TEST BANK INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION 2024

TEST BANK INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION 2024 Chapter06:NutritionalTherapy - ANS 1.ApatientishavingcomplicationsfromabdominalsurgeryandremainsNPO.Becauseenteraltubefeedingsarenotpossible,thedecisionistoinitiateparenteralfeedings.Whatarethemajorcomplicationsforthistherapy - ANS b. Fluidandelectrolyteimbalancesandsepsis .Apatientisbeingventilatedandhasbeenstartedonenteralfeedingswithanasogastricsmall-borefeedingtube.Whatistheprimaryreasonthenursemustfrequentlyassesstubeplacement? - ANS d. Topreventaspirationofthefeedings 3.Thepatientistostartparenteralnutrition.Thenurseknowstopreparewhichsiteforcatheterinsertion? - ANS d. Subclavianvein 4.Apatienthasbeenadmittedtothecriticalcareunitafterastroke.Afterfailingaswallowstudy,thepatientisplacedonenteralfeedings.Followingplacementofanasogastrictubefortubefeeding,whatisthenextcriticalstep? - ANS c. Obtainachestradiograph. 5.Apatientsfeedingtubehasbeensuccessfullyplacedinthesmallintestinewithcontinuousflowtubefeeding.Thenurseknowsthatthisapproachwaschosenbecause: - ANS c. theintestinalmucosanormallyreceivesnutrientsfromthestomachinperistalticwaves 6.Apatientisbeingfedthroughanasogastrictubeplacedinhisstomach.Thenursewouldcarryoutwhichinterventiontominimizeaspirationrisk? - ANS Elevatetheheadofthebed30degrees. 7.Apatientwhoisreceivingcontinuousenteralfeedingshasjustvomited250mLofmilkygreenfluid.Thisisaconcernbecausethismostlikelydemonstratesthatthepatienthas: - ANS d. tube feeding intolerance. 8.Apatientisreceivingenteralfeedingsandhasjustvomited250mLofmilkygreenliquid.Thenurseholdsthetubefeeding,whichhadbeeninfusingat100mL/hr.Thenurseknowsthatthenextactionshouldbe: - ANS d. recheck the residual in 2hours 9.Inadditiontoresidualstomachvolume,whatotherevidencesuggestsfeedingintolerance? - ANS a. Abdominal distention 10.Approximately5daysafterstartingtubefeedings,apatientdevelopsextremediarrhea.Astoolspecimeniscollectedtocheckforwhichpossiblecause? - ANS a. Clostridium difficile 11.Apatientwithacutepancreatitisisstartedonparenteralnutrition.Thestudentnurselistedpossibleinterventionsforthispatient.Whichinterventionneedscorrectionbeforefinalizingtheplanofcare? - ANS b. Infuseantibioticsthroughtheintravenousline. 12.Inevaluatingapatientsnutrition,thenursewouldmonitorwhichbloodtestasthemostsensitiveindicatorofproteinsynthesisandcatabolism? - ANS c. Prealbumin 13.Apatientisreceivingenteraltubefeedingsandhasdevelopeddrug-nutrientinteractions.Thenurserecognizeswhichdrugashavingthepotentialforcausingdrug-nutrientreactions? - ANS d. Phenytoin 14.Whichstatementistrueaboutnormalfunctionofthegastrointestinal(GI)tract? - ANS d. Without nutritional stimulation, mucosal villi atrophy. 15.An important nutritional consideration in the elderly population is: - ANS c. potential for drug-nutrient interaction related to polypharmacy. 16.Objectivedatadesignatingthatthenutritiongoalsarenotbeingmetinclude: - ANS d. weight loss, elevated glucose, and dehydration 17.In trauma patients ,enteral nutrition via nasogastric tube feedings into the small bowel is best initiated within what time frame following the injury? - ANS a. 24hours 18.Apatientwithahistoryofemphysema,diabetes,andhyperlipidemiaisinthecriticalcareunitonaventilator.Thenutritionassessmentnotesthatthepatienthasaproteinandvitamindeficiencyandisunderweight.Whichformulafornutritionalassessmentismostappropriate? - ANS b. Fiber-addedformula 19.Selectthephysiologicalreasoningbehindenteraltherapyasthepreferredsourceofnutritionaltherapy - ANS d. Gut mucosa is preserved. 20.Thenurseidentifieswhichpatientatgreatestriskformalabsorptionofprotein? - ANS b. The patient with ileitis 21.Thebestnursingapproachtopreventfeedingtubeobstructionis: - ANS b. flushthetubeevery4hourswith20to30mLoftapwater. 22.Patientsexperiencingseverephysiologicalstressincreasetheirnutritionalrequirementsto: - ANS c. 35kcal/kg/day 23.Malnutritioncontributestoinfectionriskby - ANS b. impairing immune function 24.Apatient,whohasatubefeeding,requiresachestx-raystudyforevaluationofacough.Toreducetheriskofaspiration,thenurse: - ANS d. stopsfeedings10to15minutesbeforeplacingflattoobtaintheradiograph. 1.Whichstatement(s)abouttotalparenteralnutritionis(are)true?(Selectallthatapply.) - ANS a. Assessingfluidvolumestatusandpreventinginfectionareimportantnursingconsiderations.b. Fingerstickglucoselevelsareassessedevery6hoursandprn. d. Totalparenteralnutrition,withaddedlipids,providesadequatelevelsofprotein,carbohydrates,andfats. 2.Whichintervention(s)is(are)criticalduringintravenouslipidadministration?(Selectallthatapply). - ANS b. Changethetubingevery24hours. d. Monitortriglyceridelevels. 3.Calorie-densefeedings:(Selectallthatapply.) - ANS a. are most useful in heart failure and liver disease. 4.Risksoftotalparenteralnutritioninclude:(Selectallthatapply.) - ANS b. elevatedbloodsugar. c. infectionatthecathetersite. d. volumeoverload. 5.Whichofthefollowingstatementsistrueaboutinsulinandparenteralnutrition?(Selectallthatapply.) - ANS a. Amountofparenteralinsulinisadjustedbasedontheprevious24-hourlaboratoryvalues. b. Insulinmaybeaddedtoaparenteralnutritionsolution. c. Subcutaneousinsulinisusedonaslidingscaleduringparenteralnutrition. Thecorrectorderofactionsforapatientstartingenteralnutritionwithafeedingtubeis:__ - ANS A.Initiatetubefeeding. B.Insertfeedingtube. C.Flushtubetoverifypatency. D.Obtainchestradiograph. E.Assessresiduals. ANS: B,D,C,A,E 1.Apatienthascoronaryarterybypassgraftsurgeryandistransportedtothesurgicalintensivecareunitatnoon.Heisplacedonmechanicalventilation.Interprethisinitialarterialbloodgaslevels: pH7.31 PaCO248mmHg Bicarbonate22mEq/L PaO2115mmHg O2saturation99% - ANS d. Uncompensated respiratory acidosis; hyperoxygenated 2.Thephysicianordersthefollowingmechanicalventilationsettingsforapatientwhoweighs75kg.Thepatientsspontaneousrespiratoryrateis22breaths/min.Whatarterialbloodgasabnormalitymayoccurifthepatientcontinuestobetachypneicattheseventilatorsettings? Settings: Tidalvolume:600mL(8mLperkg) FiO2:0.5 Respiratoryrate:14breaths/min Modeassist/ control - ANS d. Respiratoryalkalosis 3.Apatientsventilatorsettingsareadjustedtotreathypoxemia.Thefractionofinspiredoxygenisincreasedfrom.60to.70,andthepositiveend-expiratorypressureisincreasedfrom10to15cmH2O.Shortlyaftertheseadjustments,thenursenotesthatthepatientsbloodpressuredropsfrom120/76mmHgto90/60mmHg.Whatisthemostlikelycauseofthisdecreaseinbloodpressure? - ANS a. Decrease in cardiac output 4.Thenurseiscaringforapatientwithanendotrachealtube.Thenurseunderstandsthatendotrachealsuctioningisneededtofacilitateremovalofsecretionsandthattheprocedure: - ANS c. is done as indicated by patient assessment. 