Med Surg. Gastrointestinal & Renal Care

The nurse is caring for a client diagnosed with Crohn's disease. Which statement indicates more teaching is needed? -"A high-calorie, high-protein diet is best" -"I am at risk for anemia and electrolyte disturbances" -"I will deal with chronic constipation" -"I will have periods of remission and periods of exacerbation"

-"A high-calorie, high-protein diet is best" This is the appropriate diet for a client with Crohn's disease. -"I am at risk for anemia and electrolyte disturbances" The client is correctly stating a fact about the condition. -"I will deal with chronic constipation" A client with Crohn's disease will have frequent episodes of diarrhea, not constipation. -"I will have periods of remission and periods of exacerbation" This is a true statement regarding Crohn's disease.

A nurse is providing discharge teaching to a client who just had a cholecystectomy. Which of the following statements by the client indicate that further education is required? -"I will keep my T-tube clamped at all times." -"I expect for my stool to return to the normal color is about seven days." -"I'll call my doctor if I notice a sudden increase in drainage or if it starts to smell really bad." -"I'll make sure to decrease the amount of fat in my diet."

-"I will keep my T-tube clamped at all times." A T-tube is placed in the bile duct to allow for drainage while the client is healing. The T-tube should only be clamped for 1-2 hours before and after meals, not at all times, to allow for drainage. This statement demonstrates the need for more teaching by the nurse. -"I expect for my stool to return to the normal color is about seven days." This is an accurate statement. Stool may be more liquid and yellow for the first week or so after surgery. But the body will adapt and stool should return to normal color. -"I'll make sure to decrease the amount of fat in my diet." This is an accurate statement. The gall bladder is responsible for processing fat in the diet. Without a gallbladder, this is much more difficult. Clients should decrease the amount of fat in their diet to avoid adverse effects such as pain and diarrhea. -"I'll call my doctor if I notice a sudden increase in drainage or if it starts to smell really bad." This is an accurate statement. Increased drainage or a foul smell could indicate infection. Provider should be notified immediately.

The nurse is caring for a client who has pancreatitis and an order to insert a nasogastric (NG) tube. Which response by the nurse is accurate? -"This is used to decompress the stomach which stimulates the pancreas, increasing blood flow" -"The NG tube is used to administer enteral nutrition" -"This is used for removing gastric contents to suppress pancreatic secretions" -"We use the NG tube to administer your medications"

-"This is used to decompress the stomach which stimulates the pancreas, increasing blood flow" Decompressing the stomach does not increase blood flow to the pancreas. -"The NG tube is used to administer enteral nutrition" The client with pancreatitis is not able to eat or drink anything, including enteral feedings because this would cause the pancreas to start secreting enzymes. The pancreas will need to rest in order to heal. -"This is used for removing gastric contents to suppress pancreatic secretions" The purpose of an NG tube is to remove gastric secretions, which in turn suppresses pancreas secretions. This allows the pancreas to rest which is essential. The client with pancreatitis will be NPO. -"We use the NG tube to administer your medications" Medications will cause irritation to the pancreas just as food or drink would. No medications may be given PO or NG during pancreatitis.

The nurse is caring for a client with glomerulonephritis. Which of the following orders would the nurse question for this client? -Fluid resuscitation of 30 ml/kg of 0.9% normal saline -Plasmapheresis -Protein restriction -Dialysis

-Fluid resuscitation of 30 ml/kg of 0.9% normal saline A client with glomerulonephritis will retain fluid, so IV fluids would not be indicated. -Plasmapheresis A client with excess fluid will benefit from plasmapheresis. This order is appropriate for the client. -Protein restriction This is appropriate for the client with glomerulonephritis, because when protein is broken down, it produces the waste product urea. Urea cannot be filtered appropriately during glomerulonephritis, so the client must restrict protein. -Dialysis Dialysis is an appropriate order for the client with glomerulonephritis, because dialysis will filter the blood and remove excess fluid.

A client has an amylase of 155. Which of the following organs is being tested with this lab value? -Liver -Spleen -Pancreas -Uterus

-Liver Amylase is produced by the pancreas. -Spleen Amylase is produced by the pancreas. -Pancreas The pancreas produces amylase, an enzyme that breaks down carbohydrates. The normal value for amylase is between 0-130 U/L. This lab is drawn and evaluated most often to diagnose pancreatitis. -Uterus Amylase is produced by the pancreas.

The nurse is admitting a client with a history of chronic kidney disease. Which of the following lab values is inconsistent with chronic kidney disease? -Creatinine 2.4 mg/dL -Blood Urea Nitrogen 7 mg/dL -Urine positive for protein -Potassium 6.1 mEq/L

-Potassium 6.1 mEq/L This is incorrect. This electrolyte would build up in the blood with chronic filtering problems, and since normal potassium is 3.5-5 mEq/L, this is an expected lab value. -Creatinine 2.4 mg/dL This is incorrect. This is a high creatinine level, which is expected in the client with chronic kidney failure. This is a high creatinine level, which is expected in the client with chronic kidney failure. This is an elevated creatinine (cr) level, which indicates kidney dysfunction. -Blood Urea Nitrogen 7 mg/dL This is correct. A client with kidney problems will have an increased BUN rather than a low-to-normal BUN. -Urine positive for protein This is incorrect. Protein in the urine may be expected during chronic kidney issues.

The nurse is caring for a client who has been diagnosed with hepatitis A. Which of the following teaching methods is most important to prevent reoccurrence of this particular type of hepatitis? -"This type of hepatitis is spread from poor hand washing techniques and through the fecal-oral route. It is really important to practice strict hand hygiene to prevent this from happening again" -"This type of hepatitis is spread through sexual contact. Please practice safe sex to avoid this in the future" -"This type of hepatitis is spread through needle contamination. It is really important not to use recreational drugs and needles to prevent this from happening again" -"This type of hepatitis is spread through coughing and sneezing, so make sure that you are keeping a safe distance from others who may have this"

-"This type of hepatitis is spread from poor hand washing techniques and through the fecal-oral route. It is really important to practice strict hand hygiene to prevent this from happening again" Hepatitis A is spread via the fecal-oral route and is usually due to poor hand hygiene and/or dirty eating utensils. Strict hand hygiene is the best preventative measure. -"This type of hepatitis is spread through sexual contact. Please practice safe sex to avoid this in the future" Hepatitis B is spread through needlesticks and sexual contact, but not hepatitis A. -"This type of hepatitis is spread through needle contamination. It is really important not to use recreational drugs and needles to prevent this from happening again" This statement by the nurse describes the mode of transmission for hepatitis B, not A. -"This type of hepatitis is spread through coughing and sneezing, so make sure that you are keeping a safe distance from others who may have this" No form of hepatitis is spread via coughing or sneezing.

The nurse is caring for a client who has been admitted with an acute exacerbation of ulcerative colitis (UC). Which of the following orders would the nurse question? -0.9 % normal saline continuous at 75 ml/hr -High protein diet -Labs: CMP, magnesium, phosphorus serum levels -Hemoccult stools

-0.9 % normal saline continuous at 75 ml/hr This is an appropriate order for the client with an exacerbation of UC. -High protein diet A client experiencing an acute exacerbation of UC should be NPO while receiving IV fluids and electrolytes (if needed). Initiating a high-protein diet during this phase would be inappropriate. Once the client is out of the acute phase, this diet is appropriate. -Labs: CMP, magnesium, phosphorus serum levels These are expected labs to check on the client with UC. -Hemoccult stools This is not an inappropriate order for a client with exacerbated UC.

The nurse is reviewing orders for a client with peptic ulcer disease (PUD). Which of the following would the nurse question? -40 mg pantoprazole PO daily -20 mg famotidine PO BID -325 mg aspirin PO daily -500 mg calcium carbonate PO QID

-40 mg pantoprazole PO daily This is a proton pump inhibitor appropriate for clients with PUD. -20 mg famotidine PO BID This is an H2 receptor blocker, which is an appropriate medication for a client with PUD. -325 mg aspirin PO daily Aspirin and NSAIDS are avoided with PUD because they exacerbate symptoms. -500 mg calcium carbonate PO QID This medication is appropriate to relieve symptoms of peptic ulcer disease.

A nurse is caring for a client who is in end-stage renal disease and requires dialysis. Choose which alternative best describes the type of diet the nurse should recommend for this client. -A diet low in carbohydrates -A diet high in salt -A diet low in protein -A diet high in protein

-A diet low in carbohydrates In ESRD a balance of carbohydrates is important to make sure the body is getting the right amount of energy. -A diet low in protein In end stage renal disease, protein intake and absorption is very important. Often, the client with ESRD is malnourished and increased protein intake helps. -A diet high in protein Many clients with kidney disease require low-protein diets because of the effects of protein on the kidneys. However, when a client is in end-stage renal disease and requires dialysis, a low-protein diet may not be necessary. In fact, the client may more likely require a high-protein diet at this stage because of the loss of nutrients from dialysis. -A diet high in salt To much salt causes fluid retention and becomes a problem for the person in ESRD.

A nurse is preparing to administer a dose IV infliximab for Crohn's disease. What assessment data should the nurse be most concerned about? -A white blood count (WBC) of 5,000. -A positive PPD test. -Influenza a month ago. -Ten-twenty bloody stools per day.

-A white blood count (WBC) of 5,000. A client with Crohn's disease may have a fever or elevated WBC but this finding is within normal limits. -A positive PPD test. A history of tuberculosis or a positive PPD result is the most important assessment finding prior to administering infliximab IV. -Influenza a month ago. A diagnosis of influenza a month ago is important history for the client but is not the most important when administering infliximab IV. -Ten-twenty bloody stools per day. A client with Crohn's disease is expected to have multiple bloody stools every day.

The nurse is caring for a client with peptic ulcer disease due to H. pylori. Which drug combinations should be given along with a macrolide antibiotic? -Amoxicillin and Prilosec -Penicillin and Axid -Tetracycline and sodium bicarbonate -Flagyl and Amphogel

-Amoxicillin and Prilosec H. pylori can be complicated to treat, because the bacteria quickly becomes resistant to antibiotics. Therefore, "triple therapy" is used. (When triple therapy fails, "quadruple therapy" is recommended.) Triple therapy consists of a macrolide antibiotic, a proton pump inhibitor, and a penicillin-related antibiotic. -Penicillin and Axid Penicillin is part of the triple therapy. Nizatidine is a histamine 2 blocker which reduces acid but is not included in the triple therapy. -Tetracycline and sodium bicarbonate While tetracycline is one of the drugs utilized with quadruple therapy, sodium bicarbonate is an antacid that is not used to treat H. pylori. -Flagyl and Amphogel Flagyl is not used for H. pylori, and amphogel is an antacid which is also not utilized in the treatment for H. pylori.

The nurse is caring for a client who is recovering from a gastric resection. The nurse provides teaching about how to prevent dumping syndrome. Which of the following statements are correct? Select all that apply. -Avoid consuming sugar, salt and milk -Do not consume fluids with meals -Lie down after each meal -Eat two large meals each day -Increase carbohydrate intake

-Avoid consuming sugar, salt and milk One measure to prevent dumping syndrome is to avoid sugar, salt, and milk. When these elements move too quickly into the small intestine, dumping occurs. -Do not consume fluids with meals Fluids cause the intestines to rapidly push food through, causing an episode of dumping. -Lie down after each meal Dumping syndrome can occur after gastric resections when the contents of the stomach are rapidly moved into the small intestine. Symptoms of dumping syndrome include nausea, vomiting, cramping, sweating, and diarrhea. Measures to prevent dumping syndrome include consuming a low carb, high fat, high protein diet, avoiding fluid consumption with meals, avoiding sugar, salt and milk, and lying down after each meal. The patient may also take antispasmodic drugs to delay gastric emptying, if prescribed. -Eat two large meals each day Large quantities of food will stimulate the bowel into dumping syndrome and should be avoided. -Increase carbohydrate intake Small meals reduce the risk of dumping syndrome, while carbohydrate intake increases the risk.

