NEW 2022 WORKING UPDATE SOLUTION FOR ATI MED SURG FINAL EXAM ALL PRACICE QUESTIONS AND ANSWERS

[COMPANY NAME] [Company address] NEW 2022 WORKING UPDATE SOLUTION FOR ATI MED SURG FINAL EXAM ALL PRACICE QUESTIONS AND ANSWERS NEW 2022 WORKING UPDATE SOLUTION FOR ATI MED SURG FINAL EXAM ALL PRACICE QUESTIONSAND ANSWERS What is normal range for cholesterol, HDL, LDL - CORRECT ANSWER Less than 200, above 40, less than 130 What is the desired INR range for people taking warfarin - CORRECT ANSWER 2.0-3.0 What is an indicator of cardiac tamponade - CORRECT ANSWER Blood pressure is 10 MM HG or higher on expiration then on inspiration Patients scheduled for a coronary artery bypass graft should not take anticoagulants for at least blank prior to the surgery to prevent excessive bleeding - CORRECT ANSWER A week A patient is admitted with a diagnosis of Bradydysrhythmia. What assessment finding requires immediate intervention? - CORRECT ANSWER The patient reports weakness and fatigue Following insertion of a permanent pacemaker, a patient states they cannot get rid of these hiccups. Why is this potentially a problem? - CORRECT ANSWER Hiccups may indicate that the pacemaker is stimulating the chest wall or diaphragm. This could indicate a complication such as lead wire perforation Chapter 27 - CORRECT ANSWER What is the normal range for creatine kinase? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? - CORRECT ANSWER 30 to 170 units/L, 4 to 6 hours, 3 days What is the normal range for troponin T? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? - CORRECT ANSWER Less than 0.2 ng/L, 3 to 5 hours, 14 to 21 days What is normal range for troponin I? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? - CORRECT ANSWER Less than 0.03, three hours, 7 to 10 days What is normal range for myoglobin? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? - CORRECT ANSWER Less than 90 mcg/L, two hours, 24 hours While an echocardiogram is being performed what side should the patient lie on? - CORRECT ANSWER Left side and remain still What are indications for an echocardiogram - CORRECT ANSWER Cardiomyopathy Heart failure Angina Myocardial infarction What are indications for stress test - CORRECT ANSWER Dysrhythmias HF Angina MI What are two medications that are prescribed for pharmacological stress test - CORRECT ANSWER Dobutamine Adenosine What do you instruct the patient to do 2 to 4 hours before a stress test - CORRECT ANSWER Avoid tobacco, alcohol and caffeine Hemodynamic monitoring involves special indwelling catheters that provide information about blood volume and perfusion, fluid status and how well the heart is pumping. Arterial lines are placed in the radial (most common), brachial or femoral artery. What should you Monitor for? - CORRECT ANSWER Monitor circulation in the limb with the arterial line. Such as capillary refill, temperature, color. Arterial lines are not used for IV fluid administration The pulmonary artery (PA) catheter is inserted into a large vein (internal jugular, femoral, subclavian, brachial) and threaded through the right atria and ventricles into a branch of the pulmonary artery. PA catheters have multiple lumens, ports and components that allow for various hemodynamic measurements, blood sampling and - CORRECT ANSWER Infusion of IV fluids What are the different lumens used for? - CORRECT ANSWER What is the expected reference range for CVP (Central venous pressure) - CORRECT ANSWER 1 to 8 MM HG What is the expected reference range for pulmonary artery systolic (PAS) - CORRECT ANSWER 15 to 26 What is the expected range for pulmonary artery diastolic (PAD) - CORRECT ANSWER 5 to 15 What is expected range for pulmonary artery wedge pressure (PAWP)? - CORRECT ANSWER 4 to 12 What is the expected range for cardiac output - CORRECT ANSWER 4 to 7 L/minute What is expected range for mixed venous oxygen saturation - CORRECT ANSWER 60% to 80% When should a nurse anticipate lower hemodynamic values? - CORRECT ANSWER In older patients especially if dehydration is a complication What position should the patient be in with hemodynamic monitoring - CORRECT ANSWER Supine or Trendelenburg What are post procedure nursing interventions for hemodynamic monitoring - CORRECT ANSWER 1. Obtain chest x-ray to confirm catheter placement 2. Continually monitor vitals 3. Compare NIBP to arterial blood pressure 4. Observe and document waveforms. Report changes in waveforms to the provider 5. Document catheter placement each shift and as needed 6. Place the patient in supine position prior to recording hemodynamic values ( HOB can be elevated 15° to 30°) What are complications of hemodynamic monitoring - CORRECT ANSWER What are nursing actions preprocedure before an angiography - CORRECT ANSWER 1. Patient is NPO for at least eight hours before 2. Assess for iodine/shellfish allergy 3. Assess renal function 4. Teach the client that the affected leg must remain straight after the procedure 5. The other normal stuff like ensure informed consent blah blah What are post procedure nursing interventions for an angiography - CORRECT ANSWER 1. Assess vitals every 15 minutes for One hour, every 30 minutes for one hour, every hour for four hours and then every four hours 2. Assess the site for bleeding and hematoma with every vital sign check 3. Maintain bed rest for 4 to 6 hours after the procedure 4. Monitor urine output and administer IV fluids for hydration (contrast media acts as an osmotic diuretic) How long do patients receive anticoagulation therapy that have stent placement - CORRECT ANSWER 6 to 8 weeks What is cardiac tamponade - CORRECT ANSWER Fluid accumulation in the pericardial sac What are manifestations of cardiac tamponade - CORRECT ANSWER hypotension JVD Muffled heart sounds Paradoxical pulse What are nursing actions for cardiac tamponade - CORRECT ANSWER 1. Notify the provider immediately 2. Administer IV fluids to combat hypotension as prescribed 3. Obtain a chest x-ray or echocardiogram to confirm diagnosis 4. Prepare the client for pericardiocentesis What is retroperitoneal bleeding - CORRECT ANSWER Bleeding into the abdominal cavity behind the peritoneum can occur due to femoral artery puncture (after an angiography) What are nursing actions for retroperitoneal bleeding - CORRECT ANSWER 1. Assess for flank pain and hypotension 2. Notify the provider immediately 3. Administer IV fluids and blood products as prescribed What are central catheter's appropriate for - CORRECT ANSWER Any fluids due to rapid hemodilution in the superior vena cava What is post procedure care for a PICC - CORRECT ANSWER What should you do if there's an occlusion in the access device that impedes flow - CORRECT ANSWER 1. Flush the line at least every 12 hours to maintain patency (3 mL for peripheral & 10 mL for central lines) 2. Administer urokinase to lyse obstructions per facility protocol 3. Flush implanted port after every use and at least once a month while implanted What are nursing actions for a catheter thrombosis/emboli - CORRECT ANSWER 1. Flush the line per facility protocol 2. Do not force fluid if resistance is encountered 3. Use a 10 mL or larger syringe to avoid excessive pressure What is treatment for infiltration and extravasation - CORRECT ANSWER 1. Remove using direct pressure with gauze sponge until bleeding stops 2. Apply cool compress 3. Elevation is optional 4. Avoid starting a new IV site in the same extremity What are nursing interventions to prevent an air embolism in a vascular access device - CORRECT ANSWER 1. Leave central lines clamped when not in use 2. Have the patient hold breath while the tubing is changed 3. If the patient has sudden SOB, place in Trendelenburg on left side, give oxygen and notify the provider What are nursing interventions to prevent accidental dislodgment of a catheter - CORRECT ANSWER 1. Cover the extremity site with stretch netting 2. Wrap a washcloth folded into thirds around the arm before applying a needed restraint 3. When removing the