Crumbley EAQ GI/GU Practice Questions

(26) a nurse is caring for a client with AKI. which findings should the nurse anticipate when reviewing the lab report of the client's blood level of Ca+, K+, and Cr? select all that apply a. Ca+ 7.6 mg/dL (1.9 mmol/L) b. Ca+ 10.5 mg/dL (2.6 mmol/L) c. K+ 6.0 mEq/L (6.0 mmol/L) d. K+ 3.5 mEq/L (3.5 mmol/L) e. Cr 3.2 mg/dL (194 mcmol/L) f. Cr 1.1 mg/dL (90 mcmol/L)

a. Ca+ 7.6 mg/dL (1.9 mmol/L) c. K+ 6.0 mEq/L (6.0 mmol/L) e. Cr 3.2 mg/dL (194 mcmol/L) A client with acute kidney injury will have a low calcium level, a high potassium level, and an elevated creatinine level.

(21) a nurse is obtaining the health history of a 5-year-old child who has been admitted to the child health unit with acute glomerulonephritis. what does the nurse expect the child's mother to report? a. the child had a sore throat a few weeks ago b. the child has just recovered from the measles c. the child's father has a family history of UTIs d. the child's immunizations were administered at the start of school

a. the child had a sore throat a few weeks ago Acute poststreptococcal glomerulonephritis (APSGN) is associated with a history of streptococcal infection of the throat. The measles virus is not associated with the development of APSGN. APSGN is not an inherited disease. No immunizations can cause glomerulonephritis.

(47) a nurse reviews the lab results of a client with acute pancreatitis. which test is most significant in determining the client's response to treatment? a. platelet count b. amylase level c. RBC count d. erythrocyte sedimentation rate

b. amylase level In 90% of clients with acute pancreatitis, the amylase level is elevated up to three times over baseline; serum amylase usually returns to expected adult levels within three days after treatment begins. The platelet count is not an indicator of the response to treatment for pancreatitis; platelets are important in the control of bleeding. The red blood cell count is unchanged in acute pancreatitis, unless hemorrhage is present. The erythrocyte sedimentation rate is not an indicator of a response to treatment for pancreatitis.

(6) a client with AKI states, "why am I twitching and my fingers and toes tingling?" which process should the nurse consider when formulating a response to this client? a. acidosis b. calcium depletion c. potassium retention d. sodium chloride depletion

b. calcium depletion In kidney failure, as the glomerular filtration rate decreases, phosphorus is retained. As hyperphosphatemia occurs, calcium is excreted. Calcium depletion hypocalcemia causes tetany, which causes twitching and tingling of the extremities, among other symptoms. Acidosis, potassium retention, and sodium chloride depletion are not characterized by twitching and tingling of the extremities.

(32) the nurse is preparing to administer an NGT feeding to a client via infusion pump. what is the most important assessment the nurse needs to perform before beginning the pump? a. checking for the last BM b. checking for residual stomach contents c. checking to determine time of last medication for nausea d. checking to make sure the HOB is elevated at least 15 degrees

b. checking for residual stomach contents Checking for any residual feeding not absorbed in the client's stomach must be done before introducing any more feeding. Aspiration can occur if a feeding is started with excessive residual. Checking for last bowel movement is important but not as crucial as checking for gastric residual. Knowledge of last nausea medication is not necessary at this time. Clients receiving nasogastric tube feedings must have the head of their bed elevated to at least 30 degrees.

(1) a nurse administers lactulose to a client with cirrhosis of the liver. which lab test change leads the nurse to determine that the lactulose is effective? a. decreased amylase b. decreased ammonia c. increased potassium d. increased hemoglobin

b. decreased ammonia Lactulose destroys intestinal flora that break down protein and in the process give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.

(32) a nurse is caring for a client with chronic kidney failure. which clinical findings should the nurse expect the assessing this client? select all that apply a. polyuria b. lethargy c. hypotesion d. muscle twitching e. respiratory acidosis

b. lethargy d. muscle twitching Lethargy results from anemia, buildup of urea, and vitamin deficiencies. Muscle twitching results from excess nitrogenous wastes. Extensive nephron damage causes oliguria, not polyuria. Hypotension does not occur; the blood pressure is within the expected range or elevated as a result of increased total body fluid. Metabolic, not respiratory, acidosis occurs because of the kidneys' inability to excrete hydrogen and regulate sodium and bicarbonate levels.

(14) a nurse is caring for a client with hepatic encephalopathy and ascites. which elements are important to include in this client's diet? select all that apply a. high fat b. low sodium c. high vitamins d. moderate protein e. low carb

b. low sodium c. high vitamins d. moderate protein A low sodium intake controls fluid retention and edema and, consequently, ascites. Vitamins help to repair long-standing nutritional deficits associated with cirrhosis of the liver. A moderate-protein diet reduces formation of ammonia, which must be degraded by the liver. High fat intake is avoided because of related cardiovascular risks and the demand for bile that the liver may not be capable of meeting. High, not low, carbohydrate intake is necessary to meet energy requirements for tissue regeneration.

(36) a client with CKD is receiving medication to manage anemia. which primary goal should the nurse include in the carer plan from this information? a. prevention of uremic frost b. prevention of chronic fatigue c. prevention of tubular necrosis d. prevention of dependent edema

b. prevention of chronic fatigue Kidney failure [1] [2] results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathologic condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.

(46) which medication should the nurse question when it is prescribed for a client with acute pancreatitis? a. ranitidine b. cimetidine c. meperidine d. promethazine

c. meperidine Meperidine should be avoided because accumulation of its metabolites can cause central nervous system irritability and even tonic-clonic seizures (grand mal seizures). Ranitidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Cimetidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Promethazine is useful as an antiemetic for clients with pancreatitis.

(41) a client with cancer of the pancreas has a pancreaticoduodenectomy (Whipple procedure). the nurse expects that the client will have which tube after surgery? a. chest b. intestinal c. nasogastric d. gastrostomy

c. nasogastric Nasogastric surgery involves the stomach, duodenum, pancreas, and common bile duct; a nasogastric tube removes gastric secretions and prevents distention of the gastrointestinal tract. A chest tube is used to remove air or blood from the chest cavity; the chest is not entered in the Whipple procedure. Intestinal tubes are used for small bowel obstructions; except for the duodenum, the small bowel is not included in the Whipple procedure. A gastrostomy tube is used to deliver nutrients into the stomach of a client who cannot ingest food via the oral route.

(22) a nurse is notified that the latest potassium level for a client in AKI is 6.2 mEq/L. which action should the nurse take first? a. alert the cardiac arrest team b. call the lab to repeat the test c. take VS and notify PHCP d. obtain an ECG strip and obtain an anti-arrhythmic medication

c. take VS and notify PHCP Vital signs monitor the cardiopulmonary status; the primary healthcare provider must treat this hyperkalemia [1] [2] to prevent cardiac dysrhythmias. The cardiac arrest team responds to a cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time and probably reaffirm the original results; the client needs medical attention. Although obtaining an ECG strip is appropriate, obtaining an antiarrhythmic is premature; vital signs and medical attention is needed first.

(53) the nurse is reviewing the plan of care for a client who is scheduled for a barium swallow. what will the plan include? a. giving clear fluids on the day of the test b. asking the client about allergies to iodine c. admin cleaning enemas before the test d. admin a laxative after the procedure

d. admin a laxative after the procedure Barium will harden and may create an impaction; a laxative and increased fluids promote elimination of barium. The client must be kept nothing by mouth. Iodine is not used with barium. Administering cleansing enemas before the test is not part of the preparation; feces in the lower gastrointestinal (GI) tract will not interfere with visualization of the upper GI tract.