A nurse is caring for a client with diabetes who has experienced a progressive decrease in their kidney function. Which of the following areas will the nurse monitor to track the client's nephropathy? -BUN and creatinine levels -Presence of tingling in the lower extremities -Vison changes -Blood pressure patterns

-BUN and creatinine levels Nephropathy, or a progressive decrease in kidney function, is a common complication associated with diabetes. Signs that the client's nephropathy is progressing include increased BUN, creatinine and urine albumin levels, neurogenic bladder, weight loss, anemia and frequent urinary tract infections. The nurse should educate the client to restrict dietary protein, sodium and potassium and anticipate possible dialysis procedures if the condition worsens. -Presence of tingling in the lower extremities This is a sign of neuropathy, not nephropathy. -Vison changes This is a symptom of retinopathy, and does not signal a decline in kidney function. -Blood pressure patterns This does not indicate kidney function status.

The nurse is reviewing orders on a newly admitted client who has cirrhosis of the liver with various complications. Which of the following orders would the nurse question? -Bleeding precautions -Fluid restriction -Regular diet -Daily weights

-Bleeding precautions This is an expected precaution for the client with cirrhosis, because these clients are at risk for bleeding esophageal varices. Impaired liver function also leads to impaired coagulation AND portal hypertension. -Fluid restriction A fluid restriction is appropriate for a client with cirrhosis of the liver. This client will have a tendency for edema and fluid retention, and may need diuresed. -Regular diet A client with liver cirrhosis should not be on a regular diet, but instead should have a specific diet that restricts fluid, protein, sodium, alcohol, and overuse of acetaminophen, which is toxic to the liver. -Daily weights This is an appropriate order for this client because it helps monitor fluid retention.

A nurse is caring for a client who has an order for a CT scan with contrast. Which of the following medication orders would require further clarification from the provider? -Cholecalciferol -Regular insulin -Furosemide -Glucophage

-Cholecalciferol Cholecalciferol is Vitamin D and has no impact on, nor is it impacted by a CT scan with contrast. This order doesn't need to be clarified. -Regular insulin Insulin administration is not impacted by a CT scan. The only thing the nurse would need to consider is timing of meals - ensuring that the client can eat before going to scan if they need to receive their insulin. -Furosemide Clients at risk for kidney issues may receive a fluid bolus and furosemide (Lasix) after the scan to help clear their kidneys, this would not require further clarification. -Glucophage When given near IV contrast administration, Glucophage (metformin), can significantly increase the risk for contrast-induced nephropathy and may need to be held and/or additional pre-procedure medications may need to be given. This would require the nurse to call the provider to clarify and get an order to hold the medication.

A nurse takes report in the morning for 4 clients with the following active diagnoses. Which client would be the priority to see first? -Cholecystitis -Cirrhosis -Esophageal varices -Pancreatitis

-Cholecystitis Although this client likely has pain and needs to be evaluated, this condition is not immediately life threatening, nor does it have the potential to become life threatening as quickly as esophageal varices. -Cirrhosis Cirrhosis is a chronic condition that is not likely immediately life threatening. It is a higher priority to evaluate the client with esophageal varices. -Esophageal varices Esophageal varices could rupture, which is most often arterial and can become a medical emergency very quickly. Many things can cause rupture, such as high blood pressure or eating something sharp like potato chips or drinking hot beverages. It could also be caused by something as simple as coughing. It is priority for the nurse to see this client, assess their blood pressure and condition, and ensure the client knows what restrictions are in place and what to report to the nurse immediately. -Pancreatitis It is important to assess this client for diet compliance and pain control, but their condition is not potentially life threatening and therefore would not take priority over the client with esophageal varices.

A nurse is admitting a client with severe upper abdominal pain, nausea and vomiting, and an elevated amylase and lipase. What is the likely diagnosis? -Chronic gastritis -Acute pancreatitis -Liver cirrhosis -Acute cholecystitis

-Chronic gastritis A client with chronic gastritis will have abdominal pain, but not as severe as the pain with pancreatitis in most cases. Nausea is present, but lab values do not show elevated amylase or lipase levels. -Acute pancreatitis Abdominal pain, nausea and vomiting, along with an elevated amylase and lipase usually means the client has acute pancreatitis, and must immediately be put on bowel rest with robust pain management and monitoring for changes in the client's clinical condition. -Liver cirrhosis Liver cirrhosis does not involve abdominal pain. Rather, the client presents with jaundice, may have nausea or vomiting, abdominal swelling and abnormal liver function test values including ALT, AST, and ALP. -Acute cholecystitis When a client has acute cholecystitis, they will experience similar symptoms but without elevated amylase and lipase levels.

A client is complaining of chest pain. After reviewing the client's lab values and medical history, the nurse knows which of the following conditions is likely contributing to the client's condition? K+=6.7, Na=137, Mg=2.0, Hgb=14 -Aortic stenosis -Chronic kidney disease -Hyperthyroidism -COPD

-Chronic kidney disease This client has significant hyperkalemia, which can lead to chest pain and lethal arrhythmias. Chronic kidney disease often causes clients to have much higher than normal potassium, which can contribute to this client's condition. -Hyperthyroidism This condition does not tend to cause hyperkalemia, which is likely what is causing this client's chest pain. -COPD This condition does not tend to cause hyperkalemia, which is likely what is causing this client's chest pain. -Aortic stenosis This condition does not tend to cause hyperkalemia, which is likely what is causing this client's chest pain.

The nurse is assessing a client in the urgent care clinic who is complaining of burning with urination. The urinalysis shows that the client has a urinary tract infection (UTI). Which of the following medications is an appropriate medication to treat this client's UTI? -Clopidogrel -Captopril -Cephalexin -Cimetidine

-Clopidogrel Clopidogrel is an antiplatelet agent used to manage cerebrovascular accident, myocardial infarction, and peripheral vascular disease. -Captopril This is an ACE inhibitor that treats hypertension and CHF. -Cephalexin This is an anti-infective medication used for skin infections, pneumonia, UTIs, and otitis media. -Cimetidine This medication is an anti-ulcer H2 antagonist that treats GERD ulcers, and for the prevention of GI bleeding.

A 56-year-old client is suffering from interstitial nephritis and is seen in the hospital for care. The client's creatinine levels are elevated and the client has poor skin turgor and dry mucous membranes upon exam. The nurse ensures that the client does not receive any nephrotoxic medications that would worsen the condition. Which medication should be avoided? -Combivir -Abilify -Amantadine -Gentamicin

-Combivir This drug is a nucleoside reverse transcriptase inhibitor, which is used to prevent HIV from multiplying in the body. It can cause mitochondrial toxicity, but is not known for being nephrotoxic. -Abilify This drug is an atypical antipsychotic drug, used to manage symptoms of certain mood disorders. It has multiple side effects, but does not cause nephrotoxicity. -Amantadine This is an antiviral drug that is used to treat influenza. Amantadine overdose can cause toxicity to the cardiac, respiratory, and central nervous system, but is not nephrotoxic. -Gentamicin Nephrotoxic medications are those that can cause damage to the kidneys. When a client is at risk, nephrotoxic drugs could cause such damage that a client goes into a state of acute renal failure. Categories of nephrotoxic medications include aminoglycoside antibiotics (gentamicin is in this category), antineoplastics, and nonsteroidal antiinflammatory drugs.

The nurse is caring for a client who has ulcerative colitis. The nurse knows to monitor for which of the following abnormal lab work? Select all that apply. -Complete blood count -Folic acid -Urine -Potassium -Calcium

-Complete blood count A CBC is checked for signs of infection and anemia. -Folic acid If this lab value is abnormal it is not related to UC. -Urine If this lab value is abnormal it is not related to UC. -Potassium Clients with ulcerative colitis are likely to have blood in their stool, decreased amounts of electrolytes due to decreased absorption, and frequent stools leading to elimination of electrolytes before they are absorbed. -Calcium Calcium is an electrolyte that may be low due to altered elimination in the client with ulcerative colitis.

A 27-year-old female comes to the clinic for ongoing abdominal pain and diarrhea. Which additional symptoms are most suggestive of Crohn's disease? -Constant, severe abdominal pain and anemia from blood loss -Iron deficiency anemia and fever -Symptoms exacerbated by stress and anxiety -Pain in the left lower quadrant with nausea and vomiting

-Constant, severe abdominal pain and anemia from blood loss Incorrect. Ulcerative colitis causes excessive bleeding resulting in anemia from blood loss. -Iron deficiency anemia and fever Correct. Crohn's disease is characterized by abdominal pain, diarrhea, and fever from abscesses. Iron deficiency anemia results from a lack of absorption of iron in the stomach. -Symptoms exacerbated by stress and anxiety Incorrect. Irritable bowel syndrome is also characterized by chronic abdominal pain and can result in diarrhea or constipation. Other common symptoms include abdominal distention, family history, fatigue, sleep disturbances, mucus in the stool, and increased symptoms triggered by stress and anxiety. -Pain in the left lower quadrant with nausea and vomiting Incorrect. Diverticulitis most commonly causes acute left lower quadrant pain, abdominal distention, nausea, vomiting, decreased bowel sounds, and fever.

The nurse is caring for a client with a ruptured appendix who will need emergent surgery. The client has school-aged children in his care without any support system to watch the children. Which of the following interventions is most important for this client? -Calling the client's ex-wife to get additional medical information -Calling the client's ex-wife for consent for surgery -Contacting his place of employment to let them know the client won't be in for at least a few days -Attempting to secure childcare by consulting social work, case management, or a child life specialist

-Contacting his place of employment to let them know the client won't be in for at least a few days Informing a client's employer is not the priority. -Attempting to secure childcare by consulting social work, case management, or a child life specialist Hospitalized adults who have young children may need assistance with childcare during hospitalization. Out of the options listed, securing childcare is the most important. -Calling the client's ex-wife to get additional medical information This would be unnecessary because the client can give his own information. -Calling the client's ex-wife for consent for surgery There is no indication that this client is unable to make decisions for himself. Asking another person for consent is inappropriate.

Your patient had an ileostomy placed 2 weeks ago. Which bowel pattern would be expected for this patient? -Continuous output -Continent, controlled output -Output once per day -Output every 2-3 hours

-Continuous output An ileostomy is placed in the ileum of the small intestine. Therefore output will be liquid or semi-soft and will be continous. As the peristalsis occurs in the small intestine, stool output will be pushed out - therefore clients should expect continuous output throughout the day and night. -Continent, controlled output Clients with an ileostomy do not have control over their output like they might with a colostomy or other types of bowel ostomies. It is a continuous output. -Output once per day Output from an ileostomy is liquid or semi-soft and flows continuously with peristalsis, NOT once daily. -Output every 2-3 hours Because output from the ileostomy moves with peristalsis, it will be continuous, not intermittent.

The nurse is assigned to a client complaining of left flank pain. Which sign would be concerning for internal bleeding and should be checked immediately? -Cullen's sign -Murphy's sign -Battle's sign -Grey-Turner's sign

-Cullen's sign This is bruising located in the umbillicus area and indicates potential pancreatitis, but not an internal hemorrhage, which is more emergent than pancreatitis. -Murphy's sign This is demonstrated by severe pain over the RUQ and indicates possible cholecystitis. -Battle's sign This is bruising on the mastoid process and indicates a fracture of the middle cranial fossa and potential brain damage, but is not related to flank pain and would not be present with this chief complaint. -Grey-Turner's sign Grey-Turner's sign is located on the flank and is an indicator of retroperitoneal hemorrhage.

A nurse is caring for a client with pancreatitis. Which of the following labs would the nurse NOT expect to see? Select all that apply. -Decreased liver enzymes -Elevated bilirubin -Hypermagnesemia -Hypercalcemia -Elevated WBC

-Decreased liver enzymes In pancreatitis, clients are more likely to have INCREASED liver enzymes, not decreased. -Elevated bilirubin This is an expected lab finding in pancreatitis because of possible bile duct compression caused by pancreatic edema. -Hypermagnesemia The nurse would expect to see hypomagnesemia, not hypermagnesemia. -Hypercalcemia Pancreatitis creates hypocalcemia, not hypercalcemia. -Elevated WBC This would be expected in pancreatitis due to the body trying to heal itself.

