy at the work site. D. be administered through a peripheral line.

A. remove fluid without the use of a dialysate. Several features of continuous replacement therapy are different from those of hemodialysis. Solute removal can occur by convection (no dialysate required) in addition to osmosis and diffusion. The process can take days or weeks. The patient cannot receive the therapy at work and a vascular access device is required.

A patient has been admitted to the step-down unit with a diagnosis of liver malignancy. The critical care nurse caring for this patient is aware that an early manifestation of liver malignancy, in addition to pain, is what? A) A continuous dull ache in the right upper quadrant, epigastrium, or back B) Weight gain C) An increase in appetite D) Jaundice

ANS: A The early manifestations of malignancy of the liver include pain and a continuous dull ache in the right upper quadrant epigastrium or back. Weight loss, anorexia, and anemia may occur. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver.

A student asks the pathophysiology instructor what causes ascites. What would the instructor tell the student is involved in the physiologic process that causes ascites? (Mark all that apply.) A) Sodium and water retention B) A damaged liver C) Insufficient renal flow D) Increased lymphatic flow E) Decreased synthesis of immunoglobulin G

ANS: A, B, D Sodium and water retention, increased intravascular fluid volume, increased lymphatic flow, and decreased synthesis of albumin by the damaged liver all contribute to the movement of fluid from the vascular system into the peritoneal space. Insufficient renal blood flow and a decreased synthesis of immunoglobulin G do not play a part in the formation of ascites.

7. Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance

ANS: B Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.

29. Which nursing action for a patient who has arrived for a scheduled hemodialysis session is most appropriate for the RN to delegate to a dialysis technician? a. Educate patient about fluid restrictions. b. Check blood pressure before starting dialysis. c. Assess for reasons for increase in predialysis weight. d. Determine the ultrafiltration rate for the hemodialysis.

ANS: B Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.

The nurse is caring for a patient with metastasis of her cancer to the liver. The patient is undergoing chemotherapy by TACE. What does this chemotherapy procedure cause? A) Necrosis of tumor cells B) Embolization of tumor vessels C) Necrosis of tumor vessels D) Embolization of tumor cells

ANS: B Embolization of tumor vessels with chemotherapy (a process known as transarterial chemoembolization [TACE]) produces anoxic necrosis with high concentrations of trapped chemotherapeutic agents. This procedure does not work on the cellular level of the tumor.

You are caring for a patient with a blocked bile duct from a tumor. What would you document about the patient's urine? A) Urine is dark amber and concentrated. B) Urine is orange and foamy. C) Urine is rust colored and concentrated. D) Urine is pale yellow and dilute.

ANS: B If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy. Therefore options A, C, and D are incorrect.

A 55-year-old female patient is undergoing radiofrequency thermal ablation of her primary liver tumor. What does this treatment entail? A) A tube is inserted into the tumor and ablation is done by superheated water. B) A needle electrode is inserted into the tumor and heated by radiofrequency. C) A tube is inserted into the tumor and chemotherapy is placed into the tumor. D) A needle electrode is inserted into the tumor and killed by laser.

ANS: B In radiofrequency thermal ablation, a needle electrode is inserted into the liver tumor under imaging guidance. Radiofrequency energy passes through to the noninsulated needle tip, causing heat and tumor cell death from coagulation necrosis. No tube is inserted into the tumor.

What liver function test is a sensitive indicator of injury to liver cells and useful in detecting acute liver disease such as hepatitis? A) Clotting factors B) Serum aminotransferases C) GGT D) Alkaline phosphatase

ANS: B Serum aminotransferases (previously called transaminases) are sensitive indicators of injury to the liver cells and are useful in detecting acute liver disease such as hepatitis.

24. When the nurse is caring for a patient who has been admitted with a severe crushing injury after an industrial accident, which laboratory result will be most important to report to the health care provider? a. Serum creatinine level 2.1 mg/dL b. Serum potassium level 6.5 mEq/L c. White blood cell count 11,500/L d. Blood urea nitrogen (BUN) 56 mg/dL

ANS: B The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse also will report the other laboratory values, but abnormalities in these are not immediately life threatening.

After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? a. Elevate the patients arm above the level of the heart. b. Report the patients symptoms to the health care provider. c. Remind the patient about the need to take a daily low-dose aspirin tablet. d. Educate the patient about the normal vascular response after AVG insertion.

ANS: B The patients complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.

25. A patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and an elevated blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first? a. Obtain renal ultrasound. b. Insert retention catheter. c. Infuse normal saline at 50 mL/hour. d. Draw blood for complete blood count.

ANS: B The patients elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate, but should be implemented after the retention catheter.

22. The nurse is caring for Mr. P, a chronic dialysis patient who has an arteriovenous fistula, Nursing care of the fistula should include: a. Irrigating the fistula with heparin to prevent clotting b. Frequent dressing changes to prevent infection c. Washing the fistula site with soap and water d. Checking blood pressure in the arm with the fistula to see if circulation is adequate.

C

22. Which of the following information obtained by the nurse who is caring for a patient with end-stage renal disease (ESRD) indicates the nurse should consult with the health care provider before giving the prescribed epoetin alfa (Procrit)? a. Creatinine 1.2 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg

ANS: C High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when EPO is administered to a target hemoglobin of >12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider, but will not affect whether the medication is administered.

A patient has come to the clinic with vague complaints that made the physician suspect liver disease. Laboratory work shows elevated GGT levels. What can elevated GGT levels indicate? A) Hemolytic jaundice B) Cirrohsis C) Liver cell dysfunction D) Viral hepatitis

ANS: C Increased GGT levels are associated with cholestasis but can also be due to alcoholic liver disease. Although the kidney has the highest level of the enzyme, the liver is considered the source of normal serum activity. The test determines liver cell dysfunction and is a sensitive indicator of cholestasis. An elevated GGT would not indicate hemolytic jaundice, cirrohsis, or viral hepatitis.

A critical care nurse is caring for a patient post liver transplantation. The patient has a fall in blood glucose level. What would the nurse do in this instance? A) Give an ampule of D50 every 4 hours B) Monitor an infusion of 5% glucose for the first 24 hours C) Monitor an infusion of 10% glucose for the first 48 hours D) Give an ampule of D50 every 2 hours

ANS: C Metabolic abnormalities require careful attention. A constant infusion of 10% glucose may be required in the first 48 hours to prevent a precipitous fall in the blood glucose level that results from decreased gluconeogenesis. Options A, B, and D are incorrect.

A patient with portal hypertension has been admitted to the floor you work on. What will you assess for related to portal hypertension? A) Bowel obstruction B) Vitamin A deficiency C) Ascites D) Hepatic encephalopathy

ANS: C Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Portal hypertension does not generally cause bowel obstruction. Vitamin A deficiency is not something the nurse assesses for. Hepatic encephalopathy is a complication of cirrohsis.

14. When a patient who has had progressive chronic kidney disease (CKD) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. Unlimited fluids are allowed since retained fluid is removed during dialysis. c. More protein will be allowed because of the removal of urea and creatinine by dialysis. d. Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.

ANS: C Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

Postnectrotic cirrhosis is a late result of what? A) Acute bacterial hepatitis B) Hemolytic jaundice C) Acute viral hepatitis D) Chronic biliary obstruction

ANS: C Postnecrotic cirrhosis, in which there are broad bands of scar tissue, is a late result of a previous bout of acute viral hepatitis. Therefore options A, B, and D are incorrect.

A patient who has undergone liver transplantation is ready to be discharged home. The nurse is providing discharge teaching. Which topic will the nurse emphasize the most related to discharge teaching? A) The patient will obtain measurement of drainage from the T-tube. B) The patient will exercise three times a week. C) The patient will take immunosuppressive agents as required. D) The patient will monitor for signs of liver dysfunction.

ANS: C The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to assure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as they wouldn't go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress them like they would stress the immunosuppressive drug regimen.

A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has? A) Hemolytic jaundice B) Hepatic insufficiency C) Bleeding esophageal varices D) Portal hypertension

ANS: C The patient with bleeding esophageal varices may present with hematemesis, melena, or general deterioration in mental or physical status and often has a history of alcohol abuse. Signs and symptoms of shock (cool clammy skin, hypotension, tachycardia) may be present. The scenario does not describe hemolytic jaundice, hepatic insufficiency, or portal hypertension.

6. Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurses teaching about management of CKD has been effective? a. I need to try to get more protein from dairy products. b. I will try to increase my intake of fruits and vegetables. c. I will measure my urinary output each day to help calculate the amount I can drink. d. I need to take the erythropoietin to boost my immune system and help prevent infection.

ANS: C The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.

34. During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Obtain blood to check the blood urea nitrogen (BUN) level. c. Check the patients blood pressure. d. Give prescribed PRN antiemetic drugs.

ANS: C The patients complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions also may be appropriate, based on the blood pressure obtained.

3. A patient with severe heart failure develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal of a. replacing fluid volume. b. preventing hypertension. c. maintaining cardiac output. d. diluting nephrotoxic substances.

ANS: C The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patients heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.

33. A patient in the oliguric phase of acute renal failure has a 24-hour fluid output of 150 mL emesis and 250 mL urine. The nurse plans a fluid replacement for the following day of ___ mL. a. 400 b. 800 c. 1000 d. 1400

ANS: C Usually fluid replacement should be based on the patients measured output plus 600 mL/day for insensible losses.

A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringer's lactate at 150 cc/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient? A) Arterial line B) Central venous catheter C) Foley catheter D) Volume expanders

ANS: D Because patients with bleeding esophageal varices have intravascular volume depletion and are subject to electrolyte imbalance, IV fluids with electrolytes and volume expanders are provided to restore fluid volume and replace electrolytes. Transfusion of blood components also may be required. An arterial catheter, a central venous catheter, and a Foley catheter will probably be ordered, but they won't maintain the patient's volume.

The nurse is reviewing the history of a patient newly admitted to the unit. This patient has been ordered vasopressin for bleeding esophageal varices. The nurse calls the physician to question the use of vasopressin when she reads that the patient has a history of what? A) Diabetes mellitus B) Chronic kidney disease C) Arthritis D) Coronary artery disease

ANS: D Coronary artery disease is a contraindication to the use of vasopressin, because coronary vasoconstriction is a side effect that may precipitate myocardial infarction. A history of diabetes, chronic kidney disease, or arthritis does not contraindicate the use of vasopressin.

A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals who ate at this restaurant and have never received the hepatitis A vaccine? A) The hepatitis A vaccine B) The hepatitis B vaccine C) The hepatitis A and B vaccines D) An immune globulin injection

ANS: D For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular administration of globulin during the incubation period, if given within 2 weeks of exposure. Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to hepatitis A.

11. Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)? a. Blood urea nitrogen (BUN) level b. Urine output c. Creatinine level d. Calculated glomerular filtration rate (GFR)

ANS: D GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.

A patient is being discharged home after liver transplantation. The patient still has a hepatic artery catheter in place. What is this hepatic artery catheter for? A) To monitor portal hypertension B) To give immunosuppressive drugs during the first weeks after transplantation C) To monitor vascular changes in the hepatic system D) To deliver a continuous chemotherapeutic dose until completed

ANS: D In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump that delivers a continuous chemotherapeutic dose until completed. The hepatic artery catheter does not monitor portal hypertension, deliver immunosuppressive drugs, or monitor vascular changes in the hepatic system.

The critical care nurse is caring for a patient with cirrhosis. What is an essential nursing function when caring for a patient with cirrhosis? A) Monitoring the patient's oral intake B) Monitoring the patient's support network C) Monitoring the patient for signs of hypervolemia D) Monitoring the patient's mental status

ANS: D Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. An extensive neurologic evaluation is key to identify progression through the four stages of encephalopathy. The nurse would monitor the oral intake and watch for signs of hypervolemia, but they are not as essential as the patient's mental status because of the encephalopathy that goes with cirrhosis. Monitoring the support network is not essential at this time.

36. A patient complains of leg cramps during hemodialysis. The nurse should first a. reposition the patient. b. massage the patients legs. c. give acetaminophen (Tylenol). d. infuse a bolus of normal saline.

ANS: D Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

15. Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient slows the inflow rate when experiencing pain. b. The patient leaves the catheter exit site without a dressing. c. The patient plans 30 to 60 minutes for a dialysate exchange. d. The patient cleans the catheter while taking a bath every day.

ANS: D Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.

2. A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for a. vasodilation. b. poor skin turgor. c. bounding pulses. d. rapid respirations.

ANS: D Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.

27. After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first? a. Document the QRS interval. b. Notify the patients health care provider. c. Look at the patients current blood urea nitrogen (BUN) and creatinine levels. d. Check the chart for the most recent blood potassium level.

ANS: D The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patients health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.

The nurse is caring for a patient with liver failure. The nurse understands that patients in liver failure often require vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin? A) Vitamin B12 B) Vitamin A C) Vitamin D D) Vitamin K

ANS: D The liver requires vitamin K for the synthesis of prothrombin and some of the other clotting factors. Breakdown of fatty acids into ketone bodies occurs primarily when the availability of metabolism is limited, as during starvation or in uncontrolled diabetes. Vitamins stored in the liver include A, B12, D, and several of the B-complex vitamins.

A nurse is assessing a 77-year-old male admitted to the unit for suspected liver dysfunction. What assessment finding will the nurse expect to find? A) Liver function results change dramatically in the older adult. B) Metabolism of medications is delayed primarily by the liver. C) The liver is enlarged with hard edges. D) The liver is decreased in size and weight.

ANS: D The most common change in the liver is a decrease in size and weight. Results of liver function test results do not normally change in the elderly. Metabolism of medication is decreased by intestinal absorption, renal excretion, and altered body distribution of fat, as well as a decrease in liver function.

A young woman is being discharged after a liver transplant. The young woman asks the nurse when she will be able to try to become pregnant. What would be an appropriate response by the nurse? A) "You will never have a period after a liver transplant and you will never be able to get pregnant." B) "You can consider trying to get pregnant now. Let's start you on prenatal vitamins today." C) "You should see a fertility specialist to discuss this topic." D) "Pregnancy can be considered 1 year after transplantation, but it is considered a high-risk pregnancy and you will need to discuss this with your doctor."

ANS: D The nurse should immediately address the patient's question by stating that research indicates that pregnancy can be considered 1 year after transplantation. The patient should also be informed that successful pregnancy outcomes have been reported, but these pregnancies carry a risk for the mother and infant and are considered high-risk pregnancies. The female patient should be informed that she should use a reliable form of birth control as she will have her menses and be able to get pregnant and pregnancy should be avoided for at least 1 year.

21. A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patients a. urine osmolality. b. serum potassium. c. blood glucose level. d. blood urea nitrogen (BUN) and creatinine.

ANS: D When a patient at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin.

4.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? 1. Aspirin 2. Acetaminophen 3. Diphenhydramine 4. Aluminum hydroxide

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 nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse's best response to this assessment finding? A) Document the presence of normal bile output. B) Irrigate the drainage system with normal saline as ordered. C) Aspirate a sample of the drainage for culture. D) Promptly report this assessment finding to the primary care provider.

Ans: A Feedback: Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary.

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace? A) Disposing of sharps appropriately and not recapping needles B) Performing meticulous hand hygiene at the appropriate moments in care C) Adhering to the recommended schedule of immunizations D) Wearing an N95 mask when providing care for patients on airborne precautions

Ans: A Feedback: HCV is bloodborne. Consequently, prevention of needlestick injuries is paramount. Hand hygiene, immunizations and appropriate use of masks are important aspects of overall infection control, but these actions do not directly mitigate the risk of HCV.

A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure? A) Position the patient on the right side with a pillow under the costal margin after the procedure. B) Administer 1 unit of albumin 90 minutes before the procedure as ordered. C) Administer at least 1 unit of packed red blood cells as ordered the day before the scheduled procedure. D) Confirm that the patient's electrolyte levels have been assessed prior to the procedure.

Ans: A Feedback: Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin. Prior administration of albumin or PRBCs is unnecessary. Coagulation tests should be performed, but electrolyte analysis is not necessary.

A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patient's current medication regimen includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? A) Two to 3 soft bowel movements daily B) Significant increase in appetite and food intake C) Absence of nausea and vomiting D) Absence of blood or mucus in stool

Ans: A Feedback: Lactulose (Cephulac) is administered to reduce serum ammonia levels. Two or three soft stools per day are desirable; this indicates that lactulose is performing as intended. Lactulose does not address the patient's appetite, symptoms of nausea and vomiting, or the development of blood and mucus in the stool.

A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease? A) Asterixis B) Constructional apraxia C) Fetor hepaticus D) Palmar erythema

Ans: A Feedback: The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but is not a flapping tremor.

A patient's physician has ordered a "liver panel" in response to the patient's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply. A) Alanine aminotransferase (ALT) B) C-reactive protein (CRP) C) Gamma-glutamyl transferase (GGT) D) Aspartate aminotransferase (AST) E) B-type natriuretic peptide (BNP)

Ans: A, C, D Feedback: Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.

A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the patient's cognition and behavior. What is the nurse's most appropriate response? A) Ensure that the patient's sodium intake does not exceed recommended levels. B) Report this finding to the primary care provider due to the possibility of hepatic encephalopathy. C) Inform the primary care provider that the patient should be assessed for alcoholic hepatitis. D) Implement interventions aimed at ensuring a calm and therapeutic care environment.

Ans: B Feedback: Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. This change in status is likely unrelated to sodium intake and would not signal the onset of hepatitis. A supportive care environment is beneficial, but does not address the patient's physiologic deterioration.

A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases? A) Persistent fever and cognitive changes B) Abdominal pain and hepatomegaly C) Peripheral edema unresponsive to diuresis D) Spontaneous bleeding and jaundice

Ans: B Feedback: The early manifestations of malignancy of the liver include pain—a continuous dull ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia, and anemia may also occur. The liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever, cognitive changes, peripheral edema, and bleeding are atypical signs.

A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention? A) Administration of immune globulins B) A regimen of antiviral medications C) Rest and watchful waiting D) Administration of fresh-frozen plasma (FFP)

Ans: B Feedback: There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that a combination of two antiviral agents, Peg-interferon and ribavirin (Rebetol), is effective in producing improvement in patients with hepatitis C and in treating relapses. Immune globulins and FFP are not indicated.

A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient states that she fell when transferring to the commode. The patient's vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse's most appropriate action? A) Remove the patient's commode and supply a bedpan. B) Complete an incident report and submit it to the unit supervisor. C) Have the patient assessed by the physician due to the risk of internal bleeding. D) Perform a focused abdominal assessment in order to rule out injury.

Ans: C Feedback: A fall would necessitate thorough medical assessment due to the patient's risk of bleeding. The nurse's abdominal assessment is an appropriate action, but is not wholly sufficient to rule out internal injury. Medical assessment is a priority over removing the commode or filling out an incident report, even though these actions are appropriate.

A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem? A) Assessment of blood pressure and assessment for headaches and visual changes B) Assessments for signs and symptoms of venous thromboembolism C) Daily weights and abdominal girth measurement D) Blood glucose monitoring q4h

Ans: C Feedback: Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not create a risk for unstable blood glucose or VTE.

A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

Ans: C Feedback: Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG abnormalities. Patients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as found in stage 3, and patients in stage 4 are comatose. In stage 4, there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.

22. A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patient's plan? A) Increased potassium intake B) Fluid restriction to 2 L per day C) Reduction in sodium intake D) High-protein, low-fat diet

Ans: C Feedback: Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased. There is no need for fluid restriction or increased protein intake.

Diagnostic testing has revealed that a patient's hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patient's plan of care will focus on what intervention? A) Cryosurgery B) Liver transplantation C) Lobectomy D) Laser hyperthermia

Ans: C Feedback: Surgical resection is the treatment of choice when HCC is confined to one lobe of the liver and the function of the remaining liver is considered adequate for postoperative recovery. Removal of a lobe of the liver (lobectomy) is the most common surgical procedure for excising a liver tumor. While cryosurgery and liver transplantation are other surgical options for management of liver cancer, these procedures are not performed at the same frequency as a lobectomy. Laser hyperthermia is a nonsurgical treatment for liver cancer.

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patient's liver? A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand. B) Place the left hand over the abdomen and behind the left side at the 11th rib. C) Place hand under right lower rib cage and press down lightly with the other hand. D) Hold hand 90 degrees to right side of the abdomen and push down firmly.

Ans: C Feedback: To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal quadrant.

A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient's increased risk of bleeding. The nurse recognizes that this risk is related to the patient's inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function? A) Alterations in glucose metabolism B) Retention of bile salts C) Inadequate production of albumin by hepatocytes D) Inability of the liver to use vitamin K

Ans: D Feedback: Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin.

A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the patient's family how to safely perform which of the following actions? A) Aspirating bile from the catheter using a syringe B) Removing the catheter when output is 15 mL in 24 hours C) Instilling antibiotics into the catheter D) Assessing the patency of the drainage catheter

Ans: D Feedback: Families should be taught to provide basic catheter care, including assessment of patency. Antibiotics are not instilled into the catheter and aspiration using a syringe is contraindicated. The family would not independently remove the catheter; this would be done by a member of the care team when deemed necessary.

A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse should be aware that this catheter will facilitate which of the following? A) Continuous monitoring for portal hypertension B) Administration of immunosuppressive drugs during the first weeks after transplantation C) Real-time monitoring of vascular changes in the hepatic system D) Delivery of a continuous chemotherapeutic dose

Ans: D Feedback: In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump that delivers a continuous chemotherapeutic dose until completed. The hepatic artery catheter does not monitor portal hypertension, deliver immunosuppressive drugs, or monitor vascular changes in the hepatic system.

A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate? A) Infusion of intravenous heparin B) IV administration of albumin C) STAT administration of vitamin K by the intramuscular route D) IV administration of octreotide (Sandostatin)

Ans: D Feedback: Octreotide (Sandostatin)—a synthetic analog of the hormone somatostatin—is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate control of variceal bleeding. Vitamin K and albumin are not administered and heparin would exacerbate, not alleviate, bleeding.

A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding? A) Similar liver size and texture as in younger adults B) A nonpalpable liver C) A slightly enlarged liver with palpably hard edges D) A slightly decreased size of the liver

Ans: D Feedback: The most common age-related change in the liver is a decrease in size and weight. The liver is usually still palpable, however, and is not expected to have hardened edges.

A nurse is amending a patient's plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patient's care plan? A) Mobilization with assistance at least 4 times daily B) Administration of beta-adrenergic blockers as ordered C) Vitamin B12 injections as ordered D) Administration of diuretics as ordered

Ans: D Feedback: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers are not used to treat ascites and bed rest is often more beneficial than increased mobility. Vitamin B12 injections are not necessary.

Which priority teaching information should the nurse discuss with the client to help prevent contracting hep. A? 1.Explain the importance of good hand washing. 2.Tell the client to take the hepatitis B vaccine in three (3) doses. 3.Tell the client not to ingest unsanitary food or water. 4.Discuss how to implement standard precautions.

Answer 1 would be appropriate for prevention of hepatitis A.

Which priority teaching information should the nurse discuss with the client to help prevent contracting hep. B? 1.Explain the importance of good hand washing. 2.Tell the client to take the hepatitis B vaccine in three (3) doses. 3.Tell the client not to ingest unsanitary food or water. 4.Discuss how to implement standard precautions.

Answer 1 would be appropriate for prevention of hepatitis A.

"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.

"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 female 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 female 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 RN is providing discharge information to a client with hep B. The RN instructs the client to prevent transmission via: 1. 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 RN 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.

The RN is providing discharge information to a client with hep B. The RN 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 RN 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"

"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."

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.

"Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? "a. Hep A. b. Hep. B. c. Hep. C. d. Hep D

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

"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 a condom during sexual intercourse c. Have family members get an injection of immunoglobin d. Follow a low-protein, moderate-carbohydrate, moderate-fat diet

Answer B Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

"A patient with hepatitis B is being discharged in 2 days. In the discharge teching plan the nurse should include instructions to: a. Avoid alcohol for the first 3 weeks b. Use a condom during sexual intercourse c. Have family members get an injection of immunoglobin d. Follow a low-protein, moderate-carbohydrate, moderate-fat diet

Answer B Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

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.

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.

To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when: "A. Disposing of food trays B. Emptying the bed pan C. Taking an oral temperature D. Changing IV tubing"

Answer B, Rationale: 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 nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention? A.Suggest that the client take warm showers. B.Add baby oil to the client's bath water. C.Apply powder to the client's skin. D.Suggest a hot-water rinse after bathing.

Answer B. Applying baby oil could help soothe the itchy skin. Answer A, C, and D would increase dryness and worsen the itching.

A client with end-stage renal disease is receiving continuous ambulatory peritoneal dialysis. The nurse is monitoring the client for signs of complications associated with peritoneal dialysis. Select all that apply. 1. Pruritus 2. Oliguria 3. Tachycardia 4. Cloudy outflow 5. Abdominal pain

Answer: 3, 4, 5 Rationale: Tachycardia can be caused by peritonitis, a complication of peritoneal dialysis; the heart rate increases to meet the metabolic demands associated with infection. Cloudy or opaque dialysate outflow (effluent) is the earliest sign of peritonitis; it is caused by the constituents associated with an infectious process. Abdominal pain is associated with peritonitis, a complication of peritoneal dialysis; pain results from peritoneal inflammation, abdominal distention, and involuntary muscle spasms. Severe itching (pruritus) is caused by metabolic waste products that are deposited in the skin; dialysis removes metabolic waste products, preventing this adaptation associated with kidney failure. The production of abnormally small amounts of urine (oliguria) is a sign of kidney failure, not a complication of peritoneal dialysis.

A patient with diabetes who has chronic kidney disease (CKD) is considering using continuous ambulatory peritoneal dialysis (CAPD). In discussing this treatment option with the patient, the nurse informs the patient that a. patients with diabetes who use CAPD have fewer dialysis-related complications than those on hemodialysis. b. home CAPD requires more extensive equipment than does home hemodialysis. c. CAPD is contraindicated for patients who might eventually want a kidney transplant. d. dietary restrictions are stricter for patients using CAPD than for those having hemodialysis.

Answer: A Rationale: Patients with diabetes have better control of blood pressure, less hemodynamic instability, and fewer problems with retinal hemorrhages when using peritoneal dialysis than when using hemodialysis. CAPD is less expensive and has fewer dietary restrictions than hemodialysis. CAPD is not a contraindication for a kidney transplant.

The nurse is concerned that a client with potential hepatic failure is at risk for developing ascites. Which assessment finding would indicate this development? A) Increased abdominal girth B) Gallbladder pain C) Yellow-tinged skin D) Bleeding and bruising easily

Answer: A A) Ascites is the accumulation of the fluid in the abdomen, and is a result of liver failure. The client with ascites would have an increased abdominal girth. Jaundice is manifested as yellow-tinged skin, and is the result of hepatic disorders. The client experiencing hepatic problems might have bleeding and bruising issues due to inadequate vitamin K. Obstructed biliary flow could be the cause of gallbladder pain.

A client with acute renal failure is complaining of a metallic taste in the mouth and has no appetite. What should the nurse do to help this client's nutritional status? A) Provide mouth care before meals. B) Administer an antiemetic as prescribed. C) Restrict fluids. D) Encourage the intake of protein, salt, and potassium.

Answer: A Explanation: A) A metallic taste in the mouth is due to a build-up of uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic is prescribed for nausea. Restricting fluids will not reduce the metallic taste in the mouth. Encouraging the intake of protein, salt, and potassium will exacerbate the build-up of uremia which is causing the metallic taste in the mouth.

A client with renal failure will be discharged to home in the next few days. The nurse plans to reinforce dietary teaching for the client. The nurse teaches the client to choose proteins that are high in biological value. Which client statement indicates that teaching has been effective? A) "I will be sure to include eggs in my diet." B) "I should include vegetables at every meal." C) "Legumes should be included in my diet, as they are complete proteins." D) "I will eat nuts daily because they are high in protein."

Answer: A Explanation: A) Eggs are an excellent source of essential amino acids and are recommended as part of the diet for a client with renal failure who is on a protein-restricted diet. Legumes, nuts, and vegetables do contain protein, but they are incomplete proteins and are not as good protein sources as are eggs.

A nurse is caring for a client who was recently admitted for treatment of cirrhosis. The client is currently experiencing BP of 200/100, +3 pitting edema, and shortness of breath. Which diagnosis should the nurse select as a priority for this client? A) Excess Fluid Volume B) Ineffective Tissue Perfusion C) Deficient Fluid Volume D) Impaired Skin Integrity

Answer: A Explanation: A) The client experiencing shortness of breath, edema, and hypertension should have a care plan for fluid volume excess. Hypertension, shortness of breath, and edema are manifestations of fluid excess. Hypotension and dry mucous membranes are associated with deficient fluid volume. Ineffective Tissue Perfusion would be the appropriate diagnosis for a client experiencing cyanosis or tissue necrosis. Edema can cause an alteration in skin integrity, but there is no evidence of such problems with this client.

The nurse is planning care for the client with acute renal failure. The nurse selects Excess Fluid Volume as a nursing diagnosis based on what assessment finding? A) Pitting edema in the lower extremities B) Bowel sounds positive in 4 quadrants C) Wheezing in the lungs D) Generalized weakness

Answer: A Explanation: A) The client in acute renal failure will likely be edematous, as the kidneys are not producing urine. Wheezing in the lungs is an assessment consistent with asthma. Bowel sounds in 4 quadrants is a normal assessment finding. Generalized weakness may be due to whatever disease process precipitated the renal failure.

The nurse is preparing to discharge a client with chronic kidney disease. The nurse is teaching the client and family about administering calcium acetate 2 tablets by mouth with each meal at home. Which explanation by the nurse is most appropriate? A) "The calcium acetate will lower your serum phosphate levels." B) "The calcium acetate helps to neutralize your gastric acids." C) "The calcium acetate will help to stimulate your appetite." D) "The calcium acetate will decrease your serum creatinine levels."

Answer: A Explanation: A) The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease. This medication has no effect on appetite stimulation.

A client diagnosed with liver cirrhosis is being treated for an infection. For which complication should the nurse monitor the​ client? A: Portal hypertension B: Hepatic encephalopathy C: Esophageal varices D: Wilson disease

Answer: B

"A patient with hepatitis A is in the acute phase. The nurse plans to care for the patient based on the knowledge that "A. pruritus is a common problem with jaundice in this phase. B. the patient is most likely to transmit the disease in this phase. C. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. D. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.

Answer: A" The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

The nurse is concerned that an older client is at risk for developing acute renal failure. What client information caused the nurse to have this concern? Select all that apply. A) Diagnosed with hypotension B) Scheduled for aortic valve replacement surgery C) Prescribed high doses of intravenous antibiotics D) Previous total hip replacement surgery E) Taking medication for type 2 diabetes mellitus

Answer: A, B, C Explanation: A) Older adults develop acute renal failure more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for kidney failure. Hypotension, scheduled for aortic valve replacement surgery, and receiving high doses of intravenous antibiotics increase this client's risk for developing acute renal failure. A previous history of major surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute renal failure.

A client with frequent urinary tract infections in being seen in the urology clinic. The client asks the nurse if there is a chance of acute renal failure. The nurse explains that which risk factor can lead to acute renal failure? Select all that apply. A) Dehydration B) Renal calculi C) Ineffective would healing D) Low serum albumin E) Hypertension

Answer: A, B, E Explanation: A) Dehydration, renal calculi, and hypertension can all precipitate acute renal failure (ARF). Ineffective wound healing has not been shown to cause renal failure unless the infection becomes systemic. A low serum albumin does not cause ARF.

The nurse is caring for a client with cirrhosis of the liver. Which risk factors should the nurse expect to find in the​ client's history? ​(Select all that​ apply.) A: Injection drug use B: Hepatitis E infection C: Excessive alcohol use D: Biliary atresia E: Hepatitis C infection

Answer: A, C, E

A client with liver disease presents to the hospital with severe ascites. The nurse caring for the client understands that the pathophysiology involved in the development of ascites includes: Select all that apply. A) Presence of portal hypertension. B) Presence of hyperalbuminemia. C) Increased colloidal osmotic pressure. D) Sodium and water retention. E) Presence of hypoaldosteronism.

Answer: A, D Explanation: A) Ascites is the accumulation of plasma-rich fluid in the abdominal cavity. Although portal hypertension is the primary cause of ascites, decreased serum proteins and increased aldosterone also contribute to the fluid accumulation. Hypoalbuminemia (low serum albumin) decreases the colloidal osmotic pressure of plasma. This pressure normally holds fluid in the intravascular compartment, but when the plasma colloidal osmotic pressure decreases, fluid escapes into extravascular compartments. Hyperaldosteronism (an increase in aldosterone) causes sodium and water retention, contributing to ascites and generalized edema.

While visiting a family, the community nurse learns that the youngest child is home from school because of a sudden onset of nausea, vomiting, and lethargy. For which additional manifestations of acute renal failure should the nurse assess the child? Select all that apply. A) Elevated blood pressure B) Postural hypotension C) Wheezing D) Edema E) Hematuria

Answer: A, D, E Explanation: A) Pediatric manifestations of acute renal failure characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute renal failure in an older person. Wheezing is not a manifestation of acute renal failure.

The nurse is preparing to administer a hemodialysis treatment for a client with chronic kidney disease. Which laboratory values are expected for this client prior to hemodialysis occurring? Select all that apply. A) Increased blood urea nitrogen (BUN) B) Decreased potassium C) Decreased phosphorus D) Increased urine osmolality E) Increased creatinine

Answer: A, E Explanation: A) The damaged kidney is unable to excrete waste products, including creatinine, so it will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.

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

The patient with hemodialysis for ESRD arrives to the clinic c/o DOE and fatigue. The vitals are as follows: BP 154/89 HR 78 RR 18 T 95.5 Spo2 90%. Upon auscultation crackles are noted in bases of lungs. The patient also states that he has been experiencing muscle aches. What is the first question the nurse should ask? A) Have you been following your dietary restrictions? B) Are you taking your blood pressure medication? C) How much activity are you getting in a day? D) Have you noticed any swelling at the dialysis site?

Answer: A. The crackles in the lungs, elevated blood pressure and muscle aches indicate that possibly the client has not been following his dietary restrictions and it has led to pulmonary edema, HTN and hyperkalemia. Although it is important to know if the patient is taking the blood pressure medication, all of the signs and symptoms indicate that something bigger is going on. Activity and swelling at the dialysis site are not priority questions.

A patient receiving peritoneal dialysis using 2 L of dialysate per exchange has an outflow of 1200 ml. Which action should the nurse take first? a. Infuse 1200 ml of dialysate during the inflow. b. Assist the patient in changing position. c. Administer a laxative to the patient. d. Notify the health care provider about the outflow problem.

Answer: B Rationale: Outflow problems may occur because the peritoneal catheter is collapsed by a portion of the intestine, and repositioning the patient will move the catheter and allow outflow to occur. If less than the ordered 2 L of dialysate is infused, the dialysis will be less effective. Administration of a laxative may also help if the patient's colon is full, but this should be tried after repositioning the patient. If the problem with outflow persists after the patient is repositioned, the health care provider should be notified.

"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"

"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 nurse determines that a client is at risk for contracting hepatitis B because of intravenous drug use. What should the nurse teach to reduce the client's risk for this health problem? A) Avoid contaminated food and water. B) Avoid sharing needles. C) Avoid alcohol consumption. D) Wash hands frequently, as the disease is transmitted via the fecal-oral route.

Answer: B Explanation: A) Hepatitis B is contracted through contaminated blood and body fluids. The client will increase the risk of contracting hepatitis B by sharing needles. Hepatitis A is transmitted via the fecal-oral route. Laënnec's cirrhosis is the result of alcohol and hepatitis B and C. Contaminated food and water causes hepatitis A, not B.

The nurse is caring for a client admitted with a diagnosis of acute renal failure. The client asks the nurse, "Are my kidneys failing? Will I need a kidney transplant?" What is the appropriate nurse response? A) "No, don't think that. You're going to be fine." B) "Your condition can be reversed with prompt treatment and usually will not destroy the kidney." C) "Kidney transplantation is highly likely, and it would be a good idea to start talking to family members." D) "When the doctor comes to see you, we can talk about whether you will need a transplant."

Answer: B Explanation: B) Acute renal failure is often resolved without the need for transplant if treatment is initiated quickly. There is no need to start lining up donors or wait for the provider to arrive to explore options. Telling the client that everything will be fine is condescending, provides no information, and is not within the nurse's ability to know.

While caring for a client with end-stage renal disease, the nurse tracks the client's serum albumin level. For which nursing diagnosis is the action most indicated? A) Excess Fluid Volume B) Imbalanced Nutrition: Less Than Body Requirements C) Risk for Ineffective Perfusion D) Risk for Infection

Answer: B Explanation: B) Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less Than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.

A client with acute renal failure has jugular vein distention, lower extremity edema, and elevated blood pressure. Which nursing diagnosis should the nurse use to plan care for these findings? A) Ineffective Renal Tissue Perfusion B) Excess Fluid Volume C) Risk for Altered Cardiac Perfusion D) Risk for Infection

Answer: B Explanation: B) Jugular vein distention, edema, and elevated blood pressure are indications of excessive fluid. The diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Altered Cardiac Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.

The nurse is caring for client recovering from a liver transplant necessitated by cirrhosis of the liver. Which postoperative outcome would be a priority for this client? A) Moist membranes of the mouth B) Normal serum bilirubin levels C) Ability to move the legs D) Normal pupil reaction

Answer: B Explanation: B) Normal bilirubin levels would indicate that the transplanted liver is functioning correctly. Normal pupil reaction, leg movement, and moist mouth membranes are all normal findings for any postoperative client.

The nurse is caring for a client with cirrhosis of the liver. Which information in the client's health history supports this diagnosis? A) Smokes two packs of cigarettes per day. B) Drinks a six-pack of beer each evening. C) Eats salads for lunch every day. D) Plays on an adult softball team several times a week.

Answer: B Risk factors for the development of cirrhosis of the liver include excessive alcohol intake. Smoking, ingestion of salads, and exercise are not risk factors for the development of this health problem.

Key term: Asterixis

Asterixis: Aka: "Liver flap" a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. Associated with liver damage (cirrhosis)

"To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when A. Disposing of food trays B. Emptying bed pan C. Taking an oral temperature D. Changing IV tubing"

Answer: B Rationale: 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.

"To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when "A. Disposing of food trays B. Emptying bed pan C. Taking an oral temperature D. Changing IV tubing"

Answer: B Rationale: 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 community health nurse is planning education for a group of individuals from Alcoholics Anonymous on the risk factors for liver disease. The group has a high number of Native Americans in attendance. What should the nurse explain as the reasons for the high incidence of cirrhosis in this ethnic group? Select all that apply. A) Pollution B) Variations in alcohol metabolism C) Stress due to socioeconomic factors D) Consuming alcohol with food E) Climate

Answer: B, C Explanation: B) Alcohol consumption is the sixth-leading cause of death for Native Americans, particularly Alaskans. It is thought that contributing factors include variations in alcohol metabolism, socioeconomic factors that lead to stress, and, consuming alcohol without food. Climate and pollution are not factors.

A nurse is caring for a client with end-stage liver disease. Which hematological alterations might the nurse anticipate with this client? Select all that apply. A) Elevated serum albumin levels due to increased protein synthesis B) Decreased clotting factor levels due to impaired clotting mechanisms C) Hyperglycemia due to disrupted glucose metabolism D) Increased serum vitamin K due to impaired clearance of fat-soluble vitamins E) Increased plasma oncotic pressure due to impaired protein metabolism

Answer: B, C Explanation: B) Impaired function of liver cells has multiple effects. Impaired protein metabolism with decreased production of albumin and clotting factors occurs. Low albumin levels contribute to edema in peripheral tissues and ascites (accumulation of fluid in the abdomen), as plasma oncotic pressure is reduced, not increased. Impaired clotting-factor production increases the risk for bleeding. Disrupted glucose metabolism and storage may result in hyperglycemia. Also, serum vitamin K is decreased due to impaired absorption of fat-soluble vitamins.

10) The nurse is planning a seminar to instruct community members on ways to reduce the development of chronic kidney disease. What should the nurse include in this teaching? Select all that apply. A) Avoid eating red meat. B) Control blood glucose levels in diabetes mellitus. C) Adhere to medication regimen to control hypertension. D) Participate in regular exercise. E) Avoid smoking.

Answer: B, C, D, E Explanation: B) Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of end-stage renal disease.

Nurse Faith is preparing to teach the patient with CKF about dietary modifications. Which of the following aspects of the patient is most important for the nurse evaluate before teaching begins? A) Family Hx B) Attention span C) Uric Acid level D) Support system

Answer: B. Because CKF often affects and limits the attention span and ability to concentrate, it is important for the nurse to assess this before beginning teaching. Often teaching will need to be done in increments of 10-15 minute periods

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 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

Which laboratory test is prescribed for a client with suspected​ cirrhosis? A: WBC count B: CO2 level C: Liver biopsy D: O2 level

Answer: C

The nurse is caring for a client with chronic renal disease. The client is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to chronic renal disease. A student nurse assigned to assist the nurse asks why the client is anemic. Which response by the nurse is best? A) "It is most likely that the client has a genetic tendency for the development of anemia." B) "The increased metabolic waste products in the body depress the bone marrow." C) "There is a decreased production by the kidneys of the hormone erythropoietin." D) "The client is not eating enough iron-rich foods."

Answer: C Explanation: C) Anemia is common in clients with renal disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not suppress the bone marrow. Diet and heredity do not factor into the production of erythropoietin.

A child who is in renal failure has hyperkalemia. The nurse is planning meals for the child while hospitalized. Which meal choice would be most appropriate for this client? A) Hamburger on a bun, banana B) Cold cuts with bun with fresh pears C) Spaghetti and meat sauce, breadsticks D) Carrots and green, leafy vegetables

Answer: C Explanation: C) Carrots; green, leafy vegetables; pears; and bananas are high in potassium. Spaghetti and meat sauce with breadsticks would be the most appropriate meal from the choices provided.

A client with liver cirrhosis begins to drain bright red blood through the nasogastric tube. What should the nurse prepare to administer to this client? A) Vitamin K B) Ferrous sulfate C) Platelets D) Folic acid

Answer: C Explanation: C) Ferrous sulfate and folic acid are given as indicated to treat anemia. Vitamin K may be ordered to reduce the risk of bleeding. When bleeding is acute, packed RBCs, fresh frozen plasma, or platelets may be administered to restore blood components and promote hemostasis.

A client with hypertension, surprised to be diagnosed with chronic kidney disease, asks how this disease could have developed. What should the nurse respond to the client? A) "Thickening of the kidney structures and gradual death of nephrons." B) "Cysts compress renal tissue that destroys the kidneys." C) "A long history of hypertension reduces renal blood flow and harms the kidney tissue." D) "Immune complexes form in the kidney tissue that causes inflammation."

Answer: C Explanation: C) Longstanding hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. Diabetic nephropathy causes renal failure by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes renal failure by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Systemic lupus erythematosus causes renal failure by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.

A client with renal failure is being treated with peritoneal dialysis. The nurse is explaining the process to the client. Which statement would the nurse include in a discussion with the client and family? A) "The peritoneum is more permeable because of the presence of excess metabolites." B) "The metabolites will diffuse from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration." C) "The peritoneum acts as a semi-permeable membrane through which wastes move by diffusion and osmosis." D) "The solutes in the dialysate will enter the bloodstream through the peritoneum."

Answer: C Explanation: C) The peritoneum acts as a semipermeable membrane, allowing substances to move from an area of high concentration (the blood) to an area of lower concentration (the dialysate). Metabolic waste products and excess water can be eliminated through osmosis and diffusion utilizing the peritoneum as the semipermeable membrane.

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.

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.

You are teaching the patient with chronic kidney disease about what symptoms to report to the doctor when outside of the hospital. Which statement, if made by the patient, indicates correct understanding? A) "I should call my doctor if my stomach starts feeling sick or my breath smells funny like pea" B) "Muscle weakness and abdominal cramps are a sign of worsening condition and I should report this to my doctor" C) "My doctor wants me to call him if I feel a vibrating or buzzing sensation over my hemodialysis graft. D) "I should call immediately if I see swelling at my dialysis port"

Answer: C. The patient should be taught to call the doctor if he/she does NOT find a thrill over this graft as this indicates that the graft may no longer by patent. Nausea/vomiting and uric breath (smells like urine/ammonia) should be reported to the physician as this is a sign of worsening renal function. Muscle weakness and abdominal cramps are signs of hyperkalemia which could lead to life threatening arrhythmias. Swelling or redness at the dialysis port would be a sign of infection which should be reported.

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.

A client with cirrhosis is being evaluated for discharge. Which outcome and nursing observation indicate the client is ready for discharge​ home? A: Only slight bruising B: Easily reoriented to person C: Only slightly elevated liver function tests D: Improved coagulation studies

Answer: D

A nurse is caring for a client with cirrhosis. Which assessment finding warrants immediate​ attention? A: Oxygen saturation of​ 92% B: Pulse of 60 bpm C: Blood pressure of​ 110/72 mmHg D: Abdominal distention

Answer: D

For which manifestation should the nurse assess in a client with hepatorenal​ syndrome? A: Esophageal varices B: Fever C: Asterixis D: Sodium retention

Answer: D

A 5-year-old child is in the hospital with acute renal failure following a streptococcus infection. The parents are Spanish-speaking and speak little English. The parents, through an interpreter, ask the nurse what mistake they made that caused the child to be so sick. What is the most appropriate response by the nurse? A) "Your child does not have enough dietary protein." B) "Your child has a congenital defect that led to renal failure." C) "Your child's renal failure has been caused by a low calcium level." D) "Your child's recent infection precipitated the renal failure."

Answer: D Explanation: D) Clients with streptococcus are at risk for kidney and cardiac sequelae. In this case, the child has no evidence of a congenital defect leading to acute renal failure (ARF). A low-protein or low-calcium diet will not lead to ARF.

The nurse is caring for a 68-year-old client diagnosed with chronic kidney disease. The client reports no bowel movement in the past 2 days. This client is at an increased risk for which condition? A) Metabolic acidosis B) Hypercalcemia C) Increased serum creatinine levels D) Hyperkalemia

Answer: D Explanation: D) Constipation exacerbates hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium. Hypokalemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.

A client with chronic kidney disease is experiencing manifestations of anemia. Which treatment should the nurse expect to be prescribed for this client? A) Begin a fluid restriction. B) Administer intravenous glucose and insulin. C) Begin a low-sodium diet. D) Epoetin injections

Answer: D Explanation: D) Epoetin injections are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In chronic kidney disease, this hormone production will be reduced. A fluid restriction would be indicated for uremia caused by chronic kidney disease. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by chronic kidney disease. A low-sodium diet is used to help reduce fluid volume excess that is caused by chronic kidney disease.

A client agrees to receive long-term hemodialysis to treat acute renal failure. For which surgical procedure should the nurse instruct this client? A) Insertion of a double-lumen catheter into the subclavian artery B) Placement of a peritoneal catheter C) Insertion of a subarachnoid-peritoneal shunt D) Placement of an arteriovenous fistula

Answer: D Explanation: D) For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis and not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebral spinal fluid and not for hemodialysis.

The nurse instructs a client with chronic kidney disease on the prescribed medication furosemide (Lasix). Which client statement indicates that teaching has been effective? A) "I will take this medication to keep my calcium balance normal." B) "This medication will make sure I have enough red blood cells in my body." C) "I will take this pill to keep my protein level in my body stable." D) "This pill will reduce the swelling in my body and get rid of the extra potassium."

Answer: D Explanation: D) Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with chronic kidney disease that is used to stabilize protein levels in the body.

The nurse is caring for a client from another country who was admitted with hypertension and chronic kidney disease. The client is receiving hemodialysis three times a week. The nurse is assessing the client's diet and the client reports the use of salt substitutes. The nurse knows that salt substitutes should be avoided by this client because: A) They will increase the risk of AV fistula infection. B) They will cause the client to retain fluid. C) They will interact with the client's antihypertensive medications. D) They can potentiate hyperkalemia.

Answer: D Explanation: D) Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitute is to be avoided. The control of hypertension is essential in the management of a client with kidney disease, but salt substitute is not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection could be caused by constricting clothing, venipunctures, and other items.

The family of a client with cirrhosis of the liver asks what symptoms they need to look for while the client is being cared for in their home. What should the nurse teach the family that indicates portal hypertension in this client? A) Muscle wasting B) Hypothermia C) Bleeding gums D) Hemorrhoids

Answer: D Explanation: D) Obstruction to portal blood flow causes a rise in portal venous pressure, resulting in splenomegaly, ascites, and dilation of collateral venous channels predominately in the paraumbilical and hemorrhoidal veins and the cardia of the stomach, and extending into the esophagus. Bleeding gums indicate insufficient vitamin K production in the liver. Muscle wasting is commonly associated with the poor nutritional intake seen in clients with cirrhosis. Hypothermia is an unrelated finding.

The nurse is planning care for a client admitted with heart failure. For which type of kidney failure should the nurse select interventions to prevent the development in this client? A) Prerenal hypovolemia B) Intrarenal glomerular injury C) Intrarenal acute tubular necrosis D) Prerenal low cardiac output

Answer: D Explanation: D) One cause of prerenal kidney failure due to low cardiac output is heart failure. Causes of prerenal kidney failure due to hypovolemia include hemorrhage, dehydration, excess fluid loss from the gastrointestinal tract, burns, and wounds. Causes of intrarenal kidney failure due to glomerular injury include glomerulonephritis, disseminated intravascular coagulation, vasculitis, hypertension, toxemia of pregnancy, and hemolytic uremic syndrome. Causes of intrarenal kidney failure due to acute tubular necrosis include ischemia resulting from conditions associated with prerenal failure, toxins, hemolysis, and rhabdomyolysis.

A nursing student has been assigned to complete medication cards for the assigned client who is hospitalized with chronic kidney disease. The student is evaluating the therapeutic effect of the drug sodium polystyrene sulfonate (Kayexalate) in this client. Which is the therapeutic finding for this client? A) Increased serum sodium B) Increased stool excretion C) Decreased urine specific gravity D) Decreased serum potassium

Answer: D Explanation: D) The client with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the sodium level or the specific gravity.

Nurse Shelby is preparing to administer selvemer hydrochloride (Renagel) to the patient with CKF (Chronic Kidney Disease). Which of the following does the nurse know to be true? A) This medication should be given on an empty stomach B) It is used to treat hyperphosphatemia C) To administer at bedtime D) Renagel can be used to help with hypercalcemia

Answer: D. Renegal is a phosphate binder and is used to help lower calcium levels. It is also given if the calcium-phosphorous product is elevated (over 55). Calcium and Phosphate binders should be given with food. This medication is not used to treat hyperphosphatemia. Remember, the calcium phosphorous balance is important with patients with CKF because if it is imbalanced it can lead to bone disease.

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

"The school nurse is discussing ways to prevent an outbreak of hepatitis A with a groupof high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? 1. Do not allow students to eat or drink after each other 2. Drink bottled water as much as possible. 3. Encourage protected sexual activity. 4. Throughly wash hands.

Answer= 4 1. Eating after each other should be discouraged but it is not the most important intervention. 2. only bottle water should be consumed in Third World countries, but that precaution is not necessary in American high schools. 3. Hepatitis B and C, not hepatitis A, are transmitted by sexual acvitity. 4. Hepatitis A is transmitted via the fecal-oral route. Good hand washing helps to prevent its spread.

c (​Rationale: Once vascular and renal perfusion has been​ restored, fluid intake for clients with AKI is usually restricted because the kidneys cannot eliminate fluids normally. Fluid intake is calculated for these clients by adding the amount of output for the previous 24 hours to 500 mL to allow for insensible losses. The​ client's output for the past 24 hours was 250​ mL; added to 500​ mL, the fluid volume calculation equals 750 mL. A fluid intake of​ 1250, 2750, or 3000 mL would be too much fluid for the client and would put the client at risk for fluid overload.)

A​ 63-year-old man is admitted with postrenal acute kidney injury​ (AKI) because of a kidney stone. Vascular volume and renal perfusion have been restored and he is on fluid restriction. During the past 24​ hours, he has voided 250 mL of urine. He has not had any other type of output. How much fluid should the client receive over the next 24​ hours? A. 2750 mL B. 1250 mL C. 750 mL D. 3000 mL

17. Which of the following is the most common overall sign of acute renal failure? a. Urine develops a fruity odor b. Expected urine output increases or decreases significantly c. Urine specific gravity is greater than 1.040 d. Urine develops a root beer color and consistency

B

2. A nurse is evaluating a client's demonstration of peritoneal dialysis. Which of the following actions by the client demonstrates a need for further teaching? a. Primes the tubing with solution and connects it to the peritoneal catheter, taping connections. b. Instills the dialysate into the abdominal cavity quickly and clamps the tubing. c. Checks the tubing and catheter for kinks. d. Opens clams and allows the dialysate to drain by gravity after the prescribed dwell time.

B

28. The nurse is conducting peritoneal dialysis for a client with renal failure. The drainage tubing had no outflow. Which of the following actions should the nurse take first? a. Notify the physician b. Check the tubing for kinks or obstruction c. Try a more concentrated dialysate solution d. Apply a 5 pound sandbag to the abdomen

B

The liver receives blood from two sources. The _____________ is responsible for pumping blood rich in nutrients to the liver.* A. hepatic artery B. hepatic portal vein C. mesenteric artery D. hepatic iliac vein

B

The liver receives it blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen.* A. hepatic artery, low, high B. hepatic portal vein, high, low C. hepatic lobule, high, low D. hepatic vein, low, high

B

Which patient below is at MOST risk for developing a complication related to a Hepatitis E infection?* A. A 45-year-old male with diabetes. B. A 26-year-old female in the 3rd trimester of pregnancy. C. A 12-year-old female with a ventricle septal defect. D. A 63-year-old male with cardiovascular disease.

B

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action? a. Monitor the client. b. Notify the physician. c. Elevate the head of the bed. d. Medicate the client for nausea.

B Disequilibrium syndrome may be caused by the rapid decreases in the blood urea nitrogen level during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The physician must be notified.

A​ 63-year-old man is admitted with postrenal acute kidney injury​ (AKI) because of a kidney stone. Vascular volume and renal perfusion have been restored and he is on fluid restriction. During the past 24​ hours, he has voided 250 mL of urine. He has not had any other type of output. How much fluid should the client receive over the next 24​ hours? A) 1250 mL B) 750 mL C) 3000 mL D) 2750 mL

B) 750 mL Rationale: Once vascular and renal perfusion has been​ restored, fluid intake for clients with AKI is usually restricted because the kidneys cannot eliminate fluids normally. Fluid intake is calculated for these clients by adding the amount of output for the previous 24 hours to 500 mL to allow for insensible losses. The​ client's output for the past 24 hours was 250​ mL; added to 500​ mL, the fluid volume calculation equals 750 mL. A fluid intake of​ 1250, 2750, or 3000 mL would be too much fluid for the client and would put the client at risk for fluid overload.

What nursing intervention should be used to decrease pruritus in clients with liver disease? A) Vigorously scrub the skin with soap to prevent infection. B) Apply a lubricant on the skin to prevent dry skin. C) Use hot water rather than cool water when bathing the client. D) Administer an antihistamine as needed to reduce itching.

B) Apply a lubricant on the skin to prevent dry skin Rationale: Clients with pruritus require nursing interventions aimed at reducing itching and promoting skin integrity. Emollients or lubricants should be applied as needed to keep the skin moist. The skin should not be rubbed, and soap or preparations with alcohol should be avoided. Warm water should be used rather than hot water when bathing, because hot water increases pruritus. Antihistamines should be used cautiously because decreased liver function could alter drug responses.

*Shit question alert* The nurse is teaching a client how to prevent the development of cirrhosis. Which intervention should the nurse include? A) Discontinue all meds B) Avoid illegal drugs C) Cut down on alcohol use D) Get a yearly flu shot

B) Avoid illegal drugs Rationale: Clients with diagnosed liver disease are at increased risk for cirrhosis. To prevent cirrhosis from​ occurring, clients should avoid illegal drugs. They should​ avoid, not just cut down​ on, all alcohol and continue taking all medications as prescribed. Flu shots are not known to prevent cirrhosis.

The nurse is treating a client with a potassium level of 6.7 who is already on restricted potassium intake. Which medication may be ordered to reduce the neuromuscular effects of this increased level? A) H2-receptor antagonist B) Calcium chloride C) Antibiotic D) Lactated Ringer

B) Calcium chloride Rationale: Hyperkalemia may require active intervention as well as restricted potassium intake. When the serum potassium level is greater than 6.0-6.5 ​mEq/L, manifestations of its effect on neuromuscular function​ develop, including muscle​ weakness, nausea and​ diarrhea, electrocardiographic​ changes, and possible cardiac arrest. With significant​ hyperkalemia, calcium​ chloride, bicarbonate, and insulin and glucose may be given intravenously to reduce serum potassium levels by moving potassium into the cells. An​ H2-receptor antagonist helps prevent gastrointestinal hemorrhage by decreasing gastric acid production. An antibiotic would be used to treat infection. Lactated Ringer would be used in children with AKI for fluid replacement.

The nurse is caring for a client who complains of jaundice and pruritus. The HCP suspects that the client has liver disease. What modifiable risk factor for cirrhosis of the liver might the nurse see in the client's history? A) Smokes two pack of cigarettes/day B) Drinks 6 beers/day C) Hx of occupational exposure to hepatic toxins D) Family hx of fatty liver dz

B) Drinks 6 beers/day Rationale: Risk factors for the development of cirrhosis of the liver include excessive alcohol intake. Smoking is a risk factor for lung disease. A family history of fatty liver disease and past history of exposure to hepatic toxins may contribute to the risk of liver disease, but they are not modifiable risk factors.

A client diagnosed with acute kidney injury (AKI) has jugular vein distention, lower extremity edema, and elevated blood pressure. Based on this data, which nursing diagnosis is most appropriate? A) Ineffective Renal Tissue Perfusion B) Excess Fluid Volume C) Risk for Decreased Cardiac Tissue Perfusion D) Risk for Infection

B) Excess Fluid Volume Rationale: Jugular vein distention, edema, and elevated blood pressure are all indications of excess fluid. Thus, the diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Decreased Cardiac Tissue Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.

The graduate nurse is creating a care plan for a client diagnosed with cirrhosis. Which diagnosis assigned by the graduate nurse to the client should be questioned by the nursing preceptor? A) Skin Integrity: Impaired B) Fluid Volume: Deficient C) Nutrition, Imbalanced: Less than Body Requirements D) Protection: Ineffective

B) Fluid Volume: Deficient Rationale: Appropriate nursing diagnoses for a client with cirrhosis include Skin​ Integrity: Impaired due to pruritus as a result of bile salt deposits on the​ skin; ​Protection: Ineffective due to compromised mental​ status, and ​Nutrition, Imbalanced: Less than Body Requirements due to the​ client's salt and protein restrictions which may make the diet less palatable and appealing. Fluid​ Volume: Excess​, not Fluid​ Volume: Deficient​, is appropriate for a client with cirrhosis.​ (NANDA-I ©2014) Next Question

In replying to a patient's questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on what? A) Total daily urine output B) Glomerular filtration rate C) Degree of altered mental status D) Serum creatinine and urea levels

B) Glomerular filtration rate

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? a) "I'll wash my hands often." b) "How did this happen? I've been faithful my entire marriage." c) "I'll take all my medications as ordered." d) "I'll be very careful when preparing food for my family."

B) How did this happen? I've been faithful my entire marriage The client requires further teaching if he suggests that he acquired the virus through sexual contact. Hepatitis A is transmitted by the oral-fecal route or through ingested food or liquid that's contaminated with the virus. Hepatitis A is rarely transmitted through sexual contact. Clients with hepatitis A need to take every effort to avoid spreading the virus to other members of their family with precautions such as preparing food carefully, washing hands often, and taking medications as ordered.

