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Evolve, Iclickers, back of book questions

The nurse recognizes that primary manifestations of systolic failure include:
a. decreased EF and increased PAWF
b. decreased PAWF and increased EF
c. decreased pulmonary hypertension associated with normal EF
d. decreased afterload and decreased left ventricular end-diastolic pressure

A

A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is
a. ventricular dilation
b. ventricular hypertrophy
c. neurohormonal response
d. sympathetic nervous system activation

C

A drug used in the management of a patient with ADHF and pulmonary edema that will decrease both preload and afterload and provide relief of anxiety is
a. amrinone
b. furosemide
c. dobutamine
d. morphine sulfate

D

A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, the nurse needs to
a. monitor serum potassium levels
b. keep an accurate measure of intake and output
c. teach the patient about dietary restriction of potassium
d. withhold digitalis and notify health care provider if heart rate is irregular

A

Patients with a heart transplantation are at risk for which of the following complications in the first year after transplantation (select all that apply)
a. cancer
b. infection
c. rejection
d. vasculopathy
e. sudden cardiac death

B,C,E

A 50 year old woman weighs 85 kg and has a history of cigarette smoking, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease that need to be modified are:
a. weight and diet
b. activity level and diet
c. cigarette smoking and high blood pressure
d. sedentary lifestyle and high blood pressure

C

A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. Which of the following signs and symptoms would suggest that his aneurysm has ruptured?
a. sudden shortness of breath and hemoptysis
b. sudden, severe low back pain and bruising along his flank
c. gradually increasing substernal chest pain and diaphoresis
d. sudden, patchy blue mottling on feet and toes and rest pain

B

Priority nursing measures after an abdominal aortic aneurysm repair include
a. assessment of cranial nerves and mental status
b. administration of IV heparin and monitoring aPTT
c. administration of IV fluids and monitoring kidney function
d. elevation of the legs and application of graduated compression stockings

C

The first priority of collaborative care of a patient with a suspected acute aortic dissection is to
a. reduce anxiety
b. control blood pressure
c. monitor for chest pain
d. increased myocardial contractility

B

Rest pain is a manifestation of PAD that occurs due to a chronic
a. vasospasm of small cutaneous arteries in the feet
b. increase in retrograde venous blood flow in the legs
c. decrease in arterial blood flow to the nerves of the feet
d. decrease in arterial blood flow to the leg muscles during exercise

C

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to
a. elevate the leg to promote venous return
b. start anticoagulant therapy with IV heparin
c. notify the physician of the change in peripheral perfusion
d. place the bed in reverse Trendelenburg to promote perfusion

C

Which clinical manifestations are seen in both patients with Buerger's disease and Raynaud's phenomenon (select all that apply)
a. intermittent fevers
b. sensitivity to cold temperatures
c. gangrenous ulcers on fingertips
d. color changes of fingers and toes
e. episodes of superficial vein thrombosis

B,C,D

The patient at the highest risk for venous thromboembolism (VTE) is
a. a 62 year old man with spider veins who is having arthroscopic knee surgery
b. a 32 year old woman who smokes, takes oral contraceptives and is planning a trip to Europe
c. a 26 year old woman who is 3 days postpartum and received IV maintenance IV fluids for 12 hours during her labor
d. an active 72 year old man at home recovering from transurethral resection of the prostate for benign prostatic hyperplasia

B

Which are probable clinical findings in a person with an acute VTE (select all that apply)
a. pallor and coolness of foot and calf
b. mild to moderate calf pain and tenderness
c. grossly diminished or absent pedal pulses
d. unilateral edema and induration of the thigh
e. palpable cord along a superficial varicose vein

B,D

The recommended treatment for an initial VTE in an otherwise healthy person with no significant co-morbidities would include
a. IV agratoban (acova) as an inpatient
b. IV unfractionated heparin as an inpatient
c. subcutaneous unfractionated heparin as an outpatient
d. subcutaneous low-molecular-weight heparin as an outpatient