(51) a nurse is providing instructions to a client who is scheduled for a colonoscopy. what drink does the client indicate should be avoided several days before the test if these instructions are understood? a. ginger ale b. apple juice c. lemon-lime soda d. cheery kool-aid

d. cherry kool-aid Red drinks should be avoided to prevent staining of the bowel, which may cause erroneous results. Ginger ale is a clear soft drink that will not alter test results. Apple juice is an acceptable beverage that also may help to clear the bowel of stool. Lemon-lime soda is an acceptable drink; it is a clear liquid that will not alter test results.

(27) a nurse is caring for a client with a diagnosis of chronic kidney failure who has just been told by the PHCP that hemodialysis is necessary. which clinical manifestation indicates the need for hemodialysis? a. ascites b. acidosis c. hypertension d. hyperkalemia

d. hyperkalemia Protein breakdown liberates cellular potassium ions, leading to hyperkalemia, which can cause a cardiac dysrhythmia and standstill. The failure of the kidneys to maintain a balance of potassium is one of the main indications for dialysis. Ascites occurs in liver disease and is not an indication for dialysis. Dialysis is not the usual treatment for acidosis; usually this responds to administration of alkaline drugs. Dialysis is not a treatment for hypertension; this is usually controlled by antihypertensive medication and diet.

(17) a client takes isosorbide denigrate daily. the client states, "I would like to start taking sildenafil for ED." the nurse explains that taking both of these medications concurrently may result in which complication? a. constipation b. protracted vomiting c. respiratory distress d. severe hypotension

d. severe hypotension Concurrent use of sildenafil and a nitrate, which causes vasodilation, may result in severe, potentially fatal hypotension. Protracted vomiting and respiratory distress are not adverse effects associated with concurrent use of sildenafil and a nitrate. Sildenafil may cause diarrhea; adding a nitrate will not constipation.

(23) a client is to have hemodialysis. what must the nurse do before this treatment? a. obtain a urine specimen to evaluate kidney function b. weigh the client to establish a baseline for later comparison c. administer medications that are scheduled to be given within the next hour d. explain that the peritoneum serves as a semipermeable membrane to remove wastes

b. weigh the client to establish a baseline for later comparison A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.

(2) the nurse reviews the medical records of 4 male clients. which client will the nurse assess most closely for developing prostate cancer? a. black 55-year-old b. white 45-year-old c. Asian 55-year-old d. hispanic 45-year-old

a. black 55-year-old Cancer of the prostate is rare before age 50 years but increases with age; black men develop cancer of the prostate more often and at an earlier age than white men. Black men develop prostate cancer more often than any other ethnic group. Asian American men have a lower incidence than white men.

(5) a nurse is caring for a client who had a subtotal gastrectomy. which assessment finding indicates the client is ready for postoperative oral feedings? a. presence of flatulence b. extent of incisional pain c. stabilization of hematocrit levels d. occurrence of dumping syndrome

a. presence of flatulence Bowel sounds and flatulence indicate the return of intestinal peristalsis; peristalsis is necessary for movement of nutrients through the gastrointestinal (GI) tract. Incisional pain is unrelated to intestinal peristalsis. Hematocrit levels indicate blood loss, not peristalsis. Dumping syndrome occurs after, not before, the ingestion of food and does not indicate readiness to ingest food.

(29) a client is admitted to the hospital with a diagnosis of acute pancreatitis. the HCP's prescriptions include NPO and TPN. the nurse explains that the TPN therapy provides what benefit? a. is the easiest method for administering needed nutrition b. is the safest method for meeting the client's nutritional requirements c. will satisfy the client's hunger without the discomfort associated with eating d. will meet the client's nutritional needs without causing the discomfort precipitated by eating

d. will meet the client's nutritional needs without causing the discomfort precipitated by eating Providing nutrients by the intravenous route eliminates pancreatic stimulation, therefore reducing the pain experienced with pancreatitis. TPN is used to meet the client's needs, not the nurse's needs. TPN creates many safety risks for the client. Hunger can be experienced with TPN therapy.

(18) sildenafil is prescribed for a man with ED. a nurse teaches the client about common side effects of this drug, which include what? select all that apply a. flushing b. headache c. dyspepsia d. constipation e. hypertension

a. flushing b. headache c. dyspepsia Flushing is a common central nervous system response to sildenafil. Headache is a common central nervous system response to sildenafil. Dyspepsia is a common gastrointestinal response to sildenafil. Diarrhea, not constipation, is a common gastrointestinal response to sildenafil. Hypotension, not hypertension, is a cardiovascular response to sildenafil. It should not be taken with antihypertensives and nitrates because drug interactions can precipitate cardiovascular collapse.

(19) a client with a 20-year history of excessive alcohol use is admitted to the hospital with jaundice ad ascites. what is the priority nursing action during the first 48 hours after the client's admission? a. monitor the client's VS b. increase the client's fluid intake c. improve the client's nutritional status d. determine the client's reasons for drinking

a. monitor the client's VS A client's vital signs, especially the pulse and temperature, will increase before the client demonstrates any of the more severe symptoms of withdrawal from alcohol. Increasing intake is contraindicated initially because it may cause cerebral edema. Improving nutritional status becomes a priority after the problems of the withdrawal period have subsided. Determining the client's reasons for drinking is not a priority until after the detoxification process.

(4) 12 hours after a subtotal gastrectomy, a nurse identifies large amounts of bloody drainage from a client's NGT. which action should the nurse take? a. obtain VS b. clamp the NGT c. instill 30 mL of iced NS into the NGT d. record the observations and continue monitoring the client

a. obtain VS Large amounts of blood or excessive bloody drainage 12 hours postoperatively indicate that the client is hemorrhaging. Vital signs should be taken. Clamping the tube is contraindicated; accumulation of secretions causes pressure on the suture line, preventing further observation of drainage. The primary healthcare provider must prescribe instilling 30 mL of iced normal saline into the nasogastric tube. Continuing to monitor the drainage and record the observations is an unsafe intervention at this time; action must be taken to address and stop the hemorrhaging.

(19) a client develops acute glomerulonephritis after a recent streptococcal infection. the use should expect to find which clinical manifestation during the health history and physical exam? a. nocturia b. periorbital edema c. increased appetite d. recent weight loss

b. periorbital edema Periorbital edema occurs because of the retention of fluid. The client will experience oliguria, not nocturia. The client will develop anorexia related to elevated toxic substances in the blood. The client will have a weight gain because of the retention of fluid.

(3) immediately after a subtotal gastrectomy, a client is admitted to the PACU. the nurse irrigates the NGT and observes small blood clots in the return. which is the best nursing action? a. clamp the NGT b. irrigate the tube with iced saline c. document this expected response d. notify the HCP of this finding

c. document this expected response As a result of the trauma of surgery, some bleeding is expected for several hours. Clamping the tube will cause increased pressure on the gastric sutures from a buildup of gas and fluid. Iced saline is used rarely because it causes vasoconstriction, local ischemia, and a reduction in body temperature. Notifying the healthcare provider of this finding is not necessary; bleeding during the immediate postoperative period is an expected occurrence.

(45) to begin the admin of TPN, a client has a right subclavian central venous access device inserted. immediately after insertion of the catheter, what is the priority nursing action? a. obtain a CXR to determine placement b. auscultate the lungs to evaluate breath sounds c. draw a blood sample to assess BG level d. assess the right upper extremity for neurologic deficits

b. auscultate the lungs to evaluate breath sounds The most significant and life-threatening complication of insertion of a subclavian catheter is a pneumothorax because of the proximity of the subclavian vein and the apex of the upper lobe of the lung; a client's respiratory status always is the priority. Although a chest x-ray may be done before TPN is begun, it is not the priority immediately after insertion of the catheter. A baseline blood glucose level should be obtained before insertion of the catheter. After TPN is started, routine monitoring of blood glucose levels is important. Although assessing for a neurologic deficit should be done eventually, it is not the priority at this time.

