MS2 Exam #5 - Practice Questions (Liver, Pancreas, & Kidney)

23. The RN has just received the change-of-shift report for the medical unit. Which client should the RN see first? A. Client with ascites who had a paracentesis 2 hours ago and is reporting a headache B. Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse C. Client with hepatic cirrhosis and jaundice who has hemoglobin of 10.9 g/dL and thrombocytopenia D. Client with hepatitis A who has elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

B. A change in the level of consciousness of the client with PSE is the greatest concern; actions to improve the client's level of consciousness should be rapidly implemented.

8. When administering medications to the client with chronic kidney disease, the nurse recognizes that which of these medications is most effective in slowing the progression of kidney failure? A. Diltiazem (Cardizem) B. Lisinopril (Zestril) C. Clonidine (Catapres) D. Doxazosin (Cardura)

B. Angiotensin-converting enzyme (ACE) inhibitors appear to be the most effective drugs to slow the progression of kidney failure.

4. The nurse suspects that which client is at highest risk for developing gallstones? A. Obese male with a history of chronic obstructive pulmonary disease B. Obese female on hormone replacement therapy C. Thin male with a history of coronary artery bypass grafting D. Thin female who has recently given birth

B. Both obesity and altered hormone levels increase a woman's risk for developing gallstones.

1. The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? A. "Should we filter air circulation?" B. "Can we use less radiographic contrast dye?" C. "Should we add low-dose dobutamine?" D. "Should we decrease IV rates?"

B. Contrast dye is severely nephrotoxic and other options can be used in its place.

4. In caring for a client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider? A. Increased blood pressure, increased respiratory rate B. Decreased blood pressure, increased heart rate C. Increased respiratory rate, increased apical pulse, pallor D. Tachypnea, diaphoresis, increased blood pressure

B. Decreased blood pressure and increased heart rate are indicative of shock.

The nurse is providing teaching to the client with hepatitis C. Which information is essential to include? A. Pegylated interferon alpha may cause myalgia. B. When ribavirin is taken, contraception must be used. C. Immunoglobulin B should be received upon diagnosis. D. A diet moderate in protein, fats, and carbohydrates should be consumed.

B. Fetal abnormalities are associated with ribavirin; this is essential information.

6. A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis? A. "You may need a surgical consult for removal of your gallbladder." B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack." C. "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." D. "You'll need to drastically modify your alcohol intake."

B. In this case, the client's pancreatitis was likely triggered by the development of gallstones.

3. When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? A. Mild discomfort at the insertion site B. Temperature 100.8° F C. 1+ ankle edema D. Anorexia

B. Infection is a major complication of temporary catheters. Report all symptoms of infection, including fever, to the provider. The catheter may have to be removed.

8. A client has just been diagnosed with pancreatic cancer. The client's upset spouse tells the nurse that they have recently moved to the area, have no close relatives, and are not yet affiliated with a church. What is the nurse's best response? A. "Maybe you should find a support group to join." B. "Would you like me to contact the hospital chaplain for you?" C. "Do you want me to try to find a therapist for you?" D. "Do you have any friends whom you want me to call?"

B. It is appropriate for the nurse to suggest contact with the hospital chaplain as a counseling option for the client and family.

21. A client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation? A. Preventing hypotension B. Keeping the T-tube in a dependent position C. Administering antibiotic vaccinations D. Administering immune-suppressant drugs

B. Keeping the T-tube in a dependent position and secured to the client is likely to prevent bile leakage, abscess formation, and hepatic thrombosis.

4. Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? A. Consuming a low-calcium diet B. Avoiding peas, nuts, and legumes C. Drinking cola beverages only once daily D. Increasing dairy products enriched with vitamin D

B. Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes.

12. When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? A. Clients who work with shellfish B. Men who prefer sex with men C. Clients traveling to a third-world country D. Clients with elevations of aspartate aminotransferase and alanine aminotransferase

B. Men who prefer sex with men are at increased risk for hepatitis B, which is spread by exchange of blood and body fluids during sexual activity.

A 40-year-old African-American woman is newly diagnosed with mild chronic kidney disease (CKD). She is otherwise very fit and healthy, and no one in her family has CKD. She asks the nurse whether any of the following factors could have caused this problem. Which factor should the nurse indicate may have influenced the development of CKD? A. She has followed a vegetarian diet that includes eggs but no dairy products for the past 3 years. B. She has taken 220 mg of naproxen twice daily for 3 years. C. Her mother and older sister have type 2 diabetes. D. She drinks 3 liters of water daily.

B. Naproxen is an NSAID that reduces blood flow to the kidney. Prolonged use can lead to kidney damage.

The physician assistant prescribes pancreatic enzyme replacement capsules for a client with chronic pancreatitis. What health teaching will the nurse provide? A. "Drink a full glass of milk after taking the drug." B. "Swallow the capsule whole or with applesauce." C. "Take the enzymes after meals to be most effective." D. "Crush the capsules and tablets and mix with juice."

B. The client should be instructed to swallow the capsule whole if possible because of its delayed-release action. For greatest efficacy, PERT should be taken with meals, not before or after meals. They should also be taken with a full glass of water; they should not be taken with foods containing proteins, such as milk, because the enzymatic action dissolves the food into a watery substance. The capsules should not be crushed or chewed. If the client cannot swallow the capsule whole, its contents can be sprinkled over applesauce, mashed fruit, or rice cereal.

9. The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the nurse return first? A. Client with hepatitis A reporting severe and ongoing itching B. Client with severe ascites who has a temperature of 101.4° F (38° C) C. Client with cirrhosis who has had a 3-pound weight gain over 2 days D. Client with esophageal varices and mild right upper quadrant pain

B. The client with ascites and an elevated temperature may have spontaneous bacterial peritonitis; the nurse should call this client first.

12. The nurse expects that which client will be discharged to the home environment first? A. Older obese adult who has had a laparoscopic cholecystectomy B. Middle-aged thin adult who has had a laparoscopic cholecystectomy C. Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy D. Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy

B. The combination of client age, a thin frame, and the type of procedure performed will cause the client to be discharged first.

When performing an hourly assessment of a client who had a subclavian catheter placed 6 hours ago for continuous arteriovenous hemofiltration with dialysis (CAVHD), the nurse observes these findings. For which finding does the nurse stop the CAVHD? A. The right foot and ankle appear slightly more edematous than the left foot and ankle. B. Blood pressure has decreased from 148/90 to 90/60. C. Pulse oximetry is increased from 89% to 91%. D. The trachea is in a midline position.

B. The drop in blood pressure in 1 hour is very significant and indicates that the client cannot tolerate the rate of CAVHD. He or she is in danger of shock (and impairment of kidney perfusion). CAVHD should be stopped immediately and the client thoroughly assessed for cardiovascular stability.

8. Which activity by the nurse will best relieve symptoms associated with ascites? A. Administering oxygen B. Elevating the head of the bed C. Monitoring serum albumin levels D. Administering intravenous fluids

B. The enlarged abdomen of ascites limits respiratory excursion; Fowler's position will increase excursion and reduce shortness of breath.

16. A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? A. Adherence to therapy B. Handwashing C. Monitoring for low-grade fever D. Strict clean technique

B. The most important infection control measure is hand washing.

15. A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? A. "I'll talk to the health care provider and have your name removed from the waiting list." B. "You sound frustrated with the situation." C. "You're right, the wait is endless for some people." D. "I'm sure you'll get a phone call soon that a kidney is available."

B. This option reflects the feelings the client is having and offers assistance and support.

13. When providing dietary teaching to a client with hepatitis, what practice does the nurse recommend? A. Having a larger meal early in the morning B. Consuming increased carbohydrates and moderate protein C. Restricting fluid to 1500 mL/day D. Limiting alcoholic beverages to once weekly

B. To repair the liver, the client should have a high-carbohydrate and moderate-protein diet; fats may cause dyspepsia.

What is the most important precaution for the nurse to teach the client with continuing kidney impairment on discharge after treatment for acute kidney injury? A. Avoid fluids that contain either alcohol or caffeine. B. Weigh yourself daily and report any rapid weight gain. C. Drink at least 3 liters of fluid daily to prevent dehydration. D. Use a dipstick to check for glucose in your urine at least once daily.

B. The client with continuing renal impairment after acute kidney injury is at risk for fluid overload. One of the best indicators of fluid overload is rapid weight gain.

27. When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) A. Check brachial pulses daily. B. Auscultate for a bruit every 8 hours. C. Teach the client to palpate for a thrill over the site. D. Elevate the arm above heart level. E. Ensure that no blood pressures are taken in that arm.

B. C. E. Distal pulses and capillary refill are checked; for a forearm fistula, the radial pulse is checked. The brachial pulse is proximal.

29. Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) A. Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL B. Crackles in the lung fields C. Temperature of 98.8° F (37.1° C) D. Blood pressure of 164/98 mm Hg E. 3+ edema of the lower extremities

B. D. E. Increasing BUN and creatinine are symptoms of rejection; these reflect normal values.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? A. Elevated hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreased erythrocyte sedimentation rate

B. Elevated serum bilirubin level Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.

What laboratory finding is the primary diagnostic indicator for pancreatitis? A. Elevated blood urea nitrogen (BUN) B. Elevated serum lipase C. Elevated aspartate aminotransferase (AST) D. Increased lactate dehydrogenase (LD)

B. Elevated serum lipase Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client's BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.

A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: A. severe abdominal pain radiating to the shoulder. B. anorexia, nausea, and vomiting. C. eructation and constipation. D. abdominal ascites.

B. anorexia, nausea, and vomiting. Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: A. increased intracranial pressure. B. decreased urine output. C. bradycardia. D. hypertension.

B. decreased urine output. Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: A. meperidine provides a better, more prolonged analgesic effect. B. morphine may cause spasms of Oddi's sphincter. C. meperidine is less addictive than morphine. D. morphine may cause hepatic dysfunction.

B. morphine may cause spasms of Oddi's sphincter. For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn't associated with hepatic dysfunction.

A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: A. hematuria. B. weight loss. C. increased urine output. D. increased blood pressure.

B. weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

2. While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? A. Instruct the client to deep-breathe and cough. B. Document the effluent as output. C. Turn the client to the opposite side. D. Re-position the catheter.

C.

The client admitted to the emergency department 1 hour after a motorcycle crash has all of the following laboratory test results. Which result does the nurse report to the health care provider immediately? A. Blood glucose level of 138 mg/dL B. Blood urea nitrogen of 22 mg/dL C. Blood osmolarity of 330 mOsm D. Serum potassium of 4.9 mEq/L

C. Although the blood glucose and BUN levels are slightly high, the real indicator that puts this client at risk for acute kidney injury and renal failure is the extremely high blood osmolarity indicating severe depletion of the circulating blood volume. (The normal range is 285-295 mOsm/kg.)

10. The nurse carefully observes for toxicity of drugs excreted through the kidney. Which of these represents a sign or symptom of digoxin toxicity? A. Serum digoxin level of 1.2 ng/mL B. Polyphagia C. Visual changes D. Serum potassium of 5.0 mEq/L

C. Anorexia, nausea, and vomiting are symptoms of digoxin toxicity.

14. A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? A. "Your diseased kidneys will be removed at the same time the transplant is performed." B. "The new kidney will be placed directly below one of your old kidneys." C. "It is essential for you to wash your hands and avoid people who are ill." D. "You will receive dialysis the day before surgery and for about a week after."

C. Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and hand washing are essential.

7. A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? A. Blood pressure of 118/78 mm Hg B. Weight loss of 3 pounds during hospitalization C. Dyspnea and anxiety at rest D. Central venous pressure (CVP) of 6 mm Hg

C. Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse assists the client in correlating symptoms of fluid overload with nonadherence to fluid restriction.

11. The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? A. Deceased calcium, elevated amylase, decreased magnesium B. Elevated bilirubin, elevated alkaline phosphatase C. Elevated lipase, elevated white blood cell count, elevated glucose D. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

C. Elevated lipase is more specific to a diagnosis of acute pancreatitis.

14. When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which laboratory test result? A. Hemoglobin and hematocrit B. Leukocytes C. Alpha-fetoprotein D. Serum albumin

C. Fetal hemoglobin is abnormal in adults; it is a tumor marker indicative of cancers.

15. A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Measure intake and output every shift. B. Do not administer food or fluids by mouth. C. Administer opioid analgesic medication. D. Assist the client to assume a position of comfort.

C. For the client with acute pancreatitis, pain relief is the highest priority.

18. Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? A. "I can stop my medications when my kidney function returns to normal." B. "If my urine output is decreased, I should increase my fluids." C. "The anti-rejection medications will be taken for life." D. "I will drink 8 ounces of water with my medications."

C. Immune suppressant therapy must be taken for life to prevent organ rejection.

5. The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? A. Provides enzymes necessary to digest dairy products B. Reduces portal pressure C. Promotes gastrointestinal (GI) excretion of ammonia D. Decreases GI bleeding

C. Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract.

22. The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN? A. Client who is taking lactulose and has diarrhea B. Client with hepatitis C who requires a dressing change C. Client with end-stage cirrhosis who needs teaching about a low-sodium diet D. Obtunded client with alcoholic encephalopathy who needs a blood draw

C. The RN is responsible for client teaching. Assisting a client with toileting and recording stool number and amount can be accomplished by nonprofessional staff. The LPN/LVN can provide dressing changes. Ancillary staff can perform venipuncture.

10. A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? A. Obtain the charts from the previous admission. B. Listen for bowel sounds in all quadrants. C. Obtain pulse and blood pressure. D. Ask about abdominal pain.

C. The nurse assesses vital signs to detect hypovolemic shock caused by hemorrhage.

23. A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? A. RN who has floated from pediatrics for this shift B. LPN/LVN with experience working on the medical unit C. RN who usually works on the general surgical unit D. New graduate RN who just finished a 6-week orientation

C. The nurse with experience in taking care of surgical clients will be most capable of monitoring this older client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure.

