Chapter 49

Front 1

High level of protein in the blood sign of

Back 1

Renal damage and cardiac diease

Front 2

A school nurse assesses a child who has an erythematous circular patch of vesicles on her scalp with alopecia and complains of pain and pruritis. Why would the nurse use a Woods lamp?A. To dry out the lesionsB. To reduce the pruritusC. To kill the fungusD. To cause fluorescence of the infected hairs

Back 2

D. To cause fluorescence of the infected hairsRationale: Tinea capitis is commonly known as ringworm of the scalp. Microsporum audouinii is the major fungal pathogen. The use of the diagnostic Woods lamp causes the infected hairs to turn a brilliant blue green.

Front 3

The nurse is caring for a 26-year-old male patient who was burned 72 hours ago. He has partial-thickness burns to 24% of his body surface area. He begins to excrete large amounts of urine. What should the nurse do?A. Increase the IV rate and monitor for burn shockB. Monitor for signs of seizure activityC. Assess for signs of fluid overloadD. Raise the foot of the bed and apply blankets

Back 3

C. Assess for signs of fluid overloadRationale: As the blood volume increases, the cardiac output increases to increase renal perfusion. The result includes diuresis. However, a great risk for the patient includes fluid overload because of the rapid movement of fluid back into the intravascular space.

Front 4

What would the nurse stress to the 17-year-old girl who has been prescribed Accutane for her acne?A. Avoid alcoholic beveragesB. Drink at least 1000mL of fluid dailyC. Use dependable birth control to avoid pregnancyD. Avoid exposure to the sun

Back 4

C. Use dependable birth control to avoid pregnancyRationale: Accutane has a destructive effect on fetal development. Dependable birth control is important to avoid a pregnancy.

Front 5

A patient, age 27, sustained thermal burns to 18% of her body surface area. After the first 72 hours, the nurse will have to observe for the most common cause of burn-related deaths, which is:A. ShockB. Respiratory arrestC. HemorrhageD. Infection

Back 5

D. InfectionRationale: Infection is the most common complication and cause of death after the first 72 hours.

Front 6

The home health nurse assessing skin lesions uses the PQRST mnemonic as a guide. What does the S in the guide indicate?A. Severity of the symptomsB. Site of the lesionsC. Symptomatology of the lesionsD. Surface area of the lesions

Back 6

A. Severity of the symptomsRationale: The mnemonic PQRST stands for Provocative factors (causes), Quantity, Region of the body, Severity of the symptoms, Time (length of time the disorder has been present).

Front 7

A nurse can assess cyanosis in a dark-skinned patient by noting the color of the:A. ConjunctivaB. ScleraC. Lips and mucous membranesD. Soles of the feet

Back 7

C. Lips and mucous membranesRationale: Assessment of color is more easily made in areas where the epidermis is thin, such as the lips and mucous membranes.

Front 8

Most of the deaths from burn trauma in the emergent phase that require a referral to a burn center result from:A. InfectionB. Arrhythmias with cardiac arrestC. Hypovolemic shock and renal failureD. Adrenal failure

Back 8

C. Hypovolemic shock and renal failureRationale: Hypovolemic shock is frequently lethal in the emergent period of a severe burn because of the transfer of fluids into the interstitial tissue from the circulating volume.

Front 9

A patient has herpes zoster (shingles) and is being treated with acyclovir (Zovirax). What should the nurse do when administering this drug?A. Apply lightly, being carful not to completely cover the lesionB. After application, wrap in warm wet dressingsC. Use glovesD. Rub medications into lesions

Back 9

C. Use glovesRationale: The topical application requires that the nurse uses gloves, completely covers the lesion gently, then leaves it open to the air.

Front 10

A child has been sent to the school nurse with pruritus and honey-colored crusts on the lower lip and chin. The nurse believes theses lesions most likely are:A. ChickenpoxB. ImpetigoC. ShinglesD. Herpes simplex type 1 .

Back 10

B. ImpetigoRationale: Impetigo is seen at all ages, but is particularly common in children. The crust is honey-colored and easily removed and is associated with pruritis. The disease is highly contagious and spreads by contact

Front 11

What should the nurse examine in assessing a patient for tinea corporis?A. Soles of the feetB. ScalpC. ArmpitsD. Abdomen

Back 11

D. AbdomenRationale: Tinea corporis is known as ringworm of the body. It occurs on parts of the body with little or no hair.

Front 12

Melanocytes give rise to the pigment melanin, which is responsible for skin color. Where can the melanocytes be found?A. DermisB. Superficial fasciaC. EpidermisD. Loose connective tissue .

