Hepatic-i Renali NCLEXi Q's
Ai clienti whoi isi diagnosedi withi virali hepatitisi isi complainingi ofi "noi
appetite"i andi "losingi myi tastei fori food."i Whati instructioni shouldi thei nursei
givei thei clienti toi guidei adequatei nutrition?
1.i Selecti foodsi highi ini fat.
2.i Increasei intakei ofi fluids,i includingi juices.
3.i Eati ai goodi supperi wheni anorexiai isi noti asi severe.
4.i Eati lessi often,i preferablyi onlyi threei largei mealsi daily.i -i
i i i i i i i i i i i i i i ANSWER:i 2
i Rationale:i Althoughi noi speciali dieti isi requiredi toi treati virali hepatitis,i iti
isi generallyi recommendedi thati clientsi consumei ai low-fati diet,i asi fati mayi
bei toleratedi poorlyi becausei ofi decreasedi bilei production.i Small,i frequenti
mealsi arei preferablei andi mayi eveni preventi nausea.i Frequently,i appetitei isi
betteri ini thei morning,i soi iti isi easieri toi eati ai goodi breakfast.i Ani
adequatei fluidi intakei ofi 2i 500i toi 3i 000i mL/dayi thati includesi nutritionali
juicesi isi alsoi important.
Ai clienti hasi developedi hepatitisi Ai afteri eatingi contaminatedi oysters.i Thei
nursei assessesi thei clienti fori whichi expectedi assessmenti finding?
1.i Malaise
2.i Darki stools
3.i Weighti gain
4.i Lefti upperi quadranti discomforti -i
i i i i i i i i i i i i i i ANSWER:i 1
i Rationale:i Hepatitisi causesi gastrointestinali symptomsi suchi asi anorexia,i
nausea,i righti upperi quadranti discomfort,i andi weighti loss.i Fatiguei andi malaisei
arei common.i Stoolsi willi bei light-i ori clay-colouredi ifi conjugatedi bilirubini isi
unablei toi flowi outi ofi thei liveri becausei ofi inflammationi ori obstructioni ofi
thei bilei ducts.
Thei healthi carei provideri hasi determinedi thati ai clienti hasi contractedi hepatitisi
A,i basedi oni flulikei symptomsi andi jaundice.i Whichi statementi madei byi thei
clienti supportsi thisi medicali diagnosis?
1.i "Ii havei hadi unprotectedi sexi withi multiplei partners."
2.i "Ii atei shellfishi abouti 2i weeksi agoi ati ai locali restaurant."
3.i "Ii wasi ani intravenousi drugi abuseri ini thei pasti andi sharedi needles."
4.i "Ii hadi ai bloodi transfusioni 30i yearsi agoi afteri majori abdominali surgery."i
-i
i i i i i i i i i i i i i i ANSWER:i 2
i Rationale:i Hepatitisi Ai isi transmittedi byi thei fecal-orali routei viai
contaminatedi wateri ori foodi (improperlyi cookedi shellfish)i ori infectedi foodi
handlers.i Hepatitisi B,i C,i andi Di arei transmittedi mosti commonlyi viai infectedi
bloodi ori bodyi fluids,i suchi asi withi intravenousi drugi abuse,i historyi ofi bloodi
transfusion,i ori unprotectedi sexi withi multiplei partners.
1i |i P a g e
,Thei nursei isi reviewingi laboratoryi resultsi fori ai clienti withi cirrhosisi andi
notesi thati thei ammoniai leveli isi 51i mcmol/Li (85i mcg/dL).i Whichi dietaryi
selectioni doesi thei nursei suggesti toi thei client?
1.i Roasti pork
2.i Cheesei omelet
3.i Pastai withi sauce
4.i Tunai fishi sandwichi -i
i i i i i i i i i i i i i i ANSWER:i 3
i Rationale:i Cirrhosisi isi ai chronic,i progressivei diseasei ofi thei liveri
characterizedi byi diffusei degenerationi andi destructioni ofi hepatocytes.i Thei
serumi ammoniai leveli assessesi thei abilityi ofi thei liveri toi deaminatei proteini
byproducts.i Normali referencei intervali isi 6i toi 47i mcmol/Li (10i toi 80i
mcg/dL).i Mosti ofi thei ammoniai ini thei bodyi isi foundi ini thei gastrointestinali
tract.i Proteini providedi byi thei dieti isi transportedi toi thei liveri byi thei portali
vein.i Thei liveri breaksi downi protein,i whichi resultsi ini formationi ofi ammonia.i
Foodsi highi ini proteini shouldi bei avoidedi sincei thei client'si ammoniai leveli isi
elevatedi abovei thei normali range;i therefore,i pastai withi saucei wouldi bei thei
besti selection.
Ai clienti withi acutei kidneyi injuryi hasi ai serumi potassiumi leveli ofi 7.0i
mmol/Li (7.0i mEq/L).i Thei nursei shouldi plani whichi immediatei actions?i Selecti
alli thati apply.
1.i Placei thei clienti oni ai cardiaci monitor.
2.i Notifyi thei primaryi healthi carei provideri (PHCP).
3.i Puti thei clienti oni NPOi (nothingi byi mouth)i statusi excepti fori icei chips.
4.i Reviewi thei client'si medicationsi toi determinei ifi anyi containi ori retaini
potassium.
5.i Allowi ani extrai 500i mLi ofi intravenousi fluidi intakei toi dilutei thei
electrolytei concentration.i -i
i i i i i i i i i i i i i i ANSWER:i 1,i 2,i 4
i Rationale:i Thei normali potassiumi leveli isi 3.5-5.0i mmol/Li (3.5-5.0i mEq/L).i
Ai potassiumi leveli ofi 7.0i isi elevated.i Thei clienti withi hyperkalemiai isi ati
riski ofi developingi cardiaci dysrhythmiasi andi cardiaci arrest.i Becausei ofi this,i
thei clienti shouldi bei placedi oni ai cardiaci monitor.i Thei nursei shouldi notifyi
thei PHCPi andi alsoi reviewi medicationsi toi determinei ifi anyi containi
potassiumi ori arei potassiumi retaining.i Thei clienti doesi noti needi toi bei puti
oni NPOi status.i Fluidi intakei isi noti increasedi becausei iti contributesi toi fluidi
overloadi andi wouldi noti affecti thei serumi potassiumi leveli significantly.
Ai clienti withi chronici kidneyi diseasei undergoingi hemodialysisi suddenlyi
becomesi shorti ofi breathi andi reportsi chesti paini andi anxiety.i Thei clienti isi
tachycardici andi pale,i andi thei nursei suspectsi airi embolism.i Whati arei thei
priorityi nursingi actions?i Selecti alli thati apply.
1.i Administeri oxygeni toi thei client.
2.i Continuei dialysisi ati ai sloweri ratei afteri checkingi thei linesi fori air.
3.i Notifyi thei primaryi healthi carei provideri (PHCP)i andi Rapidi Responsei
Team.
4.i Stopi dialysis,i andi turni thei clienti oni theiri lefti sidei withi headi loweri
thani feet.
2i |i P a g e
,5.i Bolusi thei clienti withi 500i mLi ofi normali salinei toi breaki upi thei airi
embolus.i -i
i i i i i i i i i i i i i i ANSWER:i 1,i 3,i 4
i Rationale:i Ifi thei clienti experiencesi airi embolusi duringi hemodialysis,i thei
nursei shouldi terminatei dialysisi immediately,i positioni thei clienti soi thei airi
embolusi isi oni thei righti sidei ofi thei heart,i notifyi thei PHCPi andi Rapidi
Responsei Team,i andi administeri oxygeni asi needed.i Slowingi thei dialysisi
treatmenti ori givingi ani intravenousi bolusi willi noti correcti thei airi embolismi
ori preventi complications.
Ai clienti arrivesi ati thei emergencyi departmenti withi lowi abdominali paini andi
hematuria.i Thei clienti isi afebrile.i Whati isi thei mosti likelyi causei associatedi
withi thisi presentation?
