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482 Cards in this Set
- Front
- Back
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What are the most common type of pediatric burns?
a) electrical b) chemical c) thermal d) radiant |
c) thermal
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The nurse knows to warn which mother, that her child is at most risk for getting a burn:
a) the mother with a 2 week old b) the mother with a 1 year old c) the mother with a 2 year old d) the mother with a 3 year old e) the mother with a 5 year old |
d) the mother with a 3 year old: this is the most common age for burns
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Teaching concerning radiation burns includes:
a) stay away from chemical plants b) maintain a distance of 1-3 feet from anyone who had radiation therapy in the past 8 hours c) wear sunglasses in bright sun d) cover all exposed skin when going outdoors |
c) wear sunglasses in bright sun
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The most accurate chart to use for pediatric burn estimation is:
a) Wong and Baker b) Palm method c) Rule of 9's d) Lund and Browder |
d) Lund and Browder
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True or False: 75% of pediatric fire burns are from kitchen fires.
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False: 75% are from child set fires.
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What is the rule of thumb with children with renal disorders?
a) the get sicker quicker, and recover quicker b) they get sicker quicker, but recover more slowly c) the take longer to get sick, but recover quickly d) the take longer to get sick, and recover slowly |
a) they get sicker quicker and recover quicker
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How might the nurse assess the child's urinary system?
a) watch them as they void on a bedpan b) ask them to void in a clean catch cup c) straight cath them, and monitor their response d) ask their parents about patterns of urination and toilet training |
d) ask their parents about patterns of urination and toilet training
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Which of the following could be a possible cause of incontinence during the night?
a) mother reports that the child isn't allowed to drink before he goes to bed b) mother reports her child is a sound sleeper c) mother reports that she puts diapers on her child at night d) mother reports that her child eats a lot of carrots and beets |
b) mother reports that her child is a sound sleeper- they may not be awakened by the feeling to urge if they are heavily sleeping
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What sign in an infant might indicate a UTI?
a) frequently hungary b) crying when she is held by strangers c) recent weight gain d) diluted urine |
c) recent weight gain
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You know that a child with hypospadies:
a) will be circumcised asap b) will need to go under general anesthesia during reconstructive surgery c) will be at a higher risk for infection since they can never be circumcised d) will have surgery right away even if the baby is preterm |
none of the above! The child will not be circumcised right away since part of that skin will be used in the reconstruction; they will not go under general anesthesia but will receive a local zilocaine injection and some glucose water; circumcision can occur once reconstruction is complete; the surgery may not be preformed right away if the baby is preterm
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At what age is retraction of the foreskin in an uncircumcised infant/child acceptable?
a) newborn b) 1 week c) 6 month d) 1 year e) 2 years f) 3 years |
d) 1 year
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You know that the scrotal sac of a newborn boy is enlarged due to:
a) maternal progesterone b) maternal estrogen c) temporary edema d) initial poor cardiac function |
b) maternal estrogen
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What is a complication of undescended testicle(s)?
a) underdeveloped penis b) hypospadies c) epispadies d) sterility |
d) sterility: due to the increased temperature of the testes :(
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What is hydrocele and how is it treated?
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It is extra fluid in the scrotum and it tends to resolve on its own.
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Chordee is a ____ curve of the penis and is usually associated with ____.
a) dorsal, hypospadies b) ventral, epispadies c) dorsal, epispadies d) ventral, hypospadies |
d) ventral, epispadies
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What are possible complications of a baby with prune belly syndrome?
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undescended testes and kidney damage
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In general, to determine bladder capacity:
a) add 4 oz to their weight b) add 2 oz to their weight c) add 4 oz to their age d) age 2 oz to their age |
d) add 2 oz to their age: So a 4 year old would have a bladder capacity of: (2+4)=6oz
and a 10 year old would have a bladder capacity of: (2+10)=12oz |
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What is the expected urinary output for infants, children, and adolescents/adults?
( I am looking for the ml/kg/hr for each group) |
Infants: 2ml/kg/hr
Children: 0.5-1ml/kg/hr Adol & Adults: 1ml/kg/kr |
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What are the general dietary guidelines for the person with renal issues?
a) high calorie/high fat b) high calorie/low fat c) high protein/low salt d) low protein/low salt |
c) high protein/low salt
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The ER nurse know that her priority assessment of the patient with substantial burn injuries from a house fire in which he was reported to have gone back in the house 2 times to rescue pets is:
a) controlling the patient pain b) administering antibiotics c) assessing the lungs d) removing dirt/debris from the burn sites |
c) assessing the lungs due to the high possibility of smoke inhalation
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When the ER nurse learns that the patient suffered injury from a flash flame, the nurse anticipates which depth of burn?
a) full thickness b) superficial c) deep partial thickness d) superficial partial thickness |
c) deep partial thickness
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A patient comes to the ER with a sunburn. What type of burn is this?
a) full thickness b) superficial c) deep partial thickness d) superficial partial thickness |
d) superficial partial thickness
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What type of burns are associated with electrical current, chemical contact, and direct flame contact?
a) full thickness b) superficial c) deep partial thickness d) superficial partial thickness |
a) full thickness burns
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When caring for a client with burns, how often should a nurse change the wound dressing?
a) at least once in 3 days b) at least once a day c) at least once a week d) at least once every 8 hours |
b) At least once a day
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Acticoat antimicrobial barrier dressings used in the treatment of burn wounds can be left in place for:
a) 3 days b) 7-10 days c) 2 days d) 5 days |
d) 5 days
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What do the following have in common: Inhalation injuries, delayed resuscitation, scald burn injuries, high-voltage injuries, hyperglycemia, and alcohol intoxication.
a) they require decreased fluid requirements b) they require increased fluid requirements c) fluid replacement is not necessary d) fluid replacement cannot include solutions containing sugar |
b) they require increased fluid requirements
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A burn victim is in the ER. During the fluid resuscitation phase, the nurse understands that the I.V. infusion rate is guided by which parameter?
a) client weight b) body temperature c) hourly urine output d) urine specific gravity |
a) client weight
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The nurse is preparing to administer I.V fluids to a client with a burn injury. The nurse would question an order for:
a) dextrose 5% in water b) a blood transfusion c) a rapid rate of infusion d) lactated ringers solution |
a) dextrose 5% in water: this would result in severe electrolyte imbalance
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Among what age group are most likely to be burned by scalding?
a) younger than 5 b) 5-20 years old c) 32 months |
a) younger than 5
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What age group is most likely to be burned by fire?
a) younger than 5 b) 32 months c) 5-20 years old |
c) 5-20 years old
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In the toddler age group, 80% of thermal burns are caused by:
a) fire b) sunburn c) hot liquid d) irons |
c) hot liquids
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A patient with a child should have the hot water heater set to no higher than:
a) 98 degrees b) 100 degrees c) 120 degrees d) 140 degrees |
c) 120 degrees
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True or False: direct current is more damaging than alternating current as is causes a "lock-on" effect that does not allow the child to release from the source.
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False: Alternative current is more damaging than direct current, as it causes a "lock-on" effect that does not allow the child to release and stay released from the source.
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When are ultraviolet rays from the sun most intense?
a) 10 am - 4 pm b) 12 pm - 3 pm c) 2 pm - 4 pm d) 1 pm - 4 pm |
a) 10 am - 4 pm
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What is true in regard to sunscreen and sunlight: Check all that apply:
a) infants younger than 6 months should not wear sunscreen b) infants younger than 6 months should not be in direct sunlight ever c) sunscreen needs not be worn on cloudy days d) sunscreen should be reapplied every hour in the swimming child |
a) infants younger than 6 months should not wear sunscreen
b) infants younger than 6 months should not be in direct sunlight ever d) sunscreen should be reapplied every hour in the swimming child |
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What type of burn is described by: A sunburn with blisters.
a) First degree b) Second degree c) Third degree |
b) second degree
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What type of burn is a sunburn with no blisters?
a) first degree b) second degree c) third degree |
a) first degree
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A student nurse evaluates a patient with 3rd degree burns. Which statement by the student indicated need for further teaching?
a) "The patient is at risk for severe fluid volume loss" b) "The burned areas will blanch and bleed very easily" c) "The burned areas appear white, waxy, leathery and black" d) "The burned areas will not have as much pain as less severe burns since the nerve fibers in the dermis were completely destroyed |
b) "The burned areas will blanch and bleed easily": Areas with 3rd degree burns do not bleed or blanch.
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According to the rule of 9's, what percentage of TBSA makes up the head in a child?
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18%
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According to the rule of 9's, what percentage of TBSA makes up the left arm in a child?
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9%
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According to the rule of 9's, what percentage of TBSA makes up the left leg in a child?
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13.5%
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According to the rule of 9's, what percentage of TBSA makes up the front chest in a child?
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18%
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What is the only different in the rule of nines, between children and adults?
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More area is allotted to the head in children(18%) compared to 9% in adults; and less area is allotted to the legs in children(13.5% each leg) compared to 18% in adults
Refer to p. 1021 in Ward for a picture of pedi rule of nines. |
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Children with burns greater than ___ of TBSA require IV fluid resuscitation to maintain adequate perfusion.
a) 5% b) 15% c) 30% d) 45% |
b) 15%
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True or False: Pain medication in burned adolescents should be administered with extreme caution due to the high incidence of addiction and dependence.
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False: Undermedication is a problem and affects treatment and adequate pain relief.
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When preparing the apply Silvadene, what might the nurse check first:
a) the patient's blood pressure b) the patient's weight c) any allergies to Sulfa d) which IV antibiotics are being simultaneously administered |
c) any allergies to Sulfa: This cream is contraindicated for a child with a sulfa allergy
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What is contraindicated in the patient with an Acticoat mesh dressing?
a) IV antibiotics b) sterile saline moistening c) sterile water moistening d) dry application |
b) sterile saline moistening: Sterile saline cannot be used to moisten Acticoat because the saline reacts with the silver and may precipitate the salt out of the dressing
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What is an allograft derived from?
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cadaver skin
*remember alLOGraft: the skin comes from a lifeless natural product, like the log or cadaver skin. |
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True or False: Autografting should be limited to areas covered by clothing.
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True: The slits made in the autographed skin do cause permanent scarring so there areas should be limited to those covered by clothing.
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What is a xenograft derived from?
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Non-humans, so animals
*Remember X, as in NOT human source. |
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What is the most common malignant tumor in children?
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Wilms Tumor
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Which kidney is usually affected by wilms tumor?
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left
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What is the # 1 thing to remember about a child with suspected wilms tumor?
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You do not palpate it!
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What are some signs and symptoms of wilms tumor? Check all that apply:
a) fatigue b) weight loss c) leukocytosis d) low BP e) high BP f) fever g) hematuria h) visual changes i) swelling over kidney |
a) fatigue
b) weight loss e) high BP f) fever g) hematuria i) swelling over kidney |
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What is the primary treatment for wilms tumor?
a) antibiotics b) immunosuppressants c) removal of kidney d) chemotherapy |
c) removal of kidney
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Steven Johnson Syndrome is caused by large doses of what types of medications? Check all that apply:
a) antibiotics b) antipyretics c) diuretics d) immunosuppresants e) anticonvulsants |
a) antibiotics
e) anticonvulsants |
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____ is correlated with a reduced incidence of UTI.
a) breastfeeding b) low fluid intake c) high cranberry juice intake d) frequent baths |
a) breastfeeding
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All infants younger than 1 month with suspected UTI, even if not febrile, are:
a) given an antibiotic and sent home b) admitted as an inpatient c) held for observation in the ER for a minimum of 8 hours |
b) admitted as an inpatient
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Distension of the kidney is termed:
a) hydronephrosis b) nephrohydrosis c) nephrotic edema d) nephrotic syndrome |
a) hydronephrosis
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What medication can be given to reduce bladder pressure?
a) mitropan b) NSAIDs c) dilantin d) ditropan |
d) ditropan (oxybutynin chloride)
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What needs to be done if a urine culture specimen cannot be sent to the lab right away?
a) it should be discarded b) it should be refrigerated c) a preservative needs to be added d) a new sample needs to be obtained |
b) it needs to be refrigerated
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What lab test might be ordered on the patient who is diagnosed with acute glomerulonephritis to test for strep bacteria?
a) IgA b) serum protein clearance c) ASO titer d) immunoglobulin titer (IgT) |
c) ASO titer
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What is the primary source of E-coli?