dressing, pull from distal to proximal Hemodynamic pressure lines should be calibrated to read atmospheric pressure as blank. - CORRECT ANSWER Zero. Zero transducer to room air What kind of medication would you use for vasodilation secondary to sepsis - CORRECT ANSWER Dopamine (vasopressors) Chapter 28 - CORRECT ANSWER What are medications/electrical management for bradycardia - CORRECT ANSWER 1. Atropine and isoproterenol (antiarrhythmic and bronchodilator) 2. Pacemaker What are medications/electrical management for a fib, SVT or VT with pulse - CORRECT ANSWER 1. Amiodarone, adenosine, verapamil (CCB) 2. Synchronized cardioversion What are medications/electrical management for VT without a pulse or ventricular fibrillation - CORRECT ANSWER 1. Amiodarone, lidocaine and epinephrine 2. Defibrillation What is cardioversion - CORRECT ANSWER Delivery of a direct countershock to the heart synchronized to the QRS complex What is defibrillation - CORRECT ANSWER Delivery of an unsynchronized, direct countershock to the heart. Stops all electrical activity of the heart, allowing the SA node to take over and reestablish a perfusing rhythm What is held 48 hours prior to elective cardioversion - CORRECT ANSWER Digoxin What is indicative of an MI - CORRECT ANSWER Chest pain and ST segment depression or elevation Chapter 30 - CORRECT ANSWER What is an arthrectomy - CORRECT ANSWER Used to break up and remove plaques within cardiac vessels What is a stent - CORRECT ANSWER Placement of a mesh wire device to hold an artery open and prevent restenosis What is a percutaneous transluminal coronary angioplasty - CORRECT ANSWER Involves inflating a balloon to dilate the arterial lumen and the adhering plaque, therefore widening the arterial lumen What are indications for a PCI (angioplasty) - CORRECT ANSWER What are preprocedure nursing actions for a PCI (besides allergies, informed consent, blah blah) - CORRECT ANSWER 1. NPO at least eight hours if possible 2. Assess renal function prior to introduction of contrast dye 3. Administer antiplatelet medications as prescribed What are two medications that are administered during the intraprocedure for PCI - CORRECT ANSWER Midazolam (Versed) and fentanyl What is post procedure nursing actions after a PCI - CORRECT ANSWER 1. Assess vitals every 15 minutes for one hour, every 30 minutes for one hour, every hour for four hours and then every four hours. 2. Assess the groin site at the same intervals for bleeding and hematoma formation 3. Assess for signs of thrombosis 4. Maintain bed rest in a supine position with the leg straight for 4 to 6 hours ( or prescribed time) 5. Monitor urine output How long does a client with a stent replacement receive anticoagulation therapy - CORRECT ANSWER 6 to 8 weeks after Perforation of an artery by the catheter may cause blank - CORRECT ANSWER Cardiac tamponade What are clinical manifestations of anaphylaxis - CORRECT ANSWER chills Fever Rash Wheezing Tachycardia Bradycardia What are two medications that might be prescribed in the event of anaphylaxis - CORRECT ANSWER Diphenhydramine or epinephrine A coronary artery bypass graft is most effective when a patient has sufficient ventricular function such as an EF greater then - CORRECT ANSWER 40% to 50% What are preprocedure medications for a CABG - CORRECT ANSWER 1. Anxiolytics: lorazepam and diazepam 2. Prophylactic antibiotics 3. Anticholinergic such as scopolamine What are some important preprocedure teachings for a patient that is going to undergo a CABG - CORRECT ANSWER 1. Endotracheal tube and mechanical ventilator for airway management for several hours following the surgery 2. Inability to talk while endotracheal tube is in place 3. Sternal incision and possible leg incision 4. 1 to 2 mediastinal chest tubes 5. Indwelling urinary catheter 6. Pacemaker wires 7. Hemodynamic monitoring devices What are two medications that are discontinued before a CABG - CORRECT ANSWER 1. Diuretics 2 to 3 days before surgery 2. Aspirin and other anticoagulants one week before surgery What are medications that are often continued for CABG - CORRECT ANSWER Potassium supplements Antidysrhythmic's Antihypertensives Insulin Post procedure: what should you do with the patient within two hours following extubation - CORRECT ANSWER Dangle and turn the client from side to side as tolerated What should you do within 24 hours after CABG - CORRECT ANSWER Assist the patient to a chair. Ambulate the patient 25 to 100 feet by first postoperative day How often should you assess neurological status after CABG - CORRECT ANSWER Every 30 to 60 minutes until the client awakens from anesthesia, then every 2 to 4 hours or per facility policy Monitor chest tube patency and drainage. Measure drainage at least once an hour. Volume exceeding blank could be a sign of possible hemorrhage and should be reported to the surgeon - CORRECT ANSWER 150 mL/hour What kind of manifestations of pain might an older female patient show instead of chest pain - CORRECT ANSWER Dyspnea, indigestion What is a heart healthy diet - CORRECT ANSWER Low-fat, low cholesterol, high-fiber, low-salt What should the patient's activity level be after a CABG - CORRECT ANSWER What can hypothermia cause - CORRECT ANSWER Vasoconstriction, metabolic acidosis and hypertension What are indications of cardiac tamponade after a CABG - CORRECT ANSWER 1. Sudden decrease of chest tube drainage following heavy drainage 2. JVD with clear lung sounds 3. Equal PAWP & CVP values Treatment of cardiac tamponade after a CABG involves - CORRECT ANSWER 1. Volume expansion 2. Emergency sternotomy (Pericardiocentesis is avoided because blood may have clotted) What is maximum potassium administration rate IV - CORRECT ANSWER 10 to 20 mEq/hour How long should a patient remain NPO before a peripheral bypass graft - CORRECT ANSWER Eight hours What are two client education points for a peripheral bypass graft - CORRECT ANSWER 1. Advise the patient not to cross legs 2. Explain that pedal pulses will be checked frequently What are post procedure nursing interventions for a peripheral bypass graft - CORRECT ANSWER 1. Assess vitals every 15 minutes for one hour and then every hour after the first hour 2. Administer anticoagulant therapy/antiplatelet therapy 3. Maintain bed rest for 18 to 24 hours. The leg should be kept straight during this time What are teaching points for foot inspection and care - CORRECT ANSWER The graft may occlude due to reduced blood flow and clot formation. This occurs primarily in the first - CORRECT ANSWER 24 hours post operative What kind of procedure is used for graft occlusion - CORRECT ANSWER Thrombectomy or thrombolytic therapy What procedure is used for compartment syndrome - CORRECT ANSWER Fasciotomy Chapter 35 - CORRECT ANSWER What are physical assessment findings for peripheral artery disease - CORRECT ANSWER 1. Bruit over femoral and aortic artery's 2. Decreased capillary refill of toes 3. Decreased or non-palpable pulses 4. Loss hair on lower calf, ankle and foot 5. Dry, scaly, mottled skin 6. Thick toenails 7. Cold/cyanotic extremity 8. Pallor of extremity with elevation 9. Dependent Rubor 10. Muscle atrophy 11. Ulcers and possible gangrene What are nursing actions for arteriography - CORRECT ANSWER 1. Observe for bleeding and hemorrhage 2. Palpate pedal pulses to identify possible occlusions How does a plethysmography diagnose PAD - CORRECT ANSWER A decrease in pulse pressure of the lower extremity indicates a possible blockage in the leg A Doppler probe is used to take various blood pressure measurements for comparison. In the absence of peripheral arterial disease, pressures in the lower extremities are - CORRECT ANSWER Higher than those in the upper extremities What is nursing care for a patient with PAD - CORRECT ANSWER 1. Encourage collateral circulation 2. Avoid crossing legs 3. Avoid restrictive garments 4. Elevate the leg to reduce swelling, but not to elevate them about the level of the heart 5. Provide a warm