Review Test 1
Discharge planning for a client with chronic pancreatitis includes dietary teaching. Which statement indicates to the nurse that the client needs more teaching?
"I can eat foods high in fat now that the acute stage is over."
What is the diet for a patient that has cholecystitis?
"It will take a little while for the bladder to re-establish control, and an accident is not unusual."
A school nurse is teaching a health class of 12-year-olds about hepatitis C. Which statement by a student indicates an understanding of the origin of the disease?
"You can catch it while you're getting a tattoo."
The serum of an individual who received all doses of the hepatitis B vaccine should contain? -
-anti-HBs
Signs and symptoms of anemia?
-lethargic, fatigue...so when you give medication to treat the anemia, you're treating the fatigue
Post-op care for laparoscopic cholecystectomy:
-monitor for bleeding -place pt in Sim's position (on left side with knee flexed) -encourage deep breathing -encourage ambulation -prepare pt for discharge
Which nursing action is a priority when the nurse is caring for a patient with pancreatic cancer?
Administer prescribed opioids to relieve pain as needed
A client who had a kidney transplant develops leukopenia 3 weeks after surgery. What does the nurse conclude is the most probable cause of the leukopenia?
Antirejection medications
How do you differentiate prostate cancer from an enlarged prostate?
Biopsy
When taking the BP of a patient with severe acute pancreatitis, the nurse notices carpal spasm of the patients hand. Which action should the nurse take next?
Check the calcium level on the chart.
How do we know that hemodialysis was effective?
Check weight before and after dialysis
How do you monitor the flow of bile through the gastrointestinal tract?
Color of the stool (return to brown)
A client with a history of alcoholism and cirrhosis is admitted with severe dyspnea as a result of ascites. Which process that most likely caused the ascites should the nurse consider when planning care?
increased pressure in the portal vein
A client with cirrhosis of the liver and ascites is scheduled to have a paracentesis. What should the nurse do to prepare the client for the procedure?
instruct the client to void
Can you give fried chicken, corn to a person who has cholecystitis?
nah bruh
WBC
white blood cell count 4.5 - 11.0 x 10ᶟ/mmᶟ - 4.5 - 11.0 x 10⁹/L* (Study Guide)
Before a transurethral resection of the prostate (TURP), a client asks about what to expect postoperatively. The most appropriate response by the nurse is:
"There will be an indwelling urinary catheter and a continuous bladder irrigation in place."
A client is admitted to the hospital with cirrhosis and chronic pancreatitis. Bile salts (bile acid factor) are prescribed, and the client asks why they are needed. What is the nurse's best response?
"They aid absorption of fat-soluble vitamins."
The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase. The nurse evaluates that teaching is understood when the client identifies which time for medication scheduling? Can you crush the medication?
-with meals - no; cannot crush
Hemodialysis diet
1.2 g PRO; 30-35 kcal Supplement Vit C, B6, folate, B12, Zn, Fe Vit D
Hemodialysis diet
1.2g/kg protein(>50% HBV); 30-35cals/kg; <30% fat(<10% SAT); <300mg cholesterol; 2-3G of K; 1000-1800mg Ca; 800-1000mg/kg Ph; vitamins C,folate, E, B6, B12; 15mg Zinc
ammonia range and abnormals
10-80 mg/dl increased= hepatic disease such as cirrohosis
Hgb values female
11.7 - 15.5 g/dL - 117 - 155 mmol/L*
Hgb values male
13.2 - 17.3 g/dL - 132 - 173 mmol/L*
Platelet Values
150 - 450 x 10ᶟ/mmᶟ - 150 - 450 x 10⁹/L* (Study Guide)
Platelet values
150,000-400,000/mL
Potassium levels
3.5-5.0 mEq/L
normal potassium levels
3.5-5.0 mEq/L
Hct Female Value
36-48%
Hct male value
42-52%
WBC values
5,000-10,000
BUN levels, creatinine levels
6-20 mg/dl, 0.6-1.3mg/dl
A client with a long history of alcohol abuse develops acute pancreatitis. What should be done to best prevent stimulation of the pancreas?
