Class Quizzes: Renal

5. When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) a. Encouraging bed rest to decrease the metabolic rate b. Assisting the patient into the prone position c. Withholding oral feedings to limit the release of secretin d. Administering parenteral opioid analgesics as ordered e. Administering prophylactic antibiotics

A, C, D The current recommendation for pain management is the use of opioids, with assessment for their effectiveness and altering therapy if pain is not controlled or increased (Marx, 2009). Nonpharmacologic interventions such as proper positioning (not prone), music, distraction, and imagery may be effective in reducing pain when used along with medications. In addition, oral feedings are withheld to decrease the secretion of secretin.

4. Which of the following medications, used in the treatment of GERD, accelerate gastric emptying? a. Metoclopramide (Reglan) b. Famotidine (Pepcid) c. Nizatidine (Axid) d. Esomeprazole (Nexium)

a. Metoclopramide (Reglan) Prokinetic agents which accelerate gastric emptying, used in the treatment of GERD, include bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan). If reflux persists, the patient may be given antacids or H2 receptor antagonists, such as famotidine (Pepcid), nizatidine (Axid), or ranitidine (Zantac). Proton pump inhibitors (medications that decrease the release of gastric acid, such as esomeprazole (Nexium) may be used, also.

7. A 37-year-old male client presents at the emergency department (ED) reporting nausea and vomiting and severe abdominal pain. The client's abdomen is rigid, and there is bruising to the client's flank. The client's wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the client for what health problem? a. Severe pancreatitis with possible peritonitis b. Acute cholecystitis c. Chronic pancreatitis d. Acute appendicitis with possible perforation

a. Severe pancreatitis with possible peritonitis Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or cholecystitis.

2. A patient presents to the emergency room with complaints of severe, sharp, and intermittent pain in the flank area and has recently developed nausea and vomiting. The nurse expects to assess the patient for what? a. Urinary tract calculi b. Nephrotic Syndrome c. Glomerulonephritis d. Cystitis

a. Urinary tract calculi

3. A patient presents with a possible UTI. Which urine characteristic should the nurse assess first? a. Urine clarity b. Urine specific gravity c. Urine acetone d. Urine protein

a. Urine clarity

3. The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. The client has understood the recommended dietary changes by: a. Eliminating spicy foods. b. Avoiding chocolate and coffee. c. Eliminating cucumbers and other foods with seeds. d. Avoiding steamed foods.

b. Avoiding chocolate and coffee. Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake.

1. A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide? a. Normal activities may be resumed the day after surgery. b. Normal activities may be resumed in 1 week. c. Normal activities may be resumed in 2 weeks. d. Normal activities may be resumed in 1 month.

b. Normal activities may be resumed in 1 week. A prolonged recovery period usually is unnecessary. Most clients resume normal activities within 1 week.

4. A patient with anasarca. Which abnormally low laboratory value would indicate this assessment finding? a. Cholesterol b. Prothrombin c. Albumin d. Calcium

c. Albumin

7. The patient passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions? a. Increase intake of meat, fish, plums, and cranberries b. Avoid citrus fruits and citrus juices c. Avoid green, leafy vegetables such as spinach d. Increase intake of dairy products

c. Avoid green, leafy vegetables such as spinach

6. A nurse is providing discharge education to a client who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods? a. High-fiber foods b. Low-purine, nutrient-dense foods c. Low-fat foods high in proteins and carbohydrates d. Foods that are low-residue and low in fat

c. Low-fat foods high in proteins and carbohydrates The nurse encourages the client to eat a diet that is low in fats and high in carbohydrates and proteins immediately after surgery. There is no specific need to increase fiber or avoid purines. A low-residue diet is not indicated.

6. An 18 y/o student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student's health history? a. Renal calculi b. Renal trauma c. Recent sore throat d. Family history of acute glomerulonephritis

c. Recent sore throat

5. Which instructions should you include in the teaching plan for a patient with cystitis receiving phenazopyridine (Pyridium). a. If your urine turns orange-red, call the doctor b. Take phenazopyridine just before urination to relieve pain c. Once painful urination is relieved, discontinue prescribd antibiotics d. After painful urination is relieved, stop taking phenazopryidine.

d. After painful urination is relieved, stop taking phenazopryidine.

1. A 22 year old female patient comes into urgent care for uncomplicated UTI. The nurse will plan to teach the patient what about their treatment? a. You may continue to take baths regularly b. Once you start to feel better, you may stop taking your medication c. This infection was likely caused by the type of undergarments you wear d. You will be given a short course of antibiotics, likely over 3 days

d. You will be given a short course of antibiotics, likely over 3 days

2. A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor: a. urine output. b. abdominal girth. c. stool frequency. d. level of consciousness (LOC).

d. level of consciousness (LOC). In cirrhosis, the liver fails to convert ammonia to urea. Ammonia then builds up in the blood and is carried to the brain, causing cerebral dysfunction. When this occurs, lactulose is administered to promote ammonia excretion in the stool and thus improve cerebral function. Because LOC is an accurate indicator of cerebral function, the nurse can evaluate the effectiveness of lactulose by monitoring the client's LOC. Monitoring urine output, abdominal girth, and stool frequency helps evaluate the progress of cirrhosis, not the effectiveness of lactulose.