The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include? a) "What type of over-the-counter pain reliever do you use?" b) "How often do you drink alcohol?" c) "Have you had an infection recently?" d) "Does your work expose you to chemicals?"

B) How often do you drink alcohol? The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important. Asking about an infection or exposure to hepatotoxins or industrial chemicals would be important if the client had postnecrotic cirrhosis.

While caring for a client diagnosed with end-stage renal disease (ESRD), the nurse tracks the client's serum albumin level. For which nursing diagnosis is this action most indicated? A) Excess Fluid Volume B) Imbalanced Nutrition: Less than Body Requirements C) Risk for Ineffective Perfusion D) Risk for Infection

B) Imbalanced Nutrition: Less than Body Requirements Rationale: Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.

The nurse is discussing management of AKI with the client. Which would describe the key goal to managing this condition? A) Avoiding the use of diuretics B) Maintaining fluid and electrolyte balance C) Drinking more fluids D) Eating more vegetable that are low in iron

B) Maintaining fluid and electrolyte balance Rationale: If a client develops​ AKI, maintaining the fluid and electrolyte balance is a key goal in managing the condition. Drinking more fluids could place the client at risk for fluid overload. Diuretics may be ordered for a client who is retaining a significant amount of fluid. Increasing the amount of iron in the diet is necessary if the client is not getting the daily requirement in the foods they are consuming

A client with CKD is experiencing Kussmaul respirations. Which acid-base imbalance should the nurse suspect the client is experiencing? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis

B) Metabolic acidosis Rationale: As renal failure​ advances, the kidney loses the ability to excrete hydrogen ions. The buffering action of the kidney becomes impaired. This leads to metabolic acidosis. Kussmaul respirations​ (increasing rate and​ depth) are the​ body's attempt to compensate for the acidosis. Metabolic alkalosis occurs with an increased excretion of hydrogen ions. Respiratory acidosis occurs with retention of carbon dioxide. Respiratory alkalosis occurs with an increased loss of carbon dioxide.

The nurse is creating a plan of care for a client diagnosed with cirrhosis who has experienced GI bleeding. Which nursing intervention is most important for the nurse to perform for the client? A) Teach the family the importance of maintaining diet restrictions B) Monitor coagulation studies and platelet count C) Plan for consistent nursing care assignments D) Apply mittens to the hands to prevent scratching

B) Monitor coagulation studies and platelet count Rationale: The nurse should take steps to minimize​ bleeding, which includes monitoring coagulation studies and platelet count. Blood in the intestinal tract is digested as a​ protein, which increases serum ammonia levels and the risk for hepatic encephalopathy. Consistent nursing care assignments help clients with impaired mental​ status; mittens help promote skin integrity in clients with​ pruritus; and maintaining diet restrictions help promote nutrition.​ However, these interventions are less urgent for the client who is at risk for bleeding.

*Possible exam question* Which laboratory finding suggests that a client is experiencing acute kidney injury (AKI) as a result of glomerular damage? A) Hyperkalemia B) Proteinuria C) Urine specific gravity of 1.010 D) Moderate anemia

B) Proteinuria Rationale: Proteinuria, or excess protein in the urine, is suggestive of glomerular damage as the cause of a client's AKI. Urine specific gravity of 1.010, moderate anemia, and hyperkalemia are common laboratory findings in clients with AKI, regardless of its cause.

Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency? a) Beriberi b) Scurvy c) Night blindness d) Hypoprothrombinemia

B) Scurvy Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension? a) Kanamycin (Kantrex) b) Spironolactone (Aldactone) c) Cyclosporine (Sandimmune) d) Lactulose (Cephulac)

B) Spironlactone (Aldactone) For portal hypertension, a diuretic usually an aldosterone antagonist such as spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to treat hepatic encephalopathy to destroy intestinal microorganisms and decrease ammonia production. Lactulose would be used to reduce serum ammonia concentration in a client with hepatic encephalopathy. Cyclosporine (Sandimmune) would be used to prevent graft rejection after a transplant.

A client with ascites is scheduled for a paracentesis. The nurse is assisting the primary HCP with performing the procedure. Which position should the nurse assist the client into for this procedure? A) Flat B) Upright C) Left side-lying D) Right side-lying

B) Upright Rationale: An upright position allows the intestine to float posteriorly and helps prevent intestinal laceration during catheter insertion.

*Possible exam question* The nurse realizes that as CKD progresses, the kidney loses ability to eliminate metabolic wastes. Which way should the nurse expect a client with this disease to eliminate wastes other than through the kidneys? A) Via respirations B) Via the skin C) Via tears D) Via the bowel

B) Via the skin Rationale: Metabolic wastes that accumulate in the blood may be eliminated through the skin in the form of uremic frost. The​ bowel, tears, and respirations cannot eliminate metabolic waste.

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a) Vitamin K b) Vitamin A c) Riboflavin d) Thiamine

B) Vitamin A Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

A client suspected of having cirrhosis has prolonged prothrombin times. Which medication should the nurse expect to be prescribed? A) Vitamin B B) Vitamin K C) Nitrates D) Diuretics

B) Vitamin K Rationale: Prolonged prothrombin times indicate that the blood is taking longer to clot and the client is at risk for bleeding. Vitamin K is given to reduce the risk of bleeding. Diuretics are used to treat ascites. Nitrates are used along with a beta blocker to prevent rebleeding of esophageal varices. Vitamin B is not used for the treatment of cirrhosis.

The nurse is providing care to a client diagnosed with chronic renal failure. Which assessment finding should the nurse expect if uremia is present? SATA A) Bruising on upper extremities B) crystals noted on the skin surface C) Pruritus D) Moist skin E) Yellow color on the sclera

B, C Rationale: High levels of urea mixing with sweat can result in uremic​ frost, crystallized deposits of urea on the skin. The condition will cause pruritus. Bruising is a common manifestation of chronic renal​ failure, but this manifestation is caused by impaired platelet function. Clients with​ end-stage renal disease​ (ESRD) may develop a yellowish tinge to the skin because of retained pigmented​ metabolites, but a yellowed sclera is significant of other disease processes. Dry skin with poor turgor is a common dermatologic assessment in clients with ESRD.

The nurse is providing discharge instructions to a client going home on 80 mg of furosemide (Lasix), a loop diuretic, twice a day. Which teaching should be included in these instructions? SATA A) "Do not take at the same time as other medications." B) "Rise slowly from lying or sitting position." C) "Avoid using NSAIDs." D) "Take with water only." E) "Take in the morning and at bedtime."

B, C Rationale: Teaching for the client and the family of the client who is prescribed furosemide includes the​ following: • Unless​ contraindicated, maintain a fluid intake of 2 to 3​ L/day. • Rise slowly from lying or sitting positions because a fall in blood pressure may cause lightheadedness. • Take it in the morning​ and, if ordered twice a​ day, in the late afternoon to avoid sleep disturbance. • Take it with food or milk to prevent gastric distress. • NSAIDs interfere with the effectiveness of loop diuretics and should be avoided.

A nurse is caring for a client with end-stage liver disease. Which alterations should the nurse anticipate with this client? SATA A) Elevated serum albumin levels due to increased protein synthesis B) Decreased clotting factor levels due to impaired clotting factor production C) Hyperglycemia due to disrupted glucose metabolism D) Increased serum vitamin K due to impaired clearance of fat-soluble vitamins E) Increased plasma oncotic pressure due to impaired protein metabolism

B, C - Decreased clotting factor - Hyperglycemia Rationale: Impaired function of liver cells has multiple effects. Impaired protein metabolism with decreased production of albumin and clotting factors occurs. Low albumin levels contribute to edema in peripheral tissues and ascites (accumulation of fluid in the abdomen), as plasma oncotic pressure is reduced, not increased. Impaired clotting-factor production increases the risk for bleeding. Disrupted glucose metabolism and storage may result in hyperglycemia. Also, serum vitamin K is decreased due to impaired absorption of fat-soluble vitamins.

The nurse is identifying risk factors for liver disease among individuals who visit the community health center. Which does the nurse recognize as factors contributing to increased risk among certain ethnic groups? Select all that apply. A) Pollution B) Variations in alcohol metabolism C) Stress due to socioeconomic factors D) Consuming alcohol with food E) Climate

B, C - Variations in alcohol metabolism - Stress from socioeconomic factors Rationale: Alcohol consumption is a leading cause of death for several ethnic populations. It is thought that contributing factors include variations in alcohol metabolism, socioeconomic factors that lead to stress, and consuming alcohol without food. Climate and pollution are not factors.

Which data should the nurse collect when completing a physical examination on a client experiencing AKI? SATA A) Reports of edema B) Weight C) Lung sounds D) Skin color E) Hx of diabetes

B, C, D Rationale: When completing a physical examination on a client experiencing acute renal​ failure, the nurse needs to note the​ client's weight, skin​ color, and lung​ sounds, which may indicate fluid volume excess. Reports of edema and having a history of diabetes mellitus are information collected when obtaining a​ client's health history.

Which assessment finding of a client diagnosed with cirrhosis should the nurse correlate with expected laboratory findings? SATA A) Spider angiomas B) Peripheral edema C) Frequent infections D) Confusion E) Bruising easily

B, C, D, E Rationale: Assessment findings that correlate with expected laboratory findings in the client with cirrhosis include bruising easily​ (coagulation studies), frequent infections​ (WBC count), peripheral edema​ (albumin levels), and confusion​ (ammonia levels). Although spider angiomas can be found in clients with​ cirrhosis, their presence is not associated with any laboratory testing.

The nurse cares for a client diagnosed with cirrhosis. Which clinical manifestation suggests to the nurse that the diagnosis is correct? SATA A) Hypertension B) Hepatic encephalopathy C) Ascites D) Splenomegaly E) Esophageal varices

B, C, D, E Rationale: Complications associated with cirrhosis include esophageal​ varices, splenomegaly,​ ascites, and hepatic​ (portal systemic) encephalopathy. Hypertension is not a complication associated with cirrhosis.

A client with CKD has a potassium level of 6.5. Which prescription should the nurse anticipate receiving for this client? SATA A) Potassium 30 mEq/L in 100 mL IV over 2 hours B) IV regular insulin C) Sodium bicarb D) Sodium polystyrene sulfonate E) IV 50% dex solution

B, C, D, E Rationale: Sodium polystyrene sulfonate is a​ potassium-ion exchange resin that removes potassium by exchanging sodium ions for potassium in the small bowel. A combination of regular​ insulin, bicarbonate, and glucose​ (dextrose) facilitates the movement of potassium ions into the cells to decrease serum potassium levels. A serum potassium level of 6.5​ mEq/L is​ hyperkalemic, so potassium replacement is not appropriate.

The nurse is planning a seminar to instruct community members on ways to reduce the development of chronic kidney disease (CKD). Which topics should the nurse include in the seminar? Select all that apply. A) Avoid eating red meat. B) Control blood glucose levels in diabetes mellitus. C) Adhere to medication regimen to control hypertension. D) Participate in regular exercise. E) Avoid smoking.

B, C, D, E Rationale; Prevention of CKD should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of CKD.

The nurse is reviewing discharge instructions with a client with AKI. Which diet instruction should the nurse include? SATA A) Eat foods high in potassium B) Eat low-phosphorous foods C) Eat foods low in potassium D) Eat foods low in saturated fat E) Eat high-calcium foods

B, C, D, E - low phos - low K+ - low sat fat - high calcium Rationale: Clients with AKI experience electrolyte imbalances. The client with AKI is at particular risk for hyperkalemia caused by impaired potassium excretion and hyperphosphatemia. Calcium and phosphate have a reciprocal relationship in the​ body; as the level of one​ rises, the level of the other falls.​ Therefore, the client should eat foods high in calcium and low in phosphate. Saturated fats are known to raise the levels of cholesterol and therefore should be eaten in moderation.

Which assessment finding is commonly found in the oliguric phase of acute kidney injury (AKI)? A. Hypovolemia B. Hyperkalemia C. Hypernatremia D. Thrombocytopenia

B. Hyperkalemia In AKI, the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased due to decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

What are the precautions that nurses and hospital staff should follow while handling patients suffering from hepatitis infections? Select all that apply. a. The patient must be in a private room, and door should be closed. b. Dispose of the needles and syringes used on the patient carefully. c. Wear gloves while handling articles contaminated by urine or feces. d. Always wear a mask, gown, and gloves when entering the patient's room. e. Follow infection control precautions while injecting the patient, and avoid getting pricked by the used needle.

B, C, E Hepatitis A spreads through the fecal-oral route, and hepatitis B spreads through blood. Hence the virus can spread through needles and syringes used by the patient. Also, the virus can spread while the nurse is handling the urine or fecal material of the patient; hence it is necessary to wear gloves. Hepatitis does not spread through air; hence a mask is not required. A private room is required in respiratory diseases, not in hepatitis. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best. Text Reference - p. 1014

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-doe assessment? Select all that apply: A: frothy light-colored urine B: dark brown urine C: yellowing of the sclera D: dark brown stool E: jaundice of the skin F: bluish mucous membranes

B, C, E. Dark brown urine, yellowing of the sclera, jaundice of the skin. High bilirubin levels are because the hepatocytes are no longer able to properly conjugate the bilirubin because they are damaged. This causes bilirubin to leak into the blood and urine (rather than entering the bile and being excreted in the stool). Therefore, the bilirubin stays in the blood and will enter the urine. This will cause the patient experience yellowing of the skin, sclera of the eyes and mucus membranes, and have dark brown urine. The stools would be CLAY-COLORED, not dark brown (remember, bilirubin normally gives stool its brown color but it will be absent.)

A patient with late-stage cirrhosis develops portal hypertension. Which fo the following options below are complications that can develop from this condition? Select all that apply. A: increase albumin levels B: ascites C: splenomegaly D: fluid volume deficient E: esophageal varices

B, C, E. Ascites, splenomegaly, esophageal varices. Portal hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experiences ascites, enlarged spleen "splenomegaly," and esophageal varices.

The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrates the medication is working effectively? Select all that apply. A: decreased albumin levels B: decrease in factor hepaticus C: patient is stuporous D: decreased ammonia blood level E: presence of asterisks

B, D Decrease in factor hepaticus, decreased ammonia blood level A patient with cirrhosis may experience a complication called hepatic encephalopathy. This will cause the patient to become confused (they may enter into a coma), have pungent, musty smelling breath (feet or hepaticus), asterixis., This is due to the buildup of ammonia in the blood, which affects the brain. Lactuolose can be prescribed to help decrease the ammonia levels. Therefore, if the medication is working properly to decrease the level of ammonia th epatient would have improving mental status (NOT stuporous), decreased ammonia blood level, decreasing or absence of asterixis, and decreased ammonia blood level.

The patient with advanced cirrhosis asks why his or her skin is so yellow. The nurse's response is based on the knowledge that: a. Decreased peristalsis in the gastrointestinal tract contributes to a buildup of bile salts. b. Jaundice results from the body's inability to conjugate and excrete bilirubin. c. A lack of clotting factors promotes the collection of blood under the skin surface. d. Decreased colloidal oncotic pressure from hypoalbuminemia causes the yellowish skin discoloration.

B. Jaundice results from the functional derangement of liver cells and compression of bile ducts by connective tissue overgrowth. Jaundice occurs as a result of the decreased ability to conjugate and excrete bilirubin Jaundice is not caused by a build-up of bile salts, a lack of clotting factors, or decreased colloidal oncotic pressure. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. Text Reference - p. 1009

21. The nurse notes in the first few exchanges during peritoneal dialysis of Mrs H that the effluent is pink-tinged. Which of the following is the most appropriate action? a. Stop the dialysis immediately b. Notify the physician c. Continue the dialysis and observe d. Send a specimen of the effluent for culture.

C

The nurse provides discharge instructions to a patient with newly diagnosed cirrhosis. Which statement made by the patient indicates the need for further teaching? a. "I should take frequent rest periods." b. "I can eat anything that appeals to me." c. "I can do without my glass of wine with dinner." d. "I should take only medications that have been prescribed."

B. Even though a low-protein diet has been questioned in the treatment of patients with cirrhosis, it remains in use. In light of this, it is incorrect for the patient to say that he may eat anything. Patients with cirrhosis must also avoid alcohol. Frequent rest and limitation of medications to those that have been prescribed are appropriate resolutions in a newly diagnosed case of cirrhosis and therefore do not indicate the need for further teaching. Text Reference - p. 1022

A patient has been admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse. Laboratory results are significant for an alanine aminotransferase (ALT) of 198 IU/L and aspartate transaminase (AST) of 224 IU/L. Which diagnosis does the nurse attribute these findings to? a. Diabetes mellitus b. Alcohol abuse c. Malnutrition d. Osteomyelitis

B. In the patient with alcohol abuse, liver disease could develop as a complication, increasing the liver function tests above the normal levels. The normal ALT range is 7 to 56 IU/L and the normal AST range is 5 to 40 IU/L. Diabetes would result in elevated blood sugar levels. Malnutrition would be evidenced by low protein levels. Osteomyelitis is an infection of the bone, which would result in an elevated white blood cell count. Text Reference - p. 1015

The diet order for a client receiving hemodialysis is written as 80-3-3. When the nurse explains the diet to the client, which of the following will be included in the teaching? Select all that apply. a. 80 grams of fat are allowed per day b. 80 grams of protein are allowed per day c. potassium is restricted to 3 grams a day d. phosphorus is restricted to 3 grams a day e. potassium is restricted to 80 mg per day f. sodium is restricted to 3 grams per day

B. 80 grams of protein are allowed per day C. potassium is restricted to 3 grams a day F. sodium is restricted to 3 grams per day A typical renal diet could be written as "80-3-3," which means 80 grams of protein, 3 grams of sodium, and 3 grams of potassium are allowed per day.

A nurse is caring for a client immediately following a hemodialysis treatment. For which of the following manifestations will the nurse administer a PRN dose of phenytoin? A. Decreased blood pressure, rapid pulse B. Headache, restlessness C. Pain and tingling at the access site D. Muscle cramps, chest heaviness

B. Headache, restlessness Rationale: Headache and restlessness are manifestations of disequilibrium syndrome, which occurs during or after hemodialysis due to the rapid shift of fluids, pH, and osmolarity between fluid and blood that occurs.. This condition can cause cerebral edema leading to seizures and coma, and a PRN dose of the anticonvulsant phenytoin should be administered.

The nurse reviews laboratory data for a patient with acute kidney injury (AKI). For which laboratory value should the nurse expect hemodialysis to be ordered? A. Decreased red blood cells B. Increasing serum potassium level C. Low serum sodium D. Cell casts in urine

B. Increasing serum potassium level An increasing serum potassium level is an indication for hemodialysis because of its arrhythmogenic effects. Although anemia (decreased red blood cells) and low serum sodium are associated with AKI, they can be managed with therapies other than hemodialysis. Cell casts in the urine are a sign of acute tubular necrosis and cannot be reversed with hemodialysis.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level b. Elevated serum bilirubin level c. Elevated blood urea nitrogen level d. Decreased erythrocycle sedimentation rate"

B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.

What are the main advantages of peritoneal dialysis compared to hemodialysis? A. No medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins. B. The diet is less restricted and dialysis can be performed at home. C. The dialysate is biocompatible and causes no long-term consequences. D. High glucose concentrations of the dialysate cause a reduction in appetite, promoting weight loss.

B. The diet is less restricted and dialysis can be performed at home. Advantages of peritoneal dialysis include fewer dietary restrictions and home dialysis is possible.

The nurse is educating the client about diet after the client was treated for calcium oxalate renal stones. The nurse tells the client about foods that should be avoided to reduce the risk of development of future renal stones. Which of the following foods could the nurse tell the client to avoid? Select all that apply. a. cheese b. chocolate c. milk d. spinach e. strawberries f. tea

B. chocolate D. spinach E. strawberries F. tea About 80% of the renal stones formed contain calcium oxalate. Recent studies provide no support for the theory that a diet low in calcium can reduce the risk of calcium oxalate renal stones. In fact, higher dietary calcium intake may decrease the incidence of renal stones for most people. Stones containing oxalate are thought to be partially caused by a diet especially rich in oxalate, which is found in beets, wheat bran, chocolate, tea, rhubarb, strawberries, and spinach.

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 a condom during sexual intercourse C.) have family members get an injection of immunoglobulin D.) follow a low-protein, moderate carbohydrate, moderate fat diet.

B.) use a condom during sexual intercourse Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

The liver receives its blood supply from two sources. One of these sources is called the __________, which is a vessel network that delivers blood ______________ in nutrients but ____________ in oxygen. A: hepatic artery, low, high B: hepatic portal vein, high, low C: hepatic lobule, high, low D: hepatic vein, low, high

B: hepatic portal vein, high, low. Majorly of the blood flow to the liver comes from the hepatic portal vein. This vessel network delivers blood HIGH in nutrients (lipids, proteins, carbs, etc.,) from organs that aid in the digestion of food, but the blood is POOR in oxygen. The organs connected to the hepatic portal vein are: small/large intestine, pancreas, spleen, stomach. Rich oxygenated blood comes for the hepatic artery to the liver.

25. The nurse performing intermittent peritoneal dialysis notes that the client's medical record shows that the client has not had a bowel movement for 3 days. The nurse would be careful to assess the client for which of the following manifestations related to this information? a. Fluid leakage b. Cloudy dialysate output c. Reduced catheter outflow d. Increased thirst

C

3. A client is admitted for emergency dialysis for newly diagnosed chronic renal failure. The nurse recognizes that which of the following laboratory values poses the greatest risk to the client? a. BUN 40 mg/ml b. Serum Creatinine 5.8 c. Potassium 7.0 mEq/L d. pH 7.30

C

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings?* A. Decreased magnesium level B. Increased calcium level C. Increased ammonia level D. Increased creatinine level

C

A patient is diagnosed with an infection caused by the hepatitis A virus. Which statement, if made by the patient, would indicate the patient needs further teaching about the infection? A "I will wash raw fruits and vegetables thoroughly before I eat them." B"Before I take any over-the-counter medicines I should call the clinic." C"I might get liver cancer someday because I have this infection." D"It's important for me to remember to wash my hands after I use the bathroom."

C Hepatitis A virus is more common in areas that lack adequate sanitation or have poor hygiene practices. Infection with hepatitis A may be caused by eating contaminated foods such as fruits, vegetables, or shellfish. Many over-the-counter medications contain acetaminophen. Hepatitis A does not lead to chronic liver problems.

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a. can accommodate larger needles. b. increases patient mobility. c. is much less likely to clot. d. can be used sooner after surgery.

C Rationale: AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not impact on needle size or patient mobility.

The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information if the client states to record daily the: a. Amount of activity. b. Pulse and respiratory rate. c. Intake and output and weight. d. Blood urea nitrogen and creatinine levels.

C The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight/day.

A client diagnosed with chronic renal failure (CRF) is scheduled to begin hemodialysis. The nurse assesses that which of the following neurological and psychosocial manifestations if exhibited by this client would be unrelated to the CRF? a. Labile emotions. b. Withdrawal. c. Euphoria. d. Depression.

C The client with CRF often experiences a variety of psychosocial changes. These are related to uremia, as well as the stress associated with living with a chronic disease that is life-threatening. Clients with CRF may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation. Delusions and psychosis also can occur. Euphoria is not part of the clinical picture for the client in renal failure.

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? A "Your diseased kidneys will be removed at the same time the transplant is performed." B "The new kidney will be placed directly below one of your old kidneys." C "It is essential for you to wash your hands and avoid people who are ill." D "You will receive dialysis the day before surgery and for about a week after."

C "It is essential for you to wash your hands and avoid people who are ill." Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? A RN who has floated from pediatrics for this shift B LPN/LVN with experience working on the medical unit C RN who usually works on the general surgical unit D New graduate RN who just finished a 6-week orientation

C RN who usually works on the general surgical unit The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.

While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? A Instruct the client to deep-breathe and cough. B Document the effluent as output. Incorrect C Turn the client to the opposite side. D Re-position the catheter.

C Turn the client to the opposite side. With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.

A client with chronic renal failure has been prescribed calcium carbonate. What is the rationale for this particular medication? A) Diminishes incidence of gastric ulcer formation B) Alleviates constipation C) Binds with phosphorus to lower concentration D) Increase tubular reabsorption of sodium

C) Binds to phosphorus to lower concentration Clients with ARF have hyperphosphatemia. Clients are prescribed calcium-based phosphate binders to improve the excretion of phosphorus.

The nurse is planning care for a client diagnosed with chronic kidney disease (CKD) and osteoporosis. Based on this information, which should be the nurse's priority diagnosis for this client? A) Anxiety B) Disturbed Body Image C) Risk for Injury D) Risk for Bleeding

C) Risk for Injury Rationale: The client with CKD and osteoporosis is at high risk for fractures; therefore, preventing injury should be the priority nursing diagnosis. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, the client is not undergoing hemodialysis. Anxiety is not related to osteoporosis.

A client with a history of hypertension is diagnosed with chronic kidney disease (CKD). When the client asks the nurse how this disease developed, which response by the nurse is the most appropriate? A) "Thickening of the kidney structures and gradual death of nephrons has led to this diagnosis." B) "Cysts have compressed your renal tissue and destroyed your kidneys, causing this diagnosis." C) "High blood pressure has reduced your renal blood flow, harming the kidney tissue and causing this diagnosis." D) "Immune complexes have formed in your kidney tissue, causing inflammation that has led to this diagnosis."

C) "High blood pressure has reduced your renal blood flow, harming the kidney tissue and causing this diagnosis." Rationale: Long-standing hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. In contrast, diabetic nephropathy causes chronic kidney disease (CKD) by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes CKD by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Finally, systemic lupus erythematosus causes CKD by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.

*Possible exam question* A client diagnosed with acute kidney injury (AKI) is receiving peritoneal dialysis. The nurse is explaining the dialysis process to the client and family. Which statement should the nurse include in this discussion? A) "The peritoneum is more permeable because of the presence of excess metabolites." B) "The metabolites will diffuse from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration." C) "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." D) "The solutes in the dialysate will enter the bloodstream through the peritoneum."

C) "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." Rationale: The peritoneum acts as a semipermeable membrane, allowing substances to move from an area of high concentration (the blood) to an area of lower concentration (the dialysate). Metabolic waste products and excess water can be eliminated through osmosis and diffusion using the peritoneum as the semipermeable membrane.

*Possible exam question* The nurse is caring for a client diagnosed with chronic kidney disease (CKD) who is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to CKD. The client's spouse asks why the client is anemic. Which response by the nurse is the most appropriate? A) "Your spouse has a genetic tendency for the development of anemia." B) "The increased metabolic waste products in your spouse's body depress the bone marrow and cause anemia." C) "Your spouse's kidneys are producing reduced amounts of the hormone erythropoietin, and this is the cause of the anemia." D) "Your spouse is not eating enough iron-rich foods, and this has led to anemia."

C) "Your spouse's kidneys are producing reduced amounts of the hormone erythropoietin, and this is the cause of the anemia." Rationale: Anemia is common in clients with chronic kidney disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in stimulating the bone marrow to produce RBCs. Metabolic wastes do not suppress bone marrow, and diet and heredity do not factor into the production of erythropoietin.

A client with acute renal failure develops severe hyperkalemia. What would the nurse anticipate to be used to treat this imbalance? A) Furosemide (Lasix) B) Amphojel (aluminum hydroxide) C) 50% glucose and regular insulin D) Epoetin (Procrit)

C) 50% glucose and regular insulin Hyperkalemia can develop into an emergency situation (Cardiac Arrest). It is important to quickly move the potassium back into the cells by administering 50% glucose and regular insulin, usually in conjunction with some type of base to correct the acidosis, such as sodium bicarbonate or calcium gluconate is given IV. Insulin assists in the movement of potassium into the cells and helps to reduce the serum potassium level. Amphojel is used for the treatment of hyperphosphatemia that occurs with ARF. Procrit is used for the treatment of anemia caused by a decrease in erythropoietin production by the kidneys. A diuretic, such as Lasix, may lead to a loss of potassium, but the rate is too slow.

*Note from Mary: Not a clue if infant/child will be included on this exam, so just in case: A new mother brings her 2-week-old infant in for a checkup because he looks jaundiced and his stools are white. The provider suspects the infant might have biliary atresia. What findings does the nurse anticipate upon assessment of the infant? A) Above average weight gain B) Increased urine output C) Abdominal distention D) Reduced rooting reflex

C) Abdominal distention Rationale: Symptoms of biliary atresia usually appear 2 to 3 weeks after birth. They include jaundice, abdominal distention, white or clay-colored stools with putty-like consistency, tea-colored urine, and failure to thrive. This would result in below average weight gain rather than above average weight gain. Urine should be assessed for color, not volume. Biliary atresia may cause malnutrition due to poor absorption of nutrients, not a reduced rooting reflex.

The nurse is describing to a colleague how the accumulation of metabolites in the blood from renal failure affects the body. Which effect should the nurse include? A) Bradycardia B) Increased pain C) Altered electrolyte balance D) Decreased levels of nitrogenous wastes in blood

C) Altered electrolyte balance Rationale: Renal failure is a condition in which the kidneys are unable to remove accumulated metabolites from the​ blood, resulting in altered fluid and electrolyte balance and acid-base balance. Increased pain in a client with renal failure would not cause an alteration in the amount of metabolites. Heart palpitations are caused by​ stress, physical​ exertion, too much​ caffeine, and the use of stimulants. Decreased blood volume is usually caused by bleeding or dehydration.

