Question 1
1/ 1pts
When explaining the rationale for the use of lactulose syrup for the patient
with chronic cirrhosis, the nurse would choose which of the following
statements?
A. Lactulose helps to reverse cirrhos of the liver.is
B. Lactulose can be taken intermittently to reduce side effects.
C. Lactulose reduces constipation, which is a frequent complaint with
cirrhosis.
D. Lactulose suppresses the metabolism of ammonia and aids in its
elimination through feces.
Because a cirrhotic liver cannot process ammonia, lactulose is given to bind
to the ammonia and is excreted through the bowel. The goal is to reach 2-3
loose bowel movements daily for the patient to maintain safe ammonia
levels.
Question 2
1/ 1pts
The 72-year-old client is admitted to the medical unit diagnosed with an
acute exacerbation of diverticulosis. The health-care provider has prescribed
the intravenous antibiotic ceftriaxone (Rocephin). Which intervention should
the nurse implement first?
A. Assess the client’s most recent vital signs.
B. Determine if the client has any known allergies.
C. Send a stool specimen to the laboratory.
D. Monitor the client’s white blood cell count.
Antibiotics are notorious for causing allergic reactions, and the nurse should
make sure the client is not allergic to any antibiotics prior to administering
this medication. Therefore, this is the first intervention.
The white blood cell count is monitored to determine the effectiveness of the
medication and would not be checked prior to administering the first dose of
the antibiotic medication.
The nurse should monitor the client’s vital signs, especially the temperature,
but it would not affect the nurse administering the first dose of antibiotics.
Stool specimens are sent to the laboratory to detect ova or parasites.
Diverticulitis is not the result of ova or parasites; therefore, there is no need
for the client to have a stool specimen sent to the laboratory.
Question 3
1/ 1pts
Which laboratory data should the nurse monitor for the client with
inflammatory bowel disease who is prescribed sulfasalazine (Azulfidine), a
sulfonamide
antibiotic?
A. The client’s liver function tests.
B. The client’s serum creatinine level.
C. The client’s serum potassium level.
D. The client’s International Normalized Ratio (INR).
Sulfasalazine is insoluble in acid urine and can cause crystalluria and
hematuria, resulting in kidney damage. Therefore, the nurse should monitor
the serum creatinine level, which is normally 0.5 to 1.5 mg/dL.
There is no indication that sulfasalazine is hepatotoxic; therefore, liver
function tests do not need to be monitored when administering this
medication.
The serum potassium level is not affected by sulfasalazine; therefore, the
nurse does not need to monitor this laboratory data.
Sulfasalazine may cause abnormal bleeding and bruising, but the INR is
monitored for clients taking the oral anticoagulant warfarin (Coumadin).
Question 4
1/ 1pts
The nurse instructs the client taking dexamethasone (Decadron) to take it
with food or milk because this medication?
A. Decreases production of hydrochloric acid
B. Slows stomach emptying time
C. Retards pepsin production
D. Stimulates hydrochloric acid production
Stimulates hydrochloric acid production is the correct option. Decadron
increases the production of hydrochloric acid, which may cause
gastrointestinal ulcers.
Question 5
1/ 1pts
A client receiving peritoneal dialysis (PD) has outflow that is 100 mL less
than the inflow for two consecutive exchanges. Which of the following
actions would be best for the nurse to take first?
A. Irrigate dialysis catheter.
B. Change client’s position.
C. Check client’s blood pressure.
D. Continue to monitor third exchange.
Peritoneal dialysis uses osmosis and diffusion across the peritoneal
membrane to clear toxins from the patient. The dialysate fluid, once instilled,
migrates to the most dependent areas, which may not be in direct contact
with the dialysis catheter. To facilitate drainage, the client’s position should
be changed to move the dialysate solution into contact with the tip of the
catheter.
Although vital signs are monitored, the blood pressure is more of a concern
with hemodialysis where large amounts of fluid removal can suddenly drop
the blood pressure—not a concern at this time. The catheter would only need
to be irrigated if there is a cessation of drainage and the nurse suspects that
the catheter is completely obstructed. Continuing to monitor third exchange
does not correct the current problem.
Question 6
1/ 1pts
A client seen in the Emergency Department reports painful urination,
frequency, and urgency. Which of the following conditions would the nurse
suspect?
A. Renal calculi
B. Polycystic kidney disease
C. Cystitis
D. Glomerulonephritis
Painful urination, frequency, and urgency are common signs ofcystitis, or
bladder infection.
