326 final practice Q's
A patient with a 2L fluid restriction recommendation
How to measure every fluid
Which hematologic symptoms might be noted in a patient with cirrhosis of the liver? (3 of them)
- Anemia - Leukopenia - Thrombocytopenia
What does lack of vit k storage cause?
- Bruising - Bleeding - Bone development - Osteoporosis
A client with worsening liver failure presents to the med surg floor...which assessment findings should the nurse expect?
- Enlarged abdomen from ascites - Bruise marks on skin - Fatigue and possible confusion - Sclera that appears yellow - Reports of itchy skin
what is the primary prevention of constipation?
- High fiber diet (fruit and veggies) - Drink fluids - Regular toileting - Really depends on underlying issues (fam history? Current problems? etc) - Try and avoid constipating agents, such as milk products, coffee, tea, and alcohol
what are transfusion reaction symptoms
- Low back pain - Hypotension - Tachycardia - Fever and chills - hives/rashed - Cyanosis - Shaking - N/V - Leading to renal failure
what are some FVE symptoms
- Volume problems - Impaired perfusion - Impaired gas exchange/oxygenation - Impaired cerebral function - Impaired neuromuscular function - Crackles - Electrolyte imbalance - Anxiety - BP changed -Change in mental status - Decreased Hgb or Hct
what interventions can be implemented to treat hyperkalemia
- kayexalate - insulin and D50W - dialysis
Which blood lab values are expected to be elevated in a client with worsening liver cirrhosis?
Ammonia Bilirubin PT
What drug would you give for urge and reflex incontinence?
Anticholinergics Ex oxybutynin
Best food choice for potassium of 6.5?
Apple slices or apple juice → low k+
A patient with a 1.5 gram sodium restriction recommendation
Ask them what they eat, if they know what sodium restriction is, more seasonings may help
What drug would you give for overflow incontinence and urinary retention?
Cholinergic Ex. bethanechol
A patient who needs to add calcium recommendation
Dairy, green leafy
A nurse is assisting with a paracentesis for a patient with ascites (can also give albumin IV → attracts water) caused by cirrhosis. What action should the nurse take first?
Have pt empty bladder
Which of the following groups is typically the most vulnerable to acid/ base imbalance, and why? Infants Adolescents Pregnant adults
Infants, because of small lungs, poor respiratory reserve, soft ribcages, small airways, higher basal metabolic rate
First action when a client with cirrhosis begins vomiting blood after a meal?
Obtain vital signs (probs esophageal varices)
Client with kidney disease is weak, lethargic and bradycardic what do you suspect to see regarding potassium levels?
K+ 8.5 mEq/L is suspected
A client with a history of cirrhosis with suspected gastroesophageal varices, which order would the nurse question?
New nasogastric tube
Which class of laxatives is usually considered to be unsafe in patients with renal failure? Stimulants, osmotics, bulk-forming laxatives, or stool softeners? Why?
Osmotics, which frequently contain high amounts of magnesium or phosphate
A patient with cirrhosis and esophageal varices is vomiting and the nurse notes hematemesis. Which action should the nurse take first?
Place the patient in side lying position
Rationale for a low protein diet?
Preserve renal function
A patient who needs to add magnesium recommendation
Salmon, nuts/legumes, avocados, DARK chocolate
Which nursing intervention would be the highest priority in managing a patient with ruptured esophageal varices
Protecting the airways (ABCs)
The nurse is caring for a patient with severe liver cirrhosis and imbalanced nutrition, which nursing intervention would prevent malnutrition in this patient?
Provide oral care before meals (wakes up taste buds)
what type of acid/base imbalance will you see when someone is breathing fast?
alkalosis
What does urinary incontinence lead to ?
Uti Infection Irritation Constipation
A patient with chronic renal failure is prescribed Epogen by the nephrologist. What is the purpose of Epogen for this patient? A Increases RBC production B Decreases RBC production C Increases elimination of ammonia D Increases excretion of potassium
a
1. Which factor may indicate a patient is not an ideal candidate for peritoneal dialysis? a. Patient struggles to perform ADLs and does not have a regular caregiver b. Patient travels out of town for business at least once a week c. Patient states they struggle to abide by dietary restrictions d. Patient does not have routine access to transportation
a
19. A patient that has not had a bowel movement in over 7 days tells the nurse that they just had a bowel movement of liquid, unformed stool. Which of the following interventions by the nurse is MOST appropriate? a. Assess bowel sounds. b. Administer Loperamide, an antidiarrheal. c. Notify the provider about this sudden and unexpected change. d. Encourage the patient to walk and drink plenty of fluids to promote bowel elimination.