A client diagnosed with cirrhosis of the liver states to the nurse, "this itching is driving me crazy." Which intervention is most appropriate for the nurse to implement? A) Turn the client every 4 hours B) Wash the client's skin with cool water and soap daily C) Apply an emollient lotion D) Restrain the client's hands to prevent scratching

C) Apply an emollient lotion Rationale: As ammonia levels rise in​ cirrhosis, bile salt deposits are deposited on the​ skin, which causes pruritus. To maintain skin integrity and ease​ itching, the nurse should apply an emollient lotion to moisturize the skin and reduce itching.​ Warm, not​ cool, water should be​ used, and soap should be​ avoided, as hot water and soap dry out the skin and increase pruritus. To maintain skin​ integrity, the client should be turned every 2 hours. Restraints should always be a last option to prevent a client from causing​ self-harm. Mittens are a better option to prevent scratching.

The nurse is administering peritoneal dialysis to a client with a diagnosis of chronic kidney disease (CKD). The nurse notes the presence of a cloudy dialysate return. After notifying the healthcare provider, which action by the nurse is the most appropriate and of highest priority? A) Measure the client's abdominal girth. B) Document the cloudy dialysate. C) Culture the dialysate return. D) Increase dialysate instillation.

C) Culture the dialysate return Rationale: The client's dialysate return should be clear. The presence of cloudy drainage might indicate peritonitis, so the nurse should culture the return in order to help identify the presence and type of organism that could be causing the infection. Documenting the cloudy dialysate would be a necessary nursing action, but is not the next-priority action. Measurement of abdominal girth is performed prior to the dialysis procedure, and even though increased girth could indicate peritonitis, culturing the return is more important. The instillation part of the procedure is completed prior to the collection of the dialysate return, and the rate of the instillation has no relationship to the development of an infection.

When individuals engage in excessive alcohol consumption, which liver function is impacted, leading to subsequent liver damage? A) Metabolism B) Synthesis C) Detoxification D) Glycogen storage

C) Detoxification Rationale: The liver is responsible for detoxifying alcohol and other substances. If an individual participates in high-risk behaviors such as excessive alcohol consumption, the detoxification function of the liver can be overwhelmed, resulting in damage to the liver. Metabolism of proteins, carbohydrates, and fats; synthesis of albumin and clotting factors; and glycogen storage are normal functions of the liver that help maintain health.

A client with chronic renal failure has an internal venous access site for hemodialysis on her left forearm. What action will the nurse take to protect this access site? A) Irrigate with heparin and NS q8 hrs B) Apply warm moist packs to the area after hemodialysis C) Do not use the left arm to take blood pressure readings. D) Keep the arm elevated above the level of the heart.

C) Do not use the left arm to take blood pressure readings Protect the arm with the functioning shunt. No blood pressure readings should be taken from that arm, and there should be no needle sticks. The access is not irrigated with Heparin.

During the nursing assessment of the patient with renal insufficiency, the nurse asks the patient specifically about the history of: A) Angina. B) Asthma. C) Hypertension. D) Rheumatoid arthritis.

C) Hypertension

*Possible exam question* The lab work of a client with CKD shows an elevated potassium level. Which prescription should the nurse anticipate receiving from the HCP? A) Oral Vitamin D B) IV Potassium chloride C) IV glucose D) Oral calcium carbonate

C) IV glucose Rationale: A method to lower blood potassium levels is to administer intravenous glucose and insulin. The insulin drives the glucose into body cells. The glucose takes the potassium with it into the​ cells, thereby lowering blood potassium levels. Potassium supplements would not be prescribed for a client with an elevated potassium level. Oral calcium carbonate is a​ phosphorus-binding agent and reduces the phosphate level in the blood. Vitamin D is given to increase the absorption of calcium.

What causes the gastrointestinal (GI) manifestation of stomatitis in the patient with CKD? A) High serum sodium levels B) Irritation of the GI tract from creatinine C) Increased ammonia from bacterial breakdown of urea D) Iron salts, calcium-binders, and limited fluid intake

C) Increased ammonia from bacterial breakdown of urea

The nurse is reading a health care provider's (HCP) progress notes in the client's record and reads that the HCP has documented "insensible fluid loss of approximately 800ml daily." The nurse makes a notation that insensible fluid loss occurs through which type of excretion? A) Urinary output B) Wound drainage C) Integumentary output D) The gastrointestinal tract

C) Integumentary output

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure? a) Spleen b) Appendix c) Liver d) Sigmoid colon

C) Liver The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

The nurse is caring for a client diagnosed with hepatic encephalopathy. Which nursing action is most appropriate for this client? A) Administer meds to treat diarrhea B) Avoid meds that stimulate the CNS C) Observe the client for asterixis D) Provide a high-protein diet

C) Observe the client for asterixis Rationale: The signs of early encephalopathy are sometimes subtle. It is important to identify neurologic changes early to begin treatment promptly. Asterixis​ (flapping of the​ hands) or changes in handwriting are early signs of neurologic impairment. The client should avoid medications that depress the central nervous system. A​ low-protein diet is prescribed to decrease nitrogenous waste products that accumulate in the blood and lead to hepatic encephalopathy. Regular bowel elimination promotes protein and ammonia​ elimination; therefore, measures should be taken to prevent constipation.

A client diagnosed with recurrent urinary tract calculi would be at elevated risk for which of the following types of acute kidney injury (AKI)? A) Prerenal AKI B) Intrinsic AKI C) Postrenal AKI D) Intrarenal AKI

C) Postrenal AKI Rationale: Obstructive causes of AKI are classified as postrenal. Any condition that prevents urine excretion—including urinary tract calculi—can lead to postrenal AKI. In comparison, prerenal AKI results from conditions that affect renal blood flow and perfusion, and intrinsic AKI (also called intrarenal AKI) is characterized by acute damage to the renal parenchyma and nephrons.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a) Ascites and orthopnea b) Gynecomastia and testicular atrophy c) Purpura and petechiae d) Dyspnea and fatigue

C) Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Impaired urinary elimination b) Toileting self-care deficit c) Risk for infection d) Activity intolerance

C) Risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

The nurse is providing care to a client diagnosed with chronic renal failure. Which cardiovascular assessment finding should the nurse identify that supports this diagnosis? A) Hyperkalemia B) Anemia C) Systemic hypertension D) Decreased WBC count

C) Systemic hypertension Rationale: The cardiovascular assessment finding that supports the diagnosis of chronic renal failure is systemic hypertension. Anemia is a hematologic symptom of chronic renal failure. A decreased white blood cell count is a manifestation of chronic renal failure that affects the immune system. Hyperkalemia occurs as the result of the effects of chronic renal failure on fluids and electrolytes.

A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? a) Chenodiol b) Ursodiol c) Tacrolimus d) Interferon alfa-2b, recombinant

C) Tacrolimus In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection. Tacrolimus or cyclosporine are two immunosuppresants that may be used. Chenodiol and ursodiol are agents used to dissolve gall stones. Recombinant interferon alfa-2b is used to treat chronic hepatitis B, C, and D to force the virus into remission.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? a) The client didn't take his morning dose of lactulose (Cephulac). b) The client is relaxed and not in pain. c) The client's hepatic function is decreasing. d) The client is avoiding the nurse.

C) The client's hepatic function is decreasing The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in the client? A) There is an increased excretion of phosphate and organ acids, which leads to an increases in arterial blood pH. B) A shortened life span of red blood cells because of damage secondary to dialysis C) The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate D) An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately

C) The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate.

The patient with CKD is brought to the emergency department with Kussmaul respirations. What does the nurse know about CKD that could cause this patient's Kussmaul respirations? A) Uremic pleuritis is occurring. B) There is decreased pulmonary macrophage activity. C) They are caused by respiratory compensation for metabolic acidosis. D) Pulmonary edema from heart failure and fluid overload is occurring.

C) They are caused by respiratory compensation for metabolic acidosis.

For which reason did the nurse place a chair scale in the room of a client who has been admitted with AKI? SATA A) Because chair scales are the most accurate B) Limited availability of equipment C) To ensure an accurate weight D) Because equipment calibration can vary E) To utilize standard technique

C, D, E Rationale: Weigh the client daily or more frequently as ordered. Use standard technique​ (same scale,​ clothing, or​ coverings) to ensure accuracy. Rapid weight changes are an accurate indicator of fluid volume​ status, particularly in the client with oliguria. Any drastic shift in weight of a client with AKI indicates some malfunction and can adversely affect other organs and the treatment program.

A client with end-stage renal disease is experiencing uremia. Which prescription should the nurse expect to receive from the HCP? A) Physical therapy care consult B) Increased fluids C) Serum electrolytes D) Begin dialysis E) ABG monitoring

C, D, E - Monitor lytes, ABGs - Start dialysis Rationale: Uremia is a manifestation of ESRD that occurs when metabolic wastes build up in the blood. Dialysis is often the only option for treatment. ABGs and serum electrolytes are monitored to assess for complications of uremia. Fluids should be​ restricted, not increased. A dietary consult might be​ necessary, but not a physical therapy consult at this time.

A patient diagnosed with viral hepatitis is in the pre-icteric phase. When assessing the patient, which of these findings should the healthcare provider anticipate? CATA A. Tarry stools b. Pruritis C. Anorexia D. Dark Urine E. Nauseau

C, E A patient infected with a hepatitis virus experiences different symptoms as the infection progresses. The term "icteric" refers to jaundice During the pre-icteric phase the patient will experience some non-specific symptoms such as anorexia, nausea, and right upper quadrant pain

A patient with cancer that has metastasized to the liver manifests symptoms of fluid retention, including edema and ascites. To determine the effectiveness of the diuretic therapy that has been prescribed, what should the nurse assess? a. Breath sounds b. Bowel sounds c. Abdominal girth d. Recent blood work

C. Daily measurement of the abdominal girth provides a direct indication of ascitic fluid increase or decrease. Breath and bowel sounds are usually not affected by liver metastasis until the late stages, when fluid overload and multisystem organ involvement occur. Reviewing the results of the most recent blood work will not show direct measurement of the effectiveness of diuretic therapy. Text Reference - p. 1019

A patient admitted to the hospital with cirrhosis of the liver suddenly starts vomiting blood. What is the priority action that the nurse should take in this situation? a. Send for endoscopic variceal ligation. b. Give propronalol orally. c. Stabilize the patient and manage the airway. d. Check for signs of cirrhosis

C. Individuals with cirrhosis of the liver are at risk of bleeding from esophageal and gastric varices. Hematemesis in the patient with cirrhosis of the liver is likely to be variceal bleeding. In this case, the nurse should first stabilize the patient and manage the airway. Once the patient is stable, other steps in treatment can be initiated, such as assessing further and administering necessary medications. Text Reference - p. 1025

The nurse evaluates the effectiveness of a paracentesis in a patient who has ascites. Which measurement is most important for the nurse to note? a. Cardiac output b. Blood pressure c. Abdominal girth d. Intake and output

C. Paracentesis involves the removal of fluid from the abdominal cavity. A large-bore needle connected to tubing is inserted by the health care provider into the distended abdomen. The other end of the tubing also has a large-bore needle, which is inserted into a vacuum bottle. The vacuum bottle is then held below the level of the abdomen, facilitating gravity-flowed removal of the ascites. Several bottles of fluid can be removed, with the result measured by reduction in abdominal girth. Cardiac output may improve after paracentesis, but it is unlikely that this measurement needs to be recorded. Paracentesis has no major effect on blood pressure. Likewise, intake and output continue to be monitored to account for the paracentesis fluid but these are not as informative as abdominal girth. Text Reference - p. 1022

The nurse recalls that hepatic coma results primarily from accumulation of which substance in the blood? a. Sodium b. Calcium c. Ammonia d. Potassium

C. A high ammonia level in the blood is a late manifestation of liver failure that results in hepatic coma, causing neurologic dysfunction and brain damage. Sodium, calcium, and potassium are not directly affected by liver dysfunction or hepatic coma. Text Reference - p. 1021

A patient with hepatitis A asks whether other family members are at risk for "catching" the disease. The nurse's response will be based on the knowledge that hepatitis A is transmitted primarily: a. During sexual intercourse b. By contact with infected body secretions c. Through fecal contamination of food or water d. Through kissing that involves contact with mucous membranes

C. Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water, as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important in preventing the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important in decreasing the risk of transmission. Sexual intercourse, contact with infected body secretions, and contact through mucous membranes all present higher risk for hepatitis B and C than for hepatitis A. Text Reference - p. 1007

A patient with acute kidney injury (AKI) is on fluid restriction. Which statement by the nurse indicates an appropriate intervention? A. "I should encourage the patient to lose weight." B. "I should order extra solids with their meals." C. "I should provide frequent mouth care." D. "I should monitor weekly intake and output."

C. "I should provide frequent mouth care." The nurse should provide frequent mouth care and encourage use of hard candies to decrease thirst. Providing frequent mouth care keeps the mucous membrane moist and helps decrease the patient's desire to consume fluids. The proportion of solids in a meal has no connection to fluid restriction. Intake and output should be monitored daily for a patient on fluid restriction. Loss of extra weight affects the overall health of the patient, but it is not an indicator for fluid restriction.

The nurse is discussing the effect pregnancy can have on the kidneys with a patient. Which patient statement demonstrates effective teaching? A. "If I feel a lot of pressure in my abdomen, that demonstrates stress on the kidneys." B. "If I am not moving around daily, that stresses the kidneys." C. "If I have burning during urination, I should call my healthcare provider." D. "I should not drink more than 20 ounces of water per day."

C. "If I have burning during urination, I should call my healthcare provider." Over 90% of women develop a physiological hydronephrosis of pregnancy, which can promote urinary stasis, lead to urinary tract infection, and ultimately lead to acute kidney injury (AKI). In addition, in the first trimester, hyperemesis gravidarum and placenta previa may lead to AKI. As pregnancy progresses, pregnancy-induced hypertension, preeclampsia, and eclampsia stress the kidneys, leading to proteinuria, hydronephrosis, and AKI. Activity in pregnancy does not cause stress on the kidneys. Pressure in the abdomen is common with pregnancy and does not demonstrate stress on the kidneys. Pregnant women should increase, not restrict, fluid intake.

A nurse is teaching a client who has pre-dialysis end-stage kidney disease about diet. Which of the following 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." Rationale: The client should reduce foods high in potassium

A nurse is providing discharge teaching for a client who is to perform peritoneal dialysis at home. Which of the following 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." Rationale:Abdominal pain is expected during inflow of the dialysate during the first few weeks of therapy.

A nurse is reviewing a client's laboratory values and discovers the client has a serum potassium of 6.2 mEq/L. Which of the following interventions should the nurse anticipate? A. Initiating an IV potassium infusion. B. Encouraging the client to eat bananas. C. Administering sodium polystyrene sulfonate. D. Administering a potassium-sparing diuretic

C. Administering sodium polystyrene sulfonate. Rationale: The nurse should expect to administer sodium polystyrene sulfonate, which absorbs excessive potassium and excretes it through the stool. Other treatments include hemodialysis and IV glucose and insulin.

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.

If a patient is in the diuretic phase of AKI, you must monitor for which serum electrolyte imbalances? A. Hyperkalemia and hyponatremia B. Hyperkalemia and hypernatremia C. Hypokalemia and hyponatremia D. Hypokalemia and hypernatremia

C. Hypokalemia and hyponatremia In the diuretic phase of AKI, the kidneys have recovered their ability to excrete wastes but not to concentrate the urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

A child is admitted to the hospital with nausea, vomiting, lethargy, and oliguria, and the healthcare provider suspects fluid depletion associated with acute kidney injury (AKI). Which prescribed order should the nurse consider appropriate for this patient? A. Low doses of a diuretic B. Potassium supplement C. Isotonic saline solution D. Phosphorous supplement

C. Isotonic saline solution Initial emergency treatment of children with fluid depletion associated with AKI focuses on rapid fluid replacement with 20 mL/kg of 0.9% saline or lactated Ringer's solution given over 5 to 10 minutes and repeated as needed. This ensures renal perfusion and stabilizes blood pressure. Potassium and phosphorous would not be administered because the electrolytes would be expected to be elevated. A diuretic would not be administered because dehydration would be present due to fluid depletion.

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours earlier. What is an expected assessment finding for this patient during the early 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 after kidney transplantation. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

How should you assess the patency of a newly placed arteriovenous graft for dialysis? A. Irrigate the graft daily with low-dose heparin. B. Monitor for any increase in blood pressure in the affected arm. C. Listen with a stethoscope over the graft for presence of a bruit. D. Frequently monitor the pulses and neurovascular status distal to the graft.

C. Listen with a stethoscope over the graft for presence of a bruit. A thrill can be felt by palpating the area of anastomosis of the arteriovenous graft, and a bruit can be heard with a stethoscope. The bruit and thrill are created by arterial blood rushing into the vein.

A nurse is caring for a client who has a new arteriovenous (AV) 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. Palpate the site for a bruit. D. Auscultate the antecubital fossa using a Doppler stethoscope.

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

A pregnant patient is in the first trimester of pregnancy and has been having a lot of burning and discomfort upon urination and is diagnosed with a urinary tract infection. Which condition should the nurse suspect as a possible cause for this infection? A. Hyperphosphatemia B. Hyperkalemia C. Physiological hydronephrosis D. Acute tubular necrosis

C. Physiological hydronephrosis Over 90% of women develop a physiological hydronephrosis of pregnancy, which can promote urinary stasis, leading to urinary tract infection and ultimately acute kidney injury (AKI). Hyperkalemia is an electrolyte imbalance that causes a high level of potassium in the blood. Hyperphosphatemia is another electrolyte imbalance that causes an abnormally high level of phosphate in the blood. Acute tubular necrosis is the death of the tubular cells and is usually caused by low blood pressure or nephrotoxic drugs.

You are caring for a patient receiving continuous replacement therapy and notice that the filtrate is blood tinged. What is your priority action? A. Place the patient in Trendelenburg position. B. Initiate a peripheral intravenous line. C. Suspend treatment immediately. D. Administer vitamin K (Aquamephyton) per order.

C. Suspend treatment immediately. The ultrafiltrate should be clear yellow, and specimens may be obtained for evaluation of serum chemistries. If the ultrafiltrate becomes bloody or blood tinged, a possible rupture in the filter membrane should be suspected, and treatment is suspended immediately to prevent blood loss and infection.

A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication? A. The leukocyte count B. The platelet count C. The hematocrit (Hct) D. The erythrocyte sedimentation rate (ESR)

C. The hematocrit (Hct) Rationale:Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct.

Measures indicated in the conservative therapy of CKD include A. decreased fluid intake, carbohydrate intake, and protein intake. B. increased fluid intake; decreased carbohydrate intake and protein intake. C. decreased fluid intake and protein intake; increased carbohydrate intake. D. decreased fluid intake and carbohydrate intake; increased protein intake.

C. decreased fluid intake and protein intake; increased carbohydrate intake. Water and any other fluids are not routinely restricted in the pre-end-stage renal disease (ESRD) stages. Patients on hemodialysis have a more restricted diet than patients receiving peritoneal dialysis. For those receiving hemodialysis, as their urinary output diminishes, fluid restrictions are enhanced. Intake depends on the daily urine output. Generally, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is allowed for a patient receiving hemodialysis. Patients are advised to limit fluid intake so that weight gains are no more than 1 to 3 kg between dialyses (interdialytic weight gain). For the patient who is undergoing dialysis, protein is not routinely restricted. The beneficial role of protein restriction in CKD stages 1 through 4 as a means to reduce the decline in kidney function is being studied. Historically, dietary counseling often encouraged restriction of protein for CKD patients. Although there is some evidence that protein restriction has benefits, many patients find these diets difficult to adhere to. For CKD stages 1 through 4, many clinicians encourage a diet with normal protein intake. However, you should teach patients to avoid high-protein diets and supplements because they may overstress the diseased kidneys.

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab results would explain these abnormal assessment findings? A: decreased magnesium level B: increased calcium level C: increased ammonia level D: increased creatinine level

C: increased ammonia level Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis." Therefore, an increased ammonia level would confirm these abnormal assessment findings.

"When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses? A: Imbalanced nutrition: less than body requirements B: Impaired skin integrity related to edema, ascites, and pruritis C: Eccess fluid volume related to portal hypertension and hyperaldosteronism D: Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

CORRECT: D Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, AIRWAY and BREATHING are always the highest priorities.

"When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses? A: Imbalanced nutrition: less than body requirements B: Impaired skin integrity related to edema, ascites, and pruritis C: Ecess fluid volume related to portal hypertension and hyperaldosteronism D: Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

CORRECT: D Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, AIRWAY and BREATHING are always the highest priorities.

13.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)? 1. Serum creatinine 2. Serum potassium 3. Microalbuminuria 4. Calculated glomerular filtration rate (GFR)

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

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

Correct 1: Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, D are transmitted more commonly via infected blood or bloody fluids.

"The 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? "1. Select foods high in fat 2. Increase intake of fluids, including juices 3. Eat a good supper when anorexia is not as severe 4. Eat less often, preferbly only three large meals daily"

Correct 2: Rationale: Although no specific diet is required to treat viral hepatitis, it is recommended that clients consume a low-fat diet because fat may be poorly tolerated because of decreased bile production. Small frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.

"The 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? "1. Select foods high in fat 2. Increase intake of fluids, including juices 3. Eat a good supper when anorexia is not as severe 4. Eat less often, preferbly only three large meals daily"

Correct 2: Rationale: Although no specific diet is required to treat viral hepatitis, it is recommended tht clients consume a low-fat diet because fat may be poorly tolerated because of decreased bile production. Small frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.

A 40-year-old woman has been diagnosed with hepatitis A and asks the nurse if other members of her family are at risk for ""catching"" the disease. The nurse's response should be based on the understanding that hepatitis A is transmitted primarily:" "1. during sexual intercourse 2. by contact with infected body secretions. 3. through fecal contamination of food or water. 4. through kissing that involves contact with mucous membranes."

Correct 3: "Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important to prevent the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important to decrease transmission.

A 40-year-old woman has been diagnosed with hepatitis A and asks the nurse if other members of her family are at risk for""catching"" the disease. The nurse's response should be based on the understanding that hepatitis A is transmitted primarily:" 1. during sexual intercourse 2. by contact with infected body secretions. 3. through fecal contamination of food or water. 4. through kissing that involves contact with mucous membranes."

Correct 3: "Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important to prevent the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important to decrease transmission.

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 1)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 2)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 3) This is the expected color of urine. 4) Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines.

"The school nurse is discussing ways to prevent an outbreak of hepatitis A with a groupof high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? "1.Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands.

Correct 4: "Hepatitis A is transmitted via the fecal-oralroute. Good hand washing helps to prevent its spread. HINT - good hand washing is the most impor-tant action in preventing transmission of any of the hepatitis viruses. Often, the test taker will not select the answer option that seemstoo easy—but remember, do not overlook the"

The nurse instructs a client diagnosed with hepatitis A about 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-colored stools

Correct 4: Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines. 1)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 2)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 3) This is the expected color of urine.

Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D"

Correct A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D"

Correct A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

A client is admitted with ongoing symptoms of the flu. There are not other obvious signs of illness. This client should be tested for hepatitis because... A. She could have anicteric hepatitis, which means no jaundice B. She has an allergy to shellfish C. She has a blood pressure of 90/50 D. She was living with a roommate who had similar symptoms"

Correct A Rationale: A. Only about 25% percent of people with aute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised her liver function that is overlooked due to lack of jaundice.

A client is admitted with ongoing symptoms of the flu. There are not other obvious signs of illness. This client should be tested for hepatitis because... "A. She could have anicteric hepatitis, which means no jaundice B. She has an allergy to shellfish C. She has a blood pressure of 90/50 D. She was living with a roommate who had similar symptoms"

Correct A Rationale: A. Only about 25% percent of people with aute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised her liver function that is overlooked due to lack of jaundice.

"A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that "a. pruritus is a common problem with jaundice in this phase. b. the patient is most likely to transmit the disease during this phase. c. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.

Correct A Rationale: The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

"A college student is required to be inoculated for hepatitis before beginning college. The nurse realizes that this client will be inoculated to prevent the development of... A: Hepatitis B B: Hepatitis C C: Hepatitis E D: Hepatitis D"

Correct A: Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

A client is admitted with ongoing symptoms of the flu. There are no other obvious signs of illness. This client should be tested for hepatitis because: "a) She could have anicteric hepatitis, which means no jaundice. b) She has a blood pressure of 90/50. c) She was living with a roommate who had similar symptoms. d) She has an allergy to shellfish."

Correct A: (Correct Answer=A) Only about 25 percent of people with acute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised liver function that is overlooked due to lack of jaundice.

A client is admitted with ongoing symptoms of the flu. There are no other obvious signs of illness. This client should be tested for hepatitis because: "a) She could have anicteric hepatitis, which means no jaundice. b) She has a blood pressure of 90/50. c) She was living with a roommate who had similar symptoms. d) She has an allergy to shellfish."

Correct A: (Correct Answer=A) Only about 25 percent of people with acute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised liver function that is overlooked due to lack of jaundice.

The physician has determined that 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. Hep-A 2. Hep-B. 3. Hep-C. 4 Hep-D

Correct Answer 1: Hep-A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hep-B, -C or -D are most commonly transmitted via infected blood or body fluids.

"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 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 college student is required to be inoculated for hepatitis before starting college. The nurse recognizes that he will be inoculated for: 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

Correct Answer 2 Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

"Question: A 40-year-old woman has been diagnosed with hepatitis A and asks the nurse if other members of her family are at risk for ""catching"" the disease. The nurse's response should be based on the understanding that hepatitis A is transmitted primarily 1. During sexual intercourse; 2. By contact with infected body secretions; 3. Through fecal contamination of food or water 4. Through kissing that involves contact with mucous membranes.

Correct Answer 3 Anwer: (3). Rationale: Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important to prevent the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important to decrease transmission. Sexual intercourse (1), contact with infected body secretions (2), and contact through mucous membranes (4) all present higher risk for hepatitis B and C.

"Question: A 40-year-old woman has been diagnosed with hepatitis A and asks the nurse if other members of her family are at risk for ""catching"" the disease. The nurse's response should be based on the understanding that hepatitis A is transmitted primarily1. During sexual intercourse; 2. By contact with infected body secretions; 3. Through fecal contamination of food or water 4. Through kissing that involves contact with mucous membranes.

Correct Answer 3 Anwer: (3). Rationale: Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important to prevent the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important to decrease transmission. Sexual intercourse (1), contact with infected body secretions (2), and contact through mucous membranes (4) all present higher risk for hepatitis B and C.

The client is in the preicteric phase of hepatitis. Which signs/symptoms would thenurse expect the client to exhibit during this phase? 1.Clay-colored stools and jaundice .2.Normal appetite and pruritus. 3.Being afebrile and left upper quadrant pain. 4.Complaints of fatigue and diarrhea.

Correct Answer 4 "Flu-like" symptoms are the first com-plaints of the client in the preicteric phase of hepatitis, which is the initial phase and may begin abruptly or insidiously

The client is in the preicteric phase of hepatitis. Which signs/symptoms would thenurse expect the client to exhibit during this phase? 1.Clay-colored stools and jaundice.2.Normal appetite and pruritus.3.Being afebrile and left upper quadrant pain.4.Complaints of fatigue and diarrhea.

Correct Answer 4 "Flu-like" symptoms are the first com-plaints of the client in the preicteric phase of hepatitis, which is the initial phase and may begin abruptly or insidiously

"The nurse is caring for a pt. in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the pt. complains of pain in the right lower quadrant. The nurse will document this as which of the following signs of appendicitis? A. Rovsing sign B. Referred pain C. Chvostek's sign D. Rebound tenderness"

Correct Answer A In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.

A client is suspected of having hepatitis. Which diagnoistic test result will assist in confirming this diagonis ? A.Elevate hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreasd erythrocycte 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.

A client is suspected of having hepatitis. Which diagnoistic test result will assist in confirming this diagonis ? A.Elevate hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreasd erythrocycte 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 patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal" "a. hepatitis B surface antigen (HBsAg). b. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."

Correct Answer D "Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."

"A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal" a. hepatitis B surface antigen (HBsAg). b. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."

Correct Answer D "Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."

"A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal" A. hepatitis B surface antigen (HBsAg). B. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). C. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."

Correct Answer D "Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."

A sexually active 20-year-old client has developed viral hepatitis. Which of the following statements, if made by the client, would indicate a need for futher teaching? 1. "A condom should be used for sexual intercourse." 2. "I can never drink alcohol again." 3. "I won't go back to work right away." 4. "My close friends should get the vaccine."

Correct Answer: 2. "I can never drink alcohol again." Rationale: To prevent transmission of hepatitis, a condom is advised during sexual intercourse and vaccination of the partner. Alcohol should be avoided because it is detoxified in the liver and may interfere with recover. Rest is especially important until laboratory studies show that liver function has returned to normal. The client's activity is increased gradually

A sexually active 20-year-old client has developed viral hepatitis. Which of the following statements, if made by the client, would indicate a need for futher teaching? 1. "A condom should be used for sexual intercourse." 2. "I can never drink alcohol again." 3. "I won't go back to work right away." 4. "My close friends should get the vaccine."

Correct Answer: 2. "I can never drink alcohol again." Rationale: To prevent transmission of hepatitis, a condom is advised during sexual intercourse and vaccination of the partner. Alcohol should be avoided because it is detoxified in the liver and may interfere with recover. Rest is especially important until laboratory studies show that liver function has returned to normal. The client's activity is increased gradually

The school nurse is discussing ways to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? 1. Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands.

Correct Answer: 4. Throroughly was hands" "1.Eating after each other should be discouraged,but it is not the most important intervention. 2.Only bottled water should be consumed in Third World countries, but that precaution isnot necessary in American high schools. 3.Hepatitis B and C, not hepatitis A, are trans-mitted by sexual activity. 4.Hepatitis A is transmitted via the fecal-oralroute. Good hand washing helps to prevent its spread. TEST-TAKING HINTS: The test taker must realize that good hand washing is the most important action in preventing transmission of any of the hepatitis viruses. Often, the test taker will not select the answer option that seems"

The school nurse is discussing ways to prevent an outbreak of hepatitis A with a groupof high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? 1. Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands.

