CBA #3 (Renal, Organ Transplant, Endocrine)

The nurse notes that the patient has a potassium level of 3.1 mEq/L. Which condition(s) could be related? (Select all that apply.) a. Serum sodium level of 125 mEq/L b. Lasix 40 mg by mouth twice daily c. Nasogastric tube to low constant suction d. Insulin drip titrated to blood glucose of 90 mg/dL e. Epinephrine drip titrated to systolic blood pressure greater than 90 mm Hg

A, B, C, D A sodium deficit, diuretics, and gastrointestinal loss result in potassium loss. Insulin promotes the intracellular movement of potassium, resulting in decreased serum potassium. Epinephrine enhances potassium resorption from the distal tubule and elevated serum potassium.

Which of the following patient statements needs to be explored further regarding kidney function? (Select all that apply.) a. "These are the only shoes I could wear today." b. "I had to use three pillows to sleep last night." c. "I have this funny metallic taste in my mouth all the time." d. "I have been drinking eight glasses of water each day." e. "I have been taking ibuprofen twice a day for the past month."

A, B, C, E Only finding one pair of shoes that will fit implies swelling in the feet. Having to sleep with three pillows implies paroxysmal nocturnal dyspnea. A metallic taste in the mouth could be related to uremia. Non-steroidal anti-inflammatory drugs such as ibuprofen can lead to renal impairment. Drinking eight or more glasses of water per day is a preventive measure for kidney disease.

Which nursing actions are important in the management of a patient with an arteriovenous (AV) fistula? (Select all that apply.) a. Auscultate the bruit b. Palpate the thrill c. Draw all laboratory work from the fistula d. Avoid constrictive clothing on the limb containing the access e. Take blood pressure measurements in the fistula arm

A, B, D Auscultate the bruit, palpate the thrill, and avoid constricting clothing on the access limb. Laboratory work should not be drawn from the fistula, and the blood pressure (BP) measurements should not be taken in the arm with the fistula.

A patient is having an abdominal computed tomography (CT) scan with intravenous (IV) contrast in the morning. Which instructions should be included in the teaching for this procedure? (Select all that apply.) a. The patient should report any allergies to shellfish. b. The patient should drink several glasses of water after the procedure. c. The patient should drink three glasses of water before the procedure. d. The patient should be NPO and have IV fluids disconnected before the test. e. The patient will have an IV started if one is not already in place before the procedure.

A, B, E Shellfish allergies are associated with iodine and contrast dye. It is important for the patient to be well hydrated before and after the administration of contrast. The patient will need an IV for IV contrast. If oral contrast is ordered, the patient will be required to drink most or all of it (because the lowest dose necessary should be ordered); IV contrast does not require this. The patient should be hydrated, so even if the patient takes nothing by mouth, fluids should not be discontinued.

A patient is admitted with jugular vein distention, bounding pulses, tachycardia, and peripheral edema. What effect will the release of atrial natriuretic peptide have in this situation? (Select all that apply.) a. Diuresis b. Vasoconstriction c. Decreased cardiac preload d. Increased cardiac afterload e. Blocking of the release of aldosterone

A, C, E Diuresis, decreased cardiac preload, and blocking of the release of aldosterone are effects of the release of atrial natriuretic peptide (ANP) caused by hypervolemia. Other effects include vasodilation (not vasoconstriction) and decreased (not increased) cardiac afterload.

When providing care to a client who has undergone a nephrostomy for hydronephrosis, which observation alerts the nurse to a possible complication? (Select all that apply.) a. Urine output of 15 mL for the first hour and then diminishes b. Tenderness at the surgical site c. Pink-tinged urine draining from the nephrostomy d. A hematocrit value 3% lower than the preoperative value e. Sudden onset of abdominal pain that worsens after abdominal palpation f. Blood pressure of 180/90 that persists despite administration of pain medication g. The presence of a few small (less that 0.5 cm) clots with irrigation of the nephrostomy h. Bright red drainage through the nephrostomy tube 12 hours after the procedure

A, D, E, F, H Low output is concerning immediately after nephrostomy placement; most clients have a diuresis. After nephrostomy placement, most clients have bloody urine (red- or pink-tinged) for several hours. Irrigation may be required to maintain patency and clots may be dislodged with irrigation and this helps maintain nephrostomy patency. Clots interfere with patency. The presence of small clots in the returned irrigation fluid is not a concern. There is pain and tenderness at the surgical site but bleeding at the site is not common. New onset of abdominal pain with rebound tenderness may indicate a perforation, an uncommon but potentially life-threatening complication of manipulating the needles during nephrostomy placement. Similarly, blood loss either through the nephrostomy or surgical site can be related to a clinical important decrease in hematocrit; diuresis means that the change in hematocrit is unlikely to be from hemodilution. Inform the provider whenever this change occurs post-operatively. Hypertension can contribute to bleeding risk and occurrence; generally as will most post-operative or post-interventional procedures, a reasonable blood pressure goal is 120-140/80-90.

Which actions/interventions are most important for the nurse to perform when caring for a 70-year-old client who is scheduled for a contrast-medium enhanced CT scan? (Select all that apply.) a. Assess for co-existing conditions of pre-existing diabetes, heart failure, and established CKD. b. Assess the hourly urine output for at least 6 hours prior to the procedure. c. Assess creatinine clearance using a 24-hour urine collection test. d. Alert the provider to a serum creatinine that has increased from 0.2 to 0.4 mg/dL (20 to 40 mcmol/L) in the previous 24 hours. e. Alert the provider to a glomerular filtration rate (GFR) <60 mL/min/1.73 m2. f. Assess for hypovolemia, including evaluation of the mean arterial pressure (MAP). g. Collaborate with the provider to determine whether isotonic IV fluids should be infused before the test. h. Discuss with the provider about whether the client's prescribed diuretic should be held immediately before the test.

A, E, F, G, H Identification of risk factors and correction of modifiable factors is essential to prevent contrast-induced nephropathy. Risk factors have a cumulative property, so reduction of the number of modifiable risk factors is key to good patient outcomes. Pre-existing conditions that are associated with impaired kidney function including diabetes, heart failure, and advanced age are red flags that alert the nurse to increased risk for kidney damage from toxins like contrast media. Established CKD (diagnosed via serum creatinine and GFR) also indicates that an individual may not tolerate contrast without subsequent harm. Not all clients will have a urinary catheter nor is one necessary. Do evaluate the urine characteristics, but hourly measurements of volume are not necessary. Creatinine clearance can be estimated with a single serum creatinine level; a 24-hour urine test is not an appropriate laboratory test for this situation. Although there is an increase in serum creatinine, the values are normal and the increase does not meet any criteria for AKI (i.e., increases of 0.3 to 0.5 mg/dL [26.2 to 50 mcmol/L]). This small increase may be the result of recent protein intake (diet) or exercise. More information is needed before contacting the provider. A GFR <60mL/kg/1.73 m2 is the threshold for impaired kidney function and diagnostic of significant CKD. Other conditions that increase the potential for harm from contrast include sepsis, shock, and even hypocholesteremia. Infection and vascular conditions can also increase risk for contrast-induced nephropathy. Dehydration or blood volume contraction increases risk for AKI from hypoperfusion. Adding contrast increases the number of risk factors. MAP is a marker of adequate hydration and used to reduce risk from hemodynamic instability or hypotension. IV fluid administration is one strategy to ensure adequate intravascular volume to reduce kidney hypoperfusion and to increase elimination of the contrast so that the agent has less time to damage tubular epithelium. IV fluids also dilute the contrast, reducing exposure and harm. Holding diuretic(s) prior to contrast administration reduces the possibility of hypovolemia and hypotension around the time of contrast administration. Diuretics may be given subsequent to IV fluid administration (to dilute and eliminate contrast) to maintain euvolemia but diuretics are not typically given BEFORE contrast.