a
2. You are reviewing the chart of a new client admitted to your unit with a diagnosis of Chronic Kidney Disease. Which of the following lab values would you EXPECT upon review of their chart? a. Creatinine 1.8 mg/dL b. BUN 15 mg/dL c. Increased hemoglobin d. Creatinine Clearance 100 mL/min
a
24. A patient has been on spironolactone for five years and is getting an EKG at their primary care provider after feeling lightheaded recently. Which of the following findings would be unexpected based on the history? a. Flat T Waves b. Potassium level of 5.6 c. Diarrhea d. Cardiac dysrhythmias
a
5. 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
6. A nurse is caring for a client with type 1 diabetes mellitus. Which client complaint would alert the nurse to the presence of a possible hypoglycemic reaction? a. Tremors b. Polyuria c. Dry skin d. Muscle cramps
a
8. Your patient is being discharged with a prescription for senna. Which of the following statements by the patient requires a need for further teaching? a. "I should come in immediately if I notice discolored urine because that means my kidneys are failing" b. "I should take this medication with a full glass of water" c. "This medication may cause diarrhea" d. "I should call the doctor if I develop abdominal pain or cramps"
a
A client is taking furosemide and digoxin for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day? A Maintaining serum potassium levels B Preventing increased sodium levels C Limiting interaction between the drugs D Correcting the associated dehydration
a
A client with lower extremity edema and excess fluid in the lungs has been discharged home with the medication furosemide. For this client, which finding is the best indicator that the medication is working effectively: A Consistent daily weight B Blood pressure in normal range C High urine output D Normal potassium level
a
A client with type 1 diabetes is found unresponsive in the morning by his wife and is admitted to the emergency department. On arrival, the client is unresponsive to stimuli and has acetone smelling breath with Kussmal's respirations. Lab results include plasma glucose of 518 mg/dL. Which intervention does the nurse anticipate administering first A Administration of 0.45% NS with 40mEq KCL/L at 140ml/hr B Administer 100 units regular insulin bolus C Begin weight based dosing insulin drip at 0.1 u/Kg/Hr D Administer Sodium Bicarb 1 ampule.
a
A patient with portal hypertension has ruptured esophageal varices. Which of the following nursing diagnoses take priority? A Impaired airway clearance B Impaired gas exchange C Risk for falls D Altered mental status
a
End stage of renal disease...potassium 7.2, BUN 35, creatinine 3.8 and UO of 300 mL/24 hrs. Which order is priority? a. IV regular insulin and 50% dextrose b. IV loop diuretic c. Dialysis d. Put in vaca time??
a
The nurse is providing care for an older adult patient who is experiencing low SpO2 as a result of worsening left-sided pneumonia and a decreased cough reflex. Which intervention should the nurse use to help the patient mobilize their secretions? A Encourage use of incentive spirometer and staged coughing B Positioning the patient side-lying on his left side C Frequent nasopharyngeal suctioning D Application of oxygen at 4LPM per NC
a
The nurse is reviewing laboratory values noted in the chart of a diabetic client. Which value does the nurse prioritize the need for further assessment of the client? A Random glucose of 62 mg/dL B Hemoglobin A1c of 12.1% C Fasting blood glucose of 141 gm/dL D Urinalysis positive for glucose
a
The patient 12 hours after beginning treatment for DKA has a drop in blood glucose of 195 mg/dL/hr . Which of the following should the nurse do next: A conduct a neurological assessment B call the provider C measure intake and output D prepare to change IV fluids
a
Which of the following lab values best indicate impaired kidney function? a. BUN of 200 mg/dL b.Serum creatinine of 0.4 c. GFR of 110 ml/min d. RBC of 4.0 mcL
a
Which of the following statements are INCORRECT about Diabetic Ketoacidoisis? a. Extreme Hyperglycemia that presents with blood glucose >600 mg/dL b. Ketones are present in the urine c. Metabolic acidosis is present with Kussmaul breathing d. Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy
a
You are caring for a patient receiving an infusion of 0.45% NS. Which assessment finding is more concerning? A Decreased level of consciousness B +1 pitting edema C Serum sodium 133 mEq/L D Urine output 80ml/hr
a
You are caring for a patient with suspected urinary retention. Which of the following is an appropriate assessment? A Conduct a Post Void Residual (PVR) B Insert an indwelling Foley catheter to gravity. C Request an occult blood test D Monitor dietary fiber intake
a
You are reviewing the chart of a new client admitted to your unit with a diagnosis of Chronic Kidney Disease. Which of the following lab values would you EXPECT upon review of their chart? a. Creatinine 1.8 mg/dL b. BUN 15 mg/dL c. Increased hemoglobin d. Creatinine Clearance 100 mL/min
a
A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine. Which statement by the patient indicates a need for further teaching? A "Take this medication with food to decrease the risk for nausea." B "I understand that my dose may change depending on my lab values C "I should report insomnia, tremors, and an increased heart rate to my provider." D "If I take a multivitamin, I should take it 4 hours after the levothyroxine"
a - Levothyroxine must be taken on an empty stomach, at least 30 minutes before food or other medications. The absorption of levothyroxine in the gut is decreased when taking the hormone at the same time as calcium, iron and some foods and other drugs. Because of this, patients are usually instructed to take levothyroxine on an empty stomach 30-60 minutes before food intake to avoid erratic absorption of the hormone.
