Chronic Final Practice
The nurse just received an urgent laboratory value on a patient in renal failure. The potassium level is 6.3. The telemetry monitor is showing peaked T waves. Which prescription from the primary health care provider should be implemented first? A. Administer regular insulin intravenously (IV) B. Restrict dietary potassium intake to 40 meq daily C. Administer kayexalate enema D. Educate the patient on dietary restriction of potassium
A
A major advantage of peritoneal dialysis is: A. The diet is less restricted and dialysis can be performed at home B. The dialysate is biocompatible and causes no long-term consequences C. High glucose concentrations of the dialysate cases a reduction in appetite, promoting weight loss D. No medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins
A
The nurse monitors a client with cirrhosis for the development of hepatic encephalopathy. WHich of the following would be an indication that hepatic encephalopathy is developing? A. Decreased mental status B. Elevated blood pressure C. Decreased urine output D. Labored respirations
A
To help prevent lithium toxicity in the older adult, the nurse modifies the nursing care plan to include interventions to: A. Increase fluid intake to 3,500mL daily B. Have the patient ambulate for 10 min after the drug is given C. Restrict citrus fruits in their diet D. Administer a prescribed stool softener to ensure a bowel movement
A
What diet should be implemented for a client in the early stages of cirrhosis? A. High-calorie, high-carbohydrate B. High protein, high-fat C. High-fat, high-carbohydrate D. Low-carbohydrate, low-sodium
A
A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by A. Progressive irreversible destruction of the kidneys B. A rapid decrease in urine output with an elevated BUN C. An increasing creatinine clearance with a decrease in urine output D. Prostration, somnolence, and confusion with come and imminent death
A
Which manifestations in a patient with a T4 spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia? A. Headache and rising blood pressure B. Irregular respirations and shortness of breath C. Decreased level of consciousness or hallucinations D. Abdominal distention and absence of bowel sounds
A
Which of the following measures should the nurse focus on for the client with esophageal varices? A. Recognizing hemorrhage B. Controlled blood pressure C. Encouraging nutritional intake D. Teaching the client about the varices
A
A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? A. Assess temperature and initiate workup to rule out infection B. Reassure the patient that this is common after transplantation C. Provide warm cover for the patient and give 1 g acetaminophen orally D. Notify the nephrologist that the patient has developed symptoms of acute rejection
A
or what purpose would the nurse use the Mini-Mental State Examination (MMSE) to evaluate a patient with cognitive impairment? A. It is a good tool to determine the etiology of dementia. B. It is a good tool to evaluate mood and thought processes. C. It can help to document the degree of cognitive impairment in delirium and dementia. D. It is useful for initial evaluation of mental status but additional tools are needed to evaluate changes in cognition.
C
What should be included in the management of a patient with delirium? A. The use of restraints to protect the patient from injury B. The use of short acting benzodiazepines to sedate the patient C. Identification and treatment of underlying causes when possible D. Administration of high doses of an antipsychotic drug such as haloperidol (Haldol)
C
A client with cirrhosis begins to develop ascites. Spironolactone (Aldactone) is prescribed to treat the ascites. The nurse should monitor the client closely for which of the follow drug-related adverse effects. A. Constipation B. Hyperkalemia C. Irregular Pulse D. Dysuria
B
A nurse is caring for a client who has Alzheimer's disease and falls frequently. Which of the following actions should the nurse take first to keep the client safe? A. Keep the call light near the client. B. Place the client in a room close to the nurses' station. C. Encourage the client to ask for assistance. D. Remind the client to walk with someone for support.
B
A nurse is caring for a patient who has a new diagnosis of Hepatitis C. Which of the following is an expected laboratory finding? A. Presence of immunoglobulin G antibodies (IgG) B. Presence of enzyme immunoassay (EIA) C. Aspartate aminotransferase (AST) 35 units/L D. Alanine aminotransferase (ALT) 15 IU/L
B
A patient with acute hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to: A. Avoid alcohol for the first three weeks B. Use a condom during sexual intercourse C. Have family members get an injection of immunoglobulin D. Follow a low-protein, moderate-carbohydrate, moderate-fat diet.
B
As a first step in teaching a women with a spinal cord injury and quadriplegia about her sexual health, the nurse assess her understanding of her current sexual functioning. Which statement by the client indicated she understands her current ability? A. "I will not be able to have sexual intercourse until the urinary catheter is removed" B. "I can participate in sexual activity but might not experience orgasm" C. "I cannot have sexual intercourse because it causes hypertension, but other sexual activity is okay" D. "I should be able to participate in sexual activity, but i will be infertile"
B
The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first? A. Check for medications interactions B. Determine whether there are medications duplications C. Call the prescribing health care provider (HCP) and report polypharmacy D. Determine whether a family member supervises medication administration
B
The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement? A. "I should avoid alcohol completely for a long as a year" B. "I must avoid all physical contact with my family until the jaundice is gone" C. "I should use a condom to prevent spread of the disease to my sexual partner" D. "I will need to rest several times a day, gradually increasing my activity as I tolerate it"
B
A nurse is providing teaching to the partner of an older adult client who has Alzheimer's disease and has a new prescription for donepezil (Aricept). Which of the following statements by the partner indicates the teaching is effective? A. This medication should increase my husband's appetite. B. This medication should help my husband sleep better. C. This medication should help my husband's daily function. D. This medication should increase my husband's energy level.