Correct Answer: 4. Throroughly was hands" "1.Eating after each other should be discouraged,but it is not the most important intervention. 2.Only bottled water should be consumed in Third World countries, but that precaution isnot necessary in American high schools. 3.Hepatitis B and C, not hepatitis A, are trans-mitted by sexual activity. 4.Hepatitis A is transmitted via the fecal-oralroute. Good hand washing helps to prevent its spread. TEST-TAKING HINTS: The test taker must realize that good hand washing is the most important action in preventing transmission of any of the hepatitis viruses. Often, the test taker will not select the answer option that seems"

A patient withhepatitis 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 a condom during sexual intercourse c) have family members get an injection of immunoglobulin d) follow a low-protein, moderate-carbohydrate, moderate fat diet"

Correct B "Correct Answer: B Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B."

A patient is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level, b. Elevated serum bilirubin level, c. Elevated blood urea nitrogen level, d. Decreased erythrocyte sedimentation rate

Correct B Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin leveles, elevated erythrocyte sedimentatation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.

"The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate?" "A. "The hepatitis vaccine will provide immunity from this exposure and future exposures." B. "I am afraid there is nothing you can do since the patient was infectious before admission." C. "You will need to be tested first to make sure you don't have the virus before we can treat you." D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure.""

Correct D "Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

"A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will: "a. Mobilize iron stores from the liver. b. Prevent hypoglycemia c. Remove bilirubin from the blood d. Prevent the absorption of ammonia from the bowel.

Correct D Lactulose helps prevent the absorption of ammonia from the bowel because it will cause frequent bowel movements, which facilitates the removal of ammonia from the intestines.

"1. 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.

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.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate? "A:"The hepatitis vaccine will provide immunity from this exposure and future exposures." B:"I am afraid there is nothing you can do since the patient was infectious before admission." C:"You will need to be tested first to make sure you don't have the virus before we can treat you." D: "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure.""

Correct D: Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.

"The client with hepatitis asks the nurse ""I went to an herbalist, who recommended I take milk thistle. What do you think about the herb?"" Which statement is the nurse's best response? "1. ""You are concerned about taking an herb"" 2. ""The herb has been used to treat liver disease"" 3. ""I would not take anything that is not prescribed"" 4. ""Why would you want to take any herbs?""

Correct: 2 "1. This is a therapeutic response and the nurse should provide factual information 2. Milk thistle has an active ingredient, silymarin, which has been used to treat liver disease for more than 2,000 yrs. It is a powerful oxidant and promotes liver cell growth. 3. The nurse should not discourage complementary therapies. 4. This is a judgmental statement, and the nurse should encourage the client to ask questions."

"The client with hepatitis asks the nurse ""I went to an herbalist, who recommended I take milk thistle. What do you think about the herb?"" Which statement is the nurse's best response? 1. ""You are concerned about taking an herb"" 2. ""The herb has been used to treat liver disease"" 3. ""I would not take anything that is not prescribed"" 4. ""Why would you want to take any herbs?""

Correct: 2: Milk thistle has an active ingredient, silymarin, which has been used to treat liver disease for more than 2,000 yrs. It is a powerful oxidant and promotes liver cell growth "1. This is a therapeutic response and the nurse should provide factual information 3. The nurse should not discourage complementary therapies. 4. This is a judgmental statement, and the nurse should encourage the client to ask questions."

The home care nurse is visiting a client during an icteric phase of hepatitis of unknown etiology. The nurse would be MOST concerned if the client made which of the following comments? "1. ""I must not share eating utensils with my family."" 2. ""I must use my own bath towel."" 3. ""I'm glad that my husband and I can continue to have intimate relations."" 4. ""I must eat small, frequent feedings."""

Correct: 3 3. ""I'm glad my husband..."" - CORRECT: avoid sexual contact until serologic indicators return to normal

A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness? 1. Prilosec (omeprazole) 2. Synthroid (levothyroxine) 3. Premarin (conjugated estrogens) 4. Lipitor (atorvastatin)

Correct: 4 Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.

A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness? http://www.rnpedia.com/home/exams/nclex-exam/nclex-rn-practice-questions-6 " 1. Prilosec (omeprazole) 2. Synthroid (levothyroxine) 3. Premarin (conjugated estrogens) 4. Lipitor (atorvastatin)

Correct: 4 Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.

"A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that: "A. pruritus is a common problem with jaundice in this phase. B. the patient is most likley to transmit the disease during this phase. C. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. D. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase."

Correct: A The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level B.. Elevated serum bilirubin level c. Elevated blood urea nitrogen level d. Decreased erythrocycle sedimentation rate

Correct: B Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level B.. Elevated serum bilirubin level c. Elevated blood urea nitrogen leveld. Decreased erythrocycle sedimentation rate

Correct: B Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis

"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

"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 a condom during sexual intercourse c. have family members get an injection of imunoglobulin d. follow a low-protein, moderate-carbohydrate, moderate-fat diet."

Correct: B Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. D.cryoprecipitate and fresh frozen plasma.

Correct: D Answer D. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which has most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. D.cryoprecipitate and fresh frozen plasma.

Correct: D Answer D. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.

29. Select the most correct statement related to peritoneal dialysis treatments. a. Procedures require a venous access site. b. Dialysate is infused slowly over 20-30 minutes c. Dialysate solution is allowed to dwell for 1 hour d. Dialysate needs to be prewarmed before infusion.

D

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient?* A. Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear. B. Reassure the patient the chance of acquiring the virus is very low. C. Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection. D. Inform the patient to promptly go to the local health department to receive immune globulin.

D

A 45 year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because?* A. The liver cells are removing too much estrogen from the body which causes the testicles to produce excessive amounts of estrogen, and this leads to gynecomastia B. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level to increase in the body, and this leads to gynecomastia. C. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia. D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

D

The client with chronic renal failure is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: a. During dialysis. b. Just before dialysis. c. The day after dialysis. d. On return from dialysis.

D Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure.

When teaching the male patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement? a. "I will use care when kissing my wife to prevent giving it to her." b. "I will need to take adofevir to prevent chronic HCV." c. "Now that I have had HCV, I will have immunity and not get it again." d. "I will need to be checked for chronic HCV and other liver problems."

D The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with hepatitis A virus (HAV) and HBV, so the patient may be reinfected with another type of HCV. Text Reference - p. 1015

A client has an arteriovenous (AV) fistula in place in the right upper extremity for hemodialysis treatments. When planning care for this client, which of the following measures should the nurse implement to promote client safely? a. take blood pressures only on the right arm to ensure accuracy b. use the fistula for all venipunctures and intravenous infusions c. ensure that small clamps are attached to the AV fistula dressing d. assess the fistula for the presence of a bruit and thrill every 4 hours

D assess the fistula for the presence of a bruit and thrill every 4 hours

When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? A Pulse oximetry reading of 95% B Sinus bradycardia, rate of 58 beats/min C Blood pressure of 148/90 mm Hg D Temperature of 101.2° F (38.4° C)

D Temperature of 101.2° F (38.4° C) Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.

*Possible exam question* The nurse instructs a client diagnosed with chronic kidney disease (CKD) regarding the prescribed medication furosemide (Lasix). Which client statement indicates that the teaching has been effective? A) "I will take this medication to keep my calcium balance normal." B) "This medication will make sure I have enough red blood cells in my body." C) "I will take this pill to keep my protein level in my body stable." D) "This pill will reduce the swelling in my body and get rid of the extra potassium."

D) "This pill will reduce the swelling in my body and get rid of the extra potassium." Rationale: Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with CKD that is used to stabilize protein levels in the body.

The nurse plans to preserve renal perfusion in a client with chronic kidney disease​ (CKD). Which intervention should the nurse implement for this​ client? A) Monitor protein intake B) Assess the arteriovenous fistula on every shift C) Monitor WBC count D) Administer an angiotensin-converting enzyme (ACE) inhibitor as prescribed

D) Administer an angiotensin converting enzyme (ACE) inhibitor as prescribed Rationale: Administering an​ angiotensin-converting enzyme​ (ACE) inhibitor will reduce systemic hypertension and preserve renal function. Assessing the arteriovenous fistula is an important nursing intervention to preserve the patency of the fistula and reduce the risk of​ infection, not to preserve renal perfusion. The kidney with chronic disease is unable to excrete protein​ by-products, causing the multisystemic effects of uremia. Monitoring the​ client's protein intake will address these effects but does not directly preserve renal perfusion. An increase in white blood cells can indicate infection but does not directly affect renal perfusion.

*Possible exam question* A client with a diagnosis of chronic kidney disease (CKD) is experiencing manifestations of anemia. Based on this data, which treatment should the nurse anticipate for this client? A) Begin fluid restriction. B) Administer intravenous glucose and insulin. C) Begin a low-sodium diet. D) Administer epoetin injections.

D) Administer epoetin injections Rationale: Epoetin injections are used in the treatment of anemia caused by CKD. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In CKD, production of this hormone will be reduced. Fluid restriction would be indicated for uremia caused by CKD. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by CKD. A low-sodium diet is used to help reduce fluid volume excess that is caused by CKD.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate? A) "The hepatitis vaccine will provide immunity from this exposure and future exposures." B) "I am afraid there is nothing you can do since the patient was infectious before admission." C) "You will need to be tested first to make sure you don't have the virus before we can treat you." D) "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

D) An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.

A client with a history of cirrhosis presents to the ER with bleeding esophageal varices. The HCP inserts a Minnesota tube. Which assessment is most important for the nurse to make on the client? A) Monitor urine output B) Monitor urine specific gravity C) Auscultate bowel sounds D) Auscultate breath sounds

D) Auscultate breath sounds Rationale: Following insertion of a Minnesota tube​ (a multiple lumen nasogastric tube with a gastric and esophageal​ balloon), it is a priority for the nurse to monitor the​ client's respiratory status. Balloon tamponade carries a number of​ risks, including​ aspiration, airway​ obstruction, and tissue ischemia and necrosis. Monitoring breath sounds will provide information about the​ client's respiratory status. Bowel​ sounds, urine specific​ gravity, and urine output are not affected by a Minnesota tube.

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing which of the following? A) Relief of constipation B) Relief of abdominal pain C) Decreased liver enzymes D) Decreased ammonia levels

D) Decreased ammonia levels Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy.

A nurse is evaluating whether the drug sodium polystyrene sulfonate (Kayexalate) is exerting the desired therapeutic effect for a client diagnosed with chronic kidney disease (CKD). Which therapeutic effect should the nurse anticipate from this medication? A) Increased serum sodium B) Increased stool excretion C) Decreased urine specific gravity D) Decreased serum potassium

D) Decreased serum potassium Rationale: The client with CKD is unable to excrete potassium. Therefore, the drug sodium polystyrene sulfonate (Kayexalate) is used in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the serum sodium level or the urine specific gravity.

*Possible exam question* Which medication is used to increase renal blood flow in clients with acute kidney injury? A) Furosemide (Lasix) B) Mannitol (Osmitrol) C) Bumetanide (Bumex) D) Dopamine (Intropin)

D) Dopamine Rationale: In clients with acute kidney injury, dopamine (Intropin) is administered in low doses by intravenous infusion to increase renal blood flow. If restoration of renal blood flow does not improve urinary output, a potent loop diuretic, such as furosemide (Lasix) or bumetanide (Bumex), or an osmotic diuretic, such as mannitol (Osmitrol), may be given with intravenous fluids. These medications help "wash" nephrotoxins out of the kidneys and reestablish urine output.

A client experiencing hyperkalemia is scheduled for dialysis. The nurse anticipates an order for insulin to help lower the serum potassium level. Which beneficial action does this medication have for this client? A) Acts as an anticoagulant B) Pulls fluid from the cells C) Lowers the blood glucose rate D) Drives the potassium back into the cells

D) Drives the potassium back into the cells Rationale: Glucose and insulin are administered to the client with hyperkalemia to help drive potassium back into the intracellular​ fluid, reducing the amount of potassium in the blood. Potassium supplements would only increase the​ client's potassium levels. Insulin is used to control the blood glucose rate in a diabetic client. Insulin is not known to draw fluid from the cells or act as an anticoagulant.

Which information is most important for the nurse to include in the discharge teaching for a client diagnosed with cirrhosis of the liver? A) Importance of high-impact aerobic exercise B) Ways to increase fluid consumption C) Physical therapy consult D) How to institute bleeding precautions

D) How to institute bleeding precautions Rationale: The client diagnosed with cirrhosis is at risk for bleeding because the​ liver's ability to manufacture clotting factors is impaired. The client should be taught how to institute bleeding precautions. A referral for home health​ services, dietary​ consultation, social​ services, and counseling may be​ needed; a physical therapy consult is not. Ways to manage fatigue and conserve energy should be​ taught; the client should not engage in​ high-impact aerobic exercise. Cirrhosis affects water and salt regulation because of portal​ hypertension, hypoalbuminemia, and​ hyperaldosteronism, which causes fluid volume overload.​ Therefore, the client will most likely be on fluid restriction.

The nurse is caring for an older adult client diagnosed with chronic kidney disease (CKD). The client reports no bowel movements in the past 2 days. Based on this data, which condition is the client at risk for developing? A) Metabolic acidosis B) Hypercalcemia C) Increased serum creatinine levels D) Hyperkalemia

D) Hyperkalemia Rationale: Constipation exacerbates hyperkalemia, so it is important to monitor clients with CKD who already have elevated potassium levels. Hypercalcemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.

The nurse is taking a history on a patient with diabetes and hypertension. Because of the patient's high risk for developing kidney problems, which early sign of chronic kidney disease (CKD) does the nurse assess first? A) Decreased output with subjective thirst B) Urinary frequency of very small amounts C) Pink or blood-tinged urine D) Increased output of very dilute urine

D) Increased output of very dilute urine

When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses? A) Imbalanced nutrition: less than body requirements B) Impaired skin integrity related to edema, ascites, and pruritus C) Excess fluid volume related to portal hypertension and hyperaldosteronism D) Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

D) Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.

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. Rationale: The nurse should have the client void before obtaining a daily weight.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? a) "The effluent should be allowed to drain by gravity." b) "It is important to use strict aseptic technique." c) "The infusion clamp should be open during infusion." d) "It is appropriate to warm the dialysate in a microwave."

D) It is appropriate to warm the dialysate in a microwave Explanation: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

The nurse determines a client diagnosed with cirrhosis is at risk for bleeding. Which intervention is the priority for the nurse to include in the plan of care? A) Provide nutritional supplements B) Administer antihistamines as prescribed C) Administer albumin as prescribed D) Monitor coagulation studies and platelet count

D) Monitor coagulation studies and platelet count Rationale: Monitoring coagulation studies and platelet count help determine if the client is bleeding or is at imminent risk for​ bleeding, and if there is a need for treatment. Antihistamines are used to reduce itching. Albumin is administered to increase plasma oncotic pressure and reduce edema and ascites. Providing nutritional supplements is important but does not affect the risk for bleeding.

*Possible exam question* A client agrees to receive long-term hemodialysis to treat acute kidney injury (AKI). Based on this information, the nurse should prepare the client for which surgical procedure? A) Insertion of a double-lumen catheter into the subclavian artery B) Placement of a peritoneal catheter C) Insertion of a subarachnoid-peritoneal shunt D) Placement of an arteriovenous fistula

D) Placement of an arteriovenous fistula Rationale: For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis, not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebrospinal fluid and not for hemodialysis.

The nurse is planning care for a client admitted with a diagnosis of heart failure. Based on this diagnosis, which type of kidney failure is the client at an increased risk for experiencing? A) Prerenal hypovolemia B) Intrarenal glomerular injury C) Intrarenal acute tubular necrosis D) Prerenal low cardiac output

D) Prerenal low cardiac output Rationale: Heart failure is one possible cause of prerenal kidney failure due to low cardiac output. In comparison, causes of prerenal kidney failure due to hypovolemia include hemorrhage, dehydration, burns, wounds, and excess fluid loss from the gastrointestinal tract. Causes of intrarenal kidney failure due to glomerular injury include glomerulonephritis, disseminated intravascular coagulation, vasculitis, hypertension, toxemia of pregnancy, and hemolytic uremic syndrome. Finally, causes of intrarenal kidney failure due to acute tubular necrosis include ischemia resulting from conditions associated with prerenal failure, toxins, hemolysis, and rhabdomyolysis.

The nurse is planning care for a client with chronic kidney disease​ (CKD). Which precautions should the nurse implement for this​ client? A) Airborne B) Droplet C) Contact D) Standard

D) Standard Rationale: Because a client with chronic renal failure is at risk of​ infection, healthcare providers should use standard precautions to provide care. The other types of precautions are not appropriate for a client with chronic renal failure.

When collecting an admission history, the nurse identifies that the client prefers fish and crustaceans over other sources of protein. When planning discharge teaching for this client the nurse should include the fact that the cooked food most likely to remain contaminated by the virus that causes Hep A is A) canned tuna B) broiled shrimp C) baked haddock D) steamed lobster

D) Steamed lobster. The temperature during steaming is never high enough or sustained long enough to kill organisms

The nurse reviews findings from the assessment of a client with end-stage renal disease. Which finding should the nurse identify as the most common cardiac complication of this disease? A) Hypolipidemia B) Cardiomyopathy C) Tetralogy of Fallot D) Systemic hypertension

D) Systemic hypertension Rationale: Hypertension results from excess fluid​ volume, increased​ renin-angiotensin activity, and increased peripheral vascular resistance.​ Hyperlipidemia, not​ hypolipidemia, often occurs with ESRD. Heart​ failure, not​ cardiomyopathy, results from ESRD. Tetralogy of Fallot is a congenital heart abnormality not caused by ESRD.

On review of the clients' medical records, the nurse determines that which client is at risk for fluid volume excess? A) The client taking diuretics and has tenting of the skin B) The client with an ileostomy from a recent abdominal surgery C) The client who requires intermittent gastrointestinal suctioning D) The client with kidney disease and a 12-year-old history of diabetes

D) The client with kidney disease and a 12-year-old history of diabetes mellitus

The nurse is caring for a client from another country who was admitted to the hospital with a diagnosis of hypertension and chronic kidney disease. The client is receiving hemodialysis three times a week. When the nurse inquires about diet, the client reports the use of salt substitutes. Why should the nurse teach the client to avoid these products? A) They will increase the risk of AV fistula infection. B) They will cause the client to retain fluid. C) They will interact with the client's antihypertensive medications. D) They can contribute to hyperkalemia.

D) They can contribute to hyperkalemia Rationale: Many salt substitutes contain high levels of potassium chloride. Potassium intake must be carefully regulated in clients with chronic kidney disease, and use of salt substitutes can worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitutes should be avoided. Control of hypertension is essential in the management of a client with kidney disease, but salt substitutes are not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection, but this is unrelated to use of salt substitutes.

The nurse is assessing the skin of a patient with ESKD. Which clinical manifestation is considered a sign of very late, premorbid, advanced uremic syndrome? A) Ecchymosis B) Sallowness C) Pallor D) Uremic frost

D) Uremic frost

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a) Perform deep-breathing exercises vigorously. b) Avoid carrying heavy items. c) Auscultate the lungs frequently. d) Wear a mask when performing exchanges.

D) Wear a mask when performing exchanges The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation? The patient has completed a college education. The patient has been able to stop smoking cigarettes. The patient has well controlled type 1 diabetes mellitus. The chest x-ray showed another lung cancer lesion

D. Contraindications for liver transplant include severe extrahepatic disease, advanced hepatocellular carcinoma or other cancer, ongoing drug or alcohol abuse, and the inability to comprehend or comply with the rigorous post-transplant course. It does not matter if the patient has a college education. The fact that the patient has quit smoking is not a contraindication for liver transplant. The patient is a well-controlled diabetic, which is not a contraindication.

The nurse is admitting a patient with cirrhosis. The nurse checks the patient's history for which most frequent risk factor associated with cirrhosis? a. Polypharmacy b. Intravenous drug abuse c. Hepatitis A d. Alcohol abuse

D. Cirrhosis is highly correlated with alcohol abuse. Polypharmacy, drug abuse, and hepatitis A are not linked to cirrhosis. Text Reference - p. 1017

A patient with a 3-year history of liver cirrhosis is hospitalized for treatment of recently diagnosed esophageal varices. What is the most important information for the nurse to include in the teaching plan for this patient? a. Decrease fluid intake to avoid ascites. b. Eat foods quickly so they do not get cold and cause distress. c. Avoid exercise because it may cause bleeding of the varices. d. Avoid straining during defecation to keep venous pressure low

D. Straining during a bowel movement increases venous pressure and could cause rupture of the varices. Fluid restrictions may be a recommendation for ascites but are not directly associated with esophageal varices. If the patient is able to eat, meals should be soft or liquid, and the patient should be instructed to eat slowly and avoid extremes in food temperature to prevent irritation. Excessive exercise and activity should be avoided in a patient with esophageal varices to prevent hypertension, however, avoiding straining and other activities that cause the Valsalva maneuver is still a higher-priority recommendation. Text Reference - p. 1022

A 6-year-old child presents with a history of renal insufficiency. Which question should the nurse ask the parents to assist with the diagnosis of acute kidney injury (AKI)? A. "Which previous major surgeries has your child had?" B. "How much protein does your child consume each day?" C. "Can you tell me about your child's past infections?" D. "Has your child had a recent acute gastrointestinal illness?"

D. "Has your child had a recent acute gastrointestinal illness?" Children with renal insufficiency (decrease in the kidneys' ability to conserve sodium and concentrate the urine) are at greatest risk for developing dehydration and acute kidney injury from acute gastrointestinal illness. Therefore, the nurse needs to further question the patient's parents about recent acute gastrointestinal illnesses. Major surgery, infections, and certain medications that are nephrotoxic can increase the risk for AKI in older adult patients.

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." Rationale: 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 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

The patient admitted to the intensive care unit after a motor vehicle accident has been diagnosed with AKI. Which finding indicates the onset of oliguria resulting from AKI? A. Urine output less than 1000 mL for the past 24 hours B. Urine output less than 800 mL for the past 24 hours C. Urine output less than 600 mL for the past 24 hours D. Urine output less than 400 mL for the past 24 hours

D. Urine output less than 400 mL for the past 24 hours The most common initial manifestation of AKI is oliguria, a reduction to urine output to less than 400 mL/day.

A nurse is reviewing the laboratory data of a client following a hemodialysis treatment. The nurse should expect to find a decrease in which of the following laboratory values? A. RBC count B. Protein C. Calcium D. Potassium

D. Potassium Rationale:Potassium levels are reduced by the process of diffusion during dialysis

When caring for a patient during the oliguric phase of acute kidney injury, what would be an appropriate nursing intervention? A. Weigh patient three times weekly B. Increase dietary sodium and potassium C. Provide a low-protein, high-carbohydrate diet D. Restrict fluids according to the previous day's fluid loss

D. Restrict fluids according to the previous day's fluid loss Patients in the oliguric phase of acute kidney injury have fluid volume excess with potassium and sodium retention. They will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times per week.

Esophageal Varices

Dilate and tortuous veins of the esophagus, caused by portal hypertension

The nurse preceptor is discussing age as a risk factor for acute kidney injury (AKI) in older adults with a graduate nurse. Which statement by the graduate nurse indicates understanding of this risk? A."There are higher levels of waste products present in the blood." B."Older adults have more gastrointestinal illnesses." C."Fluid intake is generally less than the younger population." D."Thickening of the renal artery leads to decreased blood flow."

D."Thickening of the renal artery leads to decreased blood flow." Older adults are at risk for AKI due to structural changes, including reduction in cortical mass, hyperfiltration of the glomerulus associated with hypertrophy, and thickening of the renal artery, leading to decreased blood flow and further risk of AKI in older adults. They also have decreased renal reserve and declining function interfering with the kidney's ability to recover from AKI.

_____________ reside in the liver and help remove bacteria, debris and old red blood cells: A: hepatocytes B: langerhan cells C: enterocytes D: kupffer cells

D: Kupffer cells Kupffer cells perform this function and are one of the two types of cells found in the liver lobules (the functional units of the liver). These cells play a role in helping the hepatocytes turn parts of the old red blood cells into bilirubin.

Which of the following is an age-related change of the hepatobiliary system? a) Decreased prevalence of gallstones b) Decreased blood flow c) Increased drug clearance capability d) Liver enlargement

Decreased blood flow Explanation: Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in size and weight of the liver.

Which nursing diagnosis is not appropriate for a client with​ cirrhosis? Decreased fluid volume Diminished protection Impaired nutrition Impaired skin integrity

Decreased fluid volume Appropriate nursing diagnoses for a client with cirrhosis include impaired skin​ integrity, diminished protection and impaired nutrition.​ Increased, not​ decreased, fluid volume is appropriate for a client with cirrhosis.

A client has developed HELLP syndrome and the last liver function tests suggest acute liver failure is beginning. The nurse should prepare for which intervention? Insertion of a intrahepatic shunt Administration of penicillin G Delivery by cesarean section Administration of acyclovir

Delivery by cesarean section

18.A 24-yr-old woman donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing significant pain and refuses to get up to walk. How should the nurse respond? 1. Have the transplant psychologist convince her to walk. 2. Encourage even a short walk to avoid complications of surgery. 3. Tell the patient that no other patients have ever refused to walk. 4. Tell the patient she is lucky she did not have an open nephrectomy.

Encourage even a short walk to avoid complications of surgery Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication. The transplant psychologist or social worker's role is to determine if the patient is emotionally stable enough to handle donating a kidney; postoperative care is the nurse's role. Trying to shame the patient into walking by telling her that other patients have not refused and telling the patient she is lucky she did not have an open nephrectomy (implying how much more pain she would be having if it had been open) will not be beneficial to the patient or her postoperative recovery

The nurse reviews the stages of chronic kidney disease​ (CKD) before caring for a client with the disorder. Which stage of CKD should the nurse identify as occurring when the kidneys are unable to excrete metabolic waste and maintain fluid and electrolyte balance​ adequately? A. Corneal failure B. Decreasing renal reserve C. Renal insufficiency D. ​End-stage renal disease

End-stage renal disease Rationale: Chronic renal disease​ (CKD) progresses slowly. Loss of function may not be recognized for many years.​ End-stage renal​ disease, or stage​ 5, is the stage where the kidneys are finally unable to excrete metabolic wastes and to regulate fluid and electrolyte balance adequately.

A nurse is assisting with a percutaneous liver biopsy. Place the steps involved in care in the correct sequence from first to last. Ensure that the biopsy equipment is assembled and in order. Help the client assume a supine position. Make sure that the specimen container is labeled and delivered to the laboratory. While the physician inserts the needle, instruct the client to take a deep breath and hold it to keep the liver as near to the abdominal wall as possible. Place a rolled towel beneath the client's right lower ribs.

Ensure that the biopsy equipment is assembled and in order. Help the client assume a supine position. Place a rolled towel beneath the client's right lower ribs. While the physician inserts the needle, instruct the client to take a deep breath and hold it to keep the liver as near to the abdominal wall as possible. Make sure that the specimen container is labeled and delivered to the laboratory. When assisting with a percutaneous liver biopsy, the nurse ensures that the biopsy equipment is assembled and in order. He or she helps the client assume a supine position with a rolled towel beneath the right lower ribs. Before the physician inserts the needle, the nurse instructs the client to take a deep breath and hold it to keep the liver as near to the abdominal wall as possible. After specimen cells are obtained, they are placed in a preservative. The nurse makes sure that the specimen container is labeled and delivered to the laboratory.

a, b, d (​Rationale: Weigh the client daily or more frequently as ordered. Use standard technique​ (same scale,​ clothing, or​ coverings) to ensure accuracy. Rapid weight changes are an accurate indicator of fluid volume​ status, particularly in the client with oliguria. Any drastic shift in weight of a client with AKI indicates some malfunction and can adversely affect other organs and the treatment program.)

For which reason did the nurse place a chair scale in the room of a client who has been admitted with acute kidney injury​ (AKI)? (Select all that​ apply.) A. Because equipment calibration can vary B. To ensure an accurate weight C. Limited availability of equipment D. To utilize standard technique E. Because chair scales are the most accurate

A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply. a) Carbohydrate metabolism b) Glucose metabolism c) Zinc storage d) Ammonia conversion e) Protein metabolism

Glucose metabolism • Ammonia conversion • Protein metabolism Explanation: Functions of the liver include the metabolism of glucose, protein, fat, and drugs; conversion of ammonia; storage of vitamins and iron; formation of bile; and excretion of bilirubin. The liver is not responsible for the metabolism of carbohydrates or the storage of zinc. (less)

The health care provider has determined that a client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? A B C D

Hepatitis A Transmitted by the fecal-oral route via contaminated food or infected food handlers. Hep B C and D are most commonly transmitted via infected blood or body fluids.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? a) Hepatitis C increases a person's risk for liver cancer. b) Infection with hepatitis G is similar to hepatitis A. c) Hepatitis A is frequently spread by sexual contact. d) Hepatitis B is transmitted primarily by the oral-fecal route.

Hepatitis C increases a person's risk for liver cancer. Explanation: Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

A nurse is caring for a pregnant woman. Which physiologic condition may occur during pregnancy and is related to the development of acute kidney injury​ (AKI) that should concern the​ nurse? (Select all that​ apply.) A. Hydronephrosis B. Hypoglycemia C. Preeclampsia D. Hypertension E. Hyperemesis gravidarum

Hydronephrosis Preeclampsia Hyperemesis gravidarum Rationale: During​ pregnancy, glomerular filtration rate increases​ significantly, perhaps by as much as​ 50%. This leads to a decrease in baseline serum creatinine and other changes associated with the increased blood volume that pregnancy brings. AKI in pregnant women is often related to the same etiologies as are identified in the general population.​ However, there are unique etiologies that manifest themselves throughout the pregnancy cycle. Over​ 90% of women develop a physiologic hydronephrosis of​ pregnancy, and this can promote urinary​ stasis, lead to urinary tract​ infection, and ultimately lead to AKI. In​ addition, in the first​ trimester, hyperemesis gravidarum and placenta previa may lead to​ AKI, and as pregnancy​ progresses, pregnancy-induced​ hypertension, preeclampsia, and eclampsia stress the​ kidneys, leading to​ proteinuria, hydronephrosis, and AKI.