5.A65-year-oldpatientisadmittedtotheprogressivecareunitwithadiagnosisofcommunity-acquiredpneumonia.Thepatienthasahistoryofchronicobstructivepulmonarydiseaseanddiabetes.AsetofarterialbloodgasesobtainedonadmissionwithoutsupplementaloxygenshowspH7.35;PaCO255mmHg;bicarbonate30mEq/L;PaO265mmHg.Thesebloodgasesreflect: - ANS hypoxemia and compensated respiratory acidosis 6.Apatientsstatusworsensandneedsmechanicalventilation.Thepulmonologistwantsthepatienttoreceive10breaths/minfromtheventilatorbutwantstoencouragethepatienttobreathespontaneouslyinbetweenthemechanicalbreathsathisowntidalvolume.Thismodeofventilationiscalled: - ANS c. intermittent mandatory ventilation 7.Apatientsendotrachealtubeisnotsecuredtightly.Therespiratorycarepractitionerassiststhenurseintapingthetube.Afterthetubeisretaped,thenurseauscultatesthepatientslungsandnotesthatthebreathsoundsovertheleftlungfieldsareabsent.Thenursesuspectsthat: - ANS a. the endotracheal tube is in the right main stem bronchus. 8.Amodeofpressure-targetedventilationthatprovidespositivepressuretodecreasetheworkloadofspontaneousbreathingthroughtheendotrachealtubeis: - ANS c. pressure support ventilation. 9.Neuromuscularblockingagentsareusedinthemanagementofsomeventilatedpatients.Theirprimarymodeofactionis: - ANS c. paralysis 10.Oneoftheearlysignsoftheeffectofhypoxemiaonthenervoussystemis: - ANS restlessness. 11.Theamountofeffortneededtomaintainagivenlevelofventilationistermed: - ANS work of breathing. 12.Whichofthefollowingdevicesisbestsuitedtodeliver65%oxygentoapatientwhoisspontaneouslybreathing? - ANS a. Face mask with non-rebreathing reservoir 13.Apatientisbeingmechanicallyventilatedinthesynchronizedintermittentmandatoryventilationmodeatarateof4breaths/min.Hisspontaneousrespirationsare12breaths/min.Hereceivesadoseofmorphinesulfate,andhisrespirationsdecreaseto4breaths/min.Whichacid-basedisturbancewilllikelyoccur? - ANS Respiratory acidosis 14.Apatientisbeingmechanicallyventilatedinthesynchronizedintermittentmandatoryventilationmodeatarateof4breaths/min.Hisspontaneousrespirationsare12breaths/min.Hereceivesadoseofmorphinesulfate,andhisrespirationsdecreaseto4breaths/min.Whatadjustmentsmayneedtobemadetothepatientsventilatorsettings? - ANS Increasethesynchronizedintermittentmandatoryventilationrespiratoryrate 15.Currentguidelinesrecommendtheoralrouteforendotrachealintubation.Therationaleforthisrecommendationisthatnasotrachealintubationisassociatedwithagreaterriskfor: - ANS d. sinusitisandinfection. 16.Oxygensaturation(SaO2)represents: - ANS b. oxygen that is chemically combined with hemoglobin. 17.Pulseoximetrymeasures: - ANS d. oxygen saturation. 18.APaCO2of48mmHgisassociatedwith: - ANS .b. hypoventilation. 19.Thenursenotesthatthepatientsarterialbloodgaslevelsindicatehypoxemia.Thepatientisnotintubatedandhasarespiratoryrateof22breaths/min.Thenursesfirstinterventiontorelievehypoxemiaisto: - ANS c. notify the provider of values and obtain order for oxygen. 20.Apatientpresentstotheemergencydepartmentdemonstratingagitationandcomplainingofnumbnessandtinglinginhisfingers.Hisarterialbloodgaslevelsrevealthefollowing:pH7.51,PaCO225,HCO325.Thenurseinterpretsthesebloodgasvaluesas: - ANS d. uncompensated respiratory alkalosis. 21.Positiveend-expiratorypressure(PEEP)isamodeofventilatoryassistancethatproducesthefollowingcondition: - ANS d. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O. 22.Thenurseiscaringforapatientwhoismechanicallyventilated.Aspartofthenursingcare,thenurseunderstandsthat: - ANS a. communication with intubated patients is often difficult. 23.Apatientishavingdifficultyweaningfrommechanicalventilation.Thenurseassessesthepatientforapotentialcauseofthisdifficultweaning,whichincludes: - ANS b. hemoglobinof8g/dL 24.A53-year-old,80-kgpatientisadmittedtothecardiacsurgicalintensivecareunitaftercardiacsurgerywith thefollowingarterialbloodgas(ABG)levels.Whatisthenursesinterpretationofthesevalues? - ANS c. Normal ABG val 25.A53-year-old,80-kgpatientisadmittedtothecardiacsurgicalintensivecareunitaftercardiacsurgery. Fourhoursafteradmissiontothesurgicalintensivecareunitat4PM,thepatienthasstablevitalsignsand normalarterialbloodgases(ABGs),andisplacedonaT-pieceforventilatoryweaning.Duringthenurses7 PM(1900)assessment,thepatientisrestless,heartratehasincreasedto110beats/min,respirationsare36 breaths/min,andbloodpressureis156/98mmHg.Thecardiacmonitorshowssinustachycardiawith10 prematureventricularcontractions(PVCs)perminute.Pulmonaryarterypressuresareelevated.Thenurse suctionsthepatientandobtainspink,frothysecretions.Loudcracklesareaudiblethroughoutlungfields. Thenursenotifiesthephysician,whoordersanABGanalysis,electrolytelevels,andaportablechestx-ray study.Howdoesthenurseinterpretthefollowingbloodgaslevels - ANS Hypoxemia and uncompensated respiratory acidosis 26.A53-year-old,80-kgpatientisadmittedtothecardiacsurgicalintensivecareunitaftercardiacsurgery. Fourhoursafteradmissiontothesurgicalintensivecareunitat4PM,thepatienthasstablevitalsignsand normalarterialbloodgases(ABGs)andisplacedonaT-pieceforventilatoryweaning.Duringthenurses7PM (1900)assessment,thepatientisrestless,heartratehasincreasedto110beats/min,respirationsare36 breaths/min,andbloodpressureis156/98mmHg.Thecardiacmonitorshowssinustachycardiawith10 prematureventricularcontractions(PVCs)perminute.Pulmonaryarterypressuresareelevated.Thenurse suctionsthepatientandobtainspink,frothysecretions.Loudcracklesareaudiblethroughoutlungfields.The nursenotifiesthephysician,whoordersanABGanalysis,electrolytelevels,andaportablechestx-raystudy. Incommunicatingwiththephysician,whichstatementindicatesthenurseunderstandswhatislikelyoccurring withthepatient? - ANS My assessment indicates potential fluid overload 27.Thenurseiscaringforamechanicallyventilatedpatientandnotesthehighpressurealarmsounding.The nursecannotquicklyidentifythecauseofthealarmandnotesthepatientsoxygensaturationisdecreasing andheartrateandrespiratoryrateareincreasing.Thenursespriorityactionisto - ANS d. manually ventilate the patient while calling for a respiratory therapist 28.Thenurseiscaringforapatientwhoseventilatorsettingsinclude15cmH2Oofpositiveend-expiratory pressure(PEEP).Thenurseunderstandsthatalthoughbeneficial,PEEPmayresultin: - ANS d. low cardiac output secondary to increased intrathoracic pressure 29.Whenassessingthepatientforhypoxemia,thenurserecognizesthatanearlysignoftheeffect ofhypoxemiaonthecardiovascularsystemis - ANS tachycardia 30.Thenurseiscaringforamechanicallyventilatedpatient.Thephysiciansareconsideringperforminga tracheostomybecausethepatientishavingdifficultyweaningfrommechanicalventilation.Relatedto tracheostomy,thenurseunderstandswhichofthefollowing - ANS The greatest risk after a percutaneous tracheostomy is accidental decannulation 31.Thenurseisassessingtheexhaledtidalvolume(EVT)inamechanicallyventilatedpatient.The rationaleforthisassessmentisto: - ANS compare the tidal volume delivered with the tidal volume prescribed 1.Thenurseiscaringforamechanicallyventilatedpatientandrespondstoahighinspiratorypressurealarm. Recognizingpossiblecausesforthealarm,thenurseassessesforwhichofthefollowing - ANS Coughing or attempting to talk/ c. Kinks in the ventilator Need for suctioning Selectallofthefactorsthatmaypredisposethepatienttorespiratoryacidosi - ANS Central nervous system depression Overdose of sedative 3.Thenurseisassistingwithendotrachealintubationandunderstandscorrectplacementofthe endotrachealtubeinthetracheawouldbeidentifiedbywhichofthefollowing?