A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all
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1. Place the client on a cardiac monitor.
2. Notify the health care provider (HCP).
3. Put the client on NPO (nothing by mouth) status except for ice chips.
4. Review the client's medications to determine if any contain or retain potassium.
5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration. - correct answer 1, 2, 4
R: NPO is unnecessary. Adding extra fluid may worsen the situation and lead to fluid overload. Excess K can cause heart dysrhythmias, so 1&4 are appropriate. Calling the HCP is also necessary for further orders.
A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition?
1. Pyelonephritis
2. Glomerulonephritis
3. Trauma to the bladder or abdomen
4. Renal cancer in the client's family - correct answer 3
R: 1& 2 are similar/alike, and they would involve a fever. 4 would have flank pain instead of low abd pain.
The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? Select all that apply.
1. Hemodialysis
2. Peritoneal dialysis
3. Kidney transplant
4. Bilateral nephrectomy
5. Intense immunosuppression therapy - correct answer 1,3,4
R: Polycystic KD involves cysts that eventually rupture and damage the kidneys, leading to end-stage renal disease. This requires options 1, 3, or 4. 2 is contraindicated r/t infection. 5 won't help the pt's condition.
A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action?
1. Notify the HCP before performing the catheterization.
2. Use a small-sized catheter and an anesthetic gel as a lubricant.
3. Administer parenteral pain medication before inserting the catheter.
4. Clean the meatus with soap and water before opening the catheterization kit. - correct answer 1
R: blood may = urethral trauma, so you need to notify the HCP first so you can identify the true cause of blood before catheterization.
Since there's blood from an unknown cause, you need to assess first before doing anything that can worsen it.
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent?
1. Palpation of a thrill over the fistula
2. Presence of a radial pulse in the left wrist
3. Visualization of enlarged blood vessels at the fistula site
4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand - correct answer 1.
R: listen for a thrill or bruit over AV fistula site. All other options don't REALLY show if the AV fistula is patent, just that there's perfusion to the hand.
A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder?
1. Hematuria and pyuria
2. Dysuria and proteinuria
3. Hematuria and urgency
4. Dysuria and penile discharge - correct answer 4.
R: Urethritis usually involves dysuria, so 1&3 are incorrect. Proteinuria is r/t kidney dysfunction, so option 2 is also incorrect. Urethritis is also associated with chlamydia, so discharge is expected. Hematuria is not assoc. with urethritis.
The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination?
1. Fever, diarrhea, groin pain, and ecchymosis
2. Nausea, painful scrotal edema, and ecchymosis
3. Fever, nausea, vomiting, and painful scrotal edema
4. Diarrhea, groin pain, testicular torsion, and scrotal edema - correct answer 3
R: -itis is associated w/ fever, so you can narrow it down to 1&3. Epididymitis does not involve bleeding so ecchymosis (option 1) is irrelevant.
Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills.
A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder?
1. Soft and swollen prostate gland
2. Swollen, and boggy prostate gland
3. Tender and edematous prostate gland
4. Tender, indurated prostate gland that is warm to the touch - correct answer 4
R: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.
*Remember, -itis= inflammation/infection, so tenderness and local warmth is expected. so option 4 is most correct.
The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia?
1. Nocturia
2. Scrotal edema
3. Occasional constipation
4. Decreased force in the stream of urine - correct answer 4
R: Option 1 is a later sign. 2&3 are irrelevant to BPH.
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply.
1. Check the level of the drainage bag.
2. Reposition the client to his or her side.
3. Contact the health care provider (HCP).
4. Place the client in good body alignment.
5. Check the peritoneal dialysis system for kinks.
6. Increase the flow rate of the peritoneal dialysis solution. - correct answer 1,2,4,5
R: Try to fix the flow yourself before calling the HCP or messing with the flow rate. Imbalance may be r/t a kink or improper positioning so fix those first.
A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication?
1. Warmth, redness, and pain in the left hand
2. Ecchymosis and audible bruit over the fistula
3. Edema and reddish discoloration of the left arm
4. Pallor, diminished pulse, and pain in the left hand - correct answer 4
R: Arterial STEAL syndrome involves vascular insufficiency (literally stealing the blood that the hand's tissue needs!). So you'd see pallor and other signs of decr. perfusion.
1&3 sound more like an infection so they're incorrect. Option 2 is a normal finding for a fistula.
The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would expect to note which finding?
1. Elevated creatinine level
2. Decreased hemoglobin level
3. Decreased red blood cell count
4. Increased number of white blood cells in the urine - correct answer 1
R: Creat is increased only by kidney dysfunction of at least 50% loss. 2&3 are irrelevant. 4 is more involved w/ UTIs.
A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5°C (101.2°F). Which nursing action is most appropriate?
1. Encourage fluid intake.
2. Notify the health care provider.
3. Continue to monitor vital signs.
4. Monitor the site of the shunt for infection. - correct answer 2
R: Options 3&4 involve assessment, which is normally good but not for a priority situation like this so they're incorrect (you'll just watch the pt deteriorate lol). You know that dialysis patients have fluid restrictions, so option 2 is the best choice since the HCP can order further & treatment.
The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action?
1. Monitor the client.
2. Elevate the head of the bed.
3. Assess the fistula site and dressing.
4. Notify the health care provider (HCP). - correct answer 4
R: "Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified. Monitoring the client, elevating the head of the bed, and assessing the fistula site are correct actions, but the priority action is to notify the HCP."
