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Med Surg 2 > Practice Questions > Flashcards

Practice Questions Flashcards

1
Q

blood at the meatus with high riding prostate

A

urethral injury

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2
Q

fracture of the lower ribs

A

injuries to spleen and liver

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3
Q

left shoulder pain

A

kehrs sign

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4
Q

ecchymosis over flank

A

renal trauma

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5
Q

pelvic fracture

A

intra abdominal or bladder injuries

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6
Q

reliable indicator of renal performance not influenced by GI bleeding

A

creatinine

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7
Q

mortality rate from acute renal failure in the critically ill patient ranges between

A

40-80%

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8
Q

most common form of acute renal failure

A

prenreal

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9
Q

Please select the statement regarding creatinine that is TRUE:

A

By-product of muscle metabolism that reflects renal damage because it is almost exclusively excreted by renal tubules.

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10
Q

Prevention strategies for acute renal failure include:

A

Avoid nonsteroidal antiinflammatory drugs (NSAIDs) for pain relief in patients taking antibiotics or recovering from major surgery.
Delay use of intravascular x-ray contrast medium until the patient is rehydrated

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11
Q

Renal diet limits or restricts:

A

Potassium
Sodium
Phosphorus
Protein

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12
Q

Manifestations of chronic failure include. SELECT ALL THAT APPLY

A

Hypertension, heart failure and edema (altered sodium and water balance)
Uremia, pericarditis, skin disorders, neurologic dysfunction (decreased elilmination of nitrogenous wastes)
Metabolic acidosis

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13
Q

Causes of acute tubular necrosis include: SELECT ALL THAT APPLY

A

Nephrotoxic medications such as aminoglyocides, cephalosporins, antineoplastic agents, and analgesics with phenacetin
Heavy metal: lead, arsenic, mecury, uranium

Radiocontrast material
Severe prolonged hypotension from any cause
Sepsis

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14
Q

Initiating phase lasts from hours to days. If treatment is initiated during this time, irreversible damage can be alleviated.

A

onset phase

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15
Q

Lasts 5-16 days with necrotic cellular debris blocking flow of urine and damage to tubular wall

A

oliguric/anuric phase

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16
Q

Lasts 7-14 days and is characterized by an increase in GFR and sometimes polyuria

A

diuretic phase

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17
Q

Convalescent phase with increase in urine output; BUN and creatinine return to normal slowly or not at all

A

recovery phase

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18
Q

SELECT ALL OF THE CORRECT ANSWERS regarding phosphorus managment in acute or chronic renal failure.

A

Hyperphosphatemia in renal failure causes pruritis.
Nursing care includes administering phosphate binding medication with meals
Phosphorus occurs in many foods and unless eliminated will pass from the GI tract into the bloodstream
Hypocalcemia in renal failure results from multiple factors including hyperphosphatemia.

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19
Q

Select the correct statement about gastric mucosa:

A

Disruption of gastric mucosa resistance with increased acid production and decreased mucosal blood flow occurs in critical illness

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20
Q

Clinical manifestations of Class one hemorrhage (<15% blood loss) include:

A

Orthostatic hypotension and apprehensio

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21
Q

Two most common causes of acute pancreatitis are biliary disease such as gallstones and alcoholism.

A

true

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22
Q

lab value for pancreatitis

A

hyperglycemia

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23
Q

Complications of acute pancreatitis include

A

Hypoxemia and ARDS
Hypotension
Acute tubular necrosis

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24
Q

The patient’s hemoglobin and hematocrit is a reliable indicators of the severity or rapidity of blood loss.

A

false

25
Q

Please SELECT ALL CORRECT medical interventions for FHF:

A

Neomycin reduces bacterial flora of colon which aids in decreasing ammonia formation by the colon and decreases bacterial action on protein in the feces

Lactulose creates an acidic environment that decreases bacterial growth
Lactulose traps ammonia and has a laxative effect that promotes expulsion.

26
Q

You are caring for a patient with acute renal failure. What is the most common clinical manifestation of acute renal failure?

A

oliguria

27
Q

The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with ESRD. The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. What is an important instruction that the nurse should give the patient about how to take the prescribed phosphorus-binding medication?

A

with each meal
- calcium acetate

28
Q

A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based upon this GFR, the nurse interprets that the patient’s chronic kidney disease is at what stage?

A

stage 3
- Stage 1 is defined by a GFR ≥ 90 mL/min/1.73 m2. Stage 2 is defined by a GFR of 60–89 mL/min/1.73 m2. Stage 4 is a GFR in the range of 15–29 mL/min/1.73 m2. Stage 5 is a GFR > 15 mL/min/1.73 m2.

29
Q

A patient admitted with nephrotic syndrome is being cared for on your unit. When writing this patient’s care plan, based upon the major clinical manifestation of nephrotic syndrome, what nursing diagnosis would you include?

A

excess fluid volume related to generalized edema

30
Q

The nurse coming on shift is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing end-stage renal disease (ESRD)?

A

Diabetes mellitus with poorly controlled hypertension

31
Q

A living organ donor is 1 hour postoperative after donating a kidney. The critical care nurse caring for the patient notes that the patient is clammy and pale. The nurse knows the patient is exhibiting symptoms of what?

A

shock

32
Q

A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?

A

Preprocedure hydration and administration of acetylcysteine

33
Q

The nurse caring for a patient with acute glomerulonephritis would expect the patient’s urine to what?

A

cola

34
Q

A patient is admitted to the intensive care unit after a motor vehicle accident. On the second day of the hospital admission, the patient develops acute renal failure. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patient’s hypervolemia and hyperkalemia. Which of the following therapies will the patient’s hemodynamic status best tolerate?

A

Continuous venovenous hemodialysis (CVVHD)

35
Q

A specific disease process is a major cause of CKD and ESRD. It is a disease that develops usually after prolonged hypertension and diabetes. What disease process is this?

A

Nephrosclerosis

36
Q

A 16-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. What is a cause of postinfectious glomerular disease?

A

Group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks

37
Q

Body’s response to stress is profound and includes:

A

hyperglycemia

38
Q

Name that endocrine condition: develops rapidly, diaphoresis, mental confusion,

A

hypoglycemia

39
Q

Name that endocrine condition: very high urine output with low specific gravity, insufficient or hypofunction of antidiuretic hormone (ADH)

A

DI

40
Q

Name that endocrine condition: slow/subtle onset, mental confusion, dilutional hyponatremia, excess antidiuretic hormone, low serum osmolarity

A

SIADH

41
Q

A patient arrives with multiple gunshot wounds to the abdomen. The surgeon will remain in OR until all major and minor bleeding is controlled and all injuries are identified.

A

false

42
Q

SIRS is present when two or more of the following clinical manifestations are present: RR high, WBC high or low, heart rate>90, and temp high or low. The manifestations are a deviation from baseline and not related to treatment such as chemo.

A

true

43
Q

Highest level of cervical spine cord injury patient with ability to feed himself.

A

C7

44
Q

The orthopedic nurse is aware that traumatic dislocations are treated as orthopedic emergencies due to the risk of diminished blood supply and subsequent tissue death. Tissue death due to anoxia and diminished blood supply is referred to as:

A

avascular necrosis

45
Q

Name that shock: Jugular vein distension, low mean arterial pressure, paradoxical pulse, narrow pulse pressure, muffled heart sounds.

A

obstructive

46
Q

Name that shock: deviated trachea, decreased or absent BS, hyperresonce to percussion, dyspnea

A

obstructive

47
Q

Name that shock: sudden hypotension, bronchospasm, tightness in chest, recent administration of contrast, medication, or unmatched blood.

A

distributive

48
Q

Name that shock: Low mean arterial pressure, narrow pulse pressure, rales at bases, S3 heart sound, dyspnea, elevated neck veins

A

cardiogenic

49
Q

Name that shock: cool clammy skin, tachycardia, tachypnea, absence of distended neck veins, clear BBS, decreased urine output.

A

hypovolemic

50
Q

Name that shock: Warm flushed skin, tachycardia, respiratory alkalosis, slight confusion, and a tube in any orifice or vessel

A

distrubitve

51
Q

It is essential for the nurse caring for a patient to understand the pathophysiology behind shock. Which of the following statements best describes the pathophysiologic rationale for shock?

A

Cells lack an adequate blood supply and are deprived of oxygen and nutrients

52
Q

The nurse recognizes that antidiuretic hormone (ADH) plays a role during hypovolemic shock. What assessment finding will the nurse likely observe related to the role of ADH during hypovolemic shock?

A

increased thirst

53
Q

The nurse has completed a set of vital signs on a patient at risk for shock. Which assessment finding is a potential sign of shock?

A

shallow, rapid respiraitons

54
Q

A patient is receiving Dopamine, a vasoactive drug, to increase stroke volume for shock. The nurse should be aware of which of the following when monitoring a vasoactive drug?

A

The drug dose whould be weaned prior to discontinuation.

55
Q

A nurse assessing a patient for symptoms of neurogenic shock following a spinal cord injury should monitor the patient for symptoms of:

A

bradycardia

56
Q

Shock is best described as a condition in which systemic blood pressure is inadequate to deliver oxygen to the tissues. The nurse knows that without prompt intervention any type of shock will eventually result in:

A

Anaerobic metabolism and cellular death

57
Q

The nurse knows that patients who are in shock have special nutritional needs; these special nutritional needs are directl related to the:

A

Release of catecholamines that creates an increase in metabolic rate and caloric requirements.

58
Q
A

Med Surg 2 (32 decks)

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