C
During the period of spinal shock, the nurse should expect the clients bladder function to be: A. Spastic B. Normal C. Atonic D. Uncontrolled
C
The client with a spinal cord injury asks the nurse why the dietitian has recommended to decrease the total daily intake of calcium. Which response by the RN would provide the most accurate information? A. "Excessive intake of dairy products makes constipation more common" B. "Immobility increases calcium absorption from the intestine" C. "Lack of of weight bearing causes demineralization of the long bones" D. "Dairy products likely will contribute to weight gain"
C
The major risk of polypharmacy for the older adult is: A. Insufficient knowledge about medications B. The use of over the counter medications C. Being treated by more than one physician D. Taking old prescriptions rather than consulting a physician
C
The nurse is caring for a client with a spinal cord injury. The client is experiencing blurred vision and has a blood pressure of 204/102mm Hg. What should the nurse do first? A. Position the client on the left side B. Control the environment by turning the lights off and decreasing stimulation for the client C. Check the client's bladder for distension D. Administer pain medication
C
The nurse is instructing the client with chronic kidney disease to maintain adequate nutritional intake. Which diet would be most appropriate? A. High carbohydrate, high protein B. High calcium, high potassium, high protein C. Low protein, low sodium, low potassium D. Low protein, high potassium
C
A male client with a history of cirrhosis and alcoholism is admitted with ascites. The client's wife asks the nurse to explain why his abdomen is swollen and he is unable to fasten his belt. The most accurate explanation of this disease process is...? A. "He has eaten too many foods with salt in them. Salt pulls water with it" B. "The swelling in his ankle must have moved up closer to his heart so the fluid circulates better" C. " He must have forgotten to take his daily water pill" D. "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels"
D
A nurse believes that patients with the same type of tissue injury should have the same amount of pain. This statement reflects: A. A belief that will contribute to appropriate pain management B. An accurate statement about pain mechanisms and an expected goal of pain therapy C. A belief that will have no effect on the type of care provided to people in pain D. A lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management
D
A nurse on a medical-surgical unit is admitting a patient who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A. Initiate contact precautions B. Weigh patient weekly C. Measure abdominal girth 7.5 cm (3in) above the umbilicus D. Provide a high-calorie, high-carbohydrate diet
D
A nurse working in a long-term care facility is planning care for a client in stage 5 of Alzheimer's disease. Which of the following interventions should be included in the plan of care? A. Use a gait belt for ambulation. B. Thicken all liquids. C. Provide protective undergarments. D. Assist with ADL's.
D
A patient is admitted to the hospital with a C4 spinal cord injury after a motorcycle collision. The patient's BP is 84/50 mmHg, his pulse is 38 beats/min, and he remains orally intubated. The nurse determines that this pathophysiologic response is caused by A. Increased vasomotor tone after injury B. A temporary loss of sensation and flaccid paralysis below the level of injury C. Loss of parasympathetic nervous system innervation resulting in vasoconstriction D. Loss of sympathetic nervous system innervation resulting in peripheral vasodilation
D
A patient with chronic kidney disease has an arteriovenous (AV) graft in the right forearm. What is the nurse's priority in determining the patency of the graft? A. Determine the range of motion of the right arm and shoulder B. Observe for clubbing of the fingers on the right hand of the AV graft site C. Compare radial pulses by checking the right and left pulses simultaneously D. Check for a bruit by listening over the right arm AV graft site with a stethoscope
D
A visiting nurse who observes that the older male client is confined by his daughter-in-law to his room. When the nurse suggests that he walk to the den and join the family he says, "I'm in everyone's way, my daughter-in-law needs me to stay here." which is the most important action for the nurse to take? A. Say to the daugher-in-law, "Confining your father-in-law to his room is inhumane" B. Suggest to the client and daughter-in-law that they consider a nursing home for the client C. Say nothing, because it is best for the nurse to remain neutral and wait to be asked for help D. Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens center.
D
Dementia is defined as a... A. Syndrome that results only in memory loss B. Disease associated with abrupt changes in behavior C. Disease that is always due to reduced blood flow to the brain D. Syndrome characterized by cognitive dysfunction and loss of memory
D
Following a T2 spinal cord injury, the patient develops paralytic ileus. While this condition is present, the nurse anticipates that the patient will need? A. IV fluids B. Tube feedings C. Parenteral nutrition D. Nasogastric suctioning
D
To obtain the most complete assessment data about a patient's chronic pain, the nurse asks the patient A. "Can you describe where your pain is the worst?" B. "What is the intensity of your pain on a scale of 0 to 10?" C. "Would you describe your pain as aching, throbbing, or sharp?" D. "Can you describe your daily activities in relation to your pain?"
D
Which is the best method to asses for the client development of deep vein thrombosis in a client with a spinal cord injury? A. Homans sign B. Pain C. Tenderness D. Leg girth
D