30. A patient with a history of renal disease came into the clinic with constipation. Which one of the following medications should the nurse question/give with caution? a. Milk of Magnesia b. Senna c. Metamucil d. Docusate Sodium
a - should be given with caution or avoided as people with kidney problems are unable to tolerate excess magnesium.
21.A 60-year old man with kidney failure has a GFR of less than 15 ml/min and is going to start hemodialysis next week. Which of the following education points are inaccurate concerning hemodialysis? SATA. a. Hemodialysis must be done everyday in order to be effective. b. A fistula is required, and thrills and bruits are abnormal and concerning c. There are more fluid restrictions and diet changes required when starting hemodialysis compared to peritoneal dialysis d. Hemodialysis can cause rapid changes to electrolytes. e. Access to reliable transportation is vital to consistent hemodialysis..
a and b
A 60-year old man with kidney failure has a GFR of less than 15 ml/min and is going to start hemodialysis next week. Which of the following education points are inaccurate concerning hemodialysis? SATA. a. Hemodialysis must be done everyday in order to be effective. b. A fistula is required, and thrills and bruits are abnormal and concerning c. There are more fluid restrictions and diet changes required when starting hemodialysis compared to peritoneal dialysis d. Hemodialysis can cause rapid changes to electrolytes
a and b
10. Your patient just had a procedure to create a fistula for their hemodialysis treatment. Which of the following assessment findings would indicate that their fistula is patent and ready to use? SATA a. You hear swishing upon auscultation b. It is red and warm to the touch c. You can feel faint vibration upon palpation d. It is flat upon observation e. You can get an accurate blood pressure from it.
a and c
The nurse is providing care to an adult client admitted to the intensive care unit with a pneumothorax (punctured lung). Which interventions are appropriate for this client? Select all that apply A Elevate head of bed B Administer 8 liters of oxygen per minute by nasal cannula C Prepare for chest tube insertion D Administer albuterol inhaler E Administer IV methylprednisolone
a and c
5. Which of the following are effective ways to manage a patient experiencing stress incontinence? SATA a. Establishing a regular toileting schedule. b. Avoiding laughing while in social situations. c. Limiting fluid intake to only 500mL daily. d. Doing Kegel exercises to improve muscular support of the bladder. e. Administering Bethanechol, a cholinergic medication.
a and d
23. An 88-year-old patient is incontinent of their bowel. Which of the following are expected consequences of bowel incontinence? SATA a. Embarrassment b. Increased Fall risk c. Skin breakdown d. Fluid and electrolyte imbalances e. Avoidance of social interactions
a, b, c, and e
Which of the following are risk associated with portal hypertension? Select all that apply. A esophageal varices B GI Bleed C splenomegaly D ascites E hypokalemia
a, b, c, d
4. 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 nurse is providing initial dialysis teaching to a patient newly diagnosed with end stage renal disease. Which of the following education points should be included in patient teaching? SATA a. Both forms of dialysis may cause changes in body image. b. During dialysis, diffusion and osmosis allow for dialysate to move into the body and toxins to move out. c. Peritoneal dialysis allows for more flexible dialysis timing and fewer dietary restrictions. d. Hemodialysis is the ideal form of dialysis and will keep you healthiest. e. If you start dialysis, it is difficult to stop.