1.i Pyelonephritis
2.i Glomerulonephritis
3.i Traumai toi thei bladderi ori abdomen
4.i Renali canceri ini thei client'si familyi -i
i i i i i i i i i i i i i i ANSWER:i 3
i Rationale:i Bladderi traumai ori injuryi shouldi bei consideredi ori suspectedi ini
thei clienti withi lowi abdominali paini andi hematuria.i Glomerulonephritisi andi
pyelonephritisi wouldi bei accompaniedi byi feveri andi arei thusi noti applicablei
toi thei clienti describedi ini thisi question.i Renali canceri wouldi noti causei paini
thati isi felti ini thei lowi abdomen;i rather,i thei paini wouldi bei ini thei flanki
area.
Ai clienti isi admittedi toi thei emergencyi departmenti followingi ai falli fromi ai
horsei andi isi prescribedi insertioni ofi ai urinaryi catheter.i Whilei preparingi fori
thei procedure,i thei nursei notesi bloodi ati thei urinaryi meatus.i Thei nursei
shouldi takei whichi actioni next?
1.i Notifyi thei PHCPi beforei performingi thei catheterization.
2.i Usei ai small-sizedi catheteri andi ani anaesthetici geli asi ai lubricant.
3.i Administeri parenterali paini medicationi beforei insertingi thei catheter.
4.i Cleani thei meatusi withi soapi andi wateri beforei openingi thei catheterizationi
kit.i -i
i i i i i i i i i i i i i i ANSWER:i 1
i Rationale:i Thei presencei ofi bloodi ati thei urinaryi meatusi mayi indicatei
urethrali traumai ori disruption.i Thei nursei shouldi notifyi thei PHCP,i knowingi
thati thei clienti shouldi noti bei catheterizedi untili thei causei ofi thei bleedingi isi
determinedi byi diagnostici testing.i Thei otheri optionsi includei performingi thei
catheterizationi procedurei andi thereforei arei incorrect.
Whati laboratoryi resulti wouldi thei nursei mosti likelyi expecti toi findi fori ai
clienti diagnosedi withi chronici renali disease?
1.i Elevatedi creatininei level
2.i Decreasedi hemoglobini level
3.i Decreasedi redi bloodi celli count
4.i Increasedi numberi ofi whitei bloodi cellsi ini thei urinei -i
i i i i i i i i i i i i i i ANSWER:i 1
i Rationale:i Thei creatininei leveli isi thei mosti specifici laboratoryi testi usedi toi
determinei renali function.i Thei creatininei leveli increasesi wheni ati leasti 50%i
3i |i P a g e
, ofi renali functioni isi lost.i Ai decreasedi hemoglobini leveli andi redi bloodi celli
counti arei associatedi withi anemiai ori bloodi lossi andi noti specificallyi withi
decreasedi renali function.i Increasedi whitei bloodi cellsi ini thei urinei arei notedi
withi urinaryi tracti infection.
Ai clienti withi chronici kidneyi diseasei returnsi toi thei nursingi uniti followingi
hemodialysisi treatment.i Oni assessment,i thei nursei notesi thati thei client'si
temperaturei isi 38.5°C.i Whichi nursingi actioni isi mosti appropriate?
1.i Encouragei fluidi intake.
2.i Continuei toi monitori vitali signs.
3.i Notifyi thei primaryi healthi carei provider.
4.i Monitori thei sitei ofi thei shunti fori infection.i -i
i i i i i i i i i i i i i i ANSWER:i 3
i Rationale:i Ai temperaturei ofi 38.5°Ci isi significantlyi elevatedi andi mayi
indicatei infectioni asi ai complicationi ofi thisi ongoingi treatment.i Thei nursei
shouldi notifyi thei primaryi healthi carei provideri (PHCP).i Dialysisi clientsi
cannoti havei fluidi intakei encouraged.i Vitali signsi andi thei shunti sitei shouldi
bei monitored,i buti thei PHCPi shouldi bei notifiedi first,i asi sepsisi isi ai risk.
Ai clienti withi chronici kidneyi diseasei isi receivingi epoetini alfa.i Whichi
laboratoryi resulti wouldi indicatei ai therapeutici effecti ofi thei medication?
