Hepatic-z Renalz NCLEXz Q's
Az clientz whoz isz diagnosedz withz viralz hepatitisz isz complainingz ofz "noz
appetite"z andz "losingz myz tastez forz food."z Whatz instructionz shouldz thez
nursez givez thez clientz toz guidez adequatez nutrition?
1.z Selectz foodsz highz inz fat.
2.z Increasez intakez ofz fluids,z includingz juices.
3.z Eatz az goodz supperz whenz anorexiaz isz notz asz severe.
4.z Eatz lessz often,z preferablyz onlyz threez largez mealsz daily.z -z
z z z z z z z z z z z z z z ANSWER:z 2
z Rationale:z Althoughz noz specialz dietz isz requiredz toz treatz viralz hepatitis,z
itz isz generallyz recommendedz thatz clientsz consumez az low-fatz diet,z asz fatz
mayz bez toleratedz poorlyz becausez ofz decreasedz bilez production.z Small,z
frequentz mealsz arez preferablez andz mayz evenz preventz nausea.z Frequently,z
appetitez isz betterz inz thez morning,z soz itz isz easierz toz eatz az goodz
breakfast.z Anz adequatez fluidz intakez ofz 2z 500z toz 3z 000z mL/dayz thatz
includesz nutritionalz juicesz isz alsoz important.
Az clientz hasz developedz hepatitisz Az afterz eatingz contaminatedz oysters.z Thez
nursez assessesz thez clientz forz whichz expectedz assessmentz finding?
1.z Malaise
2.z Darkz stools
3.z Weightz gain
4.z Leftz upperz quadrantz discomfortz -z
z z z z z z z z z z z z z z ANSWER:z 1
z Rationale:z Hepatitisz causesz gastrointestinalz symptomsz suchz asz anorexia,z
nausea,z rightz upperz quadrantz discomfort,z andz weightz loss.z Fatiguez andz
malaisez arez common.z Stoolsz willz bez light-z orz clay-colouredz ifz conjugatedz
bilirubinz isz unablez toz flowz outz ofz thez liverz becausez ofz inflammationz orz
obstructionz ofz thez bilez ducts.
Thez healthz carez providerz hasz determinedz thatz az clientz hasz contractedz
hepatitisz A,z basedz onz flulikez symptomsz andz jaundice.z Whichz statementz
madez byz thez clientz supportsz thisz medicalz diagnosis?
1.z "Iz havez hadz unprotectedz sexz withz multiplez partners."
2.z "Iz atez shellfishz aboutz 2z weeksz agoz atz az localz restaurant."
3.z "Iz wasz anz intravenousz drugz abuserz inz thez pastz andz sharedz needles."
4.z "Iz hadz az bloodz transfusionz 30z yearsz agoz afterz majorz abdominalz
surgery."z -z
z z z z z z z z z z z z z z ANSWER:z 2
z Rationale:z Hepatitisz Az isz transmittedz byz thez fecal-oralz routez viaz
contaminatedz waterz orz foodz (improperlyz cookedz shellfish)z orz infectedz foodz
handlers.z Hepatitisz B,z C,z andz Dz arez transmittedz mostz commonlyz viaz
infectedz bloodz orz bodyz fluids,z suchz asz withz intravenousz drugz abuse,z
historyz ofz bloodz transfusion,z orz unprotectedz sexz withz multiplez partners.
1z |z P a g e
,Thez nursez isz reviewingz laboratoryz resultsz forz az clientz withz cirrhosisz andz
notesz thatz thez ammoniaz levelz isz 51z mcmol/Lz (85z mcg/dL).z Whichz
dietaryz selectionz doesz thez nursez suggestz toz thez client?
