A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis laboratory findings should the nurse expect? A. Presence of glucose B. Decreased specific gravity C. Presence of ketones D. Presence of red blood cells A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIA DH). Which of the following findings should the nurse expect? (Select all that apply.) A. Decreased blood sodium B. Urine specific gravity 1.001 C. Blood osmolarity 230 mOsm/L D. Polyuria E. Increased thirst A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching? A. “I can drink up to 2 quarts of fluid a day.” B. “I will need to use insulin to control my blood glucose levels.” C. “I should expect to gain weight during this illness.” D. “I might experience confusion or balance problems.” A nurse is planning care for a client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan? A. Maintain the client in a low‑Fowler’s position. B. Encourage deep breathing and coughing. C. Encourage the client to brush their teeth when awake and alert. D. Observe dressing drainage for the presence of glucose. Transsphenoidal hypophysectomy: The pituitary gland is taken out through your nose via the sphenoid sinus, a cavity near the back of your nose. D. The client has developed acute kidney injury and has a low urine output, hyperkalemia and confusion. What are the appropriate nursing actions? Select all that apply.
1,2,4,5 The client who has acute kidney injury and has developed a low urine output, hyperkalemia and confusion, needs nursing care focused on stabilizing the level of consciousness, potassium and kidney function. Monitoring urine output and level of consciousness, and putting the client close to the nursing station are vital to promote client safety. To stabilize hyperkalemia, administration of sodium polystyrene is needed. The client with indwelling foley catheter has polyurea associated with acute kidney injury. What is the priority nursing diagnosis?
The client has acute kidney injury and has urinated 2000 ml over the past 3 hours. The client's fluid and electrolytes are; sodium of 130 meq/L, potassium of 3 meq/L and a calcium of 8 mg/dl. What are the medications needed to stabilize the fluids and electrolytes? Select all that apply.
1,2,4 The client who has acute kidney injury developed hyponatremia, hypokalemia and hypocalcemia. The medications that can stabilize the fluid and electrolytes imbalances are 0.9% sodium chloride, potassium and calcium chloride IV infusion. 0.9% sodium chloride will help to replace the fluid volume loss while stabilizing the sodium level. 3% sodium chloride IV infusion can replace sodium, but it can shrink the cell that will lead into further dehydration. Sodium polystyrene can drop potassium level. Therefore, this can cause further hypokalemia. The nurse is caring for a patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? A. The patient reports of increased thirst. B. The patient reports a sore throat when swallowing. C. The patient supports her head when moving in bed. D. The patient makes harsh, vibratory sounds when breathing. D After thyroid surgery, the patient may experience an airway obstruction related to excess swelling, hemorrhage, hematoma formation, or laryngeal stridor (harsh, vibratory sound). Emergency equipment should be at the bedside, including oxygen, suction equipment, and a tracheostomy tray. The nurse gives corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? A. The patient is alert and oriented. B. The patient’s lung sounds are clear. C. The patient’s urinary output decreases. D. The patient’s potassium level is 5.7 mEq/L. An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? A. “The medication prevents sodium and water retention after surgery.” B. “This drug stimulates your immune system and promotes wound healing.” C. “The drug prevent clots from forming in the legs during your recovery from surgery.” D. “This medicine is given to help your body respond to stress after removal of the adrenal glands.” D Hydrocortisone is administered IV during and after a bilateral adrenalectomy to ensure adequate responses to the stress of the procedure. A patient has a serum calcium (total) level of 13.4 mg/dL (3.34 mmol/L). Which disorder would the nurse suspect? A. Type 2 diabetes B. Hyperphosphatemia C. Hyperparathyroidism D. Magnesium deficiency A patient with thyroid nodules is to undergo a thyroid scan with oral radioactive isotopes. Which instructions, if given by the nurse, are appropriate? A. “The test cannot be completed if you have an allergy to iodine or shellfish.” B.