1.i Hematocriti ofi 0.33i (33%)
2.i Plateleti counti ofi 400i ×i 109/Li (400i 000i mm3)
3.i Whitei bloodi celli counti ofi 6.0i ×i 109/Li (6i 000i mm3)
4.i Bloodi ureai nitrogeni leveli ofi 5.25i mmol/Li (15i mg/dL)i -i
i i i i i i i i i i i i i i ANSWER:i 1
i Rationale:i Epoetini alfai isi synthetici erythropoietin,i whichi thei kidneysi
producei toi stimulatei redi bloodi celli productioni ini thei bonei marrow.i Iti isi
usedi toi treati anemiai associatedi withi chronici kidneyi disease.i Thei normali
hematocriti leveli fori malesi isi 0.42i toi 0.52i (42i toi 52%)i andi fori females,i
0.37i toi 0.47i (37i toi 47%).i Therapeutici effecti isi seeni wheni thei hematocriti
reachesi betweeni 0.30i andi 0.33i (30i andi 33%).i Thei normali plateleti counti isi
150i toi 400i ×i 109/Li (150i 000i toi 400i 000i mm3).i Thei normali bloodi ureai
nitrogeni leveli isi 3.6i toi 7.1i mmol/Li (10i toi 20i mg/dL).i Thei normali whitei
bloodi celli counti isi 5i toi 10i ×i 109/Li (5i 000i toi 10i 000i mm3).i Plateleti
production,i whitei bloodi celli production,i andi bloodi ureai nitrogeni doi noti
respondi toi erythropoietin.
______________i isi solelyi filteredi fromi thei bloodstreami viai thei glomerulusi
andi isi NOTi reabsorbedi backi intoi thei bloodstreami buti isi excretedi throughi
thei urine.
A.i Urea
B.i Creatinine
C.i Potassium
D.i Magnesiumi -i
i i i i i i i i i i i i i i Thei answeri isi B.i Creatininei isi ai wastei producti
fromi musclei breakdowni andi isi removedi fromi thei bloodstreami viai thei
glomerulusi ofi thei nephron.i Iti isi thei onlyi substancei thati isi solelyi filteredi
outi ofi thei bloodi buti NOTi reabsorbedi backi intoi thei system.i Iti isi excretedi
outi throughi thei urine.i Thisi isi whyi ai creatininei clearancei testi isi usedi asi
4i |i P a g e
Ai clienti whoi isi diagnosedi withi virali hepatitisi isi complainingi ofi "noi
appetite"i andi "losingi myi tastei fori food."i Whati instructioni shouldi thei nursei
givei thei clienti toi guidei adequatei nutrition?
1.i Selecti foodsi highi ini fat.
2.i Increasei intakei ofi fluids,i includingi juices.
3.i Eati ai goodi supperi wheni anorexiai isi noti asi severe.
4.i Eati lessi often,i preferablyi onlyi threei largei mealsi daily.i -i
i i i i i i i i i i i i i i ANSWER:i 2
i Rationale:i Althoughi noi speciali dieti isi requiredi toi treati virali hepatitis,i iti
isi generallyi recommendedi thati clientsi consumei ai low-fati diet,i asi fati mayi
bei toleratedi poorlyi becausei ofi decreasedi bilei production.i Small,i frequenti
mealsi arei preferablei andi mayi eveni preventi nausea.i Frequently,i appetitei isi
betteri ini thei morning,i soi iti isi easieri toi eati ai goodi breakfast.i Ani
adequatei fluidi intakei ofi 2i 500i toi 3i 000i mL/dayi thati includesi nutritionali
juicesi isi alsoi important.
Ai clienti hasi developedi hepatitisi Ai afteri eatingi contaminatedi oysters.i Thei
nursei assessesi thei clienti fori whichi expectedi assessmenti finding?
1.i Malaise
2.i Darki stools
3.i Weighti gain
4.i Lefti upperi quadranti discomforti -i
i i i i i i i i i i i i i i ANSWER:i 1
i Rationale:i Hepatitisi causesi gastrointestinali symptomsi suchi asi anorexia,i
nausea,i righti upperi quadranti discomfort,i andi weighti loss.i Fatiguei andi malaisei
arei common.i Stoolsi willi bei light-i ori clay-colouredi ifi conjugatedi bilirubini isi
unablei toi flowi outi ofi thei liveri becausei ofi inflammationi ori obstructioni ofi
thei bilei ducts.