2. Which problem for a client with cirrhosis takes priority? A. Insufficient knowledge related to the prognosis of the disease process B. Discomfort related to the progression of the disease process C. Potential for injury related to hemorrhage D. Inadequate nutrition related to an inability to tolerate usual dietary intake

C. This is the priority client problem because this complication could be life threatening.

3. A client has been discharged to home after being hospitalized with an acute episode of pancreatitis. The client, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the client's spouse expresses frustration to the home health nurse regarding the client's refusal. What is the nurse's best response? A. "Your spouse will sign up for the meetings only when he is ready to deal with his problem." B. "Keep mentioning the AA meetings to your spouse on a regular basis." C. "I'll get you some information on the support group Al-Anon." D. "Tell me more about your frustration with your spouse's refusal to participate in AA."

C. This response assists with the spouse's frustration by putting her in contact with the Al-Anon support group.

7. The nurse is assessing a client's alcohol intake to determine whether it is the underlying cause of the client's attacks of pancreatitis. Which question does the nurse ask to elicit this information? A. "Do you usually binge drink?" B. "Do you tend to drink more on holidays or weekends?" C. "Tell me more about your alcohol intake." D. "Estimate how many episodes of binge drinking you do in a week."

C. This response is the only one that will allow the client to provide information on alcohol intake in the client's own words and to the extent that the client wishes to provide it.

9. A client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? A. "This may be an indication that you are developing sepsis." B. "The gallstones are present, but have become fibrotic and contracted." C. "This type of gallbladder inflammation is associated with hypovolemia." D. "This may be an indication of pancreatic disease."

C. This type of gallbladder inflammation is associated with: Hypovolemia Sepsis Severe taruma or burns Long-term parental nutrition Multi-system organ failure Major surgery

19. What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? A. The client must not consume alcohol. B. Avoid sharing the bathroom with the client. C. Members of the household must not share toothbrushes. D. Drink only bottled water and avoid ice.

C. Toothbrushes, razors, towels, and items that may spread blood and body fluids are not shared.

5. The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client? A. Steak and French fries B. Fried chicken and mashed potatoes C. Turkey sandwich on wheat bread D. Sausage and scrambled eggs

C. Turkey is an appropriate low-fat selection for this client.

The client with chronic kidney disease presents with bradycardia, prolonged PR interval, and diminished bowel sounds. For which of these should the nurse monitor? A. Hyperchloremia B. Hypomagnesemia C. Hyperkalemia D. Hypercalcemia

C. Hyperkalemia may be present; electrocardiographic changes and paralytic ileus may develop.

A male client who has been treated for chronic renal failure (CRF) is ready for discharge. Nurse Billy should reinforce which dietary instruction? A. "Be sure to eat meat at every meal." B. "Monitor your fruit intake, and eat plenty of bananas." C. "Increase your carbohydrate intake." D. "Drink plenty of fluids, and use a salt substitute."

C. "Increase your carbohydrate intake." In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided. Extra carbohydrates are needed to prevent protein catabolism.

Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: A. 45 units/L B. 100 units/L C. 300 units/L D. 500 units/L

C. 300 units/L The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Options A and B are within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.

26. When assessing a client with hepatitis B, the nurse anticipates which assessment findings? (Select all that apply.) A. Recent influenza infection B. Brown stool C. Tea-colored urine D. Right upper quadrant tenderness E. Itching

C. D. E.

When caring for a client with advanced cirrhosis, what laboratory assessment findings will the nurse expect? Select all that apply. A. Increased serum albumin B. Decreased bilirubin in the urine C. Increased alanine aminotransferase D. Increased alkaline phosphatase E. Decreased bilirubin in the stool F. Increased platelets

C. D. E. Bilirubin in the urine would be increased—when liver function is impaired or when biliary drainage is blocked, conjugated bilirubin leaks out of the hepatocytes and appears in the urine, turning the urine dark amber. Platelets would be decreased—splenomegaly often occurs with cirrhosis and results from the backup of blood into the spleen. Alkaline phosphatase is also increased.

Which of the following factors can cause hepatitis A? A. Contact with infected blood B. Blood transfusions with infected blood C. Eating contaminated shellfish D. Sexual contact with an infected person

C. Eating contaminated shellfish Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.

For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? A. Encouraging coughing and deep breathing B. Promoting carbohydrate intake C. Limiting fluid intake D. Providing pain-relief measures

C. Limiting fluid intake During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A. Dyspnea and fatigue B. Ascites and orthopnea C. Purpura and petechiae D. Gynecomastia and testicular atrophy

C. Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: A. place the client in a private room. B. wear a mask when handling the client's bedpan. C. wash the hands after touching the client. D. wear a gown when providing personal care for the client.

C. wash the hands after touching the client. To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.

20. A health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease? A. Requesting vaccination for hepatitis A B. Using a needleless system in daily work C. Getting the three-part hepatitis B vaccine D. Requesting an injection of immunoglobulin

D. Administration of immunoglobulin, antibodies to hepatitis A, may prevent development of the disease.

15. It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? A. Right shoulder pain B. Polyuria C. Bone marrow suppression D. Bleeding

D. An arterial approach is taken; therefore prompt detection of hemorrhage is the priority.

16. A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. Carbohydrates B. High fat C. High fiber D. Protein

D. Enzyme preparations should not be mixed with foods containing protein because the enzymes will dissolve the food into a watery substance.

6. When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? A. Vitamin K-containing products B. Potassium-sparing diuretics C. Nonabsorbable antibiotics D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

D. Lactulose reduces serum ammonia levels; it does not affect bleeding.

3. How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? A. Provides small frequent meals for the client B. Suggests taking daily potassium supplements C. Elevates the head of the bed in high-Fowler's position D. Requests a bedside commode for the client

D. Lactulose therapy increases the frequency of stools; a bedside commode should be made available to the client, especially if he or she has difficulty reaching the toilet.

17. The nurse asks a client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? A. Positive Babinski's sign B. Hyperreflexia C. Kehr's sign D. Asterixis

D. Liver flap or asterixis is related to increased serum ammonia levels. The dorsiflexed hands begin to flap upward and downward when outstretched for a few moments.

13. When caring for the client hoping to receive a kidney transplant, the nurse recognizes that which of these problems will exclude the client from transplantation? A. History of hiatal hernia B. Client with diabetes and HbA1c of 6.8 C. Basal cell carcinoma removed from nose 5 years ago D. Client with tuberculosis

D. Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with immune suppressants required to prevent rejection.

17. A client with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the client's care will be best for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Assessing dietary risk factors for cholecystitis B. Checking for bowel sounds and distention C. Determining precipitating factors for abdominal pain D. Obtaining the admission weight, height, and vital signs

D. Obtaining height, weight, and vital signs is included in the education for unlicensed assistive personnel (UAP) and usually is included in the job description for these staff members.

14. Which set of assessment findings indicates to the nurse that a client may have acute pancreatitis? A. Absence of jaundice, pain of gradual onset B. Absence of jaundice, pain in right abdominal quadrant C. Presence of jaundice, pain worsening when sitting up D. Presence of jaundice, pain worsening when lying supine

D. Pain that worsens when lying supine and the presence of jaundice are the only assessment findings indicative of acute pancreatitis.

19. The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase (Cotazym). Which instruction does the nurse include when teaching the client about this medication? A. Administer pancrelipase before taking an antacid. B. Chew tablets before swallowing. C. Take pancrelipase before meals. D. Wipe your lips after taking pancrelipase.

D. Pancrelipase (Cotazym) is a pancreatic enzyme used for enzyme replacement for clients with chronic pancreatitis. To avoid skin irritation and breakdown from residual enzymes, the lips should be wiped.

12. When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? A. Pulse oximetry reading of 95% B. Sinus bradycardia, rate of 58 beats/min C. Blood pressure of 148/90 mm Hg D. Temperature of 101.2° F (38.4° C)

D. Peritonitis is the major complication of PD caused by intra-abdominal catheter site contamination; use meticulous aseptic technique when caring for PD equipment.

24. The RN is caring for a client with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? A. Assessing skin integrity and abdominal distention B. Drawing blood from a central venous line for electrolyte studies C. Evaluating laboratory study results for the presence of hypokalemia D. Placing the client in a semi-Fowler's position

D. Positioning the client in a semi-Fowler's position is included within UAP education and scope of practice, although the RN will need to supervise the UAP in providing care and will evaluate the effect of the semi-Fowler's position on client comfort and breathing.

11. Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the heath care provider? A. The dressing has a 2-cm area of serous drainage. B. The client's platelet count is 135,000/mm3. C. The client's albumin level is 2.8 mg/dL. D. The client's heart rate is 122 beats/min.

D. Rapid removal of fluid may cause symptoms of shock; report tachycardia, especially when associated with hypotension.

A client is admitted to the same-day surgery unit after recovery from a laparoscopic cholecystectomy. Which action is the nurse's priority in caring for the client? A. Document the client's use of the patient-controlled analgesia (PCA) pump. B. Check that the nasogastric tube is connected to low intermittent suction. C. Turn the client on the right side to help the flow of bile into the drainage bag. D. Monitor the client's oxygen saturation level via pulse oximetry.

D. The client's oxygen saturation level should be assessed frequently until the effects of the anesthesia have passed. The client will not have a collection bag for bile drainage. An NG tube is not required during a laparoscopic cholecystectomy. IV pain control is usually not needed after a lapararoscopic procedure because there are only small incisions that are covered with Steri-strips and small adhesive bandages.

The wife of a client with severe chronic kidney disease who has a Kussmaul pattern of respiration asks the nurse about giving the client oxygen to ease his respirations. What is the nurse's best response? A. "That is a good idea and I will check with the physician right away." B. "The oxygen mask or tube may increase his risk for skin breakdown." C. "He will probably need a high flow of oxygen because he is also anemic." D. "Oxygen will not help his respirations and could make his acidosis worse."

D. The client's respiratory pattern is a compensatory mechanism to help get rid of excess acids. It is not caused by a lack of oxygen. It is possible that the oxygen could slow his respiratory rate somewhat, which would allow him to retain the metabolic acids longer. Oxygen should be applied if his pulse oximetry indicates he is hypoxic. If he is not hypoxic, he should not receive oxygen.

1. The nurse is attempting to position a client having an acute attack of pancreatitis in the most comfortable position possible. In which position does the nurse place this client? A. Supine, with a pillow supporting the abdomen B. Up in a chair between frequent periods of ambulation C. High-Fowler's position, with pillows used as needed D. Side-lying position, with knees drawn up to the chest

D. The side-lying position with the knees drawn up has been found to relieve abdominal discomfort related to acute pancreatitis.

13. The nurse is caring for a client recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The client asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? A. "The diabetes could be related to your obesity." B. "What has your doctor told you about your disease?" C. "Do you consume alcohol on a frequent basis?" D. "Type 1 diabetes can occur when the pancreas is destroyed by disease."

D. This is the only response that accurately describes the relationship of the client's diabetes to pancreatic destruction.

19. A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? A. "All of this is new. What can't you do?" B. "Are you afraid of dying?" C. "How are you doing this morning?" D. "What concerns do you have about your kidney disease?"

D. This statement is open ended and specific to the client's concerns.

11. Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? A. Hematocrit of 26.7% B. Potassium within normal range C. Absence of spontaneous fractures D. Less fatigue

D. Treatment of anemia with erythropoietin will result in increased (H&H) and decreased shortness of breath (SOB) and fatigue.

18. Which intervention is important for the nurse to include in the plan of care for a client who is to undergo paracentesis later today? A. Measure and record drainage. B. Monitor aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. C. Obtain informed consent for the procedure. D. Have the client void before the procedure is performed.

D. Voiding before the procedure prevents bladder injury.

1. Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? A. "Cirrhosis is a chronic disease that has scarred my liver." B. "The scars on my liver create problems with blood circulation." C. "Because of the scars on my liver, blood clotting and blood pressure are affected." D. "My liver is scarred, but the cells can regenerate themselves and repair the damage."

D. Although cells and tissues will attempt to regenerate, this will result in permanent scarring and irreparable damage.

A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure? A. Phosphate binders B. Insulin C. Antibiotics D. Cardiac glycosides

D. Cardiac glycosides Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should nurse Olivia assess first? A. Blood pressure B. Respirations C. Temperature D. Pulse

D. Pulse An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also can delay assessing respirations and temperature because these aren't affected by the serum potassium level.

A female adult client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? A. Blood urea nitrogen (BUN) level of 22 mg/dl B. Serum creatinine level of 1.2 mg/dl C. Serum creatinine level of 1.2 mg/dl D. Urine output of 400 ml/24 hours

D. Urine output of 400 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is demonstrated by a urine output of 400 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female client's uremia. Which finding signals a significant problem during this procedure? A. Potassium level of 3.5 mEq/L B. Hematocrit (HCT) of 35% C. Blood glucose level of 200 mg/dl D. White blood cell (WBC) count of 20,000/mm3

D. White blood cell (WBC) count of 20,000/mm3 An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: A. whole blood and albumin. B. platelets and packed red blood cells. C. fresh frozen plasma and whole blood. D. cryoprecipitate and fresh frozen plasma.

D. cryoprecipitate and fresh frozen plasma. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.

Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate explanation? 1. "It empties the stomach of fluids and gas." 2. "It prevents spasms at the sphincter of Oddi." 3. "It prevents air from forming in the small intestine and large intestine." 4. "It removes bile from the gallbladder."

1. "It empties the stomach of fluids and gas." An NG tube is inserted into the patients stomach to drain fluid and gas.

What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure? 1. 15 minutes 2. 30 minutes 3. 1 hour 4. 2 to 3 hours

1. 15 minutes Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours.

You are developing a care plan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include? 1. Administering a lactulose enema as ordered. 2. Encouraging a protein-rich diet. 3. Administering sedatives, as necessary. 4. Encouraging ambulation at least four times a day.

1. Administering a lactulose enema as ordered. You may administer the laxative lactulose to reduce ammonia levels in the colon.

Hepatic encephalopathy develops when the blood level of which substance increases? 1. Ammonia 2. Amylase 3. Calcium 4. Potassium

1. Ammonia Ammonia levels increase d/t improper shunting of blood, causing ammonia to enter systemic circulation, which carries it to the brain.

A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care? 1. Apply pressure to the needle site upon discontinuing hemodialysis 2. Keep the head of the bed elevated 45 degrees 3. Place the left arm on an arm board for at least 30 minutes 4. Keep the left arm dry

1. Apply pressure to the needle site upon discontinuing hemodialysis Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.

You're caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? 1. Asterixis 2. Chvostek's sign 3. Trousseau's sign 4. Hepatojugular reflex

1. Asterixis Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.

A patient who received a kidney transplant returns for a follow-up visit to the outpatient clinic and reports a lump in her breast. Transplant recipients are: 1. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral) 2. Consumed with fear after the life-threatening experience of having a transplant 3. At increased risk for tumors because of the kidney transplant 4. At decreased risk for cancer, so the lump is most likely benign

1. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral) Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors.

You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? 1. Check for kinks in the outflow tubing. 2. Raise the drainage bag above the level of the abdomen. 3. Place the patient in a reverse Trendelenburg position. 4. Ask the patient to cough.

1. Check for kinks in the outflow tubing. Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 3. Contact the health care provider (HCP). 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.

1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks.

Which sign indicated the second phase of acute renal failure? 1. Daily doubling of urine output (4 to 5 L/day) 2. Urine output less than 400 ml/day 3. Urine output less than 100 ml/day 4. Stabilization of renal function

1. Daily doubling of urine output (4 to 5 L/day) Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.

After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated? 1. Disequilibrium syndrome 2. Respiratory distress 3. Hypervolemia 4. Peritonitis

1. Disequilibrium syndrome Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can diffuse from the body's cells into the vascular system.

You're caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Before her paracentesis, you instruct her to: 1. Empty her bladder. 2. Lie supine in bed. 3. Remain NPO for 4 hours. 4. Clean her bowels with an enema.

1. Empty her bladder. A full bladder can interfere with paracentesis and be punctured inadvertently.

You're caring for a 28 y.o. woman with hepatitis B. She's concerned about the duration of her recovery. Which response isn't appropriate? 1. Encourage her to not worry about the future. 2. Encourage her to express her feelings about the illness. 3. Discuss the effects of hepatitis B on future health problems. 4. Provide avenues for financial counseling if she expresses the need.

1. Encourage her to not worry about the future. Telling her not to worry minimizes her feelings.

Immunosuppression following Kidney transplantation is continued: 1. For life 2. 24 hours after transplantation 3. A week after transplantation 4. Until the kidney is not anymore rejected

1. For life.

Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort? 1. Give tepid baths. 2. Avoid lotions and creams. 3. Use hot water to increase vasodilation. 4. Use cold water to decrease the itching.

1. Give tepid baths. For pruritus, care should include tepid sponge baths and use of emollient creams and lotions.

A nurse is performing an assessment on a client with acute kidney injury who is in the oliguric phase. During this phase, the nurse understands that which manifestations are associated findings? Select all that apply. 1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 4. Urine osmolarity of approximately 300 mOsm/L 5. A urine output of 600 to 800 mL in a 24-hour period

1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 4. Urine osmolarity of approximately 300 mOsm/L

The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient's diet? 1. Meats and beans. 2. Butter and gravies. 3. Potatoes and pastas. 4. Cakes and pastries.

1. Meats and beans. Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein adequately, causing protein by-products to build up in the body rather than be excreted.

You're developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this patient is to: 1. Remain afebrile and have negative cultures 2. Resume normal fluid intake within 2 to 3 days 3. Resume the patient's normal job within 2 to 3 weeks 4. Try to discontinue cyclosporine (Neoral) as quickly as possible

1. Remain afebrile and have negative cultures The immunosuppressive activity of cyclosporine places the patient at risk for infection, and steroids can mask the signs of infection. The patient may not be able to resume normal fluid intake or return to work for an extended period of time and the patient may need cyclosporine therapy for life.

Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity? 1. Restrict fluids 2. Encourage ambulation 3. Increase sodium in the diet 4. Give antacids as prescribed

1. Restrict fluids Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the peritoneal space.

The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess this client for pain that is: 1. Severe and unrelenting, located in the epigastric area and radiating to the back. 2. Severe and unrelenting, located in the left lower quadrant and radiating to the groin. 3. Burning and aching, located in the epigastric area and radiating to the umbilicus. 4. Burning and aching, located in the left lower quadrant and radiating to the hip.

1. Severe and unrelenting, located in the epigastric area and radiating to the back. The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiates to the back.

Which criterion is required before a patient can be considered for continuous peritoneal dialysis? 1. The patient must be hemodynamically stable 2. The vascular access must have healed 3. The patient must be in a home setting 4. Hemodialysis must have failed

1. The patient must be hemodynamically stable Hemodynamic stability must be established before continuous peritoneal dialysis can be started.

A client is about to begin hemodialysis. Which measure(s) should the nurse employ in the care of the client? Select all that apply. 1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron 5.Covering the connection site with a bath blanket to enhance extremity warmth

1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron

You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: 1. 200ml 2. 400ml 3. 800ml 4. 1000ml

2. 400ml Oliguria is defined as urine output of less than 400ml/24hours.

A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device? 1. Insert I.V. lines above the fistula. 2. Avoid taking blood pressures in the arm with the fistula. 3. Palpate pulses above the fistula. 4. Report a bruit or thrill over the fistula to the doctor.

2. Avoid taking blood pressures in the arm with the fistula. Don't take blood pressure readings in the arm with the fistula because the compression could damage the fistula. IV lines shouldn't be inserted in the arm used for hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill should be reported to the doctor.

Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? 1. Infection 2. Disequilibrium syndrome 3. Air embolus 4. Acute hemolysis

2. Disequilibrium syndrome Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.

You're caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective? 1. Pruritus 2. Dyspnea 3. Jaundice 4. Peripheral Neuropathy

2. Dyspnea Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient's breathing. The others are signs of cirrhosis that aren't relieved by paracentesis.

The most common early sign of kidney disease is: 1. Sodium retention 2. Elevated BUN level 3. Development of metabolic acidosis 4. Inability to dilute or concentrate urine

2. Elevated BUN level Increased BUN is usually an early indicator of decreased renal function.

What is the most important nursing diagnosis for a patient in end-stage renal disease? 1. Risk for injury 2. Fluid volume excess 3. Altered nutrition: less than body requirements 4. Activity intolerance

2. Fluid volume excess Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.

Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? 1. Calcium 2. Glucose 3. Magnesium 4. Potassium

2. Glucose Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets of langerhans.

Which cause of hypertension is the most common in acute renal failure? 1. Pulmonary edema 2. Hypervolemia 3. Hypovolemia 4. Anemia

2. Hypervolemia Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of renin. Therefore, hypervolemia causes hypertension.

Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? 1. Increase the rate of dialysis 2. Infuse normal saline solution 3. Administer a 5% dextrose solution 4. Encourage active ROM exercises

2. Infuse normal saline solution Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.

A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? 1. Low-protein diet with unlimited amounts of water 2. Low-protein diet with a prescribed amount of water 3. No protein in the diet and use of a salt substitute 4. No restrictions

2. Low-protein diet with a prescribed amount of water The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used without a doctor's order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement, if made by the new nursing graduate, would indicate an understanding of the procedure for hemodialysis? Select all that apply. 1. "Sterile dialysate must be used." 2. "Dialysate contains metabolic waste products." 3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion."

3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion."

Polystyrene sulfonate (Kayexalate) is used in renal failure to: 1. Correct acidosis 2. Reduce serum phosphate levels 3. Exchange potassium for sodium 4. Prevent constipation from sorbitol use

3. Exchange potassium for sodium In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium.

You suspect kidney transplant rejection when the patient shows which symptoms? 1. Pain in the incision, general malaise, and hypotension 2. Pain in the incision, general malaise, and depression 3. Fever, weight gain, and diminished urine output 4. Diminished urine output and hypotension

3. Fever, weight gain, and diminished urine output Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft site, peripheral edema, and diminished urine output.

Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes: 1. Continuous peritoneal lavage. 2. Regular diet with increased fat. 3. Nutritional support with TPN. 4. Insertion of a T tube to drain the pancreas.

3. Nutritional support with TPN. With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support.

A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient's diet? 1. Carbohydrates 2. Fats 3. Protein 4. Vitamin C

3. Protein Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so this patient's protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient's tissues.

Your patient with peritonitis is NPO and complaining of thirst. What is your priority? 1. Increase the I.V. infusion rate. 2. Use diversion activities. 3. Provide frequent mouth care. 4. Give ice chips every 15 minutes.

3. Provide frequent mouth care. Frequent mouth care helps relieve dry mouth.

Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? 1. Serum creatinine and BUN 2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 3. Serum amylase and lipase 4. Cardiac enzymes

3. Serum amylase and lipase Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis.

Which statement correctly distinguishes renal failure from prerenal failure? 1. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure 2. With prerenal failure, there is less response to such diuretics as furosemide (Lasix) 3. With prerenal failure, an IV isotonic saline infusion increases urine output 4. With prerenal failure, hemodialysis reduces the BUN level

3. With prerenal failure, an IV isotonic saline infusion increases urine output Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase blood pressure in both conditions.

You're discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient? 1. "Now I can never get hepatitis again." 2. "I can safely give blood after 3 months." 3. "I'll never have a problem with my liver again, even if I drink alcohol." 4. "My family knows that if I get tired and start vomiting, I may be getting sick again."

4. "My family knows that if I get tired and start vomiting, I may be getting sick again." Hepatitis B can recur. Patients who have had hepatitis are permanently barred from donating blood. Alcohol is metabolized by the liver and should be avoided by those who have or had hepatitis B.

Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is: 1. Call the doctor immediately 2. Give the patient IV lidocaine (Xylocaine) 3. Prepare to defibrillate the patient 4. Check the patient's latest potassium level

4. Check the patient's latest potassium level The patient with ESRD may develop arrhythmias caused by hypokalemia. Call the doctor after checking the patient's potassium values. Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.

10. Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? 1. Rub the skin vigorously with a towel 2. Take frequent baths 3. Apply alcohol-based emollients to the skin 4. Keep fingernails short and clean

4. Keep fingernails short and clean Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the risk of infection.

The nurse is reviewing the physician's orders written for a client admitted with acute pancreatitis. Which physician order would the nurse question if noted on the client's chart? 1. NPO status 2. Insert a nasogastric tube 3. An anticholinergic medication 4. Morphine for pain

4. Morphine for pain Meperidine (Demerol) rather than morphine is the medication of choice because morphine can cause spasm in the sphincter of Oddi.

What is the best way to check for patency of the arteriovenous fistula for hemodialysis? 1. Pinch the fistula and note the speed of filling on release 2. Use a needle and syringe to aspirate blood from the fistula 3. Check for capillary refill of the nail beds on that extremity 4. Palpate the fistula throughout its length to assess for a thrill

4. Palpate the fistula throughout its length to assess for a thrill The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow. Pinching the fistula could cause damage. Aspirating blood is a needless invasive procedure.

Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He's jaundiced and reports weakness. Which intervention will you include in his care? 1. Regular exercise. 2. A low-protein diet. 3. Allow patient to select his meals. 4. Rest period after small, frequent meals

4. Rest period after small, frequent meals. Rest periods and small frequent meals is indicated during the acute phase of hepatitis B.

Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective? 1. There is no skin breakdown. 2. Her appetite improves. 3. She loses more than 10 lbs. 4. Stools are less fatty and decreased in frequency.

4. Stools are less fatty and decreased in frequency. Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and carb digestion. With increased fat digestion and absorption, stools become less frequent and normal in appearance.

Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient? 1. The patient shouldn't feel pain during initiation of dialysis 2. The patient feels best immediately after the dialysis treatment 3. Using a stethoscope for auscultating the fistula is contraindicated 4. Taking a blood pressure reading on the affected arm can cause clotting of the fistula

4. Taking a blood pressure reading on the affected arm can cause clotting of the fistula Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm.

18. After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

A. Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic client is at greatest risk for rapid deterioration and requires immediate assessment and intervention.

22. Which finding in the first 24 hours after kidney transplantation requires immediate intervention? A. Abrupt decrease in urine output B. Blood-tinged urine C. Incisional pain D. Increase in urine output

A. An abrupt decrease in urine output may indicate complications such as rejection, acute tubular necrosis (ATN), thrombosis, or obstruction.

20. Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? A. Increased blood urea nitrogen (BUN) B. Increased creatinine level C. Pale-colored urine D. Decreased sodium level

A. An increase in blood urea nitrogen can be an indication of dehydration, and an increase in fluids is needed.

10. Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease? A. Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall B. Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase C. Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall D. Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase

A. An increased WBC count is evidence of inflammation. Only calcified gallstones will be visualized on abdominal x-ray.

21. A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? A. Avoiding venipuncture and blood pressure measurements in the affected arm B. Modifications to allow for complete rest of the affected arm C. How to assess for a bruit in the affected arm D. How to practice proper nutrition

A. Compression of vascular access causes decreased blood flow and may cause occlusion; dialysis will not be possible.

2. A client who had been hospitalized with pancreatitis is being discharged with home health services. The client is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the client's strength? A. Limiting the client's activities to one floor of the home B. Instructing the client to take an as-needed (PRN) sleeping medication at night C. Arranging for the client to have a nutritional consult to assess the client's diet D. Asking the health care provider for a request for PRN nasal oxygen

A. Limiting the client's activities to one floor of the home will prevent tiring the client with stair climbing.

The nurse is providing discharge teaching for the client with advanced liver disease. Which statement by the client indicates a need for further teaching? A. "I don't need hospice because I'm only 55 years old." B. "I'll ask my wife to contact our local support group." C. "I plan to talk with the pastor at our church." D. "My wife and I plan to get Meals on Wheels."