Renal calculi or stones present with flank pain that progresses toward the
groin as the stone migrates downward. Glomerulonephritis frequently
presents with hematuria. Polycystic kidney disease frequently presents with
flank pain and hypertension.
Question 7
1/ 1pts
The nurse is collecting a 24-hour urine sampling for creatinine clearance on a
client hospitalized with acute glomerulonephritis. While making rounds, the
nurse learns that the client discarded the 2 a.m. voiding. The nurse should?
A. Discard the collected urine, obtain a new bottle, and begin the
collection again
B. Continue the collection as ordered by the physician
C. Record the information in the client’s chart and continue the collection
D. Extend the collection time to replace the last voiding
Failure to collect all urine voided in the 24-hour period invalidates specimen
results; therefore, the nurse should obtain a new collection bottle, discard
the collected urine, and begin the collection again. All other options are
incorrect because they are improper ways of obtaining a 24-hour urine
specimen.
Question 8
1/ 1pts
The nurse is caring for an elderly patient who was admitted with renal
insufficiency. An expected laboratory finding for this patient may be
A. a normal serum creatinine level.
B. hypokalemia.
C. increased ability to excrete drugs.
D. an increased glomerular filtration rate (GFR).
The most important renal physiological change that occurs with aging is a
decrease in the GFR. After age 40, renal blood flow gradually diminishes at a
rate of 10% per decade. With advancing age, there is also a decrease in
renal mass, the number of glomeruli and peritubular density. Serum
creatinine levels may remain the same in the elderly patient, even with a
declining GFR, because of decreased muscle mass and hence decreased
creatinine production. Tubular changes include a diminished ability to
excrete drugs, including radiocontrast dyes used in diagnostic testing, which
necessitates a decrease in drug dosing to avoid nephrotoxicity. Many
medications, including antibiotics, require dose adjustments as kidney
function declines. Age-related changes in renin and aldosterone levels also
occur, which can lead to fluid and electrolyte abnormalities. Renin levels are
decreased by 30% to 50% in the elderly, resulting in less angiotensin II
production and lower aldosterone levels. Together these can cause an
increased risk of hyperkalemia. The aging kidney is also slower to correct an
increase in acids, causing a prolonged metabolic acidosis and the
subsequent shifting of potassium out of cells and worsening hyperkalemia.
Question 9
1/ 1pts
Acute kidney injury from postrenal etiology is caused by
A. conditions that act directly on functioning kidney tissue.
B. hypovolemia or decreased cardiac output.
C. obstruction of the flow of urine.
D. conditions that interfere with renal perfusion.
Acute kidney injury resulting from obstruction of the flow of urine is classified
as postrenal or obstructive renal injury. Conditions that result in AKI by
interfering with renal perfusion are classified as prerenal and include
hypovolemia and decreased cardiac output. Conditions that produce AKI by
directly acting on functioning kidney tissue are classified as intrarenal.
Question 10
1/ 1pts
The patient undergoes a cardiac catheterization that requires the use of
contrast dyes during the procedure. To detect signs of contrast-induced
kidney injury, the nurse should
A. evaluate the patient’s postvoid residual volume to detect intrarenal
injury.
B. obtain an order for a renal ultrasound.
C. not be concerned unless urine output decreases.
D. evaluate the patient’s serum creatinine for up to 72 hours after the
procedure.
Contrast- induced kidney injury is diagnosed by an increase in serum
creatinine of 25%, or 0.5 mg/dL, within 48 to 72 hours following the
administration of contrast. Urine output usually remains normal. The renal
ultrasound and postvoid residual assessment are not warranted.
Question 11
1/ 1pts
Which of the following patients is at the greatest risk of developing acute
kidney injury? A patient who
A. has been on aminoglycosides for the past 6 days
B. has a history of fluid overload as a result of heart failure
C. has a history of controlled hypertension with a blood pressure of
138/88 mm Hg
D. was discharged 2 weeks earlier after aminoglycoside therapy of 2
weeks
Acute kidney injury can be caused by aminoglycoside nephrotoxicity,
especially prolonged use of the drug (more than 10 days). Symptoms of
acute kidney injury are usually seen about 1 to 2 weeks after exposure.
Because of this delay, the patient must be questioned about any recent
medical therapy for which an aminoglycoside may have been prescribed. The
blood pressure of 138/88 mm Hg controlled by medication would not cause
acute kidney injury, nor would fluid overload from exacerbation of heart
failure.