a, b, and c
Which assessments would indicate if a client with cirrhosis has progressed to hepatic encephalopathy? (SATA) a. Ask client for DOB, name, date and location b. Tell client to extend their arms c. Compare ammonia blood levels with last shift (should not be going up) d. none of the above
a, b, and c
The nurse is caring for a postoperative C-Section patient. Which of the following primary prevention strategies could support this patient in avoiding constipation? Select all that apply: A Increased fluids and fiber B Ambulate in the hall around the unit C Administer Loperamide D Discuss with provider a bowel prevention plan E Promote breastfeeding
a, b, and d
Which of the following nursing actions are appropriate for a patient experiencing a post-partum hemorrhage (Select all that apply) A Administer Packed Red Blood Cells B Massage the fundus C Administer 0.45% NS D Lay the patient down E Sit the patient up
a, b, and d
The nurse is reviewing a patients complete blood count (CBC) following the administration of 2 units packed red blood cells. The nurse anticipates which values will have changed as a a result of that administration: (Select all that apply) A RBC Count B Hct C Hgb D Platelets E WBC Count
a, b, c
Which of the following are consequences of impaired renal function? Select all that apply: A Uremia B Hypokalemia C Metabolic acidosis D Anemia E Fluid volume deficit
a, c, and d
the nurse expects which client to be in respiratory acidosis? (SATA) a. morphine overdose b. panic attack c. sleep apnea d. COPD e. asthma attack f. alc intoxication
a, c, d, e, and f
17. What are common assessment findings typically associated with Diabetic Ketoacidosis? Select all that apply. a. Fatigue and lethargy b. Decreased urine output c. Hypoventilation d. Kussmaul respirations e. Increased thirst
a, d, and e
What are common assessment findings typically associated with Diabetic Ketoacidosis? SATA. a. Fatigue and lethargy b. Decreased urine output c. Hypoventilation d. Kussmaul respirations e. Increased thirst
a, d, and e
9. 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
what type of acid/base imbalance will you see when someone is breathing slow?
acidosis
27. A patient has a spinal cord injury. Which of the following interventions will help the patient avoid autonomic dysreflexia? SATA a. Rectal stimulation b. Bowel management program c. Making dietary adjustments d. Practicing proper skin care e. Proper perineal care
all of the above
elevated BUN and serum creatinine = ? what disease is it related to?
azotemia - when there is nitrogen in your blood - CKD
10. 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
11. Which of the following considerations are associated with hemodialysis treatment? a. It is done through a port catheter in the abdomen. b. It has a bleeding risk due to the use of heparin during treatment c. It is very well tolerated d. There are less fluid and dietary restrictions
b
15. Which of the following statements by a new nurse indicates a need for further teaching? a. "Verbal patient screening can be useful, but must include follow-up questions." b. "All patients will start routine kidney and liver function screening around age 40." c. "Metabolic panels are useful to see an overview of kidney function." d. "Urine specific gravity alone is not enough to diagnose a kidney problem."
b
2. 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
3. Which diabetic patient is most at risk for developing Diabetic Ketoacidosis? a. A patient that is 27-weeks pregnant and their glucose tolerance test indicates gestational diabetes b. A patient with Type 1 Diabetes that no longer can afford their insulin and has been out for four days due to recent unemployment c. A patient with Type 2 Diabetes who stopped taking their Metformin because they did not like the side effects that it was causing d. A patient with Type 1 Diabetes who accidentally administered 10 extra units of Lispro due to miscalculation
b
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
b
7. Your patient comes in with yellowed sclera, fluid buildup in their peritoneal space, and complaints of 7/10 pain in their abdomen. What lab value might you anticipate? a. BUN of 10 b. Increased serum ammonia c. Increased creatinine clearance d. Increased serum creatinine
b
A client with DKA is admitted to the ED. Their initial blood glucose level is 950 mg/dL. A continuous IV infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL. The nurse would prepare to administer which NEXT? a. NPH insulin subcutaneously b. IV fluids containing dextrose c. Phenytoin for the prevention of seizures d. Ondansetron as an antiemetic
b
The nurse is caring for a client with metabolic acidosis from diabetic ketoacidosis. Heart rate is 124; blood pressure is 90/44 (map = 59); respiratory rate is 32 and spo2 is 97%. What would be the priority collaborative intervention? a. Oxygen at 2L per nasal cannula b. iv normal saline at 2000 mL/hour c. iv sodium bicarb d. Placement of peripherally inserted central catheter
b
The nurse is reviewing laboratory values for a patient suspected of having a fluid imbalance. Which laboratory value should indicate a diagnosis of dehydration to the nurse? A Serum sodium 144mEq/L B Hematocrit 53% C Serum potassium 3.8 mEq/L D Hemoglobin 13.5 g/dL
b
The nurse suspects that a client is experiencing hypothyroidism. Which question should the nurse ask during the health history? A "Is your skin often clammy?" B "Are you having any constipation?" C "Are you intolerant to heat?" D "Have you had unexplained weight loss?"
b
Which of the following statements explains the mechanism for dehydration among patients in DKA? A nausea and vomiting leading to losses of GI fluid B osmotic diuresis due to hyperglycemia C alteration in glomerular filtration rate due to hyperglycemia D lipolysis pathway leading to Keytosis
b
Which patient is MOST likely to develop Diabetic Ketoacidosis? a. A 25 year old female newly diagnosed with Cushing's Disease taking glucocorticoids. b. A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a gastrointestinal illness and has been unable to take insulin. c. A 35 year old female newly diagnosed with Type 2 diabetes. d. None of the options are correct.
b
Your patient is complaining of "leaking of urine when I cough" throughout the day. What type of urinary incontinence is the patient describing? A Overflow B Stress C Urge D Retention
b
how does the nurse expect the client to show compensation for the following abg values? pH: 7.20, PaCO2 37 mmHg, HCO3 15 mEq/L (metabolic acidosis) a. decreased RR b. increased RR c. increased renal retention of H+ d. decreased renal excretion of HCO3
b
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, c, and e
You are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition to this, the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern? a. Patient complains of thirst. b. Patient has a potassium level of 2.3 c. Patient's skin and mucous membranes are dry. d. Patient is nauseous.
b - insulin causes potassium to enter back into the cell; therefore removing it from the blood. If the potassium is already 2.3, the patient can bottom out their potassium level. Therefore, the patient needs potassium supplements which requires a doctors order
A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus and then to start an insulin drip per protocol. The patient's labs are the following: pH 7.25, Glucose 455, potassium 2.5. Which of the following is the most appropriate nursing intervention to perform next? a. Start the IV fluids and administer the insulin bolus and drip as ordered b. Hold the insulin and notify the doctor of the potassium level of 2.5 c. Hold IV fluids and administer insulin as ordered d. Recheck the glucose level
b - remember when insulin is given it helps take potassium back into the cell which will cause potassium blood levels to fall. insulin therapy is to be started only if the patients potassium level is 3.3 or greater
28. When admitting a patient in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the nurse? a.The patient's SpO2 is 90% b. The patient is somnolent c. The patient complains of weakness d. The patient's blood pressure is 162/94
b - Hypercapnia occurs when carbon dioxide levels are too high in the bloodstream. Hypercapnia can be a life-threatening health crisis, and severe hypercapnia can lead to death. Somnolence is an indication of respiratory failure.
12. You have a patient who is taking metformin. They come into the ED presenting with confusion, tachycardia, fatigue, and vomiting. What acid base imbalance would you anticipate this patient to have? a. Metabolic alkalosis b. Metabolic acidosis c. Respiratory alkalosis d. Respiratory acidosis
b - We would expect this patient to be experiencing metabolic acidosis as a result of their metformin. A pt who is on metformin is taking it for management of their type 2 diabetes. They likely have CKD and thus are not able to properly excrete all of the toxins through their kidneys. This can cause a build up of lactic acid which can result in an acid base imbalance of metabolic acidosis.
18. You are the nurse for a patient whose most recent serum K+ level was 5.5 mEq/L. Which of the following IV fluid orders would you question for this patient? a. 0.9% NS at 75 mL/hr b. Lactated Ringer's at 50 mL/hr c. D5W at 150mL/hr d. 3% Saline at 50mL/hr
b - lactated ringers has added k+ in it, we would not want to add that since the patient is already hyperkalemic
Which of the following is not a sign or symptom of Diabetic Ketoacidosis? a. Positive Ketones in the urine b. Oliguria c. Polydipsia d. Abdominal Pain
b - oliguria means low urine output....in dka you have high urinary output (polyuria)
A patient is taking the medication prednisone Addison's disease. Which assessment findings by the nurse suggest the patient may need their dosage increased? A Central obesity B Low blood pressure C Hypoglycemia D Edema E Abdominal striae
b and c
11. 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 of the following statements regarding dietary teaching is accurate (Select all that apply) A Fluid restrictions only count free water B Grains are source of magnesium C Salt substitutes are safe for any diet D Banana's are a source of potassium E Cutting table salt from the diet is sufficient for sodium restriction
b and d
7. 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
14. A nurse is caring for a patient diagnosed with hepatitis. Which of the following assessment findings may indicate that the patient is experiencing impaired hepatic function? Select all that apply. a. Increase in hyperglycemic events b. Neurological changes c. Yellowing of the eyes d. Abdominal swelling e. Development of metabolic acidosis
b, c, and d
A nurse is caring for a patient diagnosed with hepatitis. Which of the following assessment findings may indicate that the patient is experiencing impaired hepatic function? SATA a. Increase in hyperglycemic events b. Neurological changes c. Yellowing of the eyes d. Abdominal swelling e. Development of metabolic acidosis
b, c, and d
22. 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, c, and e
3. 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
Jaundice is caused by a buildup of which waste product in the body?