“It is important to drink at least 2 to 3 liters of liquids for the next 1 to 2 days.” C. “Isolation is required for 24 hours until the radioactive substance is gone from your body.” D. “Sedation is necessary to ensure that you do not move while the scanner moves over your neck.” A patient has signs of hypothyroidism. Which diagnostic test will the nurse expect to be done first? A.Total thyroxine (T4) B.Thyroid antibodies (Ab) C.Free triiodothyronine (FT3) D.Thyroid-stimulating hormone (TSH) A nurse is caring for a client who asks why the provider bases the medication regimen on HbA1c results instead of the log of morning fasting blood glucose results. Which of the following responses should the nurse make? A.“HbA1c measures how well insulin is regulating your blood glucose between meals.” B.“HbA1c indicates how well your have regulated your blood glucose over the past 120 days.” C.“HbA1c is the first test your doctor prescribed to determine that you have diabetes.” D.“HbA1c determines if the your doctor should adjust your insulin dosage.” A nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. The nurse should identify an elevation of which of the following substances as an indication that the client has this disorder? A. Triiodothyronine (T3) B. Plasma-free metanephrine C. Urine cortisol D. Urine osmolality a. Increased triiodothyronine (T3) indicates hyperthyroidism A nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIA DH). Which of the following laboratory findings should the nurse expect? (Select all that apply.) A. Low sodium B. High potassium C. Increased urine osmolality D. High urine sodium E. Increased urine specific gravity A. CORRECT: SIA DH results in water retention, causing a low sodium level. B. SIA DH does not affect potassium levels. C. CORRECT: SIA DH results in an increase in urine osmolality due to the decreased urine volume. D. CORRECT: SIA DH results in water retention, causing a high urine sodium level. E. CORRECT: SIA DH results in water retention, causing an increase in urine specific gravity. A nurse is caring for a client who has primary adrenal insufficiency and is preparing to undergo an ACTH stimulation test. Which of the following findings should the nurse expect after an IV injection of cosyntropin? A. No change in plasma cortisol B. Elevated fasting blood glucose C. Decrease in sodium D. Increase in urinary output A. No change in plasma cortisol indicates primary adrenal insufficiency (Addison’s disease or hypocortisolism) after an IV injection of cosyntropin during an ACTH stimulation test due to an inadequate production of cortisol. A nurse is assessing a client during a water deprivation test. For which of the following complications should the nurse monitor the client? A. Bradycardia B. Orthostatic hypotension C. Neck vein distention D. Crackles in lungs A patient with type 1 diabetes calls the clinic reporting nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to: A. Withhold the regular dose of insulin. B. Drink cool fluids with high glucose content. C. Check the blood glucose level every 2 to 4 hours. D. Use a less strenuous form of exercise than usual until the illness resolves. The nurse plans a class for patients who have newly diagnosed type 2 diabetes. Which goal is most appropriate? A. Make all patients responsible for the management of their disease. B. Involve the family and significant others in the care of these patients. C. Enable the patients to become active participants in the management of their disease. D. Provide the patients with as much information as soon as possible to prevent complications. The nurse plans a class for patients who have newly diagnosed type 2 diabetes. Which goal is most appropriate? A. Make all patients responsible for the management of their disease. B. Involve the family and significant others in the care of these patients. C. Enable the patients to become active participants in the management of their disease. D. Provide the patients with as much information as soon as possible to prevent complications. The nurse is caring for a patient with type 1 diabetes who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? A. Hypokalemia B. Fluid overload C. Hypoglycemia D. Hyperphosphatemia A nurse is planning care for a client who has prerenal acute kidney injury following an abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hrs and BP is 92/58 mm Hg. The nurse should expect which of the following interventions? a. prepare the client for a CT scan with contrast dye b. plan to admin. nitroprusside c. prepare to administer a fluid challenge d. plan to position the client in trendelenburg A nurse is planning care for a client who has post renal AKI due to metastatic cancer. The client has a blood creatinine of 5mg/dL. which of the following interventions should the nurse include in the plan? a. provide a high fiber diet b. assess urine for blood c. monitor for intermittent anuria d.weigh client A client with a dx of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional healthcare team focus on? select all
The nurse should include which interventions in the plan of care for a client with hypothyroidism? select all.