A nurse is caring for a client that has been diagnosed with pancreatitis. Which of the following is NOT a complication commonly associated with this disease process? -Disseminated intravascular coagulopathy -Hypovolemia -Hypocalcemia -Right lung effusion

-Disseminated intravascular coagulopathy This is a possible complication of pancreatitis. It is thought to be caused by circulating pancreatic enzymes "eating" up coagulation factors, leading to DIC. -Hypovolemia Hypovolemia is a common complication of pancreatitis due to vomiting and poor nutrition. -Hypocalcemia Hypocalcemia is common in pancreatitis. It can be related to glucagon-stimulated calcitonin release and decreased PTH secretion. It also has to do with impaired absorption of calcium. -Right lung effusion In pancreatitis, effusions are usually seen in the LEFT lung, not right, because of its proximity to the pancreas.

A client with irritable bowel syndrome has asked the nurse if there is anything that can be done to decrease the frequency of diarrhea. Which of the following advice is appropriate for a client to develop regular bowel functioning? Select all that apply. -Drink 8 to 10 glasses of liquids per day -Increase intake of fiber -Decrease activity levels and increase rest -Eat the largest meal of the day in the evening -Utilize narcotics to reduce pain

-Drink 8 to 10 glasses of liquids per day Chronic diarrhea can lead to dehydration and electrolyte imbalances for the affected client. The client should stay hydrated to avoid further irritation of the bowels. -Increase intake of fiber The nurse who works with a client who has irritable bowel syndrome may counsel the client to increase dietary fiber, drink plenty of fluids, limit greasy and fatty foods, and increase activity levels in order to best regulate bowel function. If dietary and lifestyle changes do not assist the client in managing IBS, medications may be used. -Decrease activity levels and increase rest Having a regular exercise regimen can help clients manage symptoms of irritable bowel syndrome. -Eat the largest meal of the day in the evening A steady diet of small meals seems to work better for clients with IBS than large meals. -Utilize narcotics to reduce pain The client with irritable bowel syndrome should be instructed to avoid narcotics.

The nurse is caring for a client scheduled for plasmapheresis. Which of the following information is true regarding this procedure? Select all that apply. -During plasmapheresis, anticoagulants help prevent blood from clotting. -Plasmapheresis is used for autoimmune diseases to remove certain antibodies. -Plasmapheresis is also called therapeutic plasma exchange (TPE). -Plasmapheresis uses an arteriovenous (AV) fistula access. -Plasmapheresis removes plasma from the cellular component of blood.

-During plasmapheresis, anticoagulants help prevent blood from clotting. Plasmapheresis describes a process that involves separating plasma from blood cells. The process is somewhat similar to hemodialysis and may be used to remove such elements as toxins, clotting factors, or triglycerides from a patient's circulation. It is also known as therapeutic plasma exchange (TPE). -Plasmapheresis is used for autoimmune diseases to remove certain antibodies. Plasmapheresis describes a process that involves separating plasma from blood cells. The process is somewhat similar to hemodialysis and may be used to remove such elements as toxins, clotting factors, or triglycerides from a patient's circulation. It is also known as therapeutic plasma exchange (TPE). -Plasmapheresis is also called therapeutic plasma exchange (TPE). Plasmapheresis describes a process that involves separating plasma from blood cells. The process is somewhat similar to hemodialysis and may be used to remove such elements as toxins, clotting factors, or triglycerides from a patient's circulation. It is also known as therapeutic plasma exchange (TPE). -Plasmapheresis uses an arteriovenous (AV) fistula access. Plasmapheresis uses standard intravenous catheter access. An AV fistula is for hemodialysis -Plasmapheresis removes plasma from the cellular component of blood. Plasmapheresis describes a process that involves separating plasma from blood cells. The process is somewhat similar to hemodialysis and may be used to remove such elements as toxins, clotting factors, or triglycerides from a patient's circulation. It is also known as therapeutic plasma exchange (TPE).

An 89-year old client has been diagnosed with a urinary tract infection. Which of the following is the first sign of a urinary tract infection in the older adult? -Easily Agitated -Mild depression -Altered mental status -Paranoid state

-Easily Agitated This is not a common symptom of a UTI in the older adult population. -Mild depression This is not a common symptom of a UTI in the older adult population. -Altered mental status A urinary tract infection can cause symptoms of urinary frequency and pelvic pain for many clients. In many older adults, altered mental status and lethargy are the only symptoms of a urinary tract infection. The nurse should look for signs of cognitive changes in older adult clients and assess for possible infection when they occur. -Paranoid state This is not a common symptom of a UTI in the older adult population.

A nurse is caring for a client who is suffering from a gastric ulcer. Which of the following is an appropriate nursing intervention? Select all that apply. -Eat small, frequent meals -Drink caffeinated beverages -Drink plenty of milk -Take a histamine blocker -Take a proton pump inhibitor

-Eat small, frequent meals Small, frequent meals are less likely to cause irritation to an ulcer than large meals. -Drink caffeinated beverages Caffeinated beverages and milk should be avoided, because they cause irritation. Other irritating foods include chocolate, and foods high in sodium. -Drink plenty of milk Milk can cause irritation to a gastric ulcer. -Take a histamine blocker Histamine blockers or proton pump inhibitors should be given to reduce stomach acid. -Take a proton pump inhibitor Histamine blockers or proton pump inhibitors should be given to reduce stomach acid.

A pregnant client is undergoing a laparoscopic cholecystectomy because of severe abdominal pain. Which of the following items should the nurse teach this client about a cholecystectomy? -Encourage the client to limit fluid intake for 48 hours prior to surgery -Avoid administering pain medications after surgery to reduce the risk of fetal suppression -Remind the client that there is an increased risk of bleeding with this procedure during pregnancy -Tell the client that it is riskier to delay treatment of gallstones than to have laparoscopic surgery to correct the situation

-Encourage the client to limit fluid intake for 48 hours prior to surgery It is important for the client to maintain hydration, and once the client is NPO for surgery, IV fluid should be running to avoid dehydration. -Avoid administering pain medications after surgery to reduce the risk of fetal suppression Post-operative pain needs to be treated. If pain is left untreated, it can lead to further complications in the mother. Opioids used in therapeutic doses have not been shown to increase the risk of malformations in the baby. -Remind the client that there is an increased risk of bleeding with this procedure during pregnancy Many clotting factors in the blood increase in pregnancy, so the client would not have an increased risk of bleeding. -Tell the client that it is riskier to delay treatment of gallstones than to have laparoscopic surgery to correct the situation Pregnancy increases the risk of gallstone development and a percentage of women will need to have a cholecystectomy during pregnancy. Studies have shown that the risks of laparoscopic surgery are less than if the symptomatic client were left to manage the gallstones without surgery, which could ultimately lead to tissue necrosis and significant pain.

The nurse is assigned to a client with an acute kidney injury. The nurse understands that hemodialysis will become necessary when which of the following signs or symptoms are demonstrated? -Fluid overload with K 6.4 -Malignant hypertension -BUN 18 mg/dL -Blood pH 7.5

-Fluid overload with K 6.4 This answer indicates multiple symptoms of kidney failure, which means the client has complications. This, or severe fluid overload with refractory hypertension, severe metabolic acidosis, or BUN >70 mg/dL indicates the need for hemodialysis. -Malignant hypertension This must be accompanied by another related sign or symptom to truly indicate a need for hemodialysis. -BUN 18 mg/dL This is a normal blood urea nitrogen level, so it does not indicate a need for hemodialysis. -Blood pH 7.5 This pH is slightly alkaline. The client would have to show severe metabolic acidosis in order to require hemodialysis.

The nurse is caring for a client who has suffered an acute kidney injury. Which of the following nursing interventions are appropriate? Select all that apply. -Fluid restriction -Monitor I&O -1 gm NaCl tabs q6hrs -Daily weights -Head CT with contrast

-Fluid restriction With a fluid restriction, the client will retain less fluid and fluid overload will be less of a risk. With fluid overload, the client will begin to demonstrate adventitious heart sounds and crackles in the lungs, which indicates the need for diuresis and/or dialysis. -Monitor I&O A client with an acute kidney injury should be monitored for I&O to see how much fluid is being retained, and how much urine is being made by the kidneys. -1 gm NaCl tabs q6hrs Administering salt tablets will cause further fluid to be retained. Salt tabs are contraindicated. -Daily weights Injury to the kidneys can result in fluid retention, and tracking the client's daily weights is a way to monitor how well the kidneys are working. -Head CT with contrast The contrast dye given with CT scans is contraindicated, because it is hard on the kidneys. Additionally, there is no reason for a head CT for the client in kidney failure.

A client who has undergone a laparoscopic cholecystectomy is getting ready to be dismissed from the hospital. Which information would the nurse provide as part of post-op instructions for this client? Select all that apply. -Avoid swimming or being submerged in the bathtub after going home -Contact the provider if systolic blood pressure is above 120 mmHg -Take short walks every day -Follow a full-liquid diet until the first post-op appointment -Do not lift anything more than 10 pounds

-Follow a full-liquid diet until the first post-op appointment A client who has had their gallbladder removed should advance their diet as tolerated, but minimize fatty foods for four to six weeks while the body adjusts to digesting foods without the gallbladder. -Avoid swimming or being submerged in the bathtub after going home The client should monitor the surgical sites and avoid swimming or taking baths until the suture sites have healed, but showering is permitted the day after surgery. -Contact the provider if systolic blood pressure is above 120 mmHg The client should be counseled to avoid lifting anything heavy to prevent reopening of the surgical site. -Take short walks every day A laparoscopic cholecystectomy is a common procedure that has a short recovery time if there are no complications. The client should be counseled to increase activity by taking several short walks each day but avoid lifting anything heavy. The client should also monitor the surgical sites and avoid swimming or taking baths until the suture sites have healed, but showering is permitted the day after surgery. -Contact the provider if systolic blood pressure is above 120 mmHg cancel The provider should be contacted if the client experiences fever, chills, redness, or warmth at the incision site, nausea and vomiting, or constipation.

A client who receives peritoneal dialysis has called the nurse to explain that he is unable to infuse the dialysate into the catheter. When the nurse arrives at the client's home, which method would the nurse use to assess for an occlusion? -Gently rotate the catheter to improve inflow and check for kinks -Apply a suction catheter to low continuous suction to the end of the tube -Gently pull the catheter outward away from the body -Administer 10 mL of saline flush into the tube

-Gently rotate the catheter to improve inflow and check for kinks Occasionally, the catheter for peritoneal dialysis will become occluded, which can impede the inflow or outflow of fluid to the peritoneal cavity. The nurse should gently rotate the catheter back and forth and check for kinks to encourage outflow. The nurse can also milk the tubing to dislodge any clots that may have formed. The nurse should never pull on the tube or apply suction to the tubing. -Apply a suction catheter to low continuous suction to the end of the tube A suction should never be applied to the peritoneal catheter. -Gently pull the catheter outward away from the body This action can cause the catheter to migrate out of the peritoneal area. -Administer 10 mL of saline flush into the tube If there is a clot in the tube, it should not be flushed into the peritoneal cavity, but should be milked and sent out of the tube.

A nurse is caring for a client who is complaining of RUQ pain. Which sign should the nurse look for to indicate potential cholecystitis? -Grey-Turner sign -Battle's sign -Murphy's sign -Cullen's sign

-Grey-Turner sign Grey-Turner sign is located on the flank and is an indicator of retroperitoneal hemorrhage and/or pancreatitis. -Battle's sign Battle sign is bruising on the mastoid process and indicates a fracture of the middle cranial fossa and potential brain damage. -Murphy's sign Murphy's sign is severe pain over the RUQ and is indicative of cholecystitis. -Cullen's sign Cullen's sign is bruising located in the umbilicus area and indicates potential pancreatitis.

The nurse receives report on four clients and starts to read through their charts and symptoms. The nurse knows that which of the following is the priority to see first? -Groin pain after moving a dresser -Chronic atrial fibrillation with feelings of palpitations -GI bleed with jaundiced skin -Decreased urine output with acute kidney injury

-Groin pain after moving a dresser This is not life threatening at this time. The client with a GI bleed is the priority to assess the amount of bleeding and get treatment started. -Chronic atrial fibrillation with feelings of palpitations Most people with Afib feel palpitations so while this needs to be addressed, the priority is the client with a GI bleed that is showing worsening symptoms with jaundiced skin color. -GI bleed with jaundiced skin When the liver is compromised, it may not make all of the factors needed for clotting. A GI bleed can be concerning because stopping the bleed might be difficult. This client could also be experiencing esophageal varices, which, if they bleed, can be a medical emergency. This client is the priority to assess the bleeding and attempt to stop the bleeding. -Decreased urine output with acute kidney injury This is not abnormal and not life threatening. We expect someone with an acute kidney injury to have decreased urinary output. The priority is to see the GI bleed and assess further.

The client has a chronic peptic ulcer and wants to know the difference between an acute and chronic peptic ulcer. How does the nurse educate the client? -An acute ulcer lasts only a month and a chronic ulcer lasts greater than one month -H. pylori is present with a chronic ulcer but not with an acute ulcer -An acute ulcer is treated with H2 blockers while a chronic ulcer is treated with proton pump inhibitors -An acute ulcer is a superficial erosion, while a chronic ulcer extends through the muscular wall of the stomach

-H. pylori is present with a chronic ulcer but not with an acute ulcer H. pylori is a predisposing factor for either type of ulcer. -An acute ulcer is a superficial erosion, while a chronic ulcer extends through the muscular wall of the stomach When the erosion in the lining of the GI tract extends through the mucosal wall and muscle in a portion of the GI tract accessible to gastric secretions, it is called a chronic ulcer. Locations include the stomach, pylorus, duodenum and esophagus. An acute ulcer is in the same locations, but is a superficial erosion through the mucosal wall only. -An acute ulcer lasts only a month and a chronic ulcer lasts greater than one month An acute ulcer can take up to three months to heal, but if the ulceration extends through the mucosal wall and the muscle, it can take much longer to heal. -An acute ulcer is treated with H2 blockers while a chronic ulcer is treated with proton pump inhibitors Both types of medication may be prescribed for any ulcer.

A nurse is caring for a 69-year-old client who has just been diagnosed with disequilibrium syndrome after his first session of hemodialysis. Which symptoms would the nurse expect to see in a client with this syndrome? -Headache, nausea and vomiting -Trouble hearing and visual hallucinations -Shallow, rapid respirations and increased oxygen needs -Anuria and bladder pain

-Headache, nausea and vomiting Disequilibrium syndrome is a rare complication of hemodialysis that is more likely when a client is beginning hemodialysis therapy. It is caused by a rapid decrease in BUN and circulating fluid volume that is thought to increase intracranial pressure (ICP). The client displays symptoms related to brain edema that include nausea, vomiting, restlessness, dizziness, muscle cramping, agitation, seizures and even coma when the condition is extreme. -Trouble hearing and visual hallucinations This is not a symptom associated with disequilibrium syndrome. -Shallow, rapid respirations and increased oxygen needs -Anuria and bladder pain

The nurse suspects that a client has a duodenal ulcer. Which of the following signs would indicate this condition? -Hematemesis -Pain immediately after eating -Gnawing, sharp pain 30-60 min after eating -Pain 1.5-3 hours after eating, relieved by eating

-Hematemesis This is indicative of a gastric ulcer, not a duodenal ulcer. cancel -Pain immediately after eating This could be due to gallstones, but is not indicative of a duodenal ulcer. -Gnawing, sharp pain 30-60 min after eating Pain 30-60 min after eating is indicative of a gastric ulcer, rather than a duodenal ulcer. -Pain 1.5-3 hours after eating, relieved by eating Pain 1.5-3 hours after eating that is relieved by eating is indicative of a duodenal ulcer.

A nurse receives a client from radiology that just underwent a liver biopsy. Which position should the nurse place the client in to decrease risk of bleeding? -High-Fowler's -Left side-lying -Right side-lying -Prone

-High-Fowler's Although this may be a comfortable position and improve breathing, it will not help prevent bleeding after a liver biopsy. -Left side-lying This would leave the liver without any pressure on it, therefore increasing the risk for bleeding. -Right side-lying The goal is to place pressure over the liver, which is located on the right side of the abdominal cavity. It would also be beneficial to add a pillow underneath the area of the liver to place extra pressure to prevent bleeding. -Prone Lying on the stomach would not help prevent bleeding after a liver biopsy.

A client has acute renal failure. Which of the following is the most serious complication of acute renal failure? -Hypernatremia -Hyponatremia -Hyperkalemia -Hypokalemia

-Hypernatremia While hypernatremia is a symptom of ARF, it is not as dangerous for a client as hyperkalemia. -Hyponatremia Hyponatremia may occur during certain stages of kidney failure, but in ARF it is more likely for the client to present with hypernatremia than hyponatremia. -Hyperkalemia Acute renal failure causes an increase in certain serum electrolytes, including potassium and sodium. The most serious complication of acute renal failure is hyperkalemia, because this affects the client's heart rhythm and is potentially fatal. -Hypokalemia Decreased serum potassium is not associated with acute renal failure.

A nurse is caring for a client diagnosed with cystitis. What signs and symptoms are expected with this diagnosis? Select all that apply. -Hyperthermia -Leukocytosis -Dysuria -Flank pain -Polyuria

-Hyperthermia A increased temperature would be consistent with a diagnosis of pyelonephritis, which is an inflammation of the kidney . -Leukocytosis An elevated WBC would be consistent with a diagnosis of pyelonephritis, which is an inflammation of the kidney. -Dysuria Dysuria (difficulty urinating) is a symptom of cystitis, which is an inflammation of the bladder. The classic clinical manifestations of cystitis consist of dysuria, urinary frequency, urinary urgency, and suprapubic pain -Flank pain Flank pain would be consistent with a diagnosis of pyelonephritis, which is an inflammation of the kidney . -Polyuria Polyuria (frequent urinating) is a symptom of cystitis, which is an inflammation of the bladder. The classic clinical manifestations of cystitis consist of dysuria, urinary frequency, urinary urgency, and suprapubic pain

A nurse is talking with a 65-year-old client about care after a diagnosis of liver cancer. The nurse explains that the client can receive palliative care and the client responds by saying, "I won't have that kind of care. I'm going to fight this cancer with everything I have!" Which response from the nurse is accurate? -I know fighting this cancer is important to you, but you should let someone take care of you now -You are mistaking palliative care with hospice care. They are not even close to the same thing -You can still receive palliative care with your diagnosis. It does not necessarily mean that you will die -I know you want to fight this, but it is time to accept that your time is limited

-I know fighting this cancer is important to you, but you should let someone take care of you now This statement implies that initiating palliative care means stopping the fight against cancer, which is incorrect. -You are mistaking palliative care with hospice care. They are not even close to the same thing They are not the same thing, but are often done in conjunction with one another when a client has a terminal illness, so the two terms are often viewed as equals from the client's perspective. -You can still receive palliative care with your diagnosis. It does not necessarily mean that you will die Palliative care focuses on care interventions and symptom management. It may be provided to clients during periods of severe illness. Palliative care and hospice care are not the same thing, but are often given in conjunction. However, a client does not have to be terminal to receive palliative care services. In this case, the client may be mistaking palliative care for hospice care, and the nurse should gently educate this client about the differences between the two types of care. -I know you want to fight this, but it is time to accept that your time is limited This statement implies that initiating palliative care means stopping the fight against cancer, which is incorrect.

A client has cirrhosis of the liver and has developed abdominal pain and ascites. The nurse must administer certain medications, but the client refuses. Which of the following responses from the nurse best indicates that the nurse is acting in a paternalistic manner? -I know this is difficult for you. Is there something else you might like to try? -I will inform the provider that you do not want this medication -I know you do not want this medication, but you need to get your pain under control -It seems as if you are struggling to understand what is going on

-I know this is difficult for you. Is there something else you might like to try? In this response, the nurse is collaborating with the client rather than behaving in a paternalistic manner. In addition, this response allows the client to explore alternate pain control options. -I will inform the provider that you do not want this medication This is not a paternalistic response. In addition, the nurse should discuss with the client reasons for refusal of the medication before the provider is notified. -I know you do not want this medication, but you need to get your pain under control Paternalism is a concept within healthcare in which a nurse or provider acts in a manner that is condescending toward the client and portrays the healthcare provider "knows best" for the client. When a nurse acts in a paternalistic manner, clients are treated as if they are unable to make decisions for themselves. -It seems as if you are struggling to understand what is going on This is not a paternalistic response. This response should be followed up with a check for understanding by the nurse. For example, "It seems as if you are struggling to understand what is going on. Is this how you feel?"

Which treatment therapies are recommended for the management of Crohn's? Select all that apply. -Increase raw vegetable consumption -Anti-inflammatory medications -Immunomodulators -Perianal care and barrier wipes -Antidiarrheal medications

-Increase raw vegetable consumption Patients with Crohn's should eat a low residue diet and avoid irritating foods and high residue foods. Raw fruits and vegetables should be avoided on a low residue diet. -Anti-inflammatory medications Anti-inflammatory medications such as 5-Aminosalicylates and corticosteroids are used to decrease inflammation. -Immunomodulators Immunomodulators such as natalizumab and vedolizumab are used to prevent the migration of leukocytes from the bloodstream to the inflamed tissues. -Perianal care and barrier wipes Meticulous perianal skincare using plain water together with a skin barrier prevents skin breakdown. -Antidiarrheal medications Antidiarrheals are used to treat diarrhea, the main symptom of Crohn's disease.

The nurse is caring for a client who has been diagnosed with appendicitis and is scheduled for surgery later today. Which of the following assessment findings is the MOST concerning? -Abdominal pain at McBurney's point -Increased WBC on CBC -Rebound tenderness -Sudden pain relief

-Increased WBC on CBC This is a normal finding in appendicitis and indicates the presence of an immune response. -Rebound tenderness This is a classical sign of peritoneal irritation, and a normal finding for a client with appendicitis. -Sudden pain relief This is the most concerning because it indicates that the appendix has ruptured. -Abdominal pain at McBurney's point This is an expected assessment finding in appendicitis and is located on the right side of the abdomen between the navel and anterior superior iliac spine.

A client receiving medication as an anti-infective starts showing signs of nephrotoxicity. The nurse knows that which of the following are signs of nephrotoxicity? -Increased urine output -Fluid retention -Low blood pressure -Hearing loss -Decreased urine output

-Increased urine output Damaged renal cells cause a decrease in urine production, not an increase. -Fluid retention Damaged renal cells cause fluid retention. -Low blood pressure Nephrotoxicity can cause an irregular heartbeat and might cause high blood pressure to occur because of the increase in fluid retention. -Hearing loss This symptom is related to ototoxicity. -Decreased urine output Damaged renal cells cause a decrease in urine production.

A client presents to the emergency department complaining of right upper quadrant pain which worsens with palpation. The client has clay-colored stools. Which of the following tests will likely be ordered? Select all that apply. -CT scan -Influenza test -Complete blood count (CBC) -Ultrasound -Urinalysis

-Influenza test These are not signs of influenza. -CT scan RUQ pain and clay colored stools are classic signs of gallstones, so the client should be checked for increased bilirubin in both blood and urine, increased WBCs in the blood, and undergo imaging such as CT scan or ultra sound. -Urinalysis A UA is part of the workup for gallstones. -Ultrasound An ultrasound will give important information about the severity of the gallstones. -Complete blood count (CBC) A CBC will help the provider know whether there is an increase in WBCs or not.