(16) a client is admitted to the hospital for acute gastritis ad ascites secondary to alcoholism and cirrhosis. for which condition is it most important for the nurse to assess this client? a. nausea b. blood in the stool c. food intolerances d. hourly urinary output

b. blood in the stool Erosion of blood vessels may lead to hemorrhage, a life-threatening situation further complicated by decreased prothrombin production, which occurs with cirrhosis. Although food intolerances should be identified, there is no immediate threat to life. Although increased intraabdominal pressure because of ascites may precipitate nausea, there is no immediate threat to life. Hourly urine output measurements are unnecessary.

(4) hypertension develops in a school-aged child with acute glomerulonephritis. what medication does the nurse anticipate that the HCP will prescribe? a. digoxin b. furosemide c. diazepam d. phenytoin

b. furosemide Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal tubule, increasing urine output and thereby decreasing blood pressure. Digoxin increases the contractility and output of the heart; it is not an antihypertensive. Diazepam is inappropriate; it relaxes skeletal muscle, not the smooth muscle of the arterioles. Phenytoin is an anticonvulsant; it does not reduce blood pressure.

(29) a nurse is administering erythropoietin 3x/week to a client receiving chemo for cancer. which client response is considered most significant? a. elevated liver enzymes b. elevated hematocrit levels c. increase in Kaposi sarcoma lesions d. increase in WBC count

b. elevated hematocrit levels Erythropoietin stimulates red blood cell production, thereby increasing the hematocrit and hemoglobin level. An elevated liver panel is not related to erythropoietin because erythropoietin is not hepatotoxic. Erythropoietin increases red blood cells (RBCs), not WBCs. Increased Kaposi sarcoma lesions are a sign of acquired immunodeficiency syndrome (AIDS) progression and are not affected by erythropoietin.

(21) a client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. which diet ca the nurse expect will be prescribed for this client based upon the assessment? a. no protein b. moderate protein c. high protein d. strict protein restriction

b. moderate protein Because the liver is unable to detoxify ammonia to urea and the client is experiencing impending hepatic encephalopathy coma, protein intake should be moderate. Strict protein and no protein restrictions are not required because clients need protein for healing. High protein is contraindicated in hepatic encephalopathy.

(15) a nurse is assessing the condition of a school-aged child with acute glomerulonephritis. what clinical finding does the nurse anticipate? a. ketonuria b. periorbital edema c. increased appetite d. decreased BP

b. periorbital edema The glomerular filtration rate is reduced; this results in sodium retention, protein loss, and fluid accumulation, producing edema that is most noticeable around the eyes. Ketonuria is not a manifestation of glomerulonephritis. Usually the appetite decreases because of general malaise, and the blood pressure is increased because of kidney involvement.

(6) an older adult is returned to the surgical unit after having a subtotal gastrectomy. which dietary modification should the nurse anticipate that the HCP will most likely prescribe? a. increase intake of dietary roughage quickly b. avoid oral feedings for a prolonged period c. resume small easily digested feedings gradually d. limit intake to self-selection of personally preferred foods

c. resume small easily digested feedings gradually Small, frequent feedings are tolerated best after a subtotal gastrectomy. Roughage may be irritating to the gastrointestinal (GI) tract after surgery. As soon as edema subsides, the individual generally is given small amounts of fluid, and then the diet is progressed gradually. Allowing only personal food preferences does not ensure inclusion of nutrients necessary for recovery.

(36) a client with a rigid ad painful abdomen is diagnosed with a perforated peptic ulcer. an NGT is inserted, and surgery is scheduled. before surgery, the nurse should place the client in what position? a. sims b. flat-lying c. semi-fowler d. dorsal recumbent

c. semi-fowler The semi-Fowler position will localize the spilled stomach contents in the lower part of the abdominal cavity. The Sims position will exert pressure on the abdomen, which may be uncomfortable for the client. Lying flat in bed exerts pressure against the diaphragm from abdominal organs; this will inhibit breathing and intensify discomfort. Also, it allows spilled stomach contents to spread throughout the abdominal cavity. The dorsal recumbent position exerts pressure against the diaphragm from abdominal organs; this will inhibit breathing and intensify discomfort. Also, this position allows spilled stomach contents to spread throughout the abdominal cavity.

(11) after a subtotal gastrectomy a client demonstrates signs of dumping syndrome. about 90 min after the initial attack, the client reports feeling shaky. what does the nurse determine is the cause of the latter effect? a. a second, more extensive rise in glucose b. an overwhelmed insulin-adjusting mechanism c. a distention of the duodenum from a excessive amount of chyme d. an overproduction of insulin that occurs in response to the rise in BG

d. a overproduction of insulin that occurs in response to the rise in BG The rapid absorption of carbohydrates from the food mass causes an elevation of blood glucose, and the insulin response often causes transient hypoglycemic symptoms. The elevation in insulin usually occurs 90 minutes to 3 hours after eating and is known as late dumping syndrome. The physiological adaptations related to late dumping syndrome are caused by an increase in insulin, not glucose. The insulin-adjusting mechanism is not overwhelmed but responds vigorously, causing rebound hypoglycemia. Dumping syndrome is related to the high glucose content of food, not the amount of food, entering the duodenum.

(50) a HCP prescribes sodium biphosphate for a client before a colonoscopy. how does the drug accomplish its therapeutic effect? a. irritates the intestinal mucosa b. provides water-absorbing bulk c. softens stool by exerting a detergent effect d. increased osmotic pressure in the intestines

d. increased osmotic pressure in the intestines Sodium biphosphate is a saline (hypertonic) cathartic that increases osmotic pressure within the intestine so that body fluids are drawn into the bowel, stimulating bowel stretching, peristalsis, and defecation. Intestinal stimulants increase peristalsis by irritating the mucosa. Bulk-forming laxatives are cellulose derivatives that remain in the intestinal tract and absorb water; they stimulate peristalsis by increasing bulk. Emollients have a detergent action, softening stool by facilitating its absorption of water.

(42) famotdine (Pepcid) is prescribed for a client with PUD. the client asks the nurse what this medication does. which action does the nurse mention when replying? a. increases gastric motility b. neutralizes gastric acidity c. facilitate histamine release d. inhibits gastric acid secretion

d. inhibits gastric acid secretion Famotidine decreases gastric secretion by inhibiting histamine at H2 receptors. Increases gastric motility, neutralizes gastric acidity, and facilitates histamine release are not actions of famotidine.

(34) a HCP prescribes an intermittent eternal tube feeding for a client with an NGT. place the nursing interventions in the order which they should be implemented. a. administer the volume of feeding as per the prescription b. check the volume of residual against the parameter prescribed c. elevate the HOB to at least 30 degrees d. flush the tube with 30 mL of water after the feeding e. verify the HCP's prescription

e. verify the HCP's prescription c. elevate the HOB to at least 30 degrees b. check the volume of residual against the parameter prescribed a. administer the volume of feeding as per the prescription d. flush the tube with 30 mL of water after the feeding Before beginning the procedure, the nurse should verify the healthcare provider's prescription in the client's clinical record to ensure that the prescription is accurate and complete. The head of the bed should be elevated to at least 30 degrees during and for one hour after an intermittent feeding because gravity will assist in the flow of the feeding into the stomach, which helps prevent aspiration. The residual volume is measured before adding more feeding because the feeding may need to be held for one hour if the volume exceeds the volume identified in the prescription or based on agency policy. Adding more feeding before absorption of the previous feeding can overload the stomach and contribute to aspiration. Once it is determined that the residual volume is below the established amount prescribed by the healthcare provider or agency policy, the feeding can be administered. The tubing should be flushed with 30 mL of water after the feeding to clear the tubing of feeding solution; this will help prevent clogging of the tubing.

