Organ System Failures

Renal

100

The nurse is caring for a patient receiving hemodialysis treatments. The patient has had surgery to form an arteriovenous fistula. What is important for the nurse to be aware of in providing care for this patient? a. The patient feels best immediately after dialysis b. The patient should not feel any pain during initiation of dialysis c. Taking a BP reading on the fistula arm can cause clotting of the fistula d. Feeling a bruit means the fistula is patent

c

200

Renal failure can have pre-renal, renal, and post-renal causes. If the cause is pre-renal, which of the following was most likely the cause? a. glomerulonephritis b. heart failure c. kidney calculi d. aminoglycoside toxicity

b a - renal c - post d - renal

300

The nurse is caring for a patient in ARF. The nurse should expect which of the following medications to be used to treat the hyperkalemia? (Check all that apply) a. hypertonic glucose b. insulin infusion c. Sodium bicarb d. potassium e. sodium f. calcium g. kayexalate

a, b, c, f, g

400

Which of the following meal trays would be appropriate for a patient in ARF? a. A bowl of oatmeal and 2 slices of whole wheat toast b. two scrambled eggs and a banana c. two pancakes and 2 slices of bacon d. a cup of coffee, mixed fruit cup, and orange juice

a - ARF diet is low Protein, low Na+, lowK+, and high in carbs

500

Identify 5 interventions for a patient with a diagnosis of FVE (can not include VS)

weight QD I+O VS Fluid restriction monitor for edema lung sounds labs check for JVD low Na+ diet

Liver

100

The nurse is caring for a patient with liver failure. The nurse is aware that patients with liver failure will require which of the following vitamins for the synthesis of prothrombin? a. Vit A b. Vit B12 c. Vit C d. Vit K

d

200

A patient is undergoing a percutaneous liver biopsy. After the procedure, the nurse will place the patient in which of the following positions? a. trendelenberg b. on the left side with a pillow under the knees c. supine d. on the right side with a pillow under the costal margin

d - need to put pressure on the site to prevent bleeding.

300

A patient is brought to the ED by ambulance. He has hematemesis and an alteration in mental status. He is also tachycardic, has cool, clammy skin, and is hypotensive. The patient has a history of alcohol abuse. What will the nurse suspect is the patient's diagnosis? a. portal HTN b. bleeding esophogeal varices c. hemolytic jaundice d. hepatic encephalopathy

b. a - you would see ascites c - yellow color d - elevated NH3 levels; no bleeding

400

The nurse is reviewing the orders of a newly admitted patient who has bleeding esophogeal varices. The nurse calls the physician to question the use of vasopressin when the nurse reads that the patient has a history of which illness? a. DM b. CRF c. CAD d. Arthritis

c

500

Which of the following treatments would the nurse expect to be ordered for a patient with ascites? (Check all that apply) a. low Na+ diet b. bedrest c. salt-poor albumin d. thoracentesis e. IV NS X1 Liter f. Platelet transfusion

a, b, c TIPS (shunts blood from the hepatic system to the vena cava), labs also

Odds/Ends

100

A patient is admitted to the ED with severe abdominal pain with rebound tenderness, anorexia, and chills. VS are BP 82/50, R 34, P 130, and T 101. Of the following interventions, which should the nurse do first? a. Infuse 1000 ml of LR over 30 minutes b. Administer IV Ketoroloac 15 mg for pain c. Give the IV ABX d. Obtsin a CT scan of the abdomen with contrast

a

200

A patient with ESRD is scheduled for his first hemodialysis treatment. The patient asks the nurse what common complications may occur from the treatment. What would be the nurses' best reply? a. High blood sugar levels and low protein levels may occur b. Excessive bleeding and double vision may occur c. Confusion and diarrhea may occur d. Hypotension and cramping may occur

d

300

The nurse is assessing a patient in the beginning stages of liver failure. Which of the following assessments would indicate a worsening of the liver failure? (Check all that apply) a. elevated NH3 b. fetor hepaticus c. asterixis d. hypoactive deep tendon reflexes e. a seizure f. elevated K+ g. constructional apraxia

a, b, c, e, g b -fetor hepaticus - sweet fecal like smell to the breath c -asterixis - flapping tremor of the hands d - hyperactive f - K+ goes down when NH3 goes up g -constructional apraxia - unable to draw simple figures

400

The majority of blood supply to the liver, which is poor in nutrients, comes from the portal vein. True or False

False - rich in nutrients, poor in O2

500

Which of the following would not be part of the medical management of a patient with hepatic encepholopathy? (Check all that apply) a. increase protein in the diet b. lactulose c. tylenol for pain d. IV glucose e. antibiotics f. gastric suction

a, c b - reduces NH3 levels d - minimizes protein catabolism e - prevents/treats any infections to decrease NH3 from destruction of infectious bacteria f - decrease any acid to decrease NH3 levels

DIC

100

DIC is a disease of the blood stream that causes massive clotting factor deficiencies and bleeding True or false

False - symptom not a disease

200

The nurse is reviewing the labs of a patient with suspected DIC. Of the following lab values, which would not be elevated in DIC? a. PT/INR b. PTT c. Platelets d. D-Dimer

c

300

While planning care for a patient with DIC, the nurse will avoid performing which of the following interventions? (Check all that apply) a. VS b. neuro checks c. IV heparin administration d. rectal temperature e. dislodging clots f. intramuscular injections g. using a sponge-tipped swab for oral care

d, e, f heparin prevents the formation of more microthrombi thus allowing for greater perfusion

400

The nurse is caring for a patient who has sepsis from a UTI. While performing a morning assessment, the nurse notices one of the IV sites is bleeding and the patient is restless and anxious. The nurse supects that the patient may be displaying signs of DIC. Additional s/s of DIC include all of the following except: a. hypoxia b. heartburn c. elevated BP d. decreased urine output

c

500

The primary nursing diagnosis for a patient with DIC is which of the following? a. Risk for impaired skin integrity b. Risk for fluid volume deficit c. Ineffective tissue perfusion d. Death anxiety

b - because the patient is bleeding

MODS

100

A common body response to shock is to switch from anaerobic to aerobic metabolism True False

false

200

Place in order the progression of MODS as it effects the organ systems a. renal b. cardiac c. respiratory d. hepatic

c, b, a, d

300

The most appropriate type of fluid replacement for a patient in hypovolemic shock as a result of sepsis is which of the following: a. 0.45% NS b. 0.9% NS c. 0.9% NSD5W d. D5W

b also RL

400

Which of the following lab values would be elevated in a patient with MODS? (Check all that apply) a. glucose b. BUN/Cre c. H/H d. Platelets e. Lactic acid f. Bicarb (HCO3) g. WBC

a, b, e, g

500

The most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in the patient with MODS are: a. BP, Pulse, respirations b. LOC, UO, temperature, skin color c. breath sounds, blood pressure, temperature d. pulse pressure, LOC, and pupillary response

b