(Selectallthatapply. - ANS Equal bilateral breath sounds upon auscultation Position above the carina verified by chest x-ray Positive detection of carbon dioxide(CO2) through CO2 detector devices 1.Thenurseiscaringforamechanicallyventilatedpatientandischartingoutsidethepatientsroomwhenthe ventilatoralarmsounds.Whatisthepriorityorderforthenursetocompletetheseactions:_______________, _______________,_______________,_______________?(Putacommaandspacebetweeneachanswerchoice - ANS Go to patients bedside. After troubleshooting, connect back to mechanical ventilator and reassess patient. Manually ventilate the patient while getting respiratory therapist B.After troubleshooting, connect back to mechanical ventilator and reassess patient 2.Thenurseisassistingwithendotrachealintubationofthepatientandrecognizesthattheprocedurewill bed one in what order - ANS Assess balloon on endotracheal tube for symmetry and leaks Suction oropharynx. Insert endotracheal tube with laryngoscope and blade .Inflate balloon of endotracheal tube. Assess lung fields for bilateral expansion 1.Thenurseisworkingforahospitalthatholdsanagreementwithalocalorganprocurementorganization (OPO).ThepatienthasaGlasgowComaScale(GCS)scoreof3anddiscussionshavebeenheldwiththe familyaboutwithdrawinglifesupport.Whichstatementbythenursebestdescribesrequirementsthatmust bemettosustainCentersforMedicareandMedicaidServices(CMS)ConditionsofParticipation? - ANS a. I need to notify TransLife (OPO) of my patients impending death 2.Thenurseismanagingadonorpatientsixhourspriortothescheduledharvestingofthepatients organs.Whichassessmentfindingrequiresimmediateactionbythenurse - ANS b. pH 7.30; PaCO2 38mm Hg; HCO316mEq/ 3.Thechargenurseisreviewingthestatusofpatientsinthecriticalcareunit.Whichpatientshouldthe nursenotifytheorganprocurementorganizationtoevaluateforpossibleorgandonation? - ANS a. A36-year-old patient with a Glasgow Coma Scale score of 3 with no activity on electroencephalogram 4.Thetransplantcliniccoordinatorisevaluatingrelativesofapatientwithend-stagerenaldisease,whose bloodtypeisApositive,forsuitabilityasalivingdonorforkidneytransplantation.Whichfamilymemberbest qualifiesforevaluation? - ANS b. A35-year-old female with a history of food allergies; blood type O negative 5.Thenurseiscaringforapatientwhoisbeingevaluatedclinicallyforbraindeathbyaphysician.Which assessmentfindingsbythenursesupportbraindeath - ANS Absence of a corneal reflex 6.Thenurseisprovidingpreoperativecaretoapatientwhowillreceiveatransplant.Thepatienthashigh panelreactiveantibodies(PRA).Aspartofinductiontherapyforthispatient,thenurseunderstandswhich medicationtobeofpriorityforadministrationintheoperatingroom? - ANS Alemtuzumab(Campath) .Thenurseiscaringforamechanicallyventilatedpatientfollowingbilaterallungtransplantation.When planningthecareofthispatient,whatistheprioritynursingintervention? - ANS Endotracheal suctioning as needed 8.Afamilymemberapproachesthenursecaringfortheirgravelyillsonandstates,Wewanttodonateour sonsorgans.Whatisthebestactionbythenurse? - ANS Notify the organ procurement organization (OPO) 9.Thenurseiscaringforapatientinthecriticalcareunitwho,afterbeingdeclaredbraindead,isbeing managedbytheOPOtransplantcoordinator.Thirtyminutesintotheshift,assessmentbythenurseincludes abloodpressure75/50mmHg,heartrate85beats/min,andrespiratoryrate12breaths/minvia assist/controlventilation.Theoxygensaturation(SpO2)is99%andcoretemperature93.8F.Which physicianordershouldthenurseimplementfirst? - ANS Beginphenylephrine(Neo-Synephrine)forsystolicBP<90mmH 10.Thechargenurseofatransplantunitisreviewingtheclinicalcourseofseveraltransplantpatients beingcaredforintheunit.Whichpatientassessedbythechargenurserequiresimmediateaction? - ANS d. Liver transplant recipient,12 hours post op with a serum glucose of 58mg/dL 11.Thenurseiscaringforarenaltransplantrecipientinthepost-anesthesiacareunit.Bloodpressureis125/70 mmHg;heartrateis115beats/min;respiratoryrateis24breaths/min;oxygensaturation(SpO2)is95%on3 L/minofoxygenvianasalcannula,temperatureis97.8F,andthecentralvenouspressure(CVP/RAP)is2mm Hg.Whatisthebestactionbythenurse? - ANS a. Administer fluid replacement therapy; monitor intake and output closely. 12.Thenurseiscaringforapostoperativerenaltransplantrecipientinthecriticalcareunit.Afterseeing minimalurineoutputinthecatheterformostoftheday,thepatientexpressesconcerntothenurse.Whatis thebestresponsebythenurse? - ANS It can take a few days for your kidney to start working 13.Thenurseisprovidingdischargeinstructionstoarenaltransplantrecipient.Thepatienthasafollow-up appointmentthenextdayforroutinepost-transplantlaboratorybloodwork,includingtroughlevelsofantirejectionmedications.Whichinstructiondescribeswhatthepatientshoulddoregardingtheanti-rejection medicationsthenextday - ANS b. Take your morning dose of medications after labs have been drawn 14.Thenurseiscaringforapatientfollowingabilaterallungtransplant.Whenplanningpostoperativecareof thepatient,priorityisplacedonpulmonaryhygiene.Whichstatementprovidesthebestexplanationforthis priority? - ANS d. Loss of cough reflex results in decreased ability to remove secretions effectively 15.Whilefollowinguponapostoperativerenaltransplantrecipient,thenursediscoversthatthedonor testedpositiveforcytomegalovirus(CMV).Whatisthepriorityactionbythenurse - ANS a. Notify the OPO transplant coordinator 16.Thetransplantclinicnurseisconductingpatienteducationontheimportanceoffollow-uphealth screeningactivitiesimportantindetectingcomplicationsassociatedwithlong-termimmunosuppressant therapy.Whichstatementismostimportantforthenursetoincludeinthediscussion - ANS Avoid sun exposure during peak hours of the day 