(23) a nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. which diet should the nurse teach the client to maintain because it will help minimize clinical manifestations of dumping syndrome? a. low-residue, bland diet b. fluid intake below 500 mL c. small, frequent feeding schedule d. low-protein, high carb diet

c. small, frequent feeding schedule Small feedings reduce the amount of bulk passing into the jejunum and therefore reduce the fluid that shifts into the jejunum. Although a diet high in roughage may be avoided, a low-residue, bland diet is not necessary. Total fluid intake does not have to be restricted; however, fluids should not be taken immediately before, during, or after a meal because they promote rapid stomach emptying. Concentrated sweets pass rapidly out of the stomach and increase fluid shifts; the diet should be low in carbohydrates. Relatively high protein is needed to promote tissue repair.

(39) the nurse is teaching a client about the prescribed diet after a Whipple procedure for cancer of the pancreas. which statement should the nurse include in the dietary teaching? a. "there are no dietary restrictions because the tumor has been removed" b. "your diet should be low in calories to prevent taxing your diseased pancreas" c. "meals should be restricted in protein because of your compromised liver function" d. "low-fat meals should be eaten to prevent interference with your fat digestion mechanism"

d. "low-fat meals should be eaten to prevent interference with your fat digestion mechanism" Whipple procedure leads to malabsorption because of impaired delivery of bile to the intestine and interruption of glucose metabolism; interference with fat digestion occurs. Clients require small, frequent low-fat, high-protein, moderate-carbohydrate meals and supplemental feedings. The response "There are no dietary restrictions because the tumor has been removed" is false reassurance. High-calorie meals are needed to provide energy and to promote the use of protein for tissue repair. High protein is required for tissue building; there is no problem with the liver in clients with cancer of the pancreas unless metastasis occurs by direct extension.

(20) a nurse is assessing a malnourished client with a history of cirrhosis. the client is experiencing nausea, ascites, and GI bleeding. what is the primary cause of the client's ascites? a. a decrease in vitamins to maintain cell coenzyme functions b. a decrease in iron to maintain adequate hemoglobin synthesis c. a decrease in sodium to maintain its concentration in tissue fluid d. a decrease in plasma protein to maintain adequate capillary-tissue circulation

d. a decrease in plasma protein to maintain adequate capillary-tissue circulation Malnutrition and liver damage lead to a reduced serum albumin level and failure of the capillary fluid shift mechanism, resulting in ascites. Vitamins are unrelated to ascites. Iron promotes hemoglobin synthesis, which is unrelated to cirrhosis. The sodium level usually is excessive with cirrhosis.

(38) a client with the diagnosis of CKD develops hypocalcemia. which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit? select all that apply a. acidosis b. lethargy c. fractures d. osteomalacia e. eye calcium deposits

c. fractures d. osteomalacia e. eye calcium deposits Because of calcium loss from the bone, fractures, osteomalacia, and eye calcium deposits occur. Acidosis decreases calcium that binds to albumin, resulting in more ionized calcium (free calcium) in the blood. Lethargy and weakness are associated with hypercalcemia.

(43) a client is diagnosed with a peptic ulcer. when teaching about peptic ulcers, the nurse instructs the client to report what kind of stools? a. frothy b. ribbon shaped c. pale or clay colored d. dark brown or black

d. dark brown or black Dark brown or black stools (melena) indicate gastrointestinal bleeding and need to be reported. Frothy stools are indicative of inadequate fat absorption and are associated with sprue. Ribbon-shaped stools indicate a bowel mass or obstruction. Clay-colored stools usually are related to problems that cause a decrease in bile.

(8) which type of cytokine is used to treat anemia related to chronic kidney disease? a. alpha-interferon b. interleukin-2 c. interleukin-11 d. erythropoietin

d. erythropoietin Erythropoietin is used to treat anemia related to chronic kidney disease. α-Interferon is used to treat hairy cell leukemia or malignant melanoma. Interleukin-2 is used to treat metastatic renal carcinoma. Interleukin-11 is used to prevent thrombocytopenia after chemotherapy.

(16) a client is receiving epoetin for the treatment of anemia associated with chronic renal failure. which client statement indicated to the nurse that further teaching about this medication is necessary? a. "I realize it is important to take this medication because it will cure my anemia" b. "I know many ways to protect myself from injury because I am at risk for seizures" c. "I recognize that I may still need blood transfusions if my blood values are low" d. "I understand that I will still have to take supplemental iron therapy with this medication"

a. "I realize it is important to take this medication because it will cure my anemia" Epoetin will increase a sense of well-being, but it will not cure the underlying medical problem; this misconception needs to be corrected. Seizures are a risk during the first 90 days of therapy, especially if the hematocrit increases more than four points in a 2-week period. A dose adjustment may be necessary. Blood transfusions may still be necessary when the client is severely anemic. Supplemental iron therapy is still necessary when receiving epoetin because the increased red blood cell production still requires iron.

(5) while the nurse is at the bedside of a client in acute renal failure, the client states, "my HCP said that I will be getting some insulin. do I also have diabetes?" what is the best nursing response? a. "no, the insulin will help your body handle the increased potassium level" b. "I suggest that you ask your HCP that question" c. "you probably had an elevated blood glucose level, so your HCP is being cautious" d. "no, but insulin will reduce the toxins in your body by lowering your metabolic rate"

a. "no, the insulin will help your body handle the increased potassium level" Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. The response "I suggest that you ask your healthcare provider that question" halts communication and is not supportive. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.

(20) during an exam of a client with kidney dysfunction, the nurse finds the presence of glucose in the urine. which nursing intervention is beneficial for this client? a. admin oral fluids b. noting the finding down as normal c. admin hypoglycemic medication d. reporting this finding to the PHCP

d. reporting this finding to the PHCP The presence of glucose in the urine is an abnormal finding that requires further assessment. Therefore, the nurse should report this finding to the primary healthcare provider. The nurse should not administer oral fluids or hypoglycemic medication without instructions from the primary healthcare provider.

(10) after a partial gastrectomy is performed, a client s returned from the PACU to the surgical unit with an IV solution infusing and an NGT in place. the nurse identifies that there is no NG drainage for 30 minutes. there is a prescription for instillation of the NGT as needed. what should the nurse instill, and what is the procedure that follows? a. 30 mL of NS, then continue to suction b. 20 mL of air, then clamp off suction for 1 hour c. 50 mL of saline, then increase pressure of suction d. 15 mL of distilled water, then disconnect suction for 30 minutes

a. 30 mL of NS, then continue to suction Physiologic normal saline is used in gastric instillations to prevent electrolyte imbalance. Because of the fresh gastric sutures, slow and gentle instillation of saline should be performed to reestablish patency of the tube, and then the tube should be reconnected to suction to ensure stomach decompression. The purpose of the instillation is to maintain the patency of the tube for gastric decompression; increasing the pressure may cause damage to the suture line. With disconnection from suction, a buildup of secretions and air can occur, or the tube can become blocked by viscous drainage.

(30) a PHCP prescribes 1000 mL TPN to be infused over 12 hours vis a central venous access device. what is the most important for the nurse to obtain the preparing the equipment? a. an infusion pump b. a steady IV pole c. an infusion set delivering 60 gtts/mL d. a set of hemostats to be taped at the bedside

a. an infusion pump An infusion pump should be administered in a continuous and uniform infusion to prevent hyperosmolar diuresis. A steady IV pole is true for any intravenous infusion; this is not unique to total parenteral nutrition. Also, infusion pumps can be placed on the bedside table. The tubing set should be specific for the type of infusion pump. Hemostats (clamps) are not necessary when administering total parenteral nutrition; an infusion pump should be used.

(7) a client is diagnosed with acute kidney failure secondary to dehydration. an IV infusion of 50% glucose with regular insulin is prescribed. what does the nurse recognize as the primary purpose of the IV insulin for this client? a. correct hyperkalemia b. increase urinary output c. prevent respiratory acidosis d. increase serum calcium levels

a. correct hyperkalemia The 50% glucose and regular insulin infusion treats the hyperkalemia associated with kidney failure; it moves potassium from the intravascular compartment into the intracellular compartment. Insulin will not increase urinary output. Insulin is not a treatment for respiratory acidosis. Insulin and glucose do not increase serum calcium levels.

