NUR419 Exam Renal
The nurse assesses the NG tube on a patient who is receiving continuous tube feedings and notes that the tube is poorly secured and the measurement is different than the previous documentation. What is the nurse's first action?
Stop the tube feeding.
The new nurse is caring for a patient who is ordered to receive Jevity at 60 mL/hr. The nurse is curious why Jevity was chosen for the patient. Which member of the interdisciplinary team should the nurse consult to answer this question?
The dietitian.
The client receives heparin while on hemodialysis. The nurse explains the anticoagulation process by making which of the following statements?
"Regional anticoagulation is achieved by putting heparin in the dialysis machine and protamine sulfate, which reverses the anticoagulation, into the client."
A client with Acute Kidney Injury develops pulmonary edema. Nursing interventions for this person should include: (Select all that apply).
-Administering oxygen -Encouraging coughing and deep breathing -Placing the client in a semi-sitting position.
The nurse would include which of the following in teaching the client with a arteriovenous fistula? Select all that apply.
-Do not allow blood pressures or blood draws to be performed on the arm with the fistula. -Avoid sleeping with the arm bent for prolonged periods. -Squeeze a rubber ball for 10-15 minutes at least once a day to help develop the fistula.
Which complications are consequences of malnutrition? Select all that apply.
-Infection -Increase in legnth of stay -Prolonged mechanical ventilation -Death.
The nurse teaches the student nurse that to truly confirm absent bowel sounds, the abdomen must be auscultated for:
5 minutes.
The client with chronic renal failure complains of feeling nauseated at least part of the day. The nurse should explain that the nausea is the result of
Accumulation of waste products in the blood?
A 58 year old female is admitted to ICU with complaints of epigastric and mid-abdominal pain, rated 8/10. She is diaphoretic and has a distended abdomen. Vitals are Temp 100.6, pulse 112, RR 24, B/P 88/52. Laboratory results from the emergency department reveal elevated amylase, lipase and triglycerides. The nurse suspects that the patient is experiencing which disorder?
Acute pancreatitis.
The nurse is caring for a patient with TPN who has consistant elevated blood glucose levels. Which of the following interventions would the nurse expect the physician to order?
Adding insulin to the TPN.
One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. How do these agents lower potassium?
They force potassium out of the serum and into the cells, thus causing serum potassium levels to decrease.
Which finding is considered an abnormal gastrointestinal assessment?
Visible peristaltic waves except in very thin patients.
The goal of pain management in patients with acute pancreatitis is to:
achieve pain relief while maintaining hemodynamic stability.
An unconscious patient is brought to the ER with a blood glucose of 840 mg/dL. Family members state that the patient is diabetic and has become increasingly lethargic over the past 3 days. The health care team suspects a diagnosis of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS). Which finding supports a diagnosis of HHS rather than DKA?
pH 7.4
A patient is diagnosed with upper GI bleeding and the physician suspects peptic ulcer disease. Which IV medication does the nurse prepare to administer as part of the treatment regimen?
pantoprazole.
Esophageal varices are the result of:
portal hypertension causing backward pressure into the esophageal blood vessels.
A patient in the ICU is ordered to begin taking potassium supplements. The nurse contacts the healthcare provider to clarify this order after noting that the patient is currently taking which other medication?
spironolactone.
Which medication would the nurse administer to control ammonia levels in a patient with liver failure?
Lactulose.
A patient presents with the following: HR, 120 beats/min; BP, 80/44mm Hg; urine output averaging 20 ml/hr over the last 4 hours; afebrile, moist rales bilateral lungs; BUN 84 mg/dl; creatinine, 3.4 mg/dl. What is the probable cause of this patient's renal failure?
Left ventricular failure causing prerenal azotemia.
The nurse administers Vasopressin to a client with variceal bleeding. What is the nurse's priority responsibility following administration of this drug?
Maintaining IV access and monitoring for hypertension.
A geriatric client who takes ibuprofen and methotrexate for rheumatoid arthritis is admitted to the ICU following complications from a total hip arthroplasty. Which assessment finding indicates a serious complication related to the patient's medications?
Melena.
Which of the following IV solutions is recommended for treatment of prerenal failure?
Normal saline.
To assess whether or not an atrioventricular fistula is functioning, what must be done and why?
Palpate gently over the site of the fistula to determine if a thrill is present; listen with stethoscope over the site to appreciate a bruit to assess the quality of the blood flow.
