exam 4
The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse?
"Dialysis works by movement of wastes from lower to higher concentration."
A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this client's history?
"Have you been taking any aspirin, ibuprofen, or naproxen recently?"
A male patient comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first when taking this patient's history?
"Have you been taking any aspirin, ibuprofen, or naproxen recently?"
After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
"I hope I can go back to wearing size 8 shoes instead of size 12."
A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)
"I need to ask for an antibiotic when scheduling a dental appointment." "I'll need to check my blood sugar often to prevent hypoglycemia." "The dose of my pain medication may have to be adjusted." "I should watch for bleeding when taking my anticoagulants."
The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.)
"My weight should be maintained at a body mass index of 30." "I can continue to take an aspirin every 4 to 8 hours for my pain." "I really only need to drink a couple of glasses of water each day."
A client with chronic kidney disease states, "I feel chained to the hemodialysis machine." What is the nurse's best response to the client's statement?
"Tell me more about your feelings regarding hemodialysis treatment."
A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (Select all that apply.)
"You will not need vascular access to perform PD." "There is less restriction of protein and fluids." "You have flexible scheduling for the exchanges."
A nurse cares for a client who has hypothyroidism as a result of Hashimoto's thyroiditis. The client asks, "How long will I need to take this thyroid medication?" How should the nurse respond?
"You'll need thyroid pills for life because your thyroid won't start working again."
A staff nurse is teaching a client who has Addison's disease about the disease process. The client asks the nurse what causes Addison's disease. Which of the following responses should the nurse make?
"it is caused by the lack of production of aldosterone by the adrenal gland"
A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply.)
Adjust the rate of extracorporeal blood flow. Place the client in the Trendelenburg position. Administer a 250-mL bolus of normal saline.
The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe?
Administering IV fluids through the AV fistula
A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.)
Alopecia Moon face Purple striations
A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?
Angiotensin-converting enzyme (ACE) inhibitor
A nurse is caring for a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? select all that apply
Assess blood glucose level Jugular vein distention Daily weight
A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, "I feel numbness and tingling around my mouth." What action should the nurse take?
Assess for Chvostek sign
A nurse assesses a patient who takes lithium. Which assessment finding should alert the nurse to a side effect of this therapy?
Bradycardia and loss of eyebrow hair
A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best?
Check the client's digoxin (Lanoxin) level.
A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first?
Contact the provider and prepare for intubation
A nurse plans care for a patient with hypothyroidism. Which priority problem does the nurse address first for this patient?
Depression and withdrawal
What is the disorder that results from a deficiency of vasopressin (ADH) from the posterior pituitary gland called?
Diabetes Insipidus
A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?
Discuss what the treatment regimen means to him
The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed?
I am thrilled I can keep eating fast food
After teaching a client who is recovering from an endoscopic trans-nasal hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?
I will keep food on the upper shelf so I wont have to bend over
A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L Potassium 5 mEq/L Blood urea nitrogen (BUN) 44 mg/dL Serum creatinine 2.5 mg/dL What initial intervention would the nurse anticipate?
Increase the dose of immunosuppression
A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client's teaching? (Select all that apply.)
Increased carbohydrates Increased calorie intake Increased proteins
A nurse teaches a patient with hyperthyroidism. Which dietary modifications should the nurse include in this patient's teaching? (Select all that apply.)
Increased carbohydrates Increased calorie intake Increased proteins
A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy?
Increased thirst and urination
A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (Select all that apply.)
Low sodium Low potassium High calorie
A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema?
Maintain a balanced intake and output
A patient is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema?
Maintaining a balanced intake and output
The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.)
Man with prostate cancer Woman with blood clots in the urinary tract Client with ureterolithiasis
The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8° F (37.6° C). What is the most appropriate action by the nurse?
Monitor the client's temperature
A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time?
No adventitious sounds in the lungs
A patient is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best?
Obtain daily weights of patient
A patient is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best?
Obtain daily weights of the patient.
The nurse is caring for four patients with chronic kidney disease. Which patient would the nurse assess first upon initial rounding?
Patient with Kussmaul respirations
A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse?
Place a heparin or heparin/saline dwell after hemodialysis.
A patient has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse?
Place a heparin or heparin/saline dwell after hemodialysis.
A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse?
Place the client on cardiac monitor immediately
A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the client's nose and around the intravenous catheter. What action by the nurse is the priority?
Prepare for protamine sulfate administration
A nurse assesses a patient with anterior pituitary hyperfunction. Which clinical manifestations would the nurse expect? (Select all that apply.)
Protrusion of jaw Barrel-shaped chest Enlarged hands and feet
The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub?
Registered nurse who was assigned the same client yesterday
A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take first?
Report clear or light yellow drainage from the nose.
A nursing is providing dietary teaching for a client who has cushing's disease. Which of the following recommendations should the nurse include in the teaching?
Restrict sodium intake
A nurse cares for a patient who is recovering from a parathyroidectomy. When taking the patient's blood pressure, the nurse notes that the patient's hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition?
Serum calcium: 6.9 mg/dL (1.73 mmol/L)
A 56-year-old male presents to the hospital with acute kidney injury. Based on the Kidney Disease Improving Renal Outcomes (KDIGO) classification system, which of the following parameters should be used to determine the severity of his kidney injury?
Serum creatinine and urine output
A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse's priority action?
Slow down the normal saline infusion
Based on the Kidney Disease: Improving Global Outcomes classification (KDIGO), how will the nurse interpret this client data (serum creatinine increases 1.5 times over baseline with urine output of less than 0.5 mL/kg/hr for 6 hours or longer)?
Stage 1
A 52-year-old (80 kg) man is in the intensive care unit with sepsis and acute kidney injury. Over the last 24 hours, his serum creatinine increased from a baseline of 0.9 to 1.9 mg/dL (80 to 168 µmol/L) and he has had 100 mL/hr of urine output for the last 6 hours. His urinalysis is positive for the presence of epithelial cells, granular casts, and WBCs. According to the Kidney Disease Improving Global Outcomes (KDIGO) AKI classification, which stage of acute kidney injury does this patient have?
Stage 2
A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first?
Take vital signs, including temperature.
A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.)
Urine output of 100 mL in 4 hours Large amount of sediment in the urine Blood pressure of 90/60 mm Hg
A nurse is planning care for a client who has a new diagnosis of diabetes insipidus. Which of the following interventions should the nurse include in the plan of care?
check urine specific gravity
The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding?
client with kussmauls respirations
A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client's care?
electrolyte and fluid imbalance
A nurse is assessing a client who has cushing's disease. which of the following findings should the nurse expect?
hyperpigmentation
A nurse is completing an assessment on a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?
hyperpigmentation
Which type of IV fluids does the nurse use to treat a patient with SIADH
hypertonic
The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client's recent history?
myocardial infarction
A nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following manifestations should the nurse anticipate?
oliguria
After several diagnostic tests, a client is diagnoses with diabetes insipidus. The nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder?
polydipsia
a nurse is assessing a client who is admitted with hyperthyroidism. the client reports a weight loss of 5/4 kg (12lb) in the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. which of the following actions should the nurse take to prevent a thyroid crisis?
provide a quiet, low stimulus environment