bilirubin
Which complication is a patient at risk for with cirrhosis?
bleeding
What dietary teaching should be encouraged in a patient undergoing periotneal dialysis: A "You should restrict protein in your diet" B "You should increase the number of units of insulin you take" C "You may be able to stop restricting sodium and water in your diet" D "You will need to decrease your potassium intake"
c
13. 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
16. Which of the following lab values is most closely associated with the presence of uremia? a. eGFR value of 15 b. Elevated serum ammonia c. BUN value of 23 mg/dL d. Elevated ALT/AST
c
25. A patient has compromised comfort/function because of their ascites. Which one of the following interventions should the nurse question? a. Paracentesis b. Administering diuretics c. Prone positioning d. Low sodium diet
c
26. Which one of the following lab values are not expected for a person who is experiencing liver failure? a. Low RBC b. Elevated AST/ALT c. Elevated Albumin d. Elevated Bilirubin
c
4. Which of the following Insulin medications do you expect the provider to order to treat DKA in a patient with a blood glucose of 322? a. IV Lispro b. IV NPH c. IV Regular d. IV Glargine
c
6. 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
9. Which of the following patients would you prioritize your care for? a. A 2 year old who had an accident and urinated in their pants. b. A pregnant person who reports not having a BM in 2 days. c. An 88 year old who just had an episode of incontinence. d. A pregnant person who reports urinary accidents every once in a while.
c
A client reports difficulty breathing and a sharp pain in the right chest. The respiratory rate is 38 breaths/minute. The nurse should assign highest priority to which care goal? A Reducing anxiety B Relieving pain C Restoring effective respiration D Maintaining adequate circulatory volume
c
A client with Hashimoto's disease acquires a sudden severe illness. As a result, which condition are they at increased risk of developing? A Hypoglycemia B Malignant hyperthermia C Myxedema coma D Thyroid storm
c
A continuous pulse oximetry monitor indicates that the patient has a drop in SpO2 from 95% to 85% over several hours. RR is 18 and the patient is watching TV. The first action the nurse should take is to: A Order stat ABGs to confirm SpO2 B Notify the health care provider C Check the position of the probe on the patient's finger D Start O2 administration by nasal cannula at 2L minute
c
A nurse administers albuterol to a child with asthma. What side effect will the nurse monitor the child? A Flushing B Dyspnea C Tachycardia D Hypotension
c
A nurse is reviewing prescriptions for a client who has acute dyspnea and diaphoresis. The client states that she is anxious because she feels that she cannot get enough air. Vital signs are: heart rate 117/min, respiratory rate 38/min, SpO2 86%, temperature 38.4° C (101.2° F), and blood pressure 100/54 mm Hg. Lung sounds are clear. Which of the following actions is the priority action at this time? A Notify the provider B Administer heparin C Apply oxygen D Administer albuterol
c
A patient with Type 1 diabetes is taking aspart insulin 3x daily with meals, and glargine at night. Which lab results best indicate that this medication regimen is effective at managing the patients diabetes? A The client's fasting blood glucose is 100 mg/dL. B The client's urine specimen has no protein. C The client's HgA1c is 5.8%. D The client's random glucose is 120 mg/dL.
c
A patient with a history of constipation is seen in the clinic. Which of the following statements made by the patient indicate the need for further teaching? a. "I try to go for multiple walks during the day to help me use the bathroom." b. "I plan to start eating celery and salads instead of prepackaged snacks." c. "Every morning I make sure to take Senna with a glass of water." d. "Fiber helps keep my stools hydrated, making it easier to have a bowel movement."