Back 12

C. EpidermisRationale: A layer in the epidermis contains highly specialized cells called melanocytes

Front 13

What should the nurse examine in assessing a patient for tinea corporis?A. Soles of the feetB. ScalpC. ArmpitsD. Abdomen

Back 13

D. AbdomenRationale: Tinea corporis is known as ringworm of the body. It occurs on parts of the body with little or no hair.

Front 14

Select all that apply:During primary survey assessment of a burn patient, the nurse checks for which of the following as early signs of carbon monoxide poisoning?A. DizzinessB. UrticariaC. VomitingD. HeadacheE. VertigoF. Unsteady gait D. HeadacheF. Unsteady gait

Back 14

C. Vomiting

Rationale: Early signs of carbon monoxide poisoning include headache, nausea, vomiting, and unsteady gait.

Front 15

A 30-year-old African American had surgery 6 months ago and the incision site is now raised, indurated, and shiny. This is most likely which type of tissue growth?A. AngiomaB. KeloidC. MelanomaD. Nevus

Back 15

B. KeloidRationale: Keloids, which originate in scars, are hard and shiny and are seen more often in African Americans than in whites.

Front 16

What should a patient be assessed for upon the diagnosis of genital herpes?A. Hepatitis BB. SyphilisC. Human immunodeficiency virus (HIV)D. Cirrhosis 

Back 16

C. Human immunodeficiency virus (HIV)Rationale: Persons with genital herpes should be assessed for HIV because the therapy for herpes is suppressive; persons with HIV are not candidates for suppressant therapy.

Front 17

Urinary antiseptic are divided into 4 groups

Back 17

Quinolones

Nitrofurantoin

Methenamine

Fluroquinolones

Front 18

Interstitial cystitis is characterized by

Back 18

urinary frequency, urgency, suprapubic pain and dyspareunia.

Front 19

Intravenous (IVP) also called Intravenous urography (IVU)

Back 19

Evaluate structures of the urinary tract , filling of the renal pelvis with urine, and transport of urine via the ureters and bladders.

Front 20

Which organ in the urinary system excrete creatinine

Back 20

Creatinine like BUN, is excreted by the kidneys.

Therefore normal serum creatinine level are a sign of normal renal excretory functions.

Front 21

Elevated serum creatinine level may be caused by

Back 21

Acute tubular necrosis, glomerulonephritis, pyelonephritis, reduced kidney functions, and renal failure.

Front 22

What are serum creatinine test, BUN used to diagnosed?

Back 22

Impaired kidney functions.

Front 23

Beside impaired kidney functions what else does the BUN assessed?

Back 23

Dehydration, malnutrition, or hepatic function

Front 24

What are the accepted serum creatinine levels?

Back 24

Female 0.5- 1.1mg/dL

Male 0.6- 1.2 mg/dL

Hint 24

Creatinine depends on muscle mass, which fluctuate little. This is explains the lower creatinine levels in women.

We usually have less muscle mass

Front 25

Creatinine is generating through what metabolic activity?

Back 25

Muscle contraction and then excreted by glomerular filtration.

Front 26

An elevated serum creatinine level with a decline in urine creatinine level indicates

Back 26

Renal diease

Hint 26

Normal ranges

Serum 0.5- 1.1 mg/dL (female)

0.6- 1.2 mg/dL (male)

Urine 87- 107 mL/min (female)

107- 139 mL/ min (male)

Front 27

Organ- specific glycoprotein produced by normal prostatic tissue

Back 27

Prostate- specific antigen (psa)

Hint 27

Normal range is less than 4 ng/mL

Front 28

Elevated Prostate specific antigen

Back 28

Is a sign of prostate cancer, inflammation or infection, urinary tract infection , recent cystoscopy or prostatic biopsy

Front 29

Urine osmolarity

Back 29

More informative than urine specific gravity. More difficult test to perform.

Front 30

Kidney Ureter bladder radiograph

Back 30

Assess the general status of the abdomen and the size , structure, and position of the urinary tract structures.

Hint 30

No special preparation needed. Remind the patient that they will have to change position on the table which is uncomfortable.

Front 31

Intravenous pyelography (IVP) (IVU)

Back 31

Evaluate structures of the urinary tract,

filling of the renal pelvis with urine

Transport of urine via the ureters to the bladder

Front 32

The course of ARF is divided into phases.

Back 32

Oliguric phase - high serum creatinine and BUN levels rise while urinary output is less than 400 mL/24 hrs.

Diuretic phase- blood chemistry levels begin to return to normal and urinary output increase to 1- 2 L/24 hours.

Recovery phase- return to normal or near normal functions.

Front 33

Clinical manifestation ARF

Back 33

Anorexia, nausea, vomiting edema, and associated signs and symptoms of diminished kidney function.

Front 34

Diagnosis of Acