renal failure and perfusion practice questions

Which meal selection indicates that the client understands the nurse's teaching regarding heart-healthy diet choices? A. Fried fish, mashed potatoes, and unsweetened tea B. Ham and cheese sandwich with baked chips C. Roasted chicken, baked potato, and green beans D. Hamburger, French fries, and diet soda

C

Which medication would be most important to administer to a client experiencing chest pain? A. Ketorolac B. Metoprolol C. Aspirin D. Atorvastatin

C

Which of the following is a side effect of metoprolol? A. Yellow-green halos B. Hyperkalemia C. Hypoglycemia D. Pulmonary fibrosis

C

a RN is performing a PA of a pt who has chronic peripheral arterial disease (PAD). Which of the following is an expected finding? A. edema around the pt's ankles and feet B. ulceration around the pt's medial malleoli C. scaling eczema of the pt's lower legs with stasis dermatitis D. pallor on elevation of the pt's limb and rubor when his limbs are dependent

D

The client diagnosed with an ST elevation myocardial infarction (STEMI) has developed 2+ edema bilaterally of the lower extremities and has crackles in all lung fields. Which should the nurse implement first? A. Notify the health care provider (HCP). B. Assess what the client ate at the last meal. C. Request a STAT 12 lead electrocardiogram. D. Administer furosemide IVP.

"Has developed" indicates a new issue; the nurse should notify the HCP of the assessment findings, which indicate that the client has developed heart failure. What the client ate has no bearing on the new development of the clinical manifestations of heart failure. A 12-lead ECG will not treat heart failure. A diuretic may need to be administered but notifying the HCP is first.

A client is admitted with left-sided HF. Which clinical finding would concern the nurse the most? A. 4+ pitting edema in bilateral feet and JVD B. Crackles on auscultation and fatigue on exertion C. Shortness of breath and pulse rate of 110bpm D. Sleeping propped up on two or more pillows

A

A client with acute renal failure is in oliguirc phase of the disease. Which snack would be most appropriate? A. Graham crackers B. Yogurt C. Two popsicles D. Orange juice

A

A patient experiences severe blood loss and hypovolemia following a motor vehicle crash. The nurse should assess for signs and symptoms of which condition most likely to affect the patient? A. Prerenal acute kidney injury B. Intrarenal acute kidney injury C. Postrenal acute kidney injury D. Chronic kidney disease

A

Nitroglycerin is a ___________. A. Vasodilator B. Calcium-channel blocker C. Beta-blocker D. Antihyperlipidemic

A

The client has just returned from a cardiac cath. Which finding would require immediate attention? A. Hard knot under cath site dressing B. Pain 5/10 at cath site C. BP 98/64, pulse 92 D. 1+ pedal pulses bilaterally

A

The nurse should recognize that which assessment findings are consistent with chronic kidney disease? Select all that apply. A. Slow manifestation of symptoms B. Decreased creatinine clearance C. Increased serum creatinine levels D. Trace of protein in the urine E. History of hypertension

ABCE

The nurse is caring for a patient diagnosed with chronic kidney disease whose hemoglobin level is 10 g/dL yet remains asymptomatic. The nurse should anticipate the administration of which treatments? Select all that apply. A. Folic acid supplements B. Oral iron supplements C. Daily blood transfusion D. Erythropoietin subcutaneously E. Aminoglycoside therapy

ABD

The nurse should recognize which of the following as risk factors for acute kidney injury? Select all that apply. A. Dehydration B. Trauma C. Edema D. Hypovolemia E. Hypervolemia

ABD

The client is diagnosed with chronic renal failure is prescribed a 60mg protein, 2000mg sodium diet. Which food choices indicate the client understands the dietary restrictions? A. A 4oz grilled chicken breast, broccoli, and a small glass of unsweetened tea B. Baked potato with chopped ham and sour cream, 12 oz steak, and beer C. Double patty cheeseburger, French fries, and Kool aid D. Roast beef sandwich, potato chips, and soft drink

A

The myocardial tissue perfusion occurs during what phase of the cardiac cycle? A. Diastole B. Systole and diastole C. Systole D. Ventricle depolarization

A

The nurse is caring for a client diagnosed with acute renal failure . Which laboratory values are most significant for diagnosing acute renal failure? A. BUN and creatinine B. WBC and hemoglobin C. Potassium and sodium D. Bilirubin and ammonia levels

A

The nurse manager has taught a new staff nurse about assessing and caring for an arteriovenous graft. The staff nurse demonstrates understanding of appropriate care when performing which action? A. Feel for buzzing sensation. B. Auscultate carotid pulses C. Palpate for a bruit. D. Access graft for labs.

A

You administer clopidogrel to a client who received a stent. Which teaching statement best explains why? A. "This medication will keep you from developing another clot." B. "This medication will promote healthy cholesterol levels." C. "This medication will help prevent abnormal heart rhythms." D. "This medication will help lower your blood pressure after your procedure."

A

The nurse is admitting an older adult to the hospital. The echocardiogram revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles. Based on this finding, what should the nurse do first? A. Assess respiratory status B. Draw blood for laboratory status C. Insert a foley catheter D. Weight the client

A The ankle edema suggests fluid volume overload. The should assess respiratory status first by obtaining VS, and listening to lung sounds.

The nurse has received shift report. Which client should the nurse assess first? A. The client diagnosed with coronary artery disease complaining of severe indigestion. B. The client diagnosed with congestive heart failure who has 3+ pitting edema. C. The client diagnosed with atrial fibrillation whose apical rate is 110 and irregular. D. The client diagnosed with sinus bradycardia who is complaining of being constipated.