Question 12
1/ 1pts
The patient’s serum creatinine level is 0.7 mg/dL. The expected BUN level
should be
A. 1 to 2 mg/dL.
B. 10 to 20 mg/dL.
C. 7 to 14 mg/dL.
D. 20 to 30 mg/dL.
The normal BUN/creatinine ratio is 10:1 to 20:1. Therefore, the expected
range for this creatinine level would be 7 to 14 mg/dL.
Question 13
1/ 1pts
The patient is admitted with complaints of general malaise and fatigue,
along with a decreased urinary output. The patient’s urinalysis shows coarse,
muddy brown granular casts and hematuria. The nurse determines that the
patient has:
A. a urinary tract infection.
B. intrarenal disease, probably acute tubular necrosis.
C. acute kidney injury from a prerenal condition.
D. acute kidney injury from postrenal obstruction.
Analysis of urinary sediment and electrolyte levels is helpful in distinguishing
among the various causes of acute kidney injury. Coarse, muddy brown
granular casts are classic findings in ATN. Microscopic hematuria and a small
amount of protein also may be seen. In prerenal conditions, the urine
typically has no cells but may contain hyaline casts. Postrenal conditions
may present with stones, crystals, sediment, bacteria, and clots from the
obstruction. Bacteria would be present in a urinary tract infection.
Question 14
1/ 1pts
What is a minimally acceptable urine output for a patient weighing 75 kg?
A. 150 mL/hour
B. Less than 30 mL/hou
C. 80 mL/hour
D. 37 mL/hour
Normal urine output is 0.5 to 1 mL/kg of body weight each hour.
Question 15
1/ 1pts
The patient’s potassium level is 7.0 mEq/L. Besides dialysis, which of the
following actually reduces plasma potassium levels and total body potassium
content safely in a patient with renal dysfunction?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Regular insulin
D. Sodium polystyrene sulfonate with sorbitol
Only dialysis and administration of cation exchange resins (sodium
polystyrene sulfonate) actually reduce plasma potassium levels and total
body potassium content in a patient with renal dysfunction. In the past,
sorbitol has been combined with sodium polystyrene sulfonate powder for
administration. The concomitant use of sorbitol with sodium polystyrene
sulfonate has been implicated in cases of colonic intestinal necrosis;
therefore, this combination is not recommended. Other treatments, such as
administration of regular insulin and calcium gluconate, “protect” the patient
for only a short time until dialysis or cation exchange resins can be
instituted
Question 16
1/ 1pts
The patient is diagnosed with acute kidney injury and has been getting
dialysis 3 days per week. The patient complains of general malaise and is
tachypneic. An arterial blood gas shows that the patient’s pH is 7.19, with a
PCO2 of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares
to
A. administer morphine to slow the respiratory rate.
B. cancel tomorrow’s dialysis session.
C. prepare for intubation and mechanical ventilation.
D. administer intravenous sodium bicarbonate.
Metabolic acidosis is the primary acid-base imbalance seen in acute kidney
injury. Treatment of metabolic acidosis depends on its severity. Patients with
a serum bicarbonate level of less than 15 mEq/L and a pH of less than 7.20
are usually treated with intravenous sodium bicarbonate. The goal of
treatment is to raise the pH to a value greater than 7.20. Rapid correction of
the acidosis should be avoided, because tetany may occur as a result of
hypocalcemia. Renal replacement therapies also may correct metabolic
acidosis because it removes excess hydrogen ions and bicarbonate is added
to the dialysate and replacement solutions; therefore, dialysis would not be
canceled. The tachypnea is a compensatory mechanism for the metabolic
acidosis, and treatments to decrease the respiratory rate are not indicated.
Treatment is aimed at correcting the metabolic acidosis, and this scenario
does not provide data to support the need for intubation
Question 17
1/ 1pts
Continuous renal replacement therapy (CRRT) differs from conventional
intermittent hemodialysis in that
A. it does not allow diffusion to occur.
B. it provides faster removal of solute and water.
C. a hemofilter is used to facilitate ultrafiltration.
D. the process removes solutes and water slowly.
CRRT is a continuous extracorporeal blood purification system managed by
the bedside critical care nurse. It is similar to conventional intermittent
hemodialysis in that a hemofilter is used to facilitate the processes of
ultrafiltration and diffusion. It differs in that CRRT provides a slow removal of
solutes and water as compared to the rapid removal of water and solutes
that occurs with intermittent hemodialysis.