The charge nurse is preparing assignments on a busy medical unit. For this shift, there are two LPNs, two RNs, and one nursing assistant. Which client assignments are most appropriate? (Select all that apply.) a. An LPN is assigned to a client who is receiving the first dose of an oral immunomodulating agent to manage acute glomerulonephritis. b. An RN is assigned to the client who is receiving an IV corticosteroid twice daily to manage systemic lupus erythematous that has resulted in chronic glomerulonephritis. c. An LPN is assigned to replace a urinary catheter (in place >2 weeks) in a client with a fever who requires a chronic urinary catheter to assist healing from a genitourinary fistula. d. An RN is assigned to administer IV antibiotics to a client admitted with pyelonephritis. e. A nursing assistant is assigned to do all the morning baths. f. LPNs are assigned to clients who have oral drugs prescribed and will perform the vital signs for those clients. g. An RN is assigned to the client who is being discharged with a new diagnosis of diabetic nephropathy that is serious (stage 3 CKD).

B, C, D, E, F, G Consider which tasks are within the scope of practice for the RN, LPN, and NA. Giving a bath is within the scope of NA practice - this assignment is OK. LPNs may administer oral drugs and do vital signs - this assignment is also OK. In some states, LPNs can administer intravenous drugs after the first dose has already been given and the client's responses documented. RNs administer IV drugs, especially the first dose, and assess client responses. An LPN can insert a urinary catheter, and urinary catheters should be replaced in patients who have catheters longer than 2 weeks and appear to be symptomatic (fever) with UTI - this assignment is OK. An RN provides discharge teaching, particularly with complex or new diagnoses and interventions - this assignment is OK. Client teaching around new drug administration is reserved to the RN scope of practice - assignment to an LPN is not an assignment within the LPN scope of practice.

Which adverse drug effects does the nurse assess for a client who is hospitalized for an acute problem and is also prescribed an anticholinergic drug to manage incontinence? (Select all that apply.) a. Insomnia b. Blurred vision c. Constipation d. Dry mouth e. Loss of sphincter control f. Increased sweating g. Worsening mental function h. Hypotension

B, C, D, G Anticholinergic drugs tend to block the parasympathetic nervous system and mimic the sympathetic nervous system responses. In addition to reducing urinary output, these commonly include dry mouth, reduced gastric motility, constipation, blurred vision, hypertension, increasing confusion, dizziness, and sleepiness.

Which statements describe how the production and regulation of the thyroid is regulated by feedback mechanisms? (Select all that apply.) a. Serum blood levels of T3 and T4 are elevated, so the pituitary increases production of thyroid-stimulating hormone (TSH). b. Serum blood levels of T3 and T4 are elevated, so the pituitary decreases production of TSH. c. The release of T4 increases metabolic rate by increasing heart rate, respirations, and blood pressure through SNS stimulation. d. The release of T3 will increase metabolic rate by increasing heart rate, respirations, and blood pressure through SNS stimulation. e. T4 activated beta cell receptors in the body.

B, C, E Increased T3 and T4 levels stimulate the production of thyroid-stimulating hormone (TSH), not decrease it. T4, not T3, is released and then is converted to T3 to increase heart rate, respirations, and blood pressure through sympathetic nervous system (SNS) stimulation. T4 activates β cell receptors in the body.

When obtaining a health history from a 22-year-old female client who has new-onset urinary incontinence, which findings or factors does the nurse consider significant? (Select all that apply) a. Chemical exposure in the workplace b. A burning sensation occurring on urination c. Urinating 10 times daily although fluid intake remains unchanged d. A recent change in the client's oral contraceptive prescription e. A new inability to hold urine (urgency) f. A "stinky" odor from urine

B, C, E, F Burning on urination, frequent urination without increasing fluid intake, urgency, and malodorous urine are concerning changes in urine elimination. Although chemical exposure in the workplace may cause kidney damage, it is not associated with new onset incontinence in a young adult. Oral contraceptives do not contribute to problems with urination.

Which problems does the nurse expect in an older adult as a result of age-related changes in endocrine function? (Select all that apply.) a. Increased basal metabolic rate (BMR) b. Decreased core body temperature c. Dehydration d. Diarrhea e. Hyperglycemia f. Polyuria

B, C, E, F The aging process generally causes a decline in the secretion of hormones from endocrine glands, especially those of the thyroid, pancreas, and adrenal glands. Decreased thyroid hormone secretion causes a decrease in overall metabolism and basal metabolic rate. The slower metabolism results in lower core body temperatures and constipation. Decreased adrenal gland secretion limits the ability of the older adult to reabsorb water and sodium or to concentrate urine. This condition increases the risk for dehydration. The decreased secretion of insulin from the pancreas and the decline in metabolism both result in hyperglycemia. When hyperglycemia is present, the osmolarity (osmolality) of the blood increases, causing the adult to have increased thirst and to move interstitial and intracellular fluids into the plasma volume, leading to polyuria. If insufficient fluid intake occurs, this situation also increases the risk for dehydration.

The nurse is admitting a client who has type 2 diabetes (T2D) and is scheduled for surgery. Which laboratory findings from this client's admission panel does the nurse report as indicating possible abnormal kidney function? (Select all that apply.) a. Presence of ammonia in the urine b. Urine microalbumin 240 mcg/24 hour (0.240 g/24 hour) c. Urine specific gravity of 1.028 d. Blood urea nitrogen of 38 mg/dL (13.5 mmol/L) f. Serum creatinine 2.2 mg/dL (294.3 mcmol/L) g. Blood osmolarity 290 mOsm/kg (290 mmol/kg)

B, D, E Urine normally has a small amount of ammonia in it as a breakdown product of nitrogen. Other normal values include the urine specific gravity (normal range of 1.005 to 1.030) and the blood osmolarity (280 to 300 mOsm/kg; 280 to 300 mmol/kg). The urine microalbumin is much higher than the normal levels (30 to 80 mcg/24 hour; 0.03 to 0.08 g/24 hour) and indicates abnormal kidney function. Blood urea nitrogen is high (normal ranges 10 to 120 mg/dL; 3.6 to 7.1 mmol/L) as is the serum creatinine (normal ranges 0.5 to 1.2 mg/dL; 44 to 106 mcmol/L). Both of these values indicate abnormal kidney function.

Which physiologic mechanisms are the result of the hormonal processes of the kidneys? (Select all that apply.) a. Removal of waste b. Maintenance of fluid and electrolyte balance c. Blood pressure control d. Red blood cell production e. Maintenance of acid-base balance

C, D Blood pressure control and red blood cell production are the functions of the kidneys related to hormones. Removal of waste, maintaining fluid and electrolyte balance, and maintaining acid-base balance are also functions of the kidneys, but these functions are not hormonal.

