Med Surg Week 5 Study Guide Questions Flashcards
What stimulates aldosterone secretion from the adrenal cortex?
A) Excessive water intake
B) Increased serum osmolality
C) Decreased serum potassium
D) Decreased sodium and water
While caring for an 84-yr-old patient, the nurse monitors the patient's fluid and electrolyte balance, recognizing what as a normal change of aging?
C) Decreased insensible fluid loss
D) Increased plasma oncotic pressures
Which patient is at risk for hypernatremia?
A) Has a deficiency of aldosterone
B) Has prolonged vomiting and diarrhea
C) Receives excessive IV 5% dextrose solution
D) Has impaired consciousness and decreased thirst sensitivity
In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system?
B) Cardiovascular system
C) Musculoskeletal system
D) Central nervous system
A common collaborative problem related to both hyperkalemia and
which potential complication?
D) Acute kidney injury
With which disorder is hyperkalemia frequently associated with?
B) Metabolic acidosis
C) Respiratory alkalosis
D) Decreased urine potassium levels
In a patient with a positive Chvostek's sign, the nurse would anticipate the IV administration of which medication?
B) Vitamin D
C) Loop diuretics
D) Calcium gluconate
A patient with chronic kidney disease has hyperphosphatemia. What is a commonly associated electrolyte imbalance?
What is the normal pH range of the blood, and what ratio of base to acid does this reflect?
A) 7.32 to 7.42; 25 to 2
B) 7.32 to 7.42; 28 to 2
C) 7.35 to 7.45; 20 to 1
D) 7.35 to 7.45; 30 to 1
A patient who has a large amount of carbon dioxide in the blood also has what in the blood?
A) Large amount of carbonic acid and low hydrogen ion concentration
B) Small amount of carbonic acid and low hydrogen ion concentration
C) Large amount of carbonic acid and high hydrogen ion concentration
D) Small amount of carbonic acid and high hydrogen ion concentration
What is a compensatory mechanism for metabolic alkalosis?
A) Shifting of bicarbonate into cells in exchange for chloride
B) Kidney conservation of bicarbonate and excretion of hydrogen ions
C) Deep, rapid respirations (Kussmaul respirations) to increase CO2 excretion
D) Decreased respiratory rate and depth to retain CO2 and kidney excretion of bicarbonate
A patient with a pH of 7.29 has metabolic acidosis. Which value is useful in determining whether the cause of the acidosis is an acid gain or a bicarbonate loss?
B) Anion gap (normal: 8-12 mmol/L) (Anion Gap = Na+ - (HCO3 + Cl))
C) Serum Na+ level
D) Bicarbonate level
To provide free water and intracellular fluid hydration for a patient with acute gastroenteritis who is NPO, the nurse would expect administration of which infusion?
A) Dextrose 5% in water
B) Dextrose 10% in water
C) Lactated Ringer's solution
D) Dextrose 5% in normal saline (0.9%)
What is an example of an IV solution that would be appropriate to treat an extracellular fluid volume deficit?
B) 3% saline
C) Lactated Ringer's solution
D) D5W in normal saline (0.45%)
On assessment of a central venous access device (CVAD) site, the nurse observes that the transparent dressing is loose along two sides. What should the nurse do immediately?
A) Wait and change the dressing when it is due.
B) Tape the two loose sides down and document.
C) Apply a gauze dressing over the transparent dressing and tape securely.
D) Remove the dressing and apply a new transparent dressing using sterile technique.
A patient is scheduled to have a tunneled catheter placed for administration of chemotherapy for breast cancer. When preparing the patient for the catheter insertion, what does the nurse explain about this method of chemotherapy administration?
A) Decreases the risk for extravasation at the infusion site
B) Reduces the incidence of systemic side effects of the drug
C) Does not become occluded as peripherally inserted catheters can
D) Allows continuous infusion of the drug directly to the area of the tumor
The nurse is reviewing a patient's morning laboratory results. Which result is of greatest concern?
A) Serum Na+ of 150 mEq/L
B) Serum Mg2+ of 1.1 mEq/L
C) Serum PO43− of 4.5 mg/dL
D) Serum Ca2+ (total) of 8.6 mg/dL
Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters?
A) Upper UTI
B) Lower UTI
C) Complicated UTI
D) Uncomplicated UTI
While caring for a 77-yr-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestations is the patient likely to experience?
A) Cloudy urine and fever
B) Urethral burning and bloody urine
C) Vague abdominal discomfort and disorientation
D) Suprapubic pain and slight decline in body temperature
A woman with no history of UTI who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient?
A) Obtaining a clean-catch midstream urine specimen for culture and sensitivity
B) No treatment with medication unless she develops fever, chills, and flank pain
C) Empirical treatment with trimethoprim-sulfamethoxazole (Bactrim) for 3 days
D) Need to have a blood specimen drawn for a complete blood count
kidney function tests
A female patient, weighing 180 pounds, with a UTI has a nursing diagnosis of risk for infection related to lack of knowledge regarding prevention of recurrence. What should the nurse include in the teaching plan instructions for this patient?
A) Empty the bladder at least 4 times a day.
B) Drink at least 2 quarts of water every day.
C) Wait to urinate until the urge is very intense.
D) Clean the urinary meatus with an anti infective agent after voiding.
What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract?
A) The kidney is scarred and fibrotic.
B) The organism is resistant to antibiotics.
C) There is a preexisting abnormality of the urinary tract.
D) The patient does not take all of the antibiotics for treatment of a UTI.
Which characteristic is more likely with acute pyelonephritis than with a lower UTI?
Which test is required for a diagnosis of pyelonephritis?
A) Renal biopsy
B) Blood culture
C) Intravenous pyelogram (IVP)
D) Urine for culture and sensitivity
A patient with suprapubic pain and symptoms of urinary frequency and
urgency has two negative urine cultures. What is one assessment
finding that would indicate
interstitial cystitis (IC)?
A) Residual urine greater than 200 mL
B) A large, atonic bladder on urodynamic testing
C) A voiding pattern that indicates psychogenic urinary retention
D) Pain with bladder filling that is transiently relieved by urination
When caring for the patient with IC, what can the nurse teach the patient to do?
A) Avoid foods that make the urine more alkaline.
B) Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder.
C) Always keep a voiding diary to document pain, voiding frequency, and patterns of nocturia.
D) Use the dietary supplement calcium glycerophosphate (Prelief) to
Glomerulonephritis is characterized by glomerular damage caused by
A) growth of microorganisms in the glomeruli.
B) release of bacterial substances toxic to the glomeruli.
C) accumulation of immune complexes in the glomeruli.
D) hemolysis of red blood cells circulating in the glomeruli.
What manifestation in the patient will indicate the need for restriction of dietary protein in management of acute poststreptococcal glomerulonephritis (APSGN)?
D) Elevated blood urea nitrogen (BUN)
The nurse plans care for the patient with APSGN based on what knowledge?
A) Most patients with APSGN recover completely or rapidly improve
B) Chronic glomerulonephritis leading to renal failure is a common sequela to acute glomerulonephritis.
C) Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane.
D) A large percentage of patients with APSGN develop rapidly
glomerulonephritis, resulting in kidney failure.
What results in the edema associated with nephrotic syndrome?
C) Decreased plasma oncotic pressure
D) Decreased glomerular filtration rate
Which infection is asymptomatic in the male patient at first and then progresses to cystitis, frequent urination, burning on voiding, and epididymitis?
B) Urethral diverticula
C) Goodpasture syndrome
D) Genitourinary tuberculosis
What can patients at risk for nephrolithiasis do to prevent the stones in many cases?
A) Lead an active lifestyle
B) Limit protein and acidic foods in the diet
C) Drink enough fluids to produce dilute urine
D) Take prophylactic antibiotics to control UTIs
Which type of urinary tract calculi are the most common and frequently obstruct the ureter?
B) Uric acid
C) Calcium oxalate
D) Calcium phosphate
A female patient with a UTI also has renal calculi. The nurse knows that these are most likely which type of stone?
C) Uric acid
D) Calcium phosphate
Besides being mixed with struvite or oxalate stones, what
associated with calcium phosphate calculi?