A. No age range is attached to the benefits of hospice services. The nurse should clarify this misunderstanding because a client with advanced liver disease would benefit from hospice services for comfort and end-of-life planning.

6. The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Angiotensin-converting enzyme (ACE) inhibitors C. Opiates D. Calcium channel blockers

A. Nonsteroidal anti-inflammatory drugs may be nephrotoxic.

17. To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? A. Construction worker B. Office secretary C. Schoolteacher D. Taxicab driver

A. Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place a construction worker at risk for dehydration and prerenal azotemia.

9. When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? A. Eggs B. Ham C. Eggplant D. Macaroni

A. Suggested protein-containing foods are milk, meat, and eggs.

7. When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? A. Kidney failure B. Refractory ascites C. Fetor hepaticus D. Paracentesis scheduled for today

A. The aminoglycoside drugs, which include neomycin, are nephrotoxic and ototoxic.

5. A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A. Auscultate for pericardial friction rub. B. Assess for crackles. C. Monitor for decreased peripheral pulses. D. Determine if the client is able to ambulate.

A. The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST segment elevation.

24. The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? A. Client with chronic kidney failure who was just admitted with shortness of breath B. Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted C. Client with azotemia whose blood urea nitrogen and creatinine are increasing D. Client receiving peritoneal dialysis who needs help changing the dialysate bag

A. This client's dyspnea may indicate pulmonary edema and should be assessed immediately.

16. When caring for a client awaiting liver transplantation, the nurse recognizes that the client will be excluded from the procedure if which of these is present? A. Colon cancer with metastasis to the liver B. Hypertension C. Hepatic encephalopathy D. Ascites and shortness of breath

A. Transplantation is performed for hepatitis and primary liver cancers.

Which of these interventions is essential for the client in the oliguric phase of acute kidney injury (AKI)? A. Restrict fluids. B. Replace potassium. C. Administer blood transfusions. D. Monitor arterial blood gases (ABGs).

A. During the oliguric phase of AKI, the client will be at risk for fluid overload; fluid restriction is necessary to limit this problem.

The client with end-stage kidney disease (ESKD) appears to have pulmonary edema. Which intervention does the nurse perform first? A. Raise the head of the bed B. Apply oxygen by nasal cannula C. Notify the Rapid Response Team D. Measure oxygen saturation by pulse oximetry

A. Raising the head of the bed should be done first because it will provide the client with some immediate relief and slow the progression of pulmonary edema.

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? A. "You may have eaten contaminated restaurant food." B. "You could have gotten it by using I.V. drugs." C. "You must have received an infected blood transfusion." D. "You probably got it by engaging in unprotected sex."

A. "You may have eaten contaminated restaurant food." Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.

25. When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? (Select all that apply.) A. Prolonged partial thromboplastin time B. Icterus of skin C. Swollen abdomen D. Elevated magnesium E. Currant jelly stool F. Elevated amylase level

A. B. C.

20. A client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which precautionary measures does the nurse implement to prevent potential complications? (Select all that apply.) A. Check blood glucose often. B. Check bowel sounds and stools. C. Ensure that drainage color is clear. D. Monitor mental status. E. Place the client in the supine position.

A. B. D. - Glucose should be checked often to monitor for diabetes mellitus. - Bowels sounds and stools should be checked to monitor for bowel obstruction. - A change in mental status or level of consciousness could be indicative of hemorrhage.

28. While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) A. Obtain the client's pre-hemodialysis weight. B. Check the arteriovenous (AV) fistula for a thrill and bruit. C. Document the amount the client drinks throughout the shift. D. Auscultate the client's lung sounds every 4 hours. E. Explain the components of a low-sodium diet.

A. C.

26. The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) A. Restricted protein B. Liberal sodium C. Restricted fluids D. Low potassium E. Low fat

A. C. D. Sodium is restricted during AKI because oliguria causes fluid retention.

27. When caring for a client with portal hypertension, the nurse assesses for which potential complications? (Select all that apply.) A. Esophageal varices B. Hematuria C. Fever D. Ascites E. Hemorrhoids

A. D. E.

Dr. Smith has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D

A. Hepatitis A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: A. Pork B. Milk C. Chicken D. Broccoli

A. Pork The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes. Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid

When caring for a male client with acute renal failure (ARF), Nurse Fatrishia expects to adjust the dosage or dosing schedule of certain drugs. Which of the following drugs would not require such adjustment? A. acetaminophen (Tylenol) B. gentamicin sulfate (Garamycin) C. cyclosporine (Sandimmune) D. ticarcillin disodium (Ticar)

A. acetaminophen (Tylenol) Because acetaminophen is metabolized in the liver, its dosage and dosing schedule need not be adjusted for a client with ARF. In contrast, the dosages and schedules for gentamicin and ticarcillin, which are metabolized and excreted by the kidney, should be adjusted. Because cyclosporine may cause nephrotoxicity, the nurse must monitor both the dosage and blood drug level in a client receiving this drug.

A male client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, Nurse Billy suspects that the client is at risk for: A. cardiac arrhythmia. B. paresthesia. C. dehydration. D. pruritus.

A. cardiac arrhythmia. As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In a client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.

A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: A. confusion, headache, and seizures. B. acute bone pain and confusion. C. weakness, tingling, and cardiac arrhythmias. D. hypotension, tachycardia, and tachypnea.

A. confusion, headache, and seizures. Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

A female client is admitted for treatment of chronic renal failure (CRF). Nurse Julian knows that this disorder increases the client's risk of: A. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. B. a decreased serum phosphate level secondary to kidney failure. C. an increased serum calcium level secondary to kidney failure. D. metabolic alkalosis secondary to retention of hydrogen ions.

A. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

1. The nurse is caring for a client with acute pancreatitis. The client's health care provider has ordered gentamicin (Garamycin) 3 mg/kg/day in three divided doses. The client weighs 264 lb. The client will receive _______ milligrams/dose of Garamycin.

ANS: 120mg/dose 264 lb/(2.2 lb/kg) = 120 kg (3 mg/kg/day) 120 kg = 360 mg/day (360 mg/day)/3 = 120 mg/dose

31. A client with acute kidney injury had normal assessments 1 hour ago. Now the nurse finds that the client's respiration rate is 44 breaths/min and the client is restless. Which assessment does the nurse perform? a. Obtain an oxygen saturation level. b. Send blood for a creatinine level. c. Assess the client for dehydration. d. Perform a bedside blood glucose.

ANS: A A complication of acute kidney injury is pulmonary edema. Manifestations of this include tachypnea; frothy, blood-tinged sputum; and tachycardia, anxiety, and crackles. The nurse needs to obtain an oxygen saturation, listen to the client's lungs, and notify the health care provider, so that treatment can be started. The other interventions are not helpful.

2. A client is admitted to the hospital with a serum creatinine level of 2 mg/dL. When taking the client's history, which question does the nurse ask first? a. "Do you take any nonprescription medications?" b. "Does anyone in your family have kidney disease?" c. "Do you have yearly blood work done?" d. "Is your diet low in protein?"

ANS: A Acute renal failure can be caused by certain medications considered to have a nephrotoxic effect, such as NSAIDs and acetaminophen. Asking the client whether he or she takes any nonprescription drugs can help determine which medication(s) might have contributed to the problem. A family history is important but is not as vital as assessing for nephrotoxic agents that the client may have ingested. Yearly blood work might reveal a trend in kidney function, but again would not be as important. A diet low in protein would not be an important factor to assess.

34. A client is diagnosed with hepatitis B. Which information does the nurse include in the teaching plan as a priority? a. "Avoid drinking any alcohol until the doctor says you can." b. "You will need aggressive control of your serum lipids." c. "Once your lab work returns to normal, you can donate blood again." d. "Wash your hands well after handling meat and shellfish."

ANS: A Alcohol has a hepatotoxic effect, and clients with any liver disease should not drink it. Serum lipids need control in clients with fatty liver. Once a client has hepatitis B, he or she should not donate blood or organs. Handling contaminated shellfish is a cause of hepatitis A infection.

1. Which client is most at risk for developing postrenal kidney failure? a. Client diagnosed with renal calculi b. Client with congestive heart failure c. Client taking NSAIDs for arthritis pain d. Client recovering from glomerulonephritis

ANS: A Causes of postrenal kidney failure include disorders that obstruct the flow of urine, such as renal calculi. Heart failure can lead to prerenal failure, which is due to decreased blood flow to the kidneys. Both NSAIDs and glomerulonephritis can damage the kidney, leading to intrarenal failure.

18. When evaluating the effects of a low-protein diet in a client with chronic kidney disease, the nurse is most concerned with which result? a. Albumin level of 2 g/dL b. Calcium level of 8.0 mg/dL c. Potassium level of 5.2 mmol/L d. Magnesium level of 3 mEq/L result?

ANS: A Clients with chronic kidney disease are placed on a low-protein diet. However, decreased serum albumin levels indicate that the protein they are taking in is not enough for their metabolic needs. The electrolyte levels in the other options are not related to protein.

24. Which response by a client indicates an understanding of measures to facilitate the flow of peritoneal dialysate fluid? a. "I will take my stool softeners every day." b. "I will keep the drainage bag at the level of my abdomen." c. "Flushing the catheter is needed with each exchange." d. "Warmed dialysate infusion increases the speed of flow."

ANS: A Constipation is the primary cause of inflow and outflow problems. To prevent constipation, clients are placed on a bowel regimen before placement of a peritoneal catheter. The drainage bag should be lower than the abdomen. Warming the fluid helps prevent discomfort during the procedure. Flushing the catheter will not facilitate the flow of dialysate.

31. A client is admitted with jaundice and suspected hepatitis B. Which intervention does the nurse add to the client's care plan? a. Encourage rest during this period. b. Assist the client with ambulation. c. Place the client on a clear liquid diet. d. Administer PRN prochlorperazine maleate (Compazine).

ANS: A During the icteric phase, the client is encouraged to rest. Rest reduces the metabolic demands of the liver and promotes hepatic cell regeneration. The client may or may not need assistance with ambulation. The diet should be high in carbohydrates and calories for energy; clear liquids may be needed if the client is nauseated. The client may or may not need antiemetics.

29. The nurse is assessing health fair participants for risks for hepatitis. The nurse recognizes which client as being at greatest risk for developing hepatitis B? a. College student who has had several sexual partners b. Woman who takes acetaminophen daily for headaches c. Businessman who travels frequently d. Older woman who has eaten raw shellfish

ANS: A Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection.

1. The client with obstructive jaundice asks the nurse why his skin is so itchy. Which is the nurse's best response? a. "Bile salts accumulate in the skin and cause the itching." b. "Toxins released from an inflamed gallbladder lead to itching." c. "Itching is caused by the release of calcium into the skin." d. "Itching is caused by a hypersensitivity reaction."

ANS: A In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate.

27. A client is receiving lactulose (Heptalac). Which laboratory value leads the nurse to intervene? a. Serum potassium, 2.6 mEq/L b. Serum sodium, 132 mEq/L c. Serum glucose, 108 mg/dL d. Blood urea nitrogen, 16 mg/dL

ANS: A Lactulose can cause the client to have several loose stools daily. The nurse should monitor for hypokalemia and dehydration. This client's potassium level is low, indicating hypokalemia. The serum sodium level is slightly low, but hyponatremia is not a complication of lactulose therapy. The blood glucose is slightly high, but this is unrelated. Blood urea nitrogen (BUN) is normal.

35. A client is in the emergency department after a motor vehicle crash. In assessing the client, which clinical sign alerts the nurse to the presence of possible liver trauma? a. Abdominal pain referred to the right shoulder b. Left upper quadrant abdominal pain and swelling c. Abdominal pain referred to the spine and legs d. Abdominal pain with accompanying rebound tenderness

ANS: A One of the key features of liver trauma is abdominal pain that is increased on deep breathing and is referred to the right shoulder. The liver is on the right, not the left, side of the body. Liver injury does not produce pain that radiates to the spine and down the legs. Rebound tenderness can indicate peritonitis.

15. A client had a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output of 20 mL/hr b. Systolic blood pressure increase of 10 mm Hg c. Respiratory rate drop from 18 to 14 d. A 3-pound drop in weight

ANS: A Rapid removal of ascitic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. The nurse would expect the client's weight to drop as fluid is removed. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. A slight increase in systolic blood pressure is insignificant.

6. During a hot summer day, an older adult client tells the clinic nurse, "I am not drinking or voiding that much these days." The nurse notes a heart rate of 100 beats/min and a blood pressure of 90/60 mm Hg. Which action does the nurse take first? a. Give the client something to drink. b. Insert an intravenous catheter. c. Teach the client to drink 2 to 3 liters a day. d. Perform a bladder scan to assess urine volume.

ANS: A Severe blood volume depletion can lead to kidney failure, even in those who have no kidney problem. The client is showing signs of mild volume depletion. The first action the nurse should take is to give the client something to drink. After that, the nurse should teach the client to avoid dehydration by drinking at least 2 to 3 L of fluid daily. The client does not need an IV at this time. Performing a bladder scan will not help prevent or reverse the client's problem.

11. A client has been missing some scheduled hemodialysis sessions. Which intervention is most important for the nurse to implement? a. Discussing with the client his or her acceptance of the disease b. Discussing with the client the option of peritoneal dialysis c. Rescheduling the sessions to another day or another time d. Stressing to the client the importance of going to the sessions

ANS: A Some people on dialysis retreat into complete or partial denial of the disease and the need for treatment. They may deny the need for dialysis and/or may not adhere to drug therapy and diet restrictions. Providing support as the client struggles to accept the disease is an important step in ensuring compliance with the dialysis regimen. The nurse should explore scheduling options, but missing so many sessions cues the nurse that a bigger problem than just scheduling is involved. The nurse should provide education, but simply stressing the need for dialysis will not help the client accept it. Peritoneal dialysis, with its technical demands on the client and partner, probably is not an option for a client who appears noncompliant with hemodialysis.