A client delivered her third baby via cesarean section 1 day ago. The client needed an indwelling urinary catheter placed because she had an epidural for the procedure. Which nursing intervention would best prevent a catheter-associated urinary tract infection (CAUTI) in this client? -Keep the catheter in place only for the least amount of time necessary -Open the drainage system only to empty the catheter bag -Keep the drainage bag at the level of the client's hip -Apply antibiotic ointment to the catheter insertion site once per shift

-Keep the catheter in place only for the least amount of time necessary A catheter-associated urinary tract infection (CAUTI) occurs when an infection develops in an indwelling catheter and is a source of significant expense and disability as a type of hospital-acquired infection. The nurse can take steps to reduce the risk of a CAUTI by using aseptic technique with the catheter, keeping the drainage bag closed and below the level of the client's bladder, and only using the catheter for the least amount of time necessary. -Open the drainage system only to empty the catheter bag The outflow drainage port should be used to empty the drainage bag, but the drainage system itself should not be opened because pathogens can be introduced and cause infection. -Keep the drainage bag at the level of the client's hip The drainage bag should be kept below the level of the bladder at all times. Since the hip could be above the bladder depending on the position of the client, this is not a correct landmark at which to place the bag. -Apply antibiotic ointment to the catheter insertion site once per shift Catheter care should be performed once per shift, which includes cleaning the tube and perineal area with chlorhexidine or warm water and soap, depending on facility policy. Antibiotic ointment is not used.

The client needs an IV solution but has both kidney and liver disease. Which IV solution is contraindicated in renal and liver insufficiency? -Lactated Ringer's solution -10 percent dextrose -D5W and half normal saline -Normal Saline

-Lactated Ringer's solution Lactated Ringer's solution (LR) is contraindicated in situations of renal or liver insufficiency, due to these organs' inability to metabolize lactate. The make up of LR is similar to serum and cannot be given in cases of a blood pH of greater than 7.5. -10 percent dextrose Dextrose is not metabolized in the liver or kidney, but is directly absorbed into cells. -D5W and half normal saline Dextrose is not metabolized in the liver or kidney but is directly absorbed into cells. Sodium and chloride are used as-is in the bloodstream. -Normal Saline Sodium and chloride are used as-is in the bloodstream.

The nurse is caring for a client with an ileostomy. During assessment of the client, the nurse notes that the pouch opening is 1/2 inch larger than the stoma site. Which of the following poses a risk for this client? -Leakage and odor from the site -Peristomal skin breakdown -Stoma pain and burning -Pouch system detachment

-Leakage and odor from the site An incorrect opening size would not result in leakage and odor. Rather, leakage and odor occurs if the bag is not properly pressed into the flange, or the bag is not sealed appropriately. -Peristomal skin breakdown The opening of the skin barrier and pouch should be just 1/8 inch larger than the stoma. If the opening is any larger than this, the fecal matter will irritate the surrounding skin and can cause skin breakdown. When applying the skin barrier, the nurse should ensure that the skin around the stoma is clean and dry. The stoma is measured, and an opening 1/8 inch larger is applied to the skin using a skin barrier paste. The bag is then attached to the barrier. -Stoma pain and burning The stoma itself does not contain pain receptors. The skin around the stoma can become painful if the opening is too large, but not the stoma itself. -Pouch system detachment The pouch system is generally reliable and would not detach due to an incorrect opening size. The bag should be emptied when it is 1/3 to 1/2 full, and if this is managed appropriately and the pouch is correctly attached, it should stay in place.

The nurse is caring for a client with an acute kidney injury. Which of the following dietary recommendations is inappropriate at this time? -Limit processed or canned foods -Limit intake of whole grains -Increase fresh vegetables and fruit -Increase foods high in potassium

-Limit processed or canned foods This is an appropriate recommendation, because these foods have a high sodium content. The injured kidneys will have difficulty excreting sodium. -Limit intake of whole grains This is an appropriate recommendation for the client with a kidney injury, because whole grains contain phosphorus, which should be excreted by the kidneys. Because the kidneys are injured, this electrolyte will build up in the body, causing an imbalance. -Increase fresh vegetables and fruit This is an appropriate dietary recommendation for a client with an acute kidney injury. -Increase foods high in potassium This is an inappropriate dietary recommendation for a client with acute kidney injury, because the kidneys are not able to excrete potassium as well as normal. If the client increases these foods, he or she could get hyperkalemia.

A client with peptic ulcer disease is being assessed for an upper GI bleed. Which signs would the nurse expect to see with this diagnosis? Select all that apply. -Melena -Abdominal bloating -Hematochezia -Lower leg edema -Epigastric pain

-Melena An upper GI bleed occurs in the upper portion of the gastrointestinal tract, including the area within the esophagus. Signs or symptoms associated with bleeding from this area include dark blood in the stool, also called melena. -Abdominal bloating Abdominal bloating is not a sign of an upper GI bleed. -Hematochezia Hematochezia is the presence of visible or clinically detectable blood in feces. It may be produced by anorectal disorders, such as hemorrhoids or by bleeding from diverticuli, cancers, some forms of dysentery, or angiodysplasia of the bowel (among other causes). It sometimes results from massive bleeding from the upper gastrointestinal tract. -Lower leg edema Edema in the lower legs is not a sign of an upper GI bleed. -Epigastric pain An upper GI bleed occurs in the upper portion of the gastrointestinal tract, including the area within the esophagus. Signs or symptoms associated with bleeding from this area include epigastric pain.

A client has liver failure and is experiencing increased levels of ammonia. The nurse anticipates an order for which of the following medication? -Milk of magnesia -Lactulose -Biscodyl -Senna

-Milk of magnesia This medication, while it does not adversely affect the liver, does not decrease ammonia levels. -Lactulose This medicine is an osmotic laxative that draws water into the bowels, inducing a loose bowel movement which facilitates excretion of ammonia. Lactulose also decreases the production of ammonia in the bowel. -Biscodyl Bisacodyl is a stimulant laxative, but is not used to decrease ammonia levels in the blood. -Senna This medication is a laxative that should not be used in liver failure because it can be toxic to the liver.

A client is brought to the trauma bay after sustaining multiple gunshot wounds to the left flank and abdomen. Assessment reveals gross hematuria and an expanding palpable mass to the left flank. Vital Signs are the following: HR 145 BP 78/42 RR 36 O2 sat 96% The nurse anticipate which of the following diagnosis? -Minor kidney injury -Grade III Liver Laceration -Major kidney injury -Grade III Splenic Laceration

-Minor kidney injury While the identification of a kidney injury is correct, the presence of hematuria, an expanding mass over the flank, and signs of shock indicate a more severe injury. -Grade III Liver Laceration Liver lacerations would rarely cause hematuria and the palpable mass over the flank is not indicative of a liver injury. -Major kidney injury The client is showing signs of shock along with gross hematuria, and a palpable expanding mass over the flank are all signs of a severe kidney injury. -Grade III Splenic Laceration Splenic lacerations would rarely cause hematuria and the palpable mass over the flank is not indicative of a splenic injury.

The nurse is caring for a client who has returned to the floor from the PACU after an appendectomy. Based on this surgical procedure, the nurse knows to implement which of the following interventions for this client? -Monitor temperature and pulse to assess for infection -Apply heat to the abdomen to promote comfort -Delay assessment of the incision until 24 hours post-op to prevent infection -Encourage favorite foods to encourage the return of bowel function

-Monitor temperature and pulse to assess for infection The nurse will monitor the post-operative appendectomy client for signs and symptoms of infection by taking vital signs, monitoring lab values and assessing the incision site for redness, warmth, swelling and drainage. Pain control is important for the client as well. The bowel sounds are also monitored for return of function and the client remains NPO until bowel function has returned, at which point the client's diet can be slowly advanced. -Encourage favorite foods to encourage the return of bowel function The client must remain NPO until bowel function has returned, and THEN the nurse can begin to advance the client's diet. -Delay assessment of the incision until 24 hours post-op to prevent infection The nurse must assess the incision site or sites initially, then monitor regularly to detect any changes. -Apply heat to the abdomen to promote comfort Heat encourages bacterial growth, and is not recommended for post-op comfort. Rather, the provider will usually order ice for comfort, which can be utilized for the client as needed.

A 57-year-old client with peptic ulcer disease is being seen for abdominal pain. Which of the following are assessments for hemorrhage in this client? Select all that apply. -Monitoring the client's hemoglobin and hematocrit levels -Assessing for symptoms of dizziness or nausea -Speaking calmly to the client to reduce anxiety -Recording hourly urinary output -Administering stool softeners

-Monitoring the client's hemoglobin and hematocrit levels A client with peptic ulcer disease is at higher risk of bleeding because of the disease process. The nurse can assess for bleeding by monitoring hemoglobin and hematocrit levels and assessing for signs of low blood pressure such as dizziness or nausea. -Assessing for symptoms of dizziness or nausea A client with peptic ulcer disease is at higher risk of bleeding because of the disease process. The nurse can assess for bleeding by monitoring hemoglobin and hematocrit levels and assessing for signs of low blood pressure such as dizziness or nausea. -Speaking calmly to the client to reduce anxiety As a nurse, speaking calmly is therapeutic in most situations, but it is not a way to gain information about whether the client is hemorrhaging or not. -Recording hourly urinary output This is not used as an indication of hemorrhage in peptic ulcer disease. While urinary output drops in situations where the cardiac output is decreased from hemorrhagic shock, this is not a good indication of bleeding in a case of peptic ulcer disease, because the bleeding does not usually result in shock. Therefore, the reduction in urine may be nominal. -Administering stool softeners This intervention is unrelated to assessing for hemorrhage.

The nurse is assessing a client and observes Cullen's sign and Grey Turner's sign. The nurse knows that these are signs of which of the following conditions? -Nephritis -Diverticulitis -Cholecystitis -Pancreatitis

-Nephritis Nephritis, or inflammation of the kidney, is characterized by pain with urination, pain in the lower pelvis, and a change in color or odor of the urine. -Diverticulitis Signs of diverticulitis include pain and tenderness in the left lower quadrant. -Cholecystitis Murphy's sign is seen in cholecystitis, which is when the nurse palpates the abdomen and asks the client to take a breath. The client will catch their breath due to pain. -Pancreatitis Cullen's sign is ecchymosis around the umbillicus, and Grey Turner's sign is bruising on the flank. These signs are usually present with pancreatitis.

A nurse is caring for a client post-op colon resection and notes a decreased blood pressure, rigid abdomen and the client reports severe pain. Based on these findings and knowing the possible complications, which of the following lab values would be the MOST appropriate to evaluate at this time? -Neutrophils -Lactic acid -Potassium -Hemoglobin

-Neutrophils Neutrophils (white blood cells) would increase if the client was experiencing a post-op infection. Signs of this would include a fever, pain, and redness or drainage at the surgical site. Instead, the client is exhibiting signs of hemorrhage. Therefore a hemoglobin would be the most appropriate. -Lactic acid Lactic acid might increase if the client was experiencing necrotic bowel or sepsis. Signs of this would include hypoactive or absent bowel sounds, fever, and tachycardia. These are not the signs this client is presenting with at this time. Therefore a hemoglobin is the most appropriate. -Potassium Potassium levels be significantly affected by severe diarrhea or potassium loss in stool. However, this client is showing signs of internal bleeding. Therefore checking a hemoglobin level is the most appropriate. -Hemoglobin One of the most common complications after bowel surgery is internal bleeding. Signs of internal bleeding would include hypotension, tachycardia, severe abdominal pain, and a rigid abdomen. Since these are the signs seen in this client, checking a hemoglobin level would be the most appropriate to compare to the pre-op levels.

A nurse is caring for a client who was diagnosed with pancreatic cancer three days ago. What is the priority nursing intervention for this client? -Nutritional counseling -Pain management -Venous thromboembolism prevention -Close glucose monitoring

-Nutritional counseling Clients with pancreatic cancer will require digestive enzymes and possibly a special diet to alleviate their symptoms. This is a long-term priority, but not the priority at this time. -Pain management While all of these interventions are important, pain management is the priority with pancreatic cancer. These patients experience intense pain and typically require larger doses of pain medication to achieve control. -Venous thromboembolism prevention This is important for all hospitalized clients, but is not a specific priority for this client at this time. -Close glucose monitoring Because the pancreas is responsible for insulin and glucagon management, glucose will need to be monitored as the disease progresses. However, due to the intense pain experienced by these clients, pain management will be the top priority in the short term.