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undercooked ground beef
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What is the most common cause of ARF in children?
a) medication toxicity b) kidney degeneration c) HES d) accidental toxic chemical ingestion |
c) HES: Hemolytic uremic syndrome-bacteria is ingested, and the endotoxins are released in the GI tract causing capillary wall destruction.
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What are possible signs and symptoms of HES?
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hepatosplenomegaly, thrombocytopenia, ARF, hypertension, dehydration and bloody diarrhea
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What is the most common causative bacteria of HES?
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E-coli
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Are antibiotics used in the treatment of HUS?
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No, they are contraindicated because they may worsen the situation.
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What is a common finding is chronic glomerulonephritis?
a) proteinuria and hematuria b) costovertebral pain c) polyuria and straw colored urine d) amber colored urine with visible sediment |
a) proteinuria and hematuria
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True or False: A patient with chronic glomerulonephritis should be given nystatins to treat hyperlipidemia.
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False: Nystatins cannot be given because renal damage prevents proper clearance of the drugs.
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What is the anatomical location of the kidneys?
a) retroperitoneal b) superior mediastome c) epigastric d) suprapubic |
a) retroperitoneal
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Between what ribs do the kidneys lie?
a) 3rd thoracic to the 12th lumbar b) 12th thoracic to the 3rd lumbar c) 5th thoracic to the 7th lumbar d) 7th thoracic to the 5th lumbar c) |
b) 12th thoracic to the 3rd lumbar
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Because of the location of the liver, the ___ kidney is slightly lower then the ___ kidney.
a) left, right b) right, left |
b) right, left
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What is the functional unit of the kidney?
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the nephron
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The body's blood circulates through the kidneys approximately ___ times per hour.
a) 4 b) 8 c) 12 d) 16 |
c) 12
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A patient with renal insufficiency asks how bad his kidneys have to be, before he has to start dialysis. You tell him that replacement therapy needs to be considered when the total number of functioning nephrons is less then ___% of the normal.
a) 80 b) 60 c) 40 d) 20 |
d) 20: So....you can lose up to 80% of your functioning nephrons before you need to start dialysis
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The healthy human body is composed of approximately ___% of water.
a) 20 b) 60 c) 80 d) 93 |
b) 60%
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True or False: Normally there are small amount of glucose in urine, depending on the amount of glucose consumed that day.
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False: Normally glucose does not appear in the urine.
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How much urine do the kidneys produce on a daily basis?
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1000-1500 mL
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A patient asks you where ADH is secreted from. What do you tell her?
a) the anterior pituitary b) the posterior pituitary c) the anterior medulla d) the posterior medulla |
b) the posterior pituitary
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Does ADA increase or decrease the reabsorption of water?
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increase
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A dilute urine with a fixed specific gravity or fixed osmolality indicates an inability to concentrate and dilute the urine. What is this a common early sign of?
a) osmolality insufficiency b) hypertropic bladder c) prostate cancer d) kidney disease |
d) kidney disease
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True or False: Daily weight measurements are a reliable means of determining overall fluid status.
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True! (How many more times will we see this question on our exams!!!)
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Which of the following electrolytes is the most plentiful extracellular ion?
a) potassium b) chlorine c) magnesium d) sodium |
d) sodium
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Which of the following electrolytes is the most abundant intracellular ion?
a) potassium b) chlorine c) magnesium d) sodium |
a) potassium
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What hormone synthesized and released from the adrenal cortex regulates the excretion of sodium?
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aldosterone
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What effect does aldosterone have on potassium excretion?
a) it increases it b) it decreases it c) it has no effect |
a) it increases the renal excretion of potassium
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With increased aldosterone in the blood, is more or less sodium excreted in the urine?
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less
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Retention of _______ is the most life-threatening effect of renal failure.
a) sodium b) potassium c) chlorine d) magnesium |
b) potassium
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What 2 chemical buffers aide in the urinary excretion of acid?
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phosphate ions and ammonia
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Renin is responsible for the conversion of _____ to _____ to ____.
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Angiotensinogen to angiotensin I to angiotensin II
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Angiotension II, the most powerful _______ known, causes the blood pressure to ______.
a) vasodilator, increase b) vasodilator, decrease c) vasoconstrictor, increase d) vasoconstrictor, decrease |
c) vasoconstrictor, increase
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When the vasa recta recognizes the increase in blood pressure, renin secretion stops. Failure of this feedback mechanism is one of the primary causes of ____.
a) renal failure b) hypertension c) heart disease d) renal crisis |
b) hypertension
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A 24 hour collection of urine is required for what tests of renal function?
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renal clearance, and creatnine clearance
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Creatinine clearance is determined by collection all urine for 24 hours. What is Creatinine clearance a good measure of?
a) blood Creatinine b) renal clearance c) GFR d) glomerular filtration clearance |
c) GFR
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What is a normal GFR?
a) 50 mL/min b) 75 mL/min c) 100 mL/min d) 125 mL/min |
d) 125 mL/min
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When the kidneys sense a decrease in the oxygen tension in the renal blood flow, they release _____ which stimulates the bone morrow to produce red blood cells.
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erythropoietin
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Why might a person with renal issues have trouble maintaining normal calcium balance?
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The kidneys are responsible for the final conversion of inactive vitamin D to its active form. You need active vitamin D to maintain normal calcium balance in the body.
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The major waste product of protein metabolism is:
a) amino acids b) lactic acid c) urea d) glycogen |
c) urea
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A person with normal kidney function will excrete how many grams of urea daily?
a) 10-15 b) 25-30 c) 40-45 d) 60-65 |
b) 25-30
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You know the patient requires further teaching when she makes which of the following statements:
a) my bladder can hold up to 2000 mL of urine b) I will feel the urge to pee when my bladder has 300-400 mL of urine c) I will feel a strong urge to pee when my bladder contains 350+ mL of urine d) with an intake of 1500-2000 mL per day, I will have to pee every 2-4 hours |
b) I will feed the urge to pee when my bladder has 300-400 mL of urine in it: The bladder signals the urge to pee when it has reached 150-200 mL.
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Your patient asks how many times is normal to void per day? What do you tell her?
a) about 5 times b) about 8 times c) about 15 times d) it varies on the person |
b) about 8 times
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When preparing to do a bladder scan, the nurse knows that the approximate residual urine after voiding in a middle aged adult is ____.
a) 200 mL b) 100 mL c) 50 mL d) 0 mL |
c) 50 mL
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Do you think that the elderly are more likely to have a higher or lower residual volume compared to younger adults.
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They should have a larger residual volume; 50-100 mL after voiding.
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When examining the labs of a dehydrated elderly person. What would you expect?
a) sodium 155 b) calcium of 12 c) platelets of 200 d) potassium of 4 |
a) sodium of 155: the elderly are more prone to develop hypernatremia and fluid volume deficit because increasing age is also associated with diminished osmotic stimulation of thirst!!!
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You know that woman who deliver vaginally have a high risk for:
a) hypervolemia b) unexplained anemia c) stress incontinence d) renal insufficiency |
c) stress incontinence
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Which of the following are risk factors for renal or urologic disorders? Check all that apply.
a) history of step throat b) old age c) immobilization d) hypotension e) diabetes f) MS g) chemical exposure h) Parkinson's i) benign prostatic hyperplasia |
All of them!!!
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A patient presents to the emergency room complaining of increased urinary urgency and frequency coupled with decreased urine volumes. What is done first to prevent kidney dysfunction?
a) IV antibiotics are hung b) oral fluids are encouraged c) cranberry juice is administered via IV d) the pt is straight cath'd |
d) the pt is straight cath'd- this allow emptying of the distended bladder and allows for analysis/evaluation of the collected urine
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What are the most common GI signs and symptoms of urologic conditions?
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N/V diarrhea, abdominal discomfort and abdominal distention.
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A new mother asks what age she can expect her child to achieve bladder control. What do you tell her?
a) 2 years b) 3 years c) 4 years d) 5 years |
d) 5 years
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Output less than 400 mL/d is termed ____ and is indicative of acute or chronic renal failure.
a) hematuria b) proteinuria c) anuria d) oliguria e) polyuria |
d) oliguria
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Output less than 50 mL/d is termed ____ and is indicative of acute or chronic renal failure.
a) hematuria b) proteinuria c) anuria d) oliguria e) polyuria |
c) anuria
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True or False: You can reassure your elderly patient who is incontinent not to worry because urinary incontinence is a normal age-related change.
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False: While you do need to reassure your client, urinary incontinence is NOT a normal age-related change.
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You are observing a nursing student performing an abdominal assessment. You realize she needs further instruction when she documents which of the following as an abnormal finding?
a) ability to palpate the kidney b) ability to auscultate a bruit c) percusses dullness over the bladder after voiding d) severe pain when palpating the abdomen of an obese patient |
c) percusses dullness over the bladder after voiding: this indicates incomplete bladder emptying
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A digital rectal examination is part of the yearly physical examination for what group of people?
a) women over 40 b) women under 40 c) men over 40 d) men under 40 |
c) men over 40- Yeah baby!
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Men over 40 have what specific blood test done to test for prostate problems?
a) CBC b) Inga c) DRE d) PSA |
d) PSA: Prostate-specific antigen
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A medical student is doing a routine physical examination of a 55 year old male. He conducts a digital rectal examination and then sends the phlebotomist in to draw blood for examination of his PSA. What's wrong with this?
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You do not conducts the DRE prior to the blood draw of the PSA because manipulation of the prostate can cause the PSA level to increase temporarily: Blood needs to be drawn PRIOR to the DRE.
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When examining the vulva, urethral meatus and vagina, what is she asked to do?
a) cough and bear down b) retain a saline enema c) initiate micurition d) tighten her gluteal muscles |
a) cough and bear down to assess for any leakage of urine
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How do you perform and interpret a Marshall Boney maneuver?
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You have the woman cough and bear down. Should urine begin to come out, place your index and middle fingers on either side of the urethra as the woman is asked to repeat the valsalva maneuver. If urine comes out again, referral is needed.
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What would the doctor assess to check for neurological causes of bladder dysfunction?
a) deep tendon reflexes b) a Marshall Boney maneuver c) an EEG d) intelligence tests |
a) deep tendon reflexes- the deep tendon reflexes of the knees are assessed for quality and symmetry because the sacral area which innervates the lower extremities is the same peripheral nerve area responsible for urinary continence.
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True or False: A doctor should asses the gait of a person with a urinary dysfunction by having them use a hula hoop or jump on a trampoline.
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False: Seriously? No! The doctor has they walk heel to toe!
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A patient taking amitriptyline, triamterene, or phenylsalicylate might have what color urine?
a) colorless b) milky c) blue/green d) orange/amber e) brown/black |
c) blue/green
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The patient taking cascara, metronidazole, iron preparations, quinine, senna products, methyldopa or nitrofurantoin may have what abnormal urine color
a) colorless b) milky c) blue/green d) orange/amber e) brown/black |
d) brown/black
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A patient taking phenazopyridium HCL, nitrofurantoin, sulfasalazine, docusate calcium or thiamine might have what abnormal urine color?
a) colorless b) milky c) blue/green d) orange/amber e) brown/black |
d) orange/amber
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True or False: Dipstick analysis can be used as a detection tool for diabetic neuropathy.
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False: dipsticks analysis does not detect protein concentration of less than 30 mg/dL, so the test cannot be used to detected early diabetic neuropathy
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What medication might cause persistent proteinuria?
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ACE inhibitors and NSAIDS
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Diabetes insipidus, glomerulonephritis and severe renal damage all have what effect on urine specific gravity?
a) they decrease it b) they increase it c) they promote health buffing |
a) they all decrease urine specific gravity
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How does diabetes mellitis and nephritis alter urine specific gravity?
a) they decrease it b) they increase it c) they have no known effect on it |
b) they increase it
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______ is the most accurate measurement of the kidney's ability to dilute and concentrate urine.
a) BUN b) Creatinine c) GFR d) osmolality |
d) osmolality
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What is the normal range of serum osmolality? What is the normal range for urine osmolality?
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serum- 275-300 mOsm/kg
urine- 50-1200 mOsm/kg |
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Does informed consent need to be obtained for an ultrasonography of the kidneys?
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No- it is a noninvasive procedure that uses sound waves passed into the body through a transducer to detect abnormalities of internal tissues and organs
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What pre-procedural instruction is given to the patient preparing for a ultrasonography?
a) they need to be NPO for 4 hours prior b) they need to empty their bladder immediately prior c) they need to drink a lot of fluids prior d) they will need to take mucomyst for 1-2 after |
c) they need to drink a lot of fluids prior to the test as a full bladder is needed
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True or False: The patient with a cochlear implant scheduled for an MRI will have to have the device deactivated for the test.
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False: They can not have an MRI; another imaging procedure needs to be used.
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A healthy patient scheduled for a renal angiogram might have to take what medication the day before?
a) mucomyst b) laxative c) anti-inflammatory d) aspirin |
b) laxative- this will help to evacuate the colon so that unobstructed x-rays can be obtained
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What might you do following a renal angiogram to decrease edema and pain?
a) apply moist heat b) apply a cold compress c) massage the area d) encourage ambulation |
b) apply a cold compress to decrease edema and pain
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What is the focus of nursing care for the patient who is scheduled for an upper cystoscopy?
a) maintaining bedrest b) maintaining NPO status c) frequently monitoring blood pressure and pulse d) catheterizing the patient frequently to prevent urine accumulation in the bladder |
b) maintaining NPO status
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After a patient has undergone an upper cystoscopy, he complains of burning on voiding, blood-tinged urine, and urinary frequency. What do you do?
a) give him a sitz bath and document this as normal finding b) obtain an order for straight catheterization c) call the doctor for an antibiotic order d) flush the urethra with 40-50 mL of normal saline |
a) give him a sitz bath and document this as normal finding: those are common findings from mild trauma to the mucous membranes during the procedure
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What should be obtained prior to a kidney biopsy?
a) CVP pressure of the renal artery b) baseline CBC c) urine specimen d) xray of the renal tubules |
c) a urine specimen is obtained and saved for comparison with the post-biopsy specimen
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What is the patient instructed to do during while the kidney needle biopsy syringe is being inserted?
a) breath in slowly b) bear down c) exhale fully d) hold their breath |
d) hold their breath- this helps to prevent the kidney from moving while the needle is being inserted.
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How is the unconscious patient positioned for a kidney needle biopsy?
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In the prone position with a sandbag under the abdomen.
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Post-procedural teaching for the patient that underwent urodynamic testing includes calling the doctor if:
a) you experience chills, fever, lower back pain or continued dysuria b) mild discomfort with scant amount of bleeding on the incision dressing c) pain with bending and heavy lifting d) slight hematuria and frequency after the procedure |
a) you experience chills, fever, lower back pain or continued dysuria: These are signs and symptoms of a UTI, and need to be treated accordingly.
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What do the following have in common? group A beta-hemolytic streptococcal infection of the throat, impetigo, upper respiratory track infections, mumps, Varicella zoster virus, Epstein-Barr virus, hep B and HIV?
a) they all can cause ARF b) they all can cause heart failure c) they all can cause renal artery stenosis d) they all can cause primary glomerulonephritis |
d) they all can cause primary glomerulonephritis
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A patient with fluid volume deficit would be expected to have which of the following lab value?
a) increased BUN and Hematocrit b) decreased BUN and Hematocrit c) increased BUN and decreased Hematocrit d) increased hemoglobin and decreased BUN |
a) increased BUN and Hematocrit
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Which of the following electrolyte inbalance is described by nausea, malaise, lethargy, headache, abdominal cramps, apprehension and seizures.
a) calcium excess b) calcium deficit c) potassium excess d) potassium deficit e) sodium excess f) sodium deficit |
f) sodium deficit
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Which of the following electrolyte inbalance is described by deep bone pain, flank pain, muscle weakness, depressed deep tendon reflexes, constipation, N/V, confusion, impaired memory, polyuria, polydipsia and ECG changes.
a) calcium excess b) calcium deficit c) potassium excess d) potassium deficit e) sodium excess f) sodium deficit |
a) calcium excess
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Which of the following electrolyte inbalance is described by abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around the mouth and ECG changes.
a) calcium excess b) calcium deficit c) potassium excess d) potassium deficit e) sodium excess f) sodium deficit |
b) calcium deficit
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Which of the following electrolyte inbalance is described by Dry, sticky mucous membranes, thirst, rough dry tongue, fever, restlessness, weakness, disorientation.
a) calcium excess b) calcium deficit c) potassium excess d) potassium deficit e) sodium excess f) sodium deficit |
e) sodium excess
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Which of the following electrolyte inbalance is described by Anorexia, abdominal distention, paralytic ileus, muscle weakness, ECG changes, and dysrhythmias.
a) calcium excess b) calcium deficit c) potassium excess d) potassium deficit e) sodium excess f) sodium deficit |
d) potassium deficit
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Which of the following electrolyte inbalance is described by Diarrhea, colic, nausea, irritability, muscle weakness and ECG changes.
a) calcium excess b) calcium deficit c) potassium excess d) potassium deficit e) sodium excess f) sodium deficit |
c) potassium excess
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What dietary restrictions are implemented if renal insufficiency and an elevated BUN develops?
a) low sodium b) low fat c) low calorie d) low protein |
d) low protein
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What dietary element is given liberally to the patient with renal insufficiency or failure in order to reduce the catabolism of protein?
a) low density protein b) fat c) calories d) carbs |
d) carbs
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What may be the first indication of chronic glomerulonephritis?
a) heart attack, weakness, lethargy b) severe nosebleed, stroke or seizure c) malaise, fever and chills d) muscle wasting, hematuria and angina |
b) nosebleed, stroke or seizure
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True or False: The patient with chronic glomerulonephritis may have signs and symptoms of heart failure including peripheral edema, high blood pressure and crackles.
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True
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What are urinary casts?
|
proteins secreted by damaged kidney tubules
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Which of the following changes can be expected when a patients GFR drops below 50 mL/min? Check all that apply:
a) hyperkalemia b) hypokalemia c) hypoalbuminemia d) hyperalbuminemia |
a) hyperkalemia
c) hypoalbuminemia |
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Which of the following changes can be expected when a patients GFR drops below 50 mL/min? Check all that apply:
a) high phosphorus b) low phosphorus c) high calcium d) low calcium |
a) high phosphorus
d) low calcium |
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Nephrotic syndrome is characterized by what 3 findings?
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proteinuria, hypoalbuminemia and hyperlipidemia
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What is the major manifestation of nephrotic syndrome?
a) fever b) weakness c) hematuria d) edema |
d) edema
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What is a possible complication of nephrotic syndrome?
a) blood clots b) MI c) hypolipidemia d) pancreatitis |
a) blood clots
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Prolonged hypertension and diabetes cause decreased blood flow to the kidney and can result in:
a) nephrotic syndrome b) nephroartritis c) nephrosclerosis d) subacute renal failure(SRF) |
c) nephrosclerosis
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Who is nephrosclerosis common in?
a) young adults / men b) older men c) young adults / women d) older women |
a) young adults/men
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True or False: Some causes of acute renal failure are reversible including hypovolemia, hypotension, reduced cardiac output, heart failure and obstruction of the kidney or lower urinary tract.
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True!
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_____ is the result of impaired blood flow that leads to hypoperfusion of the kidney and a decrease in the GFR.
a) prerenal ARF b) intrarenal ARF c) postrenal ARF d) perirenal ARF |
a) prerenal ARF
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_____ is usually the result of an obstruction somewhere distal to the kidney. Pressure rises in the kidney tubules and eventually, the GFR decreases.
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c) postrenal ARF
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_____ is the result of actual parenchymal damage to the glomeruli or kidney tubules. Damage may result from nephrotoxic agents, such as aminoglycosides and radiocontrasts.
a) prerenal ARF b) intrarenal ARF c) postrenal ARF d) perirenal ARF |
b) intrarenal ARF
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Which of the following conditions may cause renal toxicity and ischemia?
a) UTI & bladder infections b) smoking & drinking c) burns & crush injuries d) bladder infections and smoking |
c) burns & crush injuries: with burns and crush injuries, myoglobin (a protein released from muscle when injury occurs) and hemoglobin are liberated, causing obstruction, renal toxicity and ischemia.
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What do the following medications have in common? gentamicin, aminoglycosides, colistimethate, polymyxin B, amphotericin B, amikacin, cyclosporin, tobramycin, radiopaque contrast agents, NSAIDS, ACE inhibitors.
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They are all nephrotoxic agents.
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How is the urine sodium effected in prerenal ARF?
|
it is decreased to <20 mEq/L
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How is urine sodium effected in intrarenal ARF?
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it is increased to >40 mEq/L
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Put the following 4 phases of acute renal failure in order.
oliguria recovery diuresis initiation |
1. initiation
2. oliguria 3. diuresis 4. recovery |
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What electrolyte inbalance typically accompanies renal failure?
a) metabolic acidosis b) metabolic alkalosis c) respiratory acidosis d) respiratory alkalosis |
a) metabolic acidosis: patients cannot eliminate the daily metabolic load of acid-type substances produced by the normal metabolic processes
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What is a common finding in renal failure patients?
a) anemia b) low sodium c) low potassium d) low blood sugar |
a) anemia
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Patients should be warned that chronic use of ____ may cause interstitial nephritis and papillary necrosis.
a) NSAIDS b) anti-histamines c) anti-ulcers d) anti-infectives |
a) NSAIDS
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Kayexalate works to lower potassium by exchanging ____ for ____.
a) potassium for sodium b) sodium for potassium c) magnesium for potassium d) potassium for magnesium |
b) sodium for potassium
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Patient teaching of the patient preparing to receive a Kayexalate enema includes:
a) evacuating the bowels with a saline enema first b) instilling 500-600 mL of solution c) retaining the enema for 30-45 minutes d) straining expelled solution |
c) retaining the enema for 30-45 minutes to promote potassium removal
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What IV solution should be administered to the hemodynamically unstable(low bp, changes in mental status, dysrhythmia) with significantly high potassium?
a) 0.9% NS b) 2% sodium chloride c) 10% dextrose d) 50% dextrose |
d) 50% dextrose
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True or False: Albuterol sulfate (Ventolin HFA) by nebulizer should not be given to people with high potassium because it can further raise plasma potassium concentrations by 0.5 to 1.5 mEq/L.
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False: It should be given because it will LOWER serum potassium by 0.5 to 1.5 mEq/L
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Aluminum hydroxide may be given to lower serum ____.
a) potassium b) sodium c) magnesium d) phosphate |
d) phosphate
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What do the following foods have in common?
citrus fruits/juices, coffee, meats, milk, tomatoes, hot dogs, ice cream, mineral salt. |
They are high in potassium and phosphate and should be avoided by the patient with ARF.
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Why might the advised activity level for the patient in ARF be bedrest during the most acute phases?
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to help reduce exertion and metabolic rate during the most acute stage of the disorder
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What non-pharmaceutical steps can be taken to promote pulmonary function in patients in ARF?
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turning, coughing, and deep breathing to prevent atelectasis and respiratory tract infection
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True or False: Even though indwelling catheters carry a high risk for infection, they are routinely inserted in patient in ARF in order to maintain strict I/O.
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False: They are avoided whenever possible because of the high risk of UTI associated with its use.
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A patient with a GFR of >90 is said to be in what stage of Chronic Kidney Disease?
a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4 |
a) Stage 1
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A patient with a GFR of 30-59 would be in what stage of chronic renal failure?
a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4 e) Stage 5 |
c) Stage 3
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A patient with a GFR of 60-89 would be in what stage of chronic kidney disease?
a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4 e) Stage 5 |
b) Stage 2
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A person with a GFR of <15 would be in what stage of chronic kidney disease?
a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4 e) Stage 5 |
e) Stage 5
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A patient with a GFR of 15-29 would be in what stage of chronic kidney disease?
a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4 e) Stage 5 |
d) Stage 4
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What is a common dermatologic manifestation of renal failure?
a) yellow scaling b) itching c) oily skin d) red rash |
b) itching
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What are common GI associated symptoms of renal failure?
|
nausea, vomiting and hiccups
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Which of the following respiratory signs and symptoms are indicative of chronic renal failure?
a) pleural friction rub b) Kussmaul-type respirations c) Cheynes-Stokes respirations d) bradypnea |
b) Kussmaul-type respirations
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Why is anemia a common finding in renal failure?
|
Because of decreased production of erythropoietin.
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How are the phosphate and calcium level effected in chronic renal failure?
|
high phosphate and low calcium
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All calcium and phosphorus binders must:
a) be taken on an empty stomach b) be taken with food c) be taken with 1 glass of water d) be taken within 1 hour of an antacid |
b) be taken with food to be effective
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What do the following medications have in common? Sevelamer hydrochloride (Renagel), Aluminum hydroxide (Alucaps), Lanthanum Carbonate (Fosrenal), Calcium Acetate (Phosex), Calcium Carbonate (titralac).
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They are phosphate binders and lower serum phosphate!
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What should be done for the patient who is at risk for seizures?
a) snug fitting clothing should be worn to prevent oral obstruction of breathing during a seizure b) side rails should be lowered in order to prevent contusions and facial injuries during a seizure c) the patient should be restrained during the seizure d) you should try to insert something into their mouth during the seizure to maintain an open airway |
None of the above! Non-restrictive clothing should be worn, side rails should be raised, the patient should not be restrained and nothing should be inserted in their mouth during the seizure.
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What medication can be given to the patient experiencing seizures?
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Dilantin or Valium
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Why would Epogen be given to a patient with ARF?
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To increase RBC
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What meal would be recommended to the patient with ARF?
a) cheese omelet and ham b) tuna fish sandwich and red wine c) banana cream pie with a glass of milk d) liver and onions |
a) cheese omelet and ham- the protein is of high biologic value: ie they are complete proteins and supply the essential amino acids necessary for growth and cell repair
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A patient with chronic renal failure develops a pericardial friction rub. What is priority treatment for this patient?
a) dialysis b) IV 50% dextrose c) lasix d) dobutamine |
a) dialysis
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What are possible cardiac complications of patients with chronic renal failure?
a) pericarditis b) pericardial effusion c) pericardial tamponade d) ECG changes |
All of the above!
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True or False: The patient with chronic renal failure is advised to avoid contact sports.
|
True: They need to be taught to prevent bleeding by avoiding vigorous nose blowing, contract sports, and by using a soft toothbrush
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How long does Hemodialysis take(each session), and how many times a week do people have to have it?
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3-4 hours, 3 times a week
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Why is heparin administered during dialysis?
a) to propagate erythropoesis b) prevent clotting at the dialysis catheter insertion site c) keep blood from clotting in the dialysis circuit d) make the blood less viscous for easier transport through the dialysis circuit |
c) keep the blood from clotting in the dialysis circuit
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The patient who required immediate hemodialysis had a dialysis catheter inserted in her subclavian. How long can this catheter stay there?
a) 1 week b) 3 weeks c) 3 months d) until infection is present |
b) 3 weeks: subclavian, internal jugular, or femoral sites can only be used for temporary use
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A patient who received a new fistula for dialysis would be recommended to:
a) use the new site within 8 days of creation b) squeeze a rubber ball frequently c) take anticoagulants for 1-3 months d) avoid using the arm for 1-2 weeks |
b) squeeze a rubber ball frequently to increase the size of the joined vessels
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Patients on dialysis may need to have higher or lower dosages of medications?
|
Higher because many medications will be removed from the blood during dialysis. But be aware that some meds will not be affected by dialysis.
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What is the recommended protein intake for the patient on dialysis?
a) 1.2 to 1.3 g/kg/day b) 1.2 to 1.3 g/lb/day c) 1.2 to 1.3 g per day d) 12 to 13 g per day |
a) 1.2 to 1.3 g/kg/day
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True or false: Because of the sensitive nature of end stage renal failure, patients are encouraged not to discuss end of life options.
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False: patients and their families should be encouraged to discuss end of life options: only between 21% and 25% of patients on hemodialysis have an advanced directive or living will.
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Very unstable patients would benefit from:
a) hemodialysis b) peritoneal dialysis c) CVVH d) HVVO |
c) CVVH: Continuous venovenous hemofiltration provides continuous slow fluid removal therefore hemodynamic effects are mild and better tolerated by patients with unstable conditions
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A patient new to peritoneal dialysis asks you how long it will take during each session. You tell her:
a) 3-4 hours b) 6-8 hours c) 20 to 20 hours d) 36 to 48 hours |
d) 36 to 48 hours
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What can be added to dialysate to treat peritonitis?
|
antibiotics genius!
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At what temperature is dialysate administered in peritoneal dialysis?
a) room temperature b) body temperature c) refrigerator temperature d) it doesn't matter |
b) body temperature to prevent patient discomfort and abdominal pain
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Dialysate drained usually is what color?
a) yellow and cloudy b) clear with visible particles c) clear or straw colored d) brown with small blood clots |
c) clear or straw colored: it should not be cloudy; bloody drainage may be seen during the first few exchanges but should subside quickly
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Patients with peritonitis loose large amount of ____ through the peritoneum.
a) glucose b) amino acids c) protein d) calcium |
c) protein
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A patient who just started peritoneal dialysis notices blood in the drained fluid.. What should he do?
a) stop the dialysis b) perform more frequent exchanges c) perform less frequent exchanges d) discard dialysate catheter and replace with a new one |
b) perform more frequent exchanges to prevent blood clots from obstructing the catheter
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What do you do if the patient's peritoneal fluid does not drain properly during peritoneal dialysis?
a) call the doctor b) increase the rate of infusion c) decrease the rate of infusion d) reposition the patient |
d) reposition the patient to facilitates drainage: turn them from side to side or raise the head of the bed
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True or False: An elderly patient who is unable to care for herself should change to acute intermittent peritoneal dialysis.
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False: This type of dialysis is performed at home by the patient 4-5 times a day, 7 days a week. It is very intensive and requires a lot of care but it allows able patients to have more control and avoid the long interruptions of dialysis treatment (3-4 hrs, 3 days a week). Patients can even travel and go on vacations which otherwise might be restricted.
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What would you advise the patient who performs their own intermittent peritoneal dialysis at home?
a) wear sterile gloves b) wear a mask c) wear a gown d) cleanse the catheter site with betadine and alcohol e) all of the above |
b) wear a mask
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What type of diet is the patient receiving peritoneal dialysis recommended to have?
a) low protein b) high protein c) low sodium d) high sodium |
b) high protein-remember that a lot of protein is lost in this type of dialysis
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How much fluid is the person on dialysis recommended to drink daily?
|
500-600mL more then the previous days output
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Are people on peritoneal dialysis put on fluid restrictions?
|
No, they lose 2-3 additional liters over and above the volume of dialysate infused into the abdomen so fluid restriction is not necessary
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True or False: An audible bruit or thrill located over the venous access site for dialysis indicates stricture or vasoconstriction and needs to promptly reported.
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False: You SHOULD hear the bruit or thrill; if you don't hear it you need to call the doctor as this may indicate blockage or clotting in the vascular access.
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True or False: The patient on dialysis should have an ample flow of IV fluids to prevent hypovolemia and subsequent shock during dialysis.
|
False: When the patient needs IV therapy, the rate of administration must be as slow as possible and should be strictly controlled by a volumetric infusion pump
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What might happen as a result of rapid or excessive administration of IV fluids in the patient on dialysis?
a) pulmonary edema b) hypovolemia c) cyclic hyperthermia d) life threatening bradycardia |
a) pulmonary edema
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What might you suspect of the patient on peritoneal dialysis who presents with a low grade fever, substernal chest pain and a pleural friction rub?
a) sepsis b) hypervolemia c) pericarditis d) ventricular dysrhythmia |
c) pericarditis
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A patient on dialysis requires a blood transfusion. When is the best time to administer it?
a) before dialysis b) during dialysis c) after dialysis d) between dialysis treatments |
b) during dialysis so that excess potassium can be removed
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What may be an indicator of malnutrition in patients undergoing long-term or maintenance dialysis?
|
hypoalbuminemia
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True or False: The patient with kidney failure is recommended to avoid use of bath oils, superfatted soaps and creams as well as lotions in order to reduce itching.
|
False: All those things will decrease itching and should be used!
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|
Why do patients with ESRD have a high risk for infection and bleeding?
|
Because they have low WBC, RBC, and platelets.
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|
What are common after renal and ureter surgery?
a) hematoma and bleeding b) abdominal distention and paralytic ileus c) nausea and vomiting d) muscle cramps and strictures |
b) abdominal distention and paralytic ileus
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|
How can abdominal distention be relieved in a patient following surgery?
|
By decompression via insertion of an NG tube
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When is the post operative patient allowed to drink fluids?
a) when they are fully conscious b) when the NG tube is no longer draining anything c) when flatus is passed d) when the patient's intrinsic thirst mechanism is activated |
c) when flatus is passed
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|
How is the patient positioned for kidney surgery?
a) prone with arms raised b) supine with arms lowered c) on their side with free arm raised d) on their stomach with a sand bag positioned under the abdomen |
c) on their side with free arm raised
*refer to Brunner p.1553 for a picture of proper positioning |
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True or False: Low-dose heparin therapy may be initiated postoperatively to prevent thromboembolism in patients who had any type of urologic surgery.
|
True!
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True or False: Urine drainage tubes inserted during surgery should begin to expel urine within 4-6 hours of insertion.
|
False: There should be fairly immediate and constant drainage from the tubes or the doctor needs to be notified as this could be indicative of an obstruction.
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True or False: Postoperatively, the patient who underwent any surgery involving the kidney is NOT recommended to cough as it may dislodge the newly placed tubes.
|
False: They are encouraged to cough and deep breath to prevent atelectasis and to loosen secretions.
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|
Why might you screen a possible kidney transplant recipient for mental illness?
|
Because the immunosuppressants they will have to take will aggravate psychiatric conditions.
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|
What do the following medications have in common? Tacrolimus (Progral), mycophenolate mofetil (cellcept), sirolimus (rapamune), antithymocyte globulin (thymoglobulin), and tacrolimus.
|
They are immunosuppressive agents used to block the body's immune response to the transplanted kidney or organ!