The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose?
The nurse is reviewing the lab test results for a client with a diagnosis of Cushings syndrome. Which lab finding would the nurse expect to note in this client?
the nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with DM who will be taking insulin.The client demonstrated understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels?
A client with DM who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question?
The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency in this client?
The nurse is monitoring a client with Grave's disease for signs of thyroid storm. Which s/s if noted in the client, will alert the nurse to the presence of this crisis?
A nurse is reviewing the assessment findings and lab data for a client with the syndrome of inappropriate hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? select all
A nurse is reviewing the assessment findings for a client who was admitted to the hosptial with a diagnosis of Diabetes Insipidus. The nurse understands that which manifestations are associated with this disorder? select all
A client with acute kidney injury has a serum potassium level of 7.0 mEq/L. The nurse should plan which actions as priority? select all
A client diagnosed with chronic kidney disease is scheduled to begin hemodialysis. The nurse determines that which neurological and psychological manifestations, if exhibited by this client, are related to the CKD? select all
The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include?
The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. which disorder, if noted on the clients record, should the nurse identify as a risk factor for this disorder?
The nursing student is assigned to care for a client with a diagnosis of acute kidney injury, diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the student, indications an adequate understanding of the treatment plan for the client?
The nurse has completed teaching with the hemodialysis client about self monitoring between hemodialysis treatments. The nurse should determine that education was effective if the client states to record which parameters daily?
The nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?
a client with acute glomerulonephritis has had a urinalysis sample sent to the lab. The report reveals the presence of hematuria and proteinuria. The nurse interprets these results as which condition?
A nurse is caring for a client who has diabetes mellitus and reports a gradual loss of peripheral vision. The nurse should recognize this as a manifestation of which of the following diseases? A. Cataracts B. Open‑angle glaucoma C. Macular degeneration D. Angle‑closure glaucoma B. CORRECT: This is a manifestation of open‑angle glaucoma. A gradual loss of peripheral vision is a manifestation associated with this diagnosis. A nurse is providing postoperative teaching to a client following cataract surgery. Which of the following statements should the nurse include in the teaching? A. “You can resume playing golf in 2 days.” B. “You need to tilt your head back when washing your hair.” C. “You can get water in your eyes in 1 day.” D. “You need to limit your housekeeping activities.” D. CORRECT: Instruct the client to limit housekeeping activities following cataract surgery. This activity could cause a rise in IOP or injury to the eye. 3. A nurse is caring for a male older adult client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize as risk factors associated with this disease? (Select all that apply.) A. Sex B. Genetic predisposition C. Hypertension D. Age E. DM B. CORRECT: Genetic predisposition is a risk factor associated with glaucoma. C. CORRECT: Hypertension is a risk factor associated with glaucoma. D. CORRECT: Age is a risk factor associated with glaucoma. E. CORRECT: Diabetes mellitus is a risk factor associated with glaucoma. A nurse is caring for a client who has a new diagnosis of cataracts. Which of the following manifestations should the nurse expect? (Select all that apply.) A. Eye pain B. Floating spots C. Blurred vision D. White pupils E. Bilateral red reflexes C. CORRECT: Blurred vision is a manifestation associated with cataracts. D. CORRECT: White pupils are a manifestation associated with cataracts. A nurse is providing teaching for a client who has a new diagnosis of dry macular degeneration. Which of the following instructions should the nurse include in the teaching? A. Increase intake of deep yellow and orange vegetables. B. Administer eye drops twice daily. C. Avoid bending at the waist. D. Wear an eye patch at night A. CORRECT: Instruct the client to increase dietary intake of carotenoids A nurse is performing an otoscopic examination of a client. Which of the following is an unexpected finding? A. Pearly gray tympanic membrane (TM) B. Malleus visible behind the TM C. Presence of soft cerumen in the external canal D. Fluid or bubbles seen behind the TM D. CORRECT: Fluid behind the TM indicates the possibility of otitis media and is not an expected finding. 