With Indepth Solutions
Save
Students also studied
Sherpath: Diabetes Mellitus Chapter 21 Test Case Study 4 (Short
30 terms 24 terms 22 terms
jesssbee Preview kenanderson2017 Preview Brittany182
Terms in this set (289)
After the insertion of an arteriovenous graft ANS: C
(AVG) in the right forearm, a patient The patient's complaints suggest the development of distal
complains ischemia (steal syndrome) and
of pain and coldness of the right fingers. may require revision of the AVG. Elevation of the arm above
Which action should the nurse take? the heart will further decrease
a. Teach the patient about normal AVG perfusion. Pain and coolness are not normal after AVG
function. insertion. Aspirin therapy is not used
b. Remind the patient to take a daily low- to maintain grafts.
dose aspirin tablet. DIF: Cognitive Level: Apply (application) REF: 1088
c. Report the patient's symptoms to the TOP: Nursing Process: Implementation MSC: NCLEX:
health care provider. Physiological Integrity
d. Elevate the patient's arm on pillows to
above the heart level.
When a patient with acute kidney injury ANS: B
(AKI) has an arterial blood pH of 7.30, the Patients with metabolic acidosis caused by AKI may have
nurse will Kussmaul respirations as the lungs
expect an assessment finding of try to regulate carbon dioxide. Bounding pulses and
a. persistent skin tenting vasodilation are not associated with
b. rapid, deep respirations. metabolic acidosis. Because the patient is likely to have fluid
c. hot, flushed face and neck. retention, poor skin turgor
d. bounding peripheral pulses. would not be a finding in AKI.
DIF: Cognitive Level: Apply (application) REF: 1072
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological
Integrity
The nurse is planning care for a patient with ANS: B
severe heart failure who has developed The primary goal of treatment for acute kidney injury (AKI) is
elevated to eliminate the cause and
blood urea nitrogen (BUN) and creatinine provide supportive care while the kidneys recover. Because
levels. The primary treatment goal in the this patient's heart failure is
plan will causing AKI, the care will be directed toward treatment of the
be heart failure. For renal failure
a. augmenting fluid volume. . caused by hypertension, hypovolemia, or nephrotoxins, the
b. maintaining cardiac output. other responses would be correct.
c. diluting nephrotoxic substances DIF: Cognitive Level: Apply (application) REF: 1073
d. preventing systemic hypertension. TOP: Nursing Process: Planning MSC: NCLEX: Physiological
Integrity
,A patient who has acute glomerulonephritis ANS: C
is hospitalized with hyperkalemia. Which The calcium gluconate helps prevent dysrhythmias that might
information will the nurse monitor to be caused by the hyperkalemia.
evaluate the effectiveness of the prescribed The nurse will monitor the other data as well, but these will
calcium not be helpful in determining the
gluconate IV? effectiveness of the calcium gluconate.
a. Urine volume DIF: Cognitive Level: Apply (application) REF: 1073
b. Calcium level TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological
c. Cardiac rhythm Integrity
d. Neurologic status
Which statement by a patient with stage 5 ANS: C
chronic kidney disease (CKD) indicates that The patient with end-stage renal disease is taught to measure
the urine output as a means of
nurse's teaching about management of CKD determining an appropriate oral fluid intake. Erythropoietin is
has been effective? given to increase the red blood
a. "I need to get most of my protein from cell count and will not offer any benefit for immune function.
low-fat dairy products." Dairy products are restricted
b. "I will increase my intake of fruits and because of the high phosphate level. Many fruits and
vegetables to 5 per day." vegetables are high in potassium and
c. "I will measure my urinary output each day should be restricted in the patient with CKD.
to help calculate the amount I can DIF: Cognitive Level: Apply (application) REF: 1082
drink." TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological
d. "I need to take erythropoietin to boost my Integrity
immune system and help prevent
infection."
Which information will the nurse monitor in ANS: B
order to determine the effectiveness of Calcium carbonate is prescribed to bind phosphorus and
prescribed prevent mineral and bone disease in
calcium carbonate (Caltrate) for a patient patients with CKD. The other data will not be helpful in
with chronic kidney disease (CKD)? evaluating the effectiveness of
a. Blood pressure calcium carbonate.
b. Phosphate level DIF: Cognitive Level: Apply (application) REF: 1081
c. Neurologic status TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological
d. Creatinine clearance Integrity
Sodium polystyrene sulfonate (Kayexalate) ANS: A
is ordered for a patient with hyperkalemia.
Before Sodium polystyrene sulfonate (Kayexalate) should not be
administering the medication, the nurse given to a patient with a paralytic
should assess the ileus (as indicated by absent bowel sounds) because bowel
a. bowel sounds. necrosis can occur. The BUN and
b. blood glucose. creatinine, blood glucose, and LOC would not affect the
c. blood urea nitrogen (BUN). nurse's decision to give the
d. level of consciousness (LOC). medication.
DIF: Cognitive Level: Apply (application) REF: 1080
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological
Integrity
Which menu choice by the patient who is ANS: C
receiving hemodialysis indicates that the Poached eggs would provide high-quality protein, and apple
nurse's juice is low in potassium. Cheese
teaching has been successful? is high in salt and phosphate, and tomato soup is high in
a. Split-pea soup, English muffin, and nonfat potassium. Split-pea soup is high in
milk potassium, and dairy products are high in phosphate. Bananas
b. Oatmeal with cream, half a banana, and are high in potassium, and
herbal tea cream is high in phosphate.
c. Poached eggs, whole-wheat toast, and DIF: Cognitive Level: Apply (application) REF: 1087
apple juice TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological
d. Cheese sandwich, tomato soup, and Integrity
cranberry juice
,Before administration of calcium carbonate ANS: C
to a patient with chronic kidney disease If serum phosphate is elevated, the calcium and phosphate
(CKD), can cause soft tissue calcification.
the nurse should check laboratory results Calcium carbonate should not be given until the phosphate
for level is lowered. Total cholesterol,
a. potassium level. creatinine, and potassium values do not affect whether
b. total cholesterol. calcium carbonate should be
c. serum phosphate. administered.
d. serum creatinine. DIF: Cognitive Level: Apply (application) REF: 1081
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
A 37-yr-old female patient is hospitalized ANS: C
with acute kidney injury (AKI). Which GFR is the preferred method for evaluating kidney function.
information BUN levels can fluctuate based
will be most useful to the nurse in evaluating on factors such as fluid volume status and protein intake.
improvement in kidney function? Urine output can be normal or high
a. Urine volume in patients with AKI and does not accurately reflect kidney
b. Creatinine level function. Creatinine alone is not
c. Glomerular filtration rate (GFR) an accurate reflection of renal function.
d. Blood urea nitrogen (BUN) level DIF: Cognitive Level: Analyze (analysis) REF: 1079
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological
Integrity
A patient will need vascular access for ANS: A
hemodialysis. Which statement by the nurse Arteriovenous (AV) fistulas are much less likely to clot than
accurately grafts, although it takes longer
describes an advantage of a fistula over a for them to mature to the point where they can be used for
graft? dialysis. The choice of an AV
a. A fistula is much less likely to clot. fistula or a graft does not have an impact on needle size or
b. A fistula increases patient mobility. patient mobility.
c. A fistula can accommodate larger DIF: Cognitive Level: Understand (comprehension) REF: 1088
needles. TOP: Nursing Process: Implementation MSC: NCLEX:
d. A fistula can be used sooner after surgery. Physiological Integrity
When caring for a patient with a left arm ANS: A
arteriovenous fistula, which action will the The presence of a thrill and bruit indicates adequate blood
nurse flow through the fistula. Pulse rate
include in the plan of care to maintain the and quality are not good indicators of fistula patency. Blood
patency of the fistula? pressures should never be
a. Auscultate for a bruit at the fistula site. obtained on the arm with a fistula. Irrigation of the fistula
b. Assess the quality of the left radial pulse. might damage the fistula, and
c. Compare blood pressures in the left and typically only dialysis staff would access the fistula.
right arms. DIF: Cognitive Level: Understand (comprehension) REF: 1087
d. Irrigate the fistula site with saline every 8 TOP: Nursing Process: Planning MSC: NCLEX: Physiological
to 12 hours.