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|
What lab finding might indicate rejection of a newly transplanted kidney?
|
increased serum Creatinine (more than a 20% rise is considered acute rejection)
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|
How often do you measure the output of the patient who underwent renal surgery or transplant?
a) every hour b) every 2 horus c) every 4 hours d) every 8 hours |
a) every hour
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|
What endocrine disorder can result as a complication of immunosuppressive therapy?
a) Addison's b) Graves c) Cushings d) Diabetes insipidus |
c) Cushings
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What should you monitor for in the patient taking corticosteroids and antibiotics?
a) UTI b) kidney infections c) fungal infections d) peritonitis |
c) fungal infections of the GI tract (especially the mouth) and urinary bladder
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What might you advise the patient who has received a kidney transplant?
a) take their immunosuppressants for 6 continuous months b) avoid contact sports c) weigh themselves weekly d) reduce smoking to 2-4 cigarettes a day |
b) avoid contact sports which may cause injury to the transplanted kidney
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|
What are risk factors for renal cancer?
|
Male smokers who are overweight and have exposure to chemicals.
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Who are UTIs most common in?
a) men b) women c) elderly d) children |
b) women
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True of False: A patient's urethra is found to have urinary immunoglobulin A (IgA). What is the primary nursing intervention?
a) call the MD with the results b) administer prescribed antibiotics c) administer a urethral saline flush d) document it as normal findings |
d) document it as normal findings: IgA is present in the urethra to provide a barrier to bacteria
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|
What is a urethrovesical reflex?
a) cell hyperplasia b) obstruction c) deviation d) urethral damage |
b) obstruction
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|
______ refers to the backward flow of urine from the bladder into one or both ureters.
|
Urethrovesical or vesicoureteral reflux
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|
What happens if the urethrovesical valve is impaired by congenital causes or urethral abnormalities?
|
Urine is allowed to back flow from the bladder to the kidneys, allowing bacteria into the kidneys.
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|
Bacteriuria is generally defined as more than ___ colonies of bacteria per milliliter of urine.
a) 10^10 b) 10^8 c) 10^5 d) 10^2 |
c) 10^5
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|
A patient with an indwelling urinary catheter should have special attention paid to monitoring for:
a) fluid volume deficit b) daily weights c) I/O balance d) urosepsis |
d) urosepsis: this is sepsis resulting from bacteria in infected urine migrating to the blood
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|
The absence of ____ in postmenopausal women makes them susceptible to colonization and increased adherence of bacteria to the vagina and urethra.
|
estrogen
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|
What is the most common subjective symptom of UTI in older adults is:
a) flank pain b) oliguria c) polyuria d) fatigue |
d) fatigue
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|
What is the most common objective symptom presenting in older adults?
a) restlessness b) altered cognitive function c) irritability d) anxiety |
b) altered cognitive function
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|
Why is pregnancy a risk factor for UTI?
a) incomplete emptying of the bladder b) concentration of urine c) high glucose content of urine d) reduced acidity of the vagina |
a) incomplete emptying of the bladder
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True or False: Upon inspection of urine obtained by suprapubic needle aspiration of the urinary bladder or catheterization, a bacterial level of under 10^5 is not indicative of infection.
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False: Any bacteria detected during suprapubic needle aspiration or catheterization is indicative of infection.
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What is a complication in women with antibiotic treatment of a UTI?
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It can cause a yeast infection
:( |
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What medication for the treatment of UTIs is contraindicated in patients with renal insufficiency, due to its ineffectiveness at glomerular filtration rates of less than 50 mL/min?
a) nitrofurantoin (Macrodantin, Furadantin) b) Levofloxacin (Levaquin) c) trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra) d) fluoroquinolone ciprofloxacin (Cipro) |
a) nitrofurantoin (Macrodantin, Furadantin)
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True or False: Long term use of antimicrobial agents consists of a treatment period of taking the med at bedtime, every other night for 2-3 weeks if there is no recurrence following the end of the short term antimicrobial therapy.
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False: Prophylactic antimicrobial treatment consists of 6-7 MONTHS of taking the med every other night at bedtime to prevent recurrence. Crazy!!!
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True or False: Evidence supports the fact that the daily intake of cranberry juice helps prevent UTIs.
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False: Current evidence about the effectiveness of daily intake of cranberry juice to prevent UTIs is inconclusive. However, patients who like cranberry juice can be encouraged to include it in their increased fluid intake that will assist to flush bacteria.
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True or False: A patient with a UTI should restrict fluids as it will increase the already uncomfortable frequency and urgency of urination.
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False: The patient is encouraged to drink liberal amount of fluids to promote renal blood flow and to flush the bacteria from the urinary tract.
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What fluids/stuff should be avoided because they cause urinary track irritation?
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coffee, tea, citrus, spices, colas, and alcohol
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How often is a patient suggested to void to lower bacterial counts?
a) every hour b) every 2-3 hours c) every 4-5 hours d) every 6-8 hours |
b) every 2-3 hours
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True or False: Applying leg straps or taping the catheter to the leg is not recommended as it puts undue tension on the catheter.
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False: It is recommended that a leg strap or tape is used to hold the catheter security. You want to prevent movement, which could further irritate the urethra and cause bacterial infection.
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Special attention should be paid to the elderly client with a UTI who has:
a) weakness and fatigue b) gram negative bacteria c) mental status changes d) lower flank pain |
b) gram- bacteria: aggressive early treatment is the key to reducing the mortality rate associated with gram-negative sepsis, especially in elderly patients
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What vitamin can be give to a patient with recurrent UTIs to help acidify the urine?
a) Vitamin A b) Vitamin B c) Vitamin C d) Vitamin D |
c) Vitamin C (ascorbic acid)
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A problem in acute pyelonephritis is:
a) pain b) polyuria c) symptomless infection d) antibiotic resistance |
c) symptomless infection- urine culture should be obtained periodically to check for infection
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Why can renal failure result from the persistent and recurring infections in chronic pyelonephritis?
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Because persistent and recurring infection may produce progressive scarring of the kidney resulting in renal failure
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Unless contraindicated, how much fluid is the patient with chronic pyelonephritis recommended to drink?
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3-4 L
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Who would you expect urinary incontinence in?
a) a 7 year old boy b) a 6 year old girl c) a 90 year old male d) a 75 year old female |
d) a 75 year old female, especially if they had multiple children
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Involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position is termed:
a) reflex incontinence b) functional incontinence c) stress incontinence d) urge incontinence |
c) stress incontinence
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Involuntary loss of urine associated with a strong urge to void that cannot be suppressed is termed:
a) reflex incontinence b) functional incontinence c) stress incontinence d) urge incontinence |
d) urge incontinence
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Involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually with spinal cord injury because they have neither neurologically mediated motor control of the detrusor nor sensory awareness of the need to void is termed:
a) reflex incontinence b) functional incontinence c) stress incontinence d) urge incontinence |
a) reflex incontinence
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The involuntary loss of urine associated with overdistention of the bladder is termed ____ incontinence.
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overflow
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What is functional incontinence?
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When cognitive impairment causes incontinence; such as in Alzheimer's and dementia.
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Which of the following are risk factors for urinary incontinence? Check all that apply:
a) age b) immobility c) diabetes d) medications e) african american race |
b) immobility
c) diabetes d) medications- particularly diuretics, sedatives, hypnotics, and opioids |
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A person with iatrogenic incontinence most likely got it because of:
a) increased activity b) decreased activity c) cognitive impairment d) new medications |
d) new medications: One such example is the use of alpha-adrenergic agents to decrease blood pressure
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True or False: Iatrogenic incontinence caused by alpha-adrenergic agents is not usually reversible.
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False: As soon as the medication is discontinued, the apparent incontinence resolves.
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What medications are considered first line treatment for urge incontinence?
a) estrogen b) pseudoephedrine sulfate (Sudafed) c) amitriptyline (Endep) d) anticholinergic agents |
d) anticholinergic agents
*think anticholURGic, as in treatment for URGE incontinence |
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What medications are considered first line treatment for stress incontinence?
a) estrogen b) pseudoephedrine sulfate (Sudafed) c) amitriptyline (Endep) d) anticholinergic agents |
b) pseudoephedrine sulfate (Sudafed)
*Cuz stressed out people need to be fed |
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Patient teaching of the patient who received periurethral bulking via collagen injection includes:
a) it can only be done 1 time b) tolerance is an ongoing problem c) it must be repeated every 12-24 months d) older patients are not good candidates |
c) it must be repeated every 12-24 months because the body absorbs the material
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What is urinary retention?
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The inability to empty the bladder completely during attempts to void.
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A patient with new onset incontinence is instructed to avoid:
a) constipation b) high fluid intake c) Kegal exercises d) vaginal cones |
a) constipation: Constipation, resulting from inadequate daily fluid intake, can increase urinary urgency and/or urine retention
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What do the following medications have in common?
anticholinergic agents, antispasmodic agents, tricyclic and antidepressants. |
They cause urinary retention.
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What do the following medications have in common?
Alpha-adrenergic agents, beta-adrenergic blockers and estrogens. |
They cause urine retention by increasing bladder outlet resistance.
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Why is smoking contraindicated for a patient with urinary incontinence?
|
Because it causes coughing which increases incontinence.
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True or False: Turning on the water while trying to pee, stroking the abdomen or inner thighs, tapping above the pubic area, or dipping the patient's hands in warm water are just myths of urination devices; they actually have no effect on promoting urination.
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False: All those DO assist in initiating urination!
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____ bladder is caused by any spinal cord lesion above the voiding reflex arc resulting in a loss of conscious sensation and cerebral motor control.
a) spastic b) paralytic c) flaccid d) indwelling |
a) spastic
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A ____ bladder is caused by a lower motor neuron lesion commonly resulting from trauma.
a) spastic b) paralytic c) flaccid d) indwelling |
c) flaccid
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What might you advise a patient with a flaccid bladder to do, to enhance bladder emptying?
a) bear down during voiding b) massage the abdomen before voiding c) double void d) sit on the toilet for 15 minute sessions |
c) double void: After each voiding, the patient is instructed to remain on the toilet, relax for 1-2 minutes and then attempt to void again in an effort to further empty the bladder.
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A patient with a suprapubic bladder catheter believes they are ready to have it removed. What needs to be done prior to removal of the catheter?
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It needs to be clamped for 4 hours during which the patient attempts to void. After the patient voids, the catheter is un clamped, and the residual urine is measured. If the amount of residual urine is less than 100 mL on two separate occasions, the catheter can be removed.
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What can be done to prevent encrustation around the suprapubic catheter?
a) Vaseline can be gently applied b) the opening can be cleansed with alcohol c) the patient can drink liberal amounts of fluids d) an occlusive dressing can be applied |
c) the patient can drink liberal amounts of fluid
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True or False: Patients may be asked to stretch the anal sphincter with a finger to trigger the bladder as a part of bladder retraining after indwelling catheterization.
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True! Sick, but true!
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What could the following signs indicate: perspiration, cold hands or feet, or feelings of anxiety.
a) a full bladder b) a UTI c) sphincter retention disorder d) none of the above |
a) a full bladder
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A patient that requires intermittent catheterization for bladder emptying should be catheterized at bedtime and:
a) every 1-2 hours b) every 2-3 hours c) every 4-6 hours d) once per shift |
c) every 4-6 hours
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What should you give a female patient who has to self-catheterize herself?
a) a mirror b) an analgesic c) a flash light d) a shot of whiskey |
a) a mirror
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Patient teaching of the woman who has to self-catheterize includes inserting a lubricated catheter ___ inches into the urethra.
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3
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Patient teaching of the man who has to self-catheterize includes inserting a lubricated catheter ___ inches into the urethra.
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6-10 inches
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Who is at most risk for urinary stones?
a) 30-59 year old men b) 30-59 year old women c) 20-49 year old african americans d) 20-49 year old native americans |
a) 30-59 year old men
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What endocrine disorder can result in hypercalcemia and hypercalciuria?
a) hypoparathyroidism b) renal tubular acidosis c) cancer d) hyperparathyroidsm |
d) hyperparathyroidsm
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What do sarcoidosis and tuberculosis have in common in terms of renal issues?
