NUR2243 Module 1 EAQs
A patient who underwent a liver transplant for the treatment of liver cancer is prescribed cyclosporin. The patient reports a sore throat and fever. The nurse suspects which complication?
infection
The laboratory results for a patient who underwent a liver transplant due to liver cancer are shown in the following chart. What is a possible finding from the set of data?
infection
Which instructions would the nurse include when educating a patient with diabetes about how to prevent fasting hyperglycemia known as "dawn phenomenon"?
"Administer Lantis (insulin glargine) at 10 p.m. instead of with the evening meal."
A liver is retrieved from a donor for liver transplantation for a patient with liver cancer. What would be the maximum duration within which the liver has to be transplanted to the cancer patient?
8 hours
Which is a chronic complication that can occur in patients with diabetes?
Cell death from macrovascular changes
Which symptoms indicate autonomic neuropathy? Select all that apply.
Atonic bladder Dried, cracked skin Orthostatic hypotension
Which activity by the nurse will best relieve symptoms associated with ascites?
Elevating the head of the bed
What does a fasting blood glucose of 65 mg/dL indicate?
Hypoglycemia
What is one of the causes of acidosis?
Kidney failure
Which blood glucose level does the operating room nurse recognize as optimal during surgery to prevent hypoglycemia?
150 mg/dL
Which explanation best assists a patient in differentiating type 1 diabetes from type 2 diabetes?
Those with type 2 diabetes make insulin, but in inadequate amounts.
What is a risk factor for liver cancer?
cirrhosis
The registered nurse is teaching a student nurse about the usage of long-term dialysis catheters. Which statement by the student nurse about the placement of a long-term dialysis catheter needs correction?
"A tunnel measuring 10 cm is made subcutaneously."
At a health fair, the nurse is teaching attendees about acute kidney injury (AKI). What statement made by a participant indicates a need for further teaching?
"AKI is usually not reversible."
The registered nurse teaches a student nurse about the dialysis catheter. Which statement of the student nurse indicates the need for further teaching?
"Central venous pressure is measured from the catheter."
A 5'8", 225-pound patient with metabolic syndrome has a blood pressure of 158/96 mm Hg, a high-density lipoprotein cholesterol level of 39 mg/dL, and a waist size of 44 inches. Which recommendation does the nurse make to this patient?
"Consume fewer calories to reduce your weight."
Which patient statements indicate that he or she has understood teaching regarding neuropathy? Select all that apply.
"I will inspect my feet every day." "I will take my prescribed gabapentin." "I will try to keep my blood glucose level steady."
The nurse is educating a patient with liver cancer about liver transplantation. What statement made by the patient indicates a need for further teaching?
"Donor liver implantation precedes surgical removal of diseased liver."
The nurse is providing discharge teaching to a patient with diabetes about injury prevention for peripheral neuropathy. Which statement by the patient indicates a need for further teaching?
"I can break in my shoes by wearing them all day."
The nurse is teaching a patient with diabetes about proper foot care. Which statement by the patient indicates that teaching was effective?
"I must inspect my shoes for foreign objects before putting them on."
The nurse is teaching a patient who has just been prescribed insulin glargine about administration. What statements by the patient indicate a need for further teaching? Select all that apply.
"I will take this before meals and at bedtime." "If I am hospitalized, I can receive this medication intravenously."
The nurse is providing discharge teaching to a patient with newly diagnosed diabetes. Which statement by the patient indicates a correct understanding about the need to wear a MedicAlert bracelet?
"If I become hypoglycemic, I could become unconscious."
The nurse is caring for a 29-year-old patient who presents to the primary care clinic for an annual well exam. The patient asks the nurse, "Should I be tested for diabetes?" What is the nurse's best response? Select all that apply.
"If you have a first-degree relative with diabetes, you should be tested for diabetes." "If you have been diagnosed with vascular disease, you should be screened for diabetes."
The nurse is providing instructions to a patient scheduled for a fasting plasma glucose (FPG) test for diabetes screening. What statement by the patient reflects a need for further teaching?
"It is important not to eat 12 hours before the labs are drawn."
A patient with ascites says, "This diet is terrible. I don't know how anyone can survive with no salt on their food." What is the best response by the nurse?
"Not eating salt is an acquired taste, which you can become used to."
The registered nurse is teaching a student nurse about liver cancer. Which statement made by the student nurse requires further teaching?
"Patients with hepatitis A are at a high risk of liver cancer."
The registered nurse is teaching a student nurse about liver cancer. What statement made by the student nurse needs correcting?
"Patients with liver cancer will have a decrease in serum alpha fetoprotein."
Discharge teaching has been provided for a patient recovering from kidney transplantation. Which information indicates that the patient understands the instructions?
"The anti-rejection medications will be taken for life."
The registered nurse is teaching a student nurse about liver transplantation as a treatment option for patients with primary liver cancer. Which statement made by the student nurse indicates the need for further teaching?
"The diseased liver is removed through an incision made in the lower abdomen."
The registered nurse is teaching a group of student nurses about assessment findings of each stage of portal systemic encephalopathy. Which statement made by a student nurse indicates a need for further teaching?
"The patient in stage II will have muscle twitching."
The registered nurse is teaching a student nurse about the complications of liver transplantation for patients with liver cancer. Which statement made by the student nurse requires further teaching?
"The use of immunosuppressants should be discontinued if there is an infection."
The registered nurse teaches a student nurse about tubular damage in the kidneys. Which statement by the student nurse indicates the need for further teaching?
"Tubular damage results in intrarenal acute kidney injury."
A diabetic patient has a glycosylated hemoglobin (A1C) level of 9.4%. What does the nurse say to the patient regarding this finding?
"What are you doing differently?"
The nurse is caring for a patient who has type 2 diabetes with poorly controlled blood glucose levels. The patient asks the nurse, "When my blood sugar is high, why am I always hungry, even when I constantly eat?" What is the nurse's best response? Select all that apply.
"When insulin is not present, increased hunger persists." "Despite eating, glucose is not being used at the cellular level." "When cellular glucose is low, cell starvation triggers excessive hunger."
The nurse is caring for a patient with diabetes mellitus who tells the nurse, "I sometimes have episodes of seeing double. What causes that?" Which response would the nurse give?
"You are likely experiencing an episode of low blood sugar when this happens."
A patient diagnosed with hepatitis A asks the nurse how this disease may have been contracted. Which answer by the nurse is correct?
"You may have consumed foods contaminated with the virus."
The nurse is counseling an asymptomatic patient who is worried about possible hepatitis C exposure several years ago. What does the nurse tell this patient about the risk of this disease?
"You may have serious long-term damage even without symptoms."
The nurse is caring for a patient with diabetes mellitus who received insulin aspart at 8:00 AM. At which time does the nurse expect hypoglycemia most likely to occur in this patient?
11:00 AM
A patient 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?
"You sound frustrated with the situation."
In reviewing the health care provider admission requests for a patient admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis?
1 ampule NaHCO 3 IV now
The nurse is reviewing the implications of culture on the development of diabetes. Which patient will the nurse determine has the greatest risk for developing type 2 diabetes mellitus?
44-year-old healthy American Indian patient with a family history of type 2 diabetes
Which patient does the nurse identify as needing screening for type 2 diabetes?
A 46-year-old patient with no health history
Which patient is more susceptible to acute kidney injury (AKI)?
A patient suffering from hypertension
Which patient with end stage kidney disease is an ideal candidate for hemodialysis?
A patient who just had surgery for appendicitis
Which finding in the first 24 hours after kidney transplantation requires immediate intervention?
Abrupt decrease in urine output
A patient admitted to the emergency department is having an acute episode of asthmatic bronchitis. The nurse notes the pH on the most recent arterial blood gas is 7.31. What is the most likely explanation for this finding?
Acidosis in response to the excessive retention of carbon dioxide
A patient who received insulin glargine subcutaneously 30 minutes ago is now cool, clammy, and anxious. The patient states "Something is wrong with me." The blood glucose level is 54. What action by the nurse is should be taken?
Administer a carbohydrate replacement
When is the best time for the nurse to counsel the patient about the importance of dialysis therapy?
After the initial reduction of uremic symptoms
The serum level of what enzyme is elevated in patients with obstructive jaundice?
Alkaline phosphatase
Which laboratory parameter will be elevated in a patient diagnosed with primary liver cancer?
Alpha-fetoprotein (AFP)
Which is the best referral that the nurse can suggest to a patient who has been newly diagnosed with diabetes?
American Diabetes Association
A registered nurse is teaching a group of nursing students about the recommendation of the American Diabetes Association (ADA) regarding indications for testing an individual with type 2 diabetes. Which individual suggested by a nursing student for testing indicates a need for further education?
An individual who is 45 years old with a body mass index (BMI) less than 25 kg/m2 READ RATIONALE; This is wrong
The nurse working in the renal care unit recognizes that which conditions are most likely to result in acute kidney injury related to prerenal perfusion reduction? Select all that apply.
Anaphylaxis Severe dehydration Antihypertensive medications Use of aspirin, ibuprofen, or nonsteroidal anti-inflammatory drugs (NSAIDs)
When caring for a patient with a pulse oximetry level of 89%, which action does the nurse take first?
Apply oxygen as prescribed.
The nurse is caring for a group of patients with acidosis. The nurse recognizes that Kussmaul respirations are consistent with which situation?
Aspirin overdose
The nurse is caring for a patient with diabetes mellitus with autonomic neuropathy. What nursing intervention will the nurse perform for this patient? Select all that apply.
Assess the patient for urine retention Apply lotion to areas of dry, cracked skin Instruct the patient to move positions slowly to avoid getting dizzy
Which nursing action can the home health nurse delegate to a home health aide who is making daily visits to a patient with newly diagnosed type 2 diabetes?
Assist the patient with washing the feet and applying moisturizing lotion.
The nurse asks a patient 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?
Asterixis
When caring for a patient with a forearm arteriovenous (AV) fistula created for hemodialysis, which actions must the nurse take? Select all that apply.
Auscultate for a bruit every 8 hours. Teach the patient to palpate for a thrill over the site. Ensure that no blood pressure measurements are taken in that arm.
What techniques should a patient with diabetes use to administer insulin injections? Select all that apply.
Avoid injecting insulin on scarred sites. Avoid injecting within a 2-inch radius around the navel. Grasp a fold of the skin and inject insulin subcutaneously.
A patient who has liver disease with ascites asks about any necessary dietary changes. What instruction does the nurse include when teaching this patient?
Avoid using table salt.
Which instruction by the nurse will help a patient with chronic kidney disease prevent renal osteodystrophy?
Avoiding peas, nuts, and legumes
A patient newly diagnosed with diabetes is being instructed when to perform blood glucose monitoring. At what times does the nurse instruct the patient to check blood glucose? Select all that apply.
Before meals Frequently if you are ill If you are thirsty and urinate frequently
The nurse is reviewing the diagnostic test results for a patient with hepatitis. Which elevated test result does the nurse correlate to the presence of jaundice?
Bilirubin
The nurse is concerned that a patient with diabetes mellitus is at risk for developing chronic kidney disease (CKD). What findings did the nurse use to make this clinical determination? Select all that apply.
Blood pressure 168/90 mm Hg 12-year history of type 2 diabetes mellitus Fasting blood glucose levels between 180 and 200 mg/dL Stopped taking prescribed angiotensin receptor blocker (ARB)
The laboratory reports of a patient show the patient has metabolic alkalosis. What conditions may result in metabolic alkalosis? Select all that apply.
Blood transfusion Prolonged vomiting Nasogastric suctioning Total parenteral nutrition
The lab values for a patient admitted for an exacerbation of chronic obstructive pulmonary disease (COPD) reveal a pH of 7.29 with a decreased PaO 2 and an elevated PaCO 2. Which initial treatment does the nurse expect the provider to most likely order?
Bronchodilator therapy
What macrovascular complications may occur as a result of diabetes mellitus? Select all that apply.
Cardiovascular disease Cerebrovascular disease
A patient in acute respiratory distress from an asthma attack becomes more confused. Respirations remain rapid but are more shallow. The most recent blood gas results are pH 7.29, PaO 2 62 mm Hg, PaCO 2 56 mm Hg, HCO 3 -25 mEq/L. What is the nurse's priority intervention?
Call the Rapid Response Team.
The nurse is providing teaching about weight gain secondary to insulin resistance to a patient with type 1 diabetes. What actions by the patient can minimize this complication?
Calorie restriction
What information should be included when teaching a patient with diabetes about foot care?
Check bath water temperature before stepping in the water.
What are the early manifestations of pulmonary edema?
Crackles at the base of the lungs
Which signs and symptoms indicate rejection of a transplanted kidney? Select all that apply.
Crackles in the lung fields Blood pressure of 164/98 mm Hg +3 edema of the lower extremities
A patient who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered?
Colon cancer with metastasis to the liver
The nurse is caring for a patient who has been prescribed digoxin for acute kidney injury. What manifestations are likely to be observed in the patient experiencing digoxin toxicity? Select all that apply.
Color vision changes Changes in mental ability Halos around bright lights
After successful resuscitation of cardiopulmonary arrest, the nurse views these arterial blood gases: pH 7.28; CO 2 52; HCO 3 - 16. What is the interpretation of these values?
Combined respiratory and metabolic acidosis
To prevent prerenal acute kidney injury, which person is encouraged to increase fluid consumption?
Construction worker
Which conditions place a patient at risk for developing metabolic alkalosis? Select all that apply.
blood transfusion nasogastric suctioning total parenteral nutrition
Following liver transplantation, which medication will the nurse administer to reduce the risk of organ rejection?
Cyclosporin
What statement is related to acute kidney injury (AKI)?
Damage to 50 to 95% of nephrons results in an AKI.
The nurse is assessing the laboratory reports of a patient with impaired kidney function. What changes most indicate the patient has metabolic acidosis?
Decrease in serum bicarbonate level
In caring for a patient who has undergone paracentesis, which changes in the patient's status should be promptly reported to the provider?
Decreased blood pressure, increased heart rate
The nurse receives a report on a 52-year-old patient with type 2 diabetes. Which complication of diabetes does the nurse report to the provider?
Decreased peripheral perfusion
Which is an important institutional measure that a hospital should take to prevent the transmission of hepatitis B (HBV) to health care workers?
Develop a hospital-wide needleless system for delivery of medications.
Which are microvascular complications of diabetes mellitus? Select all that apply.
Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction Ee and vision complications
A patient with cirrhosis reports having difficulty getting to sleep and staying asleep. Which action by the nurse is correct?
Discuss this early sign of serious complications with the provider.
What teaching regarding insulin administration should the nurse include in patient teaching? Select all that apply.
Disposable syringes should be used only once. It is important to use the same type of syringe regularly.
A patient is in an education class for diabetes care. What teaching should be provided to a patient regarding alcohol use and diabetes mellitus?
Drink alcohol with meals.