A A complaint of indigestion could be cardiac chest pain. The nurse should assess this client because of the diagnosis of CAD and the word "severe" in the option. Edema is expected for the client diagnosed with heart failure, and it is not life threatening.An irregular heart rate is not life threatening, and 110 is abnormal but also not life threatening. Constipation is not life threatening albeit uncomfortable.

The nurse is assessing the client diagnosed with congestive heart failure. Which laboratory data would indicate that the client is in severe congestive heart failure? A. An elevated B-type natriuretic peptide (BNP). B. An elevated creatine kinase (CK-MB). C. A positive D-dimer. D. A positive ventilation/perfusion (V/Q) scan.

A BNP is a specific diagnostic test. Levels higher than normal indicate congestive heart failure, with the higher the number, the more severe the CHF. An elevated CK-MB would indicate a myocar- dial infarction, not severe CHF. CK-MB is an isoenzyme.A positive D-dimer would indicate a pulmo- nary embolus. A positive ventilation/perfusion (V/Q) scan (ratio) would indicate a pulmonary embolus

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most significant for diagnosing ARF? A. BUN and creatinine. B. WBC and hemoglobin. C. Potassium and sodium. D. Bilirubin and ammonia level.

A Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure. WBCs (white blood cells) are monitored for infection, and hemoglobin is monitored for blood loss.Potassium (intracellular) and sodium (interstitial) are electrolytes and are monitored for a variety of diseases or conditions not specific to renal function. Potassium levels will increase with renal failure, but the level is not a diagnostic indicator for renal failure. Bilirubin and ammonia levels are laboratory values determining the function of the liver, not the kidneys.

The client diagnosed with CKD has a new arteriovenous fistula in the left forearm. Which intervention should the nurse implement? A. Teach the client to carry heavy objects with the right arm. B. Perform all laboratory blood tests on the left arm. C. Instruct the client to lie on the left arm during the night. D. Discuss the importance of not performing any hand exercises.

A Carrying heavy objects in the left arm could cause the fistula to clot by putting undue stress on the site, so the client should carry objects with the right arm. The fistula should only be used for dialysis access, not for routine blood draws. The client should not lie on the left arm because this may cause clotting by putting pressure on the site.Hand exercises are recommended for new fistulas to help mature the fistula.

The nurse correlates which physiological response to the secretion of natriuretic peptide hormones? A. Increase in urine output B. Increase in blood pressure C. Increase in blood volume D. Increase in serum osmolality

A Natriuretic peptide hormones are released from specialized cells within the walls of the atrium and ventricles in response to increase blood volume and blood pressure. As a result of the release of ANP and BNP, reabsorption of sodium by the kidney and increase in glomerular filtration rate results in increased urine output that is high in sodium.

The nurse on the telemetry unit has just received the a.m. shift report. Which client should the nurse assess first? A. The client diagnosed with myocardial infarction who has an audible S3 heart sound. B. The client diagnosed with congestive heart failure who has 4+ sacral pitting edema. C. The client diagnosed with pneumonia who has a pulse oximeter reading of 94%. D. The client with chronic renal failure who has an elevated creatinine level.

A An S3 heart sound indicates left ventricular failure, and the nurse must assess this client first because it is an emergency situation. The nurse would expect a client with CHF to have sacral edema of 4+; the client with an S3 would be in a more life-threatening situation. A pulse oximeter reading of greater than 93% is considered normal. An elevated creatinine level is expected in a cli- ent diagnosed with chronic renal failure.

The nurse has just received a report on assigned patients. Which of the following patients should be assessed first? A. The patient with indigestion and increased troponin levels B. The patient with indigestion and increased CK levels C. The patient admitted 2 days ago with a BNP of 75 pg/mL D. The patient admitted 2 days ago with increased LDLs and C-reactive protein

A Indigestion is sometimes an indicator of myocardial infarction, and increased troponin levels are an indicator of acute injury. Increased CK is nonspecific for cardiac injury so the patient probably just has indigestion. The patient with a BNP of 75 two days after admission without shortness of breath is not acutely worrisome. Patient D needs evaluation but is not critical.

The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive heart failure (CHF). Which signs/symptoms would the nurse expect to find when assessing this client? A. Apical pulse rate of 110 and 4+ pitting edema of feet. B. Thick white sputum and crackles that clear with cough. C. The client sleeping with no pillow and eupnea. D. Radial pulse rate of 90 and CRT less than three (3) seconds.

A The client with CHF would exhibit tachy- cardia (apical pulse rate of 110), dependent edema, fatigue, third heart sounds, lung congestion, and change in mental status. The client with CHF usually has pink frothy sputum and crackles that do not clear with coughing. The client with CHF would report sleeping on at least two pillows, if not sleeping in an upright position, and labored breathing, not eupnea, which means normal breathing. In a client diagnosed with heart failure, the apical pulse, not the radial pulse, is the best place to assess the cardiac status.

Which meal would indicate the client understands the discharge teaching concerning the recommended diet for coronary artery disease? A. Baked fish, steamed broccoli, and garden salad. B. Enchilada dinner with fried rice and refried beans. C. Tuna salad sandwich on white bread and whole milk. D. Fried chicken, mashed potatoes, and gravy.

A The recommended diet for CAD is low fat, low cholesterol, and high fiber. The diet described is a diet that is low in fat and cholesterol. This is a diet very high in fat and cholesterol. The word "salad" implies something has been mixed with the tuna, usually mayonnaise, which is high in fat, but even if the test taker did not know this, white bread is low in fiber and whole milk is high in fat. Meats should be baked, broiled, or grilled— not fried. Gravy is high in fat.

Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements would be considered true related to nutritional therapy (select all that apply)? A. Fluid is not usually restricted for patients receiving peritoneal dialysis. B. Sodium and potassium may be restricted in someone with advanced CKD. C. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving hemodialysis. D. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving peritoneal dialysis E. Decreased fluid intake and a diet with phosphate-rich foods are hallmarks of a diet for a patient receiving hemodialysis.

ABC

Stroke volume is influenced by which variables? (Select all that apply.) A. Preload B. Afterload C. Contractility D. Heart rate E. Cardiac output F. Chemoreceptors

ABC

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. A. Increased alertness and no seizure activity. B. Increase in hemoglobin and hematocrit. C. Denial of nausea and vomiting. D. Decreased urine-specific gravity. E. Increased serum creatinine level.

ABC Renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit indicates the client is in the recovery period. Nausea, vomiting, and diarrhea are common in the client with ARF; therefore, an absence of these indicates the client is in the recovery period. The client in the recovery period has an increased urine-specific gravity.The client in the recovery period has a decreased serum creatinine level.

Which interventions should the nurse discuss with the client diagnosed with coronary artery disease? Select all that apply. A. Instruct the client to stop smoking. B. Encourage the client to exercise three (3) days a week. C. Teach about coronary vasodilators. D. Prepare the client for a carotid endarterectomy. E. Eat foods high in monosaturated fats.

ABC Smoking is the one risk factor that must be stopped totally; there is no compromise. Exercising helps develop collateral circulation and decrease anxiety; it also helps clients to lose weight. Clients with coronary artery disease are usually prescribed nitroglycerin, which is the treatment of choice for angina. Carotid endarterectomy is a procedure to remove atherosclerotic plaque from the carotid arteries, not the coronary arteries. The client should eat polyunsaturated fats, not monosaturated fats, to help decrease atherosclerosis.

The home health nurse is assigned a client diagnosed with heart failure. Which should the nurse implement? Select all that apply. A. Request a dietary consult for a sodium- restricted diet. B. Instruct the client to elevate the feet during the day. C. Teach the client to weigh every morning wearing the same type of clothing. D. Assess for edema in dependent areas of the body. E. Encourage the client to drink at least 3,000 mL of fluid per day. F. Have the client repeat back instructions to the nurse.

ABCDF A dietitian can assist the nurse in explaining the sodium restrictions to the client as well as hidden sources of sodium. This will help the client's body to return excess fluid to the heart for removal from the body by the kidneys. The client should weigh himself/herself every morning in the same type of clothing (gown, underwear, jeans, etc.) and report a weight gain of 3 pounds in a week to the HCP. The nurse should not assess for edema in the feet and lower legs, but if the client is in bed the lowest part of the body may be in the sacral area. Whichever area is dependent is where the nurse should look for edema. The client should drink enough fluids to maintain body function, but 3,000 mL is excessive. Whenever the nurse is instructing a client, the nurse should determine if the client heard and understood the instructions. Having the client repeat the instructions is one way of determining "hearing." Having the client return demonstrate is a method of determining understanding.

Which client teaching should the nurse implement for the client diagnosed with coronary artery disease? Select all that apply. A. Encourage a low-fat, low-cholesterol diet. B. Instruct the client to walk 30 minutes a day. C. Decrease the salt intake to two (2) g a day. D. Refer to a counselor for stress reduction techniques. E. Teach the client to increase fiber in the diet.

ABDE A low-fat, low-cholesterol diet will help decrease the buildup of atherosclerosis in the arteries.Walking will help increase collateral circulation. Salt should be restricted in the diet of a client with hypertension, not coronary artery disease. Stress reduction is encouraged for clients with CAD because this helps prevent excess stress on the heart muscle. Increasing fiber in the diet will help remove cholesterol via the gastrointestinal system.

The healthcare provider alerts the nurse that a patient is at risk for chronic kidney disease. Which risk factors should the nurse expect to find in this patient's chart? Select all that apply. A. Diabetes mellitus B. Recent surgery C. Hypertension D. Obesity E. Acute urinary tract infection

ACD

A nurse is providing care for a patient newly diagnosed with heart disease. Which dietary, activity, or lifestyle modification(s) should be included in the plan of care? (Select all that apply.) A. Stop smoking. B. Drink lots of water. C. Limit sedentary lifestyle. D. Eat a diet rich in red meat protein. E. Limit alcohol.

ACE Smoking, exercise, and alcohol intake are modifiable risk factors for heart disease. Patients should not be told to drink lots of water as the heart may not be able to handle excessive fluids. A diet rich in red meat is a risk factor.

Which are indications that a client with left sided heart failure for which findings? SATA A. Dyspnea B. JVD C. Crackles D. Right upper abdominal pain with edema E. Frothy sputum F. Decreased oxygen saturation levels

ACEF These are s/s of left sided HF related to pulmonary congestion and inadequate tissue perfusion. JVD and right upper abdominal pain and edema are s/s of right sided HF

The nurse should include which information in the discharge teaching plan for a patient who underwent peritoneal dialysis catheter placement? Select all that apply. A. Notify the provider if fluid appears cloudy. B. Review numerous dietary restrictions. C. Purulent drainage is expected at insertion site. D. Notify provider if any redness is noted. E. Pain at the insertion site may indicate infection.