A) Associated with alkaline urine
B) Genetic autosomal recessive defect
C) Three times as common in women as in men
D) Defective gastrointestinal (GI) and kidney absorption
On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report?
A) A history of chronic UTIs
B) Dull, costovertebral flank pain
C) Severe, colicky back pain radiating to the groin
D) A feeling of bladder fullness with urgency and frequency
Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks?
A) Milk and milk products
B) Dried beans and dried fruits
C) Liver, kidney, and sweetbreads
D) Spinach, cabbage, and tomatoes
Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient?
A) Monitor for hematuria.
B) Encourage fluid intake of 3 L/day.
C) Apply moist heat to the flank area.
D) Strain all urine through gauze or a special strainer.
With which diagnosis will the patient benefit from being taught to do self catheterization?
A) Renal trauma
B) Urethral stricture
C) Renal artery stenosis
D) Accelerated nephrosclerosis
In providing care for the patient with adult-onset polycystic kidney disease, what should the nurse do?
A) Help the patient to cope with the rapid progression of the disease.
B) Suggest genetic counseling resources for the children of the patient.
C) Expect the patient to have polyuria and poor concentration ability of the kidneys.
D) Implement measures for the patient's deafness and blindness in
addition to the
Which disease causes connective tissue changes that cause glomerulonephritis?
C) Diabetes mellitus
D) Systemic lupus erythematosus
When obtaining a nursing history from a patient with cancer of the
urinary system, what does the nurse recognize as a risk factor
associated with both kidney cancer and
B) Family history of cancer
C) Chronic use of phenacetin
D) Chronic, recurrent nephrolithiasis
Thirty percent of patients with kidney cancer have metastasis at the
diagnosis. Why does this occur?
A) The only treatment modalities for the disease are palliative.
B) Diagnostic tests are not available to detect tumors before they metastasize.
C) Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced.
D) Early metastasis to the brain impairs the patient's ability to
seriousness of symptoms.
The patient has a thoracic spinal cord lesion and incontinence that occurs equally during the day and night. What type of incontinence is this patient experiencing?
A) Reflex incontinence
B) Overflow incontinence
C) Functional incontinence
D) Incontinence after trauma
To assist the patient with stress incontinence, what should the nurse teach the patient to do?
A) Void every 2 hours to prevent leakage.
B) Use absorptive perineal pads to contain urine.
C) Perform pelvic floor muscle exercises 40 to 50 times per day.
D) Increase intra abdominal pressure during voiding to empty the bladder completely.
What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients?
A) Measuring urine output every 1 to 2 hours to ensure patency
B) Turning the patient frequently from side to side to promote drainage
C) Using strict sterile technique during irrigation and obtaining culture specimens
D) Daily cleaning of the catheter insertion site with soap and water
and application of
A patient has a right ureteral catheter placed following a
lithotripsy for a stone in the ureter. In caring for the patient
immediately after the procedure, what is the most
appropriate nursing action?
A) Milk or strip the catheter every 2 hours.
B) Measure ureteral urinary drainage every 1 to 2 hours.
C) Irrigate the catheter with 30-mL sterile saline every 4 hours.
D) Encourage ambulation to promote urinary peristaltic action.
During assessment of the patient who had an open nephrectomy, what should the nurse expect to find?
A) Shallow, slow respirations
B) Clear breath sounds in all lung fields
C) Decreased breath sounds in the lower left lobe
D) Decreased breath sounds in the right and left lower lobes
Which urinary diversion is a continent diversion created by formation of an ileal pouch with a stoma for catheterization?
A) Kock pouch
B) Ileal conduit
C) Orthotopic neobladder
D) Cutaneous ureterostomy
A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient's first postoperative day, what should the nurse plan to do?
A) Measure and fit the stoma for a permanent appliance.
B) Encourage high oral intake to flush mucus from the conduit.
C) Teach the patient to self-catheterize the stoma every 4 to 6 hours.
D) Empty the drainage bag every 2 to 3 hours and measure the urinary output.
A teaching plan developed by the nurse for the patient with a new ileal conduit includes instructions to do what?