1.z Roastz pork
2.z Cheesez omelet
3.z Pastaz withz sauce
4.z Tunaz fishz sandwichz -z
z z z z z z z z z z z z z z ANSWER:z 3
z Rationale:z Cirrhosisz isz az chronic,z progressivez diseasez ofz thez liverz
characterizedz byz diffusez degenerationz andz destructionz ofz hepatocytes.z Thez
serumz ammoniaz levelz assessesz thez abilityz ofz thez liverz toz deaminatez
proteinz byproducts.z Normalz referencez intervalz isz 6z toz 47z mcmol/Lz (10z toz
80z mcg/dL).z Mostz ofz thez ammoniaz inz thez bodyz isz foundz inz thez
gastrointestinalz tract.z Proteinz providedz byz thez dietz isz transportedz toz thez
liverz byz thez portalz vein.z Thez liverz breaksz downz protein,z whichz resultsz
inz formationz ofz ammonia.z Foodsz highz inz proteinz shouldz bez avoidedz sincez
thez client'sz ammoniaz levelz isz elevatedz abovez thez normalz range;z therefore,z
pastaz withz saucez wouldz bez thez bestz selection.
Az clientz withz acutez kidneyz injuryz hasz az serumz potassiumz levelz ofz 7.0z
mmol/Lz (7.0z mEq/L).z Thez nursez shouldz planz whichz immediatez actions?z
Selectz allz thatz apply.
1.z Placez thez clientz onz az cardiacz monitor.
2.z Notifyz thez primaryz healthz carez providerz (PHCP).
3.z Putz thez clientz onz NPOz (nothingz byz mouth)z statusz exceptz forz icez
chips.
4.z Reviewz thez client'sz medicationsz toz determinez ifz anyz containz orz retainz
potassium.
5.z Allowz anz extraz 500z mLz ofz intravenousz fluidz intakez toz dilutez thez
electrolytez concentration.z -z
z z z z z z z z z z z z z z ANSWER:z 1,z 2,z 4
z Rationale:z Thez normalz potassiumz levelz isz 3.5-5.0z mmol/Lz (3.5-5.0z
mEq/L).z Az potassiumz levelz ofz 7.0z isz elevated.z Thez clientz withz
hyperkalemiaz isz atz riskz ofz developingz cardiacz dysrhythmiasz andz cardiacz
arrest.z Becausez ofz this,z thez clientz shouldz bez placedz onz az cardiacz
monitor.z Thez nursez shouldz notifyz thez PHCPz andz alsoz reviewz medicationsz
toz determinez ifz anyz containz potassiumz orz arez potassiumz retaining.z Thez
clientz doesz notz needz toz bez putz onz NPOz status.z Fluidz intakez isz notz
increasedz becausez itz contributesz toz fluidz overloadz andz wouldz notz affectz
thez serumz potassiumz levelz significantly.
Az clientz withz chronicz kidneyz diseasez undergoingz hemodialysisz suddenlyz
becomesz shortz ofz breathz andz reportsz chestz painz andz anxiety.z Thez clientz
isz tachycardicz andz pale,z andz thez nursez suspectsz airz embolism.z Whatz arez
thez priorityz nursingz actions?z Selectz allz thatz apply.
1.z Administerz oxygenz toz thez client.
2.z Continuez dialysisz atz az slowerz ratez afterz checkingz thez linesz forz air.
3.z Notifyz thez primaryz healthz carez providerz (PHCP)z andz Rapidz Responsez
Team.
2z |z P a g e
,4.z Stopz dialysis,z andz turnz thez clientz onz theirz leftz sidez withz headz lowerz
thanz feet.
5.z Bolusz thez clientz withz 500z mLz ofz normalz salinez toz breakz upz thez
airz embolus.z -z
z z z z z z z z z z z z z z ANSWER:z 1,z 3,z 4
z Rationale:z Ifz thez clientz experiencesz airz embolusz duringz hemodialysis,z thez
nursez shouldz terminatez dialysisz immediately,z positionz thez clientz soz thez airz
embolusz isz onz thez rightz sidez ofz thez heart,z notifyz thez PHCPz andz Rapidz
Responsez Team,z andz administerz oxygenz asz needed.z Slowingz thez dialysisz
treatmentz orz givingz anz intravenousz bolusz willz notz correctz thez airz
embolismz orz preventz complications.
Az clientz arrivesz atz thez emergencyz departmentz withz lowz abdominalz painz
andz hematuria.z Thez clientz isz afebrile.z Whatz isz thez mostz likelyz causez
associatedz withz thisz presentation?