environment 6. Avoid exposure to cold 7. Avoid stress, caffeine and nicotine and anything that causes vasoconstriction What are medications for PAD - CORRECT ANSWER 1. Antiplatelet medications - aspirin, Plavix, trental 2. Statins - can relieve manifestations associated with PAD such as intermittent claudication What are two surgical procedures for PAD - CORRECT ANSWER 1. Percutaneous transluminal angioplasty 2. Laser assisted angioplasty What are nursing interventions for these two procedures - CORRECT ANSWER 1. Observe for bleeding/vitals 2. Keep client on bed rest with limb straight for 6 to 8 hours before ambulation 3. Antiplatelet therapy for 1 to 3 months What is arterial revascularization surgery used for - CORRECT ANSWER Patients who have severe claudication and/or limb pain at rest, or patients who are at risk for losing a limb due to poor arterial circulation What are nursing actions for arterial revascularization surgery - CORRECT ANSWER 1. Maintain adequate circulation in the repaired artery. The location of the pedal or dorsalis pulse should be marked and its strength compared with the contralateral leg on a scheduled basis using a Doppler 2. Assess color, temperature, sensation and capillary refill compared with the contralateral extremity on a scheduled basis 3. Monitor BP!!!! 4. No bending of the hip and knee One complication of graft is compartment syndrome what are manifestations of it - CORRECT ANSWER Tingling Numbness Worsening pain Edema Pain on passive movement Unequal pulses (prepare patient for Fasciotomy) What are risk factors for peripheral venous disease - CORRECT ANSWER 1. Venus thromboembolism associated with Virchow triad 2. Hip surgery, total knee replacement, open prostate surgery 3. Heart failure 4. Immobility 5. Pregnancy 6. Oral contraceptives 7. Family history Patients with venous disease most often complain of limb pain that feels like - CORRECT ANSWER Aching pain and feeling of fullness or heaviness in the legs after standing What are signs of DVT and thrombophlebitis - CORRECT ANSWER What are signs of Venous insufficiency - CORRECT ANSWER 1. Stasis dermatitis is a brown discoloration on the ankles that extends at the calf relative to the level of insufficiency 2. Edema 3. Stasis ulcers ( typically found around ankles) What are clinical manifestation of varicose veins - CORRECT ANSWER 1. Distended, superficial veins that are visible just below the skin and are torturous in nature 2. Patients often report muscle cramping and aches, pain after sitting and pruritus What are laboratory tests for PVD - CORRECT ANSWER D dimer test measures fibrin degradation products present in the blood produced from fibrinolysis. A positive test indicates that thrombus formation has possibly occurred What are diagnostic procedures for DVT and thrombophlebitis - CORRECT ANSWER 1. Venus duplex ultrasonography 2. Impedance plethysmography 3. If the above test are negative for a DVT, but one is still suspected a venogram, which uses contrast material or MRI may be needed for accurate diagnosis For varicose veins Trendelenburg test is used. What are the nursing actions for this test - CORRECT ANSWER 1. Place the patient in the supine position with legs elevated 2. When the patient sits up, the veins will fill from the proximal and if varicosities are present What should you encourage the patient to do if they have DVT or thrombophlebitis - CORRECT ANSWER What should you teach the patient to do if they have venous insufficiency - CORRECT ANSWER What are medications for DVT and thrombophlebitis - CORRECT ANSWER Anticoagulants How long does it take for warfarin to take affect - CORRECT ANSWER 3 to 4 days DVT and thrombophlebitis both can use thrombolytic therapy. What are the details of this therapy? - CORRECT ANSWER For varicose veins, sclerotherapy may be performed. What are the details of this therapy? - CORRECT ANSWER What should the nurse monitor for postoperatively after varicose veins - vein stripping - CORRECT ANSWER What are two other surgical interventions that can be performed for varicose veins - CORRECT ANSWER 1. Endovenous laser treatment 2. Application of radiofrequency energy Venous stasis ulcers often form over the medial malleolus. Venous ulcers are chronic, hard to heal and often recur. They can lead to amputation and/or death. What are nursing interventions for venous ulcers - CORRECT ANSWER What are patient teachings for patients that have venous ulcers (diet and DVT prevention) - CORRECT ANSWER 1. Recommend a diet high in zinc, protein, iron and vitamins A & C 2. Instruct patient on the use of compression stockings A pulmonary embolism occurs when a thrombus is dislodged, becomes an embolus and lodges into a pulmonary vessels. What are manifestations of a pulmonary embolism's - CORRECT ANSWER 1. Sudden onset of dyspnea, pleuritic chest pain, restlessness and apprehension, feelings of impending doom, cough and hemoptysis What are clinical findings of a pulmonary embolism's - CORRECT ANSWER Tachypnea Crackles plural friction rub Tachycardia S3 or S4 heart sounds Diaphoresis Low-grade fever Petechia over chest and axillae Decreased arterial O2 sat What should you do if you suspect that a patient has a pulmonary embolism - CORRECT ANSWER 1. Notify the health care provider immediately, reassure the client, and assist with position of comfort with the head of the bed elevated. 2. Prepare for oxygen therapy and ABGs while continuing to monitor and assess the patient for other manifestations When should Venus compression stockings be removed - CORRECT ANSWER Before going to bed. Legs should be elevated before the stockings are reapplied Chapter 36 - CORRECT ANSWER What is secondary hypertension caused by - CORRECT ANSWER Certain disease states or medications How does hypertrophia of the left ventricle develop - CORRECT ANSWER As the heart pumps against resistance caused by the hypertension What is the maximum BMI a person should have in regards to health promotion and disease prevention for hypertension - CORRECT ANSWER 30 What are risk factors for secondary hypertension - CORRECT ANSWER Blank, can occur with verapamil hydrochloride, so encourage intake of foods that are high in fiber - CORRECT ANSWER Constipation What kind of juice should not be taken with CCB medications - CORRECT ANSWER Grapefruit juice What are two side effects of ARBs - CORRECT ANSWER Angioedema, hyperkalemia Aldosterone receptor antagonists such as blank, block aldosterone action. They promote the retention of potassium and excretion of sodium and water - CORRECT ANSWER Eplerenone What are Side effects of aldosterone receptor antagonists - CORRECT ANSWER Hypertriglyceridemia, hyponatremia, hyperkalemia What should you teach the patient that is taking aldosterone receptor antagonists - CORRECT ANSWER No grapefruit juice or St. John's wort. Do not take salt substitutes with potassium or foods rich in potassium What do central alpha antagonist such as clonidine do - CORRECT ANSWER Reduce peripheral vascular resistance and decrease blood pressure by inhibiting the reuptake of norepinephrine What are side effects of central alpha antagonist - CORRECT ANSWER Sedation, orthostatic hypotension, impotence Alpha adrenergic antagonist, such as blank, reduce blood pressure by causing vasodilation - CORRECT ANSWER Prazosin When is prazosin given - CORRECT ANSWER Usually at Night and Monitor BP for two hours after initiation of treatment What are dietary approaches to stop hypertension - CORRECT ANSWER 1. Diet high in fruits, vegetables, and low-fat dairy 2. Avoid foods high in sodium and fat 3. Consume foods rich in potassium, calcium and magnesium What are clinical manifestations of a hypertensive crisis - CORRECT ANSWER 1. Severe headache 2. Extremely high blood pressure - greater than 240/120 3. Blurred vision, dizziness and disorientation 4. Epistaxis What are two medications that are given IV for a hypertensive crisis - CORRECT ANSWER Nitroprusside Nicardipine Before, during and after