ADE

Which assessment findings should the nurse report to the healthcare provider as being indicative of possible kidney injury? Select all that apply. A. Urine output less than 400 mL/day B. Decreased potassium level C. Increasing glomerular filtration rate D. Dyspnea E. Fixed specific gravity 1.010

ADE

What laboratory values are significant indicators of acute heart injury? A. Increased CK and myoglobin B. Increased CK-MB and troponin C. Decreased BNP and platelets D. Increased CK with low levels of CK-MB

B : CK-MB and troponin are increased in acute injury, CK and myoglobin are nonspecific for cardiac injury, increased BNP is an indicator of heart failure. Increased CK is not specific for heart injury. Low levels of CK-MB indicate the damage is not cardiac.

he intensive care department nurse is assessing the client who is 12 hours post-myocardial infarction. The nurse assesses an S3 heartsound. Which intervention should the nurse implement? A. Notify the health-care provider immediately. B. Elevate the head of the client's bed. C. Document this as a normal and expected finding. D. Administer morphine intravenously.

An S3 indicates left ventricular failure and should be reported to the health-care provider. It is a potential life-threatening complication of a myocardial infarction. 2. Elevating the head of the bed will not do anything to help a failing heart. This is not a normal finding; it indicates heart failure. Morphine is administered for chest pain, not for heart failure, which is suggested by the S3 sound.

A client is taking furosemide for CHF. Which of their following lab values would concern you? A. Calcium 8.2 B. Potassium 3.0 C. Blood glucose 120 D. Sodium 140

B

The client comes to the clinic complaining of muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client's record? A. Peripheral vascular disease B. Intermittent claudication C. Deep vein thrombosis D. Dependent rubor

B

The nurse is assessing a client with CHF. Which laboratory finding would concern the nurse the most? A. CK-MB 2ng/ml B. Creatinine 4.5 mg/dl C. Troponin 0.3 ng/ml D. BNP 345 pg/ml

B

The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first? A. Call a code immediately B. Asses the client for a pulse C. Begin chest compressions D. Continue to monitor the client

B

The nurse is caring for a patient diagnosed with acute kidney injury. Which medication order should the nurse question? A. Furosemide B. Potassium chloride C. Mannitol D. Bumetanide

B

Which of the following drugs can help lower cholesterol? A. Irbesartan B. Simvastatin C. Amiodarone D. Hydralazine

B

Which statement by the client diagnosed with coronary artery disease indicates that the client understands the discharge teaching concerning diet? A. "I will not eat more than six (6) eggs a week." B. "I should bake or grill any meats I eat." C. "I will drink eight (8) ounces of whole milk a day." D. "I should not eat any type of pork products."

B According to the American Heart Association, the client should not eat more than three (3) eggs a week, especially the egg yolk. The American Heart Association recommends a low-fat, low-cholesterol diet fora client with coronary artery disease. The client should avoid any fried foods, especially meats, and bake, broil, or grill any meat. The client should drink low-fat milk, not whole milk. Porkproducts(bacon,sausage,ham)are high in sodium, which is prohibited in a low-salt diet, not a low-cholesterol, low-fat diet.

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? A. Diabetes mellitus. B. Hypotension. C. Aminoglycosides. D. Benign prostatic hypertrophy.

B Diabetes mellitus is a disease that may lead to chronic renal failure.Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal failure (before the kidney). Nephrotoxic medications are a cause of intrarenal failure (directly to kidney).Benign prostatic hypertrophy (BPH) is a cause of postrenal failure (after the kidney).

A client diagnosed with chronic kidney disease (CKD) 2 years ago is regularly treated at a community hemodialysis facility. Before the scheduled dialysis treatment, which electrolyte imbalance should the nurse anticipate? A. Hypophosphatemia B. Hypocalcemia C. Hyponatremia D. Hypokalemia

B Hypocalcemia develops in CKD because of chronic hyperphosphatemia, not option A. Increased phosphate levels cause the peripheral deposition of calcium and resistance to vitamin D absorption needed for calcium absorption. Prior to dialysis, the nurse would expect to find the client hypernatremic and hyperkalemic, not with option C or D.

Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction? A. Midepigastric pain and pyrosis. B. Diaphoresis and cool, clammy skin. C. Intermittent claudication and pallor. D. Jugular vein distention and dependent edema.

B Midepigastric pain would support a diagnosis of peptic ulcer disease; pyrosis is belching. Diaphoresis (sweating) is a systemic reaction to the MI. The body vasoconstricts to shunt blood from the periphery to the trunk of the body; this, in turn, leads to cold, clammy skin. Intermittent claudication is leg pain secondary to decreased oxygen to the muscle, and pallor is paleness of the skin as a result of decreased blood supply. Neither is an early sign of MI. Jugular vein distension (JVD) and dependent edema are signs/symptoms of congestive heart failure, not of MI.

The client comes to the clinic complaining of muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client's record? A. Peripheral vascular disease. B. Intermittent claudication. C. Deep vein thrombosis. D. Dependent rubor.

B Peripheral vascular disease is a broad term that encompasses both venous and arterial peripheral problems of the lower extremities. This is the classic symptom of arterial occlusive disease. This is characterized by calf tenderness, calf edema, and a positive Homans' sign.This term is a sign of arterial occlusive disease; the legs are pale when elevated but are dark red when in the dependent position

The client is scheduled for a right femoral cardiac catheterization. Which nursing intervention should the nurse implement after the procedure? A. Perform passive range-of-motion exercises. B. Assess the client's neurovascular status. C. Keep the client in high Fowler's position. D. Assess the gag reflex prior to feeding the client.

B The client's right leg should be kept straight to prevent arterial bleeding from the femoral insertion site for the catheter used to perform the catheterization. The nurse must make sure that blood is circulating to the right leg, so the client should be assessed for pulses, paresthesia, paralysis, coldness, and pallor. The head of the bed should be elevated no more than 10 degrees. The client should be kept on bedrest, flat with the affected extremity straight, to help decrease the chance of femoral artery bleeding. The gag reflex is assessed if a scope is inserted down the trachea (bronchoscopy) or esophagus (endoscopy) because the throat is numbed when inserting the scope. A catheter is inserted in the femoral or brachial artery when performing a cardiac catheterization.

Which intervention should the nurse implement when administering a loop diuretic to a client diagnosed with coronary artery disease?A. Assess the client's radial pulse. B. Assess the client's serum potassium level. C. Assess the client's glucometer reading. D. Assess the client's pulse oximeter reading.

B The nurse should always assess the apical (not radial) pulse, but the pulse is not affected by a loop diuretic.Loop diuretics cause potassium to be lost in the urine output. Therefore, the nurse should assess the client's potassium level, and if the client is hypokalemic, the nurse should question administering this medication.The glucometer provides a glucose level, which is not affected by a loop diuretic.The pulse oximeter reading evaluates peripheral oxygenation and is not affected by a loop diuretic.

The client is one (1) day postoperative coronary artery bypass surgery. The client complains of chest pain. Which intervention should the nurse implement first? A. Medicate the client with intravenous morphine. B. Assess the client's chest dressing and vital signs. C. Encourage the client to turn from side to side. D. Check the client's telemetry monitor.

B The nurse should medicate the client as needed, but it is not the first intervention. The nurse must always assess the client to determine if the chest pain that is occurring is expected postoperatively or if it is a complication of the surgery.Turning will help decrease complications from immobility, such as pneumonia, but it will not help relieve the client's pain.The nurse, not a machine, should always take care of the client.

An older adult with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the HCP has written which prescription for taking the metformin before the procedure? A. Increase the amount of protein in the diet the day before B. Withhold the metformin C. Administer the metformin with only a sip of water D. Give the metformin before breakfast

B The nurse should verify that the HCP has requested to withhold the metformin, for procedures like cardiac caths or others requiring dye. The drug should be withheld up to 48 before and after the procedure.

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? A. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%. B. The client who does not have a palpable thrill or auscultated bruit. C. The client who is complaining of being exhausted and is sleeping. D. The client who did not take antihypertensive medication this morning.

B These laboratory findings are low but do not require a blood transfusion and often are expected in a client who is anemic secondary to ESRD.This client's dialysis access is compromised and he or she should be assessed first.It is not uncommon for a client undergoing dialysis to be exhausted and sleep through the treatment.Clients are instructed not to take their antihypertensive medications before dialysis to help prevent episodes of hypotension.

The nurse is preparing to administer a beta blocker to the client diagnosed with coronary artery disease. Which assessment data would cause the nurse to question administering the medication? A. The client has a BP of 110/70. B. The client has an apical pulse of 56. C. The client is complaining of a headache. D. The client's potassium level is 4.5 mEq/L.

B This blood pressure is normal and the nurse would administer the medication.A beta blocker decreases sympathetic stimulation to the heart, thereby decreasing the heart rate. An apical rate less than 60 indicates a lower-than-normal heart rate and should make the nurse question administering this medication because it will further decrease the heart rate. A headache will not affect administering the medication to the client.The potassium level is within normal limits, but it is usually not monitored prior to administering a beta blocker.

The nurse identifies the concept of perfusion for a client diagnosed with congestive heart failure. Which assessment data support this concept? A. The client has a large abdomen and a positive tympanic wave. B. The client has paroxysmal nocturnal dyspnea. C. The client has 2+ glucose in the urine. D. The client has a comorbid condition of myocardial infarction.

B This indicates ascites, which can happen in HF but does not necessarily do so; it can be liver failure or other issues client is in a recumbent position indicates that the cardiac muscle is not able to compensate for extra fluid returning to the heart during sleep. This could indicate diabetes but not heart failure. The client is at risk for heart failure as a result of the MI, but it does not happen with all MI clients and does not support the diagnosis

The client diagnosed with congestive heart failure is complaining of leg cramps at night. Which nursing interventions should be implemented? A. Check the client for peripheral edema and make sure the client takes a diuretic early in the day. B. Monitor the client's potassium level and assess the client's intake of bananas and orange juice. C. Determine if the client has gained weight and instruct the client to keep the legs elevated. D. Instruct the client to ambulate frequently and perform calf-muscle stretching exercises daily.

B The client with peripheral edema will experience calf tightness but would not have leg cramping, which is the result of low potassium levels. The timing of the diuretic will not change the side effect of leg cramping resulting from low potassium levels. The most probable cause of the leg cramping is potassium excretion as a result of diuretic medication. Bananas and orange juice are foods that are high in potassium. Weight gain is monitored in clients with CHF, and elevating the legs would decrease peripheral edema by increasing the rate of return to the central circulation, but these interventions would not help with leg cramps. Ambulating frequently and performing leg- stretching exercises will not be effective in alleviating the leg cramps.

The nurse is caring for a client diagnosed with a myocardial infarction who is experiencing chest pain. Which interventions should the nurse implement? Select all that apply. A. Administer morphine intramuscularly. B. Administer an aspirin orally. C. Apply oxygen via a nasal cannula. D. Place the client in a supine position. E. Administer nitroglycerin subcutaneously.

BC Morphine should be administered intravenously, not intramuscularly.Aspirin is an antiplatelet medication and should be administered orally. Oxygen will help decrease myocardial ischemia, thereby decreasing pain.The supine position will increase respiratory effort, which will increase myocardial oxygen consumption; the client should be in the semi-Fowler's position. Nitroglycerin, a coronary vasodilator, is ad- ministered sublingually, not subcutaneously.