Question 18
1/ 1pts
The critical care nurse is responsible for monitoring the patient receiving
continuous renal replacement therapy (CRRT). In doing so, the nurse should
A. assess the hemofilter every 6 hours for clotting.
B. cover the dialysis lines to protect them from light.
C. use clean technique during vascular access dressing changes.
D. assess that the blood tubing is warm to the touch.
The critical care nurse is responsible for monitoring the patient receiving
CRRT. The hemofilter is assessed every 2 to 4 hours for clotting (as
evidenced by dark fibers or a rapid decrease in the amount of ultrafiltration
without a change in the patient’s hemodynamic status). The CRRT system is
frequently assessed to ensure filter and lines are visible at all times, kinks
are avoided, and the blood tubing is warm to the touch. The ultrafiltrate is
assessed for blood (pink-tinged to frank blood), which is indicative of
membrane rupture. Sterile technique is performed during vascular access
dressing changes.
Question 19
1/ 1pts
The patient is on intake and output (I&O), as well as daily weights. The nurse
notes that output is considerably less than intake over the last shift, and
daily weight is 1 kg more than yesterday. The nurse should
A. obtain an order to place the patient on fluid restriction.
B. draw a trough level after the next dose of antibiotic.
C. insert an indwelling catheter.
D. assess the patient’s lungs.
The scenario indicates retention of fluid; therefore, the nurse must assess for
symptoms of fluid overload, for example, by auscultating the lung fields.
Adequate hydration is essential and fluid restriction would be determined by
the provider upon physical examination and analysis of laboratory results. An
indwelling urinary catheter should not routinely be inserted because it
increases the risk of infection. A trough level is drawn just before the next
dose of a drug is given and is an indicator of how the body has cleared the
drug; it would not be done secondary to imbalanced intake and output.
Question 20
1/ 1pts
After gastric bypass surgery, the patient is getting vitamin B12 injections.
The patient asks about the purpose of this vitamin. The nurse explains that
A. vitamin B12 is needed for the formation of red blood cells.
B. vitamin B12 is essential for surgical wound healing.
C. vitamin B12 is needed to prevent a type of anemia.
D. vitamin B12 is always deficient in obese people.
Vitamin B12 is absorbed in the terminal ileum in the presence of intrinsic
factor produced in the stomach. Vitamin B12 is essential in the formation of
red blood cells. A deficiency of B12 does lead to anemia, but this answer is
not as specific as stating the relationship of B12 to red blood cells, so it is not
as informative. Vitamins A and C are more essential for wound healing.
Obese people may or may not be deficient in this vitamin.
Question 21
1/ 1pts
The nurse is assessing a patient admitted with pancreatitis. In doing so, the
nurse
A. explains to the patient that back pain is not a sign of pancreatitis.
B. emphasizes to the patient that pancreatic inflammation does not
spread.
C. palpates the pancreas for size and shape.
D. assesses symptoms that could indicate involvement of the stomach.
Because the pancreas lies retroperitoneally, it cannot be palpated; this
characteristic explains why diseases of the pancreas can cause pain that
radiates to the back. In addition, a well-developed pancreatic capsule does
not exist, and this may explain why inflammatory processes of the pancreas
can spread freely and affect the surrounding organs (stomach and
duodenum).
Question 22
1/ 1pts
The liver detoxifies the blood by
A. metabolizing inactive toxic substances to active forms.
B. excreting fat-soluble compounds in feces.
C. converting water-soluble compounds to fat-soluble compounds.
D. converting fat-soluble compounds to water-soluble compounds.
Drugs, hormones, and other toxic substances are metabolized by the liver
into inactive forms for excretion. This process is usually accomplished by
conversion of the fat-soluble compounds to water-soluble compounds. They
can then be excreted via the bile or the urine.
Question 23
1/ 1pts
The patient is being admitted to the hospital. At home, the patient takes an
over-the-counter supplement of vitamin D and is concerned because the
doctor did not order that vitamin D to be given in the hospital. The nurse
explains that
A. over-the-counter supplements are never given in the hospital.
B. vitamin D is stored in the liver with a 10-month supply to prevent
deficiency.
C. the kidneys will produce enough vitamin D and that supplements are
not needed.