A 25-year-old sexually active female client diagnosed with cystitis tells the nurse that she doesn't understand why she has these infections yearly because she tries to avoid them by drinking very little at work so she doesn't have to use the "dirty" public toilet. Which suggestions or actions by the nurse are most likely to help this client reduce her risk for cystitis? (Select all that apply.) a. Reinforce her choice to avoid using a public toilet b. Teach her to shower immediately after having sexual intercourse c. Suggest that she drink at least 2-3 L of fluid throughout the day d. Urge her to change her method of birth control from oral contraceptives to a barrier method e. Instruct her to always wipe her perineum from front to back after each toilet use f. Reinforce that she should complete the entire course of antibiotics as prescribed g. Instruct her to empty her bladder immediately before intercourse

C, E, F, G A is incorrect because using a public toilet, even sitting on the seat, does not lead to cystitis or a UTI. Showering after intercourse does not affect the development of UTIs. Showering BEFORE intercourse can reduce the number of perineal organisms and reduce the risk for UTI. Oral contraceptives do not increase the risk for UTI; however, some barrier methods (especially a cervical cap or diaphragm) can increase because of the increased manipulation of tissues in the area. Drinking more fluids throughout the day dilute the urine and increase the frequency of urination, and both responses help reduce the number of organisms in the bladder. Wiping the perineum from front to back prevents organisms around the anus and vagina from being translocated to the area around the urethra. Completing the antibiotics prescribed for a current UTI helps eradicate the organism and prevent recurrence with resistant organisms. Emptying the bladder before intercourse decreases the risk for reflux from the bladder into the ureters from external pressure

A client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response? a. "Can you please tell me more?" b. "Don't worry. That is normal." c. "How does she feel?" d. "Can I make an appointment for you with a counselor?"

a. "Can you please tell me more?" The nurse's best response to the client is, "Can you please tell me more?" Asking the client to explain his concerns in an open-ended question allows the nurse to explore his feelings more thoroughly. Infertility, impotence, and other changes in sexual function may result from endocrine problems.Telling a client that something is "normal" is dismissive and incorrect. This issue to satisfy his wife is new to the client and is a concern for him. The focus of the nurse's response needs to be on the client, not on the wife initially. Referring the client to a counselor is not an appropriate first step. This action does not allow him to express his frustrations at the moment.

The nurse is instructing a client who will undergo an adrenal suppression test. Which statement by the client indicates that teaching was effective? a. "I am being tested to see whether my hormone glands are hyperactive." b. "I am being tested to see whether my hormone glands are hypoactive." c. "I am being tested to see whether my kidneys work at all." d. "I will be given more hormones as a trigger."

a. "I am being tested to see whether my hormone glands are hyperactive." Suppression tests are used when hormone levels are high or in the upper range of normal. Failure of suppression of hormone production during testing indicates hyper function and hyperactivity.A provocative (stimulation) test assesses whether hormone glands are hypoactive. The adrenal glands are endocrine glands that are located on the kidneys. A suppression test does not measure kidney function. Hormones are given as a trigger in a provocative (stimulation) test.

Which statement made by a client newly diagnosed with polycystic kidney disease (PKD) in the hyperfiltration stage indicates to the nurse that additional teaching for self-management is needed? a. "I will need to decrease my daily water intake." b. "I need to make certain my brothers and sisters know about this disease." c. "Probably the best time of day to take my lisinopril each day is with breakfast." d. "Regular low-impact exercise may help me feel better, as well as help prevent constipation."

a. "I will need to decrease my daily water intake." Water restriction is avoided with a diagnosis of polycystic kidney disease (PKD) until the client transitions to dialysis. A liberal water intake can reduce the harm from reduced blood flow to the kidney, including decreasing the stimulus for vasopressin release, a hormone that decreases kidney perfusion. Once daily ACE inhibitors are first line drugs for management of hypertension in clients with PKD and developing a routine for daily administration is a good self-management approach. Complementary approaches to pain management that the client can initiate will increase in benefit from practice (rehearsal) and regular use. PKD is a genetic disorder. This client's brothers and sisters also have a risk for inheriting the disorder, and early diagnosis can help ensure the correct management options are used. Thus, informing siblings is an important and ethical action in this situation. Constipation is a frequent problem for clients with PKD. Fluid intake and exercise can help ameliorate this problem.

A 48-year-old African-American man is newly diagnosed with hypertension and Stage 1 chronic kidney disease (CKD). His primary health care provider has prescribed a thiazide diuretic. The client reports that he has increased his activity and changed his diet, which resulted in a 10 lbs (4.5 kg) in the past 2 months. The client says he feels well and does not want to take any drugs. What is the nurse's best response? a. "Reducing your blood pressure may slow or prevent progression of your chronic kidney disease." b. "Your provider prescribed the diuretic because it will reverse the damage caused by kidney disease." c. "Taking medications is a personal decision, and you have the right to decline this prescription." d. "Because your lifestyle changes have resulted in weight loss, this intervention is all that is needed to reduce your risk for progression of kidney disease."

a. "Reducing your blood pressure may slow or prevent progression of your chronic kidney disease." African Americans have greater risk for hypertension, CKD, and complications from both conditions. Blood pressure control is critical in the treatment of patients with CKD - lowering the blood pressure reduces the risk of stroke, MI, and progression of CKD. Stage 1 CKD already indicates some irreversible damage. Management of blood pressure at this stage of CKD can greatly slow its progression. A diuretic does not improve kidney function or reverse CKD damage. It does not alter the course of CKD progression. It does improve elimination of fluid, and fluid overload can contribute to hypertension. While personal values and preferences are essential decision points in determining a plan of care for each adult, it is also important that the client be well informed about the consequences of decisions. His risk for progression of CKD is not low and his blood pressure has not achieved a target goal, despite weight loss. It is time to consider additional interventions such as drug prescription. While this client has had a good outcome from diet and lifestyle, it has not been sufficient to meet targeted blood pressure goals and cannot slow progression of CKD.

The nurse is reviewing the function of antidiuretic hormone (ADH) with a nursing student. Which statement is accurate? a. ADH controls the amount of fluid lost and retained within the body. b. V1 receptors are located in pituitary tissue and controls smooth muscle contractions. c. V2 receptors can alter permeability of the kidney tubule to electrolytes. d. Insufficient ADH production results in fluid volume excess.

a. ADH controls the amount of fluid lost and retained within the body. Antidiuretic hormone (ADH) controls the amount of fluid lost and retained within the body. V1 receptors are located in the arterial walls and contract the smooth muscles located in the arterial walls. V2 receptors can alter the permeability of kidney tubules to water (not electrolytes). Insufficient ADH production results in fluid volume deficit, and excessive ADH production results in fluid volume excess.

Which patient with a fasting blood sugar of 110 mg/dL has the highest risk for development of metabolic syndrome? a. African American woman with a 40-inch waist, blood pressure of 140/90 mm Hg, triglycerides of 180, and high-density lipoprotein (HDL) of 25 b. Asian American man with a 30-inch waist, blood pressure of 130/60 mm Hg, triglycerides of 140, HDL of 45 c. Native American man with a 28-inch waist, blood pressure of 120/50 mm Hg, triglycerides of 130, HDL of 50 d. Hispanic American woman with a 34-inch waist, blood pressure of 130/50 mm Hg, triglycerides of 145, HDL of 40

a. African American woman with a 40-inch waist, blood pressure of 140/90 mm Hg, triglycerides of 180, and high-density lipoprotein (HDL) of 25 Although all of the patients have some risk factors for metabolic syndrome, the African American woman has the highest number of risk factors (waist greater than 40 inches in men and greater than 35 inches in women, triglycerides greater than 150, high-density lipoprotein [HDL] less than 40 for men and less than 35 for women). All of the patients have a genetic risk factor and high fasting blood sugar.