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They both can cause urinary stones.
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What do the following medications have in common: Antacids, acetazolamide (Diamox), vitamin D, laxatives, and high doses of aspirin.
a) cause increased absorption of oxalate b) can result in hypovolemia c) can cause stones d) result in dementia in the elderly |
c) can cause stones
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What is renal colic?
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Acute pain over the costovertebral area and nausea/vomiting.
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In general, patients spontaneously pass stones of what size?
a) 0.1 - 0.5 cm b) 0.5 cm - 1 cm c) 1 cm - 1.5 cm d) no stone can be spontaneously passed |
b) 0.5 - 1 cm
*huge!!!* |
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A patient presents to the ER with severe pain related to the ongoing passing of a kidney stone. What do you recommend?
a) bedrest b) non-opioid analgesic c) liberal fluid intake d) all of the above |
c) liberal fluid intake to increase the hydrostatic pressure behind the stone and assist in its downward passage
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What would be the dietary recommendation of the patient who gets frequent calcium stones?
a) low salt/low protein b) low protein/low purines c) low purines/low calcium d) low calcium/low exalates |
a) low salt/low protein
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What medication can be given to a patient with high serum calcium?
a) Silver nitrate b) lasix c) lisinopril d) ammonium chloride |
d) ammonium chloride
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What type of diet is the patient with uric acid stones put on?
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Low purines
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What foods are avoided on a low purine diet?
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shellfish, anchovies, asparagus, mushrooms and organ means.
*smelly foods |
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What medication can be given to reduce serum uric acids levels and urinary uric acid excretion?
|
Allopurinal (Zyloprim)
*remember uric acid=purinines=alloPURINal |
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True or False: In general, low calcium diets are recommended for patients with calcium kidney stones.
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False: Low-calcium diets are not generally recommended, except for true absorptive hypercalciuria. Evidence shows that limiting calcium, especially in women, can lead to osteoporosis and does not prevent renal stones.
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What do the following foods have in common: Spinach, strawberries, rhubarb, tea, peanuts, and wheat bran.
a) high in calcium b) high in purines c) high in oxalate d) high in potassium |
c) high in oxalate: they should be avoided in patients with frequent kidney stones
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Why would patients prone to kidney stone be recommended to drink two glasses of water at bedtime and an additional glass of at each nighttime awakening?
|
To prevent concentration of urine, which can lead to stones.
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What might you give to the patient who just underwent lithotripsy?
a) a saline urethral flush b) a strainer c) a stent removal device d) a joint |
b) a strainer: all urine is strained after the procedure; voided gravel or sand is sent to the lab for chemical analysis
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Who is chemolysis indicated for?
|
Those who are at risk of complications of other types of therapy and those who refuse to undergo other methods.
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What is the recommended activity level for the patient who has an kidney stone?
a) bedrest b) BRP c) up to chair d) ambulation |
d) ambulation: it helps to move the stone through the urinary tract
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It is important to inform the patient who underwent ESWL to expect hematuria for:
a) 4-5 hours b) 1-2 days c) 4-5 days d) 1-2 weeks |
c) 4-5 days
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What is the most common cause of urethral trauma?
a) gunshot wounds b) sexual abuse c) sexual intercourse d) self-catheterization |
a) gunshot wounds...seriously
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The patient with genitourinary trauma is advised to restrict activities for about _____ after trauma to minimize the incidence of delayed or secondary bleeding.
a) 1 week b) 2 weeks c) 3 weeks d) 1 month |
d) 1 month
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Who is effected most by bladder cancer?
a) black women ages 60-80 b) white women ages 50-70 c) black men ages 40-50 d) white men ages 50-70 |
d) white men ages 50-70
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What continues to be the leading risk factor for all urinary tract cancers?
a) alcohol use b) tobacco use c) race d) gender |
b) tobacco use
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What is the most common symptom of bladder cancer?
a) flank pain b) palpable mass c) polyuria d) painless hematuria |
d) painless hematuria
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Which of the following are risk factors for bladder cancer? Check all that apply:
a) cigarette smoking b) high alcohol intake c) chronic UTIs d) bladder stones |
a) cigarette smoking
c) chronic UTIs d) bladder stones |
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Is high or low urinary pH a risk factor for bladder cancer?
|
high urinary pH
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True or False: Following a transurethral resection, the treatment of choice is instillation of BCG, the causative agent for tuberculosis.
|
True: it is thought to produce a local inflammatory as well as a systemic immunologic response
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True or False: Acetic acid is now considered the most effective intravesical agent for recurrent bladder cancer.
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False: BCG is the most effective.
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What instructions are given to the patient preparing to undergo a BCG instillation?
a) you must remain NPO for 4 hours prior b) you cannot pee for 2 hours following the instillation of the liquid c) you can void 30-40 minutes after the instillation of the BCG fluid d) you must complete a bowel cleansing session the night before the treatment |
b) you cannot pee for 2 hours following the instillation of the liquid
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Patient teaching of the client who just received an ileal conduit includes:
a) you will have to insert a catheter into the stoma to empty the urine out b) you will need to limit your water intake for the first week after the surgery to avoid undue stress on the surgically created bladder c) you will need to wear an external appliance bag to catch the urine d) your urine will be re-routed to your intestines |
c) you will need to wear an external appliance bag to catch the urine
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A healthy stoma is:
a) beefy red b) soft pink c) dark purple d) brown/black |
a) beefy red
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Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine pH is kept:
a) above 7.0 b) below 6.5 c) above 6.5 d) below 7.0 |
b) below 6.5
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Why would Vitamin C be given to a patient with an ostomy?
a) to promote urine formation b) to color the urine for proper identification c) to raise urine pH d) the lower urine pH |
d) to lower urine pH to below 6.5 to help prevent encrustation
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What might the urine of a patient with an ileal conduit look like?
a) pink/red b) yellow and mucusy c) pink and mucusy d) red and jelly like |
b) yellow and mucusy
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What can help decrease the accumulation of mucus in the ileal conduit?
|
Liberal fluid intake.
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How often does the average collecting appliance(for urine) last for before having to be changed?
a) 1 day b) 3-7 days c) 1-2 weeks d) 1 month |
b) 3-7 days
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True or False: Patient teaching of the patient who received an ileal conduit includes applying gentle moisturizers after cleaning the area (for an appliance change) to help maintain good skin integrity.
|
False: Moisturizers and moisturizing soap are avoided as they will interfere with the adhesion of the pouch.
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The patient is recommended to empty the ostomy appliance pouch when it is:
a) full b) 1/2 full c) 1/3 full d) 1/4 full |
c) 1/3 full
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A patient with a new ostomy appliance asks how they should clean the collecting bottle and tubing. You tell her:
a) you do not clean them, they are disposable b) soak them in alcohol once a week c) scrub them with iodine every day d) soak them in a 3:1 solution of water and white vinegar once a week |
d) soak them in a 3:1 solution of water and white vinegar once a week
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True or False: Following cleaning of an ostomy appliance, you should allow it to air dry and then powder it with cornstarch.
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True!
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The nurse recommends that the patient have at least ____ ostomy(s) on hand.
a) 1 b) 2 c) 3 d) 7 |
b) 2 appliances are necessary- one to be worn while the other is air-drying
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During an appliance change a ____ can be used over the stoma to absorb urine and keep the skin dry throughout the appliance change.
a) saline soaked gauze b) sanitary napkin c) sock d) tampon |
d) tampon...seriously
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The patient knows that when cutting the appliance to fit the stoma, they should trim it ___ inch larger then the stoma.
a) 1 b) 3/4 c) 1/2 d) 1/8 |
d) 1/8 inch larger then the stoma
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Why would you only cut the ostomy appliance 1/8 larger then the stoma?
a) it helps prevent edema b) it helps minimize skin irritation c) it helps maintain maximal adhesion surface area d) it makes appliance remove easier |
b) it helps minimize skin irritation: less area is subjected to urine flow
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True or False: With a continent ileal urinary reservoir, urine is diverted into the intestines.
|
False: With a continent ileal urinary reservoir urine collects in the created pouch until a catheter is inserted and the urine is drained.
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How are Kock and Charleston pouches drained?
a) via a J-tube that exist the abdomen b) via the urethra c) via the rectum d) via an inserted catheter |
d) via an inserted catheter- these are different variations of a continent ileal urinary reservoir (Indiana pouch).
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The ureters are implanted into the sigmoid colon and urine exits the body via the rectum in which operation?
a) Indiana pouch b) continent ileal urinary reservoir c) ureterosigmoidostomy d) ileal conduit |
c) ureterosigmoidostomy
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What special instructions are given to the patient who underwent a ureterosigmoidostomy?
a) you will need to follow a liquid diet for 2-3 weeks b) you will need to remain NPO for 2-3 days post-op c) you cannot wait longer then 2-3 hours before emptying urine from the intestines d) you will not be able to tell the difference between needing to pee and needing to poop out of the rectum |
c) you cannot wait longer then 2-3 hours before emptying urine from the intestines
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Why would the patient who underwent a ureterosigmoidostomy be recommended to permanently follow a low gas diet?
|
Because gas can cause stress incontinence and offensive odors!
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Other then avoiding gas causing foods, what other dietary recommendations are advised for the post ureterosigmoidostomy patient?
a) low sodium/high potassium b) high potassium/high sodium c) low sodium/low potassium d) high sodium/low potassium |
a) low sodium/high potassium
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Peritonitis is a risk after urinary diversion surgery. What are the expected signs and symptoms?
|
Vital sign changes, increasing pain, N/V, and abdominal distention.
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The patient is told that the ostomy stoma:
a) is insensitive to pain b) is purple/black c) should be soft and dry d) is massaged daily to promote good circulation |
a) is insensitive to paid because it has no nerve endings
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When a significant portion of the terminal ileum is removed, the patient is at risk for:
a) Vitamin C deficiency b) iron deficiency c) Vitamin B deficiency d) uric acid deficiency |
c) Vitamin B deficiency
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While undergoing hemodialysis, a client complains of muscle cramps. What intervention is effective in relieving muscle cramps?
a) encourage active ROM exercises b) administer a 5% dextrose solution c) infuse normal saline solution d) increase the rate of dialysis |
c) infuse normal saline: because muscle cramps can occur when sodium and water are removed too quickly during dialysis
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A nurse is instructing a client with renal calculi about recommended daily fluid consumption that would be most helpful by telling the client to drink approximately:
a) 4 cups per day b) 8 cups per day c) 12 cups per day d) 16 cups per day |
c) 12 cups per day
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A client is hospitalized and diagnosed with acute hydronephrosis. Which complaint does the nurse expect from this client?
a) sudden onset of acute, colicky pain b) sharp left flank pain c) sharp, throbbing pain d) feeling of pressure and distention |
a) sudden onset of acute, colicky pain
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A nurse is caring for a client with renal calculi. Which drug does the nurse expect the physician to prescribe?
a) opioid analgesic b) NSAIDs c) muscle relaxants d) salicylates |
a) opioid analgesics
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A client is brought to the hospital after being found unconscious in his home. Which finding leads the nurse to suspect carbon monoxide poisoning?
a) agitation b) bradycardia c) cherry red skin d) vomiting |
c) cherry red skin
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A nurse is caring for a client who recently underwent a skin graft to treat a burn. When caring for the donor site, the nurse should:
a) make sure the site receives adequate ventilation b) place the site in a dependent position c) avoid putting pressure on the site d) keep the site covered |
c) avoid putting pressure on the site
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A normal uric acid level is 2.7-7.7
|
hi
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What is a normal uric acid level?