administration of IV antihypertensive what should you do - CORRECT ANSWER Monitor BP every 5 to 15 minutes and assess neurological status and monitor ECG Chapter 17 - CORRECT ANSWER How long should a patient abstain from smoking before a pulmonary function test - CORRECT ANSWER 6 to 8 hours prior to testing If a patient uses inhalers how long should they withhold use before a pulmonary function test - CORRECT ANSWER Four to six hours prior to testing What is PaO2 - CORRECT ANSWER The partial pressure of oxygen What is SaO2 - CORRECT ANSWER Percentage of oxygen bound to hemoglobin as compared with the total amount that can be possibly carried What is normal bicarbonate according to ATI - CORRECT ANSWER 21 to 28 What are preprocedure nursing actions for an arterial puncture - CORRECT ANSWER What are intraprocedural nursing actions while performing an arterial puncture - CORRECT ANSWER What are postprocedural nursing actions while performing an arterial puncture - CORRECT ANSWER What are two complications from an arterial puncture - CORRECT ANSWER Hematoma and air embolism What should you do if the patient has a hematoma - CORRECT ANSWER 1. Observe the patient for changes in temperature, swelling, color, loss of pulse or pain 2. Notify the provider immediately if symptoms persist 3. Apply pressure to the hematoma site What should you do if a patient exhibits symptoms of an air embolism - CORRECT ANSWER 1. Place the patient on his left side in the Trendelenburg position 2. Monitor the patient for a sudden onset of SOB, decrease in SaO2, chest pain, anxiety and air hunger 3. Notify the provider immediately if symptoms occur, administer oxygen and obtain ABGs Why is a bronchoscopy performed - CORRECT ANSWER 1. Visualization of abnormalities such as tumors, inflammation and strictures 2. Biopsy 3. Removal of foreign bodies and secretions 4. Treat post operative atelectasis What is preprocedure nursing interventions for a bronchoscopy - CORRECT ANSWER What are intraprocedural nursing interventions for a bronchoscopy - CORRECT ANSWER What are post procedure nursing interventions for a bronchoscopy - CORRECT ANSWER The patient is not discharged from the recovery room until adequate cough reflex and respiratory effort are present What are three complications that can occur from a bronchoscopy - CORRECT ANSWER Laryngospasm, pneumothorax, aspiration What are nursing interventions for Laryngospasm spasm and what can decrease the likelihood of laryngeal edema - CORRECT ANSWER 1. Monitor the patient for signs of respiratory distress 2. Maintain a patent airway by repositioning the patient or inserting an oral/nasopharyngeal airway as appropriate 3. Administer oxygen therapy to the patient as prescribed. Humidification can decrease the likelihood of laryngeal edema What are nursing interventions for a pneumothorax - CORRECT ANSWER 1. Assess patient's breath sounds and O2 sat and obtain a follow-up chest x-ray What are nursing interventions for aspiration - CORRECT ANSWER 1. Prevent aspiration and the patient by withholding oral fluids or food until the gag reflex returns 2. Perform suctioning as needed What is a thoracentesis - CORRECT ANSWER Performed to obtain specimens for diagnostic evaluation, instill medication into the plural space, and remove fluid or air from the plural space What are preprocedure nursing interventions for a Thoracentesis - CORRECT ANSWER 1. Obtain preprocedure x-ray as prescribed 2. Position the patient sitting upright with his arms and shoulders raised and supported on pillows and/or on an overbed table and with his feet and legs well supported 3. Instructed patient to remain absolutely still during the procedure and not to cough or talk unless instructed by the primary care provider What are intraprocedural nursing interventions for a thoracentesis - CORRECT ANSWER 1. Monitor the patient's vitals, skin color and O2 sat throughout the procedure 2. Measure and record the amount of fluid removed from the patient's chest (The amount of fluid removed is limited to one L at a time to prevent cardiovascular collapse) 3. Label and send specimens to the Laboratory What are post procedure nursing interventions for a thoracentesis - CORRECT ANSWER 1. Apply a dressing over the puncture site and assess dressing for bleeding/drainage 2. Monitor vitals and respiratory status hourly for the first several hours after 3. Encourage the patient to deep breathe to assist with lung expansion 4. Obtain a chest x-ray (check resolution of effusions, rule out pneumothorax) What are complications of a thoracentesis - CORRECT ANSWER Mediastinal shift, pneumothorax, bleeding, infection What is a mediastinal shift - CORRECT ANSWER Shift of thoracic structures to one side of the body (Monitor VS, auscultate lungs for a decrease in or absence of breath sounds) What is a symptom of pneumothorax - CORRECT ANSWER Diminished breath sounds What are indications of a pneumothorax - CORRECT ANSWER 1. Deviated trachea 2. Pain on the affected side that worsens upon exhalation 3. Affected side does not move in and out upon inhalation/exhalation 4. Increased HR 5. Rapid shallow respirations 6. Nagging cough or feeling of air hunger Chapter 20 - CORRECT ANSWER How long does it take for a patient to exhibit symptoms when exposed to healthcare acquired pneumonia - CORRECT ANSWER 24 to 48 hours What is rhinitis - CORRECT ANSWER Inflammation of the nasal mucosa What is objective data for rhinitis - CORRECT ANSWER 1. Red, inflamed, swollen nasal mucosa 2. Low-grade fever What are nursing interventions for rhinitis - CORRECT ANSWER 1. Encourage rest, 8 to 10 hours a day and increase fluid intake to at least 2000 mL/day 2. Encourage use of home humidifier or breathing steamy air 3. Proper disposal of tissues and use of cough etiquette What are medications for rhinitis - CORRECT ANSWER What are holistic or complementary therapies for rhinitis - CORRECT ANSWER Echinacea, large doses of vitamin C and zinc What is sinusitis - CORRECT ANSWER Inflammation of the mucous membranes of one or more of the sinuses What is sinusitis associated with - CORRECT ANSWER 1. Deviated nasal septum 2. Occurs after rhinitis 3. Nasal polyps 4. Inhaled pollutants or cocaine 5. Facial trauma 6. Dental infections 7. Loss of immune function What are symptoms of sinusitis - CORRECT ANSWER Nasal congestion Headache Facial pressure/pain (worse when head is tilted forwards) Cough Bloody/Purulent nasal drainage Tenderness to palpitation Low-grade fever What are diagnostic tests for sinusitis - CORRECT ANSWER 1. CT scan or sinus x-rays 2. Endoscopic sinus cavity lavage or surgery to relieve the obstruction and promote drainage of secretions may be done as a diagnostic procedure What are nursing interventions for sinusitis and what should you discourage - CORRECT ANSWER 1. Encourage the use of steam, sinus irrigation, nasal spray 2. Increase fluid and rest 3. Discourage air travel, swimming and diving What are medications for sinusitis - CORRECT ANSWER 1. phenylephrine: used to reduce swelling of the mucosa 2. Patients should be encouraged to begin OTC decongestant at the first manifestation of sinusitis 3. Signs of rebound nasal congestion may occur if decongestions are used for more than 3 to 4 days 4. Amoxicillin if there is bacteria 5. NSAIDs, Tylenol, aspirin What is patient education for sinusitis and what should the patient report - CORRECT ANSWER 1. Sinus irrigation and saline nasal spray's are an effective alternative to antibiotics for relieving nasal congestion 2. Contact the provider for manifestations of a severe headache, neck stiffness and high fever (meningitis/encephalitis) What are complications of sinusitis - CORRECT ANSWER Meningitis and encephalitis can occur if pathogens enter the bloodstream from the sinus cavity When are adults contagious when infected with the flu - CORRECT ANSWER 24 hours before manifestations develop and up to five days after What are three extra symptoms of the avian flu compared to the flu - CORRECT ANSWER Severe diarrhea and cough, hypoxia What is nursing care for hospitalized patients infected with influenza - CORRECT ANSWER What are antivirals that may be prescribed for treatment and prevention of the flu - CORRECT ANSWER 1. Amantadine 2. Rimantadine 3. Ribavirin What antivirals may be prescribed to shorten the flu - CORRECT ANSWER 1. Relenza 2. Tamiflu When should patients begin antiviral medications - CORRECT ANSWER 24 to 48 hours after the onset of manifestations Vaccination for the flu is encourage for everyone over six months of age. However high-risk patients include - CORRECT ANSWER 1. History of pneumonia 2. Chronic medical conditions 3. Over the age of 65 4. Pregnant women 5. Health care Providers What is a complication of the flu - CORRECT ANSWER Pneumonia What is the most common manifestation of pneumonia in older adults - CORRECT ANSWER Confusion How does the sputum look with pneumonia - CORRECT ANSWER Purulent, blood tinged or rust colored sputum Elevated wbc's are normally elevated in pneumonia with the exception of - CORRECT ANSWER May not be present in older patients What are diagnostic procedures for pneumonia - CORRECT ANSWER 1. Chest x-ray will show consolidation of lung tissue 2. Pulse oximetry may show less than expected range What are nursing interventions for pneumonia - CORRECT ANSWER 1. Position the patient in high Fowlers unless contraindicated 2. Encourage coughing or suctioning 3. Oxygen therapy/breathing treatments as prescribed 4. Incentive spirometer 5. Structure activity to include periods of rest 6. Encourage fluid intake of 2 to 3 L/day It is important to obtain a culture specimen before antibiotic therapy. What are two common antibiotics given - CORRECT ANSWER Penicillins and cephalosporins What are nursing considerations regarding medications for pneumonia - CORRECT ANSWER 1. Observe patients taking cephalosporins for frequent stools 2. Monitor her kidney function, especially older adults who are taking penicillins and cephalosporins 3. Take medication with food. Some penicillins should be taken one hour before meals or two hours after Bronchodilators are given to reduce bronchospasms and reduce irritation. What is a short acting Beta two agonist bronchodilator - CORRECT ANSWER Albuterol Anti-cholinergic medications such as blank, block the parasympathetic nervous system, allowing for increased bronchodilation and decreased pulmonary secretions - CORRECT ANSWER Ipratropium Methylxanthines such as blank, require close monitoring of serum medication levels due to narrow therapeutic range - CORRECT ANSWER Theophylline What are adverse effects of Theophylline - CORRECT ANSWER Nausea, tachycardia, diarrhea What should you watch for in patients taking albuterol - CORRECT ANSWER Tremors, tachycardia Observe for dry mouth in patients taking ipratropium and monitor heart rate. Adverse effects include - CORRECT ANSWER Headache, blurred vision and palpitations which may indicate toxicity What should you encourage patients to do while taking ipratropium - CORRECT ANSWER Suck on hard candies to help moisten dry mouth Anti-inflammatories such as glucocorticosteroids such as fluticasone and prednisones are prescribed to reduce inflammation. Monitor for - CORRECT ANSWER Immunosuppression, fluid retention, hyperglycemia, hypokalemia and poor wound healing, black/tarry stools What are other nursing considerations for anti-inflammatories - CORRECT ANSWER What are complications from pneumonia - CORRECT ANSWER Atelectasis, bacteremia, acute respiratory distress syndrome What are manifestations of atelectasis - CORRECT ANSWER 1. Patient reports SOB and exhibits findings of hypoxemia 2. Patient has diminished/absent breath sounds over the affected area 3. Chest x-ray shows area of density What are manifestations of acute respiratory distress syndrome (ARDS) - CORRECT ANSWER 1. Hypoxemia persists despite oxygen therapy 2. Patients dyspnea worsens as bilateral pulmonary edema develops that is non-cardiac related 3. Chest x-ray shows an area of density with a "ground glass "appearance 4. Blood gas findings demonstrate hypercarbia even though pulse oximetry shows decreased saturation Patient with pulmonary tuberculosis is being discharged with a prescription for rifampin. The nurse should plan to include which of the following in the patient's discharge teaching plan - CORRECT ANSWER Urine and other secretions orange in color A nurse is caring for a patient with COPD. What assessment finding should the nurse report to the primary care provider regarding the color of sputum - CORRECT ANSWER Productive cough with green sputum What kind of diet should a patient with COPD be on - CORRECT ANSWER High calorie and protein Chapter 21 - CORRECT ANSWER What are some things that may trigger asthma attacks - CORRECT ANSWER 1. Changes in temperature and humidity 2. Perfume 3. Air pollutants 4. Seasonal allergies 5. Stress 6. Medications (aspirin, NSAIDs, beta blockers, cholinergics) 7. enzymes in laundry detergent 8. Sinusitis with post nasal drip 9. Viral respiratory tract infection When a patient has asthma what temperature of water should be used to eliminate dust mites in bed linens? - CORRECT ANSWER Hot water What is something that should be encouraged as part of asthma therapy for a patient - CORRECT ANSWER Regular exercise because it promotes ventilation and perfusion There are many risk factors for asthma, most of them are common sense. What are two risk factors that you may not think of? - CORRECT ANSWER 1. GERD 2. The older patient is more susceptible to infection and therefore they're at bigger risk for complications What are some physical assessment findings of asthma - CORRECT ANSWER 1. Dyspnea 2. Anxiety or stress 3. Coughing 4. Wheezing 5. Mucus production 6. Use of accessory muscles 7. Prolonged exhalation 8. Poor O2 sat 9. Barrel chest or increased chest diameter What diagnostic test is most accurate for diagnosing asthma and its severity? - CORRECT ANSWER Pulmonary function test What are some things that you can do as a nurse to maximize patient comfort in a patient that has asthma - CORRECT ANSWER 1. Hi Fowler's 2. Oxygen 3. Monitor cardiac rate and rhythm for changes during an acute attack 4. Initiate and maintain IV access 5. Encourage prompt medical attention for infections and appropriate vaccinations What are some things that a nurse should monitor when a patient is using Theophylline - CORRECT ANSWER Monitor the patient's serum levels for toxicity. Side effects will include tachycardia, nausea and diarrhea What are some things that a nurse should monitor the patient for when the patient is using albuterol - CORRECT ANSWER Tremors and tachycardia What is something that a nurse should monitor the patient for when the patient is using Ipratropium - CORRECT ANSWER Dry mouth If a patient was showing symptoms of ipratropium toxicity what would the symptoms be? - CORRECT ANSWER Headache, blurred vision or palpitations What kind of asthma attack is salmeterol used for - CORRECT ANSWER Is used to prevent an asthma attack and not at the onset of an attack What are things that a nurse should watch for when a patient is taking corticosteroids, leukotriene antagonist (singulair), mast cell stabilizer (Cromolyn), or monoclonal antibodies (omalizumab) - CORRECT ANSWER 1. Decreased immune function 2. Hyperglycemia 3. Black, tarry stools 4. Fluid retention/weight gain (common) 5. Hypokalemia with corticosteroids such as prednisone How should prednisone be taken? - CORRECT ANSWER With food What is status asthmaticus - CORRECT ANSWER Life-threatening episode of airway obstruction that is unresponsive to common treatment What are symptoms of status asthmaticus - CORRECT ANSWER 1. Extreme wheezing 2. Labored breathing 3. Use of accessory muscles 4. Distended neck veins 5. Creates a risk for cardiac/respiratory arrest What are nursing interventions for status asthmaticus - CORRECT ANSWER 1. Prepare for emergency intubation 2. As prescribed, administer