Adult Health Chapter 67 and 68 Evolve Questions with some power point info Flashcards Preview

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Flashcards in Adult Health Chapter 67 and 68 Evolve Questions with some power point info Deck (43)
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1

What is the paraneoplastic syndrome that is common in clients with renal cell carcinoma?
1
Decreased serum calcium level
2
Hypotension
3
Decreased sedimentation rate
4
Erythrocytosis

Answer 4.
Erythrocytosis is a paraneoplastic syndrome common with renal cell carcinoma. It is caused by large amounts of erythropoietin secreted by tumor cells. Parathyroid hormone produced by the tumor cell increases the serum calcium level causing hypercalcemia. The increased level of renin causes hypertension rather than hypotension. Renal cell carcinoma is associated with an increased sedimentation rate.

2

The nurse is caring for a client with pyelonephritis. What does the nurse teach the client about preventing end-stage kidney disease?
1
Complete the drug therapy exactly as indicated.
2
Monitor blood glucose levels regularly.
3
Limit fluid intake to 1 L per day.
4
Increase protein intake in the diet

Answer 1.

The client must be taught the importance of completing antibiotics and other drug therapy exactly as prescribed. Clients have a tendency to discontinue drug therapy as soon as they feel better. This can result in a more resistant form of bacterial infection. Blood pressure (not glucose) levels should be monitored every day; blood pressure control is needed to slow the progression of kidney dysfunction. When kidney impairment decreases concentrating ability, the client is encouraged to drink at least 2 L of fluids every day. Dietary protein is usually restricted.

3

The nurse is caring for a client with acute pyelonephritis. Which indicator is used to determine adequate fluid intake?
A
Client reports no pain with urination
B
Urine dipstick negative for leukocytes
C
Pale yellow urine
D
Urine sample negative for bacteria

Answer C
The client with pyelonephritis is recommended to have fluid intake at 2 liters per day, sufficient to result in dilute pale yellow urine, unless there is a contraindication. Urinary antiseptic drugs may be used for comfort but is not an indication of adequate fluid intake. The presence of bacteria or leukocytes in the urine is not directly correlated to fluid intake.


Test-Taking Tip: Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action.

4

Which condition may predispose a client to chronic pyelonephritis?
1
Spinal cord injury
2
Cardiomyopathy
3
Hepatic failure
4
Glomerulonephritis

Answer 1
Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones. Weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection, but may not cause infection of the kidney.

5

When taking the health history of a client with acute glomerulonephritis, the nurse questions the client about which related cause of the problem?
1
Recent respiratory infection
2
Hypertension
3
Unexplained weight loss
4
Neoplastic disease

Answer 1- Recent respiratory infection

An infection often occurs before the kidney manifestations of acute glomerulonephritis (GN). The onset of symptoms is about 10 days from the time of infection. Hypertension is a result of glomerulonephritis, not a cause. Weight gain, not weight loss, is symptomatic of fluid retention in GN. Cancers are not part of the cause of GN.


Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.

6

The nurse is assessing a client for early signs of renal cell carcinoma (RCC). What finding does the nurse expect in this client?
1
Sharp intermittent flank pain
2
Renal bruit on auscultation
3
Gynecomastia
4
Bloody urine

Answer 2- Renal bruit on auscultation

The nurse notes renal bruit on auscultation in the client with RCC. The client often describes the pain in the flank as dull and aching. The pain is more intense if there is bleeding into the tumor or kidney. Gynecomastia and bloody urine are late stages of the disease.

7

After receiving change-of-shift report on the urology unit, which client does the nurse assess first?
1
Client post–radical nephrectomy whose temperature is 99.8° F (37.6° C)
2
Client with glomerulonephritis who has cola-colored urine
3
Client who was involved in a motor vehicle crash and has hematuria
4
Client with nephrotic syndrome who has gained 2 kg since yesterday

Answer 3- Client who was involved in a motor vehicle crash and has hematuria

The nurse should be aware of the risk for kidney trauma after a motor vehicle crash; this client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria because hemorrhage can be life-threatening. Although slightly elevated, the low-grade fever of the client who is post–radical nephrectomy is not life-threatening in the same way as a trauma victim with bleeding. Cola-colored urine is an expected finding in glomerulonephritis. Because of loss of albumin, fluid shifts and weight gain can be anticipated in a client with nephrotic syndrome.