2. A nurse is reviewing the health record of a client who has severe otitis media. Which of the following are expected findings? (Select all that apply.) A. Enlarged adenoids B. Report of recent colds C. Client prescription for daily furosemide D. Light reflex visible on otoscopic exam in the affected ear E. Ear pain relieved by meclizine A. CORRECT: Enlarged tonsils and adenoids are a finding associated with a middle ear infection. B. CORRECT: Frequent colds are findings associated with a middle ear infection. A nurse in a clinic is caring for a client who has been experiencing mild to moderate vertigo due to benign paroxysmal vertigo for several weeks. Which of the following actions should the nurse recommend to help control the vertigo? (Select all that apply.) A. Reduce exposure to bright lighting. B. Move head slowly when changing positions. C. Do not eat fruit high in potassium. D. Plan evenly-spaced daily fluid intake. E. Avoid fluids containing caffeine. A. CORRECT: Remaining in a darkened, quiet environment can reduce vertigo, particularly when it is severe. B. CORRECT: Moving slowly when standing or changing positions can reduce vertigo. D. CORRECT: Fluid intake should be planned so that it is evenly spaced throughout the day to prevent excess fluid accumulation in the semicircular canals. A nurse is caring for a client who has suspected Ménière’s disease. Which of the following is an expected finding? A. Presence of a purulent lesion in the external ear canal B. Feeling of pressure in the ear C. Bulging, red bilateral tympanic membranes D. Unilateral hearing loss D. CORRECT: Unilateral sensorineural hearing loss is an expected finding in Ménière’s disease. A nurse is completing discharge teaching to a client following middle ear surgery. Which of the following statements by the client indicates understanding of the teaching? A. “I should restrict rapid movements and avoid bending from the waist for several weeks.” B. “I should wait until the day after surgery to wash my hair.” C. “I will remove the dressing behind my ear in 7 days.” D. “My hearing should be back to normal right after my surgery.” A. CORRECT: Rapid movements and bending from the waist should be avoided for 3 weeks following ear surgery. 1. A nurse is planning care for a client who has chronic pyelonephritis. Which of the following actions should the nurse plan to take? (Select all that apply.) A. Provide a referral for nutrition counseling. B. Encourage daily fluid intake of 1 L. C. Palpate the costovertebral angle. D. Monitor urinary output. E. Administer antibiotics. A. CORRECT: The client requires adequate nutrition to promote healing. B. Encourage fluid intake of 2 L daily to maintain dilute urine. C. CORRECT: Gently palpate the costovertebral angle for flank tenderness, which can indicate inflammation and infection. D. CORRECT: Monitor urinary output to determine that 1 to 3 L of urine is excreted daily. E. CORRECT: Administer antibiotics to treat the bacteriuria and decrease progressive damage to the kidney. A nurse is caring for a client who has a urinary tract infection (UTI). Which of the following is the priority intervention by the nurse? A. Offer a warm sitz bath. B. Recommend drinking cranberry juice. C. Encourage increased fluids. D. Administer an antibiotic. D. CORRECT: The greatest risk to the client is injury to the renal system and sepsis from the UTI. The priority intervention is to administer antibiotics. A nurse is preparing educational material to present to a female client who has frequent urinary tract infections. Which of the following information should the nurse include? (Select all that apply.) A. Avoid sitting in a wet bathing suit. B. Wipe the perineal area back to front following elimination. C. Empty the bladder when there is an urge to void. D. Wear synthetic fabric underwear. E. Take a shower daily. A. CORRECT: The client should avoid sitting in a wet bathing suit, which can increase the risk for a UTI by colonization of bacteria in a moist, warm environment. C. CORRECT: The client should empty the bladder when there is an urge to void rather than retain urine for an extended period of time, which increases the risk for a UTI. E. CORRECT: The client should take a shower daily to promote good body hygiene and decrease colonization of bacteria in the perineal area that can cause a UTI. A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? (Select all that apply.) A. A client who is at 32 weeks of gestation B. A client who has kidney calculi C. A client who has a urine pH of 4.2 D. A client who has a neurogenic bladder E. A client who has diabetes mellitus