oxygen, bronchodilators, epinephrine and initiate systemic steroid therapy Chapter 22 - CORRECT ANSWER What is emphysema characterized by - CORRECT ANSWER Loss of lung elasticity and hyperinflation of lung tissue What is a genetic risk for COPD - CORRECT ANSWER Alpha-1 antitrypsin deficiency What are some physical assessment findings of COPD - CORRECT ANSWER 1. Barrel chest 2. Hyperresonance on percussion 3. Thin extremities and enlarged neck muscles 4. Clubbing of fingers and toes 5. Dependent edema secondary to right-sided heart failure (increase in pulmonary pressure) Would hematocrit be low or high in a patient that has COPD? - CORRECT ANSWER High due to low oxygenation levels Does COPD increase or decrease caloric demands - CORRECT ANSWER Increase because work of breathing has increased Patients that have COPD may need blank of oxygen via nasal cannula or up to blank via Venturi mask - CORRECT ANSWER 2 to 4 L/min, 40% Patients who have chronically increased PaCO2 levels usually require blank of oxygen via nasal cannula - CORRECT ANSWER 1 to 2 L/min A positive expiratory pressure device assist patients to remove airway secretions. The patient inhales deeply and exhales through the device. While exhaling, a ball moves causing - CORRECT ANSWER A vibration that results in loosening the clients secretions How often should a patient with COPD do exercise conditioning (walking until dyspnea occurs, resting and then walking again) - CORRECT ANSWER 20 minutes, 2 to 3 times weekly How much fluids should a patient who has COPD drink - CORRECT ANSWER 2 to 3 L/day Most of the medications for COPD are the same as asthma. With the exception of Mucolytic's. What are two kinds of mucolytic's? - CORRECT ANSWER Mucomyst, dornase alpha Chapter 23 - CORRECT ANSWER How long does it take for the risk of transmission to decrease regarding TB - CORRECT ANSWER 2 to 3 weeks after anti-tuberculin therapy A patient will have a positive intradermal TB test within blank weeks of exposure to the - CORRECT ANSWER 2 to 10 How often should patients who live in high-risk areas be screened for tuberculosis - CORRECT ANSWER On a yearly basis What are risk factors for TB - CORRECT ANSWER In addition, recent travel outside of the US, substance use and health care occupation What are symptoms of TB - CORRECT ANSWER 1. Persistent cough lasting longer than three weeks 2. Purulent sputum, possibly blood streaked 3. Fatigue and lethargy 4. Weight loss and anorexia 5. Night sweats 6. Low-grade fever in the afternoon When should the Mantoux test to be read - CORRECT ANSWER Within 48 to 72 hours What is a positive Mantoux test? - CORRECT ANSWER 1. 10 mm or greater 2. 5 mm is considered positive for immunocompromised patients What kind of diet should a patient with TB be on? - CORRECT ANSWER Foods that are rich in protein, iron and vitamin C How does isoniazid work - CORRECT ANSWER By preventing synthesis of mycolic acid in the cell wall How should isoniazid be taken - CORRECT ANSWER On an empty stomach What should you monitor for any patient that is taking isoniazid - CORRECT ANSWER Hepatotoxicity and neurotoxicity, such as tingling of the hands and feet (vitamin B6 is used to prevent neurotoxicity) How does rifampin work - CORRECT ANSWER Inhibits DNA dependent RNA polymerase activity What are side effects of rifampin - CORRECT ANSWER 1. Hepatotoxicity (they should report yellowing of the skin, pain or swelling of joints, loss of appetite or malaise) 2. Orange color of urine and other secretions 3. May interfere with oral contraceptives What is a side effect of pyrazinamide - CORRECT ANSWER Hepatotoxicity How should pyrazinamide be consumed? - CORRECT ANSWER Instruct the patient to drink a glass of water with each dose and increase fluids during the day How does ethambutol work - CORRECT ANSWER By inhibiting protein synthesis What are two things that you need to obtain before administering ethambutol to a patient - CORRECT ANSWER 1. Baseline visual acuity 2. Determine color discrimination ability (this medication should not be given to children younger than 13 years of age) What is the most important thing to teach a patient that is on ethambutol - CORRECT ANSWER To report vision changes immediately What is streptomycin sulfate - CORRECT ANSWER Aminoglycoside antibiotic that potentiates the efficacy of macrophages during phagocytosis What kind of patients are put on streptomycin - CORRECT ANSWER Those who have multi drug-resistant TB because of this medications high level of toxicity What are two side effects of streptomycin - CORRECT ANSWER Ototoxicity Renal function decline How often are sputum samples needed during tuberculosis therapy - CORRECT ANSWER Every 2 to 4 weeks to monitor therapy What is miliary TB - CORRECT ANSWER Where the infection invades the bloodstream and can lead to MODS What are symptoms/complications of miliary TB - CORRECT ANSWER Headaches Neck stiffness Drowsiness Pericarditis Chapter 56 - CORRECT ANSWER What is the only condition that increases serum creatinine levels - CORRECT ANSWER Kidney disease What is the purpose of a VCUG - CORRECT ANSWER To detect whether urine refluxes into ureters as an x-ray is taken while the patient is voiding What should you do as a nurse after a patient has a VCUG - CORRECT ANSWER 1. Monitor the patient for infection for the first 72 hours after 2. Encourage increased fluid intake 3. Monitor urine output What are preprocedure nursing interventions for a patient that is going to have a kidney biopsy - CORRECT ANSWER 1. Review coagulation studies 2. NPO for 4 to 6 hours before What are post procedure nursing interventions for a patient that has had a kidney biopsy - CORRECT ANSWER 1. Monitor vitals 2. Assess dressings and urinary output (hematuria) 3. Review HGB and HCT values 4. Administer PRN pain medication A cystography or cystourethrography are used to discover abnormalities of bladder wall and/or a occlusions of ureter or urethra. What are pre-procedure nursing interventions for these procedures? - CORRECT ANSWER 1. NPO after midnight 2. Administer laxative/enema for bowel preparation the night before the procedure What position should a patient be in for a cystography or Cystourethrography - CORRECT ANSWER Lithotomy position What color urine may come out after a cystography or cystourethrography - CORRECT ANSWER Urine maybe pink tinged What should you do if blood clots are present or urine output is decreased or absent after a cystography or Cystourethrography - CORRECT ANSWER Irrigate urinary catheter with NS What are a retrograde pyelogram, Cystogram, or urethrogram used for - CORRECT ANSWER To identify obstruction or structural disorders of the ureters and renal pelvis of the kidneys by instilling contrast dye during a cystoscopy What is a renography used for - CORRECT ANSWER To assess renal bloodflow and estimate GFR after IV injection of radioactive material to produce a scanned image of the kidneys What should you assess frequently during and after A renography if captopril is given to change blood flow to the kidneys - CORRECT ANSWER BP What is an excretory urography used for - CORRECT ANSWER To detect obstruction, assess for a parenchymal mass, and assess size of the kidney. IV contrast dye is used to enhance images What are preprocedure nursing interventions for a patient that is having an excretory urography - CORRECT ANSWER 1. Increased fluids the day before the procedure 2. Bowel prep 3. NPO after midnight 4. Hold Metformin for 24 hours before procedure What are post procedure nursing interventions for a patient that has had an excretory urography - CORRECT ANSWER 1. Administer parenteral fluid or encourage oral fluids to flush dye 2. Diuretics may be administered to increase dye secretion 3. Follow up creatinine and bun serum levels before Metformin is resumed A nurse is reviewing a patient's laboratory findings for urinalysis. The findings indicate the urine is positive for leukoesterase and nitrates. Which of is an appropriate