The islets of Langerhans excrete four different cell types with different functions. Which statement is accurate? a. Alpha cells secrete glucagon in response to decreased blood glucose levels. b. Beta cells release insulin in response to decreased blood glucose levels. c. Delta cells release somatostatin in response to decreased blood glucose levels. d. PP cells release pancreatic polypeptide to decrease gallbladder contractions.

a. Alpha cells secrete glucagon in response to decreased blood glucose levels. α cells secrete glucagon in response to decreased blood glucose levels. β cells secrete insulin in response to increased blood glucose levels. δ cells release somatostatin in response to hyperglycemia. PP cells release pancreatic polypeptide to increase gallbladder secretions.

Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function? a. An 80-year-old man who has benign prostatic hyperplasia b. A 62-year-old woman with a known allergy to contrast media c. A 48-year-old woman with established urinary incontinence d. A 45-year-old man receiving oral and intravenous fluid therapy

a. An 80-year-old man who has benign prostatic hyperplasia Older adults have fewer nephrons and about half of the glomerular filtration rate of younger adults. This change increases their risk for kidney dysfunction more profoundly and persistently after dehydration of other conditions that can impair the renal system. Although an allergy to contrast media can cause problems, the adult must be exposed to it first. Tests requiring contrast media are not used to diagnose or manage dehydration. Urinary incontinence can lead to poor quality of life and skin problems but does not reduce kidney function. The client receiving hydration therapy with both oral and intravenous fluids is at risk for over-hydration (fluid overload), not dehydration-induced kidney damage.

The charge nurse on the medical-surgical unit is making client assignments for the shift. Which client is the most appropriate to assign to an LPN/LVN? a. Client with Cushing's syndrome who requires orthostatic vital signs assessments b. Client with diabetes mellitus who was admitted with a blood glucose of 35 mg/dL (1.9 mmol/L) c. Client with exophthalmos who has many questions about endocrine function d. Client with possible pituitary adenoma who has just arrived on the nursing unit

a. Client with Cushing's syndrome who requires orthostatic vital signs assessments The most appropriate client to assign to an LPN/LVN is the client with Cushing's syndrome. An LPN/LVN would be familiar with Cushing's syndrome and the method for assessment of orthostatic vital signs.The client with a blood glucose of 35 mg/dL (1.9 mmol/L) is unstable and requires interventions and subsequent monitoring by the professional nurse. The client with questions about endocrine function and the client with a possible pituitary adenoma have complex needs, including the need for education. These clients require the experience and scope of practice of the RN.

A client with diabetes has all of the following changes after a percutaneous nephrolithotomy procedure. Which change is most important for the nurse to immediately report to the health care provider? a. Difficulty breathing and an oxygen saturation of 88% on 2 L of oxygen by nasal cannula b. A point-of-care blood glucose of 150 mg/dL and client report of thirst c. A decreased hematocrit by 1% (compared with preoperative values and hematuria) d. An oral temperature of 38C (101F) and cloudiness of urine draining from the nephrostomy tube right after IV administration of a broad-spectrum antibiotic

a. Difficulty breathing and an oxygen saturation of 88% on 2 L of oxygen by nasal cannula All changes are somewhat abnormal but the only one that raises the level of concern to a point at which it should be immediately is the difficulty breathing and drop in oxygen saturation. This is NOT an expected problem associated with the procedure and is potentially life-threatening. The blood glucose elevation, thirst, temperature elevation, cloudiness of the urine, and slight decrease in hematocrit are expected and do not pose an immediate threat.

When caring for the older adult with decreased antidiuretic hormone (ADH) production, the nurse would include which of these in the plan of care? a. Encourage fluids every 2 hours. b. Plan for weight-bearing activities. c. Inspect the feet and legs for ulcers. d. Increase fiber in the diet.

a. Encourage fluids every 2 hours. The nurse needs to encourage the client to drink fluids every 2 hours. A decrease in ADH production causes urine to be more dilute, so urine might not concentrate when fluid intake is low. The older adult is at greater risk for dehydration as a result of urine loss. If fluids are not restricted because of another health problem, unlicensed assistive personnel (UAP) can offer fluids at least every 2 hours while the client is awake.Weight-bearing activities are appropriate for older adults to prevent bone loss, not fluid loss. Foot or leg ulcers that do not heal in 2 weeks would prompt an investigation into hyperglycemia and diabetes. Increasing fiber can be helpful for decreased metabolism such as occurs with hypothyroidism.

The nervous system and endocrine system work together to maintain dynamic equilibrium. How is this accomplished? a. Hormones can travel through the bloodstream because they affect only target organs. b. The nervous system releases hormones that control cardiac muscle. c. Hormones do not require stimulation to be released; it is an automatic process. d. Target cells and receptors are required for the function of the skeletal muscle system.

a. Hormones can travel through the bloodstream because they affect only target organs. When stimulated, the endocrine glands secrete hormones into surrounding body fluids. When in circulation, these hormones travel to specific target tissues, where they exert a pronounced effect. The nervous system communicates by nerve impulses (not hormones) that control skeletal muscle, smooth muscle tissue, and cardiac muscle tissue. The endocrine system controls and communicates by distributing potent hormones throughout the body. Receptors found on or within these specialized target tissue cells are equipped with molecules that recognize the hormone and bind it to the cell, producing a specific response.

A patient has an elevated thyroid-stimulating hormone (TSH) level and low T4 values. The nurse suspects the patient is experiencing which disorder? a. Hypothyroidism b. Hyperthyroidism c. Thyrotoxicosis d. Thyroid storm

a. Hypothyroidism The laboratory results are consistent with hypothyroidism. Hyperthyroidism would be indicated by low thyroid-stimulating hormone (TSH) with high T4 levels. Thyrotoxicosis is associated with hyperthyroidism. Thyroid storm is a common name for thyrotoxicosis.

The nurse is teaching a client about proper nutrition to prevent an endocrine disorder. Which food does the nurse suggest adding to the diet when the client indicates a dislike of fish? a. Iodized salt b. Red meat c. Soy products d. Salt substitute

a. Iodized salt Dietary deficiencies in iodide-containing foods may be a cause of certain endocrine disorders. For clients who do not eat saltwater fish on a regular basis, the nurse teaches them to use iodized salt in food preparation.The client would eat a well-balanced diet that includes less animal fat. Eating soy products contributes to a healthier diet, but does not prevent an endocrine disorder. Using a salt substitute does not prevent an endocrine disorder. In fact, salt substitutes may contain high levels of potassium, which may lead to electrolyte imbalances.

Which hormone changes does the nurse expect when a client receives a continuous cortisol infusion for 24 hours when his or her endocrine feedback mechanisms are functioning normally? a. Lower than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin releasing hormone (CRH) levels b. Lower than normal adrenocorticotropic hormone (ACTH) levels; higher than normal corticotropin releasing hormone (CRH) levels c. Higher than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin releasing hormone (CRH) levels d. Higher than normal adrenocorticotropic hormone (ACTH) levels; higher than normal corticotropin releasing hormone (CRH) levels

a. Lower than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin releasing hormone (CRH) levels The release of CRH and ACTH is affected by the serum level of free cortisol acting through a negative feedback loop. The stimulus for release of CRH from the hypothalamus, which is responsible for stimulating the release of ACTH from the anterior pituitary gland, is a low blood level of cortisol. A continuous infusion of cortisol for 24 hours would be sensed by the hypothalamus as either adequate or elevated levels of cortisol, not low blood levels of cortisol. As a result, little if any CRH would be released from the hypothalamus and circulating levels would be lower than normal. With low levels of CRH, the anterior pituitary cells are not stimulated to release ACTH; thus circulating levels of this hormone would also be lower than normal. Adequate or elevated blood levels of cortisol inhibit the release of CRH and ACTH.

The patient in renal failure has experienced a severe hypotensive event, and the ratio of blood urea nitrogen (BUN) to creatinine is 15:1. The nurse is aware that this is an example of what type of kidney injury? a. Prerenal b. Intrarenal c. Postrenal d. Chronic

a. Prerenal Prerenal kidney injury occurs as a result of an event that occurred before arterial blood reaches the kidney, such as in a severe hypotensive episode. Intrarenal kidney injury occurs because of a problem in the kidney such as glomerular nephritis and maintains a 10:1 blood urea nitrogen-to-creatinine ratio. Postrenal kidney injury is caused by some type of blockage preventing the urine from leaving the kidney. Chronic kidney disease can be a result of many things that cause acute kidney injury.

A patient has the head of the bed elevated 30 degrees, and the practitioner injects 50 mL of iced saline into the ear. The diagnostic test result is positive when what happens? a. The patient's eyes deviate to the side of the injection. b. No response is noted from the patient. c. The patient's eyes deviate to the opposite side. d. The patient's eyes remain midline

a. The patient's eyes deviate to the side of the injection. The vestibuloocular reflex is elicited by elevating the patient's head 30 degrees and irrigating both tympanic membranes with 50 mL of iced saline or water. The normal eye movement response (positive response) is a conjugate, slow, tonic nystagmus deviating toward the irrigated ear and lasting 30 to 120 seconds. In brain death, no deviation of the eyes occurs in response to ear irrigation. It is recommended that the patient be observed for up to 1 minute after each ear irrigation, with a 5-minute wait between the testing of each ear. It is important to observe that several classes of drugs can influence the vestibuloocular reflex, including sedatives, aminoglycosides, tricyclic antidepressants, anticholinergics, and antiseizure medications.

Which statement by a patient with chronic kidney disease (CKD) indicates an understanding of the purpose of sevelamer (Renagel) with meals? a. "I need this drug to prevent indigestion." b. "I need this drug to keep my body from absorbing too much phosphorous from food." c. "I need to take this drug to improve my thyroid function." d. "I need to take this drug with meals to avoid constipation."

b. "I need this drug to keep my body from absorbing too much phosphorous from food." Sevelamer (Renagel) is a third-generation phosphate binder. It is not ordered for indigestion or constipation, and it will not affect thyroid function.

The nurse is teaching a client about the correct procedure for a 24-hour urine test for a hormone level. Which statement by the client indicates a need for further teaching? a. "I need to keep the urine container cool in a separate refrigerator or cooler." b. "I will not eat any protein when I am collecting urine for this test." c. "I won't save the first urine sample of the day." d. "To end the collection, I must empty my bladder and add this urine to the collection."

b. "I will not eat any protein when I am collecting urine for this test." A need for further teaching is needed when the client says that he/she will not eat any protein while collecting urine for a 24-hour urine test to evaluate a hormone level. Eating protein does not interfere with collection or testing of the urine sample.Because the specimen must be kept cool, it can be placed in an inexpensive cooler with ice. The client would not keep the specimen container with food or beverages. The timing of the 24-hour collection begins after the initial void of the day. To end a 24-hour urine specimen, emptying the bladder and adding it to the collection is the proper procedure.

The nurse is caring for a client with a parathyroid dysfunction. Which comment by the client indicates a need for further assessment? a. "I am worried about my bones breaking down." b. "Lately, I lose my temper more quickly." c. "The doctor will need to check my vitamin D levels." d. "My weight has been stable these past few years."

b. "Lately, I lose my temper more quickly." Further assessment is needed when the client says, "Lately, I lose my temper more quickly." Many endocrine problems can change a client's behavior, personality, and psychological responses. The client stating that he or she has become more quick-tempered warrants further assessment.PTH increases bone resorption (bone release of calcium into the blood from bone storage sites), thus weakening bones and increasing serum calcium. In the kidneys, PTH activates vitamin D, which then increases the absorption of calcium and phosphorus from the intestines. Vitamin D levels are affected by parathyroid dysfunction. Rapid changes in weight without diet changes are often associated with many endocrine disorders, so a stable weight is beneficial for the client.

The postoperative craniotomy patient has a serum osmolality of 320 mOsm/L and urine output of 400 mL/h for the past 3 hours with a urine specific gravity of 1.003. Which treatment would the nurse anticipate the practitioner ordering for this patient? a. 0.9 NaCl at 150 mL/h intravenously b. 1.5 mcg desmopressin acetate subcutaneously every 12 hours c. Insulin drip at 7 units/h d. Oral vasopressin 5 units every 12 hours

b. 1.5 mcg desmopressin acetate subcutaneously every 12 hours The patient has diabetes insipidus (DI), and desmopressin acetate (DDVAP) is the appropriate treatment. Hypotonic saline (not isotonic) is normally used for DI. Insulin is not indicated for DI, and vasopressin is not an oral medication.

The patient has a serum sodium level of 145 and potassium of 3.7. What is the approximate serum osmolality? a. 293.7 mOsm/L b. 290 mOsm/L c. 141 mOsm/L d. 153 mOsm/L

b. 290 mOsm/L Serum osmolality is roughly twice the sodium level. Thus it would be 145 × 2, which is 290 mOsm/L.

A client is hospitalized for pituitary function testing. Which nursing action included in the client's plan of care will be most appropriate for the RN to delegate to the LPN/LVN? a. Assess the client for clinical manifestations of hypopituitarism. b. Administer regular insulin for the growth hormone stimulation test. c. Palpate the thyroid gland for size and firmness. d. Teach the client about the adrenocorticotropic hormone stimulation test.

b. Administer regular insulin for the growth hormone stimulation test. The most appropriate nursing action for the RN to delegate to the LPN/LVN the administration of insulin. Medication administration is within the LPN/LVN scope of practice.Client assessment for clinical manifestations of hypopituitarism, palpating the thyroid gland, and client teaching are complex skills requiring education and expertise, and are best performed by an RN.

A patient is complaining of blurred vision, fatigue, and nausea. The nurse notes that the patient's face is flushed, and he has a heart rate of 125 beats/min and blood pressure of 90/40 mm Hg. Which action should the nurse take next? a. Offer the patient some orange juice b. Check a capillary blood glucose level c. Administer glucagon intramuscularly d. Start the patient on oxygen at 2 L/min

b. Check a capillary blood glucose level The patient is exhibiting signs of hyperglycemia, so the first action is to check the blood sugar to determine treatment. Orange juice would increase the blood sugar. Glucagon would increase the blood sugar, and oxygen would not address the hypoglycemia.