D

A key aspect of teaching for the patient on anticoagulant therapy includes which instructions
a. monitor for and report any signs of bleeding
b. do not take acetaminophen (tylenol) for headache
c. decrease you dietary intake of foods containing vitamin K
d. arrange to have blood drawn routinely to check
drug levels

A

In planning care and patient teaching for the patient with venous leg ulcers, the nurse recognizes that the most important intervention in healing and control of this condition is
a. sclerotherapy
b. taking horse chestnut extract daily
c. using moist environment dressings
d. applying graduated compression stockings

D

A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with
a. structural support of the kidney
b. regulation of the concentration of urine
c. entry and exit of blood vessels at the kidney
d. collection and drainage of urine from the kidney

D

A patient with renal disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of
a. tubular secretion
b. glomerular filtration
c. capillary permeability
d. concentration of filtrate

B

The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes
a. adrenal insufficiency
b. serotonin deficiency
c. hyperaldosteronism
d. hyperparathyroidism

D

Diminished ability to concentrate urine, associated with aging of the urinary system is attributed to
a. a decreased in bladder sensory receptors
b. a decrease in the number of functioning nephrons
c. decreased function of the loop of Henle and tubules
d. thickening of the basement membrane of Bowman's capsule

C

During physical assessment of the urinary system, the nurse
a. palpates an empty bladder as a small nodule
b. auscultates over each CVA to detect impaired renal blood flow
c. finds a dull percussion sound when 100 mL of urine is present in the bladder
d. palpates above the symphysis pubis to determine the level of urine in the bladder

B

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply)
a. nonpalpable left kidney
b. auscultation of renal artery bruit
c. CVA tenderness elicited by a kidney punch
d. no CVA tenderness elicited by a kidney punch
e. palpable bladder to the level of the pubic symphysis

A,D

A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion is a (n)
a. IVP
b. VCUG
c. Renal scan
d. Loopogram

C

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find
a. a pH of 8.4
b. RBCs of 4/hpf
c. color: yellow, cloudy
d. specific gravity of 1.035

D

In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through
a. the bloodstream
b. the lymphatic system
c. a descending infection
d. an ascending infection

D

The nurse teaches the female patient who has frequent UTIs that she should
a. take tub baths with bubble bath
b. urinate before and after sexual intercourse
c. take prophylactic sulfonamides for the rest of her life
d. restrict fluid intake to prevent the need for frequent voiding

B

The immunologic mechanisms involved in glomerulonephritis include
a. tubular blocking by precipitates of bacteria and antibody reactions
b. deposition of immune complexes and complement along the GBM
c. thickening of the GBM from autoimmune microangiopathic changes
d. destruction of glomeruli by proteolytic enzymes contained in the GBM

B

One of the most important roles of the nurse in relation to cute poststreptococcal glomerulonephritis is to
a. promote early diagnosis and treatment of sore throats and skin lesions
b. encourage patients to request antibiotic therapy for all upper respiratory infections
c. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence
d. monitor patients for respiratory symptoms that indicate that the disease is affecting the alveolar basement membrane

A

The edema that occurs in nephrotic syndrome is due to
a. increased hydrostatic pressure caused by sodium retention
b. decreased aldosterone secretion from adrenal insufficiency
c. increased fluid retention caused by decreased glomerular filtration
d. decreased colloidal osmotic pressure caused by loos of serum albumin

D

A patient is admitted to the hospital with severe renal colic caused by renal lithiasis. The nurse's first priority in management of the patient is to
a. administer opioids as prescribed
b. obtain supplies for straining all urine
c. encourage fluid intake of 3 to 4 L/day
d. keep the patient NPO in preparation for surgery

A

The nurse recommends genetic counseling for the children of a patient with
a. nephrotic syndrome
b. chronic pyelonephritis
c. malignant nephrosclerosis
d. adult-onset polycystic renal disease

D

The nurse encourages strict diabetic control in the patient prone to diabetic nephropathy knowing that the renal tissue changes that may occur in this condition include
a. uric acid calculi and nephrolithiasis
b. renal sugar-crystal calculi and cysts
c. lipid deposits in the glomeruli and nephrons
d. thickening of the GBM and glomerulosclerosis