20. A client is hospitalized with acute pancreatitis. The nursing assistant reports to the nurse that when a blood pressure cuff was applied, the client's hand had a spasm. Which additional finding does the nurse correlate with this condition? a. Serum calcium, 5.8 mg/dL b. Serum sodium, 166 mEq/L c. Serum creatinine, 0.9 mg/dL d. Serum potassium, 4.2 mEq/dL

ANS: A Spasm of the hand when a blood pressure cuff is applied (Trousseau's sign) is indicative of hypocalcemia. The client's calcium level is low. The sodium level is high, but that is not related to Trousseau's sign. Creatinine and potassium levels are normal.

37. A client has end-stage kidney disease (ESKD). The nurse observes tall, peaked T waves on the client's cardiac monitor. Which action by the nurse is best? a. Check the serum potassium level. b. Document the finding in the client's chart. c. Prepare to give sodium bicarbonate. d. Call the health care provider to request an electrocardiogram (ECG).

ANS: A Tall, peaked T waves are a manifestation of hyperkalemia. Thus, the nurse should check the potassium level. Afterward, the nurse should report findings to the provider. The client may need an ECG, but treatment may be based on monitor tracings and potassium levels. Sodium bicarbonate is not warranted. Documentation is important but is not the priority.

20. A client is bleeding from esophageal varices. The health care provider is arranging sclerotherapy for the client. Before the client goes to interventional radiology, the nurse prepares to administer which medication? a. Terlipressin (Glypressin) b. Enoxaparin (Lovenox) c. Lactulose (Heptalac) d. Spironolactone (Aldactone)

ANS: A Terlipressin is a vasoactive drug that works by reducing portal pressure, which decreases bleeding. These drugs are often given in conjunction with sclerotherapies. Enoxaparin is a low-molecular-weight heparin, which would be contraindicated in a client with bleeding problems. Lactulose helps rid the body of ammonia. Aldactone is a diuretic.

16. The nurse is caring for a client with end-stage pancreatic cancer. The client asks the nurse, "Why is this happening to me?" Which is the nurse's best response? a. "I don't know. I wish I had an answer for you, but I don't." b. "It's important to keep a positive attitude for your family right now." c. "Scientists have not determined why cancer develops in certain people." d. "I think that this is a trial so you can become a better person because of it."

ANS: A The client is not asking the nurse actually to explain why the cancer has occurred, but simply to validate that no easy or straightforward answer can be found.

40. The nurse is meeting a client post-liver transplantation for the first time and notices a tremor as they shake hands. The client states this has not happened before. Which action by the nurse is most appropriate? a. Conduct a thorough assessment, then notify the surgeon of the findings. b. Review today's laboratory work, including liver function studies. c. Assess the client's vital signs, and offer acetaminophen if the client is febrile. d. Perform an assessment of the client's gross and fine motor skills.

ANS: A The client may be exhibiting asterixis. Any sign of deteriorating neurologic function could indicate that the new liver is not working properly. The surgeon must be notified, but first the nurse should conduct a thorough assessment of the client. Reviewing today's laboratory work is important, but this is not the best option because the client's liver could have deteriorated after the laboratory work was drawn. Clients with any type of liver problem should not take acetaminophen. Assessing the client's fine and gross motor skills is part of an assessment.

7. The nurse is caring for a postoperative client who reports pain in the shoulder blades following laparoscopic cholecystectomy surgery. Which direction does the nurse give to the nursing assistant to help relieve the client's pain? a. "Ambulate the client in the hallway." b. "Apply a cold compress to the client's back." c. "Encourage the client to take sips of hot tea or broth." d. "Remind the client to cough and deep breathe every hour."

ANS: A The client who has undergone a laparoscopic cholecystectomy may report free air pain because of retention of carbon dioxide in the abdomen. The nurse assists the client with early ambulation to promote absorption of the carbon dioxide. Coughing and deep breathing are important postoperative activities, but they are not related to discomfort from carbon dioxide. Cold compresses and drinking tea would not be helpful.

19. A client with acute kidney injury is placed on a fluid restriction. To determine whether outcomes related to fluid balance are being met, the nurse assesses for which finding? a. Absence of lung crackles b. Decreased serum creatinine level c. Decreased serum potassium level d. Increased muscle strength

ANS: A The client with chronic kidney disease is expected to achieve and maintain an acceptable fluid balance. Fluid restriction helps with this outcome. Absence of lung crackles can indicate that the client is not fluid overloaded. The other options are not related to fluid balance.

42. A client admitted with hepatopulmonary syndrome is experiencing dyspnea but does not want oxygen increased because the client's nose keeps bleeding from it. The client becomes agitated when discussing this with the nurse. The client's oxygen saturation is 92%. What intervention by the nurse is best? a. Instruct the client to sit in as upright a position as possible. b. Tell the client that humidity can be added, but that the oxygen must be worn. c. Document the client's refusal in the chart, and call the health care provider. d. Call the health care provider to request an extra dose of the client's diuretic.

ANS: A The client with hepatopulmonary syndrome is often dyspneic. Because the oxygen saturation is not significantly low, the nurse should first allow the client to sit upright to see if that helps. If the client remains dyspneic, or if the oxygen saturation drops further, the nurse should investigate adding humidity to the oxygen and seeing whether the client will tolerate that. The other two options may be beneficial, but they are not the best choices. If the client is comfortable, his or her agitation will decrease; this will improve respiratory status.

27. A client's temperature after dialysis is 99° F (37.2° C) and was normal before dialysis. Which is the nurse's best action? a. Continue to monitor the temperature. b. Encourage the client to drink fluids. c. Obtain a white blood cell count. d. Prepare to culture the fistula site.

ANS: A The client's temperature may be elevated because the dialysis machine warms the blood slightly. An excessive temperature elevation from baseline can signal sepsis. The nurse should inform the provider and obtain blood cultures if this happens. The other actions are not needed.

22. A client who is 2 days post-femoral vein cannulation begins to have difficulty with outflow of blood during dialysis. For which complication does the nurse assess? a. Hematoma at cannula insertion site b. Infection c. Oliguria d. Skin necrosis at cannula insertion site

ANS: A The puncture site of the femoral vein is prone to hematoma formation because positioning the extremity can cause movement of the cannula and subsequent bleeding at the site. The hematoma can compress the cannula, decreasing flow through it. The other complications would not diminish outflow.

26. A client is refusing to take lactulose (Heptalac) because of diarrhea. Which is the nurse's best response to this client? a. "Diarrhea is expected; that's how your body gets rid of ammonia." b. "You may take Kaopectate liquid daily for loose stools." c. "Do not take any more of the medication until your stools firm up." d. "We will need to send a stool specimen to the laboratory."

ANS: A The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or herto remain compliant. The other statements are inaccurate.

24. The nurse reviews laboratory results for a client with cirrhosis and finds the following: hematocrit 72% blood urea nitrogen (BUN) 42 mg/dL sodium, 166 mEq/L Which action by the nurse is most appropriate? a. Check the client's blood pressure and pulse. b. Increase the client's oral fluid intake. c. Call the health care provider. d. Document the results in the chart.

ANS: A These values are all elevated, which can occur in hypovolemia. The nurse should assess the client for signs of hypovolemia, including tachycardia and hypotension. The nurse should consult with the provider about the client's fluid status before increasing oral fluids but after obtaining vital signs. Documentation should occur after all assessments have been completed and must include actions taken.

30. A client with hepatitis C is being treated with ribavirin (Copegus). What nursing action takes priority? a. Educating the client on ways to remain complaint with the drug regimen b. Teaching the client that transient muscle aching is a common side effect c. Ensuring that the client returns to the clinic each week for follow-up care d. Showing the client how to take and record a radial pulse for 1 minute

ANS: A Treatment with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. The other actions are not warranted.

15. The postanesthesia care unit nurse is caring for a client who has just undergone an open Whipple procedure. The client has multiple tubes and drains in place after the surgery. Which does the nurse assess first? a. Endotracheal tube with 40% fraction of inspired oxygen (FiO2) b. Foley catheter to bedside drainage c. Nasogastric tube to low intermittent suction d. Triple-lumen IV catheter with lactated Ringer's solution

ANS: A Using the ABCs, airway and oxygenation status should always be assessed first. Next, the nurse should assess the IV line (circulation). After that, the other two items can be assessed.

13. The nurse monitors for which clinical manifestation in a client with a decreased fecal urobilinogen concentration? a. Clay-colored stools b. Petechiae c. Asterixis d. Melena

ANS: A When fecal urobilinogen levels are decreased as a result of biliary cirrhosis, the stools become lighter or clay-colored.

25. Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) A. Football player in preseason practice B. Client who underwent contrast dye radiology C. Accident victim recovering from a severe hemorrhage D. Accountant with diabetes E. Client in the intensive care unit on high doses of antibiotics F. Client recovering from gastrointestinal influenza

ANS: A, B, C, E, F A) Urge all people to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis. B) Contrast media may cause acute renal failure (ARF), especially in older clients with reduced kidney function. C) Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause acute kidney injury. E) Certain antibiotics may cause nephrotoxicity. F) Dehydration reduces kidney blood flow and may cause acute kidney injury.

1. The infection control nurse wants to decrease the number of health care professionals who contract viral hepatitis at work. Which actions does the nurse initiate? (Select all that apply.) a. Strengthen policies related to consistent use of Standard Precautions. b. Mandate hepatitis vaccination for workers in high-risk areas. c. Implement a needleless system for IV therapy. d. Reduce the number of "sharps" needed for client care where possible. e. Provide post-exposure prophylaxis in a timely manner.

ANS: A, C, D, E Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Post-exposure prophylaxis should be provided immediately. All health care workers should receive the hepatitis vaccinations that are available.

1. A client asks the nurse, "What are the advantages of peritoneal dialysis over hemodialysis?" Which response by the nurse is accurate? (Select all that apply.) a. "It will give you greater freedom in your scheduling." b. "You have less chance of getting an infection." c. "You need to do it only three times a week." d. "You do not need a machine to do it." e. "You will have fewer dietary restrictions."

ANS: A, D, E Although peritoneal dialysis is slower than hemodialysis, it does not require a specially trained registered nurse and can be done at home, allowing for greater flexibility in scheduling. Peritoneal dialysis is ambulatory, and a machine is not needed. Nursing implications for hemodialysis include vascular access care and diet restrictions, whereas peritoneal dialysis allows for a more flexible diet (abdominal catheter care is still necessary).

2. The nurse is caring for a female client with cholelithiasis. Which assessment findings from the client's history and physical examination may have contributed to development of the condition? (Select all that apply.) a. Body mass index (BMI) of 46 b. Vegetarian diet c. Drinking 4 ounces of red wine nightly d. Pregnant with twins e. History of metabolic syndrome f. Glycosylated hemoglobin level of 15%

ANS: A, D, F Obesity, pregnancy, and diabetes are all risk factors for the development of cholelithiasis. Moderate alcohol intake and a diet low in saturated fats may decrease the risk. Metabolic syndrome is a precursor to diabetes, and the client should be informed of the connection.

14. The nurse is caring for a client with chronic pancreatitis. Which instruction by the nurse is most appropriate? a. "You will need to limit your protein intake." b. "We need to call the dietitian to get help in planning your diet." c. "You cannot eat concentrated sweets any longer." d. "Try to eat less red meat and more chicken and fish."

ANS: B A client with chronic pancreatitis needs 4000 to 6000 calories per day for optimum nutrition and healing. The client may have additional restrictions if he or she has other health problems such as diabetes. The nurse should collaborate with the registered dietitian to help the client plan nutritional intake.

25. A thin, cachectic-appearing client has hepatic portal-systemic encephalopathy (PSE). The family expresses distress that the client is receiving so little protein in the diet. Which explanation by the nurse is most appropriate? a. "A low-protein diet will help the liver rest and will restore liver function." b. "Less protein in the diet will help with the confusion." c. "Despite looking so thin, protein will not help with weight gain." d. "Less protein is needed to prevent fluid from leaking into the abdomen."

ANS: B A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. The other statements are not correct.

14. A client has cirrhosis. Which nursing intervention would be most effective in controlling ascites? a. Monitoring intake and output b. Providing a low-sodium diet c. Increasing oral fluid intake d. Weighing the client daily

ANS: B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.

6. The nurse is reviewing a client's history. Which statement by the client indicates a need for health teaching? a. "I drink 1 to 2 glasses of red wine a week." b. "Because of my arthritis, I take a lot of Tylenol." c. "One of my cousins died of liver cancer 10 years ago." d. "I got a hepatitis vaccine before traveling last year."

ANS: B Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. The other statements do not necessarily require health teaching by the nurse.

16. A client just had a paracentesis. Which nursing intervention is a priority for this client? a. Monitor urine output. b. Maintain bedrest as per protocol. c. Position the client flat in bed. d. Secure the trocar to the abdomen with tape.

ANS: B After a paracentesis, the client should remain on bedrest with the head of the bed elevated. A client with liver dysfunction is at risk for bleeding, and bedrest decreases this risk. Clients with liver dysfunction must have intake and output monitored, but this is not the priority after this procedure. A drain may be placed for short-term therapy in some clients.

4. The nurse is providing discharge teaching for a client who has just undergone laparoscopic cholecystectomy surgery. Which statement by the client indicates understanding of the instructions? a. "I will drink at least 2 liters of fluid a day." b. "I need a diet without a lot of fatty foods." c. "I should drink fluids between meals rather than with meals." d. "I will avoid concentrated sweets and simple carbohydrates."