A) Clean the skin around the stoma with alcohol every day.
B) Use a wick to keep the skin dry during appliance changes.
C) Use sterile supplies and technique during care of the stoma.
D) Change the appliance every day and wash it with soap and warm water.
Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN?
A) Patient with diabetes mellitus
B) Patient with hypertensive crisis
C) Patient who tried to overdose on acetaminophen
D) Patient with major surgery who required a blood transfusion
A dehydrated patient is in the Injury stage of the RIFLE staging of AKI. What would the nurse first anticipate in the treatment of this patient?
A) Assessment of daily weight
B) IV administration of fluid and furosemide (Lasix)
C) IV administration of insulin and sodium bicarbonate
D) Urinalysis to check for sediment, osmolality, sodium, and specific gravity
What indicates to the nurse that a patient with oliguria has prerenal oliguria?
A) Urine testing reveals a low specific gravity.
B) Causative factor is malignant hypertension.
C) Urine testing reveals a high sodium concentration.
D) Reversal of oliguria occurs with fluid replacement.
In a patient with AKI, which laboratory urinalysis result indicates tubular damage?
B) Specific gravity fixed at 1.010
C) Urine sodium of 12 mEq/L (12 mmol/L)
D) Osmolality of 1000 mOsm/kg (1000 mmol/kg)
Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of
A) excretion of sodium.
B) excretion of bicarbonate.
C) conservation of potassium.
D) excretion of hydrogen ions.
What indicates to the nurse that a patient with AKI is in the recovery phase?
A) A return to normal weight
B) A urine output of 3700 mL/day
C) Decreasing sodium and potassium levels
D) Decreasing blood urea nitrogen (BUN) and creatinine levels
While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify the HCP?
A) Urine output is 300 mL/day.
B) Edema occurs in the feet, legs, and sacral area.
C) Cardiac monitor reveals a depressed T wave and elevated ST segment.
D) The patient experiences increasing muscle weakness and abdominal cramping.
In caring for the patient with AKI, of what should the nurse be aware?
A) The most common cause of death in AKI is irreversible metabolic acidosis.
B) During the oliguric phase of AKI, daily fluid intake is limited to 1000 mL plus the prior day's measured fluid loss.
C) Dietary sodium and potassium during the oliguric phase of AKI are managed according to the patient's urinary output.
D) One of the most important nursing measures in managing fluid balance in the patient with AKI is taking accurate daily weights.
A 68-yr-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2 mEq/L (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum HCO3 − is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him?
A) Loop diuretics
B) Renal replacement therapy
C) Insulin and sodium bicarbonate
D) Sodium polystyrene sulfonate (Kayexalate)
A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take?
A) Place the patient on a cardiac monitor.
B) Check the patient's blood pressure (BP).
C) Instruct the patient to avoid high-potassium foods.
D) Call the lab and request a redraw of the lab to verify results.
A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L) and the following arterial blood gas results: pH 7.28, PaCO2 30 mm Hg, PaO2 86 mm Hg, HCO3 − 18 mEq/L (18 mmol/L). The nurse recognizes that treatment of the acid-base problem with sodium bicarbonate would cause a decrease in which value?
B) Potassium level
C) Bicarbonate level
D) Carbon dioxide level
In replying to a patient's questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on what?
A) Total daily urine output
B) Glomerular filtration rate (GFR)
C) Degree of altered mental status
D) Serum creatinine and urea levels
What causes the gastrointestinal (GI) manifestation of stomatitis in the patient with CKD?
A) High serum sodium levels
B) Irritation of the GI tract from creatinine
C) Increased ammonia from bacterial breakdown of urea
D) Iron salts, calcium-containing phosphate binders, and limited fluid intake
The patient with CKD is brought to the emergency department with
respirations. What does the nurse know about CKD that could cause this patient's
A) Uremic pleuritis is occurring.
B) There is decreased pulmonary macrophage activity.
C) They are caused by respiratory compensation for metabolic acidosis.
D) Pulmonary edema from heart failure and fluid overload is occurring.
