STUDY FOR FINAL LIVER AND URINARY

Question 1

1. The nurse anticipates the preferred treatment for a patient with acute hepatitis A infection will include

a. interferon.

b. supportive care.

c. hepatitis A vaccine.

d. direct-acting antivirals.

Answer 1

b. supportive care.

Question 2

2. A person needs postexposure prophylaxis for hepatitis B with hepatitis B immune globulin (HBIG). When should HBIG be given after exposure?

a. Within 24 hours

b. Between 1 and 2 weeks

c. At 1 month and 6 months

d. At 1 month, 4 months, and 6 months

Answer 2

a. Within 24 hours

Question 3

3. A patient with late-stage cirrhosis develops portal hypertension. Which complications can develop from this condition? (select all that apply)

a. Ascites

b. Esophageal varices

c. Decreased bilirubin

d. Decreased spleen size

e. Increased albumin levels

Answer 3

a. Ascites

b. Esophageal varices

Question 4

4. A patient with cancer that has metastasized to the liver has symptoms of fluid retention, including edema and ascites. To determine the effectiveness of diuretic therapy on ascites, what should the nurse assess?

a. Bowel sounds

b. Abdominal girth

c. Recent blood work

d. Mucous membranes

Answer 4

b. Abdominal girth

Question 5

5. Which intervention would the nurse expect for a patient admitted with acute pancreatitis?

a. Keep the patient NPO

b. Abdominal paracentesis

c. Start enteral feedings to prevent malnutrition

d. Administer acetaminophen every 4 hours for pain relief

Answer 5

a. Keep the patient NPO

Question 6

6. The patient diagnosed with pancreatic cancer underwent a Whipple procedure 2 days ago. Which clinical problem has the highest priority?

a. Anticipatory grieving

b. Fluid volume imbalance

c. Impaired tissue integrity

d. Nutritionally compromised

Answer 6

b. Fluid volume imbalance

Question 6

7. Which finding can indicate gallstones and gallbladder obstruction?

a. Dark colored stools

b. Pain in the left lower abdomen

c. Referred pain to the right shoulder

d. Improved symptoms with high-fat meals

Answer 6

c. Referred pain to the right shoulder

Question 7

8. Discharge teaching for the patient who underwent laparoscopic cholecystectomy should include the need to

a. abstain from alcohol.

b. avoid eating low-fat meals.

c. obtain hepatitis A vaccine.

d. call if there are changes in stool or urine color.

Answer 7

d. call if there are changes in stool or urine color.

Question 8

2. A patient with kidney disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of

a. tubular secretion.

b. glomerular filtration.

c. capillary permeability.

d. concentration of filtrate.

Answer 8

b. glomerular filtration.

Question 8

1. A renal stone in the pelvis of the kidney will change the patient’s kidney function by interfering with the

a. structural support of the kidney.

b. regulation of the concentration of urine.

c. entry and exit of blood vessels at the kidney.

d. collection and drainage of urine from the kidney.

Answer 8

d. collection and drainage of urine from the kidney.

Question 9

3. The nurse identifies a risk for urinary stones in a patient who relates a health history that includes

a. dehydration.

b. hyperaldosteronism.

c. serotonin deficiency.

d. adrenal insufficiency.

Answer 9

a. dehydration.

Question 9

4. Diminished ability to concentrate urine, associated with aging of the urinary system, is due to

a. a decrease in bladder sensory receptors.

b. a decrease in the number of functioning nephrons.

c. decreased function of the loop of Henle and tubules.

d. thickening of the basement membrane of Bowman capsule.

Answer 9

c. decreased function of the loop of Henle and tubules.

Question 10

5. During physical assessment of the urinary system, the nurse

a. performs fist percussion to detect tenderness in the flank area.

b. expects a dull percussion sound when 100 mL of urine is present in the bladder.

c. percusses above the symphysis pubis to determine the level of urine in the bladder.

d. palpates the lower pole of the right kidney as a smooth mass that descends on expiration.

Answer 10

a. performs fist percussion to detect tenderness in the flank area.

Question 11

7. A diagnostic study that evaluates renal blood flow, glomerular filtration, tubular function, and excretion is a(n)

a. IVP.

b. VCUG.

c. renal scan.

d. loopogram.

Answer 11

c. renal scan.