(35) the BUN/Cr ration of a client is 3. which condition does the nurse suspect in the client? a. fluid volume excess b. obstructive uropathy c. severe hepatic damage d. GI bleeding

a. fluid volume excess The normal range of the blood urea nitrogen (BUN)/creatinine ratio is from 6 to 25. A decrease in the BUN/creatinine ratio indicates fluid volume excess. An increase in the BUN/creatinine ratio indicates obstructive uropathy. A decrease in the levels of blood urea nitrogen (BUN) indicates severe hepatic damage. An increase in the levels of blood urea nitrogen (BUN) indicates gastrointestinal (GI) bleeding.

(22) a client with a long history of alcohol abuse is admitted to the hospital with ascites and jaundice. a diagnosis of hepatic cirrhosis is made. which is a nursing priority? a. institute fall prevention/safety measures b. monitor respiratory status c. measure abdominal with daily d. test stool specimens for blood

a. institute fall prevention/safety measures The high ammonia levels contribute to deterioration of mental function and then to hepatic encephalopathy and hepatic coma; safety is the priority. Although the client may have dyspnea as a result of ascites, it is not life threatening; safety is the priority. Although measuring abdominal girth daily is done to monitor ascites, it is not the priority for a confused client; safety is the priority. Testing stool specimens for blood is not the priority; providing for client safety is the priority.

(17) a client with ascites is scheduled to have a paracentesis. what should the nurse include in the plan of care? a. instruct the client to urinate before the procedure b. shave hair around the insertion site and 2-3 inches (5-7.5 cm) beyond the site c. position the client on the side with the hips and knees flexed during the procedure d. measure the abdominal girth 2 finger-breadths below the umbilicus immediately before the procedure

a. instruct the client to urinate before the procedure The bladder should be empty to prevent injury during insertion of the trocar. Shaving the hair from the needle insertion site is not necessary. Positioning a client on the side with the hips and knees flexed generally is the position assumed by the client for a spinal tap, not paracentesis; the upright position is assumed for a paracentesis to allow accumulation of fluid in the lower abdomen by gravity. Although regular monitoring of girth is important, it is not necessary immediately before this procedure; abdominal girth is measured at the level of the umbilicus.

(11) a client with T1DM is transported via ambulance to the ED of the hospital. the client has dry, hot flushed skin and a fruity odor to the breath ad is having Kussmaul respirations. which complication does the nurse suspect that the client is experiencing? a. ketoacidosis b. somogyi pheomenon c. hypoglycemic reaction d. hyperosmolar nonketotic coma

a. ketoacidosis Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat, causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.

(13) a client is admitted to the hospital with a diagnosis of cirrhosis of the liver. for which assessment signs of hepatic encephalopathy should the nurse assess this client? select all that apply. a. mental confusion b. increased cholesterol c. brown-colored stools d. flapping hand tremors e. musty, sweet breath odor

a. mental confusion d. flapping hand tremors e. musty, sweet breath odor An accumulation of nitrogenous wastes affects the central nervous system, causing mental confusion. An accumulation of nitrogenous wastes in hepatic encephalopathy affects the nervous system. Flapping tremors and generalized twitching occur in the second and third stages, respectively. Fetor hepaticus is the musty, sweet odor of the client's breath. Increased cholesterol levels are not necessarily present. Stool is often clay-colored because of lack of bile caused by biliary obstruction.

(7) a client is diagnosed with gastric cancer, and a subtotal gastrectomy is performed. after surgery the client begins to hemorrhage. what clinical findings support the nurse's conclusion that the client is experiencing hypovolemic shock? select all that apply. a. oliguria b. bradypnea c. diaphoresis d. tachycardia e. hypertension

a. oliguria c. diaphoresis d. tachycardia Decreased blood volume leads to decreased glomerular filtration; compensatory antidiuretic hormone (ADH) and aldosterone secretion cause sodium and water retention, thereby decreasing urinary output. Diaphoresis and tachycardia occur because of the sympathetic nervous system-mediated response. Respirations become rapid and shallow, not slow, because of the sympathetic nervous system-mediated response. Hypotension, not hypertension, is the response to a decrease in circulating blood volume.

(54) what is the priority of care to promote client safety directly after esophagogastroduodenoscopy? select all that apply a. preventing aspiration b. reminding the client not to drive c. monitoring for signs of perforation d. advising the client to use throat lozenges e. teaching the client about hoarseness of voice

a. preventing aspiration c. monitoring for signs of perforation The priority for care to promote client safety after esophagogastroduodenoscopy (EGD) is to prevent aspiration. Signs of perforation such as bleeding, pain, and fever are also monitored as priority care. Reminding the client not to drive is low priority. The client is advised to use throat lozenges to relieve throat discomfort, which is a low priority care. Hoarseness of voice persists for several days after EGD. Therefore the client is taught about hoarseness of voice, which is considered low priority.

(37) the nurse is providing dietary teaching to a client who is receiving hemodialysis. what should the nurse encourage the client to include in the dietary plan? a. rice b. potatoes c. canned salmon d. barbecued beef

a. rice Foods high or moderately high in carbohydrates and low in protein, sodium, and potassium are encouraged for clients on hemodialysis. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.

(37) a client is admitted to the surgical unit from the PACU with a Salem sump NGT that is to be attached to wall suction. which nursing action should the nurse implement when caring for this client? a. use NS to irrigate the tube b. employ sterile technique when irrigating the tube c. withdraw the tube quickly when decompression is terminated d. allow the client to have small sips of ice water unless nauseated

a. use NS to irrigate the tube Patency of the tube should be maintained to ensure continued suction. Use of normal saline minimizes fluid and electrolyte disturbances during irrigation. The stomach is not considered a sterile body cavity, so medical asepsis is indicated. Care must be taken to avoid traumatizing the mucosa. Ice chips and water represent fluid intake, which must be approved by the healthcare provider; being hypotonic in nature, such intake may lower the level of serum electrolytes.

(25) the nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. which statement by the client indicates a good understanding of preventing dumping syndrome after meals? select all that apply. a. "I will eat a bland diet" b. "I will not drink fluids when I eat meals" c. "I will avoid artificially-sweetened foods" d. "I will eat a low-protein, high-carb diet" e. "I will eat small, frequent meals instead of 3 large meals a day"

b. "I will not drink fluids when I eat meals" c. "I will avoid artificially-sweetened foods" e. "I will eat small, frequent meals instead of 3 large meals a day" Total fluid intake does not have to be restricted; however, fluids should not be taken immediately before, during, or after a meal because they promote rapid stomach emptying. It is safe to take fluids before or after meals. Concentrated sweets pass rapidly out of the stomach and increase fluid shift and should be avoided. Dumping syndrome after gastric surgery is managed by nutrition changes that include decreasing the amount of food taken at one time. Small feedings reduce the amount of bulk passing into the jejunum and therefore reduce the fluid that shifts into the jejunum. A bland diet is not necessary. The diet should be low to moderate in carbohydrates, high in protein, and high in fat to promote tissue repair and provide energy.

(3) a client with AKI is to receive peritoneal dialysis and asks why the procedure is necessary. which is the nurse's best response? a. "it prevents the development of serious heart problems" b. "it helps perform some of the work usually done by the kidneys" c. "it will keep your kidneys from getting worse and may 'restart' your kidneys to perform better the before" d. "it speeds recovery because the kidneys are not responding to regulating hormones"

b. "it helps perform some of the work usually done by the kidneys" Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Stating that peritoneal dialysis, "removes toxic chemicals from the body so you will not get worse," is threatening and can cause an increase in anxiety. Dialysis helps maintain fluid and electrolytes; the nephrons are damaged in acute kidney injury, so it may or may not speed recovery.

