NUR 213 Test #2

The release of platelet-activating factors in patients who have sepsis triggers which response? A. Third spacing B. Formation of microthrombi C. Increased capillary permeability D. Decreased production of cytokines

B

A patient who is hospitalized with sepsis is at risk of developing which renal pathology? A. Nephritis B. Glomerular nephritis C. Acute tubular necrosis. (ATN) D. Chronic kidney disease (CKD)

C

Which statement indicates the nurse has a correct understanding of kidney ultrasonography? A. "Kidney ultrasonography primarily makes use of iodinated contrast dye." B. "Kidney ultrasonography is performed on the client with an empty bladder." C. "Kidney ultrasonography makes use of sound waves and has minimal risk." D. "Kidney ultrasonography provides three-dimensional information regarding kidneys."

C

The nurse is helping a client and the family to set and meet goals. Which professional role is the nurse displaying? A. Educator B. Advocate C. Manager D. Caregiver

D

Which interventions would the nurse include in the plan of care for a patient with a diagnosis of bacterial meningitis? A. Restrain the patient in bed. B. Increase the patient's fluid intake. C. Maintain the patient in a flat, supine position. D. Reduce the patient's environmental stimuli as much as possible.

D

What is supplemented in a AKI diet?

Essential amino acids Dietary fat

Nutrition Therapy for CKD patient with Hyperkalemia

Limit 2-3 grams Avoid high potassium foods Like: -Dried Fruits -Avocado -Leafy Greens except Kale -Bananas Normal protein intake for HD patient, increased protein for PD patient. Fluid restriction for HD patient

Post Renal

Obstruction Urine unable to drain adequately system-"backed up" -BPH, Calculi formation, Prostate cancer, Trauma to back pelvis, or perineum

CKD

Slow, progressive, irreversible loss in kidney function

For the patient with bacterial meningitis who has a severe headache, which clinical manifestations would the nurse monitor to identify potential complications? Skin rash Vomiting Irritability Photophobia Neck stiffness

Vomiting Irritability

PTSD Older Children and Teens S/S

•Disruptive disrespectful or destructive behaviors •Guilty feelings •Negative thoughts about themselves •Thoughts of revenge

Causes of Sepsis

•Gram-negative & Gram-positive bacteria •Parasites •Fungi •Viruses •The causative agent may not be identified

PTSD Adaptive Coping Mechanisms

•Maintaining good health and proper nutrition •Exercising regularly, •Sustaining positive personal relationships and social support networks, •Preserving positive self-esteem

PTSD Avoidance Symptoms

•Staying away from places, events, or objects •Avoiding thoughts or feelings

PTSD Cognitive Behavioral Therapy: Restructuring

•The goal of therapy is that the client will make sense of bad behavior. Helps the client look at what happened in a realistic way.

Transplant Donor Criteria

-Absence of systemic disease/infection -No history of cancer -No kidney disease -No hypertension history -Adequate kidney function

Nutrition Therapy for CKD patient with Hypertension

-Avoid high sodium foods: cured meats/cold cuts, pickled foods, canned soup, salad dressings, salt substitutes should be avoided because they contain potassium -Sodium restriction: 2 to 4 g/day -As urine output decreases, fluids are restricted

Meningitis CAT scan

-Done before a LP -To rule out obstruction of foramen magnum to prevent a fluid shift resulting in herniation. Can reveal increased ICP or hydrocephalus

CKD Erythropoietin

-For Anemia -Given IV or subcutaneously -Increased hemoglobin and hematocrit in 2 to 3 weeks -Side effects: thromboembolism, hypertension

Sepsis assessments and monitoring

-Temperature/ Fever -CBC/ WBC/ Neutrophils -BP/HR/RR -Skin assessment -Mental Status -Blood sugar -Cultures and sensitivity -Lung sounds

Fluid restriction

600mL plus previous 24-hr fluid loss

A Spanish-speaking client is being cared for by English-speaking nursing staff. Which communication technique would be correct for the nurse to use when discussing health care decisions with the client? A. Contact an interpreter provided by the hospital. B. Contact the client's family member to translate for the client. C. Communicate with the client using Spanish phrases the nurse learned in a college course. D. Communicate with the client with the use of a hospital-approved Spanish dictionary.

A

Which results are the benefits of providing culturally competent care? A. Increased client safety, Reduced health disparities, Increased client satisfaction B. Limits number of visitors, Ensures adequate interpreters

A

AKI Risk Factors

-Age -Chronic diseases: HF, Liver disease, DM -Nephrotoxic Substance: Aminoglycosides, NSAIDS -Chemotherapy -Dehydration -Acute kidney issues: Glomerulonephritis

Meningitis Risk Factors

-Age: babies -Group Setting -Certain Medical Conditions -Working with meningitis causing pathogens -Travel

Viral Meningitis LP-CSF

-Slightly increased WBC -Normal protein -Normal glucose -Negative bacteria -Clear

PTSD Pathophysiology

-Sympathetic Response - "Fight or Flight" continues when there is no longer presence of danger -The physiological response (known as the fight-or-flight response) is due to the release of catecholamines epinephrine and norepinephrine. Specifically, these hormones lead to increased heart rate, blood pressure, and cardiac output; dilation of bronchial airways; pupil dilation; increased blood flow to the skeletal muscles; and increased blood glucose.

