Dialysis/Kidney Probs
A nurse is assessing the AV fistula of a client who is receiving hemodialysis. Which of the following findings indicates that the fistula is functioning properly?
A. absence of bruit over the site
B. presence of a palpable thrill over the site
C. cool skin temp at the site
D. redness and ecchymosis at the site
B. a presence of a palpable thrill and an auditory bruit indicates proper functioning. Also, an absence of warmth, bruising, bleeding, and drainage are also good indicators.
What is the correct positioning for a patient undergoing a thoracentesis?
A. Sitting upright leaning forward over a table
B. Side-lying affected side down
C. Prone
D. High Fowlers with knees to chest
A. Sitting upright leaning forward over a table
This helps the fluid drain easier, while leaning forward separates the ribs for easier insertion of the needle
A young women with type 1 DM is brought to the ED with N/V, excessive thirst, deep, rapid respirations, and fatigue. What other assessment finding would the nurse expect?
A. Hypoglycemia
B. Ketones present in urine
C. pH 7.45
D. BUN and Creatinine low
B. the presence of ketones is expected in DKA
A nurse is caring for a client undergoing chemotherapy who is neutropenic. Which of the following actions should the nurse take?
A. Allow fresh flowers in the room
B. Offer fresh fruits as part of the diet
C. Monitor the clients temperature frequently
D. Allow multiple visitors with children often
C. check temp to detect infection early.
All other options would put client at risk for infection
A nurse is planning care for a client who has cirrhosis of the liver. Which of the following actions should the nurse include in the plan of care?
A. Administer anticoagulants
B. Administer lasix
C. Encourage heavy weightlifting
D. Increase dietary sodium
B. Administer Lasix
The nurse is providing education to about preventing CKD to a group of clients. Which of the following should the nurse include in the teaching? Select all that apply.
A. Limit NSAIDS
B. Daily weights
C. Control hypertension and blood glucose levels
D. Eat foods high in potassium and sodium
A, B, C are correct
Food high in potassium and sodium can make potential kidney problems worse.
A client has the following ABG results: pH 7.31; CO2 50; HCO3 25. Which of the following interpretations are correct?
A. Metabolic acidosis, uncompensated
B. Respiratory acidosis, uncompensated
C. Respiratory alkalosis, partially compensated
D. Metabolic alkalosis, fully compensated
B. Respiratory acidosis, uncompensated
A nurse is caring for a pt with in DKA who has an order for IV Regular insulin. What lab should the nurse monitor closely?
A. sodium
B. calcium
c. magnesium
d. potassium
D. Potassium
Because insulin will be given as part of the treatment, potassium must be monitored because insulin moves potassium into the cells and the pt will be at risk for hypokalemia
A nurse is caring for a client receiving a blood product transfusion. What type of fluid should the nurse use to prime the tubing?
Normal saline
Always! Nothing else can mix with blood transfusion.
What meal choice would be best for a patient with cirrhosis and hepatic encephalopathy?
A. Hamburger with tomato and a beer
B. Breaded fish sandwich and fries
C. Veggies and white rice
D. Steak and shrimp
A! Just kidding.... no beer for these guys :)
C. this is low sodium and low protein. Also, small frequent meals are ideal.
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis?
A. distended abdomen
B. fever and nausea
C. bradycardia
D. hyperactive bowel sounds
B. fever indicates infection
The abdomen could be rigid and board-like with peritonitis. Tachycardia would be expected with infection. Bowels would be hypoactive.
The nurse is providing care to a pt who has recently diagnosed with ARDS. Vitals are: BP 80/40; O2 75%; 26 RR; HR 120 bpm. What order from the provider would the nurse expect to see?
A. 0.9% NS bolus
B. Obtain ABG
C. Place a foley
D. Mechanical ventilation
D. Mechanical ventilation
Which of the following are treatments for DKA? Select all that apply.
A. Glucocorticosteriods
B. Metformin
C. Regular insulin
D. Normal Saline
E. Potassium replacement
C, D, E, are correct
A nurse is caring for a neutropenic and considers putting them in protective isolation. What absolute neutrophil count is of highest concern?
A. 800
B. >800
C. 500
D. < 400
D. less than 400 indicates the pt is neutropenic and immunocompromised.
A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications of this condition?
A. Increased albumin levels
B. Ascites
C. Splenomegaly
D. Esophageal varies
E. Fluid volume deficit
B, C, D
Clients with portal htn may have decreased albumin and fluid volume overload
A nurse is teaching a client about self-administered peritoneal dialysis. Which of the following statements is correct?
A. You may warm the fluid but do not microwave the dialysate fluid prior to administration.
B. You don't have to worry about infection as long as you use sterile technique
C. The outflow fluid is going to be foul smelling and dark
D. You will put in more fluid than you will get out
A. You may warm the fluid but do not microwave the dialysate fluid prior to administration.
A 19 year old pt presents with persistent vomiting and electrolyte imbalances. What is the imbalance base of these ABG results?
pH: 7.5
PaCO2 36
PO2 92
HCO3 29
Metabolic Alkalosis
metabolic alkalosis presents with pH > 7.45 and HCO3 > 26. Vomiting can lead to this condition.
A nurse is caring for a patient in DKA. Which of the following physical assessment findings would the nurse expect?
A. RR of 10 breaths/min
B. Fruity breath
C. Decreased urine output
D. Hypotension
B is correct
RR would be elevated. Urine output would be increased. Hypotension could be present but not a primary symptom.
What nursing intervention helps to prevent Tumor Lysis Syndrome?
A. Encourage/Administer fluids
B. Increase dietary protein intake
C. Administer antibiotics
D. Encourage early mobility
A. Encourage / administer fluids
A patient with cirrhosis of the liver is being discharged with lactulose prescribed 2x daily (BID). Which statement indicates a correct understanding of the med?
A. This med will help lower BP
B. This med helps to absorb protein
C. This med will help to remove ammonia
D. This med will reduce fluid in the abdomen
B. Lactulose excretes ammonia through the stool
Which of the following labs will be elevated in clients with CKD? Select all that apply
A. Creatinine
B. BUN
C. Potassium
D. Calcium
E. pH level
A, B, C are correct.
Usually clients with CKD have low pH levels (acidosis) and hypocalcemia
A nurse is drawing an ABG sample from the radial artery. What is the priority assessment before obtaining the ABG?
A. Blood pressure
B. Pulse ox
C. Apical pulse for one minute
D. Allen's test
D. Allen's test
This ensures good collateral circulation of the ulnar artery prior to puncturing the radial artery
The nurse is caring for a pt in DKA on an insulin gtt. The blood glucose level is now 200. What fluid choice should the nurse expect to give?
D5W
To prevent hypoglycemia, the nurse would hang fluids with Dextrose.
Which of the following are part of the CAUTION warning signs of cancer? Select all that apply.
A. A change in bowel or bladder habits
B. Sudden weigh gain
C. A sore that doesn't heal
D. A new lump or thickening of tissue
A, C, D
Usually sudden weight loss is a sign
A nurse caring for a liver patient is delegating tasks to assistive personnel (AP). Which of the following tasks should the nurse delegate to the AP?
A. Record the urine output
B. Irrigate a pressure ulcer
C. Obtain vitals after the paracentesis
D. Teach about abstaining from alcohol
A. record urine output