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
What type of drug class is Milrinone and Dobutamine?
Positive inotropic drugs: increase contraction and cardiac output. Use for cardiogenic shock and heart failure.
Put these actions in to order using the steps of the Primary survey:
Perform the GSC
Open airway with a jaw thrust maneuver
Establish an IV
1. Open the airway (airway)
2. Establish IV (circulation)
3. Perform GCS (disability)
The nurse is providing education about nutrition to a client with CKD. Which of the following should the nurse include in the teaching? Select all that apply.
A. Limit protein, potassium, and phosphorus
B. Limit calcium
C. Limit calories
D. Eat foods high in sodium
A - Limit protein, potassium, phosphorus
Patients will need adequate calcium and calories (from carbs, mostly).
Patients will need to limit sodium
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 prior to administering?
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.
Which of the following actions help to prevent CLABSI?
a. Use friction when cleaning the access port before use
b. Use the clean technique when changing the dressing
c. Change the dressing as needed only
d. Perform hand hygiene for 10 seconds prior to changing the dressing.
a. Use friction when cleaning the access port before use (with iodine or alcohol swabs)
Use sterile technique when changing the dressings per facility policy. Hand hygiene should be between 15-30 sec.
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. clear, yellow outflow
B. fever
C. bradycardia
D. hyperactive bowel sounds
E. elevated BUN and Creatinine
B. fever indicates infection
The outflow may be purulent with peritonitis. Tachycardia would be expected with infection. Bowels would be hypoactive. We would already expect the pt to have elevated BUN and Creatinine.
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
Remember! IV Fluids with NS is the PRIORITY treatment and should be carried out first!
Which common potassium-channel blocker antidysrhythmic drug has the complications/side effects of pulmonary toxicity and Liver/Thyroid dysfunction?
Amiodarone- used for tachyarrhythmias like afib and V Tach
Which of the following would be clients in a MCI (mass casualty incident) would be tagged as black, or lowest priority?
a. Pneumothorax
b. Closed upper extremity fracture with cap refill <3 sec
c. Full thickness burns to 80% of body
c. Full thickness burns to 80% of the body
Pneumothorax would be red. Closed upper extremity fracture with normal cap refill would be green.
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 46
PO2 92
HCO3 29
Metabolic Alkalosis (partially compensated)
metabolic alkalosis presents with pH > 7.45 and HCO3 > 26. Vomiting can lead to this condition.
A nurse is caring for a patient with a glucose level of 60 mg/dL. Which of the following findings should the nurse expect?
A. Polyuria
B. Fruity breath
C. Tachycardia
D. Dry skin
C is correct
Polyuria and fruity breath is a symptom of hyperglycemia (not hypoglycemia). Skin would be diaphoretic, not dry.
Which of the following nursing interventions will help to reduce increased ICP?
a. Encourage turn, cough, deep breath
b. Administer Mannitol
c. Encourage multiple family members to visit
d. Suction the airway hourly
b. Administer Mannitol
A patient needs to receive 2600 mL of fluids in 24 hours as a part of fluid resuscitation for severe burns. She is to receive 1/2 the amount in the first 8 hours. The remaining amount will be infused over 16 hours. Calculate the rate for the infusion for the first 8 hours and remaining 16 hours. round to whole number.
first 8: 163 mL/hr
next 16: 81 mL/hr
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/cerebral edema , the nurse would hang fluids with Dextrose.
Which of the following findings indicates a stroke in the LEFT hemisphere?
a. Impulsiveness
b. Poor judgement
c. Deficits in the right visual field
d. Loss of sense of humor
c. visual deficits in the right visual field
A nurse caring for a patient is delegating tasks to assistive personnel (AP). Which of the following tasks should the nurse delegate to the AP?
A. Record the meal intake
B. Irrigate a pressure ulcer
C. Obtain vitals after the paracentesis
D. Teach about abstaining from alcohol
A. record meal intake