Administer the histamine H2receptor antagonist as prescribed.
A patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) has a serum potassium level of 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take?
Administer the spironolactone.
When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of?
Alcohol use
A client with cholelithiasis has a laser laparoscopic cholecystectomy. What is most appropriate for the nurse to do postoperatively?
Ambulate the client when the client is alert and oriented
A client is admitted to the hospital for acute pancreatitis. The nurse obtains the client's vital signs, performs a physical assessment, and reviews the client's health history. What is the priority intervention by the nurse?
Assess the client for alcohol withdrawal symptoms.
Know S/S of kidney insufficiency in chronic kidney disease (CKD)
Chronic kidney disease has a devastating effect on every system in the body. Alterations in sodium and fluid balance result in hypertension, heart failure, and pulmonary edema. Altered potassium excretion can result in lethal arrhythmias. Impaired metabolic waste elimination results in uremia and GI symptoms such as nausea, vomiting, and anorexia and neurological symptoms such as a headache, lethargy, fatigue, confusion, and ultimately, without treatment, seizures and coma. Altered calcium and phosphorus levels result in bone breakdown and osteodystrophies or defective bone development. Decreased acid clearance and bicarbonate production result in metabolic acidosis. Endocrine and reproductive dysfunctions occur, such as infertility, amenorrhea, hyperparathyroidism, and thyroid abnormalities. Decreased production of erythropoietin results in chronic anemia.
disequilibrium syndrome
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity. It is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. It most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
RBC Value Women *
Female: 4.20 - 4.87 x 10⁶ cells/mmᶟ - 4.20 - 4.87 x 10¹² cells/L
What type of hepatitis is transmitted through food, water, & fecal?
Hepatitis A & E
A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication?
Hepatitis B
A nurse is caring for a client with a diagnosis of chronic kidney failure who has just been told by the health care provider that hemodialysis is necessary. Which clinical manifestation indicates the need for hemodialysis?
Hyperkalemia
Know electrolyte disturbance to monitor in patients with ascites from cirrhosis of the liver and receiving spironolactone
Hyperkalemia
Medication for pain due to pancreatitis?
IV opioids
A nurse is caring for a client who is admitted to the hospital with ascites and a diagnosis of cirrhosis of the liver. What does the nurse conclude is the probable cause of ascites?
Impaired portal venous return
A nurse is caring for a client with a diagnosis of benign prostatic hyperplasia (BPH). Which information about this condition is important for the nurse to consider when caring for this client?
It predisposes to hydro nephrosis
A patient informs the nurse that he is concerned about dribbling and incontinence of small amounts of urine after the removal of his indwelling urinary catheter. The nurse is aware that the catheter was in place for three weeks prior to being removed. Which of the following is the nurse's best response to the patient?
It will take a little while for the bladder to re-establish control, and an accident is not unusual."
How can we eliminate the ammonia from the intestines?
Lactulose
If T-tube is draining less than expected, what should you do?
Look for kinks or call the surgeon
Hemodialysis diet
Low potassium diet, teach foods to avoid, if patient does not like foods, refer to dietitian
RBC men
Male: 4.71 - 5.14 x 10⁶ cells/mmᶟ - 4.71 - 5.14 x 10¹² cells/L*
Following an abdominal cholecystectomy, the client refuses to take deep breaths and coughs, saying "it's too painful." What action does the nurse take?
Medicate the client for pain before coughing and deep breathing.
If a patient has 300 cc of in first 24 hours is that normal or abnormal?
Normal
What is the tolerance for a patient with cholecystitis to eat fats?
Not good, they can't have foods with high fats
The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is the best choice for a client with this disorder?