c
All of the following are potential complications of DKA treatment except... a. Hypokalemia b. Fluid volume excess c. Respiratory acidosis d. Hypoglycemia
c
Surgery is performed on a client. The postoperative arterial blood gas values are pH 7.32, PCO2 53 mm Hg, and HCO3 25 mEq/L Which action should the nurse take? A Place the client in prone position B Have the client breathe into a rebreather bag C Encourage the client to take deep breaths in and out D Administer sodium bicarbonate to correct imbalance
c
The nurse gives the patient 5units of Regular insulin and 10 units of NPH insulin before their evening meal at 1700. The patient asks the nurse why they received 2 different types of insulin. What is the best response by the nurse? A "Your blood glucose was 188 mg/dL before eating and this is the amount of sliding scale that has been ordered." B "Both insulins will help with managing your glucose levels because you are about to eat a carb-heavy meal." C "One type of insulin will provide glucose regulation for your meal, and the other one will manage your glucose and maintain levels more slowly through the rest of the evening." D "Because you are in the hospital, and recently experienced an illness, this is our standard protocol to give two types of insulin with every meal."
c
The nurse is caring for a patient with a positive Chvostek's sign. Which electrolyte imbalance is the patient likely experiencing? A Hypochloremia B Hyperkalemia C Hypocalcemia D Hypermagnesemia
c
The nurse is providing care for a client admitted for an acute exacerbation of asthma. Which medication does the nurse anticipate administering to relieve the acute symptoms exhibited by the client? A Titroprium B Salmeterol C Albuterol D Beclomethasone
c
Which finding by the nurse best indicates that a patient with cirrhosis has developed hepatic encephalopathy? A Serum albumin 2.1 g/dL B Elevated serum ammonia C Decreased LOC, confusion, agitation D Sudden abdominal distention
c
Which nursing action will the home health nurse include in the plan of care for a patient with a T4 spinal cord injury in order to prevent autonomic dysreflexia? A Support the selection of a high protein diet B Discuss options for sexuality and fertility C Assist in planning a prescribed bowel program D Use staged coughing to strengthen cough efforts
c
Which of the following lab values is most closely associated with the presence of uremia? a. eGFR value of 15 b. Elevated serum ammonia c. BUN value of 23 mg/dL d. Elevated ALT/AST
c
Which of the following nursing actions is the priority for a patient experiencing a potential transfusion reaction? A Administer epinephrine B Apply oxygen C Stop the transfusion D Re-type and crossmatch
c
Your patient presents to the ED with suspected diabetic ketoacidosis. Which ABG reading would indicate potential DKA? a. pH: 7.56, PaCO2: 35, HCO3: 17 b. pH: 7.29, PaCO2: 49, HCO3: 24 c. pH: 7.32, PaCO2: 37, HCO3: 19 d. pH: 7.44, PaCO2: 31, HCO3: 28
c
the nurse is caring for a client who has had a nasogastric tube connected to low intermittent suction for the last three days. the nurse should monitor the client for which acid base disorder? a. respiratory alkalosis b. respiratory acidosis c. metabolic alkalosis d. metabolic acidosis
c
The nurse is caring for a patient with hemodialysis. What assessment findings post-dialysis need further follow-up by the nurse (Select all that apply): A Bruit over fistula B Weight loss more than 2 lbs C Bleeding from fistula D Redness around abdominal catheter E BP 80/50
c and e
What is docusate sodium used for?
constipation
12. ________ 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
13. Which of the following situations indicates the need for immediate nursing intervention? a. A patient taking senna complaining of an orange discoloration in their urine. b. A patient taking both a narcotic pain medication and docusate sodium. c. A constipated patient beginning to take over-the-counter (OTC) docusate sodium. d. A patient prescribed bisacodyl post-op 4 hours following an appendix surgery.
d
20. Which of the following statements suggests to the nurse that a patient understands their Lactulose order for elevated ammonia levels? a. "We will know this medication has been effective when I have a bowel movement" b. "I should decrease my fluid intake while taking this medication so it works better" c. "My tremors and agitation may increase while taking this medication" d. "This medication will induce diarrhea because it works to excrete excess ammonia"
d
29. Which patient below is NOT at risk for developing chronic kidney disease? a. A 58 year old patient with uncontrolled hypertension b. A 69 year old patient with diabetes mellitus c. A 71 year old patient with heart failure d. A 45 year old patient with polycystic ovarian disease
d
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
d
8. 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
A nurse is teaching a client about the importance of increasing fluids when experiencing the early stages of dehydration. Which statement by the client would express understanding? A "Dehydration is only a problem in the summer months when it's hot outside." B "If my skin becomes dry and itchy I can apply extra lotion." C "Vitamin hydration drinks would be good when I feel my heart pounding and become lightheaded." D "I should drink more water when I feel thirsty or becoming irritable"
d
A patient diagnosed with diabetes mellitus is being discharged home and you are teaching them about preventing DKA. What statement by the patient demonstrates they understood your teaching about this condition? a. "I should not be alarmed if ketones are present in my urine because this is expected during illness." b. "It is normal for my blood sugar to be 250-350 mg/dL while I'm sick." c. "I will hold off taking my insulin while I'm sick." d. "It is important I check my blood glucose every 3-4 hours when I'm sick and consume liquids."