The client tells the visiting nurse his blood glucose values over the last week have been excellent. Which of these resources does the nurse evaluate to verify the client's statement? a. Fasting blood glucose b. Glycosylated hemoglobin (HbA1c) c. Client's blood glucose log d. Postprandial glucose

b. Glycosylated hemoglobin (HbA1c) The nurse would evaluate the client's glycosylated hemoglobin (HbA1c). The laboratory result indicates the average blood glucose over several months and is the best indicator of overall blood glucose control.Fasting blood glucose can be used to monitor glucose control, but it is not the best method to evaluate blood glucose over a period of time. Oral glucose testing and urine glucose levels look at one period of time and are not the best methods to look at overall effectiveness of treatment.

Which question does the nurse ask the client who has a urinary tract infection to assess the risk for possible pyelonephritis?a. What drugs do you take for asthma? b. How long have you had diabetes? c. How much fluid do you drink daily? d. Do you take your antihypertensive drugs at night or in the morning?

b. How long have you had diabetes? Pyelonephritis risk is increased in the client who has diabetes and a urinary tract infection (UTI). While it is important to know all the drugs that a client takes, neither asthma drugs nor asthma itself increases the risk for pyelonephritis. (An exception would be high-dose systemic corticosteroids; however, these are rarely recommended in current asthma therapy). Although insufficient fluid intake may make a UTI worse, it does not increase the risk for pyelonephritis. Antihypertensives are not a risk factor for pyelonephritis.

The client is a 62-year-old admitted 2 days ago with traumatic injuries and hypovolemic shock from a car crash. The nurse reviewing the client's daily laboratory test results notices the following values. Which result is most important to report to the health care provider immediately? a. Serum sodium 132 mEq/L (mmol/L) b. Serum potassium 6.9 mEq/L (mmol/L) c. Blood urea nitrogen 24 mg/dL (mmol/L) d. Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L)

b. Serum potassium 6.9 mEq/L (mmol/L) All listed laboratory values are out of the normal range. However, the only value that has reached or is approaching a critical level is the serum potassium, which shows hyperkalemia. This problem must be addressed immediately.

A postoperative craniotomy patient has a serum osmolality of 260 mOsm/kg/H2O and a urine osmolality of 1500 mOsm/kg. The nurse suspects that the patient is experiencing which problem? a. Diabetes insipidus b. Syndrome of inappropriate antidiuretic hormone (ADH) secretion c. Diabetes mellitus d. Diabetic ketoacidosis

b. Syndrome of inappropriate antidiuretic hormone (ADH) secretion The patient has a low serum osmolality with a high urine osmolality which is evidence of syndrome of inappropraite antidiuretic hormone secretion. In diabetes insipidus, the patient has a high serum osmolality with a low urine osmolality. Diabetes mellitus is an insulin problem, and diabetic ketoacidosis (DKA) involves hyperglycemia.

Which regulation requires hospital personnel to inform the family of the deceased patient of the option to donate tissues or organs? a. The National Organ Transplant Act b. The Omnibus Budget Reconciliation Act c. The Uniform Determination of Death Act d. The Uniform Anatomical Gift Act

b. The Omnibus Budget Reconciliation Act The Omnibus Budget Reconciliation Act gave families the right to know about organ and tissue donation by mandating that all hospitals participating in the Centers for Medicare or Medicaid Services reimbursement program institute a "required request" policy to assure that families of potential donors are made aware of the option of organ or tissue donation and their option to decline. The National Organ Transplant Act relates to the United Network for Organ Sharing's ability to maintain a national donor database. The Uniform Determination of Death Act helps define death according to cardiopulmonary arrest or brain death. The Uniform Anatomical Gift Act relates to laws concerning who can pronounce a patient dead and determine donor status as well as preventing the sale of organs.

A urinalysis reveals that a patient has protein and red blood cells in the urine. The nurse understands that this can happen as a result of which pathophysiologic process? a. The outer epithelium layer of the glomerulus has been damaged b. The middle basement membrane layer of the glomerulus has been damaged c. The inner endothelial lining of the glomerulus has been damaged. d. The middle endothelial membrane layer of the glomerulus is working.

b. The middle basement membrane layer of the glomerulus has been damaged Normally, large molecules (eg, albumin and red blood cells) are prevented from entering the filtrate by the middle basement membrane. The presence of large protein molecules indicates that the membrane has been damaged. The outer epithelium layer contains pores that allow filtrate in Bowman space, and the inner endothelial layer contains numerous small pores that allow filtration of fluid and small molecules.

In organ procurement, what time is documented as the patient's time of death? a. The time the patient leaves for the operating room b. The time brain death is determined c. The time the patient is extubated in the operating room d. The time the surgical procedure is completed to remove the organs

b. The time brain death is determined When brain death is determined, the patient is pronounced dead, and the organ procurement coordinator takes over the management of the organ donation. The time the patient leaves for the operating room or is extubated in the operating room and the end of the surgery are not appropriate times to call the time of death.

Which meal is the best choice for a patient with chronic kidney disease (CKD) to eat for lunch? a. Tomato soup, grilled low-fat cheese sandwich, and diet soda b. Tuna salad on lettuce with low-salt crackers and iced tea c. Cheeseburger with french fries, a side salad, and a milkshake d. Ham and cheese sandwich on whole-grain bread with pickle, potato chips, and milk

b. Tuna salad on lettuce with low-salt crackers and iced tea Tuna salad on lettuce with low-salt crackers and iced tea is the best choice. It includes a high biologic protein source and is low in sodium, potassium, dairy, and phosphorus. A meal of tomato soup, grilled low-fat cheese sandwich, and diet soda is high in sodium, phosphorus, and fluid. A meal of a cheeseburger with french fries, a side salad, and a milkshake is high in salt, fat, sugar, and dairy. A ham and cheese sandwich on whole-grain bread with pickle, potato chips, and milk is high in salt and phosphorus.

When assessing a client with acute glomerulonephritis, which question about self-management will the nurse ask to determine whether the client is currently following best practices to slow progression of kidney damage?a. "Have you increased your protein intake to promote healing of the damaged nephrons?" b. "Do you avoid contact sports while you are taking cyclosporine?" c. "How are you evaluating the amount of daily fluid you drink?" d. "Have you contacted anyone from our dialysis support services?"

c. "How are you evaluating the amount of daily fluid you drink?" Protein intake may be increased early in Chronic Kidney Disease (CKD) and reduced late in CKD. Since you do not have information about the extent of CKF (stage), this question may be incorrect. Cyclosporine is a cytotoxic agent that reduces immune responses, which would require the client to avoid sick contacts. Because the client needs to find a balance between too much and too little fluid intake (both are harmful), this is a good question to see how the individual ensures adequate kidney blood flow (perhaps with systemic blood pressure assessment) while providing sufficient intake to eliminate waste (perhaps through urine volume or color or via staying within a target of fluid intake. A target fluid intake is generally 1.5 to 2 L daily if not receiving dialysis). The client may not progress to needing dialysis; this intervention is usually reserved until the last stage of CKD before dialysis occurs; there is no indication that CKD has been staged at this point.

The nurse is educating the patient on starting oral furosemide. Which of the following statements signifies that the teaching was successful? a. "I must count my pulse before taking the medication each morning." b. "I need to rinse my mouth after taking this drug." c. "I need to get up slowly from a sitting or lying position." d. "I need to avoid eating cheese and red wine with this medication."

c. "I need to get up slowly from a sitting or lying position." Diuretics can precipitate volume depletion and orthostatic blood pressure changes. Diuretics do not decrease heart rate. Diuretics do not cause Candida as steroids would. Patients do not need to avoid tyramine (which is in cheese and red wine) while taking diuretics.

A nurse is educating a patient receiving a kidney transplant on immunosuppressant drug therapy. Which statement indicates that the teaching was effective? a. "The purpose of these drugs is to protect me from infection." b. "I have to take these drugs whenever I start to feel bad." c. "I need to take these drugs every day for the rest of my life." d. "If I take these drugs as directed, I can spend time with my children even when they have colds."

c. "I need to take these drugs every day for the rest of my life." "I need to take these drugs every day for the rest of my life" indicates an understanding of immunosuppressant drugs. "The purpose of these drugs is to protect me from infection" and "If I take these drugs as directed, I can spend time with my children even when they have colds" show a lack of understanding of the purpose of the drugs: to prevent rejection and to reduce risk of infection. "I have to take these drugs whenever I start to feel bad" indicates a lack of understanding of taking the drugs as directed.

A 70-year-old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? a. A 5-pack year history of smoking 45 years ago b. Difficulty starting and stopping the urine stream c. A 30-year occupation as a long-distance truck driver d. A recent colon cancer diagnosis in his 72-year-old brother

c. A 30-year occupation as a long-distance truck driver Although cigarette smoking is a risk factor for bladder cancer, a 5-pack year history more than 45 years ago is not significant as a potential cause of cancer. Bladder cancer does not appear to have a familial or genetic predisposition. Difficulty starting or stopping urination is a symptom, usually of prostate issues, not a harbinger of bladder cancer. The latest research indicates exposure to gasoline and diesel fuel is a major risk factor for bladder cancer.

A patient's serum cortisol level is 7 mcg/dL. After administration of 250 mcg of cosyntropin, the cortisol level is 9 mcg/dL. The nurse suspects the patient is experiencing which disorder? a. Aldosteronism b. Hyperthyroidism c. Adrenal insufficiency d. Pheochromocytoma

c. Adrenal insufficiency Adrenal insufficiency is tested for by measuring cortisol levels. Aldosteronism and pheochromocytoma are diagnosed in the presence of uncontrolled hypertension, and hyperthyroidism is tested for by serum testing.

The nurse is trying to decrease the temperature of the patient in thyroid storm. Which treatment should the nurse question? a. Tepid water sponge bath b. Cold packs to the groin and axilla c. Aspirin suppository d. Circulating fan at the bedside

c. Aspirin suppository Pyrexia is treated with hypothermia measures such as a cooling blanket, tepid sponge baths, cold packs, fans, and acetaminophen. Salicylates (aspirin) are contraindicated because they prevent protein binding of T3 to T4, increasing the free, metabolically active thyroid hormone.

A client is hospitalized with a possible disorder of the adrenal cortex. Which nursing activity is best for the charge nurse to delegate to an experienced nursing assistant? a. Ask about risk factors for adrenocortical problems. b. Assess the client's response to physiologic stressors. c. Check the client's blood glucose levels every 4 hours. d. Teach the client how to do a 24-hour urine collection.

c. Check the client's blood glucose levels every 4 hours. The nursing activity that is the best one for the charge nurse to delegate to an experienced nursing assistant is checking the client's blood glucose every 4 hours. Blood glucose monitoring is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill.Asking the client about risk factors for adrenocortical problems is not part of a nursing assistant's education. Assessing the client's response to physiologic stressors requires the more complex skill set of licensed nursing staff. Teaching the proper method for a 24-hour urine collection is a multistep process, and would not be delegated to a nursing assistant.

The nurse is caring for a client who has frequent episodes of hypoglycemia with loss of consciousness. During interdisciplinary rounds, which of these does the nurse suggest the client's family learn to use? a. Norepinephrine b. Calcitonin c. Glucagon d. Insulin

c. Glucagon The nurse suggests that the client's family learn to inject Glucagon when the client has episodes of hypoglycemia and loss of consciousness. Glucagon is the hormone that binds to receptors on liver cells. This causes the liver cells to convert glycogen to glucose, increasing blood glucose levels.Norepinephrine is a catecholamine released from the adrenal medulla. It activates the sympathetic nervous system and creates a "fight or flight" response. Calcitonin regulates serum calcium, not glucose. Beta cells in the pancreas are responsible for synthesizing and secreting the hormone insulin which is responsible for lowering blood glucose by increasing its uptake by the cell.

A nurse is assessing a patient with end-stage kidney disease (ESKD) and notices that the patient's left cheek is twitching, the patient's gums are bleeding, and the patient is irritable. Which electrolyte disturbance should the nurse suspect the patient is experiencing? a. Hypernatremia b. Hyperkalemia c. Hypocalcemia d. Hypermagnesemia

c. Hypocalcemia The patient is displaying signs of hypocalcemia. A patient with hypernatremia would be thirsty with sticky mucous membranes and an altered level of consciousness. A patient with hyperkalemia would be anxious with nausea, vomiting, and cramps and tingling in the fingers with electrocardiogram changes. A patient with hypermagnesemia would have respiratory depression, lethargy, and bradycardia.

A patient has had several days of nausea, vomiting, and diarrhea. The heart rate is 125 beats/min, blood pressure is 80/40 mm Hg, and urine output is less than 30 mL/h. Which statement is the best explanation for the low urine output? a. Fluid dehydration in the body inhibits release of antidiuretic hormone (ADH). b. Urine output decreases with the inhibition of the release of ADH. c. Increased serum osmolality stimulates the release of ADH. d. Decreased serum osmolality results in decreased urine output.

c. Increased serum osmolality stimulates the release of ADH. Increased serum osmolality (fluid dehydration) stimulates the release of antidiuretic hormone (ADH), which in turn reduces the amount of water lost through the kidney (urine output decreases). Decreased serum osmolality inhibits the release of ADH, the kidney tubules increase their permeability, and fluid is eliminated (increased urine output) from the body in an attempt to regain normal concentration of particles in the bloodstream.

A client who performs home continuous ambulatory peritoneal dialysis reports that the drainage (effluent) has become cloudy in the past 24 hours. What is the nurse's best first action? a. Remove the peritoneal catheter. b. Notify the health care provider immediately. c. Obtain a sample of effluent for culture and sensitivity. d. Explain to the client the need to keep the dialysate in the refrigerator to prevent bacterial overgrowth.

c. Obtain a sample of effluent for culture and sensitivity. The client most likely has beginning peritonitis. This problem needs to be confirmed and interventions started quickly. A culture is needed to identify that an infection is indeed present. Although the health care provider does need to be notified, obtaining the culture is performed first. The peritoneal catheter should not be removed at this time because it may be needed to instill intraperitoneal antibiotics. Also, removal of this catheter in not within the scope of practice for registered nurses in most states. Dialysate for peritoneal dialysis is sterile and does not need to be refrigerated.