A. CORRECT: A client who is at 32 weeks of gestation is at risk for developing pyelonephritis because of increased pressure on the urinary system during pregnancy causing reflux or retention of urine. B. CORRECT: A client who has kidney calculi is at risk for pyelonephritis because stones harbor bacteria. D. CORRECT: The client who has a neurogenic bladder can retain urine, promoting bacterial growth and causing pyelonephritis. E. CORRECT: The client who has diabetes mellitus is at risk of pyelonephritis because glucose that can be in the urine promotes bacterial growth. A nurse is reviewing urinalysis results for four clients. Which of the following urinalysis results indicates a urinary tract infection? A. Positive for hyaline casts B. Positive for leukocyte esterase C. Positive for ketones D. Positive for crystals B. CORRECT: A positive leukocyte esterase indicates a urinary tract infection. A nurse is completing the admission assessment of a client who has renal calculi. Which of the following findings should the nurse expect? A. Bradycardia B. Diaphoresis C. Nocturia D. Bradypnea B. CORRECT: Diaphoresis is a manifestation associated with a client who has renal calculi. A nurse is reviewing discharge instructions with a client who had spontaneous passage of a calcium phosphate renal calculus. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Limit intake of food high in animal protein. B. Reduce sodium intake. C. Strain urine for 48 hr. D. Report burning with urination to the provider. E. Increase fluid intake to 3 L/day. A. CORRECT: The client should limit the intake of food high in animal protein, which contains calcium phosphate. B. CORRECT: The client should limit intake of sodium, which affects the precipitation of calcium phosphate in the urine. D. CORRECT: The client should report burning with urination to the provider because this can indicate a urinary tract infection. E. CORRECT: The client should increase fluid intake to 2 to 3 L/day. A decrease in fluid intake can cause dehydration, which increases the risk of calculi formation. A nurse is teaching a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statements by the client indicates understanding of the teaching? A. “I will be fully awake during the procedure.” B. “Lithotripsy will reduce my chances of having stones in the future.” C. “I will report any bruising that occurs to my doctor.” D. “Straining my urine following the procedure is important.” D. CORRECT: A client is instructed to strain urine following lithotripsy to verify that the calculi have passed. A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessment findings is the priority for the nurse to report to the provider? A. Flank pain that radiates to the lower abdomen B. Client report of nausea C. Absent urine output for 1 hr. D. Blood WBC count 15,000/mm3 C. CORRECT: The greatest risk to this client is damage to the kidney resulting from obstruction of urine flow by the renal calculus. Therefore, the priority finding to report to the provider is anuria. A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate calculus. To decrease the chance of recurrence, the nurse should instruct the client to avoid which of the following foods? (Select all that apply.) A. Red meat B. Black tea C. Cheese D. Whole grains E. Spinach B. CORRECT: A client who has renal calculi composed of calcium oxalate should avoid intake of black tea because it is a source of oxalate. E. CORRECT: A client who has renal calculi composed of calcium oxalate should avoid intake of spinach because it is a source of oxalate. A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching? A. Hemodialysis restores kidney function. B. Hemodialysis replaces hormonal function of the renal system. C. Hemodialysis allows an unrestricted diet. D. Hemodialysis returns a balance to blood electrolytes. D. CORRECT: Explain to the client that hemodialysis restores electrolyte balance by removing excess sodium, potassium, fluids, and waste products, and also restores acid base balance. A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury. Which of the following actions should the nurse take? (Select all that apply.) A. Review the medications the client currently takes. B. Assess the AV fistula for a bruit. C. Calculate the client’s hourly urine output. D. Measure the client’s weight. E. Check blood electrolytes. F. Use the access site area for venipuncture. A. CORRECT: Reviewing the medications the client currently takes can help determine which medications to withhold until after dialysis. B. CORRECT: Assessing the AV fistula for a bruit determines the patency of the fistula for dialysis. D. CORRECT: Measuring the client’s weight before dialysis is essential for comparing it with the client’s weight after dialysis. E. CORRECT: Checking the blood electrolytes determines the need for dialysis.