17.Thenurseobtainsinitialvitalsignsonapatient2weeksposttransplantwhopresentsforfollow-up monitoringtotheoutpatienttransplantclinic.Whichassessmentfindingbythenurserequires immediateaction? - ANS d. Tenderness over graft site 18.Thetransplantclinicsocialworkeriscompletingasocialhistoryonapatientwithend-stagerenal diseasewhoisbeingevaluatedfortransplant.Whichstatementbythepatientwarrantsfurtheraction - ANS a. I only smoke marijuana on an occasional basis 19.Thetransplantclinicnurseiseducatingapatientabouttherenalcriteriathatmustbemetinordertobe placedonthetransplantwaitinglist.Whichstatementbythepatientbestindicatesanunderstandingof thecriteria - ANS I qualify if my glomerular filtration rate is less than 20 mL per minute 20.Thenurseiseducatingarenaltransplantpatientabouthisimmunosuppressantmedicationtherapy. Whichstatementbythepatientbestindicatesanappropriateunderstanding - ANS c. My doctors may try to stop my steroids soon after my transplant 21.ThenurseispreparingtoadmitapatientwithheartfailurewhohasbeenlistedontheUNOStransplantlis - ANS b. Hospitalization is required with mechanical support and vasoactive infusions 22.Thenurseisprovidingpostoperativeeducationtoatransplantpatientsfamily.Whenaskedabout detectingrejection,whichanswerbythenurseismostappropriate - ANS a. Endomyocardial biopsies will be performed weekly for the first six weeks after surgery 23.Thetransplantclinicnurseisconductingapretransplanteducationsessionforpatientsbeingevaluatedfor livertransplantation.Whichstatementbythenurseprovidesthebestexplanationofthenumericsystemusedto classifytheseverityofapatientsliverdisease - ANS A score is calculated based upon kidney function, clotting time,and bilirubin level 24.Whichstatementbestrepresentsappropriatedonor-to-recipientcriteriaforlivertransplantation? - ANS Body type and body size 25.Thenurseassessesmorninglabresultsforapostoperativeday1livertransplantrecipient.Labresults notedbythenurseincludeaspartatetransaminase(AST)365U/L;alanineaminotransferase(ALT)400U/L; andserumglucoseof85mg/dL.Whatisthebestactionbythenurse? - ANS Notify the physician of liver enzyme results 26.Thetransplantclinicnurseiseducatingagroupoftransplantrecipientsonhealthpromotion andmaintenance.Whatistheprioritystatementbythenurse - ANS Obtain annual vaccinations for pneumonia from your physician. .Arenaltransplantrecipientpresentstotheoutpatienttransplantclinicwithbloodglucosevaluesforthepast3daysexceeding250mg/dL.Thepatienttakesprednisone5mgdailyandtacrolimus(Prograf)2 mgtwicedaily.HemoglobinA1Cleveldrawnthedayoftheclinicappointmentwas8.5%.Whatisthebest interpretationofthisfindingbythenurse? - ANS Thepatienthasdevelopedposttransplantdiabetes 28.ThepostanesthesiacareunitreceiveshandoffcommunicationfromtheCRNAindicatingthattherenal transplantrecipientreceivedinductiontherapyintheoperatingroomwithantithymocyteglobulin(ATG). Whatisthebestunderstandingoftheadministrationofthisdrugbythenurse? - ANS Administration of the drug decreases initial post-operative rejection rates 29.Thenurseispreparingtoadministerarenaltransplantrecipientsfirstdoseofmycophenolatemofetil (CellCept).Priortoadministeringthemedication,thenurseappropriatelyreviewsdrugformularyinformation. Whatisthebestunderstandingofthismedicationbythenurse? - ANS It is a polyclonal antibody used for maintenance therapy 30.Apatientpresentstotheoutpatienttransplantclinicstating,Iwouldliketodonateoneofmykidneys. Whatisthebestresponsebythenurse - ANS Let us orient you to the process required to become a donor Whichclinicalscenariobestrepresentshyperacuterejection? - ANS An implanted renal transplant that, upon reperfusion, becomes cyanotic 32.Whichstatementbestdescribesthelungallocationscore(LAS)usedtoprioritizelung transplantrecipients - ANS The LAS is based on lab values, diagnostic tests, and medical diagnosis 33.Thenurseiscaringforarenaltransplantrecipientinthepostanesthesiacareunit.Handoff communicationfromtheORincludedareportedoutputof500mLfollowinganastomosisoftherenalvessels andreperfusion.OnehourafterthetransplantrecipientwasadmittedtothePACU,theRNnotesnourine output.Whichphysicianordershouldthenurseimplementfirst? - ANS Irrigate the indwelling urinary catheter gently with 30 mL0.9% normal saline 34.Thenurseiscaringforarenaltransplantpatientadmittedwithanacuterejectionepisode.Thepatientasks thenursehowthedoctorswillknowifthekidneyhasbeenrejected.Whatisthebestresponsebythenurse? - ANS b. A procedure called a renal biopsy will be the best way to confirm rejection 1.Thefamilyofacriticallyillpatienthasaskedtodiscussorgandonationwiththepatientsnurse.When preparingtoanswerthefamilysquestions,thenurseunderstandswhichconcern(s)afamilysdecisiontodonate? - ANS a. Donordisfigurementinfluencesonfuneralcare, b. Fearofinferiormedicalcareprovidedtodonor e. Fearthatthepotentialdonormaynotbedeceased f. Concernoverfinancialcostsassociatedwithdonatio 1.Thenurseadmitsapatienttothecriticalcareunitfollowingamotorcyclecrash.Assessmentfindingsby thenurseincludebloodpressure100/50mmHg,heartrate58beats/min,respiratoryrate30breaths/min,and temperatureof100.5.Thepatientislethargic,respondstovoicebutfallsasleepreadilywhennotstimulated. Whichnursingactionismostimportanttoincludeinthispatientsplanofcare? - ANS Frequent neurological assessment 2.Apatientwithaheadinjuryhasanintracranialpressure(ICP)of18mmHg.Herbloodpressureis144/90mm Hg,andhermeanarterialpressure(MAP)is108mmHg.Whatisthecerebralperfusionpressure(CPP) - ANS c. 90mmH 3.Whilecaringforapatientwithatraumaticbraininjury,thenurseassessesanICPof20mmHgandaCPP of85mmHg.Whatisthebestinterpretationbythenurse? - ANS c. ICP is high; CPP is normal. 4.ThenurseiscaringforamechanicallyventilatedpatientwithasustainedICPof18mmHg.Thenurse needstoperformanhourlyneurologicalassessment,suctiontheendotrachealtube,performoralhygienecare, andrepositionthepatienttotheleftside.Whatisthebestactionbythenurse? - ANS Provide rest periods between nursing interventions 5.Whilecaringforapatientwithabasilarskullfracture,thenurseassessescleardrainagefromthe patientsleftnaris.Whatisthebestnursingaction - ANS c. Place a nasal drip pad under the nose 6.Thenurseiscaringforapatientwhowashitontheheadwithahammer.Thepatientwasunconsciousat thescenebrieflybutisnowconsciousuponarrivalattheemergencydepartment(ED)withaGCSscoreof15. Onehourlater,thenurseassessesaGCSscoreof3.Whatistheprioritynursingaction - ANS d. Notify the physician immediate 7.ThenurseiscaringforapatientwithanICPof18mmHgandaGCSscoreof3.Followingthe administrationofmannitol(Osmitrol),whichassessmentfindingbythenurserequiresfurtheraction? - ANS d. CVP of 2mm Hg 8.Thenurseiscaringforamechanicallyventilatedpatientwithabraininjury.Arterialbloodgasvaluesindicatea