Thei healthi carei provideri hasi determinedi thati ai clienti hasi contractedi hepatitisi
A,i basedi oni flulikei symptomsi andi jaundice.i Whichi statementi madei byi thei
clienti supportsi thisi medicali diagnosis?
1.i "Ii havei hadi unprotectedi sexi withi multiplei partners."
2.i "Ii atei shellfishi abouti 2i weeksi agoi ati ai locali restaurant."
3.i "Ii wasi ani intravenousi drugi abuseri ini thei pasti andi sharedi needles."
4.i "Ii hadi ai bloodi transfusioni 30i yearsi agoi afteri majori abdominali surgery."i
-i
i i i i i i i i i i i i i i ANSWER:i 2
i Rationale:i Hepatitisi Ai isi transmittedi byi thei fecal-orali routei viai
contaminatedi wateri ori foodi (improperlyi cookedi shellfish)i ori infectedi foodi
handlers.i Hepatitisi B,i C,i andi Di arei transmittedi mosti commonlyi viai infectedi
bloodi ori bodyi fluids,i suchi asi withi intravenousi drugi abuse,i historyi ofi bloodi
transfusion,i ori unprotectedi sexi withi multiplei partners.
1i |i P a g e
,Thei nursei isi reviewingi laboratoryi resultsi fori ai clienti withi cirrhosisi andi
notesi thati thei ammoniai leveli isi 51i mcmol/Li (85i mcg/dL).i Whichi dietaryi
selectioni doesi thei nursei suggesti toi thei client?
1.i Roasti pork
2.i Cheesei omelet
3.i Pastai withi sauce
4.i Tunai fishi sandwichi -i
i i i i i i i i i i i i i i ANSWER:i 3
i Rationale:i Cirrhosisi isi ai chronic,i progressivei diseasei ofi thei liveri
characterizedi byi diffusei degenerationi andi destructioni ofi hepatocytes.i Thei
serumi ammoniai leveli assessesi thei abilityi ofi thei liveri toi deaminatei proteini
byproducts.i Normali referencei intervali isi 6i toi 47i mcmol/Li (10i toi 80i
mcg/dL).i Mosti ofi thei ammoniai ini thei bodyi isi foundi ini thei gastrointestinali
tract.i Proteini providedi byi thei dieti isi transportedi toi thei liveri byi thei portali
vein.i Thei liveri breaksi downi protein,i whichi resultsi ini formationi ofi ammonia.i
Foodsi highi ini proteini shouldi bei avoidedi sincei thei client'si ammoniai leveli isi
elevatedi abovei thei normali range;i therefore,i pastai withi saucei wouldi bei thei
besti selection.
Ai clienti withi acutei kidneyi injuryi hasi ai serumi potassiumi leveli ofi 7.0i
mmol/Li (7.0i mEq/L).i Thei nursei shouldi plani whichi immediatei actions?i Selecti
alli thati apply.
1.i Placei thei clienti oni ai cardiaci monitor.
2.i Notifyi thei primaryi healthi carei provideri (PHCP).
3.i Puti thei clienti oni NPOi (nothingi byi mouth)i statusi excepti fori icei chips.
4.i Reviewi thei client'si medicationsi toi determinei ifi anyi containi ori retaini
potassium.
5.i Allowi ani extrai 500i mLi ofi intravenousi fluidi intakei toi dilutei thei
electrolytei concentration.i -i
i i i i i i i i i i i i i i ANSWER:i 1,i 2,i 4
i Rationale:i Thei normali potassiumi leveli isi 3.5-5.0i mmol/Li (3.5-5.0i mEq/L).i
Ai potassiumi leveli ofi 7.0i isi elevated.i Thei clienti withi hyperkalemiai isi ati
riski ofi developingi cardiaci dysrhythmiasi andi cardiaci arrest.i Becausei ofi this,i
thei clienti shouldi bei placedi oni ai cardiaci monitor.i Thei nursei shouldi notifyi
thei PHCPi andi alsoi reviewi medicationsi toi determinei ifi anyi containi
potassiumi ori arei potassiumi retaining.i Thei clienti doesi noti needi toi bei puti
oni NPOi status.i Fluidi intakei isi noti increasedi becausei iti contributesi toi fluidi
overloadi andi wouldi noti affecti thei serumi potassiumi leveli significantly.