1.z Pyelonephritis
2.z Glomerulonephritis
3.z Traumaz toz thez bladderz orz abdomen
4.z Renalz cancerz inz thez client'sz familyz -z
z z z z z z z z z z z z z z ANSWER:z 3
z Rationale:z Bladderz traumaz orz injuryz shouldz bez consideredz orz suspectedz
inz thez clientz withz lowz abdominalz painz andz hematuria.z Glomerulonephritisz
andz pyelonephritisz wouldz bez accompaniedz byz feverz andz arez thusz notz
applicablez toz thez clientz describedz inz thisz question.z Renalz cancerz wouldz
notz causez painz thatz isz feltz inz thez lowz abdomen;z rather,z thez painz wouldz
bez inz thez flankz area.
Az clientz isz admittedz toz thez emergencyz departmentz followingz az fallz fromz
az horsez andz isz prescribedz insertionz ofz az urinaryz catheter.z Whilez preparingz
forz thez procedure,z thez nursez notesz bloodz atz thez urinaryz meatus.z Thez
nursez shouldz takez whichz actionz next?
1.z Notifyz thez PHCPz beforez performingz thez catheterization.
2.z Usez az small-sizedz catheterz andz anz anaestheticz gelz asz az lubricant.
3.z Administerz parenteralz painz medicationz beforez insertingz thez catheter.
4.z Cleanz thez meatusz withz soapz andz waterz beforez openingz thez
catheterizationz kit.z -z
z z z z z z z z z z z z z z ANSWER:z 1
z Rationale:z Thez presencez ofz bloodz atz thez urinaryz meatusz mayz indicatez
urethralz traumaz orz disruption.z Thez nursez shouldz notifyz thez PHCP,z knowingz
thatz thez clientz shouldz notz bez catheterizedz untilz thez causez ofz thez
bleedingz isz determinedz byz diagnosticz testing.z Thez otherz optionsz includez
performingz thez catheterizationz procedurez andz thereforez arez incorrect.
Whatz laboratoryz resultz wouldz thez nursez mostz likelyz expectz toz findz forz az
clientz diagnosedz withz chronicz renalz disease?
1.z Elevatedz creatininez level
2.z Decreasedz hemoglobinz level
3.z Decreasedz redz bloodz cellz count
4.z Increasedz numberz ofz whitez bloodz cellsz inz thez urinez -z
z z z z z z z z z z z z z z ANSWER:z 1
3z |z P a g e
, z Rationale:z Thez creatininez levelz isz thez mostz specificz laboratoryz testz usedz
toz determinez renalz function.z Thez creatininez levelz increasesz whenz atz leastz
50%z ofz renalz functionz isz lost.z Az decreasedz hemoglobinz levelz andz redz
bloodz cellz countz arez associatedz withz anemiaz orz bloodz lossz andz notz
specificallyz withz decreasedz renalz function.z Increasedz whitez bloodz cellsz inz
thez urinez arez notedz withz urinaryz tractz infection.
Az clientz withz chronicz kidneyz diseasez returnsz toz thez nursingz unitz
followingz hemodialysisz treatment.z Onz assessment,z thez nursez notesz thatz thez
client'sz temperaturez isz 38.5°C.z Whichz nursingz actionz isz mostz appropriate?
1.z Encouragez fluidz intake.
2.z Continuez toz monitorz vitalz signs.
3.z Notifyz thez primaryz healthz carez provider.
4.z Monitorz thez sitez ofz thez shuntz forz infection.z -z
z z z z z z z z z z z z z z ANSWER:z 3
z Rationale:z Az temperaturez ofz 38.5°Cz isz significantlyz elevatedz andz mayz
indicatez infectionz asz az complicationz ofz thisz ongoingz treatment.z Thez nursez
shouldz notifyz thez primaryz healthz carez providerz (PHCP).z Dialysisz clientsz
cannotz havez fluidz intakez encouraged.z Vitalz signsz andz thez shuntz sitez
shouldz bez monitored,z butz thez PHCPz shouldz bez notifiedz first,z asz sepsisz
isz az risk.
Az clientz withz chronicz kidneyz diseasez isz receivingz epoetinz alfa.z Whichz
laboratoryz resultz wouldz indicatez az therapeuticz effectz ofz thez medication?