PaCO2of60mmHg.Thenurseunderstandsthisvaluetohavewhicheffectoncerebralbloodflow - ANS Increased cerebral blood volume due to vessel dilation 9.ThenurseassessesapatientwithaskullfracturetohaveaGlasgowComaScalescoreof3.Additional vitalsignsassessedbythenurseincludebloodpressure100/70mmHg,heartrate55beats/min,respiratory rate10breaths/min,oxygensaturation(SpO2)94%onoxygenat3Lpernasalcannula.Whatisthepriority nursingaction? - ANS Monitor the patients airway patency 10.Thenurseiscaringforapatientwhohasadiminishedlevelofconsciousnessandwhoismechanically ventilated.Whileperformingendotrachealsuctioning,thepatientreachesupinanattempttograbthe suctioncatheter.Whatisthebestinterpretationbythenurse? - ANS The patient is exhibiting purposeful movement 11.ThenurseiscaringforapatientadmittedtotheEDfollowingafallfroma10-footladder.Uponadmission,the nurseassessesthepatienttobeawake,alert,andmovingallfourextremities.Thenursealsonotesbruisingbehind theleftearandstraw-coloreddrainagefromtheleftnare.Whatisthemostappropriatenursingaction - ANS Apply a small nasal drip pad 12.Whilecaringforapatientwithaclosedheadinjury,thenurseassessesthepatienttobealertwitha bloodpressure130/90mmHg,heartrate60beats/min,respirations18breaths/min,andatemperatureof 102F.Toreducetheriskofincreasedintracranialpressure(ICP)inthispatient,whatis(are)thepriority nursingaction(s)? - ANS Reduce ambient room temperature and administer antipyretics 13.Thenurserespondstoahighheartratealarmforapatientintheneurologicalintensivecareunit.Thenurse arrivestofindthepatientsittinginachairexperiencingatonic-clonicseizure.Whatisthebestnursingaction - ANS Assist the patient to the floor and provide soft head support 14.Thenurseiscaringforamechanicallyventilatedpatientadmittedwithatraumaticbraininjury.Which arterialbloodgasvalueassessedbythenurseindicatesoptimalgasexchangeforapatientwiththistype of injury - ANS pH7.38; PaCO235mmHg; HCO324mEq/L; PaO285mmHg 15.Thenurseiscaringforapatientfromarehabilitationcenterwithapreexistingcompletecervicalspine - ANS Assess for a kinked urinary catheter and assess for bowel impaction 16.Thenurseadmitsapatienttotheemergencydepartmentwithnewonsetofslurredspeechandrightsidedweakness.Whatistheprioritynursingaction - ANS d. Determine the time of symptom onset 17.Whichpatientbeingcaredforintheemergencydepartmentshouldthechargenurseevaluatefirst - ANS A patient with a complete spinal injury at the C5 dermatome level 18.Thenurseadmitsapatienttotheemergencydepartment(ED)withasuspectedcervicalspineinjury.What istheprioritynursingaction? - ANS Maintain proper head and neck alignment 19.Thenurseiscaringforapatient3daysfollowingacompletecervicalspineinjuryattheC3level.The patientisinspinalshock.Followingemergentintubationandmechanicalventilation,whatisthepriority nursingaction - ANS b. Monitor blood pressure 20.Thephysicianhasoptedtotreatapatientwithacompletespinalcordinjurywithglucocorticoids.The physicianorders30mg/kgover15minutesfollowedin45minuteswithaninfusionof5.4mg/kg/minfor23 hours.Whatisthetotal24-hourdoseforthe70-kgpatient - ANS c. 10,794mg 21.Thenursereceivesapatientfromtheemergencydepartmentfollowingaclosedheadinjury.Afterinsertionof anventriculostomy,thenurseassessesthefollowingvitalsigns:bloodpressure100/60mmHg,heartrate52 beats/min,respiratoryrate24breaths/min,oxygensaturation(SpO2)97%onsupplementaloxygenat45%via Venturimask,GlasgowComaScalescoreof4,andintracranialpressure(ICP)of18mmHg.Whichphysician ordershouldthenurseinstitutefirst? - ANS a. Mannitol 1g intravenous 22.Thenurseiscaringforapatient5daysfollowingclippingofananteriorcommunicatingarteryaneurysm forasubarachnoidhemorrhage.Thenurseassessesthepatienttobemorelethargicthantheprevioushour withabloodpressure95/50mmHg,heartrate110beats/min,respiratoryrate20breaths/min,oxygen saturation(SpO2)95%on3L/minoxygenvianasalcannula,andatemperatureof101.5F.Whichphysician ordershouldthenurseinstitutefirst? - ANS 500 mL albuminin fusion intravenously 23.Thenurse,caringforapatientfollowingasubarachnoidhemorrhage,beginsanicardipine(Cardene) infusion.Baselinebloodpressureassessedbythenurseis170/100mmHg.Fiveminutesafterbeginningthe infusionat5mg/hr,thenurseassessesthepatientsbloodpressuretobe160/90mmHg.Whatisthebest actionbythenurse - ANS Increasethedoseby2.5mg/hr 24.Thenurseispreparingtoadministeraroutinedoseofphenytoin(Dilantin).Thephysicianordersphenytoin (Dilantin)500mgintravenousevery6hours.Whatisthebestactionbythenurse - ANS c. Contact the physician 25.Thenurseiscaringforapatientadmittedtotheemergencydepartmentinstatusepilepticus.Vitalsigns assessedbythenurseincludebloodpressure160/100mmHg,heartrate145beats/min,respiratoryrate36 breaths/min,oxygensaturation(SpO2)96%on100%supplementaloxygenbynon-rebreathermask.After establishinganintravenous(IV)line,whichorderbythephysicianshouldthenurseimplementfirst? - ANS Administer lorazepam(Ativan) 26.Thephysicianordersfosphenytoin(Cerebyx),1.5gintravenous(IV)loadingdosefora75-kgpatientin statusepilepticus.Whatisthemostimportantactionbythenurse - ANS Administer drug over 10 minutes 27.Thenurseistoadminister100mgphenytoin(Dilantin)intravenous(IV).Vitalsignsassessedbythenurse includebloodpressure90/60mmHg,heartrate52beats/min,respiratoryrate18breaths/min,andoxygen saturation(SpO2)99%onsupplementaloxygenat3L/minbycannula.Topreventcomplications,whatisthe bestactionbythenurse - ANS Administer over 5 minutes 28.Thenurseispreparingtoadminister100mgofphenytoin(Dilantin)toapatientinstatusepilepticus.To preventpatientcomplications,whatisthebestactionbythenurse - ANS Ensure patency of intravenous (IV) line 29. ThenurseiscaringforapaDownloaded by: jaylincoxwilliams | tientadmittedwithasubarachnoidhemorrhagefollowingsurgicalrepairofthe aneurysm.Assessmentbythenursenotesbloodpressure90/60mmHg,heartrate115beats/min,respiratoryrate 28breaths/min,oxygensaturation(SpO2)99%onsupplementaloxygenat3L/minbycannula,aGlasgow ComaScoreof4,andacentralvenouspressure(CVP)of2mmHg.Afterreviewingthephysicianorders, whichorderisofthehighestpriority - ANS 500 mL albumin intravenous infusion Afterreceivingthehand-offreportfromthedayshiftchargenurse,whichpatientshouldtheevening chargenurseassessfirst? - ANS A patient with an intracranial pressure ICP of 20mmHg and an oral temperature of 104 31.Thenursehasjustreceivedapatientfromtheemergencydepartmentwithanadmittingdiagnosisof bacterialmeningitis.Topreventthespreadofnosocomialinfectionstootherpatients,whatisthebestaction bythenurse? - ANS Implement droplet precautions upon admission 32.Thenurseiscaringforapatientadmittedwithbacterialmeningitis.Vitalsigns assessedbythenurseincludebloodpressure110/70mmHg,heartrate110beats/min,respiratoryrate30 breaths/min,oxygensaturation(SpO2)95%onsupplementaloxygenat3L/min,andatemperature103.5F. Whatistheprioritynursingaction - ANS Implement seizure precautions 1.Thenurseispreparingtomonitorintracranialpressure(ICP)withafluid-filledmonitoringsystem.The nurseunderstandswhichprinciplesand/orcomponentstobeessentialwhenimplementingICPmonitoring? (Selectallthatapply.) - ANS Recording ICP as a mean value, Zero referencing the transducer system 2.Inanunconsciouspatient,eyemovementsaretestedbytheoculocephalicresponse.Which statementsregardingthetestingofthisreflexaretrue?