The nurse is assessing a client who presents to the emergency department with complaints of abdominal pain. Which sign or symptom would indicate to the nurse that the client is having an emergency? -Pain upon palpation -Dark tarry stools -Bright red blood in stools -Sudden relief of the pain

-Pain upon palpation This is an expected finding with appendicitis. It does not indicate that the appendix has burst. -Dark tarry stools Dark tarry stools indicate an upper GI bleed, which is unrelated to appendicitis. This has the potential to be an emergency, but only if other signs and symptoms are also present, such as a low hemoglobin/hematocrit, thready pulse, dizziness, and/or additional signs of shock. -Bright red blood in stools Bright red stools indicate a lower GI bleed, which is unrelated to appendicitis. This could considered an emergency if there were other signs and symptoms present, but since the question does not list additional signs and symptoms, this is not the correct option. -Sudden relief of the pain Appendicitis is painful until the appendix ruptures, at which point the pain will suddenly stop. It is an emergency when the client has abdominal pain and then has a sudden relief of pain that is unrelated to receiving pain medication. If the appendix ruptures, the client will get peritonitis and possibly sepsis if not emergently treated.

The nurse is caring for a client who has cirrhosis of the liver. Which assessment finding is NOT consistent with this diagnosis? -Pale urine -Malaise -Ascites -Spenlomegaly

-Pale urine Clients suffering from cirrhosis of the liver will typically have dark or amber colored urine due to higher levels of bilirubin being excreted through the kidneys. -Malaise When a client has liver cirrhosis, malaise is a common symptom. This occurs because of increased ammonia, impaired protein metabolism and increased bilirubin levels in the client's body. -Ascites This is an expected finding in the client with cirrhosis, due to edema from impaired protein metabolism. -Spenlomegaly This is an expected finding in cirrhosis of the liver because of inflammation and scarring in the liver.

The nurse is caring for a client in end stage renal disease. The client has an internal arteriovenous fistula for dialysis. Which of the following interventions are appropriate in caring for the client with an AV fistula? Select all that apply. -Assess for prolonged Q-T intervals on the ECG -Monitor client for neurological changes -Monitor for signs of blood clotting -Palpate the fistula to ensure patency -Avoid checking blood pressure on the extremity with the fistula

-Palpate the fistula to ensure patency An internal arteriovenous (AV) fistula is created by surgically joining an artery and a vein in the arm. This is permanent access for the client with chronic kidney disease. Care for the client with an AV fistula includes preventing and monitoring for complications. "Feel the thrill and hear the bruit" is important to assess for fistula patency. -Avoid checking blood pressure on the extremity with the fistula Teach the client to notify all health care personnel of the presence of a fistula, because the affected extremity should not be used for blood pressure checks, IV lines, blood draws, or injections. -Monitor for signs of blood clotting The client should be monitored for signs of clotting, infection, heart failure and arterial steal syndrome. Heart failure can occur if too much arterial blood is shunted into the venous system. Arterial steal syndrome can occur if not enough arterial blood reaches the hand due to shunting into the venous system, compromising circulation to the hand. -Monitor client for neurological changes An AV fistula does not affect the client's neurological status. However, if a client with kidney disease begins to demonstrate neurological changes, the nurse should monitor laboratory values and notify the provider -Assess for prolonged Q-T intervals on the ECG An AV fistula does not affect the Q-T interval. However, the client is at risk for heart failure if too much blood enters the venous system and overloads the heart.

The nurse is caring for a client and suspects cholecystitis. Upon notification of the provider, the nurse is asked to discover whether the client has a positive Murphy's sign. Which of the following will verify the presence of a positive Murphy's sign in this client? -Place a hand below the client's costal margin on the right side at the midclavicular line. Ask the client to breathe in. If client cannot breathe in due to pain, the test is considered positive -Hold the knee flexed 45 degrees. Place one hand on the medial aspect of the knee and pull laterally. Use the other hand to rotate the knee in, and if a click is heard or pain is experienced, the test is considered positive -Tenderness at the point over the right side of the abdomen that is 1/3 of the distance from the anterior superior iliac spine to the navel -Lightly tap their facial nerve. If any twitching occurs, the test is positive

-Place a hand below the client's costal margin on the right side at the midclavicular line. Ask the client to breathe in. If client cannot breathe in due to pain, the test is considered positive Being unable to breathe in due to pain when this action is performed reveals a positive Murphy's sign. -Tenderness at the point over the right side of the abdomen that is 1/3 of the distance from the anterior superior iliac spine to the navel This location is McBurney's point, and tenderness at this area is a sign of appendicitis. -Lightly tap their facial nerve. If any twitching occurs, the test is positive Tapping the facial nerve and noting twitching is Chvostek sign, which indicates hypocalcemia. -Hold the knee flexed 45 degrees. Place one hand on the medial aspect of the knee and pull laterally. Use the other hand to rotate the knee in, and if a click is heard or pain is experienced, the test is considered positive This describes a positive McMurray test.

The nurse is working with a client who has peptic ulcer disease. Which of the following labs is important to monitor with this condition? -Procalcitonin -H/H -Lactic acid -Magnesium

-Procalcitonin This is not a lab value related to peptic ulcer disease. -H/H In PUD, bleeding is a concern, so monitoring the H/H will alert the clinician of developing or worsening bleeding. -Lactic acid This is measured in clients who may be in heart failure, sepsis and shock. It's not related to peptic ulcer disease. -Magnesium This level would not reveal any information about peptic ulcer disease.

The nurse is caring for a client who was just diagnosed with acute pancreatitis. Which of the following is the priority nursing intervention? -Promoting a clear liquid diet -Pain management -Maintaining NPO status -Monitor for hypoglycemia

-Promoting a clear liquid diet The client should be kept NPO for pancreatic rest. -Pain management Pain management is a concern, but the pain is usually caused by "using" the pancreas when trying to digest food. Therefore it would be a higher priority to implement and maintain NPO status first. -Maintaining NPO status Pancreatic rest (NPO) is key in pancreatitis. Pain occurs due to the release of pancreatic enzymes needed to digest the food. Therefore, NPO is essential. -Monitor for hypoglycemia Hyperglycemia is the major concern, not hypoglycemia.

A client presents to the emergency room with c/o nausea, vomiting, and diarrhea. Which of the following medications is appropriate to treat this condition? -Propanolol -Indomethacin -Loperamide -Ibuprofen

-Propanolol This is a beta blocker that is used to treat hypertension, angina, arrhythmias, and heart attacks. -Indomethacin This is an antirheumatic medication used most often for clients with rheumatoid arthritis. -Loperamide This is an antidiarrheal medication. -Ibuprofen This is a non-steroidal anti-inflammatory agent that treats mild to moderate pain and inflammation.

The nurse is teaching a client who has been diagnosed with peptic ulcer disease about what foods to eat. Which of the following is a food that the client is allowed to eat with this diagnosis? -Purine containing foods -Chocolate -Coffee -Tea

-Purine containing foods Purines are avoided for gout, but not peptic ulcer disease. -Chocolate Chocolate causes irritation so it must be avoided by clients with peptic ulcer disease. -Coffee This is one of the foods to avoid with PUD, because it causes irritation. -Tea Clients with peptic ulcer disease (PUD) should avoid tea, coffee, chocolate, spicy foods, high-sodium foods, and cola because these cause irritation to ulcers.

The nurse is caring for a client that arrives to the Emergency Department complaining of a fever, abdominal pain in the right lower quadrant, nausea and vomiting, and anorexia. Which of the following conditions should the nurse suspect? -Pyelonephritis -Kidney stones -Appendicitis -Hepatitis C

-Pyelonephritis The clinical presentation of pyelonephritis includes flank pain (unilateral or bilateral), fever, malaise, weight loss, and anorexia. -Kidney stones The clinical presentation for kidney stones consists of flank pain and hematuria. -Appendicitis The clinical presentation of acute appendicitis is described as a constellation of the following classic symptoms: Right lower quadrant (right anterior iliac fossa) abdominal pain, anorexia, and nausea and vomiting. -Hepatitis C The clinical presentation for Hepatitis C includes right upper quadrant pain, jaundice, dark urine, white stool, and nausea.

Before starting a session of hemodialysis, a nurse assesses her client's AV fistula. The nurse listens to the fistula with a stethoscope and notes a swishing sound under the skin. Which action of the nurse is most appropriate? -Raise the client's arm above the level of his heart -Cleanse the AV fistula site and auscultate again -Check for distal pulses and prepare to start the dialysis procedure -Contact the provider to order an ultrasound of the site

-Raise the client's arm above the level of his heart This action is not indicated when a bruit is present. -Cleanse the AV fistula site and auscultate again Since a bruit is a normal finding, there is no need to auscultate a second time. -Check for distal pulses and prepare to start the dialysis procedure An arteriovenous (AV) fistula is used for hemodialysis as a form of vascular access. The nurse should work carefully with the AV fistula site, as this is the client's access for hemodialysis. Prior to the next treatment, the nurse may listen to the site with a stethoscope to determine if a bruit is present, which manifests as a swishing sound under the skin. This is a normal finding, so in this case, the nurse would continue with the rest of the assessment. -Contact the provider to order an ultrasound of the site No ultrasound is necessary, because the nurse heard a bruit. A bruit is a normal finding.

A 63-year-old patient with hepatitis C needs assistance with making food choices. The nurse should counsel the patient to restrict which type of food? -Red meat -Oats -Skim milk -Canned fruit

-Red meat Some clients with hepatitis C have elevated iron levels in the body. When this occurs, the client would need to eat fewer foods that are good sources of iron, such as red meat or grain products that have been fortified with iron. Additionally, as the disease progresses and a person develops liver cirrhosis, proteins become difficult for the liver to break down. -Oats Whole grains, like oats, are a good choice for a client with hepatitis C. -Skim milk Foods that should be restricted with hepatitis C because lean dairy products, whole grains, fruits, and vegetables help a client to stay healthy. Fruits and vegetables, lean proteins like beans and nuts and whole grains are good choices for a client with liver disease. -Canned fruit Fruits and vegetables are good choices for a client with hepatitis C. There is no need to restrict canned fruit.

A 61-year-old client recently had surgery where the surgeon placed an ostomy appliance. Which of the following teaching principles would the nurse include when instructing this client about ostomy care? -Remove the bag and wash the stoma site with soap and water at least once every three to seven days -Empty the bag every 24 hours to remove all elimination from bowel movements -When applying a new bag, cut an opening ½ inch smaller than the size of the stoma before putting it on -Never put any kind of lotion or skin barrier near the ostomy site

-Remove the bag and wash the stoma site with soap and water at least once every three to seven days A client who has a new ostomy appliance requires extensive teaching on the principles of its care as well as lifestyle changes that may be necessary. The nurse should teach the client to empty the bag when it becomes half full and to place barrier ointment on the skin surrounding the site in order to adhere the pouch to the skin. The nurse should also teach the client to remove the bag at least once every three to seven days and to wash the stoma site with soap and water and let fully dry before attaching a new pouch. -Empty the bag every 24 hours to remove all elimination from bowel movements The bag should be emptied when it is half full, not on a time schedule. -When applying a new bag, cut an opening ½ inch smaller than the size of the stoma before putting it on If the opening is too small, it will not work appropriately and will cut off circulation to the stoma. The opening should be cut to fit closely to the size of the stoma. A measuring tool may be used. -Never put any kind of lotion or skin barrier near the ostomy site The skin will need a barrier applied to protect it from breakdown and to encourage adherence of the pouch.

A nurse is caring for a client that has been diagnosed with cirrhosis. Which of the following assessment findings is NOT consistent with this diagnosis? -Scleral edema -Asterixis -Palmar erythema -Hematemesis

-Scleral edema Scleral edema is swelling of the sclera of the eye. This is NOT common in cirrhosis. The client may experience dependent peripheral edema due to volume overload. -Asterixis Asterixis is a flapping hand tremor that is a common sign of cirrhosis and liver failure. -Palmar erythema Palmar erythema is redness of the palms of the hand, which is consistent with cirrhosis. -Hematemesis Hematemesis would be consistent with cirrhosis because these clients often have coagulopathies and are also at risk for esophageal varices, which would cause a client to vomit blood.