1.z Hematocritz ofz 0.33z (33%)
2.z Plateletz countz ofz 400z ×z 109/Lz (400z 000z mm3)
3.z Whitez bloodz cellz countz ofz 6.0z ×z 109/Lz (6z 000z mm3)
4.z Bloodz ureaz nitrogenz levelz ofz 5.25z mmol/Lz (15z mg/dL)z -z
z z z z z z z z z z z z z z ANSWER:z 1
z Rationale:z Epoetinz alfaz isz syntheticz erythropoietin,z whichz thez kidneysz
producez toz stimulatez redz bloodz cellz productionz inz thez bonez marrow.z Itz
isz usedz toz treatz anemiaz associatedz withz chronicz kidneyz disease.z Thez
normalz hematocritz levelz forz malesz isz 0.42z toz 0.52z (42z toz 52%)z andz
forz females,z 0.37z toz 0.47z (37z toz 47%).z Therapeuticz effectz isz seenz whenz
thez hematocritz reachesz betweenz 0.30z andz 0.33z (30z andz 33%).z Thez
normalz plateletz countz isz 150z toz 400z ×z 109/Lz (150z 000z toz 400z 000z
mm3).z Thez normalz bloodz ureaz nitrogenz levelz isz 3.6z toz 7.1z mmol/Lz (10z
toz 20z mg/dL).z Thez normalz whitez bloodz cellz countz isz 5z toz 10z ×z
109/Lz (5z 000z toz 10z 000z mm3).z Plateletz production,z whitez bloodz cellz
production,z andz bloodz ureaz nitrogenz doz notz respondz toz erythropoietin.
______________z isz solelyz filteredz fromz thez bloodstreamz viaz thez glomerulusz
andz isz NOTz reabsorbedz backz intoz thez bloodstreamz butz isz excretedz
throughz thez urine.
A.z Urea
B.z Creatinine
C.z Potassium
D.z Magnesiumz -z
z z z z z z z z z z z z z z Thez answerz isz B.z Creatininez isz az wastez
productz fromz musclez breakdownz andz isz removedz fromz thez bloodstreamz viaz
4z |z P a g e
Az clientz whoz isz diagnosedz withz viralz hepatitisz isz complainingz ofz "noz
appetite"z andz "losingz myz tastez forz food."z Whatz instructionz shouldz thez
nursez givez thez clientz toz guidez adequatez nutrition?
1.z Selectz foodsz highz inz fat.
2.z Increasez intakez ofz fluids,z includingz juices.
3.z Eatz az goodz supperz whenz anorexiaz isz notz asz severe.
4.z Eatz lessz often,z preferablyz onlyz threez largez mealsz daily.z -z
z z z z z z z z z z z z z z ANSWER:z 2
z Rationale:z Althoughz noz specialz dietz isz requiredz toz treatz viralz hepatitis,z
itz isz generallyz recommendedz thatz clientsz consumez az low-fatz diet,z asz fatz
mayz bez toleratedz poorlyz becausez ofz decreasedz bilez production.z Small,z
frequentz mealsz arez preferablez andz mayz evenz preventz nausea.z Frequently,z
appetitez isz betterz inz thez morning,z soz itz isz easierz toz eatz az goodz
breakfast.z Anz adequatez fluidz intakez ofz 2z 500z toz 3z 000z mL/dayz thatz
includesz nutritionalz juicesz isz alsoz important.
Az clientz hasz developedz hepatitisz Az afterz eatingz contaminatedz oysters.z Thez
nursez assessesz thez clientz forz whichz expectedz assessmentz finding?
1.z Malaise
2.z Darkz stools
3.z Weightz gain
4.z Leftz upperz quadrantz discomfortz -z
z z z z z z z z z z z z z z ANSWER:z 1
z Rationale:z Hepatitisz causesz gastrointestinalz symptomsz suchz asz anorexia,z
nausea,z rightz upperz quadrantz discomfort,z andz weightz loss.z Fatiguez andz
malaisez arez common.z Stoolsz willz bez light-z orz clay-colouredz ifz conjugatedz
bilirubinz isz unablez toz flowz outz ofz thez liverz becausez ofz inflammationz orz
obstructionz ofz thez bilez ducts.