A client with acute kidney injury is moved into the diuretic phase after 1 week of therapy. During this phase, which clinical indicators would the nurse assess? Select all that apply. One, some, or all responses may be correct. A. Dehydration, Hypovolemia B. Hyperkalemia, Metabolic acidosis, Skin rash

A

A client with end-stage renal disease receiving hemodialysis has a prescribed diet restricting proteins, sodium, and potassium. Which client statement indicates understanding of provided dietary instructions? A. "I should avoid using salt substitutes." B. "I should exclude meat from my diet." C. "I may not add seasoning to my food." D. "I may eat low-sodium canned vegetables."

A

A nurse is reviewing the chart of a 68-year-old patient admitted with pneumonia. The nurse knows that the patient has the potential to develop sepsis based on which risk factors? A. Age B. Hearing loss C. Daily exercise D. Daily intake of multivitamins

A

Where is the blood pressure cuff placed on a client with a dialysis access fistula in the right arm? A. On the left arm B. Over the fistula C. Below the fistula D. Above the fistula

A

Which medication may be used during the treatment of severe hyperkalemia resulting from intravenous (IV) administration? Select all that apply. One, some, or all responses may be correct. A. Calcium chloride, Calcium gluconate, Sodium bicarbonate, Dextrose solution with insulin B. Sodium chloride

A

uWhile you are closely monitoring N.G. during hemodialysis, which activities could you appropriately delegate to the unlicensed assistive personnel (UAP) (Select all that apply.)? A.Provide skin care for N.G. B.Administer insulin based on N.G.'s blood glucose results C.Document vital signs on the computerized patient record D.Empty and measure wound drainage on your other patient Monitor N.G. for any signs of bleeding or hemorrhage

A.Provide skin care for N.G. C.Document vital signs on the computerized patient record D.Empty and measure wound drainage on your other patient

A client who has renal failure asks the nurse why anemia keeps recurring. Which reason would the nurse explain to the client? A. Increase in blood pressure B. Decrease in erythropoietin C. Increase in serum phosphate levels D. Decrease in sodium concentration

B

Which abnormal finding would the nurse monitor for during the oliguric phase of acute kidney injury? A. Hypothermia B. Hyperkalemia C. Hypocalcemia D. Hypernatremia

B

Which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia? A. Uremic frost B. Chronic fatigue C. Tubular necrosis D. Dependent edema

B

Which test would the nurse monitor when determining whether a client's newly transplanted kidney works effectively? A. Renal scan B. Serum creatinine C. 24-hour urine output D. White blood cell (WBC) count

B

Which treatment outcome would the nurse expect when administering antibiotic therapy and symptomatic treatment of a patient with bacterial meningitis? A. The patient will experience muscle aches. B. The patient will return to maximal neurologic function. C. The patient will have a chance of recurrence of infection. D. The patient will experience some discomfort while performing daily activities.

B

Which symptom is indicative of the need for dialysis in the child with chronic kidney disease? A. Hypotension B. Hypokalemia C. Hypervolemia D. Hypercalcemia

C

Which type of organism most commonly causes sepsis? A. Fungi B. Viruses C. Bacteria D. Parasites

C

uN.G. insists on drinking diet cola despite his dietary restrictions. Which nursing intervention best applies evidence-based practice in response to N.G.'s action? A.Allow N.G. to drink the diet cola of his choice. B.Teach N.G. that cola is high in sodium and phosphorous and thus not allowed. C.Collaborate with the dietitian to find a soda with the least amount of sodium and phosphorus. D.Ask N.G.'s health care provider to prescribe diuretics to counteract N.G.'s intake of diet cola.

C.Collaborate with the dietitian to find a soda with the least amount of sodium and phosphorus.

Intra Renal

Cellular Damage Damage to the cells that make filtering mechanism possible -Acute pyelonephritis, Contrast media, Aminoglycosides (gentamicin, amikacin), Acute glomulonephritis

When teaching the staff about how the health care provider strives to work effectively within the cultural context of a client, which cultural principle is the nurse leader explaining? A. Cultural diversity B. Cultural sensitivity C. Cultural imposition D. Cultural competence

D

Which statement by a client who has chronic kidney failure treated with continuous ambulatory peritoneal dialysis (CAPD) indicates understanding of the therapy? A. "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." B. "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." C. "It decreases the need for immobility because it clears toxins in short and intermittent periods." D. "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."