D

The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of
a. aspirin use
b. tobacco use
c. chronic alcohol abuse
d. use of artificial sweeteners

B

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes
a. teaching the patient to use kegel exercises
b. clamping and releasing a catheter to increase bladder tone
c. teaching the patient biofeedback mechanisms to suppress the urge to void
d. counseling the patient concerning choice of incontinence containment device

A

A patient with a ureterolithotomy returns from surgery with a neprostomy tube in place. Postoperative nursing care of the patient includes
a. encouraging the patient to drink fruit juices and milk
b. forcing fluids of at least 2 to 3 L per day after nausea has subsided
c. irrigating the neprostomy tube with 10 mL of normal saline solution as needed
d. notifying the physician if neprostomy tube drainage is more than 30 mL per hour.

B

A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should
a. notify the physician
b. notify the charge nurse
c. irrigate the drainage tube
d. chart is as a normal observation

D

Which of the following characterize acute kidney injury (select all that apply)
a. primary cause of death is infection
b. almost always affects older people
c. disease course is potentially reversible
d. most common cause is diabetic nepropathy
e. cardiovascular disease is most common cause of death

A,C

RIFLE defines three stages of AKI based on changes in
a. blood pressure and urine osmolality
b. fractional excretion of urinary sodium
c. estimation of GFR with the MDRD equation
d. serum creatinine or urine output from baseline

D

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply)
a. hypotension
b. ECG changes
c. hypernatremia
d. pulmonary edema
e. urine with high specific gravity

B,D

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances
a. hyperkalemia and hypnatremia
b. hyperkalemia and hypernatremia
c. hypokalemia and hyponatremia
d. hypokalemia and hypernatremia

C

A patient is admitted to the hospital with chronic kidney disease, the nurse understands that this condition is characterized by
a. progressive irreversible destruction of the kidneys
b. rapid decrease in urinary output with an elevated BUN
c. an increasing creatinine clearance with a decrease in urinary output
d. prostration, somnolence, and confusion with coma and imminent death

A

Nurses need to educate patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply)
a. older African Americans
b. individuals more than 60 years old
c. those with a history of pancreatitis
d. those with a history of hypertension
e. those with a history of type 2 diabetes

A,B,D,E

Patient with chronic kidney disease experience an increased incidence of cardiovascular disease related to (select all that apply)
a. hypertension
b. vascular calcifications
c. a genetic predisposition
d. hyperinsulinemia causing dyslipidemia
e. increased high-density lipoprotein levels

A,B,D

Measures indicated in the conservative therapy of chronic kidney disease include
a. decreased fluid intake, carbohydrate intake, and protein intake
b. increased fluid intake, decreased carbohydrate intake and protein intake
c. decreased fluid intake and protein intake, increased carbohydrate intake
d. decreased fluid intake and carbohydrate intake, increased protein intake

C

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs that patient that
a. successful transplantion usually provides better quality of life than that offered by dialysis
b. if rejection of the transplanted kidney occurs, no further treatment for renal failure is available
c. the immunosuppresive therapy that is require following transplantation causes fatal malignancies in many patients
d. hemodialysis replaces the normal functions of the kidneys and patients do not have to live with continual fear of rejection

A

To assess the patency of a newly places arteriovenous graft for dialysis, the nurse should
a. irrigate the graft daily with low-dose heparin
b. monitor for any increase in BP in the affected arm
c. listen with a stethoscope over the graft for the presence of a bruit
d. frequently monitor the pulses and neurovascular status distal to the graft

C

One of the major advantages of peritoneal dialysis is that
a. no medications are required because of the enhanced efficiency
b. the diet is less restricted and dialysis can be performed at home
c. the dialysate is biocompatible and causes no long term consequences
d. high glucose concentrations of the dialysate cause a reduction in appetite promoting weight loss

B

A kidney transplant recipient complains of having fever, chills and dysuria over the course of the past 2 days. What is the first action that the nurse should take?
a. assess the temperature and intiate workup to rule out infection
b. provide warm cover for the patient and give 1 g acetaminophen orally
c. reassure the patient that this common after transplantation
d. notify the nephrologist that the patient has developed symptoms of acute rejection

A

What are clinical manifestations of Right Sided Heart Failure?