The nurse is developing a discharge-teaching plan for the client diagnosed with congestive heart failure. Which interventions should be included in the plan? Select all that apply. A. Notify the health-care provider of a weight gain of more than one (1) pound in a week. B. Teach the client how to count the radial pulse when taking digoxin, a cardiac glycoside. C. Instruct the client to remove the saltshaker from the dinner table. D. Encourage the client to monitor urine output for change in color to become dark. E. Discuss the importance of taking the loop diuretic furosemide at bedtime.

BC The client should notify the HCP of weight gain of more than two (2) or three (3) pounds in one (1) day. The client should not take digoxin if the radial pulse is less than 60. The client should be on a low-sodium diet to prevent water retention. The color of the urine should not change to a dark color; if anything, it might become lighter and the amount will increase with diuretics. Instruct the client to take the diuretic in the morning to prevent nocturia.

A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? SATA A. Remind health care providers to draw blood from veins on the left side B. Avoid sleeping on the left arm C. Wear wristwatch on the right arm D. Assess fingers on the left arm for warmth E. Obtain BP from the left arm

BCD The nurse instructs in the client to protect the site of the fistula. The client should avoid any tightness on the left arm. The client should assess the area of the fistula for adequate circulation. The client should never get bp or blood draws from the arm with the fistula

The client is admitted to the emergency department, and the nurse suspects a cardiac problem. Which assessment interventions should the nurse implement? Select all that apply. A. Obtain a midstream urine specimen. B. Attach the telemetry monitor to the client. C. Start a saline lock in the right arm. D. Draw a basal metabolic panel (BMP). E. Request an order for a STAT 12-lead ECG.

BCE A midstream urine specimen is ordered for a client with a possible urinary tract infection, not for a client with cardiac problems. Anytime a nurse suspects cardiac problems, the electrical conductivity of the heart should be assessed. Emergency medications for heart problems are primarily administered intra- venously, so starting a saline lock in the right arm is appropriate. This serum blood test is not specific to assess cardiac problems. A BMP evaluates potassium, sodium, glucose, and more. A 12-lead ECG evaluates the electrical conductivity of the heart from all planes

What is the priority teaching point when the nurse is discussing the treatment regimen with a patient who has received a kidney transplant for end stage renal disease? A. To take medications daily at the same time B. To keep all follow-up appointments as scheduled C. The need for meticulous immediate and lifelong care D. To inform patient of scarring at the incision site

C

Which discharge teaching should the nurse provide for a client with peripheral arterial disease? A. Use a heating pad to improve blood flow to lower extremities B. Apply knee-high support hose every morning C. Dangle legs to help relieve claudication D. Check both feet for injuries once a week

C

Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease? A. Encourage the client to use a heating pad on the lower extremities B. Demonstrate to the client the correct way to apply elastic support hose C. Instruct the client to walk daily for at least 30 mins D. Tell the client to check both feet for red areas at least once a week.

C

The client diagnosed with a myocardial infarction is six (6) hours post-right femoral percutaneous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would require immediate intervention by the nurse? A. The client is keeping the affected extremity straight. B. The pressure dressing to the right femoral area is intact. C. The client is complaining of numbness in the right foot. D. The client's right pedal pulse is 3+ and bounding.

C After PTCA, the client must keep the right leg straight for at least six (6) to eight (8) hours to prevent any arterial bleeding from the insertion site in the right femoral artery. A pressure dressing is applied to the insertion site to help prevent arterial bleeding. Any neurovascular assessment data that are abnormal require intervention by the nurse; numbness may indicate decreased blood supply to the right foot. A bounding pedal pulse indicates that adequate circulation is getting to the right foot; therefore, this would not require immediate intervention.

Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease? A. Encourage the client to use a heating pad on the lower extremities. B. Demonstrate to the client the correct way to apply elastic support hose. C. Instruct the client to walk daily for at least 30 minutes. D. Tell the client to check both feet for red areas at least once a week.

C External heating devices are avoided to reduce the risk of burns. Elastic support hose reduce the circulation to the skin and are avoided. Walking promotes the development of collateral circulation to ischemic tissue and slows the process of atherosclerosis. The feet must be checked daily, not weekly.

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? A. High carb, high protein B. High calcium, high potassium, high protein C. Low protein, low sodium, low potassium D. Low protein, high potassium

C dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism.

Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction (MI)? A. Creatine kinase (CK-MB). B. Lactate dehydrogenase (LDH). C. Troponin. D. White blood cells (WBCs).

C CK-MB elevates in 12 to 24 hours.Lactic dehydrogenase (LDH) elevates in 24 to 36 hours.Troponin is the enzyme that elevates within 1 to 2 hours.WBCs elevate as a result of necrotic tissue, but this is not a cardiac enzyme.

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? A. Erythropoietin. B. Calcium gluconate. C. Regular insulin. D. Osmotic diuretic.

C Erythropoietin is a chemical catalyst produced by the kidneys to stimulate red blood cell production; it does not affect potassium level. Calcium gluconate helps protect the heart from the effects of high potassium levels. Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily. A loop diuretic, not an osmotic diuretic, may be ordered to help decrease the potassium level.

Which preprocedure information should be taught to the female client having an exercise stress test in the morning? A. Wear open-toed shoes to the stress test. B. Inform the client not to wear a bra. C. Do not eat anything for four (4) hours. D. Take the beta blocker one (1) hour before the test.

C The client should wear firm-fitting, solid athletic shoes.The client should wear a bra to provide adequate support during the exercise.NPO decreases the chance of aspiration in case of emergency. In addition, if the client has just had a meal, the blood supply will be shunted to the stomach for digestion and away from the heart, perhaps leading to an inaccurate test result. A beta blocker is not taken prior to the stress test because it will decrease the pulse rate and blood pressure by direct parasympathetic stimulation to the heart.