(49) a client is scheduled to receive conscious sedate during a colonoscopy. the client asks the nurse, "how will they 'knock me out' for this procedure?" which answer by the nurse correctly describes the route of admin for conscious sedation? a. "you will receive the anesthesia through a face mask" b. "you will receive medication through an IV catheter" c. "we will give you an oral medication about 1 hour before the procedure" d. "the medicine will be injected into your spine"

b. "you will receive medication through an IV catheter" Conscious sedation is administered by direct IV injection (IV push) to dull or reduce the intensity of pain or awareness of pain during a procedure without loss of defensive reflexes. General anesthesia usually is administered via inhalation of the vapor of a volatile liquid or an anesthetic gas via a mask or endotracheal tube; as a result, the client is unconscious, unaware, and anesthetized. The oral route of drug administration is commonly used for pediatric clients, not adults. An epidural block, a type of regional anesthesia, involves the injection of a local anesthetic into the epidural (extradural) space; it works by binding to nerve roots as they enter and exit the spinal cord. Epidural blocks are not used for moderate sedation.

(13) a nurse is evaluating the results of treatment with erythropoietin. which assessment finding indicates an improvement in the underlying condition being treated? a. 2+ pedal pulses b. decreased pallor c. decreased jaundice d. 2+ deep tendon reflexes

b. decreased pallor Erythropoietin stimulates red blood cell production, thereby decreasing the pallor that accompanies anemia. It would not have a role in alleviating jaundice. It would not have an appreciable effect on pulses or deep tendon reflexes.

(12) the nurse is creating a discharge teaching plan for a client who had a subtotal gastrectomy. the nurse should include what instructions about minimizing dumping syndrome? select all that apply a. drink fluids with meals b. eat small, frequent meals c. lie down for one hour after eating d. chew food five times before swallowing e. select foods that are low in fiber

b. eat small, frequent meals c. lie down for one hour after eating Small, frequent meals keep the volume within the stomach to a minimum at any one time, limiting dumping syndrome. Lying down delays emptying of the stomach contents, which will limit dumping syndrome. Fluids should be taken between meals to decrease the volume within the stomach at one time. Dumping syndrome occurs after eating because of the rapid movement of food into the jejunum without the usual digestive mixing in the stomach and processing in the duodenum. Chewing a set number of times before swallowing is not pertinent to solving this problem. High fiber, complex carbohydrates, moderate fats, and high protein in small, frequent meals are recommended to prevent dumping syndrome.

(12) a client with a history of CKD is hospitalized. which assessment findings will alert the nurse to kidney insufficiency? a. facial flushing b. edema and pruritus c. dribbling after voiding and dysuria d. diminished force and caliber of stream

b. edema and pruritus The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.

(27) a client is receiving TP through a central venous access device. the nurse discovers that the TPN bag is empty and the next bag has not been received yet from the pharmacy. what is the most appropriate action for the nurse to take? a. perform a finger stick glucose test and call the PHCP with the results b. hang a bag of 10% dextrose at the ordered TPN rate and place an urgent request for the next TPN bag c. DC the infusion and flush the IV line with saline solution until he next TPN bag is ready d. hang a bag of 5% dextrose at a keep-open rate and notify the nurse manager of the occurrence

b. hang a bag of 10% dextrose at the ordered TPN rate and place an urgent request for the next TPN bag Clients receiving TPN require monitoring of blood glucose because the TPN solution contains a high concentration of dextrose. In response to the high-dextrose TPN solution, the pancreas increases production of insulin to meet the glucose demands. In this situation, the current TPN infusion is completed, and the nurse should infuse 10% dextrose to compensate for the loss while the next TPN bag is being prepared. If this action is not taken, the client could experience a profound hypoglycemic reaction. After beginning an infusion of 10% dextrose, the nurse may perform a finger stick glucose test and notify the healthcare provider if the results are abnormal. Discontinuing the infusion and flushing the line until the next TPN bag is ready is not recommended. Starting an infusion of 5% dextrose at keep vein open (KVO) until the next TPN is ready may not prevent hypoglycemia; the nurse manager does not need to be involved unless there is a negative client outcome that results.

(44) a client is admitted to the hospital with a diagnosis of peptic ulcer. which most common complication should the nurse assess for in this client? a. perforation b. hemorrhage c. pyloric obstruction d. esophageal varices

b. hemorrhage Hemorrhage because of erosion of blood vessel walls is the most common complication of peptic ulcer disease. The complication of gastric perforation usually occurs after, and is not as common as, hemorrhage. Pyloric obstruction is not a common complication of peptic ulcer disease. Esophageal varices occur with portal hypertension, not peptic ulcer disease.

(2) a client had has a total gastrectomy. what should the nurse include in the discharge teaching? a. daily use of a stool softener b. injections of vitamin B12 for life c. monthly injections of iron dextran d. replacement of pancreatic enzymes

b. injections of vitamin B12 for life Intrinsic factor is lost with removal of the stomach, and vitamin B12 is needed to maintain the hemoglobin level and prevent pernicious anemia. Adequate diet, fluid intake, and exercise should prevent constipation. Iron-deficiency anemia is not expected. Secretion of pancreatic enzymes should not be affected because this surgery does not alter this function.

(33) a nurse is caring for a post client who has an NGT attached to low continuous suction. which assessment findings indicate that the client may be experiencing hypokalemia? a. tingling of the fingertips and toes b. dry and sticky mucous membranes c. abdominal cramping and irritability d. muscle weakness and cardiac dysrhythmias

d. muscle weakness and cardiac dysrhythmias Muscle weakness and cardiac dysrhythmias are related to potassium depletion in the skeletal and cardiac muscles; the sodium-potassium pump facilitates conduction of nerve impulses and muscle activity. Tingling of the fingertips and toes is related to hypocalcemia or hyperkalemia, not hypokalemia. Dry and sticky mucous membranes are related to hypernatremia, not hypokalemia. Abdominal cramping and irritability are related to hyperkalemia, not hypokalemia.

(31) a client has an NGT inserted, and the HCP prescribes the feeding to be instituted immediately. what should the nurse do first? a. instill NS into the tube to maintain patency b. obtain an x-ray to verify that the tube is in the stomach c. auscultate the epigastric area while instilling 15 mL of air d. withdraw 30 mL of stomach contents to verify tube placement

b. obtain an x-ray to verify that the tube is in the stomach X-ray verification of tube placement is required before anything is instilled into the nasogastric tube. Administering a feeding through a misplaced tube can cause the formula to enter the client's lungs. Instilling normal saline into the tube to maintain patency is unsafe. The normal saline will enter the client's lungs if the tube is in the wrong place. Auscultating the epigastric area while instilling 15 mL of air and withdrawing 30 mL of stomach contents to verify tube placement are not definitive ways to ensure correct placement of the nasogastric tube. Once placement is verified by an x-ray, these methods may be used before initiating a feeding.

(31) CLIENT CHART: Lab results - Na 135 mEq/L, K 6 mEq/L, Hgb 8.5 g/dL, Cr clearance 20 mL/min; VS - temp 99 F, HR 84BPM, RR 24, BP 150/100. an older adult client is admitted to the hosptial with a diagnosis of CKD. the nurse reviews the client's medical record. which clinical finding is a priority to be communicated to the PHCP? a. sodium level b. potassium level c. creatinine results d. BP results

b. potassium level The potassium is increased outside the expected range for an adult, which places the client at risk for a cardiac dysrhythmia; the increased potassium level must be treated immediately, because elevated levels can be lethal. A serum sodium of 135 mEq/L (135 mmol/L) is expected because of the electrolyte imbalance and the anemia related to the decreased production of erythropoietin by the kidney in the presence of chronic kidney failure. A creatinine clearance of 20 mL/min (0.33 mL/sec) is low, but the priority is the high potassium level. Clients with chronic kidney disease usually have hypertension, and notification is unnecessary.