ANS: B After cholecystectomy, clients need a nutritious diet without a lot of excess fat; otherwise a special diet is not recommended for most clients. Good fluid intake is healthy for all people but is not related to the surgery. Drinking fluids between meals helps with dumping syndrome, which is not seen with this operation. Restriction of sweets is not required.

41. A client is 12 hours post-kidney transplantation. The nurse notes that the client has put out 2000 mL of urine in 10 hours. Which assessment does the nurse carry out first? a. Skin turgor b. Blood pressure c. Serum blood urea nitrogen (BUN) level d. Weight of the client

ANS: B After transplantation, the client may have diuresis. Excessive diuresis might cause hypotension. Hypotension needs to be prevented because it can reduce blood flow and oxygen to the new kidney, threatening graft survival. The other assessments can give information about fluid balance, but hypotension is the main concern here, so the nurse needs to check the client's blood pressure, then notify the provider.

17. A client is scheduled to have dialysis in 30 minutes and is due for the following medications: vitamin C, B-complex vitamin, and cimetidine (Tagamet). Which action by the nurse is best? a. Give medications with a small sip of water. b. Hold all medications until after dialysis. c. Give the supplements, but hold the Tagamet. d. Give the Tagamet, but hold the supplements.

ANS: B All three medications are dialyzable, meaning that they will be removed by the dialysis. They should be given after the treatment is over.

2. A client is admitted with cirrhosis and hepatopulmonary syndrome. Which clinical manifestation does the nurse monitor for progression or resolution of this problem? a. Right upper quadrant pain b. Crackles on auscultation c. Skin and scleral jaundice d. Nausea and vomiting

ANS: B An increase in intra-abdominal pressure from ascites can lead to hepatopulmonary syndrome. This is manifested by dyspnea and crackles on auscultation. The other symptoms are consistent with liver disease but are not specific to respiratory involvement.

41. Which statement by a client with alcohol-induced cirrhosis indicates the need for further teaching? a. "I cannot drink any alcohol at all anymore." b. "I need to avoid protein in my diet." c. "I should not take over-the-counter medications." d. "I should eat small, frequent, balanced meals."

ANS: B Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

23. The nursing assistant is helping a client who has advanced cirrhosis with a bath and other hygiene. Which action by the assistant requires intervention by the registered nurse? a. Helping the client apply lotion to dry skin areas b. Giving the client a basin of warm water and soap to use c. Providing a soft toothbrush for oral care d. Helping the client keep nails trimmed short

ANS: B Clients with advanced cirrhosis often have pruritus. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap. The other actions are appropriate.

25. When providing care for a client receiving peritoneal dialysis, the nurse notices that the effluent is cloudy. Which intervention is most important for the nurse to carry out? a. Irrigate the peritoneal catheter with saline. b. Send a specimen for culture and sensitivity. c. Document the finding in the client's chart. d. Change the dialysate solution and catheter tubing.

ANS: B Cloudy or opaque effluent is the earliest sign of peritonitis. The health care provider should be notified, and a sample of the outflow should be sent for culture and sensitivity. Irrigating the catheter or changing the solution and tubing will not help reveal the cause of the problem so that appropriate treatment can be started. Documentation is important but is not the priority.

9. The nurse recognizes that fetor hepaticus is consistent with which assessment finding? a. Purpuric lesions on the extremities b. A fruity or musty breath odor c. Warm and bright red palms d. Jaundice of the sclera

ANS: B Fetor hepaticus is a distinctive breath odor that presents with chronic liver disease. The client's breath has a fruity or musty odor. The other statements do not apply to fetor hepaticus.

38. A client who underwent liver transplantation 2 weeks ago reports a temperature of 101° F (38.3° C) and right flank pain. Which is the nurse's best response? a. "The anti-rejection drugs you are taking made you susceptible to infection." b. "You should go to the hospital immediately to have your new liver checked out." c. "You should take an additional dose of cyclosporine today." d. "Take acetaminophen (Tylenol) every 4 hours until you feel better."

ANS: B Fever, right quadrant or flank pain, and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention. The other statements are not appropriate.

8. A client with acute kidney failure and on dialysis asks how much fluid will be permitted each day. Which is the nurse's best response? a. "This is based on the amount of damage to your kidneys." b. "You can drink an amount equal to your urine output, plus 700 mL." c. "It is based on your body weight and changes daily." d. "You can drink approximately 2 liters of fluid each day."

ANS: B For clients on dialysis, fluid intake is generally calculated to equal the amount of urine excreted plus 500 to 700 mL.

43. A client is scheduled for a paracentesis. Which activity does the nurse delegate to the unlicensed assistive personnel? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed, on the right side. d. Get the client into a chair after the procedure.

ANS: B For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table. The client will be on bed rest after the procedure.

44. A client has liver cancer. Which statement by the client about treatment options demonstrates an accurate understanding? a. "I guess it's a good thing that surgery is usually so successful." b. "I choose hepatic arterial infusion of chemo to limit side effects." c. "Because I have only local metastases, I am thinking about transplant." d. "This disease is so rare, no wonder no good treatments are available."

ANS: B Hepatic arterial chemotherapy infusion allows chemotherapeutic agents to be delivered directly into the liver tumor, limiting systemic side effects. Surgery is not usually successful because the cancer is frequently widespread when detected. Transplant is considered only for primary liver tumors that have not metastasized. The lack of successful treatments is due not to rarity, but rather to the fact that generally the cancer has already spread when found.

16. A client with chronic hypertension is seen in the clinic. Which assessment indicates that the client's hypertension is not under control? a. Heart rate of 55 beats/min b. Serum creatinine level of 1.9 mg/dL c. Blood glucose level of 128 mg/dL d. Irregular heart sounds

ANS: B Increased blood pressure damages the delicate capillaries in the glomerulus and eventually results in acute kidney injury. An elevated serum creatinine level is a manifestation of this. Heart rate, blood glucose level, and irregular heart sounds are not correlated with acute kidney injury.

1. The nurse correlates which data in the client's history as a predisposing factor for Laënnec's cirrhosis? a. Gallstones b. Alcohol abuse c. Viral hepatitis d. Heart disease

ANS: B Laënnec's cirrhosis, also known as alcoholic cirrhosis, is caused by the toxic effect of alcohol on the liver. The nurse should ask the client about a history of alcohol use. The other factors are not related to this type of cirrhosis.

23. A client is admitted with a 3-day history of vomiting and diarrhea. The client's vital signs are blood pressure, 85/60 mm Hg; and heart rate, 105 beats/min. Which intervention by the nurse takes priority? a. Obtain blood and urine cultures. b. Start an IV of normal saline as ordered. c. Administer antiemetic medications. d. Assess the client's recent travel history.

ANS: B Many types of problems can reduce kidney function. Severe hypotension from shock or dehydration reduces renal blood flow and leads to prerenal acute renal failure (ARF). Volume depletion leading to prerenal azotemia is the most common cause of ARF and usually is reversible with prompt intervention. The nurse should first initiate the ordered IV fluids. Obtaining cultures will help identify a possible cause of the client's symptoms and should be done quickly after the IV has been started. Attending to the client's discomfort would be next. Assessing for travel history, although important, can wait until after the other interventions have been accomplished.

42. A client who underwent kidney transplantation 7 days ago has developed the following signs: urine output 50 mL/12 hr temperature 102.2° F (39° C) lethargy serum creatinine 2.1 mg/dL blood urea nitrogen (BUN) 54 mg/dL potassium, 5.6 mEq/L Which initial intervention does the nurse anticipate for this client? a. Immediate hemodialysis b. Increased dose of immune suppressive drugs c. Initiation of IV antibiotics after cultures are obtained d. Placement of a catheter for peritoneal dialysis

ANS: B Oliguria, lethargy, elevated temperature, and increases in serum electrolyte levels, BUN, and creatinine, 1 week to 2 years post-transplantation are hallmarks of acute rejection, which can be reversible with increased immune suppressive therapy. The client does not need hemodialysis, peritoneal dialysis, or antibiotics at this point.

3. A client is admitted for suspected cholecystitis. On reviewing laboratory results, the nurse notes that the client's amylase is elevated. Which action by the nurse is best? a. Document the finding in the chart. b. Ask the client about drinking habits. c. Notify the health care provider. d. Place the client on clear liquids.

ANS: B Serum and urine amylase levels are elevated when the pancreas becomes inflamed. One cause of pancreatitis is gallbladder disease; another causative factor is alcohol intake. The nurse should tactfully explore this subject with the client before documenting the findings and notifying the provider. The client may need to be NPO or on clear liquids, but the nurse does not have enough information yet to determine this.

13. A client has a serum creatinine level of 2 mg/dL and a urine output of 1000 mL/day. How does the nurse categorize the client's kidney injury? a. Intrarenal b. Nonoliguric c. Prerenal d. Postrenal

ANS: B Some clients have a nonoliguric form of acute renal failure (ARF), in which urine output remains near-normal but creatinine rises. The other categories relate to the cause of acute kidney injury.

11. The nurse is caring for a client with acute pancreatitis. Which nursing intervention best reduces discomfort for the client? a. Administering morphine sulfate IV every 4 to 6 hours as needed b. Maintaining NPO status for the client with IV fluids c. Providing small, frequent feedings, with no concentrated sweets d. Placing the client in semi-Fowler's position at elevation of 30 degrees

ANS: B The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric (NG) tube. Pain medications should be given around the clock and more frequently than every 4 to 6 hours. A fetal position with legs drawn up to the chest will promote comfort.

36. A client is in the emergency department after a motor vehicle crash, and the nurse notices a "steering wheel mark" across the client's chest. Which action by the nurse is most appropriate? a. Ask the client where in the car he or she was during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to come draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position.

ANS: B The liver is often injured by a steering wheel in a motor vehicle crash. Because the client's chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the client's position in the crash is not needed because of the steering wheel imprint. The client may or may not need a blood transfusion. The client does not need to be in reverse Trendelenburg position.

12. The nurse is caring for a client who has undergone surgery to drain a pancreatic pseudocyst with placement of a pancreatic drainage tube. Which nursing intervention prevents complications from this procedure? a. Positioning the client in a right side-lying position b. Applying a skin barrier around the drainage tube site c. Clamping the drainage tube for 2 hours every 12 hours d. Irrigating the drainage tube daily with 30 mL of sterile normal saline

ANS: B The nurse assesses the skin around the drainage tube for redness or skin irritation, which can be severe from leakage of pancreatic enzymes. The nurse applies a skin barrier such as Stomahesive around the drainage tube to prevent excoriation. A side-lying position may be more comfortable for the client. The drainage tube should not be clamped or irrigated without specific orders.

3. A client is admitted with end-stage cirrhosis and severe vomiting. Which problem should the nurse monitor the client most carefully for? a. Intrahepatic bile stasis b. Bleeding esophageal varices c. Decreased excretion of bilirubin d. Accumulation of ascites in the abdomen

ANS: B The portal hypertension that accompanies end-stage cirrhosis predisposes the client to esophageal varices. These varices can rupture from increased pressure in the esophagus caused by coughing or vomiting. Bleeding varices can be life threatening. None of the other assessments take priority over monitoring for bleeding from esophageal varices.

28. A client has been diagnosed with hepatitis A. The nurse evaluates that teaching regarding the disease is understood when the client makes which statement? a. "Some medications have been known to induce hepatitis A." b. "I may have been exposed when we ate shrimp last weekend." c. "I may have been infected through a recent blood transfusion." d. "My infection with Epstein-Barr virus can co-infect me with hepatitis A."

ANS: B The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. The other statements are not accurate.

11. Which laboratory data does the nurse correlate with advanced disease in a client with cirrhosis? a. Elevated serum protein level b. Elevated serum ammonia level c. Decreased serum ammonia level d. Decreased lactate dehydrogenase level

ANS: B The serum ammonia level is elevated in the presence of advanced disease because conversion of ammonia to urea for excretion is decreased. The other laboratory values do not correlate with advanced disease.

43. The nurse is assessing a client with acute kidney injury and hears a pericardial friction rub when auscultating the lungs. For what complication does the nurse plan care? a. ac tamponade b. Pericarditis c. Pulmonary edema d. Myocardial Infarction

ANS: B The sound heard is a pericardial friction rub. This is heard in pericarditis because the pericardial sac becomes inflamed from uremic toxins. Other manifestations include low-grade fever, tachycardia, and chest pain. A tamponade would manifest as muffled heart tones. Pulmonary edema would manifest with crackles in the lungs. A myocardial infarction may or may not have abnormal chest sounds associated with it.

33. A client who is admitted to the hospital with a history of kidney disease begins to have difficulty breathing. Vital signs are as follows: blood pressure, 90/70 mm Hg; heart rate, difficult to feel peripheral pulses. His heart sounds are difficult to hear. Which intervention does the nurse prepare for? a. Administration of digoxin (Lanoxin) b. Draining of pericardial fluid with a needle c. Emergency hemodialysis d. Placement of a pacemaker

ANS: B These signs and symptoms are of cardiac tamponade, an emergency situation in which fluid accumulates in the pericardial sac, making it difficult for the heart to pump normally. Treatment includes a pericardiocentesis, or withdrawing the fluid with a needle or catheter. The other interventions are not appropriate in this situation.

39. A client who had a liver transplant a month ago is admitted with fever and tachycardia. Which medication does the nurse prepare to administer to this client? a. Ceftriaxone (Rocephin) b. Cyclosporine (Sandimmune) c. Azithromycin (Zithromax) d. Ribavirin (Copegus)

ANS: B This client is showing signs of transplant rejection, which is treated with immune suppressive drugs, such as cyclosporine. Ceftriaxone and azithromycin are antibiotics. Ribavirin is used to treat hepatitis C.

29. The nurse is providing dietary teaching to a client who was just started on peritoneal dialysis (PD). Which instruction does the nurse provide to this client regarding protein intake? a. "Your protein needs will not change, but you may take more fluids." b. "You will need more protein now because some protein is lost by dialysis." c. "Your protein intake will be adjusted according to your predialysis weight." d. "You no longer need to be on protein restriction."

ANS: B When renal disease has progressed and requires treatment with dialysis, increased protein is required in the diet to compensate for protein losses through peritoneal dialysis. The other statements are inaccurate.

19. A client with an esophagogastric tube suddenly experiences acute respiratory distress. Which is the nurse's first action? a. Call the health care provider. b. Cut the balloon ports and remove the tube. c. Place the client upright and apply oxygen. d. Reduce the balloon pressure slightly.

ANS: B When respiratory compromise is noted in a client with an esophagogastric tube, the nurse should immediately cut both ports with a pair of scissors that is kept at the bedside and remove the tube. The nurse would not call the health care provider until the client was out of immediate danger. Once the tube has been removed, the nurse can reposition the client and apply oxygen.

40. The nurse is providing a client with a peritoneal dialysis exchange. The nurse notes the presence of cloudy peritoneal effluent. Which action by the nurse is most appropriate? a. Document the finding in the client's chart. b. Collect a sample to send to the laboratory. c. Reposition the client on the left side. d. Increase the free water content in the next bag.

ANS: B Cloudy or opaque effluent is an early sign of peritonitis. The nurse should collect and send a sample for culture. Then the nurse should document the finding. The other two options are not appropriate.

12. Which laboratory findings does the nurse recognize as potentially causing complications of liver disease? a. Elevated aspartate transaminase (AST) and lactate dehydrogenase (LDH) levels b. Elevated prothrombin time and international normalized ratio (INR) c. Decreased serum albumin and serum globulin levels d. Decreased serum alkaline phosphatase and alanine aminotransferase (ALT) levels

ANS: B Elevated prothrombin time and INR are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. The other values do not necessarily place the client at increased risk for complications.

1. The nurse is caring for a client after a Whipple procedure. Which manifestations might indicate that a complication from the operation has occurred? (Select all that apply.) a. Urinary retention b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

ANS: B, C, D, E Myocardial infarction (chest pain), pulmonary embolism (shortness of breath), adynamic ileus(lack of bowel sounds or flatus), and renal failure (urine output of 20 mL/6 hr) are just some of the complications that the nurse must monitor the client for after the Whipple procedure. Urinary retention is not a complication of this operation.

3. The nurse is caring for a client who is being discharged from the hospital after an attack of acute pancreatitis. Which discharge instructions does the nurse provide for the client to help prevent a recurrence? (Select all that apply.) a. "Take a 20-minute walk at least 5 days each week." b. "Attend local Alcoholics Anonymous (AA) meetings weekly." c. "Choose whole grains rather than foods with simple sugars." d. "Use cooking spray when you cook rather than margarine or butter." e. "Stay away from milk and dairy products that contain lactose." f. "We can talk to your doctor about a prescription for nicotine patches."

ANS: B, D, F The client should be advised to stay sober, and AA is a great resource. The client requires a low-fat diet, and cooking spray is low in fat compared with butter or margarine. If the client smokes, he or she must stop because nicotine can precipitate an exacerbation. A nicotine patch may help the client quit smoking. The client must rest until his or her strength returns. The client requires high carbohydrates and calories for healing; complex carbohydrates are not preferred over simple ones. Dairy products do not cause a problem.

8. The nursing care plan specifies obtaining abdominal girth measurements each shift. The nurse takes the measurement, but when compared with the previous measurement, the new finding is several millimeters off. Which action by the nurse is best? a. Document the finding in the client's chart. b. Look to see when the client last had a dose of diuretic. c. Ensure that the client's abdomen and flanks are marked with pen. d. Obtain the measurement while the client sits upright.

ANS: C Abdominal girth is measured at the end of exhalation, at the level of the umbilicus, while the client lies flat. To ensure that measurements are taken in the same place each time, the nurse should mark the client's abdomen and flanks with pen. Findings do need to be documented, but this is not the best action when such inconsistency is noted between measurements. Use of a diuretic might decrease ascites, but the best action remains ensuring that measurements are taken in a consistent manner.

4. A client has cirrhosis and has developed ascites and edema. Which laboratory value does the nurse correlate with this condition? a. Blood glucose, 120 mg/dL b. Serum sodium, 135 mEq/L c. Serum albumin, 2.1 g/dL d. Blood urea nitrogen, 18 mg/dL

ANS: C Ascites occurs as a result of the inability of the liver to synthesize albumin. Loss of albumin leads to edema. This client's albumin level is low, which correlates with the condition. Sodium and blood urea nitrogen (BUN) levels are normal. The glucose level is slightly high, but this is not directly related to edema.

10. The nurse is assessing a client for asterixis. Which instruction to the client is most appropriate? a. "Close your eyes and take turns touching your nose with your fingers." b. "Sit on the edge of the bed and hold your legs straight out for 30 seconds." c. "Extend your arm, flex your wrist upward, and extend your fingers." d. "Say 'EEEEE' while I listen to your lungs in the back on both sides."

ANS: C Asterixis, or liver flap, is a tremor in the client's wrists and fingers. The correct technique for assessing the presence of asterixis is to extend the arm, dorsiflex the wrist, and extend the fingers. The other directions are not related to asterixis.

17. The nurse is caring for a client who has just been diagnosed with end-stage pancreatic cancer. The nurse assesses the client's emotional response to the diagnosis. Which is the nurse's initial action for the assessment? a. Bring the client to a quiet room for privacy. b. Pull up a chair and sit next to the client's bed. c. Determine whether the client feels like talking about his or her feelings. d. Review the health care provider's notes about the prognosis for the client.

ANS: C Before conducting an assessment about the client's feelings, the nurse should determine whether he or she is willing and able to talk about them. If the client is open to the conversation and his or her room is not appropriate, an alternative meeting space may be located. The nurse should be present for the client during this time, and pulling up a chair and sitting with the client indicates that presence. Because the nurse is assessing the client's response to a terminal diagnosis, it is not necessary to have detailed information about the projected prognosis; the nurse knows that the client is facing an end-of-life illness.

21. A client is receiving continuous arteriovenous hemofiltration (CAVH). Which laboratory value does the nurse monitor most closely? a. Hemoglobin b. Glomerular filtration rate c. Sodium d. White blood cells

ANS: C CAVH is used for clients who have fluid volume overload. It continuously removes large quantities of plasma, water, waste, and electrolytes, such as sodium. Fluid removal can also affect the serum sodium level.

20. A client with chronic kidney disease is scheduled to be given the following medications: digoxin (Lanoxin) and epoetin alfa (Epogen). The client reports nausea and vomiting and wishes to wait to take the medications. Which action by the nurse is most appropriate? a. Administer both medications with soda crackers. b. Allow the client to wait an hour before taking the medications. c. Review today's potassium level and notify the health care provider. d. Call the health care provider to get an order for anti-nausea medication.

ANS: C Clients with kidney failure are particularly at risk for digoxin toxicity because the drug is excreted by the kidneys. When caring for clients with chronic kidney disease (CKD) who are receiving digoxin, monitor for signs of toxicity, such as nausea and vomiting. Potassium imbalances can alter digoxin levels as well. The nurse should hold the dose, check the current potassium level, and notify the provider. Giving the digoxin could be dangerous, so the nurse should not administer it with crackers, give it later, or ask for an anti-nausea medication.

19. The nurse is caring for a client who had undergone a Whipple procedure 2 days previously. The nurse notes that the client's hands and feet are edematous, and urine output has decreased from the previous day. Which intervention does the nurse expect to provide for the client? a. Increase the client's IV fluid infusion rate. b. Monitor the client's blood sugar level every 4 hours. c. Add colloids to the client's IV solutions. d. Reinsert the client's nasogastric (NG) tube.

ANS: C Edema and low urine output following the Whipple procedure most likely are caused by hypoalbuminemia. Low albumin leads to third spacing of fluids and decreased intravascular fluids. As a result, edema and low urine output develop. Adding a colloid solution to the client's IV regimen will help shift edematous fluid from the interstitial space back into the intravascular space. Increasing the client's IV infusion rate will worsen the edema unless additional protein is added. Blood glucose monitoring and NG tubes are not related to this problem.

32. A client has end-stage kidney disease (ESKD). Which food selection by the client demonstrates understanding of a low-sodium, low-potassium diet? a. Bananas b. Ham c. Herbs and spices d. Salt substitutes

ANS: C Herbs and spices can be used in place of salt to enhance food flavor. Bananas are high in potassium. Ham is high in sodium. Many salt substitutes contain potassium chloride and should not be used.

2. The nurse is caring for a client with cholecystitis. Which assessment finding indicates to the nurse that the condition is chronic rather than acute? a. Abdomen that is hyperresonant to percussion b. Hyperactive bowel sounds and diarrhea c. Clay-colored stools and dark amber urine d. Rebound tenderness in the right upper quadrant

ANS: C In chronic cholecystitis, bile duct obstruction results in the absence of urobilinogen to color the stool. Excess circulating bilirubin turns the urine dark and foamy. The other assessment findings do not correlate with chronic cholecystitis.

21. The nurse is caring for a client with cholecystitis. The client is a poor historian and is unable to tell the nurse when the symptoms started. Which assessment finding indicates to the nurse that the condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy's sign c. Light-colored stools d. Upper abdominal pain after eating

ANS: C Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic than with acute cholecystitis. The other symptoms are seen equally with both conditions.

3. A client with a decreased glomerular filtration rate asks how to prevent further damage to the kidneys. Which is the nurse's best response? a. "The diuretics you are taking will prevent further damage." b. "Kidney damage is inevitable as you age." c. "Avoid taking NSAIDs." d. "You will need to follow a high-protein diet."

ANS: C Kidney failure causes many problems, including decreased glomerular filtration rate. Nephrotoxins can worsen renal failure, especially in someone who already has some loss of kidney function.

7. A client is taking furosemide (Lasix). To detect a common adverse effect, the nurse obtains which assessment as a priority? a. Breath sounds b. Heart sounds c. Intake and output d. Nutritional patterns

ANS: C Lasix is a diuretic that causes increased urine output. If too much urine output occurs, the client may be at risk for hypovolemia, which is a cause of prerenal kidney failure. A marked change in fluid balance seen in the intake and output measurement can help identify the client who may be at risk for hypovolemia. Heart sounds and breath sounds would be more important to assess if the client was receiving Lasix for fluid overload conditions, such as heart failure. Nutrition assessment is important to ensure that the client gets enough potassium, but dehydration is more common and needs more vigorous assessment.

7. The nurse is assessing a client with mild liver disease. Which assessment does the nurse perform to detect the presence of ascites in this client? a. Measure lower extremities to assess for edema. b. Inspect and palpate the abdomen for distention. c. Palpate the abdomen in assessing for a fluid wave. d. Percuss the liver while listening for dullness.

ANS: C Mild ascites may be difficult to detect and can be assessed by percussion. Shifting dullness and a fluid wave alert the nurse to the presence of ascites. The other findings are inconsistent with ascites.

18. The nurse is teaching a community group about pancreatic cancer. Which risk factor does the nurse instruct is known for development of this type of cancer? a. Hypothyroidism b. Cholelithiasis c. BRCA2 gene mutation d. African-American ethnicity

ANS: C Mutations in both BRCA2 and p16 genes increase the risk for developing pancreatic cancer in a small number of cases. The other factors do not appear to be linked to increased risk.

39. The nurse is caring for a client who is receiving peritoneal dialysis (PD). Which nursing intervention has the greatest priority when a dialysis exchange is performed? a. Adding potassium and antibiotic to the dialysate bags b. Positioning the client on either side c. Using sterile technique when hooking up dialysate bags d. Warming the dialysate fluid in a microwave oven

ANS: C Peritonitis is the major complication of PD. The most common cause of peritonitis is connection site contamination. To prevent peritonitis, use meticulous sterile technique when caring for the PD catheter and when hooking up or clamping off dialysate bags. This safety precaution is the priority. Never warm dialysate fluid in the microwave. Positioning the client may help with the flow of fluid. Clients may need additives to their dialysate fluid, but potassium and antibiotics are not added together because interactions between them can reduce the effectiveness of the antibiotic.

33. The nurse monitors for which serologic marker in the client who is a carrier of chronic hepatitis B? a. Anti-hepatitis C virus (HCV) antibodies b. Anti-hepatitis B (HBs) antibodies c. Hepatitis B surface antigen (HBsAg) antibodies d. Hepatitis A virus (HAV) antibodies

ANS: C Persistent presence of the serologic marker HBsAg after 6 months indicates a carrier state or chronic hepatitis. The other markers are not indicative of a carrier state.

15. A client has been diagnosed with acute postrenal kidney injury. Which assessment finding does the nurse assess most carefully for? a. Blood urea nitrogen (BUN), 35 mg/dL b. Creatinine, 2.5 mg/dL c. Feeling of urgency d. Weight gain and edema

ANS: C Postrenal kidney failure is identified by focusing on urinary obstructive problems. Symptoms include changes in the urine stream or difficulty starting urination. All the other distractors can be seen with prerenal and intrarenal kidney injury.

12. Assessment findings reveal that a client with chronic kidney disease is refusing to take prescribed medications because of the "cost." The client also is having difficulty performing activities of daily living and prefers to sleep most of the day. To which health care team member does the nurse refer the client? a. Home health aide b. Physical therapist c. Psychiatric nurse practitioner d. Physician

ANS: C Professionals from many disciplines are resources for the client with renal failure. A psychiatric evaluation may be needed if depressive symptoms are present. Refusing treatment, having difficulty performing activities of daily living, and excessive sleeping could be signs of depression.