Question 11

6. Normal findings expected on physical assessment of the urinary system include (select all that apply)

a. nonpalpable bladder.

b. nonpalpable left kidney.

c. auscultation of renal artery bruit.

d. no CVA tenderness elicited by a kidney punch.

e. full bladder percusses as dullness above the symphysis pubis.

Answer 11

a. nonpalpable bladder.

b. nonpalpable left kidney.

d. no CVA tenderness elicited by a kidney punch.

e. full bladder percusses as dullness above the symphysis pubis.

Question 12

8. On reading the urinalysis results of a dehydrated patient, the nurse would expect to find

a. a pH of 8.4.

b. RBCs of 4/hpf.

c. color: yellow, cloudy.

d. specific gravity of 1.035.

Answer 12

d. specific gravity of 1.035.

Question 13

1. The nurse teaches the female patient who has frequent UTIs to

a. take tub baths with bubble bath.

b. void before and after sexual intercourse.

c. take prophylactic sulfonamides for the rest of her life.

d. restrict fluid intake to prevent the need for frequent voiding.

Answer 13

b. void before and after sexual intercourse.

Question 13

2. One of the most important nursing roles in relation to acute poststreptococcal glomerulonephritis (APSGN) is to

a. promote early diagnosis and treatment of sore throats and skin lesions.

b. encourage patients to obtain antibiotic therapy for upper respiratory tract infections.

c. teach patients that long-term prophylactic antibiotic therapy is needed to prevent recurrence.

d. monitor for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane.

Answer 13

a. promote early diagnosis and treatment of sore throats and skin lesions.

Question 14

3. The edema that occurs in nephrotic syndrome is due to

a. increased hydrostatic pressure caused by sodium retention.

b. decreased aldosterone secretion from adrenal insufficiency.

c. increased fluid retention caused by decreased glomerular filtration.

d. decreased colloidal osmotic pressure caused by loss of serum albumin.

Answer 14

d. decreased colloidal osmotic pressure caused by loss of serum albumin.

Question 15

4. The nurse’s first priority in managing the care of the patient with severe renal colic is to

a. administer opioids as prescribed.

b. obtain supplies for straining all urine.

c. encourage fluid intake of 3 to 4 L/day.

d. keep the patient NPO in preparation for surgery.

Answer 15

a. administer opioids as prescribed.

Question 16

5. The nurse recommends genetic counseling for the children of a patient with

a. nephrotic syndrome.

b. chronic pyelonephritis.

c. malignant nephrosclerosis.

d. adult-onset polycystic kidney disease.

Answer 16

d. adult-onset polycystic kidney disease.

Question 17

6. Which factor from the patient’s history does the nurse identify as a risk factor for kidney and bladder cancer?

a. Aspirin use

b. Tobacco use

c. Chronic alcohol use

d. Use of artificial sweeteners

Answer 17

b. Tobacco use

Question 18

7. In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes (select all that apply)

a. teaching the patient to use Kegel exercises.

b. clamping and releasing a catheter to increase bladder tone.

c. teaching the patient biofeedback mechanisms to train pelvic floor muscles.

d. counseling the patient concerning choice of incontinence containment device.

e. developing a fluid modification plan, focusing on decreasing intake before bedtime.

Answer 18

a. teaching the patient to use Kegel exercises.

c. teaching the patient biofeedback mechanisms to train pelvic floor muscles.

Question 19

8. A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care includes

a. clamping the tube for 10 minutes every hour to decrease spasms.

b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided.

c. notifying the provider if nephrostomy tube drainage is more than 30 mL/hr.

d. irrigating the nephrostomy tube with 10 mL of normal saline solution as needed.

Answer 19

b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided.

Question 20

9. A patient has had a cystectomy and ileal conduit diversion. Four days after surgery, the nurse notes mucous shreds in the pouch. The nurse would a. notify the provider. b. notify the charge nurse. c. irrigate the drainage tube. d. document it as a normal observation.

Answer 20

d. document it as a normal observation.

Question 20

2. During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply) a. hypotension. b. ECG changes. c. hypernatremia. d. pulmonary edema. e. urine with high specific gravity.

Answer 20

b. ECG changes. d. pulmonary edema.