A patient who has had progressive chronic ANS: B
kidney disease (CKD) for several years has When the patient is started on dialysis and nitrogenous wastes
just are removed, more protein in
begun regular hemodialysis. Which the diet is encouraged. Fluids are still restricted to avoid
information about diet will the nurse include excessive weight gain and
in patient complications such as shortness of breath. Glucose is not lost
teaching? during hemodialysis. Sodium
a. Increased calories are needed because and potassium intake continues to be restricted to avoid the
glucose is lost during hemodialysis. complications associated with
b. More protein is allowed because urea high levels of these electrolytes.
and creatinine are removed by dialysis. DIF: Cognitive Level: Apply (application) REF: 1087
c. Dietary potassium is not restricted TOP: Nursing Process: Implementation MSC: NCLEX:
because the level is normalized by dialysis. Physiological Integrity
d. Unlimited fluids are allowed because
retained fluid is removed during dialysis.
, Which action by a patient who is using ANS: C
peritoneal dialysis (PD) indicates that the Patients are encouraged to take showers rather than baths to
nurse should avoid infections at the catheter
provide more teaching about PD? insertion side. The other patient actions indicate good
a. The patient leaves the catheter exit site understanding of peritoneal dialysis.
without a dressing. DIF: Cognitive Level: Apply (application) REF: 1086
b. The patient plans 30 to 60 minutes for a TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological
dialysate exchange. Integrity
c. The patient cleans the catheter while
taking a bath each day.
d. The patient slows the inflow rate when
experiencing abdominal pain.
Which information in a patient's history ANS: B
indicates to the nurse that the patient is not Disseminated malignancies are a contraindication to
an transplantation. The conditions of the
appropriate candidate for kidney other patients are not contraindications for kidney transplant.
transplantation? DIF: Cognitive Level: Understand (comprehension) REF: 1092
a. The patient has type 1 diabetes. TOP: Nursing Process: Assessment MSC: NCLEX: Physiological
b. The patient has metastatic lung cancer. Integrity
c. The patient has a history of chronic
hepatitis C infection.
d. The patient is infected with human
immunodeficiency virus.
Which assessment finding may indicate that ANS: C
a patient is experiencing adverse effects to Aseptic necrosis of the weight-bearing joints can occur when
a patients take corticosteroids
corticosteroid prescribed after kidney over a prolonged period. Increased creatinine level,
transplantation? orthostatic dizziness, and tachycardia are
a. Postural hypotension not caused by corticosteroid use.
b. Recurrent tachycardia DIF: Cognitive Level: Apply (application) REF: 1096
c. Knee and hip joint pain TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological
d. Increased serum creatinine Integrity
A 38-yr-old patient who had a kidney ANS: C
transplant 8 years ago is receiving the A nontender lump suggests a malignancy such as a
immunosuppressants tacrolimus (Prograf), lymphoma, which could occur as a result
cyclosporine (Sandimmune), and of chronic immunosuppressive therapy. The elevated glucose,
prednisone . skin change, and hypertension
Which assessment data will be of most are possible side effects of the prednisone and should be
concern to the nurse? addressed, but they are not as great a
a. Skin is thin and fragile. concern as the possibility of a malignancy.
b. Blood pressure is 150/92. DIF: Cognitive Level: Analyze (analysis) REF: 1096
c. A nontender axillary lump. OBJ: Special Questions: Prioritization TOP: Nursing Process:
d. Blood glucose is 144 mg/dL. Assessment
MSC: NCLEX: Physiological Integrity
The nurse in the dialysis clinic is reviewing ANS: C
the home medications of a patient with Magnesium is excreted by the kidneys, and patients with CKD
chronic should not use
kidney disease (CKD). Which medication over-the-counter products containing magnesium. The other
reported by the patient indicates that medications are appropriate for a
patient patient with CKD.
teaching is required? DIF: Cognitive Level: Apply (application) REF: 1081
a. Acetaminophen TOP: Nursing Process: Assessment MSC: NCLEX: Physiological
b. Calcium phosphate Integrity
c. Magnesium hydroxide
d. Multivitamin with iron