The client diagnosed with ARF is admitted to the intensive care department and placed on a therapeutic diet. Which diet is most appropriate for the client? A. A high-potassium and low-calcium diet. B. A low-fat and low-cholesterol diet. C. A high-carbohydrate and restricted-protein diet. D. A regular diet with six (6) small feedings a day.

C The diet is low potassium, and calcium is not restricted in ARF.This is a diet recommended for clients with cardiac disease and atherosclerosis. Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products. The client must be on a therapeutic diet, and small feedings are not required

The client diagnosed with rule-out myocardial infarction is experiencing chest pain while walking to the bathroom. Which action should the nurse implement first? A. Administer sublingual nitroglycerin. B. Obtain a STAT electrocardiogram (ECG). C. Have the client sit down immediately. D. Assess the client's vital signs.

C The nurse must assume the chest pain is secondary to decreased oxygen to the myocardium and administer a sublingual nitroglycerin tablet, which is a coronary vasodilator, but this is not the first action.An ECG should be ordered, but it is not the first intervention.Stopping all activity will decrease the need of the myocardium for oxygen and may help decrease the chest pain.Assessment is often the first nursing intervention, but when the client has chest pain and a possible MI, the nurse must first take care of the client. Taking vital signs would not help relieve chest pain.

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) whois experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client? A. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH. B. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis. C. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate. D. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

C There is a decrease in the excretion of phosphates and organic acids, not an increase. The red blood cell destruction does not affect the arterial blood pH. This is the correct scientific rationale for metabolic acidosis occurring in the client with CKD.This compensatory mechanism occurs to maintain an arterial blood pH between 7.35 and 7.45, but it does not occur as a result of CKD.

The client has just returned from a cardiac catheterization. Which assessment data would warrant immediate intervention from the nurse? A. The client's BP is 110/70 and pulse is 90. B. The client's groin dressing is dry and intact. C. The client refuses to keep the leg straight. D. The client denies any numbness and tingling.

C These vital signs are within normal limits and would not require any immediate intervention.The groin dressing should be dry and intact. If the client bends the leg, it could cause the insertion site to bleed. This is arterial blood and the client could bleed to death very quickly, so this requires immediate intervention. The nurse must check the neurovascular assessment, and paresthesia would warrant immediate intervention, but no numbness and tingling is a good sign.

The nurse is reviewing the laboratory results of her patient and notes that a cardiac troponin level was drawn. This test was drawn to determine which diagnosis? A. Atrial fibrillation B. Ventricular tachycardia C. Myocardial infarction D. Congestive heart failure

C Troponin levels are the best laboratory indicator of MI. Atrial fibrillation and ventricular tachycardia are identified through an ECG. A common blood test for congestive heart failure is an elevated BNP.

The nurse is assessing the client diagnosed with congestive heart failure. Which signs/symptoms would indicate that the medical treatment has been effective? A. The client's peripheral pitting edema has gone from 3+ to 4+. B. The client is able to take the radial pulse accurately. C. The client is able to perform ADLs without dyspnea. D. The client has minimal jugular vein distention.

C Pitting edema changing from 3+ to 4+ indicates a worsening of the CHF. The client's ability to take the radial pulse would evaluate teaching, not medical treatment. Being able to perform activities ofdaily living (ADLs) without shortness of breath (dyspnea) would indicate the client's condition is improving. The client's heart is a more effective pump and can oxygenate the body better without increasing fluid in the lungs. Any jugular vein distention indicates that the right side of the heart is failing, which would not indicate effective medical treatment.

In assessing a client with an arteriovenous (AV) shunt who is scheduled for dialysis today, the nurse notes the absence of a thrill or bruit at the shunt site. What action should the nurse take? A. Advise the client that the shunt is intact and ready for dialysis as scheduled. B. Encourage the client to keep the shunt site elevated above the level of the heart. C. Notify the health care provider of the findings immediately. D. Flush the site at least once with a heparinized saline solution.

C. Absence of a thrill or bruit indicates that the shunt may be obstructed. The nurse should notify the health care provider so that intervention can be initiated to restore function of the shunt. Option A is incorrect. Option B will not resolve the obstruction. An AV shunt is internal and cannot be flushed without access using special needles.

To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should (select all that apply) A. monitor the BP in the affected arm. B. irrigate the graft daily with low-dose heparin. C. palpate the area of the graft to feel a normal thrill. D. listen with a stethoscope over the graft to detect a bruit. E. frequently monitor the pulses and neurovascular status distal to the graft.

CDE

A client still has chest pain after 3 rounds of nitroglycerin. Which BP indicates it is safe to give morphine? A. 82/44 B. 99/53 C. 90/61 D. 115/70

D

Which assessment finding in a client with renal failure would concern the nurse the most? A. Oliguria B. Itching C. Fatigue D. Hypotension

D

Which laboratory data confirm the diagnosis of congestive heart failure? A. Chest X-ray B. Liver function tests C. BUN D. Beta-type natriuretic peptide (BNP)

D

The male client is diagnosed with coronary artery disease (CAD) and is prescribed sublingual nitroglycerin. Which statement indicates the client needs more teaching? A. "I should keep the tablets in the dark-colored bottle they came in." B. "If the tablets do not burn under my tongue, they are not effective." C. "I should keep the bottle with me in my pocket at all times." D. "If my chest pain is not gone with one tablet, I will go to the ER."

D If the tablets are not kept in a dark bottle, they will lose their potency.The tablets should burn or sting when put under the tongue. The client should keep the tablets with him in case of chest pain.The client should take one tablet every five (5) minutes and, if no relief occurs after the third tablet, have someone drive him to the emergency department or call 911.