Question 21

3. When a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? a. Hyperkalemia and hyponatremia b. Hyperkalemia and hypernatremia c. Hypokalemia and hyponatremia d. Hypokalemia and hypernatremia

Answer 21

c. Hypokalemia and hyponatremia

Question 21

1. The nurse using RIFLE to determine the early stage of AKI evaluates the patient’s a. blood pressure and urine osmolality. b. fractional excretion of urinary sodium. c. estimation of GFR with the MDRD equation. d. serum creatinine or urine output from baseline.

Answer 21

d. serum creatinine or urine output from baseline.

Question 22

6. Which points must the nurse consider when planning nutrition support for patients with chronic kidney disease? (select all that apply) a. Sodium may be restricted in someone with advanced CKD. b. Fluid is not usually restricted for patients on peritoneal dialysis. c. Decreased fluid intake and a low-potassium diet are needed for a patient on hemodialysis. d. Decreased fluid intake and a low-potassium diet are needed for a patient on peritoneal dialysis. e. Decreased fluid intake and a diet in protein-rich foods are part of a diet for a patient on hemodialysis.

Answer 22

a. Sodium may be restricted in someone with advanced CKD. b. Fluid is not usually restricted for patients on peritoneal dialysis. c. Decreased fluid intake and a low-potassium diet are needed for a patient on hemodialysis.

Question 22

4. The nurse assesses the patient with chronic kidney disease with the understanding that this condition is characterized by a. progressive irreversible destruction of the kidneys. b. a rapid decrease in urine output with an elevated BUN. c. an increasing creatinine clearance with a decrease in urine output. d. prostration, somnolence, and confusion with coma and imminent death.

Answer 22

a. progressive irreversible destruction of the kidneys.

Question 22

5. Nurses can screen patients at risk for developing chronic kidney disease. Those considered to be at increased risk include (select all that apply) a. older Black patients. b. patients more than 60 years old. c. those with a history of pancreatitis. d. those with a history of hypertension. e. those with a history of type 2 diabetes.

Answer 22

a. older Black patients. b. patients more than 60 years old. d. those with a history of hypertension. e. those with a history of type 2 diabetes.

Question 23

7. An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for a transplant. In helping the patient decide about treatment, the nurse informs the patient that a. successful transplant usually provides better quality of life than that offered by dialysis. b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. c. hemodialysis replaces normal kidney functions, and they do not have to live with the continual fear of rejection. d. immunosuppressive therapy after a transplant makes the person ineligible to receive other treatments if the kidney fails.

Answer 23

a. successful transplant usually provides better quality of life than that offered by dialysis.

Question 24

8. To assess the patency of a newly placed arteriovenous graft, the nurse should (select all that apply) a. monitor the BP in the affected arm. b. irrigate the graft daily with low-dose heparin. c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. assess the pulses and neurovascular status distal to the graft.

Answer 24

c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. assess the pulses and neurovascular status distal to the graft.

Question 25

9. A kidney transplant recipient has had fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? a. Assess temperature and start workup to rule out infection. b. Reassure the patient that this is common after a transplant. c. Provide warm covers to the patient and give 1 gram oral acetaminophen. d. Notify the nephrologist that the patient has manifestations of acute rejection

Answer 25

a. Assess temperature and start workup to rule out infection.

Question 26

Hepatitis A is _____ and the mode of transmission is by ____ route

Answer 26

Acute; fecal-oral

Question 27

Hepatitis A incubates for _____ days.

Answer 27

28 days

Question 28

Hepatitis A blood test would show?

Answer 28

Positive IgM (positive IgG if patient had infection before)

Question 29

Hepatitis B can be acute or chronic and incubates for how many days?

Answer 29

56-96 days

Question 30

Hepatitis B can live on dry places for how many days?

Answer 30

7 days

Question 31

Hepatitis C is acute or chronic and incubates for how many days?

Answer 31

56 days

Question 32

How is hepatitis C contracted?

Answer 32

Drug use and sexual activity

Question 33

What percentage of people develop cirrhosis?

Answer 33

30%

Question 34

Match the type of drug therapy: Hepatitis A Hepatitis B Hepatitis C 1. Only used in severe liver failure. 2. No drugs available. 3. Only used in chronic cases to eradicate the virus.

Answer 34

1. Only used in severe liver failure. -Hepatitis B- 2. No drugs available. -Hepatitis A- 3. Only used in chronic cases to eradicate the virus. -Hepatitis C-