The nurse has provided teaching about exercise to a patient diagnosed with type 1 diabetes. What action by the patient demonstrates effective teaching?
Eat a carbohydrate snack if participating in unplanned exercise.
A new nurse is caring for a postoperative patient with the following arterial blood gas (ABG) result: pH 7.30; PaCO 2 60 mm Hg; PaO 2 80 mm Hg; bicarbonate 24 mEq/L; and O 2 saturation 96%. Which of these actions by the new graduate is indicated?
Encourage the patient to use the incentive spirometer and cough.
Which action does the nurse take first for the patient who is admitted to the emergency department (ED) with a panic attack and whose blood gases indicate respiratory alkalosis?
Encourage the patient to take slow breaths.
A nurse is reviewing the medical records of patients diagnosed with liver disease. Which patient condition can be resolved with liver transplantation? Select all that apply.
End-stage liver disease Autoimmune liver disease Recurrent bacterial peritonitis
The nurse is completing an abdominal assessment of a patient who has suspected liver cancer. What should the nurse expect to feel when palpating the right upper quadrant of the abdomen?
Enlarged and nodular liver
What information about exercise should the nurse include for patients diagnosed with diabetes? Select all that apply.
Exercise increases insulin sensitivity. Hypoglycemia can occur from increased muscle glucose uptake. Exercise can lead to hyperglycemia and ketones if diabetes is not controlled.
A patient is admitted with severe diabetic ketoacidosis. Arterial blood gas results reveal a pH of 7.21. What is this patient's acidosis most likely in response to?
Excessive breakdown of fatty acids
The nurse is providing health screening. The nurse determines that the patient with which lab value should receive teaching related to diabetes?
Fasting blood glucose of 127 mg/dL
When caring for a patient with metabolic acidosis, what must the nurse keep in mind regarding acid-base chemistry?
Fluids with lower pH have higher acidity.
The patient with diabetes is at risk for eye and vision complications. What is the distinguishing characteristic of proliferative diabetic retinopathy?
Formation of new retinal blood vessels
A patient is receiving a loop diuretic for chronic kidney disease. Which drug does the nurse recognize as a loop diuretic?
Furosemide
A patient is required to undergo hemodialysis. Which dialyzable drug does the nurse expect to be administered to the patient after hemodialysis is performed?
Ganciclovir
A patient who is scheduled for surgery in the morning is placed on NPO status. The patient is scheduled to receive insulin glargine before bed. What action by the nurse should be taken?
Give the insulin
Which hormone is responsible for maintaining blood glucose levels during periods of fasting from food?
Glucagon
Which of the following is the process of converting proteins to glucose?
Gluconeogenesis
What should the nurse expect to assess in a patient with diabetes diagnosed with distal symmetric polyneuropathy? Select all that apply.
Hammertoes Loss of sensation of the lower legs Tingling sensation in the feet and legs
A patient is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement?
Handwashing
A patient who has undergone liver transplantation due to primary liver cancer reports clay-colored stools and vomiting. What post-surgical complication does the nurse anticipate?
Hepatic complication
Which findings would the nurse see in a patient with primary liver cancer who is awaiting liver transplantation? Select all that apply.
Hepatic encephalopathy Total bilirubin of 5.5 mg/dL Increased alpha-fetoprotein
The home health care nurse is providing teaching to an insulin-dependent patient regarding infection. What symptom is priority for the patient to report to the health care provider?
Hyperglycemia
Which electrolyte abnormality does the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis?
Hyperkalemia
A patient admitted with diabetic ketoacidosis was treated for metabolic acidosis with intravenous (IV) fluids and insulin. Which electrolyte imbalance does the nurse monitor for as the acid-base imbalance resolves?
Hypokalemia
Which factors may lead to the development of hepatic encephalopathy in a patient with cirrhosis? Select all that apply.
Hypokalemia High-protein diet Gastrointestinal bleeding
For which systemic, metabolic complications does the nurse monitor the patient who is admitted with an acute kidney injury?
Hyponatremia
Which assessment finding is consistent with a diagnosis of viral hepatitis?
Icteric skin
A patient tests positive for immunoglobulin G (IgG) hepatitis A virus (HAV) antibodies. For which condition is this result indicative?
Immunity to HAV after previous HAV infection
The nurse is caring for a patient with cirrhosis and profound ascites. Which assessment finding causes the nurse to notify the provider?
Inaudible breath sounds
What is the role of incretin hormones in glucose regulation? Select all that apply.
Increase insulin secretion Slow rate of gastric emptying Prevent hyperglycemia after meals
A patient with chronic kidney disease (CKD) has developed the Kussmaul pattern of respiration. What causes this breathing pattern?
Increased acid retention
Deep and rapid breaths consistent with Kussmaul respirations are found in patients with which type of acid-base imbalance?
Metabolic acidosis
A patient is suspected of having liver cancer and the nurse is reviewing the laboratory results. Which laboratory result, if present in the patient's chart, would the nurse recognize as a confirmation of this diagnosis?
Increased alpha-fetoprotein Alpha-fetoprotein (AFP) is a tumor marker of liver cancer; increased alpha-fetoprotein levels confirm liver cancer.
Which clinical manifestation indicates the need for increased fluids in a patient with kidney failure?
Increased blood urea nitrogen (BUN)
One week after liver transplantation surgery for liver cancer, a patient reports severe pain in the right upper quadrant region, fever, and elevated heartrate. What other laboratory parameters would help to diagnose this condition as an acute graft rejection? Select all that apply.
Increased serum bilirubin Increased alkaline phosphatase
An important component of the nursing assessment for patients at risk for acute kidney injury includes monitoring laboratory values. Which alteration does the nurse expect to find in a patient with kidney disease?
Increased serum potassium
How does the body compensate for a low pH?
Increases respiratory rate
The nurse is teaching a patient about insulin administration. Which actions by the patient demonstrate an accurate understanding of the teaching provided? Select all that apply.
Inserting needle at 90-degree angle Turning bottle upside down to withdraw insulin
A patient newly diagnosed with type 1 diabetes is receiving education about the types of premeal insulin. What selection by the patient indicates the teaching was effective?
Insulin aspart
A patient has received teaching about the use of basal insulin for glucose stabilization. What selection indicates the teaching has been effective?
Insulin glargine
The nurse is teaching a patient about the movement of glucose in the body. Arrange the sequence of events that take place when blood glucose levels drop in the correct order.
Insulin secretion stops and glucagon is released. Glycogenolysis and gluconeogenesis take place. Lipolysis, or the breakdown of fat, takes place. Proteolysis, or the breakdown of proteins, takes place.
What term does the nurse use to document a condition where the ability to produce dilute urine is reduced, resulting in urine with a fixed osmolarity?
Isosthenuria
What is the primary nursing intervention for a patient with an acute kidney injury who has increased blood osmolarity?
Isotonic saline infusion
Which statement about repaglinide is correct?
It increases the secretion of insulin from the pancreas.
Which statement about hepatitis A is accurate?
It is transmitted by the fecal-oral route.
A patient with chronic kidney disease wants to undergo peritoneal dialysis. What are the advantages of peritoneal dialysis? Select all that apply.
It provides better blood pressure control than hemodialysis. It requires fewer dietary and fluid restrictions than hemodialysis.
The nurse is caring for a patient with diabetes. What distinguishing characteristic of glucagon must the nurse be aware of?
It triggers the release of glucose from cell storage sites.
When assessing a patient with hepatitis B, the nurse anticipates which assessment findings? Select all that apply.
Itching Tea-colored urine Right upper quadrant tenderness
The nurse is developing a care plan for a patient who underwent a liver transplantation secondary to primary liver cancer. What findings, if present in the patient, would indicate to the nurse that the patient is experiencing transplant rejection? Select all that apply.
Jaundice Low-grade fever Decreased bile drainage
The nurse is reviewing the medical record of a patient with type 2 diabetes mellitus. What information suggests that the patient has been focusing on changing modifiable risk factors?
Latest low-density lipoprotein (LDL) cholesterol level 68 mg/dL
Which assessment finding represents a positive response to erythropoietin therapy?
Less fatigue
The nurse is providing nutritional education to a patient newly diagnosed with diabetes. What should be considered for optimal adherence to the plan? Select all that apply.
Lifestyle Financial status Cultural background
Which instructions would the nurse give to a patient at discharge, following hospitalization for an acute kidney injury (AKI)? Select all that apply.
Limit the intake of foods containing phosphorus. Report a daily weight gain of 2 pounds or more.
Which medication is most effective in slowing the progression of kidney failure in a patient with chronic kidney disease?
Lisinopril
A patient with a history of cardiac arrhythmias is diagnosed with liver cancer. Which treatment would be contraindicated in the patient?
Liver transplantation
The nurse assists a patient with acute kidney injury (AKI) to modify the diet in which ways? Select all that apply.
Low potassium Restricted fluids Restricted protein
In teaching a patient about the prevention of complications from type 2 diabetes mellitus, which instruction does the nurse include?
Maintain a hemoglobin A 1c level less than 6%.
The nurse obtains lab results for a 50-year-old patient with the following results: pH 7.24; bicarbonate 20; PaO 2 82; PaCO 2 35. These findings are consistent with which acid-base imbalance?
Metabolic acidosis
To decrease the risk of acid-base imbalance, what goal must the patient with diabetes mellitus strive for?
Maintaining blood glucose level within normal limits.
What preventive measures should be taken while harvesting a kidney from a cadaveric patient?
Maintaining perfusion by mechanical ventilation
What intervention is appropriate for the patient with stage 4 chronic kidney disease (CKD)?
Managing complications and preparing for renal replacement
The nurse is assessing the key features of severe chronic kidney disease in a patient. What term does the nurse use to document the presence of black and tarry stools?
Melena
A patient being treated for cardiovascular disease has factors that increase the risk for developing type 2 diabetes mellitus. On which health problem should the nurse focus when assessing this patient?
Metabolic syndrome
Which medication lowers blood glucose levels by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity?
Metformin (Glucophage)
A patient currently taking acetazolamide develops metabolic acidosis. Which nursing interventions are appropriate for the nurse to include in the plan of care? Select all that apply.
Monitoring electrolyte levels Administering intravenous (IV) fluids Placing the patient on fall precautions
During a clinic visit, a patient with type 2 diabetes mellitus has a sudden onset of nausea and vomiting. What should the nurse suspect is occurring with the patient?
Myocardial infarction
What should the nurse include when reviewing microvascular complications of a patient with type 2 diabetes mellitus? Select all that apply.
Neuropathy Retinopathy Nephropathy
What can slow the progression of diabetic neuropathies?
Normal blood glucose levels
When evaluating the laboratory results of a patient with diabetic ketoacidosis, which lab value indicates the body has fully compensated from this acid-base imbalance?
Normal pH on arterial blood gases
When caring for a group of patients at risk for respiratory acidosis, the nurse identifies which person as at highest risk?
Patient who smokes cigarettes
An unconscious patient brought to the emergency department has a history of Laennec's cirrhosis and esophageal varices. What is the priority assessment for this patient?
Noting the presence of bloody emesis or stool
The nurse is teaching a class for patients who have mild chronic kidney disease. The nurse will tell the class participants that which interventions can help slow the progression to end-stage kidney disease? Select all that apply.
Nutrition therapy Fluid volume control Prescription medications Managing blood pressure
Which finding is seen in a patient with type 2 diabetes mellitus?
Obesity
A patient with diabetes mellitus has had a cholecystectomy. The nurse prioritizes blood glucose management in the patient's plan of care for which reason?
Patients with postoperative hyperglycemia are prone to poor wound healing.
What pretreatment should be given to a patient with a known history of renal failure while administering ibuprofen?
Oral or intravenous bolus of fluid volume
A patient with chronic kidney disease sustained a fall at home. The imaging and laboratory reports revealed multiple fractures, spinal sclerosis, decreased bone density, decreased serum calcium levels, and elevated serum phosphorous levels. Which diagnosis is the nurse most likely to expect for this patient?
Osteodystrophy
The nurse is assessing patients with acid-base imbalances. Which patient has a diagnosis that correctly correlates with the patient's manifestation?
Patient A has metabolic acidosis.
The urine output of four patients undergoing treatment for acute kidney injury (AKI) is given below. Which patient's finding should be reported immediately to the health care provider?
Patient D
The RN has just received a change-of-shift report. Which of the assigned patients should be assessed first?
Patient with chronic kidney failure who was just admitted with shortness of breath
Which patient would be appropriate to assign to the new nurse working on the medical-surgical unit?
Patient with emphysema and cellulitis with a PaCO 2 level of 58 mm Hg
The nurse has just received a change-of-shift report on the endocrine unit. Which patient does the nurse see first?
Patient with type 1 diabetes whose insulin pump is beeping "occlusion"
The community health nurse is exploring the cause of an outbreak of hepatitis A. Which individual does the nurse suspect may be the source?
Patients who were infected after eating at the same restaurant
The RN is caring for a patient with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)?
Placing the patient in a semi-Fowler's position
Three hours after renal transplantation surgery, the patient complains of severe pain at the transplant site. Upon examination, blood pressure is 170/90 mm Hg and body temperature is 104°F. What should the nurse do for the immediate treatment of the patient?
Prepare the patient for surgery
Which problem excludes a patient hoping to receive a kidney transplant from undergoing the procedure?
Presence of tuberculosis
The nurse is determining the learning needs of a patient diagnosed with diabetes. What items should the nurse include in this assessment? Select all that apply.
Psychosocial concerns Current mental health status Nutrition history and practices
The nurse is treating a patient with diabetes. Which are risk factors for development of vision loss in patients with diabetes? Select all that apply.
Proteinuria Poor glucose regulation
What measure should the caregiver of a patient with diabetes take to treat moderate hypoglycemia?
Provide 15 g of carbohydrate and cheese.
Which action is correct when drawing up a single dose of insulin?
Pull back plunger to draw air into the syringe equal to the insulin dose.
A computed tomography (CT) scan of a patient shows a small tumor that is confined to one liver lobe. However, the patient is not a candidate for surgery. Which treatment does the nurse anticipate to be given by the primary health care provider?
Radiofrequency ablation
When caring for a patient with kidney failure who has metabolic acidosis, which symptom does the nurse expect as evidence of the body's compensatory effort?
Rapid and deep respirations
The nurse is providing education to a patient with diabetes mellitus who has manifestations of cardiovascular disease. What is the nurse's priority action?
Reduce modifiable risk factors
After a motor vehicle crash, the nurse is consoling a patient in the emergency department who is hysterical and hyperventilating after being notified of the death of a family member. What acid-base imbalance is this patient likely to develop?
Respiratory alkalosis
The nurse is caring for a patient with a peritoneal dialysis catheter. What action does the nurse take?
Remove the old dressing and assess the area for infection.
A lab report for a 47-year-old patient shows the following results: pH 7.32; bicarbonate 24; PaO 2 77; PaCO 2 48. These findings are consistent with which acid-base imbalance?
Respiratory acidosis
What is taking place in the body when hyperventilation occurs?
