Gig EM
A nurse is caring for a client with decompensated cirrhosis and hepatic encephalopathy who has been prescribed lactulose. Which finding best indicates that the medication is achieving its therapeutic effect?
A. Decreased abdominal girth
B. Increased serum albumin level
C. Improved level of consciousness
D. Decreased serum bilirubin level
C. Lactulose decreases the absorption/production of ammonia in the intestine. A therapeutic response is improved mental status/level of consciousness as hepatic encephalopathy improves.
A nurse is caring for a client with a perforated peptic ulcer. Which assessment finding requires the most immediate intervention?
A. Nausea and vomiting
B. Rigid, board-like abdomen
C. Decreased appetite for 2 days
D. Mild abdominal distention
B. A perforated ulcer can cause peritonitis when GI contents enter the peritoneal cavity. Sudden severe abdominal pain with a rigid, board-like abdomen is a classic serious finding and requires immediate intervention.
A nurse is caring for a client with fluid volume deficit. Which finding would the nurse expect?
A. Crackles in the lungs
B. Bounding peripheral pulses
C. Increased urine specific gravity
D. Distended neck veins
C. With fluid volume deficit, the kidneys conserve water, resulting in more concentrated urine and increased urine specific gravity. Other expected findings include dry mucous membranes, orthostatic dizziness, weakness, and decreased urine output.
A client with hepatic encephalopathy is prescribed rifaximin. Which explanation by the nurse is most appropriate?
A. “It increases your liver's ability to remove ammonia from the blood.”
B. “It decreases the intestinal bacteria that produce ammonia.”
C. “It increases bile production to improve liver function.”
D. “It causes your kidneys to excrete more ammonia.”
B. Rifaximin is a poorly absorbed antibiotic that reduces intestinal bacteria that produce ammonia, helping decrease ammonia levels and improve hepatic encephalopathy.
A client with an upper GI bleed has a blood pressure of 88/52 mm Hg, heart rate of 124/min, and cool, clammy skin. Which finding is most concerning to the nurse?
A. Melena
B. Hematemesis
C. Tachycardia with hypotension
D. Mild abdominal discomfort
C. Tachycardia with hypotension indicates significant hemodynamic compromise from blood loss and possible hypovolemic shock. This is more immediately concerning than the presence of melena or hematemesis alone.
A nurse is assessing a client who has developed a 6-mm ureteral calculus. Which pathophysiologic change should the nurse expect?
A. Decreased intrarenal pressure caused by increased urine flow
B. Increased intrarenal pressure and ureteral spasm
C. Decreased renal blood flow caused by hypoproteinemia
D. Increased glomerular filtration caused by urinary obstruction
B. A 6-mm ureteral calculus can obstruct urine flow, causing increased intrarenal pressure and ureteral spasm, which contributes to the severe renal colic associated with kidney stones.
A nurse is teaching a client about factors that increase the risk for renal calculi (kidney stones). Which factors should the nurse include? Select all that apply.
A. Dehydration
B. High-protein diet
C. Obesity
D. High sodium intake
E. Increased fluid intake
F. Family or personal history of kidney stones
A client with a history of esophageal varices is receiving octreotide for an acute GI bleed. Which assessment finding is the most important for the nurse to monitor?
A. Continued evidence of bleeding
B. Increased appetite
C. Decreased abdominal girth
D. Increased urine specific gravity
A. Octreotide reduces GI blood flow and helps control variceal/GI bleeding. The nurse should closely monitor for continued bleeding, along with hemodynamic status and hemoglobin/hematocrit.
A nurse is reviewing the laboratory results of a client with chronic kidney disease. Which laboratory value most directly reflects the client's kidney filtration function?
A. Serum sodium
B. Serum albumin
C. eGFR
D. Hemoglobin
C. eGFR (estimated glomerular filtration rate) is used to assess kidney filtration/function. As kidney disease progresses, the eGFR decreases.
A nurse is assessing a client with acute glomerulonephritis. Which assessment finding should the nurse expect?
A. Hematuria and proteinuria
B. Increased GFR and polyuria
C. Severe hypercalcemia
D. Increased erythropoietin production
A. Acute glomerulonephritis commonly causes hematuria and proteinuria because inflammation increases the permeability of the glomerular membrane. Other findings can include edema, hypertension, oliguria, azotemia, and decreased GFR
A client with cirrhosis suddenly begins vomiting a large amount of bright-red blood. The client is pale, restless, and has a blood pressure of 82/48 mm Hg and a heart rate of 128/min. Which action should the nurse take first?
A. Administer lactulose
B. Obtain the client's daily weight
C. Assess the client's abdominal girth
D. Initiate measures to manage hypovolemic shock
D. The client is showing signs of acute upper GI/variceal hemorrhage with hypovolemic shock: massive hematemesis, hypotension, tachycardia, pallor, and restlessness. The priority is to stabilize circulation and manage hypovolemia/shock.
A client with esophageal varices is prescribed propranolol. Which therapeutic effect should the nurse expect?
A. Increased hepatic blood flow
B. Increased intestinal ammonia production
C. Decreased portal pressure
D. Increased clotting factor production
C. Propranolol is a nonselective beta blocker used in clients with esophageal varices to reduce portal pressure, decreasing the risk of variceal hemorrhage.
A client with end-stage renal disease is prescribed sevelamer. Which statement best describes the purpose of this medication?
