NURS 2040 Medical surgical nursing || EXAM 3 practice questions
1. During the oliguric phase of AKI, the nurse monitors the patient for (select
all that apply)
a) hypotension.
b) ECG changes.
c) hypernatremia.
d) pulmonary edema.
e) urine with high specific gravity.: ANSWER: b and d
2. When a patient is in the diuretic phase of AKI, the nurse must monitor
for which serum electrolyte imbalances? a) Hyperkalemia and
hyponatremia
b) Hyperkalemia and hypernatremia
c) Hypokalemia and hyponatremia
Hypokalemia and hypernatremia: ANSWER: c) Hypokalemia and
hyponatremia
3. The nurse assesses the patient with chronic kidney disease with the
understanding that this condition is characterized by
a) progressive irreversible destruction of the kidneys.
b) a rapid decrease in urine output with an elevated BUN.
c) an increasing creatinine clearance with a decrease in urine output.
d) prostration, somnolence, and confusion with coma and imminent death.:
ANSWER: a) progressive irreversible destruction of the kidneys.
4. Nurses can screen patients at risk for developing chronic kidney
disease. Those considered to be at increased risk include (select all that
apply) a) older Black patients.
b) patients more than 60 years old.
c) those with a history of pancreatitis.
d) those with a history of hypertension.
those with a history of type 2 diabetes.: ANSWER: a,b, dand e
5. Which points must the nurse consider when planning nutrition support for
patients with chronic kidney disease? (select all that apply)
a) Sodium may be restricted in someone with advanced CKD.
b) Fluid is not usually restricted for patients on peritoneal dialysis.
c) Decreased fluid intake and a low-potassium diet are needed for a patient
on hemodialysis.
,d) Decreased fluid intake and a low-potassium diet are needed for a patient
on peritoneal dialysis.
e) Decreased fluid intake and a diet in protein-rich foods are part of a diet for
a patient on hemodialysis: ANSWER: a,b and c
6. To assess the patency of a newly placed arteriovenous graft, the nurse
should (select all that apply)
a) monitor the BP in the affected arm.
b) irrigate the graft daily with low-dose heparin.
c) palpate the area of the graft to feel a normal thrill.
d) listen with a stethoscope over the graft to detect a bruit.
assess the pulses and neurovascular status distal to the graft.: ANSWER:
c d and e
7. During hemodialysis, the patient develops light-headedness and nausea.
What would the nurse do first?
a)Give hypertonic saline.
b) Initiate a blood transfusion.
c) Decrease the rate of fluid removal.
Administer antiemetic medications.: ANSWER: c) Decrease the rate of fluid
removal.
The patient is having hypotension from a rapid removal of vascular volume. The
rate and volume of fluid removal will be decreased, and 0.9% saline solution may
be infused. Hypertonic saline is not used because of the high sodium load. A blood
transfusion is not indicated. Antiemetic medications may help the nausea but would
not help the hypovolemia.
8. A patient with stage 2 chronic kidney disease is scheduled for an outpatient
diagnostic procedure using contrast media. Which priority action would the
nurse perform?
a)Assess the patient's hydration status.
b) Insert a urinary catheter for the expected diuresis.
c) Evaluate the patient's lower extremities for edema.
d) Check the patient's urine for the presence of ketones.: ANSWER: a)Assess
the patient's hydration status.
Preexisting kidney disease is the most important risk factor for the development of
contrast-associated nephropathy and nephrotoxic injury. If contrast media must be
administered to a high-risk patient, the patient needs to have optimal hydration.
The nurse should assess the hydration status of the patient before the procedure
, NURS 2040 Medical surgical nursing || EXAM 3 practice questions
is performed. Indwelling catheter use should be avoided whenever possible to
decrease the risk of infection.
9. The home care nurse visits a patient receiving peritoneal dialysis. Which
statement by the patient indicates a need for immediate follow-up by the
nurse?
a) "Drain time is faster if I rub my abdomen."
b) "The fluid draining from the catheter is cloudy."
c)"The drainage is bloody when I have my period."
d) "I wash around the catheter with soap and water.": ANSWER: b) "The fluid
draining from the catheter is cloudy."
The primary manifestation of peritonitis is a cloudy peritoneal effluent. Blood may
be present in the effluent of women who are menstruating, and no intervention is
indicated. Daily catheter care may include washing around the catheter with soap
and water. Drain time may be facilitated by gently massaging the abdomen.
10. Which patient diagnosis or treatment is most consistent with
prerenal acute kidney injury (AKI)? a) IV tobramycin
b) Incompatible blood transfusion
c) Poststreptococcal glomerulonephritis
d) Dissecting abdominal aortic aneurysm: ANSWER: d) Dissecting abdominal
aortic aneurysm
A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can
decrease renal artery perfusion and therefore the glomerular filtrate rate.
Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction,
and poststreptococcal glomerulonephritis are intrarenal causes of AKI.
11. Which statement about continuous ambulatory peritoneal dialysis (CAPD)
would be most important when teaching a patient new to the treatment?
a)"Maintain a daily written record of blood pressure and weight."
b)"It is essential that you maintain aseptic technique to prevent peritonitis."
c) "You will be allowed a more liberal protein diet once you complete
CAPD."
d) "Continue regular medical and nursing follow-up visits while performing
CAPD.: ANSWER: b)"It is essential that you maintain aseptic technique to
prevent peritonitis."
Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is
imperative to teach the patient methods of prevention. Although the other teaching
statements are accurate, they do not have the potential for morbidity and mortality
that peritonitis does.
, 12. A frail elderly patient with stage 3 chronic kidney disease is cared for at
home by their family. The patient has a history of taking many over-the-
counter medications. Which over-the-counter medications would the nurse
teach the patient to avoid? a)Aspirin
b)Acetaminophen
c) Diphenhydramine
d) Aluminum hydroxide: ANSWER: d) Aluminum hydroxide
Antacids (that contain magnesium and aluminum) should be avoided because
patients with kidney disease are unable to excrete these substances. Also, some
antacids contain high levels of sodium that further increase blood pressure.
Acetaminophen and aspirin (if taken for a short period of time) are usually safe for
patients with kidney disease. Antihistamines may be used, but combination drugs
that contain pseudoephedrine may increase blood pressure and should be
avoided.
13. A patient with a 25-year history of type 1 diabetes is reporting fatigue,
edema, and an irregular heartbeat. On assessment, the nurse notes newly
developed hypertension and uncontrolled blood glucose levels. Which
diagnostic study is most indicative of chronic kidney disease (CKD)?
a)Serum creatinine
b)Serum potassium
c) Microalbuminuria
d)Calculated glomerular filtration rate (GFR): ANSWER: d)Calculated
glomerular filtration rate (GFR)
The best study to determine kidney function or CKD that would be expected in the
patient with diabetes is the calculated GFR that is obtained from the patient's age,
gender, race, and serum creatinine. It would need to be abnormal for 3 months to
establish a diagnosis of CKD. A creatinine clearance test done with a blood sample
and a 24-hour urine collection is also important. Serum creatinine is not the best
test for CKD because the level varies with different patients. Serum potassium
levels could explain why the patient has an irregular heartbeat. The finding of
microalbuminuria can alert the patient with diabetes about potential renal
involvement and potentially failing kidneys. However, urine albumin levels are not
used for diagnosis of CKD.
14. The nurse is caring for a patient who is in the oliguric phase of acute
kidney disease. Which action would be appropriate to include in the plan of
care? a) Provide foods high in potassium.
b) Restrict fluids based on urine output.
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