D

N.G.'s mother also asks about the possibility of donating one of her kidneys for a transplant if N.G. would need that in the future. Your best response to her comment is that A.as a living related donor, the chances that she would be a good donor are high. B.talk of a transplant is premature because N.G. has not tried a course of dialysis yet. C.a transplant should be carefully considered because if the kidney is rejected, there is no alternative treatment. D.before any decision is made about a transplant, extensive evaluation of N.G.'s medical and psychosocial status would need to be made.

D.before any decision is made about a transplant, extensive evaluation of N.G.'s medical and psychosocial status would need to be made.

Fixed urine-specific gravity

Decreased renal concentrating ability

uYou recognize that N.G. has a decreased glomerular filtration rate based on the findings of

Periorbital and peripheral edema

A client falls at home and is brought to the emergency department by family members. The client reports intercostal pain and is confused and disoriented. Which technique is the best way for the nurse to determine whether confusion is new for the client?

Question the family members about the client's usual behavior.

Kernig's sign

Resistance to extension of the leg while the hip is flexed

Which response is best when the home care nurse calls to make an appointment for the initial visit with a client who has heart failure and the client reports that many family members are visiting today and requests that the nurse wait a week for the appointment?

Tell the client that it might be helpful to talk with family members during the initial visit.

PTSD Cognitive Behavioral Therapy: Exposure

The goal is to help people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced.

PTSD Re-experiencing Symptoms

•Flashbacks •Recurrent, intrusive recollection of the event •Dreams or images related to the event •Illusions, or hallucinations •Physical signs of stress

PTSD Maladaptive Coping Mechanisms

•Use or abuse of alcohol and other substances •Smoking •Excessive eating •Denial •Withdrawal, or avoidance

For the febrile patient diagnosed with meningitis, which parameter would the nurse monitor to prevent development of potential complications? A. Fluid intake B. Urine output C. BP D. Respiratory rate

A

Which interventions would the nurse follow while dealing with family members after the death of the client who was critically injured in an earthquake? A. Coordinating with crisis staff, Offering the option of speaking to a clergy B. Expressing intense grief, Avoiding concrete language, Avoiding words such as "death" or "died"

A

Phosphate Binders

▪Bind phosphate in bowel and excrete in stool ▪Calcium acetate (PhosLo) ▪Sevelamer hydrochloride (Renagel) ▪Calcium carbonate ▪Should be administered with each meal and snacks •Side effect: constipation, Think about tx of constipation with CKD

uBecause of N.G.'s elevated serum potassium levels, you monitor him closely for which complication of AKI? A.Gastrointestinal (GI) bleeding B.Dysrhythmias C.Seizure activity D.Pulmonary embolism

B.Dysrhythmias

Characteristics of HD

Contributes to anemia Effective and rapid clearance of potassium and creatinine Extensive equipment necessary Less protein loss Lowers serum triglycerides Rapid fluid removal Requires surgical placement of vascular access

Types of Immunosuppressants

Cyclosporine Corticosteroids Azathioprine Cyclophosphamide

Metabolic acidosis

Failure of excretory ability of kidneys

Hypertension

Fluid retention

Asterixis

High urea content of the blood

General central nervous system depression

High urea content of the blood

CKD Proteinuria

Persistent proteinuria typically first sign of CKD

Which nursing action establishes the nurse as a caregiver for a client in spiritual distress?

Provides therapeutic treatment to the client

For which complications would the nurse monitor a client hospitalized with end-stage kidney disease? Select all that apply. One, some, or all responses may be correct. A. Anemia, Dyspnea B. Jaundice, Hyperexcitability, Hypophosphatemia

A

For which potential complication would the nurse monitor a client receiving continuous ambulatory peritoneal dialysis for end-stage kidney disease? Select all that apply. One, some, or all responses may be correct. A. Tachycardia, Cloudy outflow, Abdominal pain B. Pruritus, Oliguria

A

In which situation would the nurse consider family members as the primary source of information? A. The client is an infant or child., The client is brought in as an emergency., The client is critically ill and disoriented. B. The client is an older adult., The client visits the outpatient department.

A

Which action would the nurse take after reviewing laboratory results and noting that a client with acute kidney injury has a potassium level of 6.2 mEq (6.2 mmol/L)? A. Alert the cardiac arrest team. B. Call the laboratory to repeat the test. C. Notify the health care provider. D. Obtain an antiarrhythmic medication.

C

The adolescent children are having difficulty talking with their mother, who is in the terminal stage of cancer. Which rationale best supports initiating a family meeting? A. It is important to make goals for solving family problems before death occurs. B. The children will be unable to deal with their feelings until after their mother dies. C. A deeper level of knowledge will help the children understand the mother's teelings. D. Open communication increases ability to work through reactions to the terminal illness.

D

When assessing a patient presenting with clinical manifestations of meningeal irritation and nuchal rigidity, which description would the nurse use to explain nuchal rigidity to the patient? A. Tonic spasms of the legs B. Curling into a fetal position C. Arching the neck and back D. Resistance to flexion of the neck

D

Calcium carbonate is ordered for N.G. to be taken with each meal. You explain to him that this medication is used to: A.prevent osteoporosis. B.inactivate potassium in the GI tract. C.decrease his risk of gastric ulcer formation. D.bind phosphorus in the bowel, preventing its absorption.