d
A patient with type II diabetes is prescribed the medication glyburide. Which statement by the patient demonstrates understanding of how to take this medication? A "I will take with food so that I do not develop GI upset" B "This medication is safe to take if I become pregnant." C "My diabetes in not serious because I do not need insulin." D "I will monitor for sweating, racing heart rate, and changes in vision"
d
All of the following are possible complications of bowel retention except? a. Fecal impaction. b. Bowel perforation. c. Painful defecation. d. Paralytic ileus.
d
As a nurse, you are providing education and teaching on ways to prevent autonomic dysreflexia following a spinal cord injury. Which statement indicates correct understanding by the patient? a. I will ensure that I will only pee when I have to in order to limit my movement and prevent further injury b. I will report sudden tachycardia and hypotension to my provider immediately because that may indicate autonomic dysreflexia c. I should limit my fiber intake in order to prevent frequent episodes of diarrhea and loose stool d. I will make sure to report any presence of cloudy urine to my provider
d
The client with type 2 diabetes is admitted into the medical department with a wound on the left leg that will not heal. The HCP prescribes sliding-scale insulin. The client tells the nurse, "I take pills at home, why am I now taking insulin?" Which statement is the nurse's best response? A "If you can't manage your glucose with pills, you must take insulin." B "You should discuss the insulin order with your HCP if you do not want to take it." C "You are worried about having to take insulin. I will sit down and we can talk." D "During illness you may need to take insulin to keep your blood glucose level down."
d
The nurse is caring for a client with Graves disease. When observing the facial features of the client, the nurse notes that the client is exhibiting which associated sign of the disease? A Conjunctivitis B Lacrimation C Periorbital edema D Exophthalmos
d
The nurse is providing care for a client with arterial blood gas analysis as follows: PaO2 82, PaCO2 49, HCO3- 26, and pH 7.31. Which assessment by the nurse is correct? A Metabolic Alkalosis B Metabolic Acidosis C Respiratory Alkalosis D Respiratory Acidosis
d
What type of insulin do you expect the doctor to order for treatment of DKA? a. IV Novolog b. IV Levemir c. IV NPH d. IV Regular Insulin
d
Which of the following detoxification complications is emergent and warrants immediate nursing intervention? a. Presence of asterixis b. Enlargement of the spleen c. Dyspnea caused by ascites d. Blood present in emesis
d
Which of the following situations indicates the need for immediate nursing intervention? a. A patient taking Senna complaining of an orange discoloration in their urine. b. A patient taking both a narcotic pain medication and Docusate sodium. c. A constipated patient beginning to take over-the-counter (OTC) Docusate sodium. d. A patient prescribed Senna post-op 4 hours following an appendix surgery.
d
Your patient with liver failure is being prescribed albumin IV. What is the purpose of albumin administered IV? A to prepare for paracentesis B to counteract a fluid restriction C to improve neurological function D to increase oncotic pressure
d
what is loperamide used for
diarrhea
1. 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
What could be given to help with anemia?
epogen
During an assessment of a pt, the nurse finds asterixis, twitching of the extremities and notices that the patient is displaying inappropriate behavior and disorientation. Which conditions does the nurse suspect?
hepatic encephalopathy
what fluid would you give a dka patient
hypotonic
What IV solution wouldn't you give to someone with a head injury?
hypotonic, low sodium, and dextrose containing fluids
are incontinence and constipation normal findings in older adults?
no
A client with cirrhosis shows signs of hepatic encephalopathy. The nurse should plan a dietary consultation to limit which ingredient?
protein
how should you position a patient with severe asites?
sitting up
True or False: When priming the tubing for an Insulin infusion it is best practice to waste 50cc to 100cc of insulin prior to starting the infusion because insulin absorbs into the plastic lining of the tubing.
true
What do the kidneys excrete?
urea, excess water and salts - Potassium - sodium - phosphate.