(9) a nurse is caring for a client with orders for furosemide daily, a 2-gram sodium diet, and an oral fluid restriction of 1200 mL daily. the most recent lab results are BUN 42 mg/dL and Cr 1.1 mg/dL. considering the assessment findings, which is the most appropriate intervention by the nurse? a. sending the client's urine for analysis b. requesting an increase in the oral fluid intake c. placing the client on strict I&O measurements d. notifying a nutritionist/dietitian so that sodium can be restricted further

b. requesting an increase in the oral fluid intake Diuretics such as furosemide can cause dehydration. This is evidenced in this scenario by an elevation in the BUN and a normal creatinine. Increasing fluid intake will result in improved hydration status and a decrease in the BUN level. Although sending the client's urine for analysis should be done, it will not change the client's hydration status. Although the client should be on strict intake and output, it will not change the client's hydration status. Sodium restriction will not lower the BUN level; in addition, nutritionists only make suggestions to the primary healthcare provider regarding interventions. The primary healthcare provider is the professional legally responsible for prescribing a sodium-restricted diet.

(18) a client with ascites is scheduled to receive albumin. to have the greatest therapeutic effect, the nurse expects what infusion rate and what oral fluid intake? a. slow IV rate + liberal fluid intake b. slow IV rate + restricted fluid intake c. rapid IV rate + withheld fluid intake d. rapid IV rate + moderate fluid intake

b. slow IV rate + restricted fluid intake When albumin is administered slowly and oral fluid intake is restricted, fluid moves from the interstitial spaces into the circulatory system so it can be eliminated by the kidneys. Administration should not exceed 5 to 10 mL/min. Oral fluids are restricted to facilitate the optimal effects of the albumin, which shifts fluids from the interstitial spaces to the intravascular compartment. Rapid administration may cause circulatory overload; fluid is restricted, not withheld. Unrestricted fluid intake will limit the shift of fluid from the interstitial to the intravascular compartment, interfering with the optimal effects of the albumin.

(52) a client reports a loss of 20 lbs (9 kgs) in 3 months and black, tarry stools. a colonoscopy is scheduled. what instructions does the nurse give to prepare the client for this test? a. instructs that a bland diet will be prescribed for the night before the test b. tells the client not to eat or drink anything the morning of the test c. administers a oil-retention enema just before the test d. explains that the pretest laxative will cause diarrhea after the test

b. tells the client not to eat or drink anything the morning of the test Eating or drinking the morning of the test could interfere with the test results. A liquid, not bland, diet should be consumed the night before the test. An oil-retention enema will interfere with visualization during the colonoscopy and therefore should not be administered. Diarrhea should not occur after the test.

(10) which statement regarding erythropoietin is true? a. erythropoietin is released by the pancreas b. an erythropoietin deficiency causes diabetes c. an erythropoietin deficiency is associated with renal failure d. erythropoietin is released only when there is adequate blood flow

c. an erythropoietin deficiency is associated with renal failure Erythropoietin is produced by the kidneys; its deficiency occurs in renal failure. Erythropoietin is released by the kidneys, not the pancreas. Erythropoietin deficiency causes anemia. Erythropoietin is secreted in response to hypoxia, which results in decreased oxygenated blood flow to the tissues.

(26) a client will be discharged with a peripherally inserted central venous catheter (PICC) for administration of PPN. what would be appropriate for the nurse to include in the client's discharge teaching? a. learning how to change the percutaneous catheter b. determining which days to self-administer the PPN solution c. arranging for professional help to monitor the alternative nutrition d. scheduling administration of the PPN solution around mealtimes

c. arranging for professional help to monitor the alternative nutrition Professional assistance will ensure correct administration, which may limit complications such as intravascular overload and sepsis; eventually, the client may self-administer the PPN with supervision. Learning how to change the percutaneous catheter usually is done by an appropriate health care provider. PPN usually is administered every day. The PPN solution usually is administered as an intermittent infusion while the client is sleeping at night, not at mealtimes; this allows for independent movement during the day.

(28) during the postoperative period after surgery for a kidney transplant, the client's Cr level is 3.1 mg/dL (260 mcmol/L). what should the nurse do first in response to this lab result? a. notify the PHCP b. obtain current blood test results c. assess for decreased urine output d. check the IV infusion

c. assess for decreased urine output The expected serum creatinine range is 0.7 to 1.4 mg /dL (62 to 124 mcmol/L). The nurse should obtain additional information that may indicate acute rejection; therefore, the nurse must first assess for decreased urine output and changes in vital signs. Once additional data are collected (e.g., urine output, current blood work reports) and the intravenous (IV) infusions are checked, the nurse should contact the primary healthcare provider, explain the situation, and implement further prescriptions. Eventually the nurse should ensure that proper infusion rates, along with IV medications, are being maintained after the client is first assessed for decreased urine output and for changes in vital signs. Current blood work reports should be obtained after the client is assessed for decreased urine output and changes in vital signs.

(30) a client has enid-stage kidney disease ad is receiving hemodialysis. during dialysis the client reports nausea and a HA and appears confused. operating on prescribed protocols, which action will the nurse take? a. give an analgesic b. administer a antiemetic c. decrease the rate of exchange d. DC the procedure immediately

c. decrease the rate of exchange Headache, nausea, and confusion are signs and symptoms of disequilibrium syndrome [1] [2], which results from rapid changes in composition of the extracellular fluid; therefore, the rate of exchange should be decreased. Although an analgesic may relieve the headache, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Although administering an antiemetic may relieve the nausea, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Discontinuing the procedure is unnecessary; reducing the rate of exchange should reduce the adaptations of disequilibrium syndrome.

(15) a nurse reviews the medical record of a client with ascites. which client condition may be contributing to the development of ascites? a. portal hypotension b. kidney malfunction c. diminished plasma protein level d. decreased production of K+

c. diminished plasma protein level The liver manufactures albumin, the major plasma protein. A deficiency of this protein lowers the osmotic (oncotic) pressure in the intravascular space, leading to a fluid shift. An enlarged liver compresses the portal system, causing increased, rather than decreased, pressure. The kidneys are not the primary source of the pathologic condition. It is the liver's ability to manufacture albumin that maintains the colloid oncotic pressure. Potassium is not produced by the body, nor is its major function the maintenance of fluid balance.

(24) a client had a gastric bypass procedure to treat morbid obesity. after surgery the client reports weakness, sweating, palpitations, and dizziness after eating. what should the nurse encourage the client to do? a. reduce intake of protein-rich foods b. drink 8 oz (240 mL of water with meals c. divide the daily caloric intake into 6 smaller meals d. remains in a upright position for 1 hour after eating

c. divide the daily caloric intake into 6 smaller meals The client's clinical manifestations are related to the dumping syndrome from the gastric bypass procedure. Smaller meals along with other interventions will help minimize this response. After gastric bypass, a bolus of hypertonic fluid enters the intestines before carbohydrates and electrolytes are diluted. Extracellular fluid is drawn into the bowel lumen; this causes a decrease in plasma volume, distention of the bowel lumen, and rapid intestinal transit. Protein intake should be increased, not decreased, to meet energy needs and promote healing. Fluids should be avoided at mealtimes because they increase the volume in the stomach and decrease the transit time of gastric contents moving from the stomach to the intestine, which contributes to dumping syndrome. An upright position decreases the transit time of gastric contents moving from the stomach to the intestines via gravity, which contributes to the dumping syndrome; clients may lie flat after eating for a short time.

(8) a nurse is caring for a client who just had a gastrectomy. what should the nurse emphasize when teaching the client how to avoid dumping syndrome? a. increase activity after eating b. drink at least 2-3 glasses of fluid with each meal c. eat small meals with low carb and moderate fat content d. sit in a high-fowler position for 30 minutes after eating

c. eat small meals with low carb and moderate fat content Small meals with low carbohydrate, moderate fat, and high protein are recommended; these are digested more readily and prevent rapid stomach emptying. Rest, not activity, after meals assists in limiting dumping syndrome. Fluid intake with meals should be in moderation. Fluids with meals cause rapid emptying of the food from the stomach into the jejunum before it is adequately subjected to the digestive process; the hyperosmolar mixture causes a fluid shift to the jejunum. A high-Fowler position will not reduce the risk of dumping syndrome.