a) 0.5-1.5 b) 8.2-10 c) 2.7-7.7 d) 1.2-2.1 |
c) 2.7-7.7
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What is a normal uric acid level?
|
2.7-7.7
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What is a normal BUN?
|
8-22
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What is a normal Creatinine?
|
.5-1.2
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A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:
a) generalized edema, especially of the face and periorbital area b) Green-tinged urine c) moderate to severe hypotension d) polyuria |
a) generalized edema, especially of the face and periorbital area
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What is the most common formation site of renal calculi?
a) bladder b) kidney c) ureters d) urethra |
b) kidney
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What lab test is the most accurate indicator of a client's renal function?
a) BUN b) Creatinine clearance c) serum Creatinine d) urinalysis |
b) Creatinine clearance
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A client requires hemodialysis. Which tyye of drug should be withheld before this procedure?
a) phosphate binders b) insulin c) antibiotics d) cardiac glycosides |
d) cardiac glycosides: Hypokalemia generally occurs during dialysis which could be further facilitated by digoxin
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Which clinical finding would the nurse look for in a client with chronic renal failure?
a) hypotension b) uremia c) metabolic alkalosis d) polycythemia |
b) uremia: the buildup of nitrogenous wastes in the blood, evidenced by an elevated BUN and Creatinine
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For a client in the oliguric phase of acute renal failure, which nursing intervention is most important?
a) encouraging coughing and deep breathing b) promoting carb intake c) limiting fluid intake d) providing pain-relief measures |
c) limiting fluid intake because during the oliguric phase, urine output decreases markedly, possibly leading to fluid overload so limiting oral and I.V. fluid intake can prevent fluid overload and it s complications
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What medication can be given to increase renal perfusion by dilating the renal arteries?
a) dopamine b) epinephrine c) lasix d) spironolactone |
a) dopamine: 3mcg/kg/min
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What type of problems are glomerulonephritis and nephrotic syndrome?
a) medication related destruction b) alcohol related destruction c) toxic agent related destruction d) autoimmune related destruction |
d) autoimmune related destruction
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What medications can be given to treat autoimmune disorders?
a) corticosteroids b) diuretics c) NSAIDs d) antipyretics |
a) corticosteroids
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A patient who suddenly stops taking corticosteroids is at risk for:
a) a rise in blood sugar b) a rise in blood pressure c) tachypnea d) adrenal insufficiency |
d) adrenal insufficiency
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Of the following terms, which refers to casts in the urine?
a) pyuria b) bacteruria c) cylindruria d) crystalluria |
c) cylindruria
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To assess circulating oxygen levels, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which of the following diagnostic tests?
a) serum iron levels b) hematocrit c) arterial blood gases d) hemoglobin |
d) hemoglobin
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A history of infection specifically caused by group A B-hemolytic streptococci is associated with which of the following disorders?
a) acute glomerulonephritis b) acute renal failure c) nephrotic syndrome d) chronic renal failure |
a) acute glomerulonephritis
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When caring for a patient with an uncomplicated, mild UTI, recent studies have show that which of the following drugs is a good choice of short-term course therapy?
a) Nitrofurantoin b) Bactrim c) Cipro d) Levaquin |
d) Levaquin
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When the nurse observes the patient's urine to be orange, she further assesses the patient for:
a) intake of medication such as phenytoin(Dilantin) b) intake of multiple vitamin preparations c) bleeding d) infection |
a) intake of medication such as phenytoin (Dilantin)
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A nurse is instructing a client with oxalate renal calculi. What foods should the nurse urge the client to eliminate from his diet?
a) citrus foods, molasses, and dried apricots b) milk, cheese, and ice cream c) sardines, liver, and kidney d) spinach, rhubarb, and asparagus |
d) spinach, rhubarb, and asparagus
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A nurse is assessing a client diagnosed with acute pyelonephritis. Which of the following symptoms does the nurse expect to see?
a) jaundice and flank pain b) costovertebral angle tenderness and chills c) burning sensation on urination d) polyuria and nocturia |
b) costovertebral angle tenderness and chills
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A client is hospitalized and diagnosed with acute hydronephrosis. Which complaint does the nurse expect from this client?
a) sudden onset of acute, colicky pain b) sharp left flank pain c) sharp, throbbing pain d) feeling of pressure and distention |
a) sudden onset of acute, colicky pain
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A nurse is caring for a client with end-stage renal disease. Which nursing diagnosis has priority?
a) activity intolerance b) excess fluid volume c) deficient knowledge d) chronic pain |
b) excess fluid volume: they client's kidneys can no longer remove excess fluid
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The skin of what group of people is thin and fragile?
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young children and elderly
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It is recommended that smoke detectors be installed:
a) in every home b) in every room c) on every level d) in every bedroom |
c) on every level
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True or False: in a deep partial-thickness burn, the epidermis is destroyed or injured and a portion of the dermis may be injured. The damaged skin may be painful and appear red and dry, as in sunburn or it may blister.
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False: That is true of a deep partial-thickness burn
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Describe the full thickness burn.
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The dermis and epidermis is destroyed and in some cases, underlying tissue is destroyed as well.
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What type of burn involves destruction of the epidermis and upper layers of the dermis and injury to deeper portions of the dermis. The wound is painful, appears red, and exudes fluid.
a) superficial partial-thickness burn b) deep partial-thickness burn c) full-thickness burn |
b) deep partial-thickness burn
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True or False: The burned area in a full-thickness burn is very painful and requires analgesic salve.
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False: The burned area is painless because nerve fibers are destroyed. The wound edge is the painful area.
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Describe the follicle and sweat glands of the full-thickness burn.
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They are all destroyed.
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In the rule of nines, how much does the left arm represent?
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9%
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In the rule of nines, how much does the right arm represent?
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9%
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In the rule of nines, how much does the head represent?
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9%
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In the rule of nines, how much does the left or right leg represent?
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18% each
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In the rule of nines, how much does the anterior or posterior chester represent?
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18% each
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In the rule of nines, how much does the peri area represent?
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1%
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In the palm method of body surface area burn calculation, what does a palm size burn represent?
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1% of total body surface area
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What is one of the worst type of burn injuries?
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electrical burns
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In what type of burn is there an entrance wound and an exit wound?
a) lightning b) chemical c) fire d) electrical |
d) electrical
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True or False: In an electrical burn, the cutaneous injury is small compared with the damage under the surface of the skin.
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True!
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What is a priority in high-voltage electrical injuries?
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cervical spine immobilization
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_____ is the immediate consequence of fluid loss and results in decreased perfusion and oxygen delivery.
a) hypervolemia b) acidosis c) alkalosis d) hypovolemia |
d) hypovolemia
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In a major burn, vascular volume decreases, cardiac output continues to decrease and the sympathetic nervous system releases catecholamines, resulting in an increase in peripheral resistance and _____.
a) vasodilation b) vasoconstriction c) aneurysm d) stroke |
b) vasoconstriction
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When can edema be expected to completely resolve following burn injuries?
a) 24 hours b) 2 days c) 7-10 days d) 3-4 weeks |
c) 7-10 days
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What is an escharotomy?
a) surgical removal of eschar b) surgical chemical lysis of eschar c) surgical incision into eschar |
c) surgical incision into eschar to relieve the constricting effect of the burned tissue
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During burn shock, serum sodium levels vary in response to fluid resuscitation, but _____ is usually present.
a) hypernatremia b) hyponatremia c) hypercalcemia d) hypocalcemia |
b) hyponatremia
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Immediately after burn injury, ____ is present resulting from massive cell destruction.
a) hypokalemia b) hyperkalemia c) hypercalcemia d) hypocalcemia |
b) hyperkalemia
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Release of histamine, serotonin, and thromboxane can cause _______.
a) diuresis b) restlessness c) bronchoconstriction d) blood thinning |
c) bronchoconstriction
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True or False: Early in the post burn period, catecholamine release in response to the stress of the burn injury alters peripheral blood flow, thereby increasing oxygen delivery to the periphery.
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False:Early in the post burn period, catecholamine release in response to the stress of the burn injury alters peripheral blood flow, thereby DECREASING oxygen delivery to the periphery.
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What is done to facilitate removal of carbon monoxide from the hemoglobin molecules?
a) 100% oxygen is administered b) the patient is give helium c) the patient is put in a hyperbaric chamber d) the patient is put on dialysis |
a) the patient is put on 100% oxygen
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How can the nurse tell if inhalation injuries are present?
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By testing blood gas levels and serum carboxygemoglobin levels
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What is the leading cause of morbidity and mortality in patients with thermal injuries?
a) dehydration b) respiratory arrest c) sepsis d) malnutrition |
c) sepsis
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Loss of skin from burns results in:
a) inability to produce melanin b) inability to produce keratin c) inability to regulate body temperature d) inability to produce sweat |
c) inability to regulate body temperature
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What are the 2 potential gastrointestinal alterations that may occur with burns?
a) acidosis and vomiting b) paralytic ileus and Curling's ulcer c) hyperactive bowl sounds and protein sensitivity d) pyloric sphincter stenosis and bariatric instability |
b) paralytic ileus and Curling's ulcer
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What might the following symptoms indicate: Occult blood in the stool, regurgitation of "coffee ground" material from the stomach, or bloody vomit?
a) paralytic ileus b) GI cancer c) Curling's ulcer d) detrusor spasticity |
c) Curling's ulcer
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After a burn injury, the intestinal mucosa becomes permeable to bacteria. Now, patients are unable to defend against:
a) E-coli b) staphylococcus aureus c) absorbic acid d) the patient's own bacteria |
d) the patient's own bacteria: due to immunosuppression
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What is the first thing the rescue workers do to the person who has been burned?
a) establish an IV line b) apply oxygen c) cool the wound d) establish an airway |
c) cool the wound: they need to halt the burning process ASAP
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True or False: Your child is burned with hot oil. You quickly grab a bag of ice and apply it to the burn site as you wait for the ambulance.
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False: You never apply ice directly to the burn; instead use cold soaks or dressings
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Emergency procedures at the burn scene include:
a) applying any available ointment(bacitracin/neosporin) b) apply only sterile dressings c) apply a clean dry cloth d) do not flush a chemical burn |
c) apply a clean dry cloth: do not apply any ointments, sterile dressings are best, but not required, any you want to flush a chemical burn asap
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True or False: All burn patients have a nasogastric tube inserted and connected to low intermittent suction because they become nauseated as a result of the gi effects of the burn injury.
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False: Only those with 20-25% TBSA will have an NG tube inserted.
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_____ technique is used while assessing burn wounds.
a) sterile b) clean c) surgical d) infectious |
b) clean
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What is worn by personnel while assessing the exposed burned areas?
a) clean gloves b) sterile gloves, gown, mask c) clean gloves, caps, and gown d) clean gloves, mask, gown |
c) clean gloves, cap and gown
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True or False: If possible, avoid applying a sheet over the burned patient, as any material in contact with the burns will cause excruciating pain.
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False: A sheet is place over and under the patient to protect the burn wound from contamination, maintain body temperature, and to reduce pain caused by air currents passing over exposed nerve endings.
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Because burns are contaminated wounds, _____ is administered if the patient's immunization status is not current or is known.
a) tetanus b) antibiotics c) BCG vaccination d) Rotavirus vaccination |
a) tetanus prophylaxis
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How are pain medications administered to the patients with burns?
a) orally b) analgesic creams c) IV d) rectally |
c) IV: because poor tissue perfusion accompanies burn injuries, only IV analgesia (usually morphine) is administered and titrated to the patient.