Smaller meals with between-meal snacks and nutritional supplements. Adequate nutrition is important for immune function and healing in patients with hepatitis. Encourage the patient to eat smaller meals and to eat snacks in between meals to maintain nutrient and calorie intake. Also, encourage the use of nutritional supplements such as Ensure or instant breakfast drinks. Intake of low-fat proteins such as egg whites and beans may need to be increased. Instruct the patient to avoid alcohol, diet drinks, and fatty meals.

In addressing the impaired nutritional balance for a patient who has been diagnosed with hepatitis B, which dietary changes should the nurse discuss with the patient? Limit alcohol and diet drinks. Increase dietary fat intake. Decrease low-fat proteins such as egg whites and beans. Smaller meals with between-meal snacks and nutritional supplements.

d (rationale: Contrast-induced nephropathy is an abrupt deterioration in renal function that can be associated with the use of contrast medium. It is important to know if the patient had undergone testing utilizing the contrast to determine if that may be the cause of AKI. In obtaining a health history, the nurse should also ask the patient about complaints of anorexia, nausea, weight gain, or edema; recent exposure to a nephrotoxin, such as an aminoglycoside antibiotic; previous transfusion reaction; and chronic diseases, such as diabetes, heart failure, or kidney disease. Physical exams include monitoring: Vital signs. Urine output. (Amount.Clarity.Color.Specific gravity.Presence of blood cells or protein.) Weight. Skin color. Peripheral pulses. Presence of edema, periorbital or dependent. Lung, heart, and bowel sounds.)

In an initial interview, the nurse asks a patient who is newly diagnosed with acute kidney injury (AKI) if they had any radiologic testing using a contrast medium recently. Which would be the purpose of this question? a. Impaired perfusion affects liver functioning. b. It will complete the patient's health history. c. It will prevent recent tests from being repeated. d. Contrast medium is associated as a cause of AK.

A pt 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? Select foods high in fat. Increase intake of fluids, including juice. Eat a food supper when anorexia is not as severe. Eat less often, preferably only three large meals.

Increase intake of fluids, including juice. No specia diet, but recommended to consume a low-fat diet since fat may be poorly tolerated b/c of decreased bile production. Small frequent meals preferred and may prevent nausea.

The nurse is explaining to the client the most common causes of acute kidney injury​ (AKI). Which cause should the nurse​ present? (Select all that​ apply) A. Insufficient blood supply B. Fluid overload C. Chemical imbalance D. Dehydration E. Exposure to nephrotoxins

Insufficient blood supply Exposure to nephrotoxins Rationale: The most common causes of acute kidney injury​ (AKI) are ischemia​ (insufficient blood​ supply) and exposure to nephrotoxins​ (substances that damage nerves or nerve​ tissue). Because of the amount of blood that passes through​ them, the kidneys are particularly vulnerable to these factors. A fall in blood pressure or volume can cause ischemia of kidney tissues. Nephrotoxins in the blood damage renal tissue directly. Other causes of AKI include major​ surgery, sepsis, and severe pneumonia.

A client diagnosed with acute kidney injury​ (AKI) is experiencing hyperkalemia. Which medication should the nurse anticipate being prescribed to this​ client? (Select all that​ apply.) A. Insulin B. Glucose C. ​Angiotensin-converting enzyme​ (ACE) inhibitors D. Sodium bicarbonate E. Calcium chloride

Insulin Glucose Sodium bicarbonate Calcium chloride Rationale: The nurse should anticipate that calcium​ chloride, sodium​ bicarbonate, insulin, and glucose would be prescribed to treat the​ client's hyperkalemia. Calcium​ chloride, sodium​ bicarbonate, and insulin can be used to reduce serum potassium levels by moving potassium into the cells. Calcium is also administered to correct hypocalcemia and reduce hyperphosphatemia.​ (Calcium and phosphate have a reciprocal relationship in the​ body; as the level of one​ rises, the level of the other​ falls.) An ACE inhibitor is used to treat​ hypertension, not hyperkalemia.

A nurse is reviewing laboratory test results from a client. The report indicates that the client has jaundice. What serum bilirubin level must the client's finding exceed? Enter the correct number only.

Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.5 mg/dL (43 fmol/L).

Ms. Charlotte is​ 66-years-old and admits to being an alcoholic for most of her adult life. She is brought to the emergency department with bleeding esophageal varices. Which therapy should be the most effective for Ms. Charlotte at this​ time? ​Beta-blocker Minnesota tube Paracentesis Transjugular intrahepatic portosystemic shunt​ (TIPS)

Minnesota tube While a​ beta-blocker can be used for esophageal​ varices, the best therapy at this time is a balloon tamponade​ (either a​ Sengstaken-Blakemore or Minnesota​ tube). A paracentesis is done to relieve severe ascites. A transjugular intrahepatic portosystemic shunt​ (TIPS) relieves portal hypertension and reduces the onset of esophageal varices and ascites.

12. The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? 1. Monitor the patient's cardiac status. 2. Teach the patient about hand washing. 3. Obtain a serum specimen for electrolytes. 4. Increase direct observation of the patient.

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 client has hepatic encephalopathy (HE) that is currently grade I. Which reflex findings would the nurse expect if the client's HE progresses to grade II? Normal reflexes Overall reflexes are diminished. A positive Babinski Reflexes are brisker than normal. Absence of reflexes

Positive Babinsky Reflexes brisker than normal

A patient has undergone a liver biopsy. Which of the following postprocedure positions is appropriate? a) On the right side b) Trendelenburg c) High Fowler's d) On the left side

On the right side Explanation: In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the patient on his left side is not indicated. Positioning the patient in the Trendelenburg position may be indicated if the patient is in shock, but is not the position designed for the patient after liver biopsy. High Fowler's position is not indicated for the patient after liver biopsy.

Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?

Phosphate level

The most common cause of esophageal varices includes which of the following? a) Ascites b) Portal hypertension c) Asterixis d) Jaundice

Portal hypertension Explanation: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

What is bacterial peritonitis?

Primary or spontaneous peritonitis refers to an extraperitoneal etiology, in which the infectious bacteria enter the peritoneal cavity through the circulatory or lymphatic system. In these cases, the patient usually has an underlying comorbidity that can lead to bacterial migration into the peritoneum.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a) Dyspnea and fatigue b) Gynecomastia and testicular atrophy c) Purpura and petechiae d) Ascites and orthopnea

Purpura and petechiae Explanation: A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

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

The answer is C. Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding...patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged.

After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take?

Report the patient's symptoms to the health care provider.

The nurse is caring for a 68-yr-old man who had coronary artery bypass surgery 3 weeks ago. During the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care? Provide foods high in potassium. Restrict fluids based on urine output. Monitor output from peritoneal dialysis. Offer high-protein snacks between meals.

Restrict fluids based on urine output. Fluid intake is monitored during the oliguric phase. Fluid intake is determined by adding all losses for the previous 24 hours plus 600 mL. Potassium and protein intake may be limited in the oliguric phase to avoid hyperkalemia and elevated urea nitrogen. Hemodialysis, not peritoneal dialysis, is indicated in acute kidney injury if dialysis is needed.

Which therapy for cirrhosis is considered nutritional​ therapy? Increasing fluid intake Restricting sodium intake Administering vitamin K Recommending antacids

Restricting sodium intake Nutritional support for cirrhosis includes restricting sodium intake to 2 g per day. Administering vitamin K and recommending antacids is pharmacologic therapy. Decreasing fluid​ intake, not increasing​ it, is considered a nutritional therapy for cirrhosis.

A client with chronic kidney disease​ (CKD) has a potassium level of 6.5​ mEq/dL. Which prescription should the nurse anticipate receiving for this​ client? (Select all that​ apply.) A. Sodium polystyrene sulfonate B. Sodium bicarbonate C. Intravenous regular insulin D. Intravenous​ 50% dextrose solution E. Potassium 30​ mEq/L in 100 mL intravenous over 2 hours

Sodium polystyrene sulfonate Sodium bicarbonate Intravenous regular insulin Intravenous​ 50% dextrose solution Rationale: Sodium polystyrene sulfonate is a​ potassium-ion exchange resin that removes potassium by exchanging sodium ions for potassium in the small bowel. A combination of regular​ insulin, bicarbonate, and glucose​ (dextrose) facilitates the movement of potassium ions into the cells to decrease serum potassium levels. A serum potassium level of 6.5​ mEq/L is​ hyperkalemic, so potassium replacement is not appropriate.

A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of Hepatitis?* A. Icteric B. Posticteric C. Preicteric D. Convalescent

The answer is A. The Preicteric (prodromal) Phase: flulike symptoms...joint pain, fatigue, nausea vomiting, abdominal pain change in taste, liver enzymes and bilirubin increasing....Icteric Phase: decrease in the flu-like symptoms but will have jaundice and dark urine (buildup of bilirubin) yellowing of skin and white part of the eyeball, clay-colored stool (bilirubin not going to stool to give it's normal brown color) enlarged liver and pain in this area....Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

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

The answer is A. There are two types of drugs that can be used to treat hypertension and protect the kidneys in patients with CKD. These drugs include angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). The only drug listed here that is correct is Lisinopril. This drug is known as an ACE inhibitor. Metoprolol is a BETA BLOCKER. Amlodipine and Verapamil are calcium channel blockers.

3 Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity.

The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? 1.The blood urea nitrogen is 15 mg/dL. 2.The creatinine level is 1.2 mg/dL. 3.The glomerular filtration rate is 40 mL/min. 4.The 24-hour creatinine clearance is 100 mL/min.

3. You're assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician? A. Potassium level 4.2 mEq/L B. Creatinine clearance 35 mL/min C. BUN 20 mg/dL D. Blood pH 7.40

The answer is B. A normal creatinine clearance level in a female should be 85-125 mL/min (95-140 mL/min males). A creatinine clearance level indicates the amount of blood the kidneys can make per minute that contain no amounts of creatinine in it. Remember creatinine is a waste product of muscle breakdown. Therefore, the kidneys should be able to remove excessive amounts of it from the bloodstream. A patient who has experienced a myocardial infraction is at risk for pre-renal acute injury due to decreased cardiac output to the kidneys from a damaged heart muscle (the heart isn't able to pump as efficiently because of ischemia). All the other labs values are normal.

You're assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician? A. Potassium level 4.2 mEq/L B. Creatinine clearance 35 mL/min C. BUN 20 mg/dL D. Blood pH 7.40

The answer is B. A normal creatinine clearance level in a female should be 85-125 mL/min (95-140 mL/min males). A creatinine clearance level indicates the amount of blood the kidneys can make per minute that contain no amounts of creatinine in it. Remember creatinine is a waste product of muscle breakdown. Therefore, the kidneys should be able to remove excessive amounts of it from the bloodstream. A patient who has experienced a myocardial infraction is at risk for pre-renal acute injury due to decreased cardiac output to the kidneys from a damaged heart muscle (the heart isn't able to pump as efficiently because of ischemia). All the other labs values are normal.

8. While assessing morning labs on your patient with CKD. You note the patient's phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be? A. Elevated B. Low C. Normal D. Same as the phosphate level

The answer is B. A normal phosphate level is 2.7-4.5 mg/dL. This patient is experiencing HYPERphosphatemia. When hyperphosphatemia presents the calcium level DECREASES because phosphate and calcium bind to each. When there is too much phosphate in the blood it takes too much calcium with it and it decreases the calcium in the blood. Therefore, the nurse would expect to find the calcium level decreased.

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

The answer is B. Creatinine is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a creatinine clearance test is used as an indicator for determining renal function and for calculating the glomerular filtration rate.

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

The answer is B. Creatinine is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a creatinine clearance test is used as an indicator for determining renal function and for calculating the glomerular filtration rate.

You're developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing diagnosis would you include in the care plan? A. Excess fluid volume B. Risk for electrolyte imbalance C. Urinary retention D. Acute pain

The answer is B. During the diuresis stage of AKI, the patient will be losing an excessive amount of urine (3-6 Liters/day) and is at risk for fluid volume deficient and electrolyte imbalance. The nurse must monitor the patient's electrolyte levels, especially potassium (hypokalemia).

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

The answer is B. EPO (erythropoietin) helps create red blood cells in the bone marrow. The kidneys produce EPO and when the kidneys are damaged in CKD they can decrease in the production of EPO. Therefore, the patient is at risk for anemia.

A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective.* A. 2 weeks B. 24 hours C. 1 month D. 7 days

The answer is B. HBIg should be given 24 hours after exposure to maximum effectiveness of temporary immunity against Hepatitis B. It would be given within 12 hours after birth to an infant born to a mother who has Hepatitis B.

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as?* A. The patient has an active infection of Hepatitis A. B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. C. The patient is in the preicteric phase of viral Hepatitis. D. The patient is in the icteric phase of viral Hepatitis.

The answer is B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A.

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful?* A. Bilirubin <1 mg/dL B. ALT 8 U/L C. Ammonia 16 mcg/dL D. AST 10 U/L

The answer is C. Lactulose is ordered to decrease a high ammonia level. It will cause excretion of ammonia via the stool. A normal ammonia level would indicate the medication was successful (normal ammonia level 15-45 mcg/dL).

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

The answer is C. Options A, B, and D are all at risk for developing CKD. However, option C is not at risk for CKD.

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

The answer is C. Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding...patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged.

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

The answer is C. The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein, low-potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products, excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown (creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for hyperkalemia and fluid overload (needs low-potassium and sodium foods).

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

The answer is C. The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein, low-potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products, excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown (creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for hyperkalemia and fluid overload (needs low-potassium and sodium foods).

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

The answer is C. This is known as Stage 4 of CKD because the GFR (glomerular filtration rate) for this stage is 15-29 mL/min (patient's GFR is 25 mL/min). The other stage's criteria are as follows: Stage 1: Kidney damage with normal renal function GFR >90 ml/min but with proteinuria (3 months or more); Stage 2: Kidney damage with mild loss of renal function GFR 60-89 ml/min with proteinuria (3 months or more); Stage 3: Mild-to-severe loss of renal function GFR 30-59 mL/min; Stage 4: Severe loss renal function GFR 15-29 mL/min; Stage 5: End stage renal disease GRF less 15 mL/min

A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B?* A. Positive IgG B. Positive HBsAg C. Positive IgM D. Positive anti-HBs

The answer is D. A positive anti-HBs (Hepatitis B surface antibody) indicates either a past infection of Hepatitis B that is now cleared and the patient is immune, OR that the vaccine has been successful at providing immunity. A positive HBsAg (Hepatitis B surface antigen) indicates an active infection.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is?* A. Blood B. Percutaneous C. Mucosal D. Fecal-oral

The answer is D. Hepatitis A is most commonly transmitted via the fecal-oral route.

What is the MOST common transmission route of Hepatitis C?* A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

The answer is D. IV drug use is the MOST common transmission route of Hepatitis C.

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient?* A. Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear. B. Reassure the patient the chance of acquiring the virus is very low. C. Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection. D. Inform the patient to promptly go to the local health department to receive immune globulin.

The answer is D. Since the patient was exposed to Hepatitis A, the patient would need to take preventive measures to prevent infection because infection is possible. The patient should not wait until signs and symptoms appear because the patient can be contagious 2 weeks BEFORE signs and symptoms appear. The vaccine would not prevent Hepatitis A from this exposure, but from possible future exposures because it takes the vaccine 30 days to start working. The best answer is option D. The patient would need to receive immune globulin to provide temporary immunity within 2 weeks of exposure.

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

The answer is D. The patient's potassium level is extremely elevated. A normal potassium level is 3.5-5.1 mEq/L. This patient is experiencing hyperkalemia, which can cause tall peak T-waves. Remember in CKD (especially prior to dialysis), the patient will experience electrolyte imbalances, especially hyperkalemia.

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

The answer is D. This patient is in the recovery stage of AKI. The patient's labs and urinary output indicate the renal function has returned to normal. Remember the recovery stages starts when the GFR (glomerular filtration rate) has returned to normal (normal GFR 90 mL/min or higher), which will allow waste levels and electrolyte levels to be maintained.

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

The answer is D. This patient is in the recovery stage of AKI. The patient's labs and urinary output indicate the renal function has returned to normal. Remember the recovery stages starts when the GFR (glomerular filtration rate) has returned to normal (normal GFR 90 mL/min or higher), which will allow waste levels and electrolyte levels to be maintained.

Select all the types of viral Hepatitis that have preventive vaccines available in the United States?* A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

The answers are A and B. Currently there is only a vaccine for Hepatitis A and B in the U.S.

Which statements are INCORRECT regarding the anatomy and physiology of the liver? SELECT ALL THAT APPLY A. the liver has 3 lobes and 8 segments B. The liver turns urea, a by-product of protein breakdown, into ammonia C. the liver produces bile which is released into the small intestine to digest fats D. the liver plays an important role in the coagulation process

The answers are A and B. The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea), which is a by-product of protein breakdown, into ammonia. All the other statements are true about liver's anatomy and physiology.

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

The answers are A and C. The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney's ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood...hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine.

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

The answers are A and C. The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney's ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood...hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine.

You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply:* A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

The answers are A and E. Only Hepatitis A and E cause ACUTE infections...not chronic. Hepatitis B, C, and D can cause both acute and chronic infections.

7. You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply: A. "This medication will help keep my calcium level normal." B. "I will take this medication with meals or immediately after." C. "It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication." D. "This medication will help prevent my phosphate level from increasing."

The answers are B and D. Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient's phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.

During the posticteric phase of Hepatitis the nurse would expect to find? Select all that apply:* A. Increased ALT and AST levels along with an increased bilirubin level B. Decreased liver enzymes and bilirubin level C. Flu-like symptoms D. Resolved jaundice and dark urine

The answers are B and D. Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

Select all the ways a person can become infected with Hepatitis B:* A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

The answers are B, C, E, and F. Hepatitis B is spread via blood and body fluids. It could be transmitted via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply:* A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

The answers are B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections....not chronic.

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply:* A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

The answers are B, C, and E. This is associated with a high bilirubin level. A normal bilirubin level is 1 or less.

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply:* A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

The answers are C and D. The patient should NOT take acetaminophen (Tylenol) due to its effective on the liver. The patient should eat small (NOT large), but frequent meals...this may help with the nausea. The patient should rest (not perform aerobic exercises daily) because this will help with liver regeneration.

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

The answers are: B, C, and D. This patient is in the DIURESIS stage of AKI. The nephrons are now starting to filter out waste but cannot concentrate the urine. There is now a high amount of urea in the filtrate (because the nephrons can filter the urea out of the blood) and this causes osmotic diuresis. Urinary output will be excessive (3 to 6 L/day). Therefore, the patient is at risk for hypotension, diluted urine (low urine specific gravity), and hypokalemia (waste potassium in the urine). The patient is not at risk for water intoxication and will not have a normal GFR until the recovery stage.

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

The answers are: B, C, and D. This patient is in the DIURESIS stage of AKI. The nephrons are now starting to filter out waste but cannot concentrate the urine. There is now a high amount of urea in the filtrate (because the nephrons can filter the urea out of the blood) and this causes osmotic diuresis. Urinary output will be excessive (3 to 6 L/day). Therefore, the patient is at risk for hypotension, diluted urine (low urine specific gravity), and hypokalemia (waste potassium in the urine). The patient is not at risk for water intoxication and will not have a normal GFR until the recovery stage.

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

The answers are: C, E, and F. These patients are at risk for an intra-renal injury, which is where there is damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury because there is an obstruction that can cause back flow of urine into the kidney, which can lead to decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is an issue with perfusion to the kidney.

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

The answers are: C, E, and F. These patients are at risk for an intra-renal injury, which is where there is damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury because there is an obstruction that can cause back flow of urine into the kidney, which can lead to decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is an issue with perfusion to the kidney.

4. The white blood cell count is elevated;normal is 5,000 to 10,000/mm3.

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1.A serum potassium level of 3.8 mEq/L. 2.A urinalysis shows microscopic hematuria. 3.A creatinine level of 0.8 mg/100 mL. 4.A white blood cell count of 14,000/mm3.

2. Elevating the scrotum on a towel for support is a task which can be delegated to the UAP.

The client is one (1) day postoperative TURP. Which task should the nurse delegate to the UAP? 1.Increase the irrigation fluid to clear clots from the tubing. 2.Elevate the scrotum on a towel roll for support. 3.Change the dressing on the first postoperative day. 4.Teach the client how to care for the continuous irrigation catheter.

1 Fever, chills, and costovertebral pain are symptoms of a urinary tract infection (acute pyelonephritis), which requires a urine culture first to confirm the diagnosis.

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe first? 1.A midstream urine for culture. 2.A sonogram of the kidney. 3.An intravenous pyelogram for renal calculi. 4.A CT scan of the kidneys.

1. The nurse should place the client's chair with the head lower than thebody, which will shunt blood to the brain; this is the Trendelenburg position.

The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first? 1.Place the client in the Trendelenburg position. 2.Turn off the dialysis machine immediately. 3.Bolus the client with 500 mL of normal saline. 4.Notify the health-care provider as soon as possible.

4 Coffee, tea, cola, and alcoholic beverages are urinary tract irritants.

The female client in an outpatient clinic is being sent home with a diagnosis of urinary tract infection (UTI). Which instruction should the nurse teach to prevent a recurrence of a UTI? 1.Clean the perineum from back to front after a bowel movement. 2.Take warm tub baths instead of hot showers daily. 3.Void immediately preceding sexual intercourse. 4.Avoid coffee, tea, colas, and alcoholic beverages.

a, b (Rationale: The client with AKI has an increased risk of GI​ bleeding, probably related to the stress response and impaired platelet function. Regular doses of antacids​ (although not ones that are magnesium​ based), histamine​ H2-receptor antagonists​ (e.g., famotidine,​ ranitidine), or a proton pump inhibitor​ (e.g., omeprazole​ [Prilosec]) are often ordered to prevent GI hemorrhage. All​ medications, including​ over-the-counter medications, should be discussed with the healthcare provider to see if they are contraindicated in their medical condition. Milk will not coat the stomach or protect the gastric mucosa.)

The nurse describes the increased risk of gastrointestinal bleeding to a client with AKI. Which factor should the nurse inform the client about with regard to​ medication? (Select all that​ apply.) A. ​"Avoid magnesium-based​ antacids." B. ​"Regular doses of antacids are​ indicated." C. "Take antacids at​ bedtime." D. "Over-the-counter calcium carbonate​ (Tums) is​ helpful." E. "Drink milk to coat the stomach prior to taking​ medication."

The patient has become lethargic and is hyperventilating. Lethargy and hyperventilation are concerns because the drug can cause lactic acidosis. If the patient becomes lethargic, the drug should be discontinued, and the healthcare provider notified promptly.

The nurse is assessing a patient with chronic hepatitis who is receiving the antiretroviral agent lamivudine (Epivir). Which assessment finding is a priority to communicate to the healthcare provider? The patient has frequent loose stools. The patient has a temperature of 99°F orally. The patient has become lethargic and is hyperventilating. The patient has nausea.

2. Bladder spasms are common, but being relieved with medication indicates the condition is improving.

The nurse is caring for a client with a TURP. Which expected outcome indicates the client's condition is improving? 1.The client is using the maximum amount allowed by the PCA pump. 2.The client's bladder spasms are relieved by medication. 3.The client's scrotum is swollen and tender with movement. 4.The client has passed a large, hard, brown stool this morning.

​"I must use hormonal birth control to prevent​ pregnancy." The client should use barrier​ contraception, not hormonal birth​ control, in order to prevent transmission of the infection to her spouse. It is strongly recommended that the spouse get vaccinated if he is not already immune. Careful hand hygiene and avoidance of hepatotoxins is crucial for clients with hepatitis

The nurse is caring for a client with a new diagnosis of Hepatitis B and is performing teaching to the client and family. Which statement by the client requires immediate​ correction? ​"My husband will get a hepatitis B vaccination​ immediately." ​"I will avoid alcohol and​ Tylenol." ​"We will wash our hands very carefully throughout the​ day." ​"I must use hormonal birth control to prevent​ pregnancy."

Risk for Infection Deficient Knowledge Risk for Impaired Skin Integrity A client with severe pruritus or itching is at risk for skin breakdown​ (from scratching) and infection​ (from potentially introducing harmful bacteria into a break in the​ skin). The client also has deficient knowledge related to caring for​ hepatitis-associated pruritus. Imbalanced nutrition and nausea are not applicable for this client.

The nurse is caring for a client with active hepatitis infection. The client is complaining of severe pruritus. Which are the priority nursing diagnoses for this​ client? (Select all that​ apply.) Imbalanced Nutrition​ (less than body​ requirements) Risk for Infection Nausea Deficient Knowledge Risk for Impaired Skin Integrity

a, b, c, d (rationale: Major​ trauma, heart​ failure, and hemorrhage are all possible risks and causes for AKI because they can reduce blood flow to the kidneys. Radiologic contrast media can be nephrotoxic and cause AKI. Cerebrovascular disease is not a risk factor for AKI because it does not reduce blood flow to the kidneys and it does not cause nephrotoxicity.)

The nurse is caring for a client with acute kidney injury​ (AKI). Which condition should the nurse recognize as a possible cause for this​ disease? (Select all that​ apply.) A. Severe heart failure B. Major trauma C. Radiologic contrast media D. Hemorrhage E. Cerebrovascular disease

Preparation for liver transplantation Liver transplantation may be necessary if a client goes into liver failure secondary to chronic hepatitis. If antivirals​ aren't working, a transplant may be the only treatment option to restore liver function and promote survival. Supportive care and a​ high-protein diet will not be effective alone if the antivirals are not working. Hospice or palliative care may not be​ appropriate, as there are other options.

The nurse is caring for a client with chronic hepatitis. Recent liver enzyme testing results indicate liver​ failure, despite use of antiviral medication. Which plan of care should the nurse anticipate​ next? Preparation for liver transplantation ​High-protein diet Supportive care Hospice or palliative care

Proper diet Avoiding alcohol Rest Treatment for hepatitis consists mostly of supportive measures. Supportive therapy includes​ rest, proper​ diet, and avoiding alcohol and diet drinks.

The nurse is caring for a client with hepatitis. Which supportive treatment should the nurse​ encourage? (Select all that​ apply.) Proper diet Increase in dietary fat Avoiding alcohol Consumption of diet drinks Rest

Hepatitis A Hepatitis A is commonly spread through the fecal-oral route and is found in populations with unsafe food and water preparation practices, such as the homeless population. This is not a risk factor for hepatitis B, C, D, or E.

The nurse is caring for a homeless patient who does not have access to clean water to prepare meals. The patient is experiencing nausea and vomiting, fatigue, and mild fever. The nurse notes yellowish sclera and mucous membranes. The nurse should recognize these clinical manifestations as being consistent with which form of hepatitis? Hepatitis D Hepatitis C Hepatitis B Hepatitis A

Drawing blood for a hepatitis B panel The nurse should anticipate drawing blood to test for the presence of hepatitis B. The vaccine should not be administered without confirming that the mother wasn't already immune to the disease. Because of the potential complications of hepatitis B infection, the infant should be treated to prevent transmission.

The nurse is caring for a newly pregnant woman who recently learned that her husband has an active hepatitis B infection. Which collaborative intervention should the nurse anticipate? Drawing blood for a hepatitis B panel Administering the hepatitis B vaccine Administering hepatitis B immune globulin Nothing; hepatitis B is self-limiting and doesn't put infant at risk

Hepatitis A Hepatitis A is spread through the fecal-oral route through contaminated food, water, shellfish, or direct contact. This type of hepatitis is often contracted during travel outside the United States. Cirrhosis and nonalcoholic fatty liver disease are not transmitted between people. Hepatitis C is spread through contact with infected blood or body secretions.

The nurse is caring for a patient admitted for abdominal pain and jaundice. The patient reports having recently traveled outside the United States. Which condition should the nurse suspect? Hepatitis A Hepatitis C Cirrhosis Nonalcoholic fatty liver disease

b (rationale: Prerenal AKI results from conditions that affect renal blood flow and perfusion. Any disorder that significantly decreases vascular volume, cardiac output, or systemic vascular resistance can affect renal blood flow. Sepsis causes prerenal AKI because it causes altered vascular resistance. Renal calculi are the cause of postrenal failure. Fluid retention is not a cause of prerenal AKI. Glomerulonephritis is the cause of intrarenal AKI.)

The nurse is caring for a patient diagnosed with prerenal acute kidney injury (AKI). Which condition should the nurse recognize as a cause for this disorder? a. Hyperkalemia b. Sepsis c. Glomerulonephritis d. Renal calculi

"The disease is into the next stage, during which you may feel hungrier, have itchy and yellowish skin, and see changes in your urine and stool." By providing information that pruritus, jaundice, and passing brown urine and clay-colored stools are typical presentations, the nurse teaches the patient about manifestations of the hepatitis disease process. Although speaking with the healthcare provider about the patient's concerns is always valid, information about manifestations of the disease process could be shared. It is unlikely that the patient will develop another fever. Ascites and an increased risk for bleeding are potential complications of cirrhosis. Telling the patient that the changes could be insignificant ignores his real and valid concern about his health. Suggesting meeting his nutritional needs is changing the subject, and it does not address the patient's real concern.

The nurse is caring for a patient who has been diagnosed with early-stage hepatitis. The patient says to the nurse, "My fever has gone down, I am less achy, and I am not vomiting anymore. I thought I was getting better, but now my skin is yellow, and I am itchy. What's happening?" Which is the nurse's best response to the patient? "I suggest that you ask your healthcare provider about your progress. Since you feel better, I suggest we walk down the hall." "So far you are making progress. We will be alert for the possibility of retaining fluid in your abdomen and bleeding." "The disease is into the next stage, during which you may feel hungrier, have itchy and yellowish skin, and see changes in your urine and stool." "I am not sure about these changes. It could be nothing at all. Is there something that I can get for you to eat because you seem to have an appetite now?"