Fatigue, dependent edema, increased peripheral venous pressure & distended jugular veins

What is an important lab test in determining severity of heart failure (ie decompensated heart failure)?

Elevated B-Type Natiuretic Peptide (BNP)

What is the treatment for patients with heart failure in fluid overload?

Furosamide (Lasix) - loop diuretic administered IV push

What are nursing discharge instructions/education for HF patients?

Weigh daily, before breakfast, after urinating, without clothes, take medication as prescribed, take daily pulse if on digoxin, keep appointments for follow-up labs ... CALL THE DOCTOR IF...
>3 pound weight gain in a day
SOB, palpitations, persistent cough, decrease in urine output
Pulse < 60 if on digoxin, or signs of toxicity

What are nursing priorities for a patient with heart failure in fluid overload?

Assess, sit patient in semi-fowlers or high-fowlers position, apply oxygen, administer diuretics per HCP orders, monitor Potassium, monitor I&Os closely...

What are the risk factors for PAD?

Smoking, Hyperlipidemia, Cardiovascular Disease, HTN, DM

What are the clinical manifestations of PAD?

Patient presents with no pedal pulses in the right foot, right lower leg shiny without hair. The patient's main complaint is "Extreme pain every time" he walks his dog... within minutes of resting pain is relieved.

What are clinical manifestations of DVT?

Post - Op day #3 the nurse completes the initial head to toe assessment: +1 bilateral pedal pulses, LLE +2 NP edema, red, warm, swollen left calf.

What is the treatment for venous stasis ulcers?

Provide patient with ted hose if closed or ointment with ace wrap if open.

What is post procedure care for arterial revascularization?

Monitor I & Os (urine output most important), monitor serum BUN/Cr within the first 24hours post this procedure.

The steps for proper collection of a 24hour urine.

dump first urine, start time initiated until the final 24 hours is completed, maintaining on ice at all times including sending down to lab

What is an IV Pyelogram?

This test injects dye to assess the kidneys for renal calculi, strictures, etc..

What is cystitis?

Chronic bladder pain

What are the clinical manifestations of a Renal Calculi?

What is the RN's priority discharge instruction for a patient with a Renal Calculi? & WHY?

Patient diagnosed with this complains of back pain radiating down the groin. Patient commonly has blood in the urine AKA RBCs in the UA.


Ask the patient to strain their urine. This allows for testing to identify the cause of the kidney stones so that preventative changes to the diet can be achieved.

This is the nursing priority for a post-nephrectomy patient.

Monitor for clinical manifestations of bleeding

These are the important dietary considerations for a patient diagnosed with Chronic Kidney Disease.

decrease potassium, magnesium, and protein intake

These organs are damaged as a result of Chronic Kidney Disease.

liver, heart and peripheral vascular system

This is a common infection a patient is previously diagnosed with prior to being admitted for acute glomerulonephritis or acute pyelonephritis.

Recent strep infection of the upper airway

It is for this reason patient's receive Epogen SQ weekly.

Chronic anemia or low erythropoetin

These two are the priority nursing considerations for a patient admitted for Acute Renal Failure or Acute Kidney Injury during the oliguric phase.

administer IVF and antibiotics that do not involve the renal system

These are the two types of Dialysis treatment for a patient with renal failure.

Hemodialysis & Peritoneal Dialysis

This is the priority nursing consideration when caring for a patient on Peritoneal Dialysis.

prevent infection

This is what the patient on PD can do to help drain more fluid from the abdomen, if the output is less than the input.

ambulate to move the fluid

This medication is administered throughout the HD procedure putting the patient at a higher risk for bleeding.

Heparin

This is the major difference in dietary recommendations with patient's on PD versus HD.

Increase protein- PD

With this type of treatment for thoracic aneurysms the patient is at high risk for Renal Failure. . .