Ai clienti withi chronici kidneyi diseasei undergoingi hemodialysisi suddenlyi
becomesi shorti ofi breathi andi reportsi chesti paini andi anxiety.i Thei clienti isi
tachycardici andi pale,i andi thei nursei suspectsi airi embolism.i Whati arei thei
priorityi nursingi actions?i Selecti alli thati apply.
1.i Administeri oxygeni toi thei client.
2.i Continuei dialysisi ati ai sloweri ratei afteri checkingi thei linesi fori air.
3.i Notifyi thei primaryi healthi carei provideri (PHCP)i andi Rapidi Responsei
Team.
4.i Stopi dialysis,i andi turni thei clienti oni theiri lefti sidei withi headi loweri
thani feet.
2i |i P a g e
,5.i Bolusi thei clienti withi 500i mLi ofi normali salinei toi breaki upi thei airi
embolus.i -i
i i i i i i i i i i i i i i ANSWER:i 1,i 3,i 4
i Rationale:i Ifi thei clienti experiencesi airi embolusi duringi hemodialysis,i thei
nursei shouldi terminatei dialysisi immediately,i positioni thei clienti soi thei airi
embolusi isi oni thei righti sidei ofi thei heart,i notifyi thei PHCPi andi Rapidi
Responsei Team,i andi administeri oxygeni asi needed.i Slowingi thei dialysisi
treatmenti ori givingi ani intravenousi bolusi willi noti correcti thei airi embolismi
ori preventi complications.
Ai clienti arrivesi ati thei emergencyi departmenti withi lowi abdominali paini andi
hematuria.i Thei clienti isi afebrile.i Whati isi thei mosti likelyi causei associatedi
withi thisi presentation?
1.i Pyelonephritis
2.i Glomerulonephritis
3.i Traumai toi thei bladderi ori abdomen
4.i Renali canceri ini thei client'si familyi -i
i i i i i i i i i i i i i i ANSWER:i 3
i Rationale:i Bladderi traumai ori injuryi shouldi bei consideredi ori suspectedi ini
thei clienti withi lowi abdominali paini andi hematuria.i Glomerulonephritisi andi
pyelonephritisi wouldi bei accompaniedi byi feveri andi arei thusi noti applicablei
toi thei clienti describedi ini thisi question.i Renali canceri wouldi noti causei paini
thati isi felti ini thei lowi abdomen;i rather,i thei paini wouldi bei ini thei flanki
area.
Ai clienti isi admittedi toi thei emergencyi departmenti followingi ai falli fromi ai
horsei andi isi prescribedi insertioni ofi ai urinaryi catheter.i Whilei preparingi fori
thei procedure,i thei nursei notesi bloodi ati thei urinaryi meatus.i Thei nursei
shouldi takei whichi actioni next?
1.i Notifyi thei PHCPi beforei performingi thei catheterization.
2.i Usei ai small-sizedi catheteri andi ani anaesthetici geli asi ai lubricant.
3.i Administeri parenterali paini medicationi beforei insertingi thei catheter.
4.i Cleani thei meatusi withi soapi andi wateri beforei openingi thei catheterizationi
kit.i -i
i i i i i i i i i i i i i i ANSWER:i 1
i Rationale:i Thei presencei ofi bloodi ati thei urinaryi meatusi mayi indicatei
urethrali traumai ori disruption.i Thei nursei shouldi notifyi thei PHCP,i knowingi
thati thei clienti shouldi noti bei catheterizedi untili thei causei ofi thei bleedingi isi
determinedi byi diagnostici testing.i Thei otheri optionsi includei performingi thei
catheterizationi procedurei andi thereforei arei incorrect.
Whati laboratoryi resulti wouldi thei nursei mosti likelyi expecti toi findi fori ai
clienti diagnosedi withi chronici renali disease?