D.bind phosphorus in the bowel, preventing its absorption.

Hyperkalemia

Failure of excretory ability of kidneys

Brudzinski's sign

Flexion of the hips and knees in response to neck flexion

Bacterial Meningitis

Meningitis caused by bacteria can be deadly and requires immediate medical attention. Vaccines are available to help protect against some kinds of bacterial meningitis.

CKD Hyperkalemia Tx

•Restriction of high-potassium foods and drugs •Acute: IV glucose and insulin, IV 10% calcium gluconate •Sodium polystyrene sulfonate (Kayexalate): Osmotic laxative action (diarrhea) •Patiromer (Veltessa)—binds K+ in GI tract: May bind other oral meds; take 6 hours before or 6 hours after, delayed onset •Dialysis—most effective

PTSD Pharmacology

•SSRI antidepressants, such as sertraline (Zoloft), are the first line of treatment for trauma- and stressor-related disorders. Clients who have anxiety disorders also can benefit from other types of antidepressants. •Benzodiazepines, such as diazepam (Valium) and lorazepam (Ativan), are indicated for short-term use. •Nonbenzodiazepine antianxiety agents, such as buspirone (BuSpar), are used to manage anxiety • Beta blockers and antihistamines to decrease anxiety. •Anticonvulsants are used as mood stabilizers for the client who is experiencing anxiety

CKD Risk Factors

-Age > 60 years -Cardiovascular disease -Ethnic minorities: African American (4x) highest rate secondary to hypertension, Native Americans (2x) second highest rate secondary to diabetes, Hispanic (1.5x) -Exposure to nephrotoxic drugs -Family history of CKD -Hypertension

Sepsis Blood Cultures

-Blood Cultures: Identify probable microorganisms by characteristics: shape, growth patterns and gram-staining qualities -Sensitivity Testing= After organism is cultured, it is subjected to sensitivity testing using various antibiotics to determine which antibiotic is to be MOST EFFECTIVE, Usually takes 24-48 hours to grow organism, SPECIMENS SHOULD BE OBTAINED BEFORE ANTIBIOTIC THERAPY INITIATED

AKI Dx

-Creatinine Clearance Test: 24-hour urine test, Some may be 8-12 hours, Encourage fluids before/during test, Avoid caffeine during 24-hour testing period, Void and discard the first urine at the starting time of the test, Boric acid used as preservative, Educate client this may smell like vinegar, Keep on ice or refrigerated throughout testing time, Document/lab specimen correctly prior to sending to lab -Biopsy: Renal biopsy is gold standard diagnostic treating for intrarenal AKI etiologies

AKI Diuretic Phase

-Duration: 1 to 3 weeks -Gradual decline in BUN and Cr, but still elevated -Continued low creatinine clearance with improving GFR -Hypokalemia -Hyponatremia -Hypovolemia -UOP will increase significantly (4 to 5 L/day) -Monitor for f & e imbalances -End of this phase acid/base, f & e, and waste production (BUN) values stabilize

How is meningitis spread?

-Group B Streptococcus and E. coli: Mothers can pass these bacteria to their babies during birth. -H. influenzae, M. tuberculosis, and S. pneumoniae: People spread these bacteria by coughing or sneezing while in close contact with others, who breathe in the bacteria. -N. meningitidis: People spread these bacteria by sharing respiratory or throat secretions (saliva or spit). This typically occurs during close (coughing or kissing) or lengthy (living together) contact. -E. coli: People can get these bacteria by eating food prepared by people who did not wash their hands well after using the toilet.

A client suffering from cancer is near the end of life. Which action(s) would be performed by the nurse to support the client's family members?

-Helping the family set up hospice -Taking time to make sure that the family understands care options -Staying with the client in the absence of family members -Giving the family information about the dying process -Making sure that the family knows what to do at the time of death

AKI Recovery Phase

-Increased GFR -UOP returns to normal -Memory improves -Strength returns -Stabilization or continual decline in BUN and Cr toward normal -Complete recovery (may take 1 to 2 years) -Clients that recovery still are considered in the early stage of CKD -If recovery phase not reached, ESRD

Sepsis S/S

-Increased HR/ weak pulse -Confusion/ Disorientation -Extreme pain/ Discomfort -Fever/Shivering/ Cold -Shortness of breath -Clammy or sweaty skin

Bacterial Meningitis LP- CSF

-Increased WBC -Increased protein -Decreased glucose -Positive bacteria -Cloudy to turbidity

Sepsis Risk Factors

-Infants, children, older adults -People who have serious injuries -People who survived sepsis -People with recent severe illness or hospitalization -People with chronic medical condition-Diabetes -Immunosuppressed patients- HIV, Chemotherapy Patients