Thez healthz carez providerz hasz determinedz thatz az clientz hasz contractedz
hepatitisz A,z basedz onz flulikez symptomsz andz jaundice.z Whichz statementz
madez byz thez clientz supportsz thisz medicalz diagnosis?
1.z "Iz havez hadz unprotectedz sexz withz multiplez partners."
2.z "Iz atez shellfishz aboutz 2z weeksz agoz atz az localz restaurant."
3.z "Iz wasz anz intravenousz drugz abuserz inz thez pastz andz sharedz needles."
4.z "Iz hadz az bloodz transfusionz 30z yearsz agoz afterz majorz abdominalz
surgery."z -z
z z z z z z z z z z z z z z ANSWER:z 2
z Rationale:z Hepatitisz Az isz transmittedz byz thez fecal-oralz routez viaz
contaminatedz waterz orz foodz (improperlyz cookedz shellfish)z orz infectedz foodz
handlers.z Hepatitisz B,z C,z andz Dz arez transmittedz mostz commonlyz viaz
infectedz bloodz orz bodyz fluids,z suchz asz withz intravenousz drugz abuse,z
historyz ofz bloodz transfusion,z orz unprotectedz sexz withz multiplez partners.
1z |z P a g e
,Thez nursez isz reviewingz laboratoryz resultsz forz az clientz withz cirrhosisz andz
notesz thatz thez ammoniaz levelz isz 51z mcmol/Lz (85z mcg/dL).z Whichz
dietaryz selectionz doesz thez nursez suggestz toz thez client?
1.z Roastz pork
2.z Cheesez omelet
3.z Pastaz withz sauce
4.z Tunaz fishz sandwichz -z
z z z z z z z z z z z z z z ANSWER:z 3
z Rationale:z Cirrhosisz isz az chronic,z progressivez diseasez ofz thez liverz
characterizedz byz diffusez degenerationz andz destructionz ofz hepatocytes.z Thez
serumz ammoniaz levelz assessesz thez abilityz ofz thez liverz toz deaminatez
proteinz byproducts.z Normalz referencez intervalz isz 6z toz 47z mcmol/Lz (10z toz
80z mcg/dL).z Mostz ofz thez ammoniaz inz thez bodyz isz foundz inz thez
gastrointestinalz tract.z Proteinz providedz byz thez dietz isz transportedz toz thez
liverz byz thez portalz vein.z Thez liverz breaksz downz protein,z whichz resultsz
inz formationz ofz ammonia.z Foodsz highz inz proteinz shouldz bez avoidedz sincez
thez client'sz ammoniaz levelz isz elevatedz abovez thez normalz range;z therefore,z
pastaz withz saucez wouldz bez thez bestz selection.
Az clientz withz acutez kidneyz injuryz hasz az serumz potassiumz levelz ofz 7.0z
mmol/Lz (7.0z mEq/L).z Thez nursez shouldz planz whichz immediatez actions?z
Selectz allz thatz apply.
1.z Placez thez clientz onz az cardiacz monitor.
2.z Notifyz thez primaryz healthz carez providerz (PHCP).
3.z Putz thez clientz onz NPOz (nothingz byz mouth)z statusz exceptz forz icez
chips.
4.z Reviewz thez client'sz medicationsz toz determinez ifz anyz containz orz retainz
potassium.
5.z Allowz anz extraz 500z mLz ofz intravenousz fluidz intakez toz dilutez thez
electrolytez concentration.z -z
z z z z z z z z z z z z z z ANSWER:z 1,z 2,z 4
z Rationale:z Thez normalz potassiumz levelz isz 3.5-5.0z mmol/Lz (3.5-5.0z
mEq/L).z Az potassiumz levelz ofz 7.0z isz elevated.z Thez clientz withz
hyperkalemiaz isz atz riskz ofz developingz cardiacz dysrhythmiasz andz cardiacz
arrest.z Becausez ofz this,z thez clientz shouldz bez placedz onz az cardiacz
monitor.z Thez nursez shouldz notifyz thez PHCPz andz alsoz reviewz medicationsz
toz determinez ifz anyz containz potassiumz orz arez potassiumz retaining.z Thez
clientz doesz notz needz toz bez putz onz NPOz status.z Fluidz intakez isz notz
increasedz becausez itz contributesz toz fluidz overloadz andz wouldz notz affectz
thez serumz potassiumz levelz significantly.
