Medical-Surgical Nursing, 12th Edition Test Bank by Harding Lewis’s Chapter 1-69 Latest Version 2022/2023.

11. A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can be used sooner after surgery. d. A fistula can accommodate larger needles. ANS: A Arteriovenous (AV) fistulas are much less likely to clot than grafts. It takes longer for AV fistulas to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility. 12. Which action will the nurse include in the plan of care to maintain the patency of a patient‘s left arm arteriovenous fistula? a. Auscultate for a bruit at the fistula site. b. Assess the quality of the left radial pulse. c. Irrigate the fistula with saline every 8 to 12 hours. d. Compare blood pressures in the left and right arms. ANS: A The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures would never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula. 13. A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. More protein is allowed because urea and creatinine are removed by dialysis. c. Dietary potassium is not restricted because the level is normalized by dialysis. d. Unlimited fluids are allowed because retained fluid is removed during dialysis. ANS: B When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Glucose is not lost during hemodialysis. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes. 14. Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while in the bathtub each day. d. The patient slows the inflow rate when experiencing abdominal pain. ANS: C Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis. 15. Which information in a patient‘s history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation? a. The patient has type 1 diabetes. b. The patient has metastatic lung cancer. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with human immunodeficiency virus. ANS: B Advanced cancer is a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant. 16. Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid taken for four years after kidney transplantation? a. Postural hypotension b. Recurrent tachycardia c. Knee and hip joint pain d. Increased serum creatinine ANS: C Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not associated with corticosteroid use. 17. A patient who had a kidney transplant eight years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone. Which assessment data will be of most concern to the nurse? a. Skin is thin and fragile. b. Blood pressure is 150/92. c. A lump is palpable in the axilla. d. Fasting blood glucose is 144 mg/dL. ANS: C A palpable lump suggests a possible cancer, such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The increased glucose, skin change, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of cancer. 18. The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication being taken by the patient indicates a need for patient teaching? a. Acetaminophen b. Calcium phosphate c. Magnesium hydroxide d. Multivitamin with iron ANS: C Magnesium is excreted by the kidneys, so patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD. 19. What laboratory value would the nurse check before administering captopril to a patient with stage 2 chronic kidney disease? a. Glucose b. Potassium c. Creatinine d. Phosphate ANS: B Angiotensin-converting enzyme (ACE) inhibitors are often used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect administration of captopril. 20. A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin. Which laboratory value would the nurse monitor for adverse effects of the medication? a. Blood glucose b. Urine osmolality c. Serum creatinine d. Serum potassium ANS: C When a patient with diabetes, which increases risk for chronic kidney disease (CKD), receives a potentially nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in assessing for the adverse effects of the gentamicin. 21. A patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information would the nurse discuss with the health care provider before giving the medication? a. Creatinine 1.6 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg ANS: C High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) so the recommendation is to use the lowest possible dose of erythropoietin. Hemoglobin levels well in the normal range indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider but will not affect whether the medication is administered.