A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis. The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply.
1. Peritoneal dialysis
2. Analysis of the urinary stone
3. Intravenous opioid analgesics
4. Insertion of a nephrostomy tube
5. Placement of a ureteral stent with ureteroscopy - correct answer 4, 5
R: "Urolithiasis is the condition that occurs when a stone forms in the urinary system. Hydronephrosis develops when the stone has blocked the ureter and urine backs up and dilates and damages the kidney. Priority treatment is to allow the urine to drain and relieve the obstruction in the ureter. This is accomplished by placement of a percutaneous nephrostomy tube to drain urine from the kidney and placement of a ureteral stent to keep the ureter open. Peritoneal dialysis is not needed since the kidney is functioning. Stone analysis will be done later when the stone has been retrieved and analyzed. Opioid analgesics are necessary for pain relief but do not treat the obstruction."
The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication?
1. Peritonitis
2. Hyperglycemia
3. Hyperphosphatemia
4. Disequilibrium syndrome - correct answer 2
R: Patients with DM may req an increase in insulin w/ peritoneal dialysis bc there's an increased amount of time for glucose to absorb. Option 1 is r/t improper aseptic technique. 3 is just r/t renal imbalance. 4 is only with HEMOdialysis, not peritoneal.
A week after kidney transplantation, a client develops a temperature of 101°F (38.3°C), the blood pressure is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment?
1. Antibiotic therapy
2. Peritoneal dialysis
3. Removal of the transplanted kidney
4. Increased immunosuppression therapy - correct answer 4
R: Symptoms of rejection = fever, malaise, elevated white blood cell count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Treatment consists of increasing immunosuppressive therapy. Antibiotics are used to treat infection. Peritoneal dialysis cannot be used with a newly transplanted kidney due to the recent surgery. Removal of the transplanted kidney is indicated with hyperacute rejection, which occurs within 48 hours of the transplant surgery.
A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider (HCP)?
1. Red, bloody urine
2. Pain rated as 2 on a 0-10 pain scale
3. Urinary output of 200 mL higher than intake
4. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute - correct answer 4
R: Options 1, 2, and 3 are all expected findings for several days after surgery. Option 4 sounds like a response to excessive blood loss.
The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations?
1. Hypertension, tachycardia, and fever
2. Hypotension, bradycardia, and hypothermia
3. Restlessness, irritability, and generalized weakness
4. Headache, deteriorating level of consciousness, and twitching - correct answer 4
R: Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. This is common in pt new to dialysis.
The nurse is conducting an interview of an older client and is concerned about the possibility of benign prostatic hyperplasia (BPH). Which are characteristics of this disorder? Select all that apply.
1. Nocturia
2. Incontinence
3. Enlarged prostate
4. Nocturnal emissions
5. Decreased desire for sexual intercourse - correct answer 1, 2, 3
R: Option 4 is seen commonly in prepubescent males. 5 is seen w/ low testosterone levels.
Nocturia=urination at night. Nocturnal emissions=ejaculation while sleeping lol.
The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a 3-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period?
1. Pale pink urine
2. Dark pink urine
3. Tea-colored urine
4. Bright red blood with small clots in the urine - correct answer 1
R: Option 2 means the irrigation solution should be increased (dark=concentrated). 3 is more r/t renal failure. 4 would indicate a complication, so you'd need to call the HCP.
A client who has had a prostatectomy has been instructed in perineal exercises to gain control of the urinary sphincter. The nurse determines that the client demonstrates a need for further teaching when he states that he will perform which movement as part of these exercises?
1. Bearing down as if having a bowel movement
2. Tightening the muscles as if trying to prevent urination
3. Contracting the abdominal, gluteal, and perineal muscles
4. Tightening the rectal sphincter while relaxing abdominal muscles - correct answer 1
R: Bearing down (vagal/vasalva) may increase bleeding from surgical site, and should be avoided. Option 4 is different bc relaxing the abd muscles prevents the vasalva maneuver.
A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client?
1. Bradycardia
2. Hypertension
3. Decreased cardiac output
4. Decreased central venous pressure - correct answer 2
R: Signs of AKI=hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.
The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process?
1. Anxiety
2. Memory deficits
3. Presence of family
4. Short attention span - correct answer 3
R: literally the only positive option
The nurse is analyzing the posthemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased?
1. Potassium
2. Creatinine
3. Phosphorus
4. Red blood cell (RBC) count - correct answer 4
R: Anemia occurs bc RBCs are lost during the dialysis process (sampling, residual blood in dialyzer, etc). Dialysis also lowers 1,2, and 3 but those are therapeutic & expected findings.
A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply.
1. Agitation
2. Euphoria
3. Depression
4. Withdrawal
5. Labile emotions - correct answer 1,3,4,5
R: "Clients with CKD may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation. Delusions and psychosis also can occur."
Ok honestly who's gonna have Euphoria with dialysis and CKD
A client with chronic kidney disease (CKD) has been taking aluminum hydroxide gel. On the basis of this information, the nurse determines that the client is most at risk for which problem?
1. Constipation
2. Dehydration
3. Inability to tolerate activity
4. Impaired physical mobility - correct answer 1
R: Options 3&4 are too similar and can be eliminated. Aluminum hydroxide can cause constipation, so option 1 is most correct.
The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a [Show Less]