10. Which staff member does the charge nurse assign to care for a client newly diagnosed with chronic kidney disease? a. Licensed practical nurse who usually works on the unit b. Registered nurse floated from the hemodialysis unit c. Registered nurse who has taken care of this client before d. Registered nurse with the most years of experience

ANS: C Provide continuity of care, whenever possible, by using a consistent nurse-client relationship to decrease anxiety and promote discussion of concerns.

32. Which statement made by a client traveling to a nonindustrialized country indicates the need for further teaching regarding the prevention of viral hepatitis? a. "I will drink bottled water while I'm gone." b. "I will not share my drinking glass." c. "I should eat plenty of fresh fruits and vegetables." d. "I will use careful handwashing."

ANS: C The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, not sharing glasses (or eating utensils), and careful hand washing are all good ways to prevent illness.

13. The nurse is providing discharge teaching for a client who will be receiving pancreatic enzyme replacement at home. Which statement by the client indicates that additional teaching is needed? a. "The capsules can be opened and the powder sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that contain protein."

ANS: C The enzymes should be taken immediately before eating meals or snacks. The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin. If the client cannot swallow the capsules whole, they can be opened up and the powder sprinkled on applesauce, mashed fruit, or rice cereal. Protein items will be dissolved by the enzymes if they are mixed together.

14. A client has a serum creatinine level of 2.5 mg/dL, a serum potassium level of 6 mmol/L, an arterial pH of 7.32, and a urine output of 250 mL/day. Which phase of acute kidney failure is the client experiencing? a. Intrarenal b. Nonoliguric c. Oliguric d. Postrenal

ANS: C The oliguric phase of acute kidney failure is characterized by the accumulation of nitrogenous wastes, resulting in increasing levels of serum creatinine and potassium, bicarbonate deficit, and decreased or no urine output. Intrarenal and postrenal refer to causes of kidney injury. Nonoliguric is not a classification.

37. The nurse recognizes which client as being at greatest risk for the development of carcinoma of the liver? a. Middle-aged client with a history of diabetes mellitus b. Young adult client with a history of blunt liver trauma c. Older adult client with a history of cirrhosis d. Older adult client with malnutrition

ANS: C The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. The other factors do not increase a person's risk for developing liver cancer.

30. A client was just admitted to the emergency department for new-onset confusion. As the nurse starts the IV line, the client says he just finished a hemodialysis session. The IV site is bleeding briskly. What action by the nurse takes priority? a. Assess for a bruit and thrill over the vascular access site. b. Draw blood for coagulation studies and white blood cell count. c. Prepare to administer protamine sulfate. d. Hold constant firm pressure with a gauze pad for 5 minutes.

ANS: C To prevent blood clots from forming within the dialyzer or blood tubing, anticoagulation is needed during hemodialysis treatment. The drug used is heparin, which makes the client at risk for hemorrhage for the next 4 to 6 hours. Protamine sulfate is the antidote to heparin, and the nurse should prepare to administer it. Pressure may help, and someone else can apply it while the nurse is getting the medication. Laboratory studies are not needed because the client is at known risk for bleeding from heparin. Assessing the vascular access device does nothing to help the situation.

34. A client with chronic kidney disease states that he will be going to the dentist for a planned tooth extraction. Which is the nurse's best response? a. "Rinse your mouth with an antiseptic solution after the procedure." b. "Kidney disease is probably what caused your dental decay." c. "You should receive prophylactic antibiotics before any dental procedure." d. "You may take any medication for pain that the dentist prescribes."

ANS: C To prevent sepsis from oral cavity bacteria, the client should be given prophylactic antibiotics before any dental procedure. Rinsing the mouth with antiseptic solution would not be sufficient to prevent infection. Kidney disease may have contributed to the dental decay through loss of calcium from the teeth, but this cannot be confirmed. Clients with kidney disease should not take antibiotics known to be nephrotoxic. Dosage adjustments based on the client's kidney function may be needed.

17. A client just returned to the nursing unit after having a trans-jugular intrahepatic portal-systemic shunt (TIPS) procedure. Which clinical finding does the nurse expect to observe in this client? a. Decreased level of consciousness b. Decreased urinary volume c. Increased blood pressure d. Increased abdominal girth

ANS: C With TIPS placement, ascitic fluid is routed into the venous system, resulting in vascular volume expansion. An increase in blood pressure is reflective of increased circulating volume. The client should not have the other findings.

9. The nurse is caring for a client who had a T-tube placed 3 days ago. Which assessment finding indicates to the nurse that the procedure was successful? a. Sclera that is slightly icteric b. Positive Blumberg's sign c. Soft, brown, formed stool this morning d. Sips of clear liquid tolerated without nausea

ANS: C A transhepatic biliary catheter (T-tube decompresses extrahepatic ducts to promote the flow of bile. When bile flows normally, it reaches the large intestine, where bile is converted to urobilinogen, coloring the stools brown. The other findings would not indicate successful T-tube placement.

5. The nurse is caring for a client who has just undergone traditional cholecystectomy surgery and has a Jackson-Pratt (JP) drain in place. The nurse notes serosanguineous drainage present in the drain. Which is the nurse's priority action? a. Gently milk the drain tubing. b. Notify the surgeon immediately. c. Document the finding in the client's chart. d. Irrigate the drain with sterile normal saline.

ANS: C Drainage from the JP drain initially appears serosanguineous in color. The drainage will appear bile-colored within 24 hours. The nurse does not need to notify the surgeon, milk the tubing, or irrigate the drain because this is an expected finding.

36. The nurse is caring for a client with chronic kidney disease who has developed uremia. Which assessment finding does the nurse correlate with this problem? a. Decreased breath sounds b. Foul-smelling urine c. Heart rate of 50 beats/min d. Respiratory rate of 40 breaths/min

ANS: D A client with uremia will also have metabolic acidosis. With severe metabolic acidosis, the client will develop hyperventilation, or Kussmaul respirations, as the body attempts to compensate for the falling pH. The other manifestations would not be associated with acidosis.

9. Which statement by a client who has undergone kidney transplantation indicates a need for more teaching? a. "I will need to continue to take insulin for my diabetes." b. "I will have to take my cyclosporine for the rest of my life." c. "I will take the antibiotics three times daily until the medication is finished." d. "My new kidney is working fine. I do not need to take medications any longer."

ANS: D A crucial role of the nurse in long-term follow-up of the kidney transplantation client involves maintenance of prescribed drug therapy. Such clients will need to take immune suppressants for the rest of their lives to prevent rejection of the kidney.

4. A client who has chronic kidney disease is being discharged from the hospital after receiving treatment for a hip fracture. Which information is most important for the nurse to provide to the client before discharge? a. "Increase your intake of foods with protein." b. "Monitor your daily intake and output." c. "Maintain bedrest until the fracture is healed." d. "Take your aluminum hydroxide (Nephrox) with meals."

ANS: D Aluminum hydroxide lowers serum phosphate levels by binding phosphorus present in food. High blood phosphate levels cause hypocalcemia and osteodystrophy; this makes a client prone to fracture. Increasing protein may not be feasible for a client with chronic kidney disease and would not help prevent fracture. Intake and output will not be helpful for orthopedic problems. Bedrest will promote complications.

5. Which intervention is most important for the nurse to implement in a client after kidney transplant surgery? a. Promote acceptance of new body image. b. Monitor magnesium levels daily. c. Place the client on protective isolation. d. Remove the indwelling (Foley) catheter as soon as possible.

ANS: D Because of increased risk for infection related to immune suppressive drugs given to prevent rejection, the catheter is removed as soon as possible to avoid infection, usually 3 to 7 days after surgery. The client may need assistance with changes in body image, but this is not the priority. The client does not require protective precautions. Laboratory values will be monitored frequently in a post-transplant client, but this is not as important as preventing a complication by removing the catheter.

10. The nurse is caring for a client with acute pancreatitis. During the physical assessment, the nurse notes a grayish-blue discoloration of the client's flanks. Which is the nurse's priority action? a. Prepare the client for emergency surgery. b. Place the client in high Fowler's position. c. Insert a nasogastric (NG) tube to low intermittent suction. d. Ensure that the client has a patent large-bore IV site.

ANS: D Grayish-blue discoloration on the flanks (Turner's sign) indicates pancreatic enzyme leakage into the peritoneal cavity. This presents a risk of shock for the client, so IV access should be maintained with at least one large-bore patent IV catheter. The client may or may not need surgery; usually a fetal position helps with pain, and having an NG tube would not take priority over IV access.

26. During hemodialysis, a client with chronic kidney disease develops headache, nausea, vomiting, and restlessness. After notifying the health care provider, which action by the nurse is most appropriate? a. Administer a bolus of dextrose solution. b. Draw blood for sodium and potassium. c. Order a blood urea nitrogen level stat. d. Prepare to administer phenytoin (Dilantin)

ANS: D Headache, nausea, vomiting, and restlessness may be signs of dialysis disequilibrium syndrome. Rapid decreases in fluid and in blood urea nitrogen (BUN) level can cause cerebral edema and increased intracranial pressure (ICP). Early recognition and treatment of this syndrome are essential for preventing a life-threatening situation. Treatment includes administration of anticonvulsants (Dilantin) or barbiturates. Dextrose is not used to treat disequilibrium syndrome, and sodium and potassium levels are not helpful because the symptoms are related to changes in urea levels and increased intracranial pressure. Obtaining the BUN would provide useful information; however, it is more important to treat the problem.

5. The client with end-stage cirrhosis presents with GI bleeding, combativeness, and confusion. The nurse anticipates an order to administer which medication? a. Omeprazole (Prilosec) b. Somatostatin (Octreotide) c. Propranolol (Inderal) d. Lactulose (Heptalac)

ANS: D Lactulose helps rid the body of ammonia. Excess ammonia leads to encephalopathy, which this client is manifesting. Omeprazole is a proton pump inhibitor used for reflux and ulcer disease. Somatostatin is given to treat bleeding from esophageal varices. Inderal is given to prevent bleeding from esophageal varices.

18. A client is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which nursing intervention is the priority? a. Keep the client sedated to prevent tube dislodgement. b. Maintain balloon pressure at between 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Maintain the client's airway.

ANS: D Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this procedure. The other interventions are not a priority over airway.

21. A client is receiving an infusion of vasopressin (Pitressin) to treat bleeding esophageal varices. Which client complaint indicates to the nurse that a serious adverse effect of the drug may be occurring? a. Acute nausea and vomiting b. A pounding frontal headache c. Vertigo and syncope d. Midsternal chest pain

ANS: D Midsternal chest pain is indicative of acute angina or myocardial infarction, which can be precipitated by vasopressin. The other side effects do not necessarily indicate that a serious side effect has occurred.

28. The RN has assigned a client with a newly placed arteriovenous (AV) fistula in the right arm to an LPN. Which information about the care of this client is most important for the RN to provide to the LPN? a. "Avoid movement of the right extremity." b. "Place gentle pressure over the fistula site after blood draws." c. "Start any IV lines below the site of the fistula." d. "Take blood pressure in the left arm."

ANS: D Repeated compression of a fistula site can result in loss of vascular access. Therefore, avoid taking blood pressures and performing venipunctures or IV placement in the arm with the vascular access. The other statements are not appropriate.

35. A client hospitalized for worsening kidney injury suddenly becomes restless and agitated. Assessment reveals tachycardia and crackles bilaterally at the bases of the lungs. Which is the nurse's first intervention? a. Begin ultrafiltration. b. Administer an antianxiety agent. c. Place the client on mechanical ventilation. d. Place the client in high Fowler's position.

ANS: D Restlessness, anxiety, tachycardia, dyspnea, and crackles at the bases of the lungs are early manifestations of pulmonary edema, which is a complication of kidney failure. Initial treatment of pulmonary edema consists of placing the client in high Fowler's position and administering oxygen. Mechanical ventilation and ultrafiltration may be indicated if symptoms become worse. An antianxiety agent would not be helpful. Morphine, however, has both vasoactive and sedating effects.

22. A client with severe esophageal varices is scheduled for trans-jugular intrahepatic portal-systemic shunt (TIPS) insertion. The nurse determines that teaching has been effective when the client makes which statement? a. "I will be discharged home after I wake up completely." b. "The procedure may be painful because I get only light sedation." c. "My liver will function normally within 8 hours of placement of the shunt." d. "I will be monitored closely for a while after the procedure is over."

ANS: D This procedure is performed in the radiology department under heavy sedation or general anesthesia. The client will be monitored as would any other postoperative client. The other statements are inaccurate.

38. Which assessment parameter does the nurse monitor in a client with chronic kidney disease to determine fluid and sodium retention status? a. Capillary refill b. Intake and output c. Muscle strength d. Weight and blood pressure

ANS: D Weight and blood pressure are helpful in estimating fluid and sodium retention. Weight and blood pressure rise with excess fluid and sodium. Weight is the most accurate noninvasive assessment for fluid status and therefore sodium status. Capillary refill also gives information on perfusion and oxygenation so is not specific for fluid status. Intake and output are part of the assessment for fluid status but do not account for insensitive water losses. Muscle strength is unrelated.

8. The nurse is teaching a client with a history of cholelithiasis to select menu items for dinner. Which selections made by the client indicate that the nurse's teaching was effective? a. Lasagna, tossed salad with Italian dressing, 2% milk b. Grilled cheese sandwich, tomato soup, coffee with cream c. Caesar salad with chicken, soft breadstick with butter, diet cola d. Roasted chicken breast, baked potato with chives, hot tea with sugar

ANS: D Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, 2% milk, grilled cheese, cream, and butter all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner.

6. The nurse is providing discharge teaching for a client who will be going home with a T-tube following cholecystectomy surgery. Which statement by the client indicates the need for additional teaching? a. "I will keep the drainage bag lower than the tube itself." b. "I will inspect the T-tube drainage site daily for signs of infection." c. "I will be careful not to pull on the tube or to accidentally pull it out." d. "I will slowly pull about an inch of the tube out each day until it's out."

ANS: D The provider will discontinue the T-tube. The other statements are accurate.