Az clientz withz chronicz kidneyz diseasez undergoingz hemodialysisz suddenlyz
becomesz shortz ofz breathz andz reportsz chestz painz andz anxiety.z Thez clientz
isz tachycardicz andz pale,z andz thez nursez suspectsz airz embolism.z Whatz arez
thez priorityz nursingz actions?z Selectz allz thatz apply.
1.z Administerz oxygenz toz thez client.
2.z Continuez dialysisz atz az slowerz ratez afterz checkingz thez linesz forz air.
3.z Notifyz thez primaryz healthz carez providerz (PHCP)z andz Rapidz Responsez
Team.
2z |z P a g e
,4.z Stopz dialysis,z andz turnz thez clientz onz theirz leftz sidez withz headz lowerz
thanz feet.
5.z Bolusz thez clientz withz 500z mLz ofz normalz salinez toz breakz upz thez
airz embolus.z -z
z z z z z z z z z z z z z z ANSWER:z 1,z 3,z 4
z Rationale:z Ifz thez clientz experiencesz airz embolusz duringz hemodialysis,z thez
nursez shouldz terminatez dialysisz immediately,z positionz thez clientz soz thez airz
embolusz isz onz thez rightz sidez ofz thez heart,z notifyz thez PHCPz andz Rapidz
Responsez Team,z andz administerz oxygenz asz needed.z Slowingz thez dialysisz
treatmentz orz givingz anz intravenousz bolusz willz notz correctz thez airz
embolismz orz preventz complications.
Az clientz arrivesz atz thez emergencyz departmentz withz lowz abdominalz painz
andz hematuria.z Thez clientz isz afebrile.z Whatz isz thez mostz likelyz causez
associatedz withz thisz presentation?
1.z Pyelonephritis
2.z Glomerulonephritis
3.z Traumaz toz thez bladderz orz abdomen
4.z Renalz cancerz inz thez client'sz familyz -z
z z z z z z z z z z z z z z ANSWER:z 3
z Rationale:z Bladderz traumaz orz injuryz shouldz bez consideredz orz suspectedz
inz thez clientz withz lowz abdominalz painz andz hematuria.z Glomerulonephritisz
andz pyelonephritisz wouldz bez accompaniedz byz feverz andz arez thusz notz
applicablez toz thez clientz describedz inz thisz question.z Renalz cancerz wouldz
notz causez painz thatz isz feltz inz thez lowz abdomen;z rather,z thez painz wouldz
bez inz thez flankz area.
Az clientz isz admittedz toz thez emergencyz departmentz followingz az fallz fromz
az horsez andz isz prescribedz insertionz ofz az urinaryz catheter.z Whilez preparingz
forz thez procedure,z thez nursez notesz bloodz atz thez urinaryz meatus.z Thez
nursez shouldz takez whichz actionz next?
1.z Notifyz thez PHCPz beforez performingz thez catheterization.
2.z Usez az small-sizedz catheterz andz anz anaestheticz gelz asz az lubricant.
3.z Administerz parenteralz painz medicationz beforez insertingz thez catheter.
4.z Cleanz thez meatusz withz soapz andz waterz beforez openingz thez
catheterizationz kit.z -z
z z z z z z z z z z z z z z ANSWER:z 1
z Rationale:z Thez presencez ofz bloodz atz thez urinaryz meatusz mayz indicatez
urethralz traumaz orz disruption.z Thez nursez shouldz notifyz thez PHCP,z knowingz
thatz thez clientz shouldz notz bez catheterizedz untilz thez causez ofz thez
bleedingz isz determinedz byz diagnosticz testing.z Thez otherz optionsz includez
performingz thez catheterizationz procedurez andz thereforez arez incorrect.
Whatz laboratoryz resultz wouldz thez nursez mostz likelyz expectz toz findz forz az
clientz diagnosedz withz chronicz renalz disease?