Synthetic Graft Placement with Aorta cross-clamped

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which of the following symptoms?
A) a. Muscle aches
B) b. Constipation
C) c. Pounding headache
D) d. Anorexia and nausea

D

The nurse is preparing to administer digoxin to a patient with HF. In preparation, lab results are reviewed with the following findings: sodium 139 mEq/L, potassium 3.0 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dl. The nurse should do which of the following at this time?
A) a. Withhold the daily dose until the following day.
B) b. Withhold the dose and report the potassium level.
C) c. Give the digoxin with a salty snack, such as crackers.
D) d. Give the digoxin with extra fluids to dilute the sodium level.

B

The nurse is caring for a patient newly diagnosed with heart failure. The patient is to receive a first dose of digoxin (Lanoxin) 0.125 mg IV push. An ampule containing 0.25 mg/ml is available. How many milliliters should the nurse draw up to administer the dose?
A) a. 0.5 ml
B) b. 0.6 ml
C) c. 1.2 ml
D) d. 1.4 ml

A

The priority nursing assessment of a patient receiving IV nesiritide (Natrecor) to treat HF would be
A) a. Urine output.
B) b. Lung sounds.
C) c. Blood pressure.
D) d. Respiratory rate.

C

A patient admitted with HF appears very anxious and complains of shortness of breath. Which of the following nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)?
A) a. Position patient in a semi-Fowler's position.
B) b. Administrate ordered morphine sulfate.
C) c. Position patient on left side with head of bed flat.
D) d. Instruct patient on the use of relaxation techniques.
E) e. Use a calm, reassuring approach while talking to patient.

B,D,E

A male patient with a long-standing history of HF has recently qualified for hospice care. Which of the following measures should the nurse now prioritize when providing care for this patient?
A) a. Tapering the patient off his current medications
B) b. Continuing education for the patient and his family
C) c. Pursuing experimental therapies or surgical options
D) d. Choosing interventions to promote comfort and prevent suffering

D

The nurse would recognize that indications for the use of dopamine (Intropin) in the care of a patient with heart failure include
A) a. Acute anxiety.
B) b. Hypotension and tachycardia.
C) c. Peripheral edema and weight gain.
D) d. Paroxysmal nocturnal dyspnea (PND).

B

A patient with a recent diagnosis of HF has been prescribed furosemide (Lasix) in an effort to
A) a. Reduce preload.
B) b. Decrease afterload.
C) c. Increase contractility.
D) d. Promote vasodilation.

A

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. This patient should be advised to avoid
A) a. High-potassium foods.
B) b. Drugs to treat erectile dysfunction.
C) c. Over-the-counter H2-receptor blockers.
D) d. Nonsteroidal antiinflammatory drugs.

B

The nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient has an order to receive 30 mg enoxaparin (Lovenox). Which of the following injection sites should the nurse use to administer this medication safely?
A) Buttock, upper outer quadrant
B) Abdomen, anterior-lateral aspect
C) Back of the arm, 2 inches away from a mole
D) Anterolateral thigh, with no scar tissue nearby

B

The nurse is preparing to administer a scheduled dose of enoxaparin (Lovenox) 30 mg subcutaneously. The nurse should do which of the following to administer this medication correctly?
A) Remove the air bubble in the prefilled syringe.
B) Aspirate before injection to prevent intravenous administration.
C) Rub the injection site after administration to enhance absorption.
D) Pinch the skin between the thumb and forefinger before inserting the needle.

