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36 Cards in this Set

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Which of the following should the nurse suspect as an iatrogenic cause of acute renal failure?

(1) ETOH
(2) Diet
(3) Nephrotoxic meds
(4) Exercise
Answer (3) Nephrotoxic meds

Rationale: Iatrogenic causes result from tx. from a physician or other caure provider.

Some examples include: nephrotoxic meds, radiologic contrast dye, and shock after surgery.
What laboratory test is a common measure of renal function?

(1) CBC
(2) BUN/CREATININE
(3) Glucose
(4) ALT- alanine amino transferase
Answer (2) BUN/Creatinine

Rationale: The blood urea nitrogen is promarily used as an indicator of kidney funciton because most renal diseases interere with its excretion and cause blood levels to rise. Creatinine is produced in relatively constant amounts, according to the amount of muscle mass and is excreted entirely by the kidneys making it a good indicator of renal function.
A 45 y/o female hospitalized with acute pancreatitis has orders for meperidine (Demerol) 50 mg IM Q 4 hrs PRN as needed for pain. Demerol has been ordered rather than morphine for this client because it:

(1) Has a faster onset of action than morphine
(2) Is less addictive than morphine.
(3) Causes fewer spasms in the sphincter of Oddi
(4) Has fewer cognitive side effects
Answer: (3) Causes fewer spasms in the sphincter of Oddi.

Rationale: The onset of action for meperidine is 10-15 minutes and the onset of morphine is 20-60 minutes. Both drugs are equal in the potential for addiction. Demerol is less sedating than morphine. The most important difference is that the meperidine causes fewer spasms of the sphincter of Oddi, which contributes to the goal of giving the pancreas a rest.
A 65 y/o F w/ a hx of hepatic encephalopathy is hospitalized for pneumonia and dehydration. When she complains to the nurse about the small portions of meat ordered by the dietitian, the best response would be:

(1) Ask your doc. about it
(2) The amount of meat on the tray is dictated by certain blood test results.
(3) Your protein is being limited, but you can have more food from another group.
Answer: (4) Protein is being limited, can pick from another group.

Rationale: The client is at inc. risk for a return of encephalopathy b/c of the dx. of penumonia and dehydration. She has vol. depletion and the potential for electrolyte imbalance, both of whic can contribute to the development of encephalopathy. Dietary protein intake must be controlled (or eliminated) in order to minimize the ammonia levels in the blood stream.
The physical assessment findings of spider angiomas, palmar erythema, peropheral edema, ascities, and change in mental status are consistent with which of the following d/o?

(1)Cirrhosis
(2)Pancreatitis
Answer: (1) Cirrhosis

Rationale: Portal hypertension and liver dailure contribute to the late manifestationso f cirrhosis. Pancreatitis presents with pain radiating to the back, mild cardiovascular changes, and hypocalcemia.
The physical assessment of a 55 y/o female with end-stage cirrhosis reveals a protuberant abdomen with bulging flanks and dullness to the dependent side while lying on the right. The appropriate terminology for documentation of this assessment is what?

(1) Fluid overload
(2) Ascities
(3) Distension
Answer: (2) Ascities

Rational: In a person who has cirrhosis, fibrous tissue develops among the parenchymal cells preventing the production of adequate plasma proteins. The consequence of low plasms proteins leads to a decrease in colloid osmotic pressure and generalized edema. When combined with high portal capillary pressures, larga amounts of fluid and protein can form in the abd. cavity, which is called ascities.
When assessing the abdomen of a patient who has ascities what notable sounds can be heard?
Shifting dullness and tympany during assessment
When doing discharge teaching to a client with chronic cirrhosis, why is it important to put emphasis on bleeding percautions?

(1) Because of the cirrhosis, the liver is unable to produce clotting factors
(2) the low protein diet will result in reduced clotting factors
(3) The increased production of bile decreases clotting factors.
(4) The required medications reduce clotting factors.
Answer: (1) B/c of the cirrhosis, the liver is unable to produce clotting factors.

Rationale: When bile productions is reduced, the body has reduced ability to absorb fat-soluble vitamins. W/o adequate Vit K absorption, clotting factors II, VII, IX, and X are not produced in sufficient amounts.
What is the rationale for the use of lactulose (Chronulac) syrup for a patient with chronic cirrhosis?
Answer: Chronulac syrup suppresses the metabolism of ammonia and aids in its elimination through feces.