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What IV solution is the patient with extensive burns started on?
a) 10% dextrose b) lactated Ringer's solution c) 0.9% NS d) 50% dextrose |
b) lactates Ringer's solution
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Within the first 24 hours after injury, if the hematocrit and hemoglobin levels decrease or if the urinary output exceeds 50 mL/hour, the rate of IV fluid administration may be _____.
a) increased b) decreased c) left as it is d) turned off |
b) decreased
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The consensus formula provides for the volume of an isotonic solution to be administered during the first 24 hours in a range of:
a) 2-4 mL/kg b) 4 mL/kg c) 4-8 mL/kg d) 8-12 mL/kg |
a) 2-4 mL/kg
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True or False: Nurse Aides need to be instructed never to apply a blood pressure cuff to a burned extremity as it can lead to further reduced circulation on the burn extremity.
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False: If all extremities are burned, determining blood pressure may be difficult. A sterile dressing applied under the blood pressure cuff protects the wound from contamination.
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Peripheral pulses of burned extremities are checked:
a) every hour b) every 2 hours c) every 4 hours d) every 8 hours |
a) every hour
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What can you administer to reduce gastric acidity and risk of ulceration?
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histamine blockers and antacids
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____ is common in patients after burn shock resolves.
a) sepsis b) UTI c) gastritis d) fever |
d) fever: a resetting of the core body temperature in severely burned patients results in a body temperature a few degrees higher than normal for several weeks after the burn
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Fluid and electrolyte changes in the acute phase of burn injury includes:
a) Respiratory Acidosis b) Respiratory Alkalosis c) Metabolic Acidosis d) Metabolic Alkalosis |
c) Metabolic Acidosis: due to loss of sodium depleting the fixed base and increasing relative carbon dioxide content.
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A primary source of bacterial infection for the burn patient appears to be:
a) the blood b) the wound bed c) the air d) the GI tract |
d) the GI tract
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What protective equipment is worn during caring for the patient with open burn wounds?
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Cap, gown, mask, and gloves.
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True or False: Prophylactic antibiotics are usually prescribed for the burn patient due to the high chance of infection.
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False: Antibiotics are seldom prescribed prophylactically because of the risk of promoting resistant strains of bacteria.
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During wound cleaning:
a) bath water temp should be set at 98.6 degrees b) the room temp should be set between 80-85 degrees c) hydrotherapy should be set for 45-60 minute intervals d) plastic liners are avoided during hydrotherapy |
b) the room temp should be set between 80-85 degrees: and: bath water should be set at 100 degrees, hydrotherapy should last 20-30 minutes to prevent chilling and plastic liners should be used because of the high risk of infection and sepsis
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How long after the burn does eschar typically begins to separate from the viable tissue beneath?
a) 1-2 days b) 1 week c) 1-2 weeks d) 1-2 months |
c) 1-2 weeks
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What do the following have in common: Acticoat, Aquacel, Silversorb or Silverlon?
a) they are slow release b) they are quick release c) they have a quick peak interval d) they are inexpensive |
a) they are slow release and allow for less discomfort since they need to be changed less frequently
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Circumferential dressings should be applied:
a) distally to proximally b) proximally to distally c) anterior to posterior d) posterior to anterior |
a) distal to proximal: So wrap the leg from the ankle up toward the groin, or the arm from the wrist up toward the elbow.
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Where are occlusive dressings most often used?
a) over burned areas b) over areas with little exudate c) over grafted areas d) over infected areas |
c) over grafted areas
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True of False: Burns to the face may be left open to air once they have been cleaned and the topical agent has been applied.
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True
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What is worn during removal of a soiled dressing?
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Mask, goggles, hair cover, gown and gloves.
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True or False: Nurses should cut loose eschar with sterile scissors and forceps to encourage separation of devitalized skin.
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True!
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True or False: Mechanical debridement is carried out to the point of pain and bleeding.
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True! Hemostatic agents or pressure can be used to stop bleeding from small vessels.
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Are wet-to-dry dressings advocated in burn care?
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No, because of the chance of removing viable cells along with necrotic tissue.
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True or False: Silver cream should be applied in conjunction with an antimicrobial agent to promote optimal healing.
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False: Heavy metals such as silver deactivate the debriding agent; therefore, caution is necessary to ensure that the debriding agent does not interfere with the topical antimicrobial agent. Separate dressings are used to prevent this from occurring.
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True or False: Aggressive surgical wounds closure has reduced the incidence of burn wound sepsis thus improving survival rates.
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True!
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Following surgical excision of a burn wound:
a) the wound is left open to air b) the wound is irrigated every hour with saline c) the wound is covered with a skin graft or biological dressing d) the wound is warmed under a heating lamp |
c) the wound is covered with a skin graft or biological dressing
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What might need to happen, following an extensive and lengthy surgical excision?
a) antibiotic administration b) heating blanket c) blood transfusion d) sepsis protocol |
c) blood transfusion: the procedure creates a high risk of extensive blood loss (as much as 100 to 125 mL of blood per percent of body surface excised
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What are the main areas for skin grafting?
a) hands, feet, face, joints b) chest, back c) groin and genitals d) legs and arms |
a) hand, feet, face, joints
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What are homografts obtained from?
a) animals b) synthetic material c) dead people d) the patients body |
c) dead people
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What are heterographs obtained from?
a) animals b) synthetic material c) dead people d) the patients body |
a) animals
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Does INTEGRA or split-thickness autograft result is less scaring?
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INTEGRA
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When is the outer silicone membrane removed with INTEGRA dressings?
a) never b) 1 weeks after application c) 2 weeks after application d) 4 weeks after application |
c) 2 weeks after application
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What is the preferred material for burn wound closure after excision?
a) homograft b) heterograft c) xenograft d) autograft |
d) autografts are ideal means of covering burn wounds because the grafts are the patient's own skin and therefore are not rejected by the patient's immune system.
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Split-thickness, full-thickness, pedicle flaps, or epithelial grafts all what types of graft?
a) homograft b) heterograft c) xenograft d) autograft |
d) autografts
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When is the first dressing change after a skin graft?
a) the evening after surgery b) the next day c) 2-5 days later d) 1 week later |
c) 2-5 days later
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What is the first thing you should do if you discover a patient's skin graft has dislodged?
a) carefully slide it back into position b) call the doctor c) cover it with gauze d) cover it with a sterile saline compress |
d) cover it with a sterile saline compress
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When is the patient advised to begin exercising the grafted limb?
a) immediately b) 1 day post-op c) 5 days post-op d) 10 days post-op |
c) 5-7 days post-op
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Patient teaching of the patient who underwent a skin graft includes:
a) the donor site will heal in 7-14 days b) the donor site will heal in 1-2 days c) donor sites are not painful because both the hair follicles and nerve endings are removed with the grafted skin |
a) the donor site will heal in 7-14 days
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The goal of pain management for burn victims is:
a) complete absence of pain b) reduction of pain to a 7/10 c) reduction of pain to an acceptable goal set by the patient d) pain reduction is not possible without complete anesthesia |
c) reduction of pain to an acceptable goal set by the patient
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Why is Fentanyl a useful opioid for procedural burn pain?
a) it has few side effects b) it causes drowsiness c) it has a rapid onset d) it lasts for several hours |
c) it has a rapid onset and short duration which is appropriate for procedural pain
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What should be particularly monitored while patients are on
Fentanyl? a) urine output b) respiratory/cardiac status c) serum AST and ALT d) hematocrit and hemoglobin |
b) respiratory/cardiac status
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What is important during the administration of self-administered nitrous oxide during burn wounds procedure? Check all that apply
a) proper ventilation b) a private room c) monitoring equipment d) glucometer testing |
a) proper ventilation and
c) monitoring equipment |
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What is different in the resting metabolic rate of patients with more then 40% TBSA?
a) it is doubled b) it is cut in half c) it is not effected d) it varies from patient to patient |
a) it is doubled: effective nutrition management depends on how well the energy expenditure due to the burn injury can be estimated and matched with appropriate amount of micronutrients, carbs, lipids, and protein.
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What type of diets are recommended for burn victims?
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high-protein and high-calorie meals
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A patient with more than ___% body weight loss would be indicated for parenteral nutrition.
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10%
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What can be used to help promote adequate circulation and compression in the patient with bilateral leg burns?
a) lowering the legs to the dependent position b) applying ace wraps c) applying an air cast d) applying intermittent compression stockings |
b) applying ace wraps
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What can be done to prevent contractures in burn patients?
a) apply splints b) limit mobility c) avoid ROM activities that increase pain d) rest the affected extremity as much as possible |
a) apply splints
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What medication can be given to increase renal perfusion?
a) atropine b) epinephrine c) dopamine d) lisinopril |
c) dopamine
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What medication class can be given to promote increased urine output?
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diuretics
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Invasive hemodynamic monitoring is usually initiated in severe burn patients in order to monitor for early signs of sepsis and infection.
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False: Invasive hemodynamic monitoring is avoided because of the high risk of infection.
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True or False: Passive and active ROM exercises are initiated within 4-5 days of admission and are continued after grafting.
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False: Passive and active ROM exercises are initiated from the day of admission and are continued after grafting.
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True or False: Patients who experience a burn injury tend to have high rates of involvement in risk behaviors (eg, alcohol and substance abuse, depression) before the injury.
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True.
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One way to help the patient handle their feelings of anger is to enlist a nurse, social worker or another person who is involved in their care, to listen to the patient vent their feelings without fear of retaliation.
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False: The person enlisted should not be a person involved in the direct care of the patient. It helps the patient vent better if they don't have to worry about feelings of grudge or retaliation.
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What is the key sign of ARDS?
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hypoxemia while receiving 100% oxygen
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Patient teaching of the burned patient includes their need to wear pressure garments for at least:
a) 1 week b) 3 weeks c) 6 months d) 1 year |
d) 1 year
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Teaching instructions for the patient going home with small areas of clean, open wounds that are healing slowly are includes:
a) cover the areas while in the shower b) wear sterile gloves while performing dressing changes c) wash the areas daily with mild soap and water d) avoid prescribed topical agents |
c) wash the areas daily with mild soap and water
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Patient teaching of the client who has to wear compression garments includes wearing them for ___ hours a day.
a) 8 b) 12 c) 23 d) 24 |
c) 23 hours a day
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A burn victim is in the emergency department. During the fluid resuscitation phase, the nurse understands that the I.V. infusion rate is guided by which parameter?
a) client weight b) body temperature c) hourly urine output d) urine specific gravity |
a) client weight
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A nurse is applying silver sulfadiazine (Silvadene) cream to a client with second and third degree burns sustained in a house fire. Which actions is the top priority?
a) using a non sterile gloved hand to apply the cream b) monitoring the client's WBC c) applying the cream to burns before debridement d) warning the client that the cream may cause pain |
b) monitoring the client's WBC count
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A client is admitted to a burn intensive care unit with extensive full-thickness burns. Initially the nurse should be most concerned with the clients:
a) fluid status b) risk of infection c) body image d) level of pain |
a) fluid status: large volumes of fluid are lost through damaged skin, making fluid resuscitation a high priority
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Which nursing intervention has the highest priority for a severely burned client?
a) give high doses of an opioid b) give oxygen if dyspnea occurs c) monitor urine output every hour d) check ABG results every hour |
c) monitor urine output every hour to check for hypovolemia; oxygen is given immediately without waiting for signs of dyspnea
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A client is recovering from extensive burn injuries. The nurse instructs him about diet and stresses the importance of consuming foods high in calories and protein. The nurse knows the teaching was effective when the client chooses which meal?
a) fresh fruit salad with frozen yogurt, bran muffin, and black coffee b) broiled chicken, fruit gelatin with pineapple, green beans, and iced tea c) cheeseburger, french fried, assorted raw vegetables with dip, and a chocolate milkshake d) split-pea soup, cottage cheese with peach half, saltine crackers, and lemon-lime carbonated beverage |
c) cheese burger...ect: This meal seems like an unhealthy choice, but since the client is in a hypermetabolic state, they need a high-calorie diet to promote wound healing
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