1.i Elevatedi creatininei level
2.i Decreasedi hemoglobini level
3.i Decreasedi redi bloodi celli count
4.i Increasedi numberi ofi whitei bloodi cellsi ini thei urinei -i
i i i i i i i i i i i i i i ANSWER:i 1
i Rationale:i Thei creatininei leveli isi thei mosti specifici laboratoryi testi usedi toi
determinei renali function.i Thei creatininei leveli increasesi wheni ati leasti 50%i
3i |i P a g e
, ofi renali functioni isi lost.i Ai decreasedi hemoglobini leveli andi redi bloodi celli
counti arei associatedi withi anemiai ori bloodi lossi andi noti specificallyi withi
decreasedi renali function.i Increasedi whitei bloodi cellsi ini thei urinei arei notedi
withi urinaryi tracti infection.
Ai clienti withi chronici kidneyi diseasei returnsi toi thei nursingi uniti followingi
hemodialysisi treatment.i Oni assessment,i thei nursei notesi thati thei client'si
temperaturei isi 38.5°C.i Whichi nursingi actioni isi mosti appropriate?
1.i Encouragei fluidi intake.
2.i Continuei toi monitori vitali signs.
3.i Notifyi thei primaryi healthi carei provider.
4.i Monitori thei sitei ofi thei shunti fori infection.i -i
i i i i i i i i i i i i i i ANSWER:i 3
i Rationale:i Ai temperaturei ofi 38.5°Ci isi significantlyi elevatedi andi mayi
indicatei infectioni asi ai complicationi ofi thisi ongoingi treatment.i Thei nursei
shouldi notifyi thei primaryi healthi carei provideri (PHCP).i Dialysisi clientsi
cannoti havei fluidi intakei encouraged.i Vitali signsi andi thei shunti sitei shouldi
bei monitored,i buti thei PHCPi shouldi bei notifiedi first,i asi sepsisi isi ai risk.
Ai clienti withi chronici kidneyi diseasei isi receivingi epoetini alfa.i Whichi
laboratoryi resulti wouldi indicatei ai therapeutici effecti ofi thei medication?
1.i Hematocriti ofi 0.33i (33%)
2.i Plateleti counti ofi 400i ×i 109/Li (400i 000i mm3)
3.i Whitei bloodi celli counti ofi 6.0i ×i 109/Li (6i 000i mm3)
4.i Bloodi ureai nitrogeni leveli ofi 5.25i mmol/Li (15i mg/dL)i -i
i i i i i i i i i i i i i i ANSWER:i 1
i Rationale:i Epoetini alfai isi synthetici erythropoietin,i whichi thei kidneysi
producei toi stimulatei redi bloodi celli productioni ini thei bonei marrow.i Iti isi
usedi toi treati anemiai associatedi withi chronici kidneyi disease.i Thei normali
hematocriti leveli fori malesi isi 0.42i toi 0.52i (42i toi 52%)i andi fori females,i
0.37i toi 0.47i (37i toi 47%).i Therapeutici effecti isi seeni wheni thei hematocriti
reachesi betweeni 0.30i andi 0.33i (30i andi 33%).i Thei normali plateleti counti isi
150i toi 400i ×i 109/Li (150i 000i toi 400i 000i mm3).i Thei normali bloodi ureai
nitrogeni leveli isi 3.6i toi 7.1i mmol/Li (10i toi 20i mg/dL).i Thei normali whitei
bloodi celli counti isi 5i toi 10i ×i 109/Li (5i 000i toi 10i 000i mm3).i Plateleti
production,i whitei bloodi celli production,i andi bloodi ureai nitrogeni doi noti
respondi toi erythropoietin.
______________i isi solelyi filteredi fromi thei bloodstreami viai thei glomerulusi
andi isi NOTi reabsorbedi backi intoi thei bloodstreami buti isi excretedi throughi
thei urine.
A.i Urea
B.i Creatinine
C.i Potassium
D.i Magnesiumi -i
i i i i i i i i i i i i i i Thei answeri isi B.i Creatininei isi ai wastei producti
fromi musclei breakdowni andi isi removedi fromi thei bloodstreami viai thei
glomerulusi ofi thei nephron.i Iti isi thei onlyi substancei thati isi solelyi filteredi
outi ofi thei bloodi buti NOTi reabsorbedi backi intoi thei system.i Iti isi excretedi
outi throughi thei urine.i Thisi isi whyi ai creatininei clearancei testi isi usedi asi
4i |i P a g e