Study Tip: Identify your problem areas that need attention. Do not waste time on restudying information you know.

8

The nurse anticipates that a client who develops hypotension and oliguria post-nephrectomy may need the addition of which element to the regimen?
1
Increase in analgesics
2
Addition of a corticosteroid
3
Administration of a diuretic
4
Course of antibiotic therapy

Answer 2- Addition of a corticosteroid

Loss of water and sodium occurs in clients with adrenal insufficiency, which is followed by hypotension and oliguria; corticosteroids may be needed. The nurse should use caution when administering analgesics to a hypotensive client; no indication suggests that pain is present in this client. A diuretic would further contribute to fluid loss and hypotension, potentially worsening kidney function. A few doses of antibiotics are used prophylactically preoperatively and postoperatively; additional therapy is used when evidence of infection exists.

9

What is the appropriate range of urine output for the client who has just undergone a nephrectomy?
1
23-30 mL/hr
2
30-50 mL/hr
3
41-60 mL/hr
4
50-70 mL/hr

Answer 2- 30-50 ml/hr

Urine output of 30-50 mL/hr or 0.5-1 mL/kg/hr is considered within acceptable range for the client who is post nephrectomy. Output of less than 25 to 30 mL/hr suggests decreased blood flow to the kidney and the onset or worsening of acute kidney injury. A large urine output, followed by hypotension and oliguria, is a sign of hemorrhage and adrenal insufficiency.

10

Which statement by a client with diabetic nephropathy indicates a need for further education about the disease?
1
"Diabetes is the leading cause of kidney failure."
2
"I need less insulin, so I am getting better."
3
"My blood sugar may drop really low at times."
4
"I must call my provider if the urine dipstick shows protein."

Answer 2- "I need less insulin, so I am getting better."

When kidney function is reduced, insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving. It is true that diabetes mellitus is the leading cause of end-stage kidney disease (ESKD) among Caucasians in the United States. Proteinuria, which may be mild, moderate, or severe, indicates a need for follow-up.


Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, “I know the material, and I'll do well on the test.” Try it; many students have found that it works because it reduces “test anxiety.”

11

The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor?
1
Hemoglobin and hematocrit (H&H)
2
White blood cell (WBC) count
3
Blood urea nitrogen (BUN) and creatinine
4
Lipid levels

Answer 3- BUN and creatinine

BUN and creatinine are kidney function tests. With back pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction; H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.


Study Tip: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.

12

A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve?
1
Decreases bacterial count
2
Destroys white blood cells
3
Enhances the action of antibiotics
4
Provides comfort

Answer 4- Provides Comfort

Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis. Antibiotics, not antiseptics, are used to decrease bacterial count and treat pyelonephritis infection; the action of antibiotics is not enhanced with antiseptics. White blood cells, along with antibiotics, fight infection.

13

During discharge teaching for a client with kidney disease, what does the nurse teach the client to do?
1
"Drink 2 liters of fluid and urinate at the same time every day."
2
"Eat breakfast and go to bed at the same time every day."
3
"Check your blood sugar and do a urine dipstick test."
4
"Weigh yourself and take your blood pressure."

Answer 4- "Weigh yourself and take your blood pressure."

Regular weight assessment monitors fluid restriction control, while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction. Fluid intake and urination, and breakfast time and bedtime, do not need to be at the same time each day. Clients with diabetes, not kidney disease, should regularly check their blood sugar and perform a urine dipstick test.

14

The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse?
1
Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min.
2
Urine output over the past hour was 80 mL.
3
Pain is at a level 4 (on a 0 to 10 scale).
4
Dressing has a 1-cm area of bleeding.

Answer 1- Blood pressure is 98/56 mmHg; heart rate is 118 beats/ min.

Bleeding is a complication of radical nephrectomy; tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. The surgeon should be notified immediately and fluids should be administered, complete blood count (CBC) should be checked, and blood administered, if necessary. A urine output of 80 mL can be considered normal. The nurse can administer pain medication, but must address hemodynamic instability and possible hemorrhage first. Administering pain medication to a client who has developed shock will exacerbate hypotension. A dressing with a 1-cm area of bleeding is expected postoperatively

15

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include?
1
Avoiding venipuncture and blood pressure measurements in the affected arm
2
Modifications to allow for complete rest of the affected arm
3
How to assess for a bruit in the affected arm
4
How to practice proper nutrition

Answer 1- Avoiding venipuncture and blood pressure measurements in the affected arm.

Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.



Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question.

16

When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next?
1
Check vital signs.
2
Notify the surgeon.
3
Continue to monitor.
4
Insert a nasogastric (NG) tube.

Answer-1- Check the vital signs

The client's abdomen may be distended from bleeding; hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred. The surgeon should be notified after vital signs are assessed. An NG tube is not indicated for this client.


Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night’s sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.

17

Which instruction does the nurse provide to a client with hypertension and diabetes to prevent or delay the onset of chronic kidney disease (CKD)?
1
Test for microalbuminuria every 6 months.
2
Adhere to all drug and diet regimens.
3
Take over-the-counter drugs after checking labels.
4
Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) if required.

Answer 2- Adhere to all drug and diet regimens

The client with hypertension and diabetes must strictly adhere to drug and diet regimens to prevent blood vessel changes that lead to kidney damage. These medications are not a cure but need to be taken along with changes in lifestyle. The client must test for microalbuminuria every year for early detection of the disease. The client must restrict the use of over-the-counter drugs or NSAIDs as they reduce blood flow to the kidney and their long-term use reduces kidney function.

18

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to the unlicensed assistive personnel (UAP)? Select all that apply.
A
Obtain the client’s predialysis weight.
B
Check the arteriovenous (AV) fistula for a thrill and bruit.
C
Document the amount the client drinks throughout the shift.
D
Auscultate the client’s lung sounds every 4 hours.
E
Explain the components of a low sodium diet.

Answer A and C- Obtain the client's predialysis weight and Document the amount the client drinks throughout the shift

Obtaining the client’s weight and documenting oral fluid intake are routine tasks that can be performed by a UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.


Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

19

A client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse? Record using a whole number. ___ drops/min

20 gtt × 500 mL = 10,000/60 min = 167 drops/min


Test-Taking Tip: When taking the NCLEX exam, an on-screen calculator will be available for you to determine your response, which you will then type in the provided space.

20

A client with chronic kidney disease (CKD) wants to undergo peritoneal dialysis. What are the advantages of peritoneal dialysis? Select all that apply.
1
It does not cause hyperlipidemia in clients.
2
It requires a shorter time for treatment than hemodialysis.
3
It is useful for clients who have had abdominal surgeries.
4
It provides better blood pressure control than hemodialysis.
5
It requires fewer dietary and fluid restrictions than hemodialysis.

Answer 4 and 5 - It provides better blood pressure control than hemodialysis. and It requires fewer dietary and fluid restrictions than hemodialysis

Peritoneal dialysis provides better blood pressure control than hemodialysis due to hemodynamic tolerance. It requires fewer dietary and fluid restrictions than hemodialysis because it is a simpler process that is less stressful on the body. Peritoneal dialysis causes hyperlipidemia because of the excessive glucose load. It requires a longer time for treatment than hemodialysis because of the time-consuming exchanges of wastes, fluids, and electrolytes. Clients who have undergone abdominal surgeries cannot have peritoneal dialysis, as the surface area of the peritoneal membrane is not sufficient for adequate dialysis exchange.

21

The nurse is caring for a client who underwent a nephrostomy tube insertion due to a urethral stricture. What assessment findings does the nurse report immediately to the health care provider? Select all that apply.
1
Increase in urinary output into the drainage bag
2
Red-tinged drainage into the collection bag
3
Foul-smelling drainage into the collection bag
4
Leakage of blood from the nephrostomy site
5
Leakage of urine from the nephrostomy site
6
Reports of back pain

Answer 3, 4, 5, 6- Foul-smelling drainage into the collection bag
Leakage of blood from the nephrostomy site
Leakage of urine from the nephrostomy site
Reports of back pain

After nephrostomy, the nurse should notify the provider immediately if there is foul-smelling urine because it can be a manifestation of infection. Any leakage of blood or urine is also reported immediately. Reports of back pain also need immediate attention because the tube may be blocked or dislodged. An increase in urine flow into the drainage bag is a good sign that kidney function is not being compromised due to the obstruction. Red-tinged drainage is common in the first few hours after nephrostomy. It gradually becomes clear and does not require critical rescue.


Test-Taking Tip: Calm yourself by closing your eyes, putting down your pencil (or computer mouse), and relaxing. Deep-breathe for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension.

22

The nurse instructor is teaching a group of nursing students about acute rejection of kidney transplantation. What statement made by the nurse instructor is accurate?
1
"Acute rejection manifests as pain at the transplant site."
2
"Acute rejection can occur within 48 hours after transplantation."
3
"A gradual increase in blood urea nitrogen (BUN) levels occurs as a result of acute rejection."
4
"Increased doses of immunosuppressive drugs are used to treat and manage acute rejection."

Answer 4- Increased doses of immunosuppressive drugs are used to treat and manage acute rejection."

Acute rejection of kidney transplantation is an immune reaction and is managed by increased doses of immunosuppressive drugs. Hyperacute rejection manifests as pain at the transplant site. Hyperacute rejection occurs within 48 hours after the surgery. Chronic rejection causes a gradual increase in BUN levels.

23

The RN is working with unlicensed assistive personnel (UAP) in caring for a group of clients. Which action is best for the RN to delegate to UAP?
1
Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria.
2
Assisting a client who had a radical nephrectomy 2 days ago to turn in bed.
3
Helping the provider with a kidney biopsy for a client admitted with acute glomerulonephritis.
4
Palpating for bladder distention on a client recently admitted with a ureteral stricture.

Answer 2- Assisting a client who had a radical nephrectomy 2 days ago to turn in bed

UAP would be working within legal guidelines when assisting a client to turn in bed. Although assessment of vital signs is within the scope of practice for UAP, the trauma victim should be assessed by the RN because interpretation of the vital signs is needed. Assisting with procedures such as kidney biopsy and assessment for bladder distention are responsibilities of the professional nurse that should not be delegated to staff members with a limited scope of education.


Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the “old” material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don’t wait until the middle to end of the semester to try to cram information.

24

At a health fair, the nurse is teaching attendees about acute kidney injury (AKI). What statement made by a participant indicates a need for further teaching?
1
"The onset of AKI is sudden."
2
"AKI involves 50% of nephrons."
3
"Duration of AKI is around 2-3 weeks."
4
"AKI affects every body system."

Answer 4- "AKI affects every body system"

Chronic kidney disease, not AKI, affects every body system. AKI affects some body systems. The onset of AKI is sudden and involves around 50% of nephrons. The duration of AKI is around 2-3 weeks and is usually less than 3 months.

25

The nurse is educating a group of individuals at the community center about methods to prevent kidney trauma. Which statement from a member of the group indicates that further teaching is required?
1
"I should quit the soccer team so I don't injure my kidneys."
2
"I should wear a seatbelt when riding in the car."
3
"It is important to wear protective gear when participating in kick-boxing."
4
"I need to use caution when riding a motorcycle."

Answer 1
"I should quit the soccer team so I don't injure my kidneys."
It is not necessary to quit sports, but it is recommended to not play contact sports or participate in high-risk activities such as kickboxing if the client has only one kidney. All individuals should wear a seatbelt, wear protective gear when participating in contact sports, and use caution when riding a bicycle or motorcycle.

26

Serum Creatinine

Monitor in renal disease: a waste product in your blood that comes from muscle activity. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises. Your doctor should use the results of your serum creatinine test to calculate your GFR.

27

Glomerular Filtration Rate (GFR):

tells how much kidney function you have. It may be estimated from your blood level of creatinine. If your GFR falls below 30 you will need to see a kidney disease specialist (called a nephrologist), Your kidney doctor will speak to you about treatments for kidney failure like dialysis or kidney transplant. A GFR below 15 indicates that you need to start one of these treatments.

28

BUN

normal waste product in your blood that comes from the breakdown of protein from the foods you eat and from your body metabolism. It is normally removed from your blood by your kidneys, but when kidney function slows down, the BUN level rises. BUN can also rise if you eat more protein, and it can fall if you eat less protein.

29

Urine Protein

When your kidneys are damaged, protein leaks into your urine. A simple test can be done to detect protein in your urine. Persistent protein in the urine is an early sign of chronic kidney disease.

30

Microalbuminuria

This is a sensitive test that can detect a small amount of protein in the urine.