D. the body does not store vitamins so the doctor will have to be called.
The liver plays a central role in the storage, synthesis, and transport of
various vitamins and minerals. It functions as a storage depot principally for
vitamins A, D, and B12, where up to 3-, 10-, and 12-month supplies,
respectively, of these nutrients are stored to prevent deficiency states. The
kidneys do not produce vitamin D. Over-the-counter supplements are
ordered, depending on the patient’s status.
Question 24
1/ 1pts
Infection by Helicobacter pylori bacteria is a major cause of
A. duodenal ulcers.
B. stress ulcers.
C. Curling’s ulcers.
D. Cushing’s ulcers.
Infection with Helicobacter pylori bacteria is a major cause of duodenal
ulcers. A stress ulcer is an acute form of peptic ulcer that often accompanies
severe illness, systemic trauma, or neurological injury. Stress ulcers that
develop as a result of burn injury are often called Curling’s ulcers. Stress
ulcers associated with severe head trauma or brain surgery are called
Cushing’s ulcers.
Question 25
1/ 1pts
The patient is admitted with the diagnosis of GI bleeding. The patient’s heart
rate is 140 beats per minute, and the blood pressure is 84/44 mm Hg. These
values may indicate:
A. increased blood flow to the skin, lungs, and liver.
B. resolution of hypovolemic shock.
C. a need for hourly vital signs.
D. approximately 25% loss of total blood volume.
Hypotension is an advanced sign of shock. As a rule, a systolic pressure of
less than 100 mm Hg, a postural decrease in blood pressure of greater than
10 mm Hg, or a heart rate of greater than 120 beats/min reflects a blood loss
of at least 1000 mL—25% of the total blood volume. Vital signs should be
monitored at least every 15 minutes. As blood loss exceeds 1000 mL, the
shock syndrome progresses, causing decreased blood flow to the skin, lungs,
liver, and kidneys.
Question 26
1/ 1pts
The patient is admitted with acute pancreatitis and is demonstrating severe
abdominal pain, vomiting, and ascites. Using the Ranson classification
criteria, the nurse determines that this patient
A. has a 99% chance of survival.
B. has a 15% chance of dying.
C. has a 40% chance of dying.
D. has no chance of survival.
Patients with acute pancreatitis can develop mild or fulminant disease. As a
consequence, research has addressed criteria for predicting the prognosis of
patients with acute pancreatitis. The early classification criteria were
developed by Ranson, who suggested that the number of signs present
within the first 48 hours of admission directly relates to the patient’s chance
of significant morbidity and mortality. In Ranson’s research, patients with
fewer than three signs had a 1% mortality rate, those with three or four signs
had a 15% mortality rate, those with five or six signs had a 40% mortality
rate, and those with seven or more signs had a 100% mortality rate.
Question 27
1/ 1pts
Noninvasive diagnostic procedures used to determine kidney function
include which of the following? (Select all that apply.)
A. Intravenous pyelography (IVP)
B. Renal ultrasound
C. Kidney, ureter, bladder (KUB) x-ray
D. Magnetic resonance imaging (MRI)
E. Renal angiography
Noninvasive diagnostic procedures are usually performed before any
invasive diagnostic procedures are conducted. Noninvasive diagnostic
procedures that assess the renal system are radiography of the kidneys,
ureters, and bladder (KUB); renal ultrasonography; and magnetic resonance
imaging. Invasive diagnostic procedures for assessing the renal system
include intravenous pyelography, computed tomography, renal angiography,
renal scanning, and renal biopsy.
Question 28
1/ 1pts
The most common reasons for initiating dialysis in acute kidney injury
include which of the following? (Select all that apply.)
A. Volume overload
B. Uremia
C. hyperkalemia
D. Hypokalemia
E. Acidosis
The most common reasons for initiating dialysis in acute kidney injury
include acidosis, hyperkalemia, volume overload, and uremia. Dialysis is
usually started early in the course of the renal dysfunction before uremic
complications occur. In addition, dialysis may be started for fluid
management when total parenteral nutrition is administered.
Question 29
1/ 1pts
Complications common to patients receiving hemodialysis for acute kidney
injury include which of the following? (Select all that apply.)
A. Muscle cramps
B. Air embolism
C. Hemolysis
D. Dysrhythmias
E. Hypotension
Hypotension is common and is usually the result of preexisting hypovolemia,
excessive amounts of fluid removal, or excessively rapid removal of fluid.