The nurse is caring for a client who has chronic kidney disease. Which of the following medications would the nurse question? -Insulin -Calcium gluconate -Spironolactone -Kayexalate

-Spironolactone This is a medication that should not be given to a client with kidney disease. Hyperkalemia is a major concern, and since spirolactone is a potassium-sparing diuretic it should NOT be used in clients with CKD. -Calcium gluconate This drug increases the threshold of cardiac cell contraction in hyperkalemia, which is appropriate for a client with chronic kidney disease who is experiencing arrhythmias. -Kayexalate Kayexalate eliminates potassium by binding to it in the intestinal tract. -Insulin Insulin helps transport potassium into cells, it causes the potassium level to decrease, which is a benefit to the client with kidney disease.

The nurse is caring for a client with a BUN of 28. The nurse recognizes this as a sign of dysfunction of which of the following? -Spleen -Liver -Heart -Kidneys

-Spleen The organs responsible for filtering blood urea nitrogen are the kidneys. -Liver The organs responsible for filtering blood urea nitrogen are the kidneys. -Heart The organs responsible for filtering blood urea nitrogen are the kidneys. -Kidneys Kidneys excrete blood urea nitrogen (BUN) and if they are in acute or chronic failure, they will not eliminate BUN and it will remain high in the blood. Normal BUN range is 7-20 mg/dL.

A client with severe, uncontrolled hypertension is being evaluated for chronic kidney disease. The provider checks the glomerular filtration rate and determines that it is 22 mL/min. Which stage of chronic kidney disease does -this GFR place the client? -Stage III -Stage IV -Stage I -Stage II

-Stage IV The glomerular filtration rate (GFR) is a measure of kidney function that determines how well the kidney is able to filter waste products. A normal GFR is approximately 125 mL/minute. A client who has a GFR of 22 mL/min would be categorized as having severe kidney disease and would be classified at stage IV. -Stage II Stage II GFR is 60-89 mL/min. -Stage I Stage I GFR is >90 mL/minute. -Stage III Stage III is 30-59 mL/min. Stage IV is 15-29 mL/min. Stage V is <15 mL/min.

The nurse is caring for a client who has been diagnosed with a urinary tract infection. Which of the following isolation precautions should be implemented? -Standard -Contact -Airborne -Droplet

-Standard A client with a UTI should be placed on standard precautions, since the question does not state the type of bacteria that is present. If the bacteria was a resistant drug organism such as methilicin-resistant staph aureus (MRSA), the client would be placed on contact precautions. Since the question does not specify the pathogen, contact precautions is incorrect. -Contact The client simply needs to be on standard precautions. -Airborne The client simply needs to be on standard precautions. -Droplet The client simply needs to be on standard precautions.

A client is admitted to the unit with glomerulonephritis. Which of the following answers is a common cause of this condition? -Staphylococcus infection -Systemic lupus erythematosus -Bacteremia -Acute cystitis

-Staphylococcus infection Glomerulonephritis is a term used to describe an inflammatory injury to the glomerulus. A staphylococcus infection does not predispose a person to develop glomerulonephritis. -Systemic lupus erythematosus Glomerulonephritis is a term used to describe an inflammatory injury to the glomerulus. This is most commonly caused by an immunological reaction, such as from systemic lupus erythematosus or scleroderma. B-hemolytic streptococcal invasion of the skin or pharynx and history of pharyngitis or tonsillitis can also predispose a person to develop glomerulonephritis. Loss of kidney function develops as a result of this condition. -Bacteremia Glomerulonephritis is a term used to describe an inflammatory injury to the glomerulus. Bacteremia is a blood infection that does not predispose a person to develop glomerulonephritis. -Acute cystitis Glomerulonephritis is a term used to describe an inflammatory injury to the glomerulus. Acute cystitis is an inflammation of the bladder that does not predispose a person to develop glomerulonephritis.

A nurse is assessing a client with an indwelling urinary catheter for signs of a catheter-associated urinary tract infection (CAUTI). Which assessment finding would best help to identify a CAUTI? -Suprapubic pressure and pain -Excess urine output -Temperature of 99.0 F -Frequent diarrhea

-Suprapubic pressure and pain A catheter-associated urinary tract infection (CAUTI) is a potential complication of indwelling catheter use that refers to a bacterial infection that would not have occurred if the catheter were not present. The nurse can assess for signs or symptoms of a CAUTI by checking the catheter site and assessing urine output. The client may complain of suprapubic tenderness or pressure, the urine may be cloudy or bloody with a strong odor, and the client may have a fever over 100.0 F. -Excess urine output Urine may be cloudy and/or have a strong odor, but excess urine output is not a sign of a CAUTI. -Temperature of 99.0 F A temperature of 100.0 F can indicate infection, not 99.0 F. -Frequent diarrhea A urinary tract infection does not affect the GI system.

The nurse is managing a client's care who has kidney disease. Which of the following interventions are appropriate because of this condition? Select all that apply. -Take daily weights at the same time each day -Assess apical pulse each shift -Ensure the client is following a high protein diet -Watch for changes in mental status -Monitor urine output

-Take daily weights at the same time each day The client with kidney disease is unable to get rid of fluid at the same rate as a person with properly functioning kidneys. This client will need daily weights to monitor whether they are retaining fluid. -Assess apical pulse each shift The pulse rate should be assessed routinely regardless of whether a client has kidney disease or not. -Ensure the client is following a high protein diet A diet appropriate for kidney disease includes low protein, low sodium, and low potassium. Excessive *or even normal* amounts of these lead to an increased concentration in the blood from the kidney's lack of filtration. -Watch for changes in mental status If a client with kidney disease has a sudden change in mentation, it may be a sign of cerebral edema or stroke which are increased risks in kidney disease. -Monitor urine output Urine output decreases as the kidneys become less effective at filtering the blood. Urine output is a sign of how well the kidneys are functioning.

An 80-year-old client is confused because he has developed a urinary tract infection. The client cowers and screams when the nurse enters the room. Which action of the nurse best demonstrates that she is attempting to minimize the client's fear in this situation? -Tell the client that everything is okay and he will be just fine -Explain to the client about his condition and provide information in printed form -Remain calm and continue to try to reorient the client -Help the client to verbalize that he is not afraid of the nurse

-Tell the client that everything is okay and he will be just fine When a client behaves in this manner, they are not likely to believe the nurse who tells them that everything will be just fine. The best approach is to speak directly to the client in a normal voice to reorient the client and remain calm. -Explain to the client about his condition and provide information in printed form This client is cowering and screaming, so the nurse knows that it would not be effective to provide printed information. -Remain calm and continue to try to reorient the client A client who is confused may be afraid of once-familiar people or the healthcare providers caring for him. In this case, the nurse probably cannot reach the client by giving him information to read that will help him with his diagnosis. Instead, the nurse should talk to the client calmly and try to reorient them if possible. -Help the client to verbalize that he is not afraid of the nurse The client IS afraid of the nurse, so it would not be helpful to tell the client to verbalize something that they do not feel.

A nurse is discussing options for home hemodialysis with a client who has kidney disease. Which of the following is correct regarding home hemodialysis? Select all that apply. -Home hemodialysis sessions are shorter than outpatient sessions -The catheter system must remain sterile in the home -The home care nurse will be present to assist with the dialysis process -Home hemodialysis promotes client independence -Home hemodialysis may involve nocturnal sessions

-The catheter system must remain sterile in the home The same rules of cleanliness apply in the home that would apply in a facility. If there is a catheter that enters the body internally, it must be kept clean. In this case, sterility must be maintained to avoid an infection. -Home hemodialysis sessions are shorter than outpatient sessions Peritoneal dialysis is a method used in the home, dwell time is factored into the session time, which takes longer than a in-clinic hemodialysis, which is done with a machine in a facility. -The home care nurse will be present to assist with the dialysis process The client who is proficient with peritoneal dialysis may perform the process independently in the home. Additionally, dialysis patients can become trained and skilled at administering Home Dialysis with proper training and with a care partner. -Home hemodialysis promotes client independence Home hemodialysis is an option for some clients with renal failure. It allows the client to live a more normal life, and often the client can perform dialysis independently. -Home hemodialysis may involve nocturnal sessions There are different types of dialysis done at home. Peritoneal dialysis, which involves the instillation of dialysate into the peritoneum, allowed to dwell, and drained. This process of exchange is repeated on a schedule based on which type of dialysis is being utilized. Home dialysis can consist of short, long, or overnight dialysis sessions.

A nurse is assisting a provider with obtaining informed consent for a client who is preparing to undergo a laparoscopic cholecystectomy. What must the nurse consider when determining if the client is competent to sign the informed consent? -The client has a low level of health literacy -The client is feeling stress about the upcoming procedure -The provider does not have much time to give information about the procedure -The client does not ask any questions about the procedure

-The client does not ask any questions about the procedure The client's competence cannot be measured by the number of questions asked about the procedure. -The client has a low level of health literacy When a client undergoes a surgical procedure, the provider's role is to explain the procedure, as well as its risks, benefits, and alternatives of the procedure. The nurse should note whether the client is competent to sign the consent and that the client understands what he is signing. A client with a low level of health literacy may not understand the provider's explanation or the information on the form. -The client is feeling stress about the upcoming procedure Stress related to the upcoming procedure is normal and is not an indication of the client's competence. -The provider does not have much time to give information about the procedure The client's competence is not related to the amount of time the provider spends with the client.

A nurse is caring for an 86-year-old client who is undergoing surgery for a bladder suspension. The nurse assesses the client's medical history prior to surgery and documents that the client also has arthritis. Which best describes why this information is important? -The client will have problems transferring from the bed to the operating table -A client with arthritis will be less likely to have bladder stones -The client's arthritis medications can interfere with the anesthesia used during surgery -The client with arthritis has a higher risk for a cardiovascular event

-The client will have problems transferring from the bed to the operating table When a client is in the operating room, they are usually under the influence of painkillers or anesthetics, so clients with and without arthritis alike will need to be moved and positioned by staff members. -A client with arthritis will be less likely to have bladder stones Bladder stones do have an increased association with arthritis. -The client's arthritis medications can interfere with the anesthesia used during surgery There are many medications that can interfere with anesthesia, and all medications should be reviewed and discussed by the provider and client prior to surgery. -The client with arthritis has a higher risk for a cardiovascular event When assessing a client who is getting ready for surgery, the nurse must determine if the client has any medical history that could impact the surgery and surgical outcomes. A client with arthritis is at an increased risk for a cardiovascular event, including myocardial infarction. This is similar to a person with diabetes mellitus, or a person ten years older than the age of the surgical candidate. Additionally, the client with arthritis typically presents with fewer complaints of angina and a higher unrecognized cardiovascular disease state.

A client who had an indwelling catheter has developed a urinary tract infection that has spread to the kidneys. The nurse should include which of the following information as part of her teaching? -The client will need to confirm the diagnosis with urine testing, kidney x-ray, and a voiding cystourethrogram -The client should restrict fluids until the infection has cleared -The client will need surgery for removal of infected tissue -The client can continue to recover with antibiotics at home

-The client will need to confirm the diagnosis with urine testing, kidney x-ray, and a voiding cystourethrogram A kidney infection is usually diagnosed with a urine culture and possible blood cultures. -The client should restrict fluids until the infection has cleared The client with a kidney infection should be encouraged to take in fluids to help flush the infection from the kidneys. -The client will need surgery for removal of infected tissue Pyelonephritis could also involve an abscess, which if severe enough, could warrant surgery. However, this does not occur with the majority of pyelonephritis cases. -The client can continue to recover with antibiotics at home An indwelling catheter places a client at a higher risk of a urinary tract infection (UTI). A kidney infection can develop if the UTI is left untreated, when the bacteria ascend from the lower urinary tract. While a kidney infection, or pyelonephritis, can be very serious and may require hospitalization if complications develop, most clients can recover at home on oral medication after a loading dose of IV antibiotics.