"To prevent the complications of hepatitis B, which include liver cancer or cirrhosis" Hepatitis B is caused by the hepatitis B virus that is transmitted by exposure to infected blood or body fluids. Complications include chronic hepatitis, cirrhosis, and liver cancer. Complications of hepatitis B do not include fulminant hepatitis, death, gallstones, or biliary failure.

The nurse is caring for a patient who just found out that his spouse was diagnosed with hepatitis B. The nurse recommends that the patient get a hepatitis B vaccination. The patient asks, "Why is this necessary. Which is the best reply by the nurse? "To prevent the complications of hepatitis B, which include liver cancer or cirrhosis" "To prevent the complications of hepatitis B, which include bile stones and gall bladder failure" "To prevent the complications of hepatitis B, which include fulminant hepatitis" "To prevent the complications of hepatitis B, which include death"

b (rationale: The nurse should promptly report a urine output of less than 30 mL/hr or other evidence of decreased cardiac output for a patient with AKI.)

The nurse is caring for a patient with acute kidney injury (AKI). For which urine amount should the nurse report promptly to the healthcare provider? a. Less than 35 mL/hr b. Less than 30 mL/hr c. Less than 40 mL/hr d. Less than 45 mL/hr

​"Hepatitis D is rarely seen in the United States due to the use of hepatitis B vaccination in​ babies." Hepatitis D can only occur in the presence of hepatitis B. It is rarely seen in children in the United States because of widespread hepatitis B vaccination during infancy or young childhood. Hepatitis A is more commonly spread in daycare centers with children in diapers or who are potty training. Hepatitis A and E are spread through fecaldash-oral transmission. Hepatitis D is associated with chronic​ hepatitis, liver​ cancer, or fulminant​ hepatitis, not cirrhosis.

The nurse is caring for a young child whose parents express concerns about a local hepatitis outbreak. Which statement by the parents indicates effective teaching regarding their​ child's risk for hepatitis​ D? ​"Hepatitis D is only found in young children with​ cirrhosis." ​"Hepatitis D is rarely seen in the United States due to the use of hepatitis B vaccination in​ babies." ​"Hepatitis D is most commonly spread in daycare centers when children are in​ diapers." ​"Hepatitis D is commonly spread through poor hand​ hygiene."

2. When an elderly client's mental status changes to confused and irritable, the nurse should seek the etiology, which may be a UTI secondary to an indwelling catheter. Elderly client soften do not present with classic signs and symptoms of infection.

The nurse is caring for an elderly client who has an indwelling catheter. Which data warrant further investigation? 1.The client's temperature is 98.0˚F. 2.The client has become confused and irritable. 3.The client's urine is clear and light yellow. 4.The client feels the need to urinate.

Administration of an antiviral medication Antiviral medication is contraindicated in the older population due to advanced age and concurrent medical problems. Referral to a​ nutritionist, testing of liver enzymes to screen for advancing liver​ failure, and eating a​ high-protein diet are all appropriate interventions for an older adult client with hepatitis C.

The nurse is caring for an older adult client with hepatitis C. Which collaborative intervention should the nurse​ question? Periodic testing of liver enzymes Provision of​ high-protein diet Administration of an antiviral medication Referral to a nutritionist

"Hepatitis A is more serious in older adults because of nutritional deficits and diminished immune response." In older adults, hepatitis A tends to be more serious and with more complications due to nutritional deficits, diminished immune response, and cumulative toxin exposure. Therefore, older adults should recive the vaccine. Hepatitis A has a higher morbidity rate, not mortality rate. Hepatitis B, not hepatitis A, tends to be asymptomatic.

The nurse is caring for an older adult patient who was never vaccinated for hepatitis A. The nurse offers the vaccine and the patient asks why it's necessary for someone "as old as" her. Which response by the nurse is accurate? "Hepatitis A has a high mortality rate in the older population." "Hepatitis A vaccination may not be necessary in the older population." "Hepatitis A is usually asymptomatic in the older population, leading to delays in treatment." "Hepatitis A is more serious in older adults because of nutritional deficits and diminished immune response."

d (rationale: Prerenal AKI results from conditions that affect renal blood flow and perfusion. Any disorder that significantly decreases vascular​ volume, cardiac​ output, or systemic vascular resistance can affect renal blood flow. Prerenal AKI is​ common, particularly in clients who experience trauma or surgery or are critically ill. The kidneys normally receive 20-​25% of the cardiac output to maintain the glomerular filtration rate​ (GFR), the rate at which fluid is filtered through the kidneys. A drop in renal blood flow to less than​ 20% of normal causes the GFR to fall.​ Hypoperfusion, not​ hyperperfusion, would be a concern. Obstruction is a concern with postrenal​ AKI, not prerenal. Dehydration due to fluid loss would be the​ concern, not fluid overload.)

The nurse is caring for a​ critically-ill client who experienced significant blood loss during surgery. Which concern related to the​ client's risk for prerenal acute kidney injury​ (AKI) should the nurse consider the priority​? A. Fluid overload B. Hyperperfusion C. Urinary obstruction D. Diminished cardiac output

Receive hepatitis A and B vaccinations The most important recommendation for the nurse to give that older adults living in nursing homes or other community settings is to receive the hepatitis A and B vaccinations since the disease can spread rapidly.​ Also, older adults have a higher likelihood of complications from hepatitis than other populations. Food preparation in communal dining rooms is highly regulated and should be considered safe. All individuals should be sure food is cooked well prior to consuming. The older population living in a community setting is at no greater risk than that of all populations for contracting infection from blood transfusion.

The nurse is caring for older clients in an assisted living complex. Which behavior is most important for the nurse​ encourage? Avoid any blood transfusions Avoid eating fish prepared in communal dining areas Receive hepatitis A and B vaccinations Drink only bottled water

a, c, d, e (​Rationale: When completing a health history on a client with acute renal​ failure, the nurse needs to collect information on recent exposure to nephrotoxic medications​ (e.g., nonsteroidal​ anti-inflammatory drugs​ [NSAIDs] and some chemotherapeutic​ drugs); previous transfusion​ reactions; chronic diseases such as diabetes​ mellitus, heart​ failure, and kidney​ disease; and reports of anorexia. The nurse needs to collect information on reports of weight​ gain, not weight loss.)

The nurse is completing a health history on a client admitted with acute renal failure. Which information should the nurse​ collect? (Select all that​ apply.) A. Recent exposure to nephrotoxic medications B. Reports of weight loss C. Reports of anorexia D. Previous transfusion reactions E. Chronic diseases

c (rationale: Renal failure is a condition in which the kidneys are unable to remove accumulated metabolites from the​ blood, resulting in altered fluid and electrolyte balance and aciddash-base balance. Increased pain in a client with renal failure would not cause an alteration in the amount of metabolites. Heart palpitations are caused by​ stress, physical​ exertion, too much​ caffeine, and the use of stimulants. Decreased blood volume is usually caused by bleeding or dehydration.)

The nurse is describing to a colleague how the accumulation of metabolites in the blood from renal failure affects the body. Which effect should the nurse​ include? A. Decreased levels of nitrogenous wastes in blood B. Increased pain C. Altered electrolyte balance D. Bradycardia

3 The client should be taught to take all the prescribed medication anytime a prescription is written for antibiotics.

The nurse is discharging a client with a health-care facility acquired urinary tract infection. Which information should the nurse include in the discharge teaching? 1.Limit fluid intake so the urinary tract can heal. 2.Collect a routine urine specimen for culture. 3.Take all the antibiotics as prescribed. 4.Tell the client to void every five (5) to six (6) hours.

b (​Rationale: All drugs that either are directly nephrotoxic or may interfere with renal perfusion​ (e.g., potent​ vasoconstrictors) should be avoided.​ NSAIDs, nephrotoxic​ antibiotics, and other potentially harmful drugs are avoided throughout the course of AKI. Iron supplementation can be continued if the client is not receiving the required amount in the foods they consume. Acetaminophen can be taken for​ discomfort, as it does not contain the same chemical​ make-up as the NSAIDS. The client should take their blood pressure medication as ordered by the healthcare provider.)

The nurse is discussing medications with a client with acute kidney injury​ (AKI) upon discharge. Which should be included in the​ teaching? A. Avoid taking acetaminophen​ (Tylenol). B. Avoid taking NSAIDS. C. Avoid taking blood pressure medication at night. D. Avoid taking iron supplementation.

c, e (rationale: The most common causes of acute kidney injury​ (AKI) are ischemia​ (insufficient blood​ supply) and exposure to nephrotoxins​ (substances that damage nerves or nerve​ tissue). Because of the amount of blood that passes through​ them, the kidneys are particularly vulnerable to these factors. A fall in blood pressure or volume can cause ischemia of kidney tissues. Nephrotoxins in the blood damage renal tissue directly. Other causes of AKI include major​ surgery, sepsis, and severe pneumonia.)

The nurse is explaining to the client the most common causes of acute kidney injury​ (AKI). Which cause should the nurse​ present? (Select all that​ apply) A. Chemical imbalance B. Dehydration C. Exposure to nephrotoxins D. Fluid overload E. Insufficient blood supply

d (rationale: A patient recovering from AKI needs to avoid nephrotoxic drugs for up to 1 year, not 1 month. The patient will need to continue monitoring blood pressure and symptoms of possible relapse after discharge, as well as avoid life stressors, which can slow healing. Teaching points for patients with AKI include: Educating the patient on how to maintain fluid balance. Discussing proper administration of medications at home. Discussing ways to reduce the risk of infection. Outlining the important points of fluid restriction. Discussing meals. Eating small meals more frequently.)

The nurse is performing discharge teaching to a patient recovering from an acute kidney injury (AKI). Which patient statement indicates a need for further teaching on how to manage AKI after discharge? a. "I will monitor my blood pressure." b. "I need to avoid life stressors." c. "I will monitor for symptoms of possible relapse." d. "I need to avoid NSAIDs for 1 month."

"A vaccination is available for hepatitis B." There are vaccinations available that promote active immunity against hepatitis A and hepatitis B. They can be administered as individual injections or as one combination vaccination. There are no vaccinations available against hepatitis C, hepatitis D, and hepatitis E.

The nurse is providing a reveiw session about hepatits to colleagues. Which statement regarding vaccination availability for viral hepatitis should the nurse include? "A vaccination is available for hepatitis D." "A vaccination is available for hepatitis B." "A vaccination is available for hepatitis C." "A vaccination is available for hepatitis E."

b, c (Rationale: Teaching for the client and the family of the client who is prescribed furosemide includes the​ following: - Unless​ contraindicated, maintain a fluid intake of 2 to 3​ L/day. - Rise slowly from lying or sitting positions because a fall in blood pressure may cause lightheadedness. - Take it in the morning​ and, if ordered twice a​ day, in the late afternoon to avoid sleep disturbance. - Take it with food or milk to prevent gastric distress. - NSAIDs interfere with the effectiveness of loop diuretics and should be avoided.)

The nurse is providing discharge instructions to a client going home on 80mg of furosemide​ (Lasix), a loop​ diuretic, twice a day. Which teaching should be included in these​ instructions? (Select all that​ apply.) A. Take with water​ only." B. "Avoid using nonsteroidal​ anti-inflammatory drugs​ (NSAIDs)." C. "Rise slowly from lying or sitting​ position." D. "Do not take at the same time as other​ medications." E. "Take in the morning and at​ bedtime."

b (rationale: Etiology of AKI in older adults includes sepsis and the presence of polypharmacy, especially nephrotoxic drugs such as NSAIDs. Acetaminophen is an analgesic and so would not be contraindicated in this patient. Calcium carbonate is an antacid and is not of the NSAID classification. Multivitamins do not contain the same compound as an NSAID medication. Older adults should review their medication list frequently with their healthcare provider to avoid issues associated with polypharmacy. The conversation should also include over-the-counter medications or dietary supplements.)

The nurse is providing discharge instructions to a patient recently admitted with complications associated with acute kidney injury (AKI). Which statement by the patient indicates successful teaching? a. "I will stop taking my multivitamin in the morning." b. "I will not take ibuprofen for pain." c. "I will not take acetaminophen for pain." d. "I will not take calcium carbonate when I have heartburn."

c (rationale: If the patient is discharged during the recovery phase of AKI, teach the signs and symptoms of complications, including FVE or FVD, heart failure, and electrolyte imbalances. Monitoring intake and output closely is a vital practice to alert the patient and healthcare provider that there may be a problem. Some expected outcomes related to the recovery phase of AKI based on tubular cell repair and regeneration include: Dehydration. Excess fluid loss. Orthostatic hypotension. Electrolyte imbalance.)

The nurse is providing discharge teaching for a patient in the recovery phase of acute kidney injury (AKI). Which patient statement demonstrates understanding of the signs of possible dehydration? a. "I am up all night going to the bathroom." b. "My urine appears very clear." c. "I am not urinating much during the day." d. "I am urinating more than usual."

"Plan rest periods during the day." Patients diagnosed with hepatitis are at risk for fatigue. The nurse will educate regarding the need to plan rest periods throughout the day. Although they are all appropriate interventions that address other issues that patients with hepatitis often encounter, encouraging smaller meals, adhering to the plan of care, and bathing in warm water do not address the patient's fatigue.

The nurse is providing discharge teaching to a patient diagnosed with hepatitis. Which instruction should the nurse include for dealing with daily fatigue? "Bathe in warm water." "Adhere to the follow-up plan of care." "Plan rest periods during the day." "Take small meals."

"Use barrier contraception every time you have sex." Someone with hepatitis B can spread the infection through blood or body fluids. Counseling the patient to avoid those activities, such as having unprotected sex, is essential to minimize transmission to others. Hence, this is the priority teaching point. Comfort measures, energy preservation, and avoidance of hepatotoxins are important but not the priority.

The nurse is providing discharge teaching to a patient with chronic viral hepatitis. Which is the priority teaching point for this patient? "Avoid hepatotoxins such as alcohol or acetaminophen." "Attend to management of pruritis and promotion of skin integrity." "Use barrier contraception every time you have sex." "Limit activity to prevent fatigue."

​"It is best to eat small meals with snacks in between​ meals." Clients should be encouraged to eat small meals with snacks in between meals. Diet drinks and alcoholic beverages should be​ avoided, as clients with liver disease have decreased liver function and have difficulty detoxifying and breaking down certain foods. Clients should be encouraged to use nutritional supplements. Clients with liver disease are often malnourished and require additional supplementation to improve nutritional status.

The nurse is providing nutritional teaching to a client recently diagnosed with hepatitis. Which statement is appropriate for the nurse to​ include? ​"It is acceptable to drink diet​ drinks." ​"No nutritional supplements are​ needed." ​"Moderate alcohol intake is​ acceptable." ​"It is best to eat small meals with snacks in between​ meals."

b (rationale: Teach the patient how to monitor weight, blood pressure, and pulse. These are important means of assessing fluid status. Daily weights would most likely be ordered for this patient to monitor extreme losses and gains. Measuring the patient's waistline has no bearing on maintaining fluid balance. Counting calories may be a direction provided by a dietitian to gain or lose weight, but it does not play a part in maintaining fluid balance. Some expected outcomes related to the recovery phase of AKI based on tubular cell repair and regeneration include: Dehydration. Excess fluid loss. Orthostatic hypotension. Electrolyte imbalance.)

The nurse is providing teaching to a patient diagnosed with acute kidney injury (AKI). Which intervention would be important to review with the patient as a means to assess fluid balance? a. Showing them how to calculate calories at each meal b. Teaching them how to monitor their blood pressure c. Showing them how to weigh themselves accurately on a monthly basis d. Demonstrating how to measure their waistline

"I will come back in 2 weeks for the next dose." Conventional interferons have a short half-life and require administration several times a week. It is not accurate for the new graduate nurse to have the patient return in 2 weeks for the next dose. There are also longer-acting preparations; however, they have a higher rate of side effects.

The nurse is providing teaching to a patient receiving a conventional interferon. Which patient statement indicates the need for further teaching? "I will make sure to use a reliable form of birth control." "I will come back in 2 weeks for the next dose." "I may experience flu-like symptoms as I get used to this medication." "Side effects should go away the longer I am taking the medicine."

a, b, d, e, (Rationale: Clients with AKI experience electrolyte imbalances. The client with AKI is at particular risk for hyperkalemia caused by impaired potassium excretion and hyperphosphatemia. Calcium and phosphate have a reciprocal relationship in the​ body; as the level of one​ rises, the level of the other falls.​ Therefore, the client should eat foods high in calcium and low in phosphate. Saturated fats are known to raise the levels of cholesterol and therefore should be eaten in moderation.)

The nurse is reviewing discharge instructions with a client with acute renal injury​ (AKI). Which diet instruction should the nurse​ include? (Select all that​ apply.) A. Eat​ high-calcium foods. B. Eat foods low in saturated fat. C. Eat foods high in potassium. D. Eat​ low-phosphorus foods. E. Eat foods low in potassium.

The patient has long red scratches on the arms. Having long red scratches on the arms indicates that the patient's skin is not intact, owing to continued issues with itching. The patient may need further intervention to promote skin integrity and manage pruritis.

The nurse is seeing a patient who is recovering from an acute hepatitis A infection. Which observation by the nurse indicates a need for further intervention? The patient has long red scratches on the arms. The patient states that he is eating already-prepared meals. The patient denies having abdominal pain. The patient is eating a high-protein snack.

Assess the patient for pruritis and skin integrity. Itching and pruritis are a sign that the patient has continued problems resulting from hepatitis infection. The nurse must assess the patient to get more information before recommending an intervention. Bed rest will not relieve the patient's itching. It is not normal to continue to feel itchy during recovery. The nurse will need to get an order from the healthcare provider before applying a hydrocortisone cream.

The nurse is seeing a patient who is recovering from an acute hepatitis A infection. The nurse notes long red scratch marks on the patient's arms. Which is the nurse's next step? Reassure the patient that it is normal to feel itchy during recovery. Put the patient on bed rest for 1 week to promote rest. Assess the patient for pruritis and skin integrity. Administer hydrocortisone cream to relieve itching.

​"I will take acetaminophen for arthritis​ pain." : Acetaminophen is toxic to the liver and should be avoided in a client with liver dysfunction. A​ low-fat, high-carbohydrate diet and dry toast to relieve nausea are appropriate.

The nurse is teaching a client with hepatitis who has an increased alanine aminotransferase​ (ALT) lab value. Which statement by the client requires further teaching by the​ nurse? ​"I will follow a​ low-fat, high-carbohydrate​ diet." ​"I will eat dry toast to relieve my​ nausea." ​"I will require increased periods of​ rest." ​"I will take acetaminophen for arthritis​ pain."

c (rationale: Because excess fluid and solutes are removed more gradually in peritoneal dialysis, this type of renal replacement therapy poses less risk than other methods for patients who are unstable. However, this slower rate of metabolite removal can be a disadvantage in patients with acute kidney injury (AKI) because it reduces waste removal. Peritoneal dialysis is contraindicated in the following situations: Recent abdominal surgery Significant lung disease Peritonitis)

The nurse is teaching a patient about the differences between hemodialysis and peritoneal dialysis. Which statement demonstrates that the patient understands how peritoneal dialysis differs from hemodialysis? a. "Waste is not removed at all." b. "The waste is removed faster." c. "The waste is removed more slowly." d. "Waste accumulates during peritoneal dialysis."

What is the purpose of liver functions tests in diagnosing​ cirrhosis? To determine the presence of anemia To determine the prothrombin time To determine glucose and lipid metabolism To determine the degree of elevation of liver enzymes

To determine the degree of elevation of liver enzymes The purpose of liver functions tests in diagnosing cirrhosis is to determine the degree of elevation of liver enzymes. A CBC is used to determine the presence of anemia. Coagulation studies are used to determine the prothrombin time. Serum glucose and cholesterol levels are used to determine the effect cirrhosis is having on glucose and lipid metabolism.

b (rationale: Carbohydrates are increased for a patient with AKI in order to maintain adequate caloric intake. For a patient with AKI, protein is limited in the diet to reduce the risk of azotemia. Decreasing dietary fiber and dairy intake is not essential for these patients. Dietary interventions for patients with AKI include: Adequate nutrients. Adequate calories. Proteins limited to 0.6 g/kg of body weight. Dietary proteins that are rich in amino acids. An increase in carbohydrates.)

The nurse is teaching a patient diagnosed with acute kidney injury (AKI) about diet. Which statement should the nurse include? a. "You should increase the amount of protein in your diet." b. "Your diet should include an increase in carbohydrates." c. "You should decrease the amount of dairy in your diet." d. "You should decrease the amount of fiber in your diet."

"In this phase I will have dark urine." The urine may be dark during the icteric phase owing to increased levels of conjugated bilirubin, which results from the breakdown of hemoglobin conjugated by hepatocytes and excreted in the bile. A decrease in appetite and muscle aches and fever are noted before the icteric phase of hepatitis.

The nurse is teaching a patient recently diagnosed with hepatitis about the icteric phase. Which statement by the patient indicates teaching has been effective? "In this phase I will have dark urine." "In this phase I will have muscle aches." "In this phase I will have fever." "In this phase I will have a decrease in appetite."

Impaired flow of bile into the biliary system Inflammation in the liver causes damage to the cells. Eventually, this cellular damage restricts the flow of bile through the biliary system, causing jaundice of the skin and mucous membranes. It is not associated with a lymph blockage or backup of bile in the skin. Bile salts are processed by the liver, not the kidney.

The nurse is teaching a patient recently diagnosed with hepatitis. Which description best explains the cause of jaundice? Accumulation of yellow lymph in the lymph nodes in the neck Buildup of excess bile into the cells of the skin and mucous membrane Increased excretion of bile salts from the kidney Impaired flow of bile into the biliary system

b (rationale: In kidney disease, extra fluid and sodium in the circulation can pool and cause edema in the lower legs and around the eyes. It is important to teach the patient that elevating their legs can decrease the edema. The patient will be on fluid restriction, which should be followed. Actions for a patient with edema include: Providing good skin care. Enforcing the fluid restriction. Discussing the patient's concerns with the restriction.)

The nurse is teaching a patient with acute kidney injury (AKI) how to diminish lower leg edema. Which patient statement demonstrates effective teaching? a. "I should not drink alcohol." b. "I should prop my legs up as frequently as possible." c. "I should drink more fluid to help move the excess water through my body." d. "I should only drink one glass of water a day while my legs are swollen."

c (​Rationale: Hyperkalemia may require active intervention as well as restricted potassium intake. When the serum potassium level is greater than 6.0-6.5 mEq/L, manifestations of its effect on neuromuscular function​ develop, including muscle​ weakness, nausea and​ diarrhea, electrocardiographic​ changes, and possible cardiac arrest. With significant​ hyperkalemia, calcium​ chloride, bicarbonate, and insulin and glucose may be given intravenously to reduce serum potassium levels by moving potassium into the cells. An​ H2-receptor antagonist helps prevent gastrointestinal hemorrhage by decreasing gastric acid production. An antibiotic would be used to treat infection. Lactated Ringer would be used in children with AKI for fluid replacement.)

The nurse is treating a client with a serum potassium level of​ 6.7mEq/L who is already on restricted potassium intake. Which medication may be ordered to reduce the neuromuscular effects of this increased serum​ level? A. Antibiotic B. H2-receptor antagonist C. Calcium chloride D. Lactated Ringer

a (rationale: Older adults are at risk for AKI due to structural changes, including reduction in cortical mass, hyperfiltration of the glomerulus associated with hypertrophy, and thickening of the renal artery, leading to decreased blood flow and further risk of AKI in older adults. They also have decreased renal reserve and declining function interfering with the kidney's ability to recover from AKI. Points to remember include: In the critical care setting, there is a 20% greater risk for AKI among older adults than younger adults. Etiology of AKI in older adults includes sepsis and the presence of polypharmacy, especially nephrotoxic drugs such as NSAIDs. Older adults who have undergone life-saving cardiac care, such as heart valve or bypass surgery, are also at high risk for AKI.)

The nurse preceptor is discussing age as a risk factor for acute kidney injury (AKI) in older adults with a graduate nurse. Which statement by the graduate nurse indicates understanding of this risk? a. "Thickening of the renal artery leads to decreased blood flow." b. "Older adults have more gastrointestinal illnesses." c. "There are higher levels of waste products present in the blood." d. "Fluid intake is generally less than the younger population."

c (rationale: Patients with AKI have hyperkalemia and should not be given potassium supplements. Nursing care for patients with fluid volume overload caused by AKI includes maintaining intake and output measurements and daily weighing to assist in tracking fluid balance. Liberal fluid intake is contraindicated in patients with AKI because of their inability to excrete excess fluid. The semi-Fowler position helps improve respiratory excursion of the patient with fluid overload.)

The nurse preceptor is working with a new graduate nurse to provide care for a patient with fluid volume overload due to acute kidney injury (AKI). Which statement indicates that the new graduate nurse needs further teaching about interventions that should be implemented for this patient? a. "I need to limit fluid intake." b. "I need to place the patient in a semi-Fowler position." c. "I need to administer potassium replacements." d. "I need to weigh the patient daily."

Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse?

There is a nontender lump in the axilla.

Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation?

Urine output

Color of urine and stool The color of urine and stool will change with the presence of cirrhosis. Stool is clay​ colored, and urine is brown. Although lipid metabolism may be​ affected, this finding is also present in other disease conditions. Hypoxia is not a finding of cirrhosis. Dysphagia and gastric reflux are not noted in cirrhosis.

When documenting the assessment of a client who possibly has​ hepatitis, which item should be most important for the nurse to​ include? Pulse oximetry reading to note hypoxia Color of urine and stool Dysphagia and gastric reflux Review of serum lipid profile

b (rationale: Arranging for consultation with a dietitian is the most appropriate action. A registered dietitian can assist in planning meals within prescribed limitations that consider the patient's and family's food preferences, especially if the patient follows cultural or religious mandates regarding foods. Diets restricted in protein, salt, and potassium can be unpalatable. A nurse or healthcare provider planning the patient's weekly meals does not necessarily address the patient's preferences within the dietary restrictions. Sending the patient to a website does not ensure accurate understanding and use of information. Lifestyle alterations include: Monitoring and recording food intake. Performing daily weights. Consulting with a dietitian. Planning the diet with the patient and family.)

Which action by the nurse would be most appropriate to address the nutritional imbalances of an older adult patient with acute kidney injury? a. Planning weekly meals for the patient b. Having the patient and family consult with a registered dietitian c. Having the healthcare provider write up meal plans for the patient d. Providing a website to research their new diet

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) Once a patient has tested positive for chronic hepatitis, it is important to determine the extent of liver damage. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are two enzymes that are produced by the liver; elevated levels indicate liver damage. BUN/Cr test for kidney damage. Gallbladder biopsy and amylase levels do not test for liver damage.

Which blood test(s) should the nurse anticipate the healthcare provider to order for a patient newly diagnosed with chronic hepatitis? Amylase Blood Urea Nitrogen (BUN) and Creatinine (Cr) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) Gallbladder biopsy

a, c, e (Rationale: When completing a physical examination on a client experiencing acute renal​ failure, the nurse needs to note the​ client's weight, skin​ color, and lung​ sounds, which may indicate fluid volume excess. Reports of edema and having a history of diabetes mellitus are information collected when obtaining a​ client's health history.)

Which data should the nurse collect when completing a physical examination on a client experiencing acute kidney injury​ (AKI)? (Select all that​ apply.) A. Weight B. Reports of edema C. Lung sounds D. History of diabetes mellitus E. Skin color

Current medications The nurse will ask about current medications during the health history portion of the nursing assessment. Weight, skin color, and peripheral pulses are assessed during the physical examination portion of the nursing assessment.

Which data should the nurse include in the health history portion of an assessment of a patient diagnosed with hepatitis? Skin color Peripheral pulses Current medications Current weight

4. Clients with acute bacterial prostatitis will frequently experience a sudden onset of fever and chills. Clients with chronic prostatitis have milder symptoms.

Which data support to the nurse the client's diagnosis of acute bacterial prostatitis? 1.Terminal dribbling. 2.Urinary frequency. 3.Stress incontinence. 4.Sudden fever and chills.

b (rationale: Edema decreases tissue perfusion and increases the risk of skin breakdown, especially in patients who are older or debilitated. It is common practice to reposition patients frequently because the pressure points of the body can break down with constant pressure to that area of skin. The way the skin is cleansed has no effect on an edematous abdomen. A hoyer lift is used to lift an obese patient in and out of bed. The patient should be encouraged to move as often as possible to redistribute the fluid Actions for a patient with edema include: Providing good skin care. Enforcing the fluid restriction. Discussing the patient's concerns with the restriction.)

Which nursing intervention should be a priority for a patient diagnosed with acute kidney injury (AKI) who has an edematous abdomen while hospitalized? a. Cleanse the patient's skin with an antimicrobial soap. b. Encourage frequent position changes. c. Use a hoyer lift to move the patient. d. Restrict the patient's movement to decrease the potential fluid shift.

12) What nursing intervention should be used to decrease pruritus in clients with liver disease? A) Vigorously scrub the skin with soap to prevent infection. B) Apply a lubricant on the skin to prevent dry skin. C) Use hot water rather than cool water when bathing the client. D) Administer an antihistamine as needed to reduce itching.

b

4) A nurse is caring for a client who was recently admitted for treatment of cirrhosis. The client is currently experiencing ascites, +3 pitting edema, and oliguria. Which nursing diagnosis should the nurse select as a priority for this client? A) Excess Fluid Volume B) Ineffective Peripheral Tissue Perfusion C) Deficient Fluid Volume D) Impaired Skin Integrity

a

Which of the following client responses shows a correct understanding of continuous ambulatory peritoneal dialysis (CAPD)? a) I am expected to perform the procedure at home b) the procedure lasts for one hour c) I have to sit and raise my legs during the procedure d) I have to go to the hospital for this procedure

a) I am expected to perform the procedure at home

Which of the following is an expected finding in the client with chronic renal failure? a) anemia b) polyuria c) increased creatinine clearance d) increased serum calcium levels

a) anemia

The client has been diagnosed to have glomerulonephritis. What should the nurse observe in the urine? a) blood b) pus c) white blood cells d) glucose

a) blood

The client with chronic renal failure has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. The nurse should immediately: a) change the dressing b) reinforce the dressing c) flush the peritoneal dialysis catheter d) scrub the catheter with povidine-iodine

a) change the dressing - Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.