Dysrhythmias may occur during dialysis. Causes of dysrhythmias include a
rapid shift in the serum potassium level, clearance of antidysrhythmic
medications, preexisting coronary artery disease, hypoxemia, or
hypercalcemia from rapid influx of calcium from the dialysate solution.
Muscle cramps occur more commonly in chronic renal failure. Hemolysis, air
embolism, and hyperthermia are rare complications of hemodialysis.
Question 30
1/ 1pts
Nursing priorities for the management of acute pancreatitis include: (Select all that apply.)
A. withholding analgesics that could mask abdominal discomfort.
B. assessing and maintaining electrolyte balance.
C. managing respiratory dysfunction.
D. utilizing supportive therapies aimed at decreasing gastrin release.
E. stimulating gastric content motility into the duodenum.
Nursing and medical priorities for the management of acute pancreatitis
include several interventions. Managing respiratory dysfunction is a high
priority. Fluids and electrolytes are replaced to maintain or replenish
vascular volume and electrolyte balance. Analgesics are given for pain
control, and supportive therapies are aimed at decreasing gastrin release
from the stomach and preventing the gastric contents from entering the
duodenum.
Question 31
1/ 1pts
The patient is admitted with end-stage liver disease. The nurse evaluates the patient for
which of the following? (Select all that apply.)
A. Malnutrition
B. Hypercoagulation
C. Hypoglycemia
D. Disseminated intravascular coagulation
E. Ascites
Altered carbohydrate metabolism may result in unstable blood glucose
levels. The serum glucose level is usually increased to more than 200 mg/dL.
This condition is termed cirrhotic diabetes. Altered carbohydrate metabolism
may also result in malnutrition and a decreased stress response. Protein
metabolism, albumin synthesis, and serum albumin levels are decreased.
Low albumin levels are also thought to be associated with the development
of ascites, a complication of hepatic failure. Fibrinogen is an essential protein
that is necessary for normal clotting. A low plasma fibrinogen level, coupled
with decreased synthesis of many blood-clotting factors, predisposes the
patient to bleeding. Clinical signs and symptoms range from bruising and
nasal and gingival bleeding to frank hemorrhage. Disseminated intravascular
coagulation may also develop.
Question 32
1/ 1pts
The nurse is caring for a patient with an electrical injury. The nurse understands that
patients with electrical injury are at a high risk for acute kidney injury secondary to
A. hypervolemia from burn resuscitation.
B. increased incidence of ureteral stones.
C. release of myoglobin from injured tissues.
D. nephrotoxic antibiotics for prevention of infection.
Myoglobin is released during electrical injury and is a risk factor for
rhabdomyolysis and acute kidney injury. Hypervolemia is not a cause of
acute kidney injury. Ureteral stones and nephrotoxic antibiotics may cause
acute kidney injury but are not associated with the electrical injury.
Question 33
1/ 1pts
Which of the following statements would reflect that the patient does not
understand the long term effects of liver failure?
A. “It is important that I get more rest.”
B. “If I stop drinking, my liver will get better.”
C. “I need to monitor and limit my salt intake.”
D. “My skin might become more yellow and change in color.”
The statement that reflects that the patient does not understand the long
term effects of liver failure is the statement, “If I stop drinking, my liver will
get better.” Damage to the liver is irreversible. It is important to monitor salt
intake, get more rest and be aware of changes that will occur, such as
jaundice, as the disease progresses.
Question 34
1/ 1pts
A client has a 10-year history of Crohn’s disease and is seeing the physician
due to increased diarrhea and fatigue. What is the recommended dietary
approach to treat Crohn’s disease?
A. high-fiber diet
B. dietary approach varies.
C. lactose-rich foods
D. low-fiber diet
The dietary approach varies. A high-fiber diet may be indicated when it is
desirable to add bulk to loose stools. A low-fiber diet may be indicated in
cases of severe inflammation or stricture. A high-calorie and high-protein
diet helps replace nutritional losses from chronic diarrhea. The client may
need nutritional supplements, depending on the area of the bowel affected.
When the small intestine is inflamed, some clients experience lactose
intolerance, requiring avoidance of lactose-rich foods.
Question 35
1/ 1pts
The nurse working in the ED is evaluating a client for signs and symptoms of
appendicitis. Which of the client's signs/symptoms should the nurse report to
the physician?
A. Left lower quadrant pain
B. Pain when pressure is applied to the right lower quadrant
C. High fever
D. Nausea
Nausea, with or without vomiting, is typically associated with appendicitis.
