WEEK 10 BSN 445 SHERPATH UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS

WEEK 10 BSN 445 SHERPATH UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS

Question:
1. 1. The nurse would document which patient statement when collecting a health history related to kidney
status? Select all that apply. One, some, or all responses may be correct.
"I regularly take acetaminophen for chronic headaches and back pain." "I had a CT scan last week to look
for causes of my stomach pain." "I take lisinopril to control my hypertension." "I feel like I constantly have
to pee, but I never get it all out." "When I drink orange juice, it doesn't burn as much when I pee."
Answer:
"I had a CT scan last week to look for causes of my stomach pain." "I take lisinopril to control my
hypertension." "I feel like I constantly have to pee, but I never get it all out." "When I drink orange juice, it
doesn't burn as much when I pee."

Question:
2. 2. Which patient statement would indicate the development of a rapid fluid volume gain? "My mouth
feels so dry all of the time." "I need to sleep on two extra pillows at night." "I have a metallic taste in my
mouth." "My skin tents up when I pinch it."
Answer:
"I need to sleep on two extra pillows at night."

Question:
3. 3. Which patient statement would indicate a potential cause of kidney dysfunction? "I had nephrotic
syndrome when I was a child." "My skin is so dry and itchy all of the time." "I have lost 10 pounds in the
last 2 months." "I always have to pee during the night."
Answer:
"I had nephrotic syndrome when I was a child."

Question:
4. 3. The nurse would prepare to administer intravenous (IV) fluids to a patient demonstrating which
assessment finding? +2 pitting edema Moist mucous membranes Distended jugular veins Poor skin turgor
Answer:
Poor skin turgor

Question:
5. 4. Which assessment finding would indicate fluid volume overload? Distention of the jugular veins 1 cm
above the sternal notch when the bed is at 45 degrees Delayed return to shape after pinching the skin over
the forearm Distention of hand veins for 8 seconds when the hand is elevated Dryness of the oral cavity
and mucous membranes
Answer:
Distention of hand veins for 8 seconds when the hand is elevated

Question:
6. 5. The nurse assesses for edema by applying fingertip pressure to the ankles and notes a 6-mm indention
that remains for about 45 seconds. In which way would the nurse document these findings? +1 Pitting
edema +2 Pitting edema +3 Pitting edema +4 Pitting edema

, Answer:
+3 Pitting edema
+3 Pitting edema creates an indentation about 6-mm deep that lasts up to 60 seconds.

Question:
7. 6. When the nurse is performing percussion of the kidneys, the patient states, "Ow! It hurts when you
press there!" Based on the assessment findings, the nurse would assess for which condition? Pyelonephritis
Kidney stones Fluid volume deficit Fluid volume overload
Answer:
Pyelonephritis

Question:
8. 7. Which assessment finding would indicate fluid volume overload? Respiratory rate of 18 breaths/min
Central venous pressure (CVP) of 12 mm Hg Decreased skin turgor Mean arterial pressure (MAP) of 50
mm Hg
Answer:
Central venous pressure (CVP) of 12 mm Hg

Question:
9. 8. Which assessment finding would indicate an imbalance in calcium? Trousseau sign Change in muscle
strength Nausea and vomiting Altered mental status
Answer:
Trousseau sign

Question:
10. 1. Which assessment finding would indicate the development of acute kidney injury in a critically ill
patient? Sudden change in creatinine from 1.35 mg/dL to
0.59 mg/dL Abrupt change in urine output from 40 mL/h to 90 mL/h Gradual change in potassium from 5
mmol/L to 3 mmol/L Increase in blood pressure from 115/82 mm Hg to 142/90 mm Hg
Answer:
Increase in blood pressure from 115/82 mm Hg to 142/90 mm Hg

Question:
11. 2. The nurse notes that a patient who weighs 165 lb (75 kg) is experiencing a sudden decrease in urine
output and has produced 500 mL of urine over the last 24 hours. Based on the RIFLE criteria, in which
way would the nurse classify this patient? Risk Failure Injury Loss
Answer:
Failure

Question:
12. 3. Which serum creatinine result would indicate stage 3 acute kidney injury according to the Acute
Kidney Injury Network (AKIN) criteria if a patient's baseline serum creatinine level is 1.25 mg/dL?
1.9 mg/dL
2.5 mg/dL
3.75 mg/dL
4.25 mg/dL