Sepsis

-Life-threatening syndrome in response to an infection -A group of symptoms or syndrome in response to an infection that can include organ dysfunction related to the infection -Infection fighting processes turn on the body, causing organs to work poorly

Nutrition Therapy for AKI patient

-Maintain adequate caloric intake which would include: Increasing carbohydrates, fat, and proteins to prevent breakdown -Restrict sodium, potassium, and phosphorus: kidneys not making vitamin D so calcium is not being absorbed, kidneys cannot excrete phosphorus, restrict sodium because this will cause increased fluid retention

Not Candidates for Transplant Selection

-Morbidly Obese -Smoker -Advance cancer -Chronic respiratory failure -Chronic infections -Unresolved psychosocial disorders -Noncompliant with medication regimens -Alcohol use -Drug use -CVD -DM

Which factors would the nurse consider when evaluating the lumbar puncture results of a patient with bacterial meningitis?

-Perform a lumbar puncture atter ruling out an obstruction in the foramen magnum. -Lumbar puncture usually helps to confirm the diagnosis of bacterial meningitis. -Lumbar puncture obtains cerebrospinal fluid (CSF) for analysis in case of bacterial meningitis

Nutrition Therapy for CKD patient with Hyperphosphatemia

-Phosphate binders -1 gram of phosphate per day -Foods that are high in phosphate include meat and dairy products (e.g., milk, ice cream, cheese, yogurt, pudding) -Many foods that are high in phosphate are also high in protein -Since patients on dialysis are encouraged to eat a diet containing protein, phosphate binders are essential to control the phosphate level. -Dairy, beans, meat, nuts, seeds, grains

AKI

-Rapid loss of kidney function from renal cell damage -Slight deterioration function to severe impairment -Over hours or days -Reduction in glomerular filtration rate (GFR) -Progressive elevations in BUN, creatinine, and potassium -With/without reduction in urine output -Azotemia: Accumulation of urea nitrogen & creatinine in the blood -Most common cause acute tubular necrosis

Meningitis Causes

-Several types of bacteria can cause meningitis. Leading causes in the United States include: - Streptococcus pneumoniae - Group B Streptococcus - Neisseria meningitidis - Haemophilus influenzae - Listeria monocytogenes - E Coli.

Nutrition Therapy for CKD patient with Hypermagnesemia

-Spinach, chard, pumpkin seeds, yogurt, almond, black beans, avocado, figs, dark chocolate, banana AVOID: -Milk of Magnesia -Magnesium Citrate -Laxatives with magnesium -Antacids containing magnesium

Transplant Rejection S/S

-Temperature higher than 100° F (37.8° C) -Pain or tenderness over the grafted kidney -2- to 3-lb (0.9 to 1.4 kg) weight gain in 24 hours -Edema -Hypertension -Malaise -Elevated blood urea nitrogen and serum creatinine levels -Decreased creatinine clearance -Elevated white blood cell count -Rejection indicated by ultrasound or biopsy

AKI Oliguric Phase

-Within 1-15 days of the injury to the kidneys -Longer duration the less chance of recovery -UOP less than 400mL/day -Elevated BUN and Cr -Decreased urine specific gravity -Decreased GFR and creatinine clearance -Hyperkalemia- Most serious complication of AKI -Normal or decreased serum sodium level -Hypervolemia -Hypocalcemia -Hyperphosphatemia -Metabolic Acidosis

The nurse is preparing to discharge a client who is partially paralyzed after a stroke. Which behaviors would the nurse alert the family of as symptoms of caregiver role strain? A. Disturbed sleep patterns, Reduced appetite and weight, Fearful about administering medications to the client B. Concerned about personal appearance, Engages in leisure activities as often as possible

A

The registered nurse teaches a student nurse regarding the management of increased potassium levels in a client. Which action performed by the student nurse indicates effective learning? A. Administering sodium polystyrene sulfonate B. Instructing a client to increase potassium and sodium intake C. Monitoring glucose levels hourly D. Providing potassium-sparing diuretics

A

When caring for a patient with sepsis and a suspected infection, which action would the nurse take next? A. Initiate broad-spectrum antibiotics. B. Obtain blood cultures after antibiotic initiation. C. Provide pain medication to increase patient comfort. D. Hold antibiotic therapy until the organism is identified.

A

Which assessment finding is associated with rejection of a kidney transplant? Select all that apply. One, some, or all responses may be correct. A. Fever, Oliguria, Weight gain B. Jaundice, Polydipsia

A

Which clinical manifestation suggests sepsis? A. Hyperglycemia in the absence of diabetes B. Sudden diuresis unrelated to drug therapy C. Respiratory rate of seven breaths per minute D. Bradycardia with sudden increase in BP

A

Which criterion is a clinical manifestation of sepsis? A. Infection B. Hypoglycemia C. Normal body temperature D. Systolic BP of 100 mm Hg or higher

A

Which goals of care are associated with the family health system model? A. Improving family health or well-being, Providing assistance in family management of illnesses, Achieving health outcomes related to the family's areas of concern B. Preparing for family transitions later in life, Promoting positive family behaviors to achieve essential tasks

A

Which intervention would the nurse include in the plan of care of a client with end-stage renal disease who has a mature arteriovenous (AV) fistula? Select all that apply. One, some, or all responses may be correct. A. Auscultate the fistula for the presence of a bruit., Palpate the site to identify the presence of a thrill., Avoid drawing blood from the affected extremity. B. Irrigate the fistula with saline to maintain patency., Keep the fistula clamped until ready to perform dialysis.