Pain is generally felt in the right lower quadrant. Rebound tenderness, or
pain felt upon the release of pressure applied to the abdomen, may be
present with appendicitis. Low-grade fever is associated with appendicitis.
Question 36
1/ 1pts
A client is scheduled for a flexible sigmoidoscopy. Which preparation will the
nurse instruct the client to complete before the procedure?
A. Maintain liquid diet for 3 days before the procedure.
B. Administer tap water enemas until liquid from rectum is clear.
C. Avoid aspirin products a week before the procedure.
D. Take oral laxatives for 2 days before the procedure.
The flexible fiberoptic sigmoidoscope permits the colon to be examined up to
40 to 50 cm (16 to 20 inches) from the anus. It has many of the same
capabilities as the scopes used for the upper GI study, including the use of
still or video images to document findings. This examination requires only
limited bowel preparation, including a warm tap water or Fleet enema until
returns are clear. Dietary restrictions usually are not necessary. Oral
laxatives before the procedure are not needed. There are no medication
restrictions before the procedure.
Question 37
1/ 1pts
The nurse is caring for a client with a gastrointestinal condition. For which
reason will the nurse question the client being scheduled for a barium
enema?
A. Chronic constipation
B. Possible rectal tumor
C. History of polyps
D. Frank blood in stool
Barium enemas may be contraindicated for specific conditions. One of these
is active gastrointestinal bleeding as this would prohibit the use of laxatives
and enemas. A barium enema would be indicated for a history of polyps, to
diagnose bowel malfunction such as constipation, and to detect tumors or
other lesions of the large intestine.
Question 38
1/ 1pts
The nurse is caring for a geriatric client experiencing diarrhea. When
teaching about the site in the body where water and electrolytes are
absorbed, the nurse is most correct to instruct on which location?
A. The cecum
B. The stomach
C. The large intestine
D. The small intestine
The nurse is correct in instructing the client that water and electrolytes are
mainly absorbed in the large intestine. The other options are not the best
site for absorption.
Question 39
1/ 1pts
A client will be undergoinga urea breath test for the detection
ofHelicobacter pylori. Which instruction should thenursegive to the client to
prepare for this test?
A. Ingest a capsule of carbon-labeled urea ingested three days before the
test.
B. Fast for 12 hours before the test.
C. Avoid taking cimetidine 24 hours before the test.
D. Take prescribed antibiotics one month before the test.
The client undergoing a urea breath test should avoid taking cimetidine for
24 hours before the test. The capsule with the carbon-labeled urea is
ingested at the time of the test and a breath sample is obtained 10 to 20
minutes later. Antibiotics should be avoided for one month before the test.
There is no need to fast for this test.
Question 40
1/ 1pts
Which neuroregulator increase gastric acid secretion?
A. acetylcholine
B. secretin
C. norepinephrine
D. gastrin
Acetylcholine causes increased gastric acid. Norepinephrine inhibits
secretions of the GI tract. Gastrin increases secretion of gastric juice, which
is rich in HCL. Secretin in the stomach inhibits gastric secretion somewhat.
Question 41
1/ 1pts
Which of the following describes awakening at night to urinate?
A. Oliguria
B. Dysuria
C. Polyuria
D. Nocturia
Nocturia is awakening at night to urinate. Oliguria is a urine output of less
than 400 mL in 24 hours. Polyuria is increased urine output. Dysuria is
painful or difficult urination.
Question 42
1/ 1pts
Which of the following urine characteristics would the nurse anticipate when
caring for a client whose lab work reveals a high urine specific gravity related
to dehydration?
A. Turbid urine
B. Dark amber urine
C. Clear or light yellow urine
D. Red urine
Concentrated urine (one with a high specific gravity) is a dark amber color
due to the solutes in the urine. Clear or yellow urine indicates a flushing of
the urinary system. Red urine indicates hematuria. A turbid urine may
indicate bacteriuria.
Question 43
1/ 1pts
A client reports having to get up frequently to void in the night, or nocturia.
What isnota probable cause of his problem?
A. heart failure
B. neurogenic bladder
C. diabetes mellitus
D. decreased renal concentrating ability
Neurogenic bladder will cause a delay, or difficulty in initiating voiding, called
hesitancy. Nocturia may be caused by decreased renal concentrating ability,
heart failure, diabetes mellitus, incomplete bladder emptying, excessive fluid
intake at bedtime, nephrotic syndrome, or cirrhosis with ascites.