(Selectallthatapply.) - ANS a. Dollseyesabsentindicateadisruptioninnormalbrainstemprocessing. b. Dollseyespresentindicatebrainstemactivity. c. Eyemovementintheoppositedirectionastheheadwhenturnedindicatesanintactreflex . e. Increasedintracranialpressure(ICP)isacontraindicationtotheassessmentofthisreflex. f. Presenceofcervicalinjuriesisacontraindicationtotheassessmentofthisreflex 3.Thenurseiscaringforapatientadmittedwithnewonsetofslurredspeech,facialdroop,andleft-sided weakness8hoursago.Diagnosticcomputedtomographyscanrulesoutthepresenceofanintracranial bleed.Whichactionsaremostimportanttoincludeinthepatientsplanofcare?(Selectallthatapply.) - ANS a. Make frequent neurological assessments c. Maintain MAP less than 130 mmHg Chapter15:AcuteRespiratoryFailure - ANS i will make a 92 on this exam 1.ThenurseiscaringforapatientwithacuterespiratoryfailureandidentifiesRiskforIneffectiveAirway Clearanceasanursingdiagnosis.Anursinginterventionrelevanttothisdiagnosisis: - ANS Reposition patient every 2 hours 2.Thepatientwithacuterespiratorydistresssyndrome(ARDS)wouldexhibitwhichofthefollowing symptoms? - ANS Decreasing PaO2 levels despite increased FiO2 administration 3.Thenurseassessesapatientwhoisadmittedforanoverdoseofsedatives.Thenurseexpectstofindwhichacid-basealteration - ANS Hypoventilation and respiratory acidosis 4.Intrapulmonaryshuntingrefersto - ANS blood that is shunted from the right side of the heart to the left without oxygenation 5.When fluid is present in the alveoli - ANS diffusion of oxygen and carbon dioxide is impaired. 6.Inassessingapatient,thenurseunderstandsthatanearlysignofhypoxemiais: - ANS d. restlessnes 7.Thebasicunderlyingpathophysiologyofacuterespiratorydistresssyndromeresultsfrom: - ANS damage to the type II pneumocytes, which produce surfactant 8.Thenurseiscaringforapatientwithacuterespiratorydistresssyndromewhoishypoxemicdespite mechanicalventilation.Thephysicianordersanontraditionalventilatormodeaspartoftreatment. Despitesedationandanalgesia,thepatientremainsrestlessandappearstobeindiscomfort.Thenurse informsthephysicianofthisassessmentandanticipatesanorderfor - ANS c. neuromuscular blockade. 9.Apatientpresentstotheemergencydepartmentinacuterespiratoryfailuresecondarytocommunityacquiredpneumonia.Thepatienthasahistoryofchronicobstructivepulmonarydisease.Thenurse anticipateswhichtreatmenttofacilitateventilation? - ANS c. Non-invasive positive-pressure ventilation (NPPV) 10.Whichofthefollowingacid-basedisturbancescommonlyoccurswiththehyperventilationandimpaired gasexchangeseeninsevereexacerbationofasthma - ANS Respiratory acidosis 11.Anacuteexacerbationofasthmaistreatedwithwhichofthefollowing? - ANS Inhaled bronchodilators and intravenous corticosteroids 12.Thenurseisdischargingapatienthomefollowingtreatmentforcommunity-acquiredpneumonia.Aspart ofthedischargeteaching,thenurseinstructs: - ANS It is important for you to get an annual influenza shot to reduce your risk of pneumonia 13.Thenurseisdischargingapatientwithasthma.Aspartofthedischargeinstruction,thenurseinstructs thepatienttopreventexacerbationby: - ANS taking all asthma medications as prescribed. 14.Thenurseiscaringforapostoperativepatientwithchronicobstructivepulmonarydisease(COPD).Which assessmentwouldbeacuetothepatientdevelopingpostoperativepneumonia - ANS Change in sputum characteristics 15.Thenurseiscaringforapatientwithadiagnosisofpulmonaryembolism.Thenurseunderstandsthat themostcommoncauseofapulmonaryembolusis: - ANS deep vein thrombosis from lower extremities 16.Thenurseisconcernedthatapatientisatincreasedriskofdevelopingapulmonaryembolusand developsaplanofcareforpreventiontoincludewhichofthefollowing - ANS Mobility 17.Whichofthefollowingstatementsistrueregardingvenousthromboembolism(VTE)andpulmonary embolus(PE)? - ANS PE should be suspected in any patient who has unexplained cardiorespiratory complaints and risk factors for VTE 18.ApatientathighriskforpulmonaryembolismisreceivingLovenox.Thenurseexplainstothepatient: - ANS This injection is being given to prevent blood clots from forming. 19.Adefinitivediagnosisofpulmonaryembolismcanbemadeby: - ANS pulmonary angiogram 20.Astrategyforpreventingthromboembolisminpatientsatriskwhocannottakeanticoagulantsis - ANS insertionofavenacavafilter. 21.Whichofthefollowingtreatmentsmaybeusedtodissolveathrombusthatislodgedinthepulmonary artery? - ANS Thrombolytics 22.Thenurseisassessingapatient.Whichassessmentwouldcuethenursetothepotentialofacute respiratorydistresssyndrome(ARDS)? - ANS Increased peak inspiratory pressure on the ventilator 23.ThenursecalculatesthePaO2/FiO2ratioforthefollowingvalues:PaO2is78mmHg;FiO2is0.6(60%). - ANS 130; meets criteria for ARDs 24.Thenurseisassessingapatientwithacuterespiratorydistresssyndrome.Anexpectedassessmentis: - ANS PAOP of 10mmHg and Pa O2 of 55. 25.Thenurseiscaringforapatientwhoisbeingturnedproneaspartoftreatmentforacuterespiratorydistress syndrome.Thenurseunderstandsthattheprioritynursingconcernforthispatientiswhichofthefollowing - ANS Management and protection of the airway 26.Duringrounds,thephysicianalertstheteamthatproningisbeingconsideredforapatientwith acuterespiratorydistresssyndrome.Thenurseunderstandsthatproningis: - ANS an optional treatment if the PaO2/FiO2 ratio is less 100 27.Theetiologyofnoncardiogenicpulmonaryedemainacuterespiratorydistresssyndrome(ARDS)isrelated todamagetothe - ANS alveolar-capillary membrane 1.IdentifydiagnosticcriteriaforARDS.(Selectallthatapply. - ANS a.Bilateralinfiltratesonchestx-raystudy / PaO2/FiO2 ratio of less than 20 2.Whichofthefollowingstatementsistrueregardingoralcareforthepreventionofventilatorassociatedpneumonia(VAP)?(Selectallthatapply.) - ANS b. Implementing a comprehensive oral care program is an intervention for preventing VAP. c. Oral care protocols should include oral suctioning and brushing teeth. d. Protocols that include chlorhexidine gluconate have been effective in preventing VAP 3.Whichofthefollowingarephysiologicaleffectsofpositiveend-expiratorypressure(PEEP)usedinthe treatmentofARDS?(Selectallthatapply. - ANS a. Increase functional residual capacity b. Prevent collapse of unstable alveoli c. Improve arterial oxygenation d. Open collapsed alveoli 4.WhichofthefollowingarecomponentsoftheInstituteforHealthcareImprovements(IHIs)ventilator bundle?(Selectallthatapply. - ANS a. Interrupt sedation each day to assess readiness to extubate. b.Maintain head of bed at least 30 degrees elevation. c. Provide deep vein thrombosis prophylaxis. d. Provide prophylaxis for peptic ulcer disease 5.Selectthestrategiesforpreventingdeepveinthrombosis(DVT)andpulmonaryembolus(PE).(Selectall thatapply.) - ANS a. Graduated compression stockings b. Heparin or low molecular weight heparin for patients at risk c. Sequential compression devices 6.Thenurseiscaringforamechanicallyventilatedpatient.Thenurseunderstandsthatstrategiesto preventventilator-associatedpneumoniaincludewhichofthefollowing?(Selectallthatapply.) - ANS a. Drain condensate from the ventilator tubing away from the patient. b. Elevate the head of the bed 30 to 45 degrees. c. Instill normal saline as part of the suctioning procedure. d. Perform regular oral care with chlorhexidine 7.Thenurseiscaringforapatientinacuterespiratoryfailureandunderstandsthatthepatientshould bepositioned:(Selectallthatapply. - ANS a. high Fowlers. b. side lying with head of bed elevated. c. sitting in a chair 8.Thenurseiscaringforapatientwithcysticfibrosis(CF)andunderstandsthattreatmentconsistsofwhich ofthefollowing?(Selectallthatapply.) - ANS a. Airway clearance therapies b. Antibiotic therapy c. Nutritional support if you see a pic of a plum - ANS its shunting Chapter16:AcuteKidneyInjur - ANS I am going to earn a 92 on this exam 1.Withsuddencessationofrenalfunction,allbodysystemsareaffectedbytheinabilitytomaintainfluidand electrolytebalanceandeliminatemetabolicwaste.Incriticallyillpatients,renaldysfunction - ANS b. affects nearly two thirds of patient 2.Thenurseiscaringforapatientwhohassustainedblunttraumatotheleftflankarea,andisevaluating thepatientsurinalysisresults.Thenurseshouldbecomeconcernedwhe - ANS d. red blood cells and albumin are found in the urine. 3.Anormalglomerularfiltrationrateis: - ANS b. 80 to 125 mL/mi 4.Anormalurineoutputisconsideredtobe: - ANS d. 1 to 2L/day 5.Reninplaysaroleinbloodpressureregulationby: - ANS a. activating the renin-angiotensin-aldosterone cascade 6.Thenurseiscaringforanelderlypatientwhowasadmittedwithrenalinsufficiency.Thenurserealizesthatwith advanceageoftencomesdecliningrenalfunction.Anexpectedlaboratoryfindingforthispatientmaybe - ANS a normal serum creatinine level. 7.Thetermusedtodescribeanincreaseinbloodureanitrogen(BUN)andserumcreatinineis - ANS b. azotemia .Themostcommoncauseofacutekidneyinjuryincriticallyillpatientsis - ANS a. sepsis 9.Thenurseiscaringforapatientwhohasundergonemajorabdominalsurgery.Thenursenoticesthatthe patientsurineoutputhasbeenlessthan20mL/hourforthepast2hours.Itis0200inthemorning.The patientsbloodpressureis100/60mmHg,andthepulseis110beatsperminute.Previously,thepulsewas90 beatsperminutewithabloodpressureof120/80mmHg.Thenurseshould: - ANS a. contact the provider and expect an order for a normal saline bolus. 10.Acute kidney injury from post renal etiology is caused by: - ANS a. obstruction of the flow of urine 11.Conditionsthatproduceacutekidneyinjurybydirectlyactingonfunctioningkidneytissueareclassifiedaintrarenal.Themostcommonintrarenalconditionis: - ANS c. acute tubular necrosis 12.Thepatientundergoesacardiaccatheterizationthatrequirestheuseofcontrastdyesduringthe procedure.Todetectsignsofcontrast-inducedkidneyinjury,thenurseshould - ANS b. evaluate the patients serum creatinine for up to 72 hours after the procedure 13.Thenurseiscaringforapatientwithacutekidneyinjurywhoisbeingtreatedwithhemodialysis.Thepatient asksifhewillneeddialysisfortherestofhislife.Whichofthefollowingwouldbethebestresponse - ANS d. recovery is possible, but it may take several months 14.Whichofthefollowingpatientsisatthegreatestriskofdevelopingacutekidneyinjury?Apatientwho: - ANS c. was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks. 15.Thepatienthaselevatedbloodureanitrogen(BUN)andserumcreatininelevelswithanormal BUN/creatinineratio.Theselevelsmostlikelyindicate - ANS b. acute kidney injury, such as acute tubular necrosis (ATN). 16.Thepatientsserumcreatininelevelis0.7mg/dL.TheexpectedBUNlevelshouldbe - ANS b. 7-14 mg/d 17.Indeterminingtheglomerularfiltrationrate(GFR)orcreatinineclearance,a24-hoururineisobtained.Ifa reliable24-hoururinecollectionisnotpossible, - ANS d. a standardized formula may be used to calculate GFR 18.Incalculatingtheglomerularfiltrationrate(GFR)resultsforwomen,thecreatinineclearanceisusually - ANS c. multiplied by 0.85 19.Thepatientisadmittedwithcomplaintsofgeneralmalaiseandfatigue,alongwithadecreasedurinary output.Thepatientsurinalysisshowscoarse,muddybrowngranularcastsandhematuria.Thenurse determinesthatthepatienthas - ANS c. intrarenaldisease,probablyacutetubularnecrosi 20.Thepatientiscomplainingofsevereflankpainwhenhetriestourinate.Hisurinalysisshowssediment andcrystalsalongwithafewbacteria.Usingthisinformationalongwiththeclinicalpicture,thenurserealizes thatthepatientsconditionis: - ANS postrenal. 21.Thepatientisanewpostoperativepatient.Sheweighs75kg.Thenurseexpectstheminimal acceptableurineoutputtobe: - ANS b. 37mL/hour 2.Dailyweightsarebeingrecordedforthepatient.Hisurineoutputhasbeenlessthanhisintravenous andoralintake.Hisweightyesterdaywas97.5kg.Thismorningitis99kg.Thenurseunderstandsthatthis correspondstoa(n): - ANS a. fluid retention of 1.5l 23.Thepatientisadmittedtotheunitwiththediagnosisofrhabdomyolysis.Thepatientisstartedon intravenous(IV)fluidsandIVmannitol.Becausemannitolisanosmoticdiuretic,thenurseshould - ANS Assess the patients lungs. 24.Thepatientgetshemodialysis3daysaweek.Heis74inchestallandweighs100kg.Inplanningthe careforthispatient,thenurserecommends: - ANS 2500to3500kcaldietperda 25.Thepatientspotassiumlevelis7.0mEq/L.Besidesdialysis,whichofthefollowingactuallyreduces plasmapotassiumlevelsandtotalbodypotassiumcontentsafelyinapatientwithrenaldysfunction? - ANS a. Kayexala 6.Thepatientisdiagnosedwithacutekidneyinjuryandhasbeengettingdialysis3daysperweek.Thepatient complainsofgeneralmalaiseandistachypneic.AnarterialbloodgasisorderedandshowsthatthepatientspH is7.19,withaPCO2of30mmHgandabicarbonatelevelof13mEq/L.Thenursepreparesto: - ANS c. administer intravenous sodiumbicarbonate 27.Theremovalofplasmawaterandsomelowmolecularweightparticlesbyusingapressureor osmoticgradientisknownas: - ANS d. ultrafiltration 28.Thepatientisinneedofimmediatehemodialysis,buthasnovascularaccess.Thenurseprepares thepatientforinsertionof - ANS a. apercutaneouscatheteratthebedside 29.Thepatienthasatemporarypercutaneouscatheterinplacefortreatmentofacutekidneyinjury. Thecatheterhasbeeninplacefor5days.Thenurseshould - ANS b. evaluatethepatientforsignsandsymptomsofinfectio 30.Thepatienthasjustreturnedfromhavinganarteriovenousfistulaplaced.Thepatientasks,Whenwillthey beabletousethisandtakethisothercatheterout?Thenurseshouldreply - ANS c. The fistula will be usable in about 4 to 6 weeks 31.Thepatientisinprogressivecareunitfollowingarteriovenousfistulaimplantationinhisleftupperarm, andisduetohaveblooddrawnwithhisnextsetofvitalsignsandassessment.Whenthenurseassesses thepatient,thenurseshoul - ANS d. auscultate the left arm for a bruit and palpate for a thrill. 