A

Which interventions would the nurse implement for a dying client and the family? A. Help the family set up home care if required., Determine the client and family's strengths and weaknesses., Arrange for church or community support for the family. B. Arrange for restorative care., Refrain from telling the family that the client is dying.

A

Which nursing action is the priority for a client who has a serum potassium level of 6.7 mEq/L (6.7 mmol/L)? A. Monitor for cardiac dysrhythmias. B. Inquire about changes in bowel patterns. C. Assess for leg muscle twitching or weakness. D. Assess for signs and symptoms of dehydration.

A

Which nursing instruction would the nurse provide to a diabetic client who developed renal disease? Select all that apply. One, some, or all responses may be correct. A. Instruct the client to check their blood pressure regularly. Direct the client to contact their primary health care provider before taking ibuprofen. Encourage the client to undergo a microalbuminuria test yearly. B. Recommend the client drink boiled water. Suggest the client go for morning walks.

A

Which prescribed medication would the nurse expect as maintenance therapy for a client with a kidney transplant? Select all that apply. One, some, or all responses may be correct. A. Azathioprine, Prednisone B. Basiliximab, Antithymocyte globulin (equine) Erythropoietin

A

Which response would the nurse give to a client with endstage renal disease who states, "I heard that it is inevitable that I will need a kidney transplant. If so, which one of my kidneys will be removed?" A."Neither of your kidneys will be removed unless they become infected." B. "The kidney that is the most diseased is removed and replaced with a new one." C. "Your primary health care provider determines which kidney is replaced with a new one." D. "Your right kidney will be removed, because it has a longer renal vein, making transplantation easier."

A

Which statement would the nurse include in the preoperative teaching plan of a client who, after receiving hemodialysis for several years, has a kidney transplant scheduled? Select all that apply. One, some, or all responses may be correct. A. "The kidney may not function immediately." "Precautions are needed to prevent infection." "A urinary catheter will be present postoperatively." B. "Immunosuppressive medications will be given preoperatively." "The arteriovenous fistula will be used for drawing blood specimens preoperatively."

A

Which statements by the student nurse indicate an understanding of caring for clients of various cultures? A. "The focus is on understanding the traditions, beliefs, and values of the client's culture.", "I will be aware of my own cultural background and beliefs when attending to clients who belong to different cultures." B. "Care would be provided strictly on the basis of the traditions, beliefs, and values of the client's community." • "Generalized education and information would be provided to clients belonging to a different community." • "The cultural background of the client has no effect on health, wellness, and illness."

A

The nurse is caring for a patient who is diagnosed with bacterial meningitis. What are the priority actions by the nurse?

Administer a corticosteroid along with the first dose of IV antibiotics. Collect specimens for a culture to confirm the diagnosis of bacterial meningitis. Initiate antibiotic therapy after obtaining specimen but prior to confirming diagnosis.

uWhen planning care for N.G., you consider the interprofessional care indicated for patients with acute poststreptococcal glomerulonephritis. Select all the interventions that are indicated in the management of N.G. There are 8 correct answers. A.Administration of antibiotics B.Administration of antihypertensive agents C.Administration of corticosteroids D.Administration of diuretics E.Administration of insulin F.Capillary blood glucose monitoring ACHS G.Daily weights H.Intake and output I.High protein diet J.Rest K.Sodium and fluid restriction

Administration of antihypertensive agents Administration of diuretics Administration of insulin Capillary blood glucose monitoring ACHS Daily weights Intake and output Rest Sodium and fluid restriction

Which description of family-centered care is correct? A. The nursing care is focused on the client as an individual. B. A collaborative plan of care is developed to achieve optimal health. C. The health care provider is the expert in developing a plan of care. D. The nursing care is based solely on standards of practice.

B

Which intervention would the nurse implement to develop a caring relationship with the client's family? A. Deciding health care options for the client B. Identifying the client's family members and their roles C. Declining to inform the client's family after performing a procedure D. Refraining from discussing the client's health with the family

B

Which intervention would the nurse implement when a patient, receiving treatment for viral meningitis since last week, arrives at the hospital reporting a persistent severe headache? A. Instruct the patient to use analgesics for the headache. B. Inform the patient that. headaches can occur after recovery. C. Teach the patient that a headache is not a major complication. D. Notity the patient that a full recovery from viral meningitis is not possible.