The central nervous system is responding to a rise in carbon dioxide.
A patient with diabetes mellitus is brought to the emergency department after vomiting for several days. The patient has rapid, deep respirations and a urine dipstick reveals ketonuria. Which process does the nurse suspect is occurring with this patient?
Respiratory compensation for metabolic acidosis
A patient is diagnosed with liver cancer, and the tumor is found to be unresectable. Which targeted therapy would be prescribed by the primary health care provider?
Sorafenib
Which drug is used to treat liver cancer and acts by kinase inhibition?
Sorafenib
What laboratory parameters are decreased in acute kidney injury (AKI)?
Serum calcium
The nurse provides care for a patient admitted with an acute kidney injury. Which characteristics of the condition does the nurse expect this patient to exhibit? Select all that apply.
Sudden onset May not progress Nephron involvement between 50 and 95 percent
The nurse is providing preoperative instructions to a patient with diabetes. What instructions should the nurse include?
Sulfonylureas should be discontinued one day before surgery.
What teaching should be included for a patient with a new diagnosis of type 1 diabetes? Select all that apply.
Sick day rules Daily inspection of feet Reporting any vision changes
The nurse is providing teaching to a patient diagnosed with peripheral neuropathy secondary to diabetes. Which instructions regarding footwear should be included for the patient?
Socks or stockings should be fitted properly.
The nurse knows that a patient's glomerular filtration rate of 22 mL/min signifies that the patient is in which stage of chronic renal disease?
Stage 4, severe chronic kidney disease
The nurse is preparing teaching material for a patient newly diagnosed with type 1 diabetes mellitus. What should the nurse include about the main metabolic effects of insulin? Select all that apply.
Suppresses liver production of glucose Stimulates glucose uptake in heart muscle Stimulates glucose uptake in skeletal muscle Suppresses liver production of very-low-density lipoproteins
A patient underwent a liver transplantation surgery and receives cyclosporine. The nurse monitors the patient for which primary indicator of an acute graft rejection?
Tachycardia
A patient receiving hemodialysis is prescribed folic acid and ferrous sulfate orally. What does the nurse teach the patient about folic acid therapy?
Take the drug after dialysis.
The nurse is teaching a group of nursing students about the American Diabetes Association (ADA) recommendations for patient care. Which recommendation made by a nursing student indicates understanding?
The LDL cholesterol should be below 100 mg/dL for patients without signs of CVD.
A patient diagnosed with type 1 diabetes has had multiple episodes of hypoglycemia. What teaching by the nurse is indicated?
Use the fingertip only for blood glucose checks.
A patient with type 2 diabetes, retinopathy, and complaints of painful "pins and needles" sensations in the feet presents to the primary care clinic. The nurse notes the patient's low-density lipoprotein cholesterol (LDL) level is at 75 mg/dL. What can the nurse determine regarding the patient's LDL level?
The level is higher than the recommended level and should be addressed by the health care provider.
Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the health care provider?
The patient's heart rate is 122 beats/min.
How do nonsteroidal anti-inflammatory drugs (NSAIDs) cause acute kidney injury?
Through renal hypoperfusion NSAIDs inhibit the secretion of prostaglandins, which are essential for the vasodilatation of the afferent arterioles of the glomeruli and the maintenance of the glomerular filtration rate (GFR). NSAIDs drastically reduce the GFR and cause renal hypoperfusion.
What is the role of alarms in renal replacement therapy?
To detect an air embolus
The primary health care provider prescribes cyclosporin A to a patient who underwent a liver transplant for the treatment of primary liver cancer. What is the rationale behind this intervention?
To prevent acute graft rejection
The nurse places a long-term dialysis catheter into the internal jugular vein of a patient by making a 7 cm long subcutaneous tunnel. Why did the nurse use the tunneling technique?
To reduce the risk of infection
Which nephrotoxic nonsteroidal anti-inflammatory drug (NSAID) can cause acute kidney injury (AKI) in patients?
Tolmetin
A patient with acute kidney injury (AKI) is scheduled to undergo dialysis. What types of nutritional therapy may be required for the patient? Select all that apply.
Total parenteral nutrition (TPN) Fluid intake equal to urine output plus 500 mL
A patient with hepatic encephalopathy may require which dietary or pharmacologic therapy to help decrease serum ammonia levels?
Trial of lactulose to increase the excretion of ammonia
Which is a feature of metabolic syndrome?
Triglycerides 220 mg/dL
The urinalysis report of a patient suffering from acute kidney injury (AKI) reveals the presence of red blood cell casts and hemoglobin. What etiology of AKI should the nurse anticipate?
Tubular damage in kidneys
While assisting a patient during peritoneal dialysis, the nurse observes the drainage discontinue after 200 mL of peritoneal effluent. What action should the nurse implement first?
Turn the patient to the opposite side.
Under what circumstances does the nurse teach a patient with diabetes to contact the primary health care provider? Select all that apply.