nursing action? - CORRECT ANSWER Obtain a clean catch urine specimen for culture and sensitivity because this determines the antibiotic that will be most effective for treatment of the urinary tract infection Why would a patient with a history of asthma be at risk for a complication when undergoing excretory urography? - CORRECT ANSWER A patient who has a history of asthma has a higher risk of having an asthma attack as an allergic response to the contrast dye used during the procedure Chapter 57 - CORRECT ANSWER How do you estimate a patient's amount of fluid removed after dialysis - CORRECT ANSWER By comparing the patients preprocedure weight to the post procedure weight How long should invasive procedures be avoided after dialysis - CORRECT ANSWER 4 to 6 hours due to the risk of bleeding related to an anticoagulant How do you check an AV fistula or AV graft for patency - CORRECT ANSWER By checking for thrill or bruit When should you contact the provider after dialysis - CORRECT ANSWER 1. If bleeding from the insertion site last longer than 30 minutes 2. Absence of thrill/bruit 3. Signs of infection What kind of diet should a patient be on after dialysis - CORRECT ANSWER high folate, high protein diet What is disequilibrium syndrome - CORRECT ANSWER Caused by too rapid of a decrease in BUN and circulating fluid volume. It may result in cerebral edema and increased ICP What are signs/symptoms of disequilibrium syndrome - CORRECT ANSWER nausea Vomiting Change in LOC Seizures Agitation Blank, is a risk factor for dialysis disequilibrium and hypotension due to rapid changes in fluid and electrolyte status - CORRECT ANSWER Advanced age What can a nurse do to decrease the risk of disequilibrium syndrome - CORRECT ANSWER 1. Use a slow dialysis exchange rate, especially for older adults and those being treated with hemodialysis for the first time 2. Administer anticonvulsants/barbiturates if needed What is something that a nurse should do for a patient experiencing hypotension from dialysis other than administer IV fluids - CORRECT ANSWER Lower the head of the patient's bed What is peritoneal dialysis - CORRECT ANSWER Involves instillation of a hypertonic solution into the peritoneal cavity. The solution dwells in the peritoneal cavity as ordered by the provider. Drain the solution that includes the waste products. The peritoneum serves as the filtration membrane What color should the dialysate solution be - CORRECT ANSWER Clear, light yellow is expected How much should the outflow be compared to the inflow - CORRECT ANSWER Expected to equal or exceed amount of dialysate inflow (insufficient outflow could mean infection) If a fibrin clot has formed in the peritoneal dialysis catheter what should you do? - CORRECT ANSWER Carefully milk the catheter What are two conditions caused by dialysis - CORRECT ANSWER Hyperglycemia and hyperlipidemia Blank, is a common cause of poor inflow or outflow - CORRECT ANSWER Constipation What position should a patient be in during CCPD and APD treatment - CORRECT ANSWER Supine with head slightly elevated If medications are held before dialysis can they be administered after it is done - CORRECT ANSWER Yes, medications that can be partially dialysed during the treatment should be withheld. After the treatment, the nurse should administer the medication. Why should a patient that is experiencing shortness of breath not receive peritoneal dialysis - CORRECT ANSWER Because they may not be able to tolerate excessive fluids being instilled into their abdomen Chapter 58 - CORRECT ANSWER What are patient indications of end-stage kidney disease necessitating kidney transplant - CORRECT ANSWER 1. Anuria 2. Proteinuria 3. Marked azotemia 4. Severe electrolyte imbalance 5. Fluid volume excess conditions (heart failure, pulmonary edema) 6. Uremic lung What are subjective signs/symptoms of end-stage kidney disease - CORRECT ANSWER Anorexia Fatigue Paresthesia SOB Dry, itchy skin Metallic taste Muscle cramping What are object of signs/symptoms of end-stage kidney disease - CORRECT ANSWER Decreased attention span, seizures, tremor, HF, Edema, dyspnea, hypertension, distended jugular vein's, anemia, vomiting, pulmonary edema, cardiac dysrhythmias, pallor, dry itchy skin, bruising, halitosis and diminished or dark colored urine What is methylprednisone sodium succinate - CORRECT ANSWER An anti-inflammatory and immunosuppressant used to decrease the immune system response of inflammation and rejection of donor kidney What is another immunosuppressant medication used to prevent rejection of the donor kidney - CORRECT ANSWER Cyclosporine A patient has had a kidney transplant is usually dialyzed within blank of the surgery - CORRECT ANSWER 24 hours What are some things you should assess/monitor the patient for after a kidney transplant - CORRECT ANSWER 1. Vital signs every 15 minutes initially and advance to every hour 2. Report urine output less than 30 mL/HR 3. Urine appearance and older should be checked hourly (initially pink and bloody) 4. Daily weights 5. Maintain continuous bladder irrigation as prescribed (to prevent clots from forming) What diuretic is preferred when oliguria is present after a kidney transplant - CORRECT ANSWER Mannitol What kind of diet should a patient be on after a kidney transplant - CORRECT ANSWER Lowfat, high-fiber, increased protein, low-sodium, avoid sugars or carbohydrates When taking cyclosporine what are two things you need to do - CORRECT ANSWER 1. Magnesium supplements because it reduces magnesium levels 2. Avoid grapefruit What is hyper acute rejection - CORRECT ANSWER Rejection that occurs within 48 hours after surgery caused by an anti-body mediated response that causes small blood clot to form in the transplanted kidney What are symptoms of a hyper acute rejection - CORRECT ANSWER Fever, hypertension, pain at the transplant site What is treatment for hyper acute rejection - CORRECT ANSWER Immediate removal of the donor kidney What is acute rejection - CORRECT ANSWER Occurs one week to two years after surgery. An antibody mediated response causing vasculitis in the donor kidney and cellular destruction starts with inflammation that causes lysis of the donor kidney What are symptoms of an acute rejection - CORRECT ANSWER Oliguria Anuria Low-grade fever Hypertension Tenderness over the transplanted kidney Lethargy Azotemia Fluid retention What is treatment for acute rejection - CORRECT ANSWER Involves increased doses of immunosuppressive medications What is chronic rejection - CORRECT ANSWER Occurs gradually over months to years. Blood vessel injury from overgrowth of the smooth muscles of the blood vessels causing fibrotic tissue to replace normal tissue resulting in a nonfunctioning donor kidney What are symptoms of chronic rejection - CORRECT ANSWER Gradual return of azotemia Fluid retention Electrolyte imbalance Fatigue What is treatment for chronic rejection - CORRECT ANSWER Monitor kidney status, continue immunosuppressive therapy until dialysis is required What is acute tubular necrosis - CORRECT ANSWER Caused by a delay in transplanting the donor kidney after harvesting may result in hypoxic injury of the donor kidney What are symptoms/signs of renal artery stenosis - CORRECT ANSWER Hypertension Bruit over artery anastomosis site Decreased kidney function Peripheral edema What is the most common cause of first transplant year morbidity and mortality - CORRECT ANSWER Infection Chapter 60 - CORRECT ANSWER What are the four phases of acute kidney injury - CORRECT ANSWER 1. Onset: begins with the onset of the event, ends when oliguria develops and lasts for hours to days 2. Oliguria: begins with the kidney insult, urine output is 100 to 400 mL/24 hour with or without diuretics and lasts for 1 to 3 weeks 3. Diuresis: begins when the kidneys start to recover, diuresis of a large amount of fluid occurs and can last for 2 to 6 weeks 4. Recovery: continues until kidney function is fully restored and can take up to 12 months