A nurse is caring for a client who has developed a surgical site infection following surgery for an open cholecystectomy. Which of the following factors contribute to infection rates in surgical wounds? Select all that apply. -The pain medications used during surgery -The time between the client's skin preparation and the actual surgery -The client having diabetes or being immunocompromised -The presence of an existing infection before surgery -The temperature of the client during surgery

-The pain medications used during surgery Different types of pain medication do not increase or decrease the risk of infection. Some medications, like steroids or immunocompromising drugs DO increase the risk for infection, but medications for pain do not. -The time between the client's skin preparation and the actual surgery If there was a longer time between skin prep and actual surgery, this exposes the affected area to bacteria and viruses that cause an infection. Additionally, the hospital staff has a responsibility to maintain asepsis during care and monitor for signs of infection. -The presence of an existing infection before surgery Surgical site infections are a type of healthcare associated infection (HAI) that cause an increased burden on the client and hospital, increased the length of stay, and increased morbidity and mortality. A client is at greater risk of developing a surgical site infection if their body or a wound was contaminated prior to surgery. -The temperature of the client during surgery The client's temperature during surgery does not have an influence on whether they get an infection. When a client has an elevated temperature it is a sign of infection, but it is not the reason for the infection. -The client having diabetes or being immunocompromised A preexisting condition that predisposes the client to infection, such as diabetes or an immunocompromised status, has been shown to be a factor contributing to surgical site infection.

A provider has ordered a serum creatinine test for a client who is being assessed for chronic kidney disease. The client asks the nurse about the test. Which of the following responses correctly explains serum creatinine? -The provider ordered this test to check for an infection -This test tells us if you are releasing excess sugar in your urine -We are testing to see if your kidneys are able to excrete waste through your urine -This will tell us if your kidneys are damaged and you will need dialysis

-This will tell us if your kidneys are damaged and you will need dialysis Dialysis is not the first step once it is determined that kidneys are damaged. Dialysis is necessary once a client is in end stage renal disease, have lost 85-90% of kidney function and have a profoundly low glomerular filtration rate. -The provider ordered this test to check for an infection Serum creatinine levels are not indicative of an infection. -This test tells us if you are releasing excess sugar in your urine This is not reflected in a serum creatinine level. -We are testing to see if your kidneys are able to excrete waste through your urine A creatinine test is a test of kidney function that measures the amount of creatinine in the bloodstream. Creatinine is a waste product of creatine, which is produced by the muscles for energy. Creatinine is removed from the body by the kidneys, and increased levels indicate that the kidneys are not able to excrete normal amounts of creatinine from the body. An increased serum creatinine is not seen until there is at least a 50% renal function loss.

A client is undergoing a liver biopsy for complications of hepatitis. Following the procedure, the nurse positions the client on their right side and tells the client to lie in that position for two hours. Which best describes the rationale for this? -To prevent hemorrhage -To promote comfort for the client -To increase production of glucagon -To improve circulation to the liver and surrounding tissues

-To prevent hemorrhage A liver biopsy involves removing a small portion of the liver tissue to examine for cancer or disease. The liver is an organ with a large blood supply, and it is responsible for producing coagulation factors. Therefore a client with hepatitis has an increased bleeding risk due to decreased production of coagulation factors. The nurse may ask the client to lie on the right side after the procedure, which will put some pressure on the liver and prevent excess bleeding. -To promote comfort for the client The purpose of having the client lie on their right side for two hours is to prevent bleeding from the biopsy site. -To increase production of glucagon The purpose of having the client lie on their right side for two hours is to prevent bleeding from the biopsy site. To improve circulation to the liver and surrounding tissues The purpose of having the client lie on their right side for two hours is to prevent bleeding from the biopsy site

The nurse is caring for a client who has been diagnosed with chronic kidney failure. Which of the following aspects of this client's history could have contributed to this? -Diabetes mellitus -Hypertension -Rheumatoid arthritis -Generalized anxiety disorder -Transient ischemic attack (TIA)

-Transient ischemic attack (TIA) This is not a direct cause of chronic kidney failure. -Diabetes mellitus Diabetes can cause chronic kidney failure, because the high glucose level causes damage to the nephrons, which decreases their ability to filter the blood. -Hypertension Hypertension causes too much pressure on the structures of the kidneys over time, causing them to fail. -Rheumatoid arthritis Autoimmune disorders can cause chronic kidney failure when the body's immune system begins to attack these organs. -Generalized anxiety disorder This does not cause chronic kidney failure.

The nurse is caring for a client who has had an indwelling urinary catheter for 2 weeks. The nurse suspects that the client is developing a urinary tract infection. Which of the following assessment findings is inconsistent with this disease process? -Urinary urgency -Malodorous urine -Confusion -Fruity breath

-Urinary urgency This is a an expected finding when a client has a UTI, so this answer is incorrect. -Malodorous urine This is a normal finding when a client has a UTI. -Confusion Confusion is commonly seen in older adults with a urinary tract infection. Since this finding IS consistent with a UTI, this answer is incorrect. -Fruity breath This is NOT a finding associated with a urinary tract infection (UTI). Fruity breath is seen with hyperglycemia.

A client with end-stage renal disease is getting ready to undergo hemodialysis. Which factors would the nurse assess before the client starts the dialysis session? Select all that apply. -Urine pH -Skin turgor -Heart rate and rhythm -AV fistula site -Weight

-Urine pH The client undergoing hemodialysis has malfunctioning kidneys, so any urine tests will likely be abnormal, and would not affect whether the client undergoes hemodialysis. -Skin turgor Skin turgor gives the nurse an idea of hydration status, but does not affect the process of hemodialysis. -Heart rate and rhythm Vital signs, including pulse, and the presence of any arrythmias are assessed prior to a hemodialysis session. -AV fistula site When preparing a client for hemodialysis, the nurse must first perform an assessment of certain body systems, including weight, heart rate and rhythm, lab values that would be affected by the dialysis, such as BUN or electrolyte levels, any signs of infection, and the AV fistula site. Other general assessments include the client's understanding of the purpose and procedure, and reconciling client medications. -Weight Weight is assessed before hemodialysis.

A client is suffering from fluid overload due to a history of severe liver disease. Which of the following interventions would be the highest priority for this client? -Weigh the client daily -Check skin regularly for signs of skin breakdown -Monitor for heart arrhythmias and the presence of crackles on auscultation -Elevate the lower extremities to reduce edema

-Weigh the client daily While monitoring the client's daily weights is helpful, it is not an urgent priority for a client with fluid overload. -Check skin regularly for signs of skin breakdown Skin breakdown is not a priority in this client at this time. -Monitor for heart arrhythmias and the presence of crackles on auscultation Fluid overload can develop as a result of various types of disease processes. It can lead to edema, weight gain, and electrolyte imbalance. To avoid complications of fluid overload, the nurse should listen to the client's heart rate to determine if excess fluid has caused heart arrhythmias. The nurse should also listen to the client's breath sounds for signs of breathing difficulties because of increased fluid. -Elevate the lower extremities to reduce edema This is not the highest priority, because this is unrelated to breathing and circulation. Monitoring for heart arrhythmias and lung crackles are MOST important because these assessments indicate an affect on the cardiac and respiratory systems. These body systems must be addressed FIRST.

A client with Crohn's disease has been using whey protein shakes for weight gain. What information should the nurse give to this client about the safety of using these types of shakes? Select all that apply. -Whey protein has been shown to increase the risk of blood clots -Whey protein powder can significantly increase blood glucose levels -Whey protein has been known to lower blood pressure in some people -Whey protein may cause changes in cholesterol levels -Whey protein is usually safe for use in adults when used at recommended amounts

-Whey protein has been shown to increase the risk of blood clots Whey protein has not been shown to increase the risk of blood clots. -Whey protein powder can significantly increase blood glucose levels Whey protein has been shown to lower blood glucose levels rather than increase them. -Whey protein has been known to lower blood pressure in some people Whey protein is a type of supplement that may be used to assist with weight gain because of the protein provided. Whey protein shakes can be helpful but they should be used with caution in some clients, particularly those who are lactose intolerant. Whey protein has also been shown to lower blood pressure, moderate blood glucose levels, reduce C-reactive protein levels (inflammatory markers), and can lower cholesterol levels. -Whey protein may cause changes in cholesterol levels Whey protein has been shown to lower cholesterol levels in some clients. -Whey protein is usually safe for use in adults when used at recommended amounts Whey protein is safe for most adults, unless the client is known to have a lactose intolerance.

The nurse is caring for a client who is being treated for pancreatitis. The provider orders a metabolic panel as part of routine testing and the nurse notes that the client's calcium level is 5.2 mg/dL. The client asks the nurse what this means. Which of the following responses from the nurse is correct? -Your calcium levels are elevated. I will have to give you a diuretic to help your body get rid of some of the excess -Your calcium levels are normal, which is a sign that you are healing -As long as you are feeling all right, I wouldn't worry about this level -Your calcium levels are low, most likely from your condition. I will need to administer a supplement of calcium through your IV

-Your calcium levels are elevated. I will have to give you a diuretic to help your body get rid of some of the excess This level is not elevated. Normal range is 8.4 - 10.2mg/dl. -Your calcium levels are normal, which is a sign that you are healing The normal Ca+ level for an adult is 8.4 - 10.2 mg/dL, so this level is low. -As long as you are feeling all right, I wouldn't worry about this level A client with a calcium level below 7.0 mg/dL usually gets a provider order to replace calcium, regardless of whether the client is symptomatic. -Your calcium levels are low, most likely from your condition. I will need to administer a supplement of calcium through your IV Calcium may be measured as part of a metabolic panel performed with lab testing of the blood. The normal calcium level is between 8.4 and 10.2 mg/dL for an adult. In this case, the client has a level of 5.2 mg/dL and the nurse would need to provide calcium replacement.

A nurse is caring for an adult client who has put out less than 15 mL per hour of urine for the last 6 hours. The nurse knows that this is which phase of acute kidney injury? -normouric -oliguric -anuric -polyuric

-normouric "normo-" would indicate normal amounts of urine. The normal urine output is 30-50 mL/hr of urine for an average sized adult. This client is putting out much less than that. -oliguric The normal urine output is 30-50 mL/hr of urine for an average sized adult. The term "olig/o" refers to "little" or "less than" and "-uric" refers to urine. Therefore putting out very little urine or lower than normal amounts of urine is considered 'oliguria'. This is also known as the oliguric phase of a kidney injury. -anuric The term "an-" would infer that there is zero or NO urine being produced. -polyuric "poly" would indicate 'many' or 'much' - but this client is putting out LESS than average amounts of urine.

A nurse is caring for a client who has been diagnosed with cirrhosis. The client has been prescribed corticosteroids. Which information describes how this drug helps the cirrhotic liver? Select all that apply. -Anemia -Reduction in inflammation -Steady glucose levels -Suppression of immune system liver destruction -Polyuria

Anemia Corticosteroids do not affect blood levels and therefore do not cause anemia. -Reduction in inflammation Corticosteroids are often prescribed for clients with cirrhosis to suppress inflammation. -Steady glucose levels Corticosteroids commonly alter a client's glucose level. -Suppression of immune system liver destruction Corticosteroids are often prescribed for clients with cirrhosis to slow immune-mediated liver destruction. -Polyuria Corticosteroids do not cause excessive urination, nor does excessive urination help the patient with cirrhosis.

Antilipemics that act on the GI tract include which of the following? Select all that apply. -Cholestyramine -Simvastatin -Clofibrate -Lovastatin -Cholestipol

holestipol Cholestipol is a bile acid sequesterant. This acts on the GI tract to reduce cholesterol levels. Lovastatin cancel Statins are another type of medication that lower cholesterol by inhibiting HMG CoA reductase. Simvastatin cancel Statins are another type of medication that lower cholesterol by inhibiting HMG CoA reductase. Cholestyramine Cholestyramine is a bile acid sequesterant. This acts on the GI tract to reduce cholesterol levels. Clofibrate check_circle Clofibrate is a fibrate. These act on the GI tract to reduce cholesterol levels.