The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication? A. The client's apical pulse is 64. B. The client's calcium level is elevated. C. The client's telemetry shows occasional PVCs. D. The client's blood pressure is 90/58.

D The apical pulse is within normal limits—60 to 100 beats per minute. The serum calcium level is not monitored when calcium channel blockers are given. Occasional PVCs would not warrant immediate intervention prior to administering this medication. The client's blood pressure is low, and a calcium channel blocker could cause the blood pressure to bottom out.

The telemetry nurse notes a peaked T wave for the client diagnosed with congestive heart failure. Which laboratory data should the nurse assess? A. CK-MB. B. Troponin. C. BNP. D. Potassium.

D CK-MB is assessed to determine if the client has had a myocardial infarction. The electrical activity of the heart will not be affected by elevation of this enzyme. Troponin is assessed to determine if the client has had a myocardial infarction. The electrical activity of the heart will not be affected by elevation of this enzyme. Beta-type natriuretic peptide (BNP) is elevated in clients with congestive heart failure, but it does not affect the electrical activity of the heart. Hyperkalemia will cause a peaked T wave; therefore, the nurse should check these laboratory data.

The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is priority for the client? A. Low self-esteem. B. Knowledge deficit. C. Activity intolerance. D. Excess fluid volume.

D Low self-esteem, related to dependency, role changes, and changes in body image, is a pertinent client problem, but psychosocial problems are not priority over physiological problems. Teaching is always an important part of the care plan, but it is not priority over a physiological problem. Activity intolerance related to fatigue, anemia, and retention of waste products is a physiological problem, but it is not a life-threatening problem. Excess fluid volume is priority because of the stress placed on the heart and vessels, which could lead to heart failure, pulmonary edema, and death.

The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate intervention by the nurse? A. Inability to auscultate a bruit over the fistula. B. The client's abdomen is soft, is nontender, and has bowel sounds. C. The dialysate being removed from the client's abdomen is clear. D. The dialysate instilled was 1,500 mL and removed was 1,500 mL.

D Peritoneal dialysis is administered through a catheter inserted into the peritoneal cavity; a fistula is used for hemodialysis. Peritonitis, inflammation of the peritoneum, is a serious complication resulting in a hard, rigid abdomen. Therefore, a soft abdomen does not warrant immediate intervention. The dialysate return is normally colorless or straw-colored, but it should never be cloudy, which indicates an infection. Because the client is in ESRD, fluid must be removed from the body, so the output should be more than the amount instilled. These assessment data require intervention by the nurse.

The nurse is caring for a client who suddenly complains of crushing substernal chest pain while ambulating in the hall. Which nursing action should the nurse implement first? A. Call a Code Blue. B. Assess the telemetry reading. C. Take the client's apical pulse. D. Have the client sit down.

D The client has not arrested. The nurse might call the rapid response team (RRT) but not a code blue. The client is in distress; the nurse should implement a procedure that will alleviate the distress. The client is in distress; the nurse should implement a procedure that will alleviate the distress. The client began to have a problem during physical exertion. Stopping the exertion should be the first action taken by the nurse.

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview? A. "Have you recently traveled outside the United States?" B. "Did you recently begin a vigorous exercise program?" C. "Is there a chance you have been exposed to a virus?" D. "What over-the-counter medications do you take regularly?"

D Usually there are no diseases or conditions warranting this question when discussing ARF. Vigorous exercise will not impede blood flow to the kidneys, leading to ARF. Usually viruses do not cause ARF. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate.

Which is a prerenal cause of AKI? A. Acute glomerulonephritis and neoplasms B. Septic shock and nephrotoxic injury from medications C. Pyelonephritis and calculi formation D. Hypovolemia and myocardial infarction

D Severe blood loss or hypovolemia and the hypotension related to cardiac events are major causes of prerenal acute kidney injury. Acute glomerulonephritis, pyelonephritis and nephrotoxic injuy are causes of intra-renal AKI. Calculi can cause post-renal AKI. Septic shock can cause pre-renal AKI. Neoplasms may be implicated in AKI depending on location.

The nurse is discussing angina with a client who is diagnosed with coronary artery disease. Which action should the client take first when experiencing angina? A. Put a nitroglycerin tablet under the tongue. B. Stop the activity immediately and rest. C. Document when and what activity caused angina. D. Notify the health-care provider immediately.

The client should take the coronary vasodilator nitroglycerin sublingually, but it is not the first intervention.Stopping the activity decreases the heart's need for oxygen and may help decrease the angina (chest pain). The client should keep a diary of when angina occurs, what activity causes it, and how many nitroglycerin tablets are taken before chest pain is relieved. If the chest pain (angina) is not relieved with three (3) nitroglycerin tablets, the client should call 911 or have someone take him to the emergency department. Notifying the HCP may take too long.

The nurse is administering morning medications to clients on a telemetry unit. Which medication would the nurse question? A. Furosemide IVP to a client with a potassium level of 3.6 mEq/L. B. Digoxin orally to a client diagnosed with rapid atrial fibrillation. C. Enalapril orally to a client whose BP is 86/64 and apical pulse is 65. D. Morphine IVP to a client complaining of chest pain and who is diaphoretic

The potassium level is within normal range; this medication would not be questioned. Digoxin is given to clients with rapid atrial fibrillation to slow the heart rate; this medication would not be questioned. Enalapril, an ACE inhibitor, will lower the blood pressure even more. The nurse should hold the medication and notify the HCP that the medication is being held. This would be the first medication to be administered because it indicates a potential cardiac muscle perfusion issue.