What is prerenal acute kidney injury - CORRECT ANSWER Occurs as a result of volume depletion and prolonged reduction of blood flow to the kidneys which leads to ischemia of the nephrons What is treatment for prerenal acute kidney injury - CORRECT ANSWER 1. Administer IV fluid if no fluid restrictions 2. Administer calcium channel blocker to prevent the movement of calcium into the kidney cells and to increase GFR 3. Monitor I and O's 4. Monitor for decreased cardiac output Intrarenal acute kidney injury occurs as a result of direct damage to the kidney from lack of oxygen (acute tubular necrosis). What are causes of intrarenal acute kidney injury - CORRECT ANSWER 1. Physical injury 2. Hypoxic injury - renal artery or vein stenosis or thrombosis 3. Chemical injury - acute nephrotoxins (antibiotics, NSAIDs, contrast dye, heavy metal, blood transfusion reaction) 4. Immunologic injury - infection, vasculitis, acute glomerulonephritis What are two complications of intrarenal acute kidney injury - CORRECT ANSWER Heart failure or pulmonary edema What are signs/symptoms of acute intrarenal kidney injury - CORRECT ANSWER ECG dysrhythmias (tall T waves) Flank pain N/V Lethargy Tremors Confusion Post renal acute kidney injury occurs as a result of bilateral obstruction of structures leaving the kidney. What are causes - CORRECT ANSWER 1. Stone, tumor, bladder atony 2. Prostate hyperplasia, urethral stricture 3. Spinal cord disease or injury How do laboratory values look in post renal acute kidney injury - CORRECT ANSWER Gradually increases in serum creatinine, BUN, urine specific gravity What is nutrition for post renal acute kidney injury - CORRECT ANSWER Restrict potassium, phosphate and magnesium during oliguric phase and increase protein What are the five stages of chronic kidney disease - CORRECT ANSWER Stage one: minimal kidney damage with normal GFR (greater than 90 ML/min) Stage two: mild kidney damage with GFR 60 to 89 mL/min Stage III: GFR 30 to 59 mL/min Stage 4: GFR is 15 to 29 mL/min Stage five: GFR less than 15 mL/min How much fluids are patients with chronic kidney disease encouraged to drink - CORRECT ANSWER At least 3 L of water daily If a patient has diabetes or hypertension and chronic kidney disease what should you encourage them to come in for regarding yearly tests - CORRECT ANSWER Yearly testing for albumin in the urine What are some signs and symptoms of chronic kidney failure - CORRECT ANSWER Fatigue Lethargy Involuntary movement of the legs Depression Intractable hiccups How do you serum electrolytes look in chronic kidney disease - CORRECT ANSWER Decreased sodium and calcium; increased potassium, phosphorus and magnesium Why is hemoglobin and hematocrit decreased in chronic kidney disease - CORRECT ANSWER From anemia secondary to the loss of erythropoietin What are complications of CKD - CORRECT ANSWER Electrolyte imbalance Dysrhythmias Fluid overload Hypertension Metabolic acidosis Secondary infection Uremia What kind of diet should a patient be on that has chronic kidney disease - CORRECT ANSWER High in carbohydrates and moderate in fat What medications are considered nephrotoxic - CORRECT ANSWER Aminoglycosides Amphotericin b NSAIDs Ace inhibitors Arbs Contrast dye If a patient is on digoxin when should you administer it - CORRECT ANSWER After receiving dialysis Why is aluminum hydroxide given to patients with chronic kidney disease - CORRECT ANSWER Taken with meals to bind phosphate in food and stop phosphate absorption (take two hours before or after digoxin) What kind of diuretic should be avoided in patients that have end stage kidney disease - CORRECT ANSWER Loop diuretics What kind of Antacids should a patient with kidney disease avoid - CORRECT ANSWER Those containing magnesium If a patient has a high creatinine level what should you assess for in the urine - CORRECT ANSWER Blood Chapter 61 - CORRECT ANSWER Who is more at risk for urosepsis women or men - CORRECT ANSWER Aging women due to decreased estrogen which promotes atrophy of the urethral opening towards the rectum What are subjective signs/symptoms of a urinary tract infection - CORRECT ANSWER 1. Lower back/abdominal discomfort 2. Urinary frequency/urgency 3. Nausea 4. Dysuria, cramping 5. Urinary retention 6. Perineal itching 7. Hematuria 8. Pyuria (greater than four wbc in urine sample) What are objective signs/symptoms of a urinary tract infection - CORRECT ANSWER 1. Fever 2. Vomiting 3. Voiding in small amounts 4. Nocturia 5. Urethral discharge 6. Cloudy/smelly urine What are older adult clinical manifestations of a UTI - CORRECT ANSWER 1. Mental confusion 2. Incontinence 3. Loss of appetite 4. Nocturia and dyslexia 5. Signs of urosepsis What are signs of urosepsis - CORRECT ANSWER Hypotension Tachycardia Tachypnea Fever If a patient has a urinary tract infection what are some things you'd expect to find in the urine - CORRECT ANSWER Bacteria, sediment, WBCs, RBCs, positive leukocyte esterase and nitrates If a patient has a urinary tract infection what are some things you can encourage the patient to do to relieve symptoms - CORRECT ANSWER 1. Promote fluid intake up to 3 L a day 2. Encourage urination every 3 to 4 hours instead of waiting until the bladder is completely full 3. Recommend warm sitz Bath 2 to 3 times a day to promote comfort What are two medications that are prescribed less frequently for UTIs because the medicine is less effective and tolerated - CORRECT ANSWER Penicillins and cephalosporins If a sulfonamide is prescribed for a patient with a UTI what should you ask the patient about? - CORRECT ANSWER Allergy to sulfa What is a bladder analgesic that is used to treat UTIs - CORRECT ANSWER Phenozopyridine (take with food) When a patient has a UTI they are encouraged to drink cranberry juice because a compound in cranberries may stop certain bacteria from adhering to the mucosa of the urinary tract. Patients who have blank should avoid cranberry juice, which irritates the bladder - CORRECT ANSWER Chronic cystitis What are risk factors for pyelonephritis - CORRECT ANSWER 1. Men over 65 who have prostatitis and hypertrophy of the prostate 2. Chronic urinary stone disorders 3. Spinal cord injury 4. Pregnancy 5. Bladder tumors 6. Urine pH increases 7. Chronic illnesses (DM, HTN) Chills, nausea, malaise, fatigue, burning/urgency/frequency with urination are all subjective signs and symptoms of pyelonephritis. What are two more less obvious symptoms? - CORRECT ANSWER Colicky type abdominal pain and costovertebral tenderness What are objective signs/symptoms of pyelonephritis - CORRECT ANSWER Fever Tachycardia Tachypnea Hypertension Flank/back pain Vomiting Nocturia Asymptomatic bacteremia Inability to concentrate urine or conserve sodium What are 4 lab values that will be increased with pyelonephritis nephritis - CORRECT ANSWER C-reactive protein, ESR, Creatinine and BUN What are complications of chronic pyelonephritis - CORRECT ANSWER Septic shock Chronic kidney disease Hypertension Although penicillin antibiotics are rarely used to treat urinary tract infections with kidney infections this type of penicillin may be used - CORRECT ANSWER Ampicillin Chapter 62 - CORRECT ANSWER Does a diet high in calcium increase the risk for kidney Stones. Since the majority of stones are composed of calcium phosphate or calcium oxalate - CORRECT ANSWER No not unless there is a pre-existing metabolic disorder or renal tubular defect Who is more at risk for urolithiasis? Males or females - CORRECT ANSWER There is an increased incidence of urolithiasis in males What are four things that contribute to an environment favorable for stone formation - CORRECT ANSWER Urinary stasis, urinary retention, immobilization and dehydration What is something that you might see in a urinalysis of a patient that has a kidney stone - CORRECT ANSWER Crystals What does KUB stand for - CORRECT ANSWER X-ray of kidney, ureters and bladder What are things that a nurse should assess/monitor for any patient that