Penne pasta, spinach, banana, and decaffeinated iced tea
Lab Values
RBCs: Male: 4.71 - 5.14 x 10⁶ cells/mmᶟ - 4.71 - 5.14 x 10¹² cells/L* Female: 4.20 - 4.87 x 10⁶ cells/mmᶟ - 4.20 - 4.87 x 10¹² cells/L* WBCs: 4.5 - 11.0 x 10ᶟ/mmᶟ - 4.5 - 11.0 x 10⁹/L* Platelets: 150 - 450 x 10ᶟ/mmᶟ - 150 - 450 x 10⁹/L* Hgb: Male: 13.2 - 17.3 g/dL - 132 - 173 mmol/L* Female: 11.7 - 15.5 g/dL - 117 - 155 mmol/L* Hct: Male: 42% to 52% Female: 36% to 48%
Neomycin is prescribed for a client with cirrhosis. What should the nurse explain is the reason for taking this medication?
Reduces the blood ammonia level
What kind of pain medication should you avoid giving a patient with hepatitis?
Tylenol
A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective?
abdominal pain is decreased
What could be an indication of peritonitis in peritoneal dialysis?
abdominal pain, cloudy urine, tachycardia.
What are the reasons you warm up the dialysate?
allows vasodilation to facilitate the exchange
Which of these laboratory test results will be most important for the nurse to monitor when evaluating the effects of therapy for a patient who has acute pancreatitis?
amylase
What is the flapping of the hand called in patients with hepatic encephalopathy?
asterixis
Between jaundice, elevation bilirubin, and asterixis which one has priority being reported to the doctor?
asterixis (hand flapping) this is a sign of hepatic encephalopathy (jaundice, elevated bilirubin, and tenderness are an expected finding)
The nurse is assessing a client with severe cirrhosis and discovers fetor hepaticus. What did the nurse assess?
breath
How do they do peritoneal dialysis? What do you do when a patient has respiratory issues due to fluid in the abdomen?
drain the fluid
What could be a result of accumulation of fluids when the kidneys aren't working?
edema and hypertension
A concern about a patient with acute pancreatitis receiving parenteral nutrition (TPN)?
glucose level (hyperglycemia)
What precautions should you use when dealing with urine & feces of a patient with Hepatitis A?
gown and gloves
A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for?
hyperkalemia
An intravenous solution of lactated Ringers is prescribed to replace the T-tube output of a client who had a cholecystectomy and common bile duct exploration. The nurse recalls that the condition that will improve if the administration of lactated Ringers solution is effective is:
metabolic acidosis
A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. Which diet can the nurse expect will be prescribed for this client based upon the assessment?
moderate protein
Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider?
muscle twitching and finger numbness
How do you know a transplanted kidney is working fine?
normal creatinine levels
What could be a skin problem with accumulation of urea?
puritis
How do you treat it? disequilibrium syndrome
rapid change of extracellular fluid composition during dialysis resulting in cerebral edema
Where does the pain radiate to in a patient with cholecystitis?
right shoulder or scapula
What is the purpose of the T-tube?
to divert the bile
A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a thiazide diuretic. Why did the provider add spironolactone to the client's medication regimen?
to help prevent potassium loss
Patient stops draining fluid, what do you do?
turn side to side
A patient has a hepatitis B profile performed and is positive for hepatitis B surface antibody only. This patient
was vaccinated against hepatitis B
1) A nurse is caring for a client with acute kidney injury. Which findings should the nurse anticipate when reviewing the laboratory report of the client's blood level of calcium, potassium, and creatinine? Select all that apply.
· Calcium: 7.6 mg/dL (1.9 mmol/L) · Potassium 6.0 mEq/L (6.0 mmol/L) · Creatinine: 3.2 mg/dL (194 mcmol/L)
A client with acute kidney injury moves into the diuretic phase after 1 week of therapy. For which clinical indicators during this phase should the nurse assess the client? Select all that apply
· Dehydration · Hypovolemia
A client has a kidney transplant. The nurse should monitor for which assessment findings associated with rejection of the transplant? Select all that apply.
· Fever · Oliguria · Weight gain
A client with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The nurses hould monitor the client for which peritoneal dialysis complications? Select all that apply.
· Tachycardia · Cloudy outflow · Abdominal pain
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.
· low sodium · high vitamins · moderate protein