A nurse is teaching the diabetic patient about insulin therapy. Which statement by the patient indicates the teaching was effective? a. "I will take my long-acting insulin before a meal." b. "I will monitor my blood sugar weekly." c. "If I am not going to eat right away, it is okay to take my short-acting insulin anyway." d. "I need to rotate the site I use to obtain blood for glucose monitoring."

d. "I need to rotate the site I use to obtain blood for glucose monitoring." Sites should be rotated to avoid trauma and bruising. Long-acting insulin is administered once or twice daily. Blood sugar should be monitored at least daily in the diabetic patient and probably more often depending on therapy. Short-acting insulin should be taken before a meal.

The patient has a glycosylated hemoglobin of 8. The nurse understands that this represents an average blood sugar of over what time frame? a. 7 days b. 30 days c. 60 days d. 120 days

d. 120 days HgbA1C represents the average blood sugar level for the life of the red blood cells, which is 120 days. The other answers are not the correct correlation or time frame (120 days) to represent HgbA1C.

For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter? a. A 35-year-old woman who was admitted with a splenic laceration and femur fracture (closed repair completed) following a car crash b. A 48-year-old man who has established paraplegia and is admitted for pneumonia c. A 61-year-old woman who is admitted following a fall at home and has new-onset dysrhythmia d. A 74-year-old man who has lung cancer with brain metastasis and is bring transitioned to hospice for end-of-life care

d. A 74-year-old man who has lung cancer with brain metastasis and is bring transitioned to hospice for end-of-life care The man with advanced lung cancer and brain metastasis is dying and likely to be incontinent, in a lot of pain, and confused. An indwelling catheter can help provide comfort at this time by reducing the amount of manipulation needed to keep him and his bed dry. The other clients have no conditions for which use of a bedpan or intermittent catheterization would be contraindicated.

The nurse knows that humoral immunity is responsible for the production of immunoglobulin. What cells mediate this type of immunity? a. Cytotoxic T cells b. Complement cells c. Helper T cells d. B cells

d. B cells B cells control humoral immunity and react to the antigen by starting the process to develop antibodies. Cytotoxic cells kill invading cells. Complement is a protein system that develops enzymes necessary for immunity. Helper T cells stimulate the B cells to begin antibody production and activate cytotoxic cells, natural killer cells, and macrophages.

The nurse is preparing a client for discharge who experienced an acute kidney injury during coronary artery by-pass graft surgery. The nurse notices that the client has a serum creatinine of 1.2 mg/dL (106 mcmol/L) and a glomerular filtration rate (GFR) of 75 mL/kg/1.73 m2. Which is the priority nursing action? a. Reminding the client to remain hydrated by drinking 500 mL of an electrolyte-based solution daily. b. Encouraging the client to reduce protein intake to reduce creatinine production until the follow-up visit with the nephrologist occurs. c. Checking the remaining values on the metabolic panel and informing the primary care provider of all results before the client is discharged. d. Educating the client about the need for follow-up, including re-evaluation of serum creatinine with the primary care provider or nephrologist in 8 to 12 weeks.

d. Educating the client about the need for follow-up, including re-evaluation of serum creatinine with the primary care provider or nephrologist in 8 to 12 weeks. The serum creatinine is within normal limits but the GFR is reduced, indicating risk for CKD. Follow-up is needed but not urgently and follow-up should occur within the health care team members who are familiar with her hospital course and general health. Protein is an essential nutrient needed for wound healing after surgery. A normal creatinine typically does not require protein restriction to avoid progression of kidney problems. Water or electrolyte-free fluid is recommended for hydration unless there is an indication that electrolytes are being excreted in urine. Although the rest of the metabolic panel should be evaluated by the discharge nurse, the primary care provider need only be informed of critical values in an urgent manner

An older female patient admitted with weight gain, depression, and cold intolerance has respiratory acidosis and hypoventilation. She is unarousable. Which treatment would the nurse anticipate the practitioner ordering for this patient? a. Propranolol 1 mg IV every 4 hours b. Sodium iodine 1 g IV every 12 hours c. Reserpine 1 mg every 24 hours d. Levothyroxine 100 mcg IV followed by 75 mg/day

d. Levothyroxine 100 mcg IV followed by 75 mg/day The patient is experiencing myxedema coma, and the treatment is levothyroxine 100 mcg IV followed by 75 mg/day. Sodium iodine, reserpine, and propranolol are treatments for thyroid storm or thyrotoxicosis.

The patient has a blood sugar level of 350 and an anion gap of 17. The nurse is aware that this is indicative of which disorder? a. Respiratory acidosis b. Metabolic alkalosis c. Respiratory alkalosis d. Metabolic acidosis

d. Metabolic acidosis A normal anion gap is 1 to 12 mEq/L and should not exceed 14 mEq/L. An increased anion gap level reflects overproduction or decreased excretion of acid products and indicates metabolic acidosis; a decreased anion gap indicates metabolic alkalosis. Diabetic ketoacidosis (DKA) is a cause of metabolic acidosis. Respiratory acidosis and respiratory alkalosis are due to problems with CO2 excretion (too little or too much).

The nurse is reviewing the laboratory test results for a client with a possible pituitary disorder. Which information requires immediate intervention by the nurse? a. Blood glucose 125 mg/dL (6.9mmol/L) b. Blood urea nitrogen (BUN) 40 mg/dL (14.3 mmol/L) c. Serum potassium 5.0 mEq/L (5.0 mmol/L d. Serum sodium 110 mEq/L (110 mmol/L)

d. Serum sodium 110 mEq/L (110 mmol/L) The normal range for serum sodium is 135 to 145 mEq/L (135 to 145 mmol/L). A result of 110 mEq/L (110 mmol/L) represents severe hyponatremia leading to dangerous complications. The client is at risk for increased intracranial pressure, seizures, and death as the intravascular fluid shifts toward the brain. The RN must act quickly because this situation requires immediate intervention.The normal range for fasting blood glucose is 60 to 110 mg/dL <3.3 to 6.1 mmol/L); 125 mg/dL (6.9 mmol/L) is high, but is not considered dangerous. The normal range for BUN is 7 to 20 mg/dL (2.5 to 7.1 mmol/L); 40 mg/dL (14.3 mmol/L) is high, but does not require immediate intervention. The normal range for serum potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L); 5.0 mEq/L (5.0 mmol/L) is high normal.

Which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure? a. The client experiences nausea and vomiting after drinking juice. b. The biopsy site is tender to light palpation. c. The abdomen is distended and the client reports abdominal discomfort. d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.

d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready. The most serious complication after a kidney biopsy is excessive bleeding. Nausea and vomiting are not signs of bleeding. Some discomfort at the biopsy site is expected and not considered a complication unless there is swelling and a large amount of bruising/discoloration in the flank area. The kidneys are not in the abdomen. Bleeding from the kidney would cause flank pain and swelling, not abdominal pain and swelling. The elevated pulse rate, thready peripheral pulses, and low diastolic blood pressure are consistent with excessive bleeding.

When the nurse caring for a client with severe chronic kidney disease asks what dietary modifications he has made for the disease, he reports the following actions. Which action indicates to the nurse that additional client education is needed? a. Using a scale to measure protein weight b. Taking calcium and vitamin D supplements daily c. Eliminating bananas, citrus fruits, and avocados d. Using a salt-substitute instead of ordinary table salt

d. Using a salt-substitute instead of ordinary table salt Salt substitutes contain very little sodium, which is a good thing because sodium restriction is needed. However, the sodium is replaced with potassium. Clients with CKD must restrict their intake of potassium severely to avoid life-threatening cardiac dysrhythmias.