D

The nurse is admitting a 68-year-old preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which of the following medications?
A) Vitamin K
B) Vitamin B12
C) Heparin sodium
D) Protamine sulfate

A

The nurse is caring for a patient who has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed?
A) Decreased cardiac output
B) Increased blood pressure
C) Cerebral or pulmonary emboli
D) Excessive bleeding from incision or IV sites

C

The nurse is reviewing the laboratory test results for a 68-year-old patient whose warfarin (Coumadin) therapy was terminated during the preoperative period. The nurse concludes that the patient is in the most stable condition for surgery after noting which of the following INR (international normalized ratio) results?
A) 2.7
B) 1.0
C) 3.4
D) 1.8

B

The nurse would determine that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox) after noting which of the following during a routine shift assessment?
A) Generalized weakness and fatigue
B) Crackles bilaterally in the lung bases
C) Pain and swelling in lower extremity
D) Abdominal pain with decreased bowel sounds

C

The nurse is caring for a patient with a recent history of deep vein thrombosis (DVT). The patient now needs to undergo surgery for appendicitis. The nurse is reviewing the laboratory results for this patient before administering an ordered dose of vitamin K. The nurse determines that the medication is both safe to give and is most needed when the international normalized ratio (INR) is which of the following?
A) 2.2
B) 1.0
C) 1.6
D) 1.2

A

A postoperative patient asks the nurse why the physician ordered daily administration of enoxaparin (Lovenox). Which of the following replies by the nurse is most appropriate?
A) "This medication will help prevent breathing problems after surgery, such as pneumonia."
B) "This medication will help lower your blood pressure to a safer level, which is very important after surgery."
C) "This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal."
D) "This medication is a narcotic pain medication that will help take away any muscle aches caused by positioning on the operating room table."

C

The nurse is caring for a preoperative patient who has an order for vitamin K by subcutaneous injection. The nurse should verify that which of the following laboratory studies is abnormal before administering the dose?
A) Hematocrit (Hct)
B) Hemoglobin (Hb)
C) Prothrombin time (PT)
D) Partial thromboplastin time (PTT)

C

The nurse is caring for a newly admitted patient with vascular insufficiency. The patient has a new order for enoxaparin (Lovenox) 30 mg subcutaneously. Which of the following should the nurse do to correctly administer this medication?
A) Spread the skin before inserting the needle.
B) Leave the air bubble in the prefilled syringe.
C) Use the back of the arm as the preferred site.
D) Sit the patient at a 30-degree angle before administration.

B

Which of the following is a priority nursing intervention in the care of a patient with a diagnosis of chronic venous insufficiency (CVI)?
A) Application of topical antibiotics to venous ulcers
B) Maintaining the patient's legs in a dependent position
C) Administration of oral and/or subcutaneous anticoagulants
D) Teaching the patient the correct use of compression stockings

D

A patient with varicose veins has been prescribed compression stockings. How should the nurse teach the patient to use these?
A) "As much as possible, try to keep your stockings on 24 hours a day."
B) "While you're still lying in bed in the morning, put on your stockings."
C) "Dangle your feet at your bedside for 5 minutes before putting on your stockings."
D) "Your stockings will be most effective if you can remove them for a few minutes several times a day."

B

Assessment of a patient's peripheral intravenous site reveals that phlebitis has developed over the past several hours. Which of the following interventions should the nurse implement first?
A) Remove the patient's IV catheter.
B) Apply an ice pack to the affected area.
C) Decrease the IV rate to 20 to 30 ml/hr.
D) Administer prophylactic anticoagulants.

A

In preparing a patient for an intravenous pyelogram (IVP), the nurse would expect to
A) a. administer a cathartic or enema.
B) b. assess patient for allergies to penicillin.
C) c. keep the patient NPO for 4 hours preprocedure.
D) d. advise the patient that a metallic taste may occur during procedure.

A

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which of the following physiologic processes are performed by the kidneys (select all that apply)?
A) a. Production of renin
B) b. Hemolysis of old red blood cells (RBCs)
C) c. Activation of vitamin D
D) d. Carbohydrate metabolism
E) e. Erythropoietin production

A,C,E

As a component of the head-to-toe assessment of a patient who has been recently transferred, the nurse is preparing to palpate the patient's kidneys. The nurse should position the patient
A) a. Prone.
B) b. Supine.
C) c. Seated at the edge of the bed.
D) d. Standing, facing away from the nurse.

B

A 70-year-old male patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. The nurse would document which of the following abnormal assessment findings?
A) a. Anuria
B) b. Dysuria
C) c. Oliguria
D) d. Enuresis

B

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. Which of the following teaching points should the nurse emphasize before the procedure?
A) a. "You might have pink-tinged urine and burning after your cystoscopy."
B) b. "You'll need to refrain from eating or drinking after midnight the day before the test."
C) c. "You'll require a urinary catheter inserted before the cystoscopy and it will be in place for a few days."
D) d. "The morning of the test, the nurse will ask you to drink some water that contains a contrast solution."

A

Which of the following urinalysis results would the nurse recognize as an abnormal finding?
A) a. pH 6.0
B) b. White blood cells (WBCs) 9/hpf
C) c. Amber yellow color
D) d. Specific gravity 1.025

B

The nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find which of the following as the "classic triad" of presenting symptoms occurring in patients with renal cancer?
A) a. Fever, chills, flank pain
B) b. Hematuria, flank pain, palpable mass
C) c. Hematuria, proteinuria, palpable mass
D) d. Flank pain, palpable abdominal mass, and proteinuria

B

Which of the following nursing interventions is appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)?
A) a. Help the patient cope with the rapid progression of the disease.
B) b. Suggest genetic counseling resources for the children of the patient.
C) c. Expect the patient to have polyuria and poor concentration ability of the kidneys.
D) d. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

B

An elderly male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for which of the following factors that may dispose him to urinary tract infections (UTIs)?
A) a. High-purine diet
B) b. Sedentary lifestyle
C) c. Benign prostatic hyperplasia (BPH)
D) d. Recent use of broad-spectrum antibiotics

C

The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. Which of the following is a priority nursing assessment in the care of this patient?
A) a. Assessment of pain and level of consciousness
B) b. Assessment of serum calcium and phosphorus levels
C) c. Blood pressure and assessment for orthostatic hypotension
D) d. Daily weights and measurement of the patient's abdominal girth

D

Which of the following nursing diagnoses is a priority in the care of a patient with renal calculi?
A) a. Acute pain
B) b. Deficient fluid volume
C) c. Risk for constipation
D) d. Risk for powerlessness

A

Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which of the following measures should the nurse first recommend in an attempt to resolve the woman's incontinence?
A) a. Kegel exercises
B) b. Use of adult incontinence pads
C) c. Intermittent self-catheterization
D) d. Dietary changes including fluid restriction

A

The nurse preparing to administer a dose of PhosLo to a patient with chronic kidney disease would interpret that this medication should have a beneficial effect on which of the following laboratory values of the patient?
A) a. Sodium
B) b. Potassium
C) c. Magnesium
D) d. Phosphorus

D

When caring for a patient during the oliguric phase of acute kidney injury, which of the following would be an appropriate nursing intervention?
A) a. Weigh patient three times weekly.
B) b. Increase dietary sodium and potassium.
C) c. Provide a low-protein, high-carbohydrate diet.
D) d. Restrict fluids according to previous daily loss.

D

Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention; hence, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 ml for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times a week.

Which of the following statements by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure?
A) a. "It is essential that you maintain aseptic technique to prevent peritonitis."
B) b. "You will be allowed a more liberal protein diet once you complete CAPD."
C) c. "It is important for you to maintain a daily written record of blood pressure and weight."
D) d. "You will need to continue regular medical and nursing follow-up visits while performing CAPD.

A

A patient with a history of end-stage renal disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which of the following assessments should the nurse prioritize before, during, and after his treatment?
A) a. Level of consciousness
B) b. Blood pressure and fluid balance
C) c. Temperature, heart rate, and blood pressure
D) d. Assessment for signs and symptoms of infection

B

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. Which of the following is an expected assessment finding for this patient during this early stage of recovery?
A) a. Hypokalemia
B) b. Hyponatremia
C) c. Large urine output
D) d. Leukocytosis with cloudy urine output

C

Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

Which of the following assessment findings is a consequence of the oliguric phase of acute kidney injury (AKI)?
A) a. Hypovolemia
B) b. Hyperkalemia
C) c. Hypernatremia
D) d. Thrombocytopenia

B

In AKI the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

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