Rationale: Chronulac is a synthetic nonabsorbable disaccharide metabolized to organic acids by enteric bacteria and causes osmotic catharsis while reducing the growth of ammonia-forming bacteria. This medication also lowers the pH of the colon, whic converts ammonia to a nonabsorbable for allowing the expulsion through the laxative action of the drug.
Which of the follwing clients is more likely to develop pancreatitis?

(1) 59 y/o male w/ a hx of occasional ETOH use
(2) Pt. w/ renal probs and hypocalcemia
(3) Pt. recovering from MI with hypercholesterolemia
(4) A client with a stone lodged in the pancreatic duct
Answer: (4) A client w/ a stone in pancreatic duct

Rationale: Stones in the pancreatic duct can cause obsrtuction and lead to inflammation of the pancreas.
What are the causes of pancreatitis?
*ETOH abuse
*high triglyceride level
*hypercalcemia
What are the following actions of pancreatic enzymes that can cause pancreatic damage?
Answer: Autodigestion of the pancreas

Rationale: When the pancreas is injured and/or has an impaired or disrupted fx., the pancreatic enzymes (phospholipase A, lipase, and elastase) leak into the pancreatic tissue and initiate autodigestions.
Which of the following laboratory tests indicates a diagnosis of pancreatitis?

(1) Lipase 230 IU/L
(2) Calcium 6.0 mEq/L
(3) Blood glucose 65 mg/dL
(4) WBC count 5,000/mm3
Answer: (1) For pancreatits, the liapse, amylase, glucose and WBC are all elevated. The calcium is low for 7-10 days and is a sign of severe pancreatitis.
The client with pancreatitis may exhibit Cullen's sign on physical examination. Which of the following data best describes Cullen's sign?

(1) Jaundiced sclera
(2) Pain that occurs with movement
(3) Bluish discoloration of the left flank area
(4) Bluish discoloration of the periumbilical area
Answer: (4) Bluish discoloration of the periumbilical area

Rationale: Bleeding is a complication of pancreatitis and is usually identified through a positive Turner's sign (flank bruising) or Cullen's sign (umbilical bruising).
Which of the following findings would strongly indicate the possibility of cirrhosis?

(1) Dry skin
(2) Hepatomegaly
(3) Peripheral edema
(4) Pruritus
Answer: (2) hepatomegaly

Rationale: Although option 4 is correct, it is not a strong indicator of cirrhosis. Pruritus can occur for many reasons. Options 1 and 3 are incorrect, fluid accumulation is usually in the form of ascites in the abdomen. Hepatomegaly is an enlarged liver. The spleen may also be enlarged.
A client with chirrhosis may have alterations in what lab values?

(1) CO2 level
(2) pH
(3) prothrombin time (PT)
(4) WBC
Answer: prothrombin time (PT)

Rationale: Clients with cirrhosis have used their clotting factors, and their liver is unalbe to provide enough clotting factors. A PT time is an indication of the time needed for blood to clot. If clotting factorsa ren't present, bleeding is more likely.
A client with a hx. of renal calculi has progressively lost renal fx. and is admitted to the unit w/ a dx. of chronic renal failure. The physician has prescribed polystyrene sulfonate (Kayexalate). Which of the following is the best reason to use this drug in renal failure?

(1)to lower serum phosphat elevels
(2) To correct acidosis
(3) To exchange potassium for sodium
Answer: (3) to exchange potassium for sodium.

Rationale: In renal failure, clients become hyperkalemic b/c they can't excrete potassium into urine. Kayaxelate provides the mechanism for potassium excretion by pulling potassium into the bowels andexchanging it for sodium. The potassium is then excreted in the feces. Phosphate binders, such as aluminum hydroxide gel, are given to lower phophate levels. Diet changes, sodium bicarbonate, or dialysis might be used to help control acidosis.

Kayaxelate can cause constipation and MUST be given with a laxatve such as sorbitol.
The nurse is caring for a client with acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to treat what?
Answer: Hyperkalemia

Rationale: Hyperkalemia is a common complication of acute renal failure.

Glucose and reg. insulin, w/ sodium bicarbonate if necessary, can temporarliy precent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels.
Which nursing intervention is most important during the oliguric phase of acute renal failure (ARF)?

(1) Encourage coughing and deep breathing
(2) Promoteing carb intake
(3) Limiting fluid intake
(4) Controlling pain
Answer: (3) Limit fluid intake

Rationale: IN the ologuric phase of acute renal failure, urine output is dimishes and can lead to fluid overload.

