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Medical-Surgical Nursing
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Medical surgical nursing 6th edition test bank completed
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Medical-Surgical Nursing
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Medical-Surgical Nursing
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TEST BANK For Medical-Surgical Nursing, Concepts andPractice, 5th Edition (Stromberg, 2023), Verified Chapters 1 -
49, Complete Newest Version
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
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
d) Hypokalemia and hypernatremia ANSWER: c) Hypokalemia and hyponatremia
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.
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.
e) those with a history of type 2 diabetes. ANSWER: a,b, dand e
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
,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.
e) assess the pulses and neurovascular status distal to the graft. ANSWER: c d and
e
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.
d) 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.
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 is
performed. Indwelling catheter use should be avoided whenever possible to
decrease the risk of infection.
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.
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.
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.
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.
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.
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.
c) Monitor output from peritoneal dialysis.
d) Offer high-protein snacks between meals. ANSWER:Restrict fluids based on
urine output.
Fluid intake is monitored during the oliguric phase. Fluid intake is determined by
adding all losses for the previous 24 hours plus 600 mL. Potassium and protein intake
may be limited in the oliguric phase to avoid hyperkalemia and elevated urea
nitrogen. Hemodialysis, not peritoneal dialysis, is indicated in acute kidney injury if
dialysis is needed.
Which assessment findings would alert the nurse that the patient has entered the
diuretic phase of acute kidney injury (AKI)? (Select all that apply.)
a) Dehydration
b) Hypokalemia
c) Hypernatremia
d) BUN increases
e)Urine output increases
f) Serum creatinine increases ANSWER: a,b and e
The hallmark of entering the diuretic phase is the production of copious amounts of
urine. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of
AKI because the nephrons can excrete wastes but not concentrate urine. Serum BUN
and serum creatinine levels begin to decrease.
A patient with type 2 diabetes and chronic kidney disease has a serum potassium
level of 6.8 mEq/L. Which finding will the nurse monitor for?
a) Fatigue
b) Dysrhythmias
c) Hypoglycemia
d) Elevated triglycerides ANSWER: b) Dysrhythmias
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