A. It increases calcium absorption from the intestine.
B. It stimulates erythropoietin production.
C. It binds phosphate in the gastrointestinal tract and decreases phosphate absorption.
D. It increases potassium excretion through the kidneys.
C. Sevelamer is a calcium-free phosphate binder. It binds phosphate in the GI tract, reducing phosphate absorption and helping manage hyperphosphatemia in clients with end-stage renal disease.
A nurse is caring for a client with ascites related to decompensated cirrhosis. Which interventions should the nurse anticipate? Select all that apply.
A. Monitor daily weights
B. Encourage a high-sodium diet
C. Measure abdominal girth
D. Administer spironolactone as prescribed
E. Monitor intake and output
F. Administer lactulose specifically to remove excess abdominal fluid
A,C,D,E
For ascites, the nurse should:
A client with chronic renal failure is prescribed calcitriol. Which laboratory value is most important for the nurse to monitor?
A. Calcium
B. Sodium
C. Chloride
D. Hemoglobin
A. Calcitriol is a vitamin D analog used in chronic renal disease to help increase calcium levels. The nurse should monitor serum calcium because calcitriol can cause hypercalcemia.
A nurse is caring for a client with chronic renal failure. Which findings should the nurse expect? Select all that apply.
A. Hyperkalemia
B. Increased erythropoietin production
C. Metabolic acidosis
D. Hypocalcemia
E. Hyperphosphatemia
F. Increased ability to excrete excess fluid
A client with chronic renal failure has several laboratory results. Which finding should the nurse recognize as the priority?
A. Hemoglobin 9.2 g/dL
B. Phosphorus 5.8 mg/dL
C. Calcium 8.4 mg/dL
D. Potassium 6.3 mEq/L
D. A potassium level of 6.3 mEq/L indicates significant hyperkalemia, which is a priority because elevated potassium can cause life-threatening cardiac dysrhythmias. Chronic renal failure decreases the kidneys’ ability to excrete potassium.
A nurse is caring for a client with decompensated cirrhosis and ascites. Which assessment finding requires the most immediate follow-up?
A. Abdominal distention
B. Bilateral peripheral edema
C. New-onset confusion and disorientation
D. Increased abdominal girth
C. New-onset confusion and disorientation can indicate worsening hepatic encephalopathy, which is a priority because it can progress to decreased consciousness and coma. The nurse should assess neurologic status and protect the client from injury.
A client with cirrhosis is receiving tacrolimus following a liver transplant. Which finding should the nurse recognize as a potential adverse effect requiring monitoring?
A. Hypokalemia
B. Nephrotoxicity
C. Severe hypoglycemia
D. Increased immune system activity
B. Tacrolimus is an immunosuppressant used to prevent liver transplant rejection. A major adverse effect is nephrotoxicity, so renal function should be monitored. Other possible adverse effects include tremors/neurotoxicity, hyperglycemia, hyperkalemia, and infection risk.
A client with cirrhosis and esophageal varices suddenly develops massive hematemesis. Which assessment finding indicates the client is developing hypovolemic shock?
A. Blood pressure 84/50 mm Hg and heart rate 132/min
B. Abdominal girth increased by 2 cm
C. Mild nausea and epigastric discomfort
D. Ammonia level is elevated
A. A blood pressure of 84/50 mm Hg with a heart rate of 132/min indicates significant blood loss and hypovolemic shock. This requires immediate intervention to support circulation and control the hemorrhage.
A nurse is assessing a client with acute pyelonephritis. Which finding is most characteristic of this condition?
A. Painless hematuria without systemic symptoms
B. Severe suprapubic pressure without fever
C. Fever, chills, and costovertebral angle tenderness
D. Urinary retention with a weak urinary stream
C. Acute pyelonephritis is an upper urinary tract infection involving the kidney. Expected findings include fever, chills, malaise, and costovertebral angle (CVA) tenderness/back pain.
A nurse is assessing a client with hepatic encephalopathy. Which findings are consistent with this condition? Select all that apply.
A. Asterixis
B. Fetor hepaticus
C. Improved level of consciousness
D. Inappropriate behavior or altered mental status
E. Progression to decreased consciousness or coma
F. Increased urine output
A,B,D,E
Hepatic encephalopathy results from accumulation of toxins such as ammonia and can cause:
A nurse is assessing a client with chronic renal failure. Which complications should the nurse expect? Select all that apply.
A. Hyperkalemia
B. Anemia
C. Metabolic acidosis
D. Hypophosphatemia
E. Fluid volume overload
F. Increased erythropoietin production
A,B,C,E
Chronic renal failure can cause:
A nurse is teaching a client with chronic renal failure about dietary management. Which instructions should the nurse include? Select all that apply.
A. Limit phosphorus intake
B. Consume adequate calories
C. Limit potassium as prescribed
D. Eliminate all dietary protein
E. Follow fluid restrictions if prescribed
F. Increase phosphorus intake to prevent hypophosphatemia
A,B,C,E
The renal diet should include:
A nurse is assessing a client with acute pyelonephritis. Which findings should the nurse expect? Select all that apply.
A. Costovertebral angle tenderness
B. Fever and chills
C. Dysuria and urinary frequency
D. Elevated white blood cell count
E. Painless hematuria as the only symptom
F. Cloudy or foul-smelling urine