Limiting PO and IV fluids can prevent fluid overload and itscomplications such as heart failure or pulmonary edema.
A patient with chronic renal failure has developed faulty RBC production. The nurse should monitor this clinet for early manifestation of what?

(1)n/v
(2)dyspnea nd tachypnea
(3) fatigue and weakness
(4) thrush and fever
Answer: (3)# fatigue and weakness

Rationale: RBCs can carry 02 througout the body. Decreased RBC production diminishes cellular O2. Thus causing fatigue and weakness.
A client with renal failure is undergoing continuous ambulatory peritoneal dualysis (CAPD). What nursing diagnosis is most appropriate?

(1) Impaired urinary elimination
(2) Risk for infection
(3) ACtivity intolerance
Answer: (3) Risk for infection.

Rationale: B/c the perotoneal dialysis catherter and regular exchanges of the dialysis bag give bacteria a direct portal of entry into the body, the client has a risk for infection.
For a patient with advanced cirrhosis, which assessment finding best indicates deterioration of liver fx. ?

(1) fatigue and muscle weakness
(2) Difficulty in arousal
(3) Nausea and anorexia
(4) Weight gain
Answer: (2) difficulty in arousal.

Rationale: Hepatic encephalopathy, which is a major complication of advanced cirrhosis, occurs when the liver can no longer convert ammonia ( a by-product of protein beakdown) into glutamine. It increases the blood level of ammonia-- a CNS toxin-- which decreases the cloent's level of consciousness.
A patient is admitted with increased ascities associated with cirrhosis. Which nursing diagnosis should eceived top priority?

(1) Fatigue
(2) Excess fluid volume
(3) Ineffective breathing pattern
(4) Imbalanced nutrition: Less than body requirements.
Answer: (3) Ineffective breathing pattern

Rationale: In ascities, the accumulation of large amounts of fluid produces extreme abdominal distension that can put pressure on the diaphragm and interfere with respiration. If uncorrected, this can lead to atelectasis or phenumonia.
The physican prescribed spironolactone (Aldactone), 50 mg, PO QID, for a client with fluid retention due to cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?

(1) Seum potassium level of 3.5 mEq/L
(2) Weight loss of 2 lbs. in 24 hours.
(3) Serum sodium level of 135 mEq/L
(4) Blood pH of 7.25
Answer: Weight loss of 2 lbs in the past 24 hours.

Rationale: Daily weight measurement is themost accurate indicator of fluid status. A loss of 2.2 lbs demonstrates the loss of 1 L of fluid.

Spironlactone is a diuretic, weight loss is the best indicator of its effectiveness.

A blood pH of 7.25 indicates acidosis, a potential adverse reaction to spironolactone.
A patient with cirrhosis of the liver is increasingly confused an combative. Which of the following diets would the nurse expect to see ordered for this client?

(1) low fat and sodium
(2) high carbs, low protein
(3) low potassium and phos
(4) Gluten and wheat free
Answer: (2) high carbs, low protein

Rationale: Restricting dietary protein prevents dangerous azotemia and hepatic encephalopathy. Low-fat, low-sodium are typically used with hypertension and heart diesase. Dietary potassium and phos are restricted in renal failure. Gluten and wheat are restricted in celiac disease.
Which of the following should the nurse teach a client using recombinant epoetin alpha (Epogen) for chronic renal failure?

(1) Will help with the bleeding probs. associated with kidney damage.
(2) Should reduce fatigue and improve energy level
(3) May reduce the need for dialysis.
Answer: Epoetin alpha should reduce fatigue and improve energy levels.

Rationale: Epoetin alpha stimulates the bone marrow to increase red blood cell production, thus helping to resolve anemia and improving activity tolerance. The drug has no effect on bleeding or the need for dialysis.
An appropriate lunch selection for a client with azotemia would include which of the following foods?

(1) Pasta, veggies, and canned peaches
(2) Hamburger patty, scoop of cottage cheese, and sliced pears
(3) Chicken breast and cheddar cheese on a bun, whith lettuce and tomato
(4) Turket sandwich with Swiss cheese and milk.
Answer: (1) Pasta, veggies, and canned veggies.

Rationale: Dietary protein must be restricted in azotemia b/c amino acids in proteins increase blood urea nitrogen levels. The other lunch selections have high protein content.
A 40 y/o patient has been admitted to the med-surgical floor with acute pancreatitis. Which comfort measure should the nurse use for this client?