1.z Elevatedz creatininez level
2.z Decreasedz hemoglobinz level
3.z Decreasedz redz bloodz cellz count
4.z Increasedz numberz ofz whitez bloodz cellsz inz thez urinez -z
z z z z z z z z z z z z z z ANSWER:z 1
3z |z P a g e
, z Rationale:z Thez creatininez levelz isz thez mostz specificz laboratoryz testz usedz
toz determinez renalz function.z Thez creatininez levelz increasesz whenz atz leastz
50%z ofz renalz functionz isz lost.z Az decreasedz hemoglobinz levelz andz redz
bloodz cellz countz arez associatedz withz anemiaz orz bloodz lossz andz notz
specificallyz withz decreasedz renalz function.z Increasedz whitez bloodz cellsz inz
thez urinez arez notedz withz urinaryz tractz infection.
Az clientz withz chronicz kidneyz diseasez returnsz toz thez nursingz unitz
followingz hemodialysisz treatment.z Onz assessment,z thez nursez notesz thatz thez
client'sz temperaturez isz 38.5°C.z Whichz nursingz actionz isz mostz appropriate?
1.z Encouragez fluidz intake.
2.z Continuez toz monitorz vitalz signs.
3.z Notifyz thez primaryz healthz carez provider.
4.z Monitorz thez sitez ofz thez shuntz forz infection.z -z
z z z z z z z z z z z z z z ANSWER:z 3
z Rationale:z Az temperaturez ofz 38.5°Cz isz significantlyz elevatedz andz mayz
indicatez infectionz asz az complicationz ofz thisz ongoingz treatment.z Thez nursez
shouldz notifyz thez primaryz healthz carez providerz (PHCP).z Dialysisz clientsz
cannotz havez fluidz intakez encouraged.z Vitalz signsz andz thez shuntz sitez
shouldz bez monitored,z butz thez PHCPz shouldz bez notifiedz first,z asz sepsisz
isz az risk.
Az clientz withz chronicz kidneyz diseasez isz receivingz epoetinz alfa.z Whichz
laboratoryz resultz wouldz indicatez az therapeuticz effectz ofz thez medication?
1.z Hematocritz ofz 0.33z (33%)
2.z Plateletz countz ofz 400z ×z 109/Lz (400z 000z mm3)
3.z Whitez bloodz cellz countz ofz 6.0z ×z 109/Lz (6z 000z mm3)
4.z Bloodz ureaz nitrogenz levelz ofz 5.25z mmol/Lz (15z mg/dL)z -z
z z z z z z z z z z z z z z ANSWER:z 1
z Rationale:z Epoetinz alfaz isz syntheticz erythropoietin,z whichz thez kidneysz
producez toz stimulatez redz bloodz cellz productionz inz thez bonez marrow.z Itz
isz usedz toz treatz anemiaz associatedz withz chronicz kidneyz disease.z Thez
normalz hematocritz levelz forz malesz isz 0.42z toz 0.52z (42z toz 52%)z andz
forz females,z 0.37z toz 0.47z (37z toz 47%).z Therapeuticz effectz isz seenz whenz
thez hematocritz reachesz betweenz 0.30z andz 0.33z (30z andz 33%).z Thez
normalz plateletz countz isz 150z toz 400z ×z 109/Lz (150z 000z toz 400z 000z
mm3).z Thez normalz bloodz ureaz nitrogenz levelz isz 3.6z toz 7.1z mmol/Lz (10z
toz 20z mg/dL).z Thez normalz whitez bloodz cellz countz isz 5z toz 10z ×z
109/Lz (5z 000z toz 10z 000z mm3).z Plateletz production,z whitez bloodz cellz
production,z andz bloodz ureaz nitrogenz doz notz respondz toz erythropoietin.
______________z isz solelyz filteredz fromz thez bloodstreamz viaz thez glomerulusz
andz isz NOTz reabsorbedz backz intoz thez bloodstreamz butz isz excretedz
throughz thez urine.
A.z Urea
B.z Creatinine
C.z Potassium
D.z Magnesiumz -z
z z z z z z z z z z z z z z Thez answerz isz B.z Creatininez isz az wastez
productz fromz musclez breakdownz andz isz removedz fromz thez bloodstreamz viaz
4z |z P a g e