B

Which patient would the nurse monitor most closely for possible development of sepsis? A. A seven-year-old patient with ear pain and history of chronic otitis media B. An 86-year-old patient with a fever and history of chronic urinary tract infections C. A 54-year-old patient with a sore throat and no significant previous medical problems D. A 62-year-old patient with complaints of cough and history of chronic obstructive pulmonary disease (COPD)

B

Which process would the nurse consider when formulating a response to a client with acute kidney injury who states "Why am I experiencing twitching and tingling of my fingers and toes?" A. Acidosis B. Calcium depletion C. Potassium retention D. Sodium chloride depletion

B

Which rationale best supports informing the family about what is happening with the client's permission? A. The family can reassure the client to decrease anxiety. B. The family will be better equipped to assist the client. C. The family will appear more relaxed with the situation. D. The family is less likely to cause problems for the nurse.

B

Three days after his admission, N.G. is experiencing increased edema and his blood pressure rises to 182/102. His BUN increased to 42 mg/dL (15 mmol/L) and his creatinine has increased to 1.8 mg/dL (159.1 mmol/L). N.G. continues to have marked hematuria and proteinuria. He is placed on strict bed rest, and antihypertensive drugs are started in addition to corticosteroids and increased diuretic dosages. His health care provider is concerned that he may be developing rapidly progressive glomerulonephritis and orders a creatinine clearance test. You understand that the creatinine clearance test A.requires the collection of a urine specimen every 6 hours for 24 hours. B. reflects the glomerular filtration rate and indicates the amount of functioning renal tissue. C.is a 24-hour collection of urine used to evaluate the kidneys' ability to concentrate urine. D.is a measurement of urea and creatinine in the blood at hourly

B.reflects the glomerular filtration rate and indicates the amount of functioning renal tissue.

During the beginning phase of a therapeutic relationship, why is a clear understanding of participants' roles important? A. To understand what will be discussed B. To display that the nurse is trying to be helpful C. To know what to expect from the relationship D. To prepare for termination of the relationship

C

Of the four assigned patients on the acute care unit, which patient has the highest risk for developing bacterial meningitis? A. The patient with a skull fracture B. The patient with prior brain trauma C. The patient with a pulmonary infection D. The patient with bacterial endocarditis

C

The nurse is assisting with the end-of-life care of a client. Which activity is performed when the nurse views family as context? A. Assess the resources available to the family. B. Meet the client's family's comfort and nutritional needs. C. Meet the client's comfort, hygiene, and nutritional needs. D. Determine the family's need for rest and their stage of coping.

C

Which clinical response will the nurse assess to determine kidney damage in a client who develops a transfusion reaction? A. Glycosuria B. Blood in the urine C. Decreased urinary output D. Acute pain over the kidney

C

Which information would the nurse give the parent of a child being treated for acute poststreptococcal glomerulonephritis (APSGN)? A. How to obtain vital signs daily B. Date on which to return to prepare for renal dialysis C. Instructions about which high-sodium foods to avoid D. List of activities that will encourage the child to remain active

C

Which prescribed hemodialysis protocol would the nurse implement when a client with end-stage renal failure, beginning hemodialysis for the first time, reports nausea and a headache, and then appears to become confused? A. Administer an analgesic for the headache. B. Administer an antiemetic for the nausea. C. Decrease the rate of the hemodialysis exchange. D. Discontinue the procedure immediately.

C

Which priority action would the nurse perform when discharging a client with limited English proficiency? A. Ask the family to translate information for the client. B. Speak directly to the client during the instruction process. C. Assess the need for a medical interpreter for client teaching. D. Provide discharge instructions in the client's native language.

C

Which reason describes the purpose of restricting sodium for a client with hypertension? A. To chemically stimulate the loop of Henle B. To diminish the thirst response of the client C. To prevent reabsorption of water in the distal tubules D. To cause fluid to move toward the interstitial compartment

C

Which statement explains the amount of prescribed fluid when the nurse estimates that a client admitted in the oliguric phase of acute kidney injury had a urinary output of 200 mL over the past 12 hours and the client's plan of care indicates a fluid restriction of 900 mL of free water per 24 hours? A. The fluid equals the expected urinary output for the next 24 hours. B. The fluid prevents the development of pneumonia and a high fever. C. The fluid compensates for insensible fluid loss and the expected urinary output. D. The fluid reduces hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.

C

A client injured in a motor vehicle accident was brought to the emergency department and taken immediately for a scan. The client's family arrives and asks about the client's condition. Which response would the nurse provide? A. "Please do not worry; everything will be all right." B. "I am sorry; I do not have any information about the client." C. "You will have to wait for the primary health care provider." D. "Please wait; I will update you as soon as I have any information."