Question 44
1/ 1pts
Which part of the kidney contains the nephrons?
A. Glomerulus
B. Medulla
C. Cortex
D. Pelvis
The cortex is located farthest from the center of the kidney and around the
outermost edges. It contains the nephrons (the functional units of the
kidney).
Question 45
1/ 1pts
A client has experienced excessive losses of bicarbonate and has
subsequently developed an acid–base imbalance. How will this lost
bicarbonate be replaced?
A. Alveoli in the lungs will synthesize new bicarbonate.
B. Bicarbonate will be released from the adrenal medulla.
C. The kidneys will excrete increased quantities of acid.
D. Renal tubular cells will generate new bicarbonate.
To replace any lost bicarbonate, the renal tubular cells generate new
bicarbonate through a variety of chemical reactions. This newly generated
bicarbonate is then reabsorbed by the tubules and returned to the body. The
lungs and adrenal glands do not synthesize bicarbonate. Excretion of acid
compensates for a lack of bicarbonate, but it does not actively replace it.
Question 46
1/ 1pts
Aclient with a history of chronic renal infections is to undergo CT with
contrast. Before the procedure, the nurse should complete which action?
A. Instruct the client to maintain a full bladder for the diagnostic test.
B. Place emergency medical equipment in the procedure room.
C. Hold the client’s iron supplement until after the diagnostic test.
D. Keep the client NPO for 1 hour before the scan.
For some clients, contrast agents are nephrotoxic and allergenic. Emergency
equipment and medications should be available in case of an anaphylactic
reaction to the contrast agent. Emergency supplies include epinephrine,
corticosteroids, vasopressors, oxygen, and airway and suction equipment.
The client is instructed to maintain a full bladder for an ultrasonography. The
other instructions/interventions relate to magnetic resonance imaging.
Question 47
1/ 1pts
A client has been experiencing severe pain and hematuria and is hardly able
to ambulate into the physician’s office. The physician suspects kidney stones
and orders diagnostic tests to confirm. What test would the nurse expect the
physician to order?
A. ultrasound
B. MRI
C. KUB
D. CT
An x-ray study of the abdomen includes x-rays of the kidneys, ureters, and
bladder (KUB). It is performed to show the size and position of the kidneys,
ureters, and bony pelvis as well as any radiopaque urinary calculi (stones),
abnormal gas patterns (indicative of renal mass), and anatomic defects of
the bony spinal column (indicative of neuropathic bladder dysfunction).
Renal ultrasonography identifies the kidney's shape, size, location, collecting
systems, and adjacent tissues. A computed tomography (CT) scan or
magnetic resonance imaging (MRI) of the abdomen and pelvis may be
obtained to diagnose renal pathology, determine kidney size, and evaluate
tissue densities with or without contrast.
Question 48
1/ 1pts
The nurse notes that the client’s urine is blood-tinged following cystoscopy.
Which nursing action should the nurse takenext?
A. Inspect the client’s urinary meatus.
B. Document the finding in the health record.
C. Notify the physician of the finding.
D. Instruct the client to increase fluid intake.
The physician does not need to be contacted as blood-tinged urine is an
expected finding following cystoscopy due to trauma of the procedure. The
nurse should document the finding and continue to monitor the client. The
client should be encouraged to increase fluid intake to help flush the urinary
tract of microorganisms. The urinary meatus does not need to be inspected.
Question 49
1/ 1pts
The nurse at the diabetes clinic is instructing a client who is struggling with
compliance to the diabetic diet. When discussing disease progression, which
manifestation of the disease process on the urinary system is most notable?
A. Clients have frequent urinary tract infections.
B. Clients have chronic renal failure.
C. Clients develop a neurogenic bladder.
D. Clients have urinary frequency.
Although all of the options may occur in the client with diabetes mellitus, the
option which is most notable, and potentially life threatening, is chronic renal
failure.
Question 50
1/ 1pts
The nurse is caring for an older client admitted to the health-care facility with
a new onset of confusion and a low-grade fever. Which age-related changes
might contribute to decreased functioning of the immune system?
A. Decreased kidney function
B. Thickening of the skin
C. Increased gastric secretions
D. Increased ciliary action
Decreased kidney function, changes in lower urinary tract function
(enlargement of the prostate), and altered genitourinary tract flora all
contribute to increased urinary tract infections. With age, the skin thins,
gastric secretions decrease, and ciliary action decreases.