Which serum laboratory value indicates to the nurse that the
patient's CKD is getting
A) Decreased BUN
B) Decreased sodium
C) Decreased creatinine
D) Decreased calculated glomerular filtration rate (GFR)
What is the most serious electrolyte disorder associated with kidney disease?
What is the most appropriate snack for the nurse to offer a patient with stage 4 CKD?
B) Ice cream
C) Dill pickles
D) Hard candy
Which complication of chronic kidney disease is treated with erythropoietin?
D) Mineral and bone disorder
The patient with CKD asks why she is receiving nifedipine (Procardia)
furosemide (Lasix). The nurse understands that these drugs are being used to treat the
D) mineral and bone disorder.
Which description accurately describes the care of the patient with CKD?
A) Iron is a nutrient that is commonly supplemented for the patient on dialysis because it is dialyzable.
B) The syndrome that includes all of the signs and symptoms seen in the various body systems in CKD is azotemia.
C) The use of morphine is contraindicated in the patient with CKD because accumulation of its metabolites may cause seizures.
D) The use of calcium-based phosphate binders in the patient with CKD is contraindicated when serum calcium levels are increased.
During the nursing assessment of the patient with renal insufficiency, the nurse asks the patient specifically about a history of
D) rheumatoid arthritis.
What does the dialysate for PD routinely contain?
A) Calcium in a lower concentration than in the blood
B) Sodium in a higher concentration than in the blood
C) Dextrose in a higher concentration than in the blood
D) Electrolytes in an equal concentration to that of the blood
In which type of dialysis does the patient dialyzed during sleep and leave the fluid in the abdomen during the day?
A) Long nocturnal HD
B) Automated peritoneal dialysis (APD)
C) Continuous venovenous hemofiltration (CVVH)
D) Continuous ambulatory peritoneal dialysis (CAPD)
To prevent the most common serious complication of PD, what is important for the nurse to do?
A) Infuse the dialysate slowly.
B) Use strict aseptic technique in the dialysis procedures.
C) Have the patient empty the bowel before the inflow phase.
D) Reposition the patient frequently and promote deep breathing.
A patient on HD develops a thrombus of a subcutaneous arteriovenous graft (AVG), requiring its removal. While waiting for a replacement graft or fistula, the patient is most likely to have what done for treatment?
A) Peritoneal dialysis
B) Peripheral vascular access using radial artery
C) Long-term cuffed catheter tunneled subcutaneously to the jugular vein
D) Peripherally inserted central catheter (PICC) line inserted into subclavian vein
A man with end-stage renal disease (ESRD) is scheduled for HD following healing of an arteriovenous fistula (AVF). What should the nurse explain to him that will occur during dialysis?
A) He will be able to visit, read, sleep, or watch TV while reclining in a chair.
B) He will be placed on a cardiac monitor to detect any adverse effects that may occur.
C) The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the waste products.
D) A large catheter with two lumens will be inserted into the fistula to send blood to and return it from the dialyzer.
What is the primary way that a nurse will evaluate the patency of an AVF?
A) Palpate for pulses distal to the graft site.
B) Auscultate for the presence of a bruit at the site.
C) Evaluate the color and temperature of the extremity.
D) Assess for the presence of numbness and tingling distal to the site.
A patient with AKI is a candidate for continuous renal replacement therapy (CRRT). What is the most common indication for use of CRRT?
C) Fluid overload
A patient rapidly progressing toward ESRD asks about the possibility
of a kidney transplant. In responding to the patient, the nurse knows
that what is a
contraindication to kidney transplantation?
A) Hepatitis C infection
B) Coronary artery disease
C) Refractory hypertension
D) Extensive vascular disease
During the immediate postoperative care of a recipient of a kidney transplant, what is a priority for the nurse to do?
A) Regulate fluid intake hourly based on urine output.
B) Monitor urine-tinged drainage on abdominal dressing.
C) Medicate the patient frequently for incisional flank pain.
D) Remove the urinary catheter to evaluate the ureteral implant.
A patient received a kidney transplant last month. Because of the effects of immunosuppressive drugs and CKD, what complication of transplantation should the nurse be assessing the patient for to decrease the risk of mortality?
D) Cardiovascular disease