The client with chronic renal failure has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. The nurse should immediately: a) change the dressing b) reinforce the dressing c) flush the peritoneal dialysis catheter d) scrub the catheter with povidine-iodine

a) change the dressing - Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.

The nurse instructs a client with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu? a) cream of wheat, blueberries, coffee b) sausage and eggs, banana, orange juice c) bacon, cantaloupe melon, tomato juice d) cured pork, strawberries, orange juice

a) cream of wheat, blueberries, coffee - the diet for a client with renal failure who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids. Option B, C, and D are high in sodium, phosphorus, and potassium.

The client hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale and anxious. The nurse suspects air embolism. The priority action for the nurse is to: a) discontinue dialysis and notify the physician b) monitor vital signs every 15 minutes for the next hour c) continue dialysis at a slower rate after checking the lines for air d) bolus the client with 500 ml of normal saline to break up the air embolus

a) discontinue dialysis and notify the physician

A client with renal failure is receiving epoetin alfa (Epogen) to support erythropoiesis. The nurse questions the client about compliance with taking which of the following medications that supports red blood cell (RBC) production? a) iron supplement b) zinc supplement c) calcium supplement d) magnesium supplement

a) iron supplement

Which of the following should be considered in the diet of the client with end-stage-renal-disease (ESRD)? a) limit fluid intake during anuric phase b) limit phosphorus and vitamin D-rich food c) limit calcium-rich food d) limit carbohydrates

a) limit fluid intake during anuric phase during ESRD, fluid intake of the client should be limited during anuric phase to prevent fluid overload. Fluid overload increases renal workload, pulmonary edema, and congestive heart failure.

The physician orders a combination of Sulfamethoxazole and Phenazopyridine hydrochloride (Azogantrisol) for a patient. Which therapeutic effect should this combination drug have: a) plain relief and a decreased WBC count b) equal fluid intake and output c) polyuria with reddish stain d) increased complaints of bladder spasm after 20 minutes

a) plain relief and a decreased WBC count

The client with continuous ambulatory peritoneal dialysis (CAPD) has cloudy dialysate. Which of the following is the best initial nursing action? a) send fluid to the laboratory for culture b) administer antibiotic c) do nothing, this is expected d) stop drainage of fluid

a) send fluid to the laboratory for culture cloudy diasylate indicates infection (peritonitis). Culture of the fluid must be done to determine the microorganism present.

The client with continuous ambulatory peritoneal dialysis (CAPD) has cloudy dialysate. Which of the following is the best initial nursing action? a) send fluid to the laboratory for culture b) administer antibiotic c) do nothing, this is expected d) stop drainage of fluid

a) send fluid to the laboratory for culture cloudy diasylate indicates infection (peritonitis). Culture of the fluid must be done to determine the microorganism present.

The client with chronic renal failure is on chronic hemodialysis. Which of the following indicate improvement of the client's condition due to hemodialysis? Select all that apply a) the client's BP is 130/90 b) the client's serum potassium is 4.8 mEq/L c) the client's hemoglobin level is 10 g/dL d) the client's serum calcium is 7.7 mg/dL e) the client's serum sodium is 140 mEg/L f) the client's serum magnesium is 4 mEq/L g) the client's weight has increased from 60 kg to 63 kg

a) the client's BP is 130/90 b) the client's serum potassium is 4.8 mEq/L e) the client's serum sodium is 140 mEg/L

The client with chronic renal failure is on chronic hemodialysis. Which of the following indicate improvement of the client's condition due to hemodialysis? Select all that apply a) the client's BP is 130/90 b) the client's serum potassium is 4.8 mEq/L c) the client's hemoglobin level is 10 g/dL d) the client's serum calcium is 7.7 mg/dL e) the client's serum sodium is 140 mEg/L f) the client's serum magnesium is 4 mEq/L g) the client's weight has increased from 60 kg to 63 kg

a) the client's BP is 130/90 b) the client's serum potassium is 4.8 mEq/L e) the client's serum sodium is 140 mEg/L

Which key points does the nurse include when teaching the patient with cirrhosis and his family about drug therapy before discharge? a. "Do not take over-the-counter medications unless approved by your health care provider." b. "The beta blocker call propranolol (Inderal) will cause your heart rate to increase." c. "The lactulose syrup should cause you to have two to three bowel movements every day." d. "Take your furosemide (Lasix) early in the day so that it does not keep you up at night." e. "Report any muscle weakness or lightheadedness to your health care provider right away."

a. "Do not take over-the-counter medication unless approved by your health care provider." c. "The lactulose syrup should cause you to have two to three bowel movements every day." d. "Take your furosemide (Lasix) early in the day so that it does not keep you up at night." e. "Report any muscle weakness or lightheadedness to your health care provider right away."

Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP) when caring for a patient with cirrhosis experiencing pruritus? a. Apply lotion to soothe the patient's skin b. Use lots of soap and hot water to cleanse the skin c. Assess the patient for signs of skin infection d. Encourage the patient to use distraction to avoid scratching

a. Apply lotion to soothe the patient's skin

A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient?* a. Beef tips and broccoli rabe b. Pasta noodles and bread c. Cucumber sandwich with a side of grapes d. Fresh salad with chopped water chestnuts

a. Beef tips and broccoli rabe

Which elevated laboratory test results indicate hepatic cell destruction? Select all that apply. a. Elevated serum aspartate aminotransferase (AST) b. Elevated serum alanine aminotransferase (ALT) c. Elevated lactate dehydrogenase (LDH) d. Decreased serum total bilirubin e. Increased fecal urobilinogen f. Increased International Normalized Ratio (INR)

a. Elevated serum aspartate aminotransferase (AST) b. Elevated serum alanine aminotransferase (ALT) c. Elevated lactate dehydrogenase (LDH) f. Increased International Normalized Ration (INR)

The nurse is assessing a male patient with cirrhosis. Which male-specific characteristics does the nurse expect to find? Select all that apply. a. Gynecomastia b. Testicular atrophy c. Ascites d. Impotence e. Spider angiomas

a. Gynecomastia b. Testicular atrophy d. Impotence

When admitting the patient with cirrhosis, the nurse assesses for which conditions related to splenomegaly as possible complications of the disease? Select all that apply. a. Thrombocytopenia b. Bleeding esophageal varies c. Hepatorenal syndrome d. Portal hypertensive gastropathy

a. Thrombocytopenia

Symptom a person will experience with disequilibrium syndrome? a. confusion b. SOB c. weakness d. abdominal pain

a. confusion

What would an increased potassium level do to digoxin effectiveness for a person with AKI? a. decreases it b. may increase or decrease it c. increase it d. no effect on it

a. decreases it

2) The nurse is caring for a client who complains of jaundice and pruritus. The healthcare provider suspects that the client has liver disease. What modifiable risk factor for cirrhosis of the liver might the nurse see in the client's history? A) Smokes two packs of cigarettes per day B) Drinks a six-pack of beer each evening C) History of occupational exposure to hepatic toxins D) Family history of fatty liver disease

b

A pt with stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. as the nurse, you know this is due to excessive amounts of what substance found in the blood? a.calcium b. urea c. phosphate d. EPO

b

While assessing morning labs on your pt with CKD. you note the pt's phosphate level as 6.2mg/dL. as the nurse, you expect to find the Ca level to be? a. elevated b. low c. normal d. same as the phosphate level

b

A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen level drops to: a) 3 mg/dL b) 15 mg/dL c) 29 mg/dL d) 35 mg/dL

b) 15 mg/dL the normal blood urea nitrogen level is 8 to 25 mg/dL

Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome Prednisone is prescribed for Carlo. The nurse evaluate its effectiveness by a) checking his BP every 4 hours b) checking his urine for protein c) weighing him each morning before breakfast d) observing him for behavioral changes

b) checking his urine for protein Monitor side effect of prolonged steroid therapy Hyperglycemia - test urine monitor growth of child by checking height because steroid has growth suppressing effect by preventing calcium deposition in the bones Gastric Irritation - give milk or meals, test for occult blood, administer with antacids Avoid exposure to infection because child is immunosuppressed

The client who has a history of gout also is diagnosed with urolithisis and the stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including: a) milk b) liver c) apples d) carrots

b) liver

The client had been diagnosed to have chronic renal failure. He had undergone hemodialysis for the first time. What signs and symptoms when experienced by the client suggest that he is experiencing disequilibrium syndrome? a) restlessness, hypotension, headache b) nausea and vomiting, hypertension, dizziness c) lethargy, hypotension, dizziness d) thachycardia, hypotension, headache

b) nausea and vomiting, hypertension, dizziness disequilibrium syndrome is caused by more rapid removal of waste products from the blood from the brain. This is due to the presence of blood-brain barrier. This causes increased intracranial pressure.

The client with acute renal failure has a serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action? a) check the sodium level b) place the client on a cardiac monitor c) encourage increased vegetables in the diet d) allow an extra 500 ml of fluid intake to dilute the electrolyte concentration

b) place the client on a cardiac monitor

The client with chronic renal failure is undergoing peritoneal dialysis. He asks why the nurse monitors his blood glucose levels. Which of the following will be the most appropriate response by the nurse? a) I have to check if you have diabetes mellitus b) the dialysate contains glucose c) the procedure may lower your blood glucose levels d) it is a routine procedure for every client who undergoes the treatment

b) the dialysate contains glucose

The client with chronic renal failure is undergoing peritoneal dialysis. He asks why the nurse monitors his blood glucose levels. Which of the following will be the most appropriate response by the nurse? a) I have to check if you have diabetes mellitus b) the dialysate contains glucose c) the procedure may lower your blood glucose levels d) it is a routine procedure for every client who undergoes the treatment

b) the dialysate contains glucose

Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome: At Carlo's last check-up when he was 2 1/2 years old, his BP was 95/60, PR was 110/min and weight was 15 kg. Which unexpected assessment today would the nurse report to help the diagnosis? a) BP: 95/60 b) weight: 20 kg c) PR: 110 d) temp: 37 C

b) weight: 20 kg during the toddler period, the child gains 2.5 kg a year. Carlo has gained 5 kg in only 6 months. In nephrotic syndrome, this excessive weight gain is due to edema.

you are providing education to a pt with CKD about calcium acetate. Which statement by the pt demonstrates they understood your teaching about this medication? (Select all) a. "this medication will help keep my calcium level normal" b. "I will take this medication with meals or immediately after" c. "it is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication" d. "this medication will help prevent my phosphate level from increasing"

b, d

A patient diagnosed with hepatitis is undergoing a liver biopsy. When caring for the patient, which of these actions would be essential for the healthcare provider to take? Choose all answers that apply: (Choice A) A Review the patient's baseline liver function tests B Ensure the patient's clotting profile is within normal limits C Provide a mechanical soft diet for before the procedure D Ensure the patient has an empty bladder before the procedure E Help the patient assume a left lateral position after the procedure F Monitor the patient's vital signs after the procedure

b,d,f The liver is located in the right upper quadrant of the abdomen Liver function labs will be assessed, but these are not directly related to the procedure. Hemorrhage is a potential complication of the procedure. To manage bleeding, the patient's clotting profile should be within normal limits and the patient should be positioned on the right side after the procedure to provide pressure to the site. Vital signs are checked afterwards to detect changes that could signal hemorrhage. An empty bladder before the procedure will ensure it isn't damaged. The patient is usually advised to have nothing to eat or drink for six hours before the procedure.

In a patient with AKI, which laboratory urinalysis result indicates tubular damage? a. hematuria b. specific gravity fixed at 1.010 c. urine sodium of 12 mEq/l (12 mmol/L) d. osmolality of 1000 mOsm/kg (1000 mmol/kg)

b. A urine specific gravity that is consistently 1.010 and a urine osmolality of about 300 mOsm/kg is the same specific gravity and osmolality as plasma. This indicates that tubules are damaged and unable to concentrate urine.

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply:* a. Increase albumin levels b. Ascites c. Splenomegaly d. Fluid volume deficit e. Esophageal varices

b. Ascites c. Splenomegaly e. Esophageal varices

Which assessment finding indicates neurologic function deterioration in a patient with stage II cirrhosis? a. Fetor hepaticus b. Asterixis c. Palmar erythema d. Icterus

b. Asterixis

The nurse identifies which laboratory value as the usual indication of hepatic encephalopathy? a. Elevated sodium level b. Elevated ammonia level c. Increase blood urea nitrogen (BUN) d. Increased clotting time

b. Elevated ammonia level

While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as:* a. Metallic Hepatico b. Fetor Hepaticus c. Hepatic Acidosis d. Asterixis

b. Fetor Hepaticus

A dehydrated patient is in the injury stage of RIFLE staging of AKI. What would the nurse first anticipate in the treatment of this patient? a. assess daily weight b. IV administration of fluid and furosemide (Lasix) c. IV administration of insulin and sodium bicarbonate d. reversal of oliguria occurs with fluid replacement

b. Injury is the stage of RIFLE classification when urine output is less than 0.5 ml/kg/hr for 12 hours, the serum creatinine is increased times two or the glomerular filtration rate is decreased by 50%. This stage maybe reversible by treating the cause or in, this patient, the dehydration by administering IV fluid a low dose of a loop diuretic, furosemide (Lasix).

What would alert the nurse that a patient undergoing peritoneal dialysis may be experiencing peritonitis? a. complaints of nausea b. return of cloudy dialysate c. patients complains of SOB d. return of less dialysate than what was infused

b. return of cloudy dialysate

3) The nurse is identifying risk factors for liver disease among individuals who visit the community health center. Which does the nurse recognize as factors contributing to increased risk among certain ethnic groups? Select all that apply. A) Pollution B) Variations in alcohol metabolism C) Stress due to socioeconomic factors D) Consuming alcohol with food E) Climate

bc

8) A nurse is caring for a client with end-stage liver disease. Which alterations should the nurse anticipate with this client? Select all that apply. A) Elevated serum albumin levels due to increased protein synthesis B) Decreased clotting factor levels due to impaired clotting factor production C) Hyperglycemia due to disrupted glucose metabolism D) Increased serum vitamin K due to impaired clearance of fat-soluble vitamins E) Increased plasma oncotic pressure due to impaired protein metabolism

bc

11) When individuals engage in excessive alcohol consumption, which liver function is impacted, leading to subsequent liver damage? A) Metabolism B) Synthesis C) Detoxification D) Glycogen storage

c

7) A client with liver cirrhosis begins to drain bright red blood through the nasogastric tube. Which should the nurse prepare to administer to this client? A) Vitamin K B) Ferrous sulfate C) Platelets D) Folic acid

c

Which pt below is NOT at risk for developing CKD? a. a 58yo Female with uncontrolled HTN b. a 69yo Female with DM c. a 45yo male with polycystic ovarian disease d. a 78yo female with an intrarenal injury

c

A adult client has had laboratory work done as part of a routine physical examination. The nurse interprets that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is noted? a) 0.2 mg/dlL b) 0.5 mg/dL c) 1.9 mg/dL d) 3.5 mg/dL

c) 1.9 mg/dL the normal serum creatinine level foadults is 0.6 to 1.3 mg/dL. The client with a mild degree of renal insufficiency would have a slight elevated level. A creatinie level of 0.2 mg/dL is low, and a level of 0.5 mg/dL is just below normal. A creeatinie level of 3.5 mg/dL may be associated with acute or chronic renal failure.

A client who has a renal mass asks the nurse why an ultrasound has been scheduled, as opposed to other diagnostic tests that may be ordered. The nurse formulates a response based on the understanding that: a) all other tests are more invasive than an ultrasound b) all other tests require more elaborate postprocedure care c) an ultrasound can differentiate a solid mass from a fluid-filled cyst d) an ultrasound is much more cost effective than other diagnostic tests

c) an ultrasound can differentiate a solid mass from a fluid-filled cyst

Situation: Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome. The diagnosis of Idiopathic Nephrotic Syndrome has been confirmed. Which unexpected finding would the nurse report? a) proteinuria b) distended abdomen c) blood in the urine d) elevated serum lipid levels

c) blood in the urine hematuria is rare in nephrotic syndrome but it is profuse is acute glomerulonephritis The manifestations of nephrotic syndrome are: Proteinuria - nephrosis is believed to be due to immunologic response that results in increased permeability of glomerular membrane to proteins resulting in massive protein losses in the urine -- proteinuria and albuminuria (+3 +4), the child losses 50-100 mg/kg weight/day from proteinuria. Hypoalbuminemia - loss of protein in blood results in hypoalbumenimia Edema - cardinal sign and appears first in the periorbital region followed by dependent edema and accompanied by pallor, fatigue and lethargy. Hypoalbuminemia leads to decreased oncotic pressure resulting in fluid shift from intravascular to interstitial causing generalized edema or anasarca.The child has lost appetite but gained weight -- puffiness of the eyes on awakening decreases during the day but appears on the legs and abdomen. Fluid shift causes decreased blood volume that leads to decreased blood supply to kidney. Decreased blood supply to kidney initiates release of aldosterone. Aldosterone causes sodium retention (in interstitial spaces so child will have hyponatremia) and water retention contributing to edema. Hypocholesteronemia and hyperlipidemia - triglycerides and fats are released by the liver in the blood to make up for the protein loss

Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome. Carlo's potential for impairment of skin integrity is related to: a) joint inflammation b) drug therapy c) edema d) generalized body rash

c) edema - management: reduce protein excretion Prevention of Skin Breakdown from Edema frequent turning keep nails short to prevent scratching meticulous skin care to dependent and edematous areas - sacrum, scrotum, labia, abdomen, legs loose clothing Monitor Edema weigh daily and monitor I and O check for pulmonary edema manifested by crackles on auscultation ascites - measure abdominal girth Prevention of Infection - pulmonary edema predisposes to respiratory infection and generalized edema predisposes to skin breakdown. Avoid contact with persons who have infection. Diet - usually anorexic because of GI edema high protein diet sodium restriction if with severe edema fluid intake equal to output and insensible loss vitamin and iron supplements small feedings, give favorite foods

The home care nurse is making follow-up visits to a client following renal transplant. The nurse assesses the client for which signs of acute graft rejection? a) hypotension, graft tenderness, and anemia b) hypertension, oliguria, thirst, and hypothermia c) fever, hypertension, graft tenderness, and malaise d) fever, vomiting, hypotension, and copious amounts of dilute urine

c) fever, hypertension, graft tenderness, and malaise

The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the best understands the information if the client states to record daily the: a) amount of activity b) pulse and respiratory rate c) intake and output and weight d) blood urea nitrogen and creatinine levels

c) intake and output and weight

Diagnosis of acute pyelonephritis has been established your nursing intervention includes the following except: a) provide health teaching and discharge planning b) administer antibiotic c) measure I and O d) provide adequate comfort and rest

c) measure I and O

Which of the following complaints is common in a client with pyelonephritis? a) right upper quadrant pain b) left upper quadrant pain c) pain at the costovertebral region d) pain at the suprapubic region

c) pain at the costovertebral region

The client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of: a) pyelonephritis b) glomerulonephritis c) trauma to the bladder or abdomen d) renal cancer in the client's family

c) trauma to the bladder or abdomen Use the process of elimination. Eliminate options A and B, knowing that any inflammatory disease or infection is accompanied by fever. Because this client is afebrile, these are not possible options. Use knowledge of anatomy and pain assessment to select option C. Pain from renal cancer is a later finding and is localized in the flank area.

A nurse is assessing a client who is diagnosed with cystitis. Which assessment finding is inconsistent with the typical clinical manifestations noted in this disorder? a) hematuria b) low back pain c) urinary retention d) burning on urination

c) urinary retention

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings?* a. Decreased magnesium level b. Increased calcium level c. Increased ammonia level d. Increased creatinine level

c. Increased ammonia level

The nurse is assessing a patient with massive ascites. What related complication must the nurse monitor for with this patient? a. Bleeding due to fragile, thin-walled veins b. Hematemesis due to absence of clotting factors c. Increased ascites due to sodium and water retention d. Bruising due to low platelet count

c. Increased ascites due to sodium and water retention

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: a) appendicitis. b) peptic ulcer disease. c) cholelithiasis. d) cirrhosis.

cirrhosis. Explanation: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

Which of the following anti-hypertensive medications is contraindicated for clients with renal insufficiency? a) beta-adrenergic blockers b) calcium-channel blockers c) direct-acting vasodilators d) angiotensin-converting enzyme inhibitors

d) angiotensin-converting enzyme inhibitors

Which of the following may be included in the diet of the client with chronic renal failure? a) orange slices b) watermelon slices c) cantaloupe slices d) apple slices

d) apple slices the client with renal failure should be given low potassium diet because of hyperkalemia. Apple contains very little potassium. So, it can be given to the client.

A client has an arteriovenous (AV) fistula in place in the right upper extremity for hemodialysis treatments. When planning care for this client, which of the following measures should the nurse implement to promote client safely? a) take blood pressures only on the right arm to ensure accuracy b) use the fistula for all venipunctures and intravenous infusions c) ensure that small clamps are attached to the AV fistula dressing d) assess the fistula for the presence of a bruit and thrill every 4 hours

d) assess the fistula for the presence of a bruit and thrill every 4 hours

The client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. The priority nurse action would be to: a) check the shunt for the presence of bruit and thrill b) observe the site once as time permits during the shift c) check the results of the prothrombin time as they are determined d) ensure that small clamps are attached to the arteriovenous shunt dressing

d) ensure that small clamps are attached to the arteriovenous shunt dressing - An arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours.

A client is being admitted to the hospital with a diagnosis of urolithiasis and ureteral colic. The nurse assesses the client for pain that is: a) dull and aching in the costovetebal area b) aching and camplike thoughout the abdomen c) sharp and radiating posteriorly to the spinal column d) excruciating, wavelike, and radiating toward the genitalia

d) excruciating, wavelike, and radiating toward the genitalia

The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: a) during dialysis b) just before dialysis c) the day after dialysis d) on return form dialysis

d) on return form dialysis

A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis. During history-taking the nurse first asks the client about a recent history of: a) bleeding ulcer b) deep vein thrombosis c) myocardial infarction d) streptococcal infection

d) streptococcal infection

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 45 year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because?* a. The liver cells are removing too much estrogen from the body which causes the testicles to produce excessive amounts of estrogen, and this leads to gynecomastia b. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level to increase in the body, and this leads to gynecomastia. c. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia. d. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

d. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

Patients with cirrhosis are susceptible to bleeding and easy bruising because there is a decrease in the production of bile in the liver preventing the absorption of which vitamin? a. Vitamin A b. Vitamin D c. Vitamin E d. Vitamin K

d. Vitamin K

A post-kidney transplant patient experiences an elevated temperature, elevated BUN and creatinine, and sudden weight gain 2 months after the transplant. Which kind of rejection is the patient experiencing? a. acute b. hyperacute c. none of the above d. chronic

d. chronic

Medication used to decrease the serum potassium level? a. sodium bicarbonate b. epoietin alpha c. sevelamar d. sodium polystyrene sultanate (PSP)

d. sodium polystyrene sultanate (PSP)

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it

is much less likely to clot.

Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the ______________

patient's bowel sounds.

The nurse is discussing medications with a client with acute kidney injury​ (AKI) upon discharge. Which should be included in the​ teaching? A. Avoid taking blood pressure medication at night. B. Avoid taking acetaminophen​ (Tylenol). C. Avoid taking NSAIDS. D. Avoid taking iron supplementation.

​Avoid taking NSAIDS. Rationale: All drugs that either are directly nephrotoxic or may interfere with renal perfusion​ (e.g., potent​ vasoconstrictors) should be avoided.​ NSAIDs, nephrotoxic​ antibiotics, and other potentially harmful drugs are avoided throughout the course of AKI. Iron supplementation can be continued if the client is not receiving the required amount in the foods they consume. Acetaminophen can be taken for​ discomfort, as it does not contain the same chemical​ make-up as the NSAIDS. The client should take their blood pressure medication as ordered by the healthcare provider.

The nurse is treating a client with a serum potassium level of​ 6.7mEq/L who is already on restricted potassium intake. Which medication may be ordered to reduce the neuromuscular effects of this increased serum​ level? A. Lactated Ringer B. Antibiotic C. Calcium chloride D. ​H2-receptor antagonist

​Calcium chloride Rationale: Hyperkalemia may require active intervention as well as restricted potassium intake. When the serum potassium level is greater than 6.0-6.5 ​mEq/L, manifestations of its effect on neuromuscular function​ develop, including muscle​ weakness, nausea and​ diarrhea, electrocardiographic​ changes, and possible cardiac arrest. With significant​ hyperkalemia, calcium​ chloride, bicarbonate, and insulin and glucose may be given intravenously to reduce serum potassium levels by moving potassium into the cells. An​ H2-receptor antagonist helps prevent gastrointestinal hemorrhage by decreasing gastric acid production. An antibiotic would be used to treat infection. Lactated Ringer would be used in children with AKI for fluid replacement.

A client experiencing hyperkalemia is scheduled for dialysis. The nurse anticipates an order for insulin to help lower the serum potassium level. Which beneficial action does this medication have for this​ client? A. Pulls fluid from the cells B. Drives the potassium back into the cells C. Acts as an anticoagulant D. Lowers the blood glucose rate

​Drives the potassium back into the cells Rationale: Glucose and insulin are administered to the client with hyperkalemia to help drive potassium back into the intracellular​ fluid, reducing the amount of potassium in the blood. Potassium supplements would only increase the​ client's potassium levels. Insulin is used to control the blood glucose rate in a diabetic client. Insulin is not known to draw fluid from the cells or act as an anticoagulant.

A young adult client receiving peritoneal dialysis feels fat and unattractive. Which action should the nurse use to help the client cope with a disturbed body​ image? A. Recommend increasing physical activity to manage weight. B. Encourage expression of feelings related to the disease and treatment and their impact on life. C. Recommend speaking with adolescents who also have developed chronic renal failure. D. Provide written information regarding the technical aspects of the dialysis procedure.

​Encourage expression of feelings related to the disease and treatment and their impact on life. Rationale: An appropriate intervention for a client with a disturbed body image is to encourage the expression of feelings related to the disease process and the treatments. While support groups are​ encouraged, the nurse would not recommend that the client speak to an adolescent client with chronic renal failure. While offering written information regarding treatment is​ important, this intervention is not appropriate for a client with disturbed body image. Telling the client to increase physical activity to avoid gaining weight is not therapeutic.

The nurse reviews the complications of chronic kidney disease​ (CKD) with a group of new graduate nurses. Which complication should the nurse include in the​ teaching? (Select all that​ apply.) A. Celiac disease B. Diabetes insipidus C. Osteodystrophy D. Anemia E. Uremic encephalopathy

​Osteodystrophy (due to low Vit. D & Calcio) Anemia (due less erythropoietin) Uremic encephalopathy Rationale: In​ CKD, the kidneys produce less​ erythropoietin ( Erythropoietin= is secreted mainly by the kidneys to stimulate red blood cell production by the bone marrow), which results in anemia. The kidney loses the ability to excrete metabolic waste​ products, so they build up in the blood​ (uremia). These waste products cause changes in the central nervous system known as Uremic Encephalopathy. Decreased vitamin D synthesis and decreased calcium absorption leads to bone resorption and remodeling that leads to Osteodystrophy. Diabetes insipidus and celiac disease are not complications of CKD.

The nurse notes that the plan of care for a client with acute kidney injury​ (AKI) instructs them to reposition the client every 2 hours while in bed. Which is the rationale behind this​ instruction? A. To avoid skin breakdown B. To avoid bone fractures C. To keep skin dry D. To keep the client awake

​To avoid skin breakdown Rationale: Turning the client frequently and providing good skin care help to avoid skin breakdown. Edema decreases tissue perfusion and increases the risk of skin​ breakdown, especially in clients who are older or debilitated. Frequent repositioning has no bearing on bone fractures. The client should be kept dry to assist in avoiding skin breakdown. Repositioning is not done to disturb or keep the client awake.

For which reason did the nurse place a chair scale in the room of a client who has been admitted with acute kidney injury​ (AKI)? (Select all that​ apply.) A. To utilize standard technique B. Limited availability of equipment C. Because chair scales are the most accurate D. To ensure an accurate weight E. Because equipment calibration can vary

​To utilize standard technique To ensure an accurate weight Because equipment calibration can vary Rationale: Weigh the client daily or more frequently as ordered. Use standard technique​ (same scale,​ clothing, or​ coverings) to ensure accuracy. Rapid weight changes are an accurate indicator of fluid volume​ status, particularly in the client with oliguria. Any drastic shift in weight of a client with AKI indicates some malfunction and can adversely affect other organs and the treatment program.

The nurse is providing discharge instructions to a client going home on 80mg of furosemide​ (Lasix), a loop​ diuretic, twice a day. Which teaching should be included in these​ instructions? (Select all that​ apply.) A. ​"Take in the morning and at​ bedtime." B. Take with water​ only." C. ​"Do not take at the same time as other​ medications." D. ​"Avoid using nonsteroidal​ anti-inflammatory drugs​ (NSAIDs)." E. ​"Rise slowly from lying or sitting​ position."

​​"Avoid using nonsteroidal​ anti-inflammatory drugs​ (NSAIDs)." ​"Rise slowly from lying or sitting​ position." Rationale: Teaching for the client and the family of the client who is prescribed furosemide includes the​ following: • Unless​ contraindicated, maintain a fluid intake of 2 to 3​ L/day. • Rise slowly from lying or sitting positions because a fall in blood pressure may cause lightheadedness. • Take it in the morning​ and, if ordered twice a​ day, in the late afternoon to avoid sleep disturbance. • Take it with food or milk to prevent gastric distress. • NSAIDs interfere with the effectiveness of loop diuretics and should be avoided.