Unable to take food or fluids Ketonuria lasting longer than 24 hours
A patient with severe azotemia reports severe chest pain radiating to the trapezoid region and difficulty in breathing. Upon examination, tachycardia, dysrhythmia, narrow pulse pressure, and low-grade fever are noticed. Which diagnosis is the nurse most likely to expect for this patient?
Uremic pericarditis
The nurse is caring for a patient with diabetes mellitus who is being screened for nephropathy. What laboratory test will the nurse reference as the test used to screen for early nephropathy?
Urine for albumin
A patient with cirrhosis is preparing for discharge home. What instruction does the nurse include when teaching this patient about dietary supplements?
Use only supplements prescribed by the provider.
The trauma nurse is caring for a patient who sustained thoracic trauma with multiple rib fractures and flail chest. Which intervention may be considered to promote gas exchange and prevent respiratory acidosis in this patient?
Ventilatory assistance
Which assessment finding is identified as a risk for type 2 diabetes mellitus (DM) and cardiovascular disease (CVD)?
Waist circumference of 40 inches or more
The nurse is teaching a patient with diabetes mellitus how to inject a mixture of NPH and regular insulins. In which order does the nurse instruct the patient to prepare and administer the insulin?
Wash the hands. Swab the rubber stoppers of the vials with alcohol. Draw up regular insulin. Draw up NPH insulin. Wipe the skin with alcohol. Inject the insulin at a 90-degree angle.
The nurse is providing information for a patient diagnosed with proliferative diabetic retinopathy. What exercise should the nurse instruct the patient to avoid?
Weightlifting
What are the causes of acute renal failure in a patient after undergoing a liver transplant secondary to liver cancer? Select all that apply.
hypotension use of cyclosporin acute liver failure
It is essential that the nurse monitor the patient returning from hepatic artery embolization for hepatic cancer for which potential complication?
bleeding
What complications should the nurse review with the patient prior to undergoing an ultrasound-guided liver biopsy to confirm a diagnosis of liver cancer? Select all that apply.
bleeding infection spread of tumor cells
What biochemical parameter may be decreased during renal failure?
calcium
What treatment utilizes liquid nitrogen to destroy liver tumors?
cryotherapy
The nurse is administering medications to a patient with liver cancer who just underwent a liver transplant. The nurse will closely monitor the patient's blood pressure after which medication?
cyclosporin
The nurse understands that which condition occurs in late chronic kidney disease?
decreased urine production
While assessing a patient suffering from acute kidney injury, the nurse observes peripheral edema and declined cognition. Further laboratory reports reveal the findings given in the patient chart. What is the most appropriate treatment?
dialysis
When caring for a patient with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? Select all that apply.
icterus of skin swollen abdomen prolonged partial thromboplastin time (PTT)
The nurse is providing screening for diabetes. What findings are consistent with both type 1 and type 2 diabetes diagnosis? Select all that apply.
fatigue polyuria polydipsia
A patient recently underwent liver transplantation for the treatment of liver cancer. Which post-surgery complications should the nurse anticipate? Select all that apply.
infections acute graft rejection
When caring for a patient with hepatic encephalopathy, which patient condition would cause the nurse to question the use of neomycin?
kidney failure
Which medication taken by a patient with diabetes mellitus will protect the kidneys and help prevent diabetic nephropathy?
lisinopril
The nurse is assessing a patient with chronic kidney disease and pericarditis. What manifestations of pericarditis does the nurse expect to find in the patient? Select all that apply.
low-grade fever pericardial friction rub
The nurse is caring for a patient with metabolic alkalosis. What manifestations of metabolic alkalosis is the nurse likely to assess? Select all that apply.
numbness around the mouth hyperactivity of deep tendon reflexes
Which conditions and/or symptoms may be most likely responsible for this acid-base imbalance: pH 7.32, PaO 2 82 mm Hg, PaCO 2 50 mm Hg, HCO 3 - 18 mEq/L? Select all that apply.
oliguria dehydration respiratory rate of 8 breaths/min
Which arterial blood gas result does the nurse anticipate in the care of a patient diagnosed with acute kidney failure?
pH 7.33, PaO 2 82 mm Hg, PaCO 2 35 mm Hg, HCO 3 - 19 mEq/L
Which arterial blood gas laboratory values would be seen in metabolic alkalosis?
pH 7.49, HCO 3 - 32
A patient has undergone liver transplantation for the treatment of liver cancer. Which findings may indicate impaired function of the transplanted liver? Select all that apply.
petechiae ecchymosis encephalopathy
Lab results for a 62-year-old patient show the following results: pH 7.48; bicarbonate 26; PaO 2 90; PaCO 2 32. These findings are consistent with which acid-base imbalance?
respiratory alkalosis
What microvascular complications of the blood vessel structure can occur in the patient with diabetes mellitus? Select all that apply.
retinopathy nephropathy
A patient with cirrhosis has a weight gain of 2 kg. The nurse notes distention of the abdomen, a heart rate of 92 beats/min, and a blood pressure of 88/58 mm Hg. For which condition is this patient at risk?
shock
Which vitamin may be especially important for a patient who is alcoholic with liver disease?
thiamine
Which factor represents a sign or symptom of digoxin toxicity?
vision changes