D

A client is placed on a restricted diet. Which communication is best for the nurse to use when beginning to teach the client about the diet? A. Asking about what type of foods the client usually eats B. Telling the client that the diet must be followed exactly as written C. Telling the client that the intake of foods on the list must be limited D. Asking what the client knows about the diet that was prescribed

D

Which response would the nurse make to the spouse of a client who had a cerebrovascular accident and seems unable to accept the goal that the client will participate in self-care? A. Tell the spouse to let the client do things independently. B. Allow the spouse to assume total responsibility for the client's care. C. Explain that the nursing staff has full responsibility for the client's activities. D. Ask the spouse for assistance in planning activities most helpful to the client.

D

The health care provider determines that hemodialysis is necessary for N.G. when he fails to respond to conservative treatment. A temporary vascular access catheter, exiting from his chest wall and tunneled subcutaneously to the internal jugular vein, is placed for immediate use with hemodialysis. During the initial hemodialysis treatment, your priority assessment focuses on N.G.'s A.intake and output. B.capillary blood glucose. C.emotional response to dialysis. D.blood pressure and cardiac rhythm.

D.blood pressure and cardiac rhythm.

You plan to promote rest for N.G. during his hospitalization, but when entering his room later, you find him pacing around the room, fretting because he is missing classes. He asks you how long it will be until he can go back to school. Your best response to him is that he: A.should be able to go back to school within a few days. B.should just be glad he isn't feeling bad and not worry about school. C.has the right to sign himself out of the hospital in order to prioritize his school work. D.needs to take it easy until his BP returns to normal and his edema subsides.

D.needs to take it easy until his BP returns to normal and his edema subsides.

Pre Renal

Inadequate perfusion Not enough blood at sufficient pressure to allow filtering -HF, MI, Dysrhythmias, Embolism, Neurologic injury, Burns, Dehydration, Hemorrhage

The nurse starts a new job and recognizes that the client population is very diverse. Which action will help the nurse provide culturally competent care?

Increase self-awareness of cultural identity, cultural knowledge, and potential biases.

Meningitis

Inflammation of the protective membranes covering of the protective membranes covering the brain and spinal cord

Characteristics of PD

Less cardiovascular stress Less complicated May lead to high blood glucose levels Provides more flexibility and portable system Requires fewer dietary restrictions Risk for tunnel and exit-site infections

Viral Meningitis

Meningitis caused by viruses is serious but often is less severe than bacterial meningitis. People with normal immune systems who get viral meningitis usually get better on their own. There are vaccines to prevent some kinds of viral meningitis.

What is restricted in a AKI diet?

Phosphorus Potassium Sodium Water

PTSD Cognition and Mood Symptoms

• Trouble remembering key features of the traumatic event • Negative thoughts about oneself or the world •Distorted thoughts about the event that cause feelings of blame • Ongoing negative emotions, such as fear, anger, guilt, or shame • Loss of interest in previous activities •Feelings of social isolation •Difficulty feeling positive emotions, such as happiness or satisfaction

PTSD Kids under Age 6 S/S

•Bedwetting, after previously learning how to use the toilet •Forgetting how or being unable to talk •Acting out the scary event during playtime •Being unusually clingy with a parent or other adult.

PTSD Arousal and Reactivity Symptoms

•Being easily startled •Feeling tense, on guard, or "on edge" •Having difficulty concentrating •Having difficulty falling asleep or staying asleep • Feeling irritable and having angry or aggressive outbursts • Engaging in risky, reckless, or destructive behavior.

PTSD Patient Education

•Educate regarding identification of manifestations of anxiety. •Instruct to notify the provider of worsening effects and to not adjust medication dosages. •Warn the client against stopping or increasing medication without consultation with the provider. •Assist to evaluate coping mechanisms that work and do not work for controlling the anxiety •Assist to learn new methods of coping mechanisms. •Use of alternative stress relief and coping mechanisms may increase medication effectiveness and decrease the need for medication in most cases.

PTSD Risk Factors

•Genetic and neuro biological link •Can occur at any age-including childhood •Women more likely than men •War veterans •Survivors or witnesses of physical and sexual assaults, abuse, accidents, disasters •Sudden death of a loved one •Not everyone with PTSD has been through a dangerous event—some get it after a friend or family member experiences danger or is harmed.

PTSD Interventions

•Provide a structured interview to keep the client focused on the present. •Assess for comorbid condition of substance use disorder. •Provide safety and comfort to the client during the crisis period of these disorders, as clients in severe- to panic-level anxiety are unable to problem solve and focus. •Remain with the client during the worst of the anxiety to provide reassurance. •Perform a suicide risk assessment. •Provide a safe environment for other clients and staff. •A structured environment for physical safety and predictability •Monitoring for, and protection from, self-harm or suicide •Activities that encourage the client to share and be cooperative •Use of therapeutic communication skills •Client participation in decision making regarding care •Use relaxation techniques •Instill hope for positive outcomes (but avoid false reassurance). •Enhance client self-esteem by encouraging positive statements and discussing past achievements. •Assist the client to identify defense mechanisms that interfere with recovery. •Postpone health teaching until after acute anxiety subsides. Clients experiencing a panic attack or severe anxiety are unable to concentrate or learn