(25) a client with acute glomerulonephritis reports thirst. which is the most common appropriate choice that the nurse can offer to relieve the client's thirst? a. ginger ale b. milkshake c. hard candy d. cup of broth

c. hard candy Sucking on a hard candy will relieve thirst and increase carbohydrates but does not supply extra fluid. Low protein, low sodium, and fluid restrictions are needed. The goal is to minimize unnecessary fluid intake. Carbonated beverages contain sodium and provide additional fluid, which must be restricted. A milkshake contains both fluid and protein, which must be restricted. Broth contains sodium, which increases fluid retention.

(28) during the admin of TPN, an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and a cough. what is the priority nursing intervention? a. restart the client's infusion at another site b. slow the rate of the client's infusion of the TPN c. interrupt the client's infusion and notify HCP d. obtain the VS and continue monitoring the client's status

c. interrupt the client's infusion and notify HCP The client is experiencing pulmonary edema because of a fluid volume excess. The high concentration of TPN precipitates a fluid shift from the interstitial compartment into the intravascular compartment. Fluid will continue to be infused, which will continue to increase the intravascular volume.

(48) a client with an obstruction of the pancreatic ducts has been diagnosed with acute pancreatitis. the client's physical condition continues to deteriorate despite supportive care, and a subtotal pancreatectomy is performed. the nurse should monitor the client for what postoperative complication? a. constipation b. cholecystitis c. paralytic ileus d. respiratory distress

c. paralytic ileus A paralytic ileus may occur because of the surgical manipulation of the gastrointestinal tract. If after pancreatic surgery the endocrine function of the pancreas is compromised, diarrhea and steatorrhea may develop as a result of insufficient pancreatic enzymes. Cholecystitis does not occur after a subtotal pancreatectomy; cholecystitis may accompany pancreatitis. Acute respiratory distress syndrome may occur three to seven days after the onset of pancreatitis; it is related to pancreatitis, not subsequent to the surgery.

(14) a nurse teaches a client with chronic real failure that salt substitutes cannot be used in the diet. what is the rationale for the nurse's instruction? a. a person's body tends to retain fluid when a salt substitute is included in the diet b. limiting salt substitutes in the diet prevents a buildup of waste products in the blood c. salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats d. a substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca

c. salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen (BUN) and creatinine levels; these are the result of protein metabolism. There is no such substance in salt substitutes that interferes with the transfer of fluid across capillary membranes.

(9) after a subtotal gastrectomy, a client begins to eat more food in varied forms. after meals the client experiences a cramping discomfort ad a rapid pulse with waves of weakness, which often are followed by N/V. the nurse concludes that the client is experiencing dumping syndrome, which is caused by what process? a. sluggish passage of food into the SI b. rapid passage of a dilute food mixture into the SI c. sudden passage of a hyperosmolar food solution into the SI d. passage of food that is less concentrated than surrounding extracellular fluid in the SI

c. sudden passage of a hyperosmolar food solution into the SI Without an adequate stomach reservoir, the hypertonic, concentrated food mass quickly empties ("dumps") into the small intestine, drawing fluid from surrounding blood and tissue, causing hypovolemia and typical signs and symptoms of shock. Dumping syndrome occurs when food passes too quickly, not too slowly, into the small intestine. The food mass is more concentrated (hypertonic), not dilute, in dumping syndrome.

(24) a nurse is caring for a client with AKI who is receiving a protein-restricted diet. the client asks why this diet is necessary. which information should the nurse include in a response to the client's questions? a. a high-protein intake ensures an adequate daily supply of amino acids to compensate for losses b. essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis c. this supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys d. urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amnio acid synthesis must come from the dietary protein

c. this supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys The amount of protein permitted in the diet depends on the extent of kidney function; excess protein causes an increase in urea concentration, excess metabolic waste, and added stress on the kidneys, which should be prevented. Adequate calories are provided to prevent tissue catabolism that also results in an increase in metabolic waste products. In kidney failure the kidneys are unable to eliminate the waste products of a high-protein diet, which is to be avoided. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.

(34) a student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? a. "it provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration" b. "it exchanges and classes blood by correction of electrolytes ad excretion of creatinine" c. "it decreases the need for immobility because it clearers toxins in short and intermittent periods" d. "it uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion"

d. "it uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion" Diffusion [1] [2] moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.

(33) a client with CKD is admitted to the hospital with severe infection ad anemia. the client is depressed ad irritable. the client's spouse asks the nurse about the anticipated plan of care. which is an appropriate nursing response? a. "the staff will provide total care, because the infection causes severe fatigue" b. "mood elevators will be prescribed to improve depression and irritability" c. "vitamin B12 will be prescribed for the anemia, and the stools will be dark" d. "the intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products"

d. "the intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products" One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron and folic acid supplements are used for anemia in chronic kidney disease; Vitamin B12 is used for pernicious anemia and does not make the stools dark; iron makes the stools dark.

(1) a client with acute kidney failure is fatigued and becomes lethargic. upon reviewing the client's medical record, which finding does the nurse determine is the most likely cause of this change in symptoms? a. hyperkalemia b. hypernatremia c. a limited fluid intake d. an increased BUN level

d. an increased BUN level An increased blood urea nitrogen level, indicating uremia, is toxic to the central nervous system and causes fatigue and lethargy. Hyperkalemia is associated with muscle weakness, irritability, nausea, and diarrhea. Hypernatremia is associated with firm tissue turgor, oliguria, and agitation. Dehydration can cause fatigue, dry skin and mucous membranes, and rapid pulse and respiratory rates.

(35) a client is admitted to the hospital with GI bleeding, and an NGT is inserted. the HCP prescribes the NGT to be irrigated with NS whenever necessary to maintain patency. what should the nurse do first when it is determined that the NGT is not patent? a. instill NS b. assess breath sounds c. auscultate for bowel sounds d. check the tube for placement

d. check the tube for placement Checking the tube for placement reduces the risk of introducing the irrigant into the lungs. Instilling normal saline increases the risk of introducing irrigant into the lungs if the tube is not in the stomach. Assessing for breath sounds is not related to the steps associated with instilling a nasogastric tube with an irrigant. Auscultating for bowel sounds is not related to the steps associated with instilling a nasogastric tube with an irrigant.

(38) a HCP prescribes intermittent NGT feedings to supplement a client's oral nutritional intake. which hazard associated with a GT feeding will be reduced if the nurse administers this feeding over 30-60 minutes? a. distention b. flatulence c. indigestion d. regurgitation

d. regurgitation Because the cardiac sphincter of the stomach is slightly opened to admit the nasogastric tube, rapid instillation may result in regurgitation. Distention is diminished by avoiding the instillation of air with the feeding. The speed of a feeding does not cause flatulence, but the administration of air may. Administering this feeding over 30 to 60 minutes may or may not decrease indigestion.

(40) to prepare a client for discharge, the nurse is providing dietary instructions to a client who had a pancreaticoduodenectomy (Whipple procedure). what should the nurse include in the instructions? a. the surgery has established normal digestive processes; no dietary restrictions are needed b. to prevent overworking the pancreas, follow a low-calorie diet c. because of compromised liver function, restrict protein intake d. the surgery has interfered with the fat digestion mechanism; a low-fat diet is needed

d. the surgery has interfered with the fat digestion mechanism; a low-fat diet is needed A pancreaticoduodenectomy leads to malabsorption because of impaired delivery of bile to the intestine; fat metabolism is interfered with, causing dyspepsia. These clients are anorexic, require small, frequent meals, and should eat a high-calorie, high-protein, low-fat diet. High-calorie meals are needed for energy and to promote use of protein for tissue repair. High protein is required for tissue building; there is no problem with the liver in clients with cancer of the pancreas unless direct extension occurs.