The nurse is assessing a client with cirrhosis for signs of hypoalbuminemia. Which physical assessment finding will the nurse look for?
Peripheral edema.
The nurse is admitting an older adult male patient to the critical care unit who has a history of benign prostatic hyperplasia (BPH). Which condition does the BPH potentially place him at risk for?
Postrenal acute kidney injury.
The patient reports all the following conditions during the medical history. Which is most likely to have precipitated the patient's renal failure?
Recent computed tomography of the brain with contrast.
A client has chronic renal failure with persistent hypertension. The nurse's actions are guided by the knowledge that this hypertension is from which one of the following mechanisms?
Renin-angiotensin-aldosterone system?
The nurse initiates treatment for a patient with diabetic ketoacidosis (DKA). Which laboratory result does the nurse carefully monitor for potential complications?
Serum potassium level.
A patient presents to the ED with bloody stools, dizziness, and hypotension. What is the priority intervention?
Infuse IV fluids for volume resuscitation
A bluish discoloration of the umbilicus or flank is indicative of
Intraperitoneal bleed.
Which of the following is an appropriate reason for CRRT to be chosen for a patient?
It is indicated for patients who require large-volume removal for severe uremia or critical acid-base imbalances.
Which problem is a potentially devastating complication of nasogastric tube feedings?
Aspiration.
Which physiological alteration is responsible for acute pancreatitis?
Autodigestion caused by premature activation of digestive enzymes.
The nurse is caring for a patient who is receiving continuous tube feeding at 40mL/hr. After 4 hours, the nurse finds 50 mL or residual feeding. What should the nurse do next?
Continue the tube feeding and recheck residual in 4 hours?
A critically ill patient in the ICU has persistently high fasting blood glucose levels > 150 mg/dL. The family asks if the patient has developed diabetes. What is the nurse's best response?
Critical illness and hospitalization stress the body, which can increase blood sugar levels.
Which of the following manifestations is always present in acute renal failure?
Decrease in glomerular filtration rate (GFR).
Which anatomical structures are located in the right upper quadrant of the abdomen?
Duodenum Transverse colon Liver Stomach
What is the CRRT filter permeable to?
Electrolytes.
A client presents to the emergency department with hematemesis, melena, and hemoglobin 8.4 g/dL. Which diagnostic procedure does the nurse anticipate for this client?
Endoscopy.
he nurse notes the following in the client with chronic renal failure: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in 1 day. Based on these data, which of the following nursing diagnoses is appropriate?
Excess fluid volume related to the kidney's inability to maintain fluid balance.
A patient with 10-year history of diabetes mellitus is admitted to the ICU with increasing lethargy. Laboratory values indicate a diagnosis of diabetic ketoacidosis (DKA). Which physical symptom is most suggestive of DKA?
Excessive thirst.
The nurse administers sodium polystyrene sulfonate to the client with potassium imbalance. What is the intended action of this medication?
Exchange sodium for potassium ions in the colon.
A patient in the ER is diagnosed with diabetic ketoacidosis (DKA). The patient is lethargic, hypotensive, and tachycardic. Which intervention is most important for the ER nurse to initiate first for this patient?
Fluid resuscitation.
A client is at risk for gastrointestinal hemorrhage. Which findings does the nurse carefully assess for to detect this complication?
Hematemesis and melena.
A patient is seen in the ER with a necrotic diabetic ulcer on the left foot. When the nurse asks the patient about his normal blood glucose levels, he reports he cannot afford a glucometer. Which lab test should the nurse request from the healthcare provider?
Hemoglobin A1C.
A client presents to the ER with confusion, disorientation, and lethargy. The patient's wife reports history of cirrhosis and recent urinary tract infection, and explains the patient has become more confused and lethargic over the past several days. Which condition does the nurse suspect?
Hepatorenal syndrome.
A patient develops antidiuretic hormone imbalance after sustaining a head injury. Which assessments are most important for preventing complications associated with this imbalance?
I & O and daily weights.
A client with potassium level 6.7 mEq/L experiences frequent pre-ventricular contractions (PVCs) and chest pain. What medications does the nurse plan to administer?
IV dextrose and IV regular insulin.
The nurse assesses a patient who is receiving TPN and finds the TPN infusion rate is set at 75mL/hr. The ordered rate is 100mL/hr. What does the nurse do next?
Increase the rate to 100mL/hr and notify the physician and pharmacist?