(1) Administer an analgesic once pershift to prevent addiction.
(2) Position the client on the side with the knees flexed.
(3) Encourage frequent visits from family and friends.
(4) Administer frequent oral feedings.
Answer: Position the client on the side with the knees flexed.

Rationale: The nurse should place the client with acute pancreatitis in a side-lying postition with the knees flexed to promote comfort by decreased pressure on the abdominal muscles. The nurse should administer an analgesic PRN, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute stage, the nurse hsould discourage frequent visits. Frequent PO feedinds are contraindicated in the acute stage to rest the pancreas.
Which of the following laboratory values will the nurse interpret as confirming a client's diagnosis of pancreatitis?

(1) Elevated amylase, elevated lipase, elevated serum glucose, and decreased serum calcium levels.
(2) Elevated amylase, elevated lipase, decreased serum glucose, and decreased serum calcium levels.
(3) Decreased amylase, decreased lipase, elevated serum glucose, and increased serum calcium levels.
(4) Decreased amylase, decreased liapse, decreased serum glucose, and increased serum calcium levels.
Answer: (1) Elevated amylase, elevated lipase, elevated serum glucose and decreased serum calcium levles.

Rationale: The elevated amylase and lipase are key lab tests for pancreatitis. The glucose is elevated because of the role of the pancreas controlling glucose values. The calcium is decreased because the calcium is deposited in the fatty necrotic tissue of the pancreas.
A client with cirrhosis begins with a flapping of the hands whenever the arms are extended. Her orientation is decreased, she is having trouble concentrating, and appears anxious. The client is probably developing what?
Answer: Hepatic encephalopathy

Rationale: Hepatic encepalopathy is a complication of cirrhosis and is manifested by changes in consciousnes and motor fx. Asterixis os the flapping tremor of the hands when extending the arms.
What are the signs of hemorrhage?
Answers:
1)Tachycardia
2)Hypotension
3)Low platelets
4)Low H/H
When a client who has a liver d/o is having an invasive procedure, the nurse helps assure safety by assessing the results of which of the following tests?

(1) Prothrombin time (PT) and Partial thromboplastin time (PTT)
(2) Liver enzyme levels
(3) Serum chemistries
(4) WBC
Answer: PT/PTT

Rationale: Bleeding is a primary complication of a liver biopsy or invasive procedure invilving the liver because the liver has more than likely altered mthe clotting factors. in order to prevent a massive hemorrhage or complications, the coagulation studies should be assessed priot to the procedure.
Which of the following considerations is of the highest priority when preparing to administer a medication to a client with cirrhosis?

(1)Frequency of the medication
(2) Purpose of the medication
(3) Necessity of the medication
(4) Metabolism of the medication
Answer: (4) Metabolism of the medicaion

Rationale: In cirrhosis, the liver is usually not fx. properly and cannot metabolize medications as well as it normally would if healthy due to the scarring of the tissue. Certain meds are metabolized primarily by the liver, while other meds are metabolized by other organs. Consideration should be made for each med ordered to avoid overburdening the liver.
Which of the following diets should be ordered for clients with chronic renal failure?

(1)Low protein, high carbohydrates
(2) High protein, high carbohydrates
(3) High protein, low carbohydrates
(4) Low protein, low carbohydrates
Answer: Low protein, high carbs

Rationale: Restricting dietary protein early in chronic renal failure may slow the disease progression and also reduce nausea and vomiting due to anorexia associated with uremia. Protien intake of 0.6g/kg body weight of approximately 40 g/day is usually adequate. Carbohydrates should be high to compensate for energy needs.
The goal of treatment for the client with chronic renal failure is to:

(1)Maintain present renal function.
(2)Prepare the client for dialysis.
(3)Prepare for transplantation.
(4)Limit involvement and activity to decrease stress.
Answer: Maintain present renal function.

Rationale: Early management of the client with chronic renal failure focuses on elimination factors that may further the decrease of renal failure and measures to slow the progression of the disease to end-stage renal disease.
What is the best test to measure renal function?

(1)Creatinine
(2)Bilirubin
(3)Blood urea nitrogen (BUN)
(4)Electrolytes
Answer: Creatnine

Rationale: Cratinine is solely indicative of renal fx and represents damage to a large number of nephrons. BUN can be affected by the amount of protein in the diet. Bilirubin indicates liver probs. And electrolytes can be altered for many reasons.