32.Thenurseisassessingapatientwithanewarteriovenousfistula,butdoesnothearabruitorfeelathrill. Pulsesdistaltothefistulaarenotpalpable.Thenurseshould: - ANS c. notify the provider immediately 33.Thenurseiscaringforapatientwhohasatemporarypercutaneousdialysiscatheterinplace.Incaring forthispatient,thenurseshould: - ANS c. assess the catheter site for redness and/or swelling. 34.Thepatientisgettinghemodialysisforthesecondtimewhenhecomplainsofaheadacheandnauseaand, alittlelater,ofbecomingconfused.Thenurserealizesthesearesymptomsof: - ANS c. dialysis disequilibrium syndrome 35.Continuousrenalreplacementtherapy(CRRT)differsfromconventionalintermittenthemodialysisinthat: - ANS d. the process removes solutes and water slowly 36.Slowcontinuousultrafiltrationisalsoknownasisolatedultrafiltrationandisusedto: - ANS a. remove plasma water in cases of volume overload 37.Continuousvenovenoushemofiltrationisusedto: - ANS a. remove fluids and solutes through the process of convection 38.Continuousvenovenoushemodialysisisusedto - ANS c. remove plasma water and solutes by adding dialysate. 39.Thecriticalcarenurseisresponsibleformonitoringthepatientreceivingcontinuousrenal replacementtherapy(CRRT).Indoingso,thenurseshould - ANS a. assess that the blood tubing is warm to the touch 40.Peritonealdialysisisdifferentfromhemodialysisinthatperitonealdialysis - ANS b. uses the patients own semipermeable membrane (peritonealmembrane). 41.Anadvantageofperitonealdialysisisthat - ANS the danger of hemorrhage is minimal 42. Thenurseiscaringforapatientreceivingperitonealdialysis.Thepatientsuddenlycomplainsof abdominalpainandchills.Thepatientstemperatureiselevated.Thenurseshould: - ANS assess peritoneal dialysate return. 43.Thepatientisonintakeandoutput(I&O)aswellasdailyweights.Thenursenotesthatoutputis considerablylessthanintakeoverthelastshift,anddailyweightis1kgmorethanyesterday.Thenurse should - ANS c. assess thepatientslungs 44.Thepatienthasbeenadmittedtothehospitalwithnauseaandvomitingthatstarted5daysearlier.Hisbloodpressureis80/44mmHgandheartrateis122beats/min;hehasnotvoidedin8hoursandhisbladderisnotdistended.Thenurseanticipatesanorderforstatadministrationof: - ANS b. fluid replacement with 0.45% saline. 1.Identifywhichsubstanceswouldindicateaproblemwithrenalfunction.(Selectallthatapply). - ANS e. uricacid/ d. redbloodcells/ a. protein 2.Thepatientisadmittedwithacutekidneyinjuryfromapostrenalcause.Acceptabletreatmentsforthatdiagnosisinclude:(Selectallthatapply.) - ANS a. bladder catheterization, b. Renal ultrasound c. c. Magneticr esonance imaging(MRI) 4.Themostcommonreasonsforinitiatingdialysisinacutekidneyinjuryincludewhichofthefollowing?(Selectallthatapply.) - ANS a. Acidosis a c. Volume overload d. Hyperkalemia e. Uremia 5.Complicationscommontopatientsreceivinghemodialysisforacutekidneyinjuryincludewhichofthefollowing?(Selectallthatapply.) - ANS a. Hypotension, b. Dysrhythmias 6.Thepatientisinthecriticalcareunitandwillreceivedialysisthismorning.Thenursewill:(Selectallthatapply.) - ANS a. evaluatemorninglaboratoryresultsandreportabnormalresults. c. assessthedialysisaccesssiteandreportabnormalities. d. weighthepatienttomonitorfluidstatu The patient is admitted with constipation. In anticipation of treatment, the nurse prepares to: - ANS provide therapies that will innervate the autonomic nervous system. The nurse is assessing the patient and notices that his oral cavity is only slightly moist and contains a scant amount of thick saliva even though the patients fluid intake has been sufficient. The nurses realizes that the condition of the patients mouth is probably caused by - ANS thetic nerve stimulation. The nurse is caring for a patient who has a peptic ulcer. To treat the ulcer and prevent more ulcers from forming, the nurse should be prepared to administer: - ANS a.H2-histamine receptor blockers. The nurse is caring for a patient who is receiving several cardiac medications designed to stimulate the sympathetic nervous system, vitamin B12, and an H2 blocker. The nurse should do which of the following? - ANS a.Assess for signs of peptic ulcer. After gastric bypass surgery, the patient is getting vitamin B12 via injection. The patient asks why he cant get the vitamin by mouth. The nurse explains that: - ANS a. the patient may not have enough intrinsic factor for normal absorption. The nurse is assessing the patient admitted with pancreatitis. In doing so, the nurse: - ANS assesses symptoms that could indicate involvement of the stomach. The liver plays a major role in homeostasis by: - ANS c. removing active clotting factors from the circulation. The liver detoxifies the blood by: - ANS a. converting fat-soluble compounds to water-soluble compounds. The patient is being admitted to the hospital. At home, the patient take an over-the-counter supplement of Vitamin D and is concerned because the doctor did not order that vitamin D to be given in the hospital. The nurse explains that - ANS vitamins D is stored in the liver with a 10-month supply to prevent deficiency. The nurse is caring for a patient with a heart rate of 140 beats/min. The provider orders parasympathetic medications to slow down the heart rate. With this type of medication, the nurse should - ANS observe for diarrhea. In assessing the patient complaining of abdominal pain, it is important for the nurse to understand that: - ANS increasing intensity of pain is always significant. The nurse is assessing a patient who is admitted with abdominal pain. To detect abdominal masses, the nurse: - ANS has the patient take a deep breath. When assessing the patients bowel sounds, the nurse: - ANS c. listens to bowel sounds before palpation. When assessing bowel sounds, the nurse: - ANS listens for 5 minutes before noting absent bowel sounds. Infection by Helicobacter pylori bacteria is a major cause of: - ANS