A nurse is planning post-procedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Check BUN and blood creatinine. B. Administer medications the nurse withheld prior to dialysis. C. Observe for findings of hypovolemia. D. Assess the access site for bleeding. E. Evaluate blood pressure on the arm with AV access. A. CORRECT: Check the BUN and blood creatinine to determine the presence and degree of uremia or waste products that remain following dialysis. B. CORRECT: Withhold medications the treatment can partially dialyze. After the treatment, the nurse should administer the medications. Antihypertensive medications might need to be withheld until the next day if the client is hypotensive. C. CORRECT: A client who is post dialysis is at risk for hypovolemia due to a rapid decease in fluid volume. D. CORRECT: Assess the access site for bleeding because the client receives heparin during the procedure to prevent clotting of blood. E. Never measure blood pressure on the extremity that has the AV access site because it can cause collapse of the AV fistula or graft. A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? A. Administer an opioid medication. B. Monitor for hypertension. C. Assess level of consciousness. D. Increase the dialysis exchange rate. C. CORRECT: Assess the client’s level of consciousness. A change in urea levels can cause increased intracranial pressure. Subsequently, the client’s level of consciousness decreases. A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? (Select all that apply.) A. Monitor blood glucose levels. B. Report cloudy dialysate return. C. Warm the dialysate in a microwave oven. D. Assess for shortness of breath. E. Check the access site dressing for wetness. F. Maintain medical asepsis when accessing the catheter insertion site A. CORRECT: Monitor blood glucose levels because the dialysate solution contains glucose. B. CORRECT: Monitor for cloudy dialysate return, which indicates an infection. Clear, light yellow solution is typical during the outflow process. D. CORRECT: Assess for shortness of breath, which can indicate inability to tolerate a large volume of dialysate. E. CORRECT: Check the access site dressing for wetness and look for kinking, pulling, clamping, or twisting of the tubing, which can increase the risk for exit site infections. 1. A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. The nurse should expect which of the following interventions? A. Prepare the client for a CT scan with contrast dye. B. Plan to administer nitroprusside. C. Prepare to administer a fluid challenge. D. Plan to position the client in Trendelenburg. C. CORRECT: Plan to administer a fluid challenge for hypovolemia, which is indicated by the client’s low urinary output and blood pressure. A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a blood creatinine of 5 mg/dL. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A. Provide a high protein diet. B. Assess the urine for blood. C. Monitor for intermittent anuria. D. Weight the client once per week. E. Provide NSAIDs for pain. A. CORRECT: Provide a high protein diet due to the high rate of protein breakdown that occurs with acute kidney injury. B. CORRECT: Assess urine for blood, stones, and particles indicating an obstruction of the urinary structures that leave the kidney. C. CORRECT: Assess for intermittent anuria due to obstruction or damage to kidneys or urinary structures. A nurse is planning care for a client who has Stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Assess for jugular vein distention. B. Provide frequent mouth rinses. C. Auscultate for a pleural friction rub. D. Provide a high sodium diet. E. Monitor for dysrhythmias A. CORRECT: Assess for jugular vein distention, which can indicate fluid overload and heart failure. B. CORRECT: Provide frequent mouth rinses due to uremic halitosis caused by urea waste in the blood. C. CORRECT: Auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalances and fluid retention. E. CORRECT: Monitor for dysrhythmias related to increased blood potassium caused by Stage 4 chronic kidney disease. A nurse is reviewing client laboratory data. Which of the following findings is expected for a client who has Stage 4 chronic kidney disease? A. Blood urea nitrogen (BUN) 15 mg/dL B. Glomerular filtration rate (GFR) 20 mL/min C. Blood creatinine 1.1 mg/dL D. Blood potassium 5.0 mEq/L B. CORRECT: The GFR is severely decreased to approximately 20 mL/min, which is indicative of stage 4 chronic kidney disease. C. In stage 4 chronic kidney disease, a blood creatinine level can be as high as 15 to 30 mg/dL. A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? (Select all that apply.) A. Reduced BUN B. Elevated cardiac enzymes C. Reduced urine output D. Elevated blood creatinine E. Elevated blood calcium C. CORRECT: A manifestation of prerenal AKI is reduced urine output. D. CORRECT: A manifestation of prerenal AKI is elevated blood creatinine. The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestations should the nurse expect to find? A.Decreased body weight B.Decreased urinary output C.Increased plasma osmolality D. Increased serum sodium levels B. In SIADH, decreased output of concentrated urine with increased urine osmolality and specific gravity occur. During care of the patient with SIADH, what should the nurse do? A. Monitor neurologic status at least every 2 hours. B. Teach the patient receiving diuretic therapy to restrict sodium intake. C.Keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release. D. Notify the health care provider (HCP) if the patient’s BP decreases more than 20 mm Hg from baseline. A. the patient with SIADH has marked dilutional hyponatremia and should be monitored for decreased neurologic function and seizure every 2 hours. The patient with diabetes insipidus is brought to the emergency department (ED) with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were consumed. What is a diagnostic test that the nurse should expect to be done first to help make a diagnosis? a. Blood glucose b.Serum sodium level c.CT scan of the head d.Water deprivation test Which statement accurately describes Graves’ disease? a.Exophthalmos occurs in Graves’ disease. b. It is an uncommon form of hyperthyroidism. c. Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system. d. Diagnostic testing in the patient with Graves’ disease will reveal an increased thyroid-stimulating hormone level (TSH). A patient with Graves’ disease asks the nurse what caused the disorder. What is the best response by the nurse? a. “The cause of Graves’ disease is not known, although it is thought to be genetic.” b. “It is usually associated with goiter formation from an iodine deficiency over a long period.” c.“Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones.” d. “In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion.” A patient is admitted to the hospital with acute thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and laryngeal stridor b. Bulging eyeballs and dysrhythmias c. Increased temperature and signs of heart failure d. Lethargy progressing suddenly to impaired consciousness c. a thyroid storm results in marked manifestations of hyperthyroidism. Severe tachycardia, heart failure, shock, hyperthermia, agitation delirium, seizures, abdominal pain, vomiting, diarrhea, and coma occurs. Although exophthalmos may be present in the patient with Graves’ disease, it is not a significant factor in thyrotoxic crisis. A patient suspected of having acromegaly has an increased plasma growth hormone (GH) level. In acromegaly, what would the nurse expect the patient’s diagnostic results to show? a.Hyperinsulinemia b.Plasma glucose of less than 70 mg/dL (3.9 mm/dL) c.Decreased GH levels with an oral glucose challenge test d.Increased levels of plasma insulin-like growth factor-1 (IGH-1) During assessment of the patient with acromegaly, what should the nurse expect the patient to report? a.Infertility b.Dry, irritated skin c.Undesirable changes in appearance d.An increase in height of 2 to 3 inches a year c. The increased production of GH in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, feet, and head; oily and coarse skin; and speech difficulties. What is an appropriate nursing intervention for the patient with hyperparathyroidism? a.Pad side rails as a seizure precaution. b.Increase fluid intake to 3000 to 4000 mL daily. c.Maintain bed rest to prevent pathologic fractures. d. Monitor the patient for Trousseau’s and Chvostek’s signs.
A patient with hypoparathyroidism from surgical treatment of hyperparathyroidism is preparing for discharge. What should the nurse teach the patient? a. Milk and milk products should be increased in the diet. b.Parenteral replacement of parathyroid hormone will be needed for life. c.Calcium supplements with vitamin D can effectively maintain calcium balance. d. Bran and whole-grain foods should be used to prevent gastrointestinal effects of replacement therapy. c. hypocalcemia results from PTH deficiency is controlled with calcium and vitamin D supplementation and possibly oral phosphate binders. Milk products, although good sources of calcium, have high levels of phosphate, which reduce calcium absorption. A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, what should the nurse expect to find? a. Hypertension, moon face, and purple striations b.Weight loss, buffalo bump, and hypoglycemia c.Abdominal and buttock striae, truncal obesity, and hypotension d.Anorexia, signs of dehydration, and moon face A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids? a.Reduced to promote wound healing. b.Withheld until symptoms of hypocortisolism appear c.Increased to promote an adequate response to the stress of surgery d. Reduced with excessive hormone release during surgical manipulation of adrenal glands. A patient with Addison’s disease comes to the ED with reports of nausea, vomiting, diarrhea, and fever. What interprofessional care should the nurse expect? a.IV administration of vasopressors b.IV administration of hydrocortisone c.IV administration of D5W with 20 mEq KCL d.Parenteral injections of adrenocorticotropic hormone (ACTH) When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan? a.Achieving a normal weight b.Performing daily aerobic exercise c.Eliminating red meat from the diet d.Monitoring the blood glucose periodically When teaching the patient with diabetes about insulin administration, the nurse should include which instruction? a.Pull back on the plunger after inserting the needle to check for blood. b.Consistently use the same size of insulin syringe to avoid dosing errors. c.Shake the NPH to ensure it is mixed thoroughly. d.Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies. Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. When should the nurse administer lispro insulin? a.Only once a day b.1 hour before meals c.30 to 45 minutes before meals d.At mealtime or within 15 minutes of meals The home care nurse should intervene to correct a patient whose insulin administration includes a.Warming a prefilled refrigerated syringe in the hands before administration. b.Storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c.Placing the insulin bottle currently in use in a small container on the bathroom countertop. d.Mixing an evening dose of regular insulin with insulin glargine in 1 syringe for administration. What type of urinary tract stones are the most common and often obstruct the ureter? a.Cystine b.Uric acid c.Calcium oxalate d.Calcium phosphate While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestations is the patient likely to experience? a.Cloudy urine and fever b.Urethral burning and bloody urine c.Vague abdominal discomfort and disorientation d.Suprapubic pain and slight decline in body temperature What should the nurse include in the teaching plan for a female patient with UTI? a.Empty the bladder at least 4 times a day. b.Drink at least 2 Lof water every day. c.Wait to urinate until the urge is very intense. d.Clean the urinary meatus with an anti-infective agent after voiding What results in the edema associated with nephrotic syndrome? a. Hypercoagulability b.Hyperalbuminemia c.Decreased plasma oncotic pressure d. Decreased glomerular filtration rate c. With nephrotic syndrome, the body excrete too much protein causing serum hypoalbuminemia which leads to decreased plasma oncotic pressure. Manifestations include swelling around the eyes and in the feet and ankles, foamy urine, and weight gain due to excess fluid retention. Treatment: blood pressure medications, water pills, and restrict sodium intake to reduce edema and control hypertension. On assessment of the patient with a kidney stone passing down the ureter, what should the nurse expect the patient to report? a.A history of chronic UTIs. b.Dull, costovertebral flank pain c.Severe, colicky back pain radiating to the groin d.A feeling of bladder fullness with urgency and frequency In providing care for the patient with adult-onset polycystic kidney disease, what should the nurse do? a.Help the patient cope with the rapid progression of the disease. b.Suggest genetic counseling resources for the children of the patient. c.Expect the patient to have polyuria and poor concentration ability of the kidneys d. Implement measures for the patient’s deafness and blindness in addition to the renal problems. b. adult-onset polycystic kidney disease is an inherited autosomal dominant disorder that often manifests after the patient has had children. Therefore, the children should receive genetic counseling regarding their life choices. The disease progresses slowly, eventually causing progressive renal failure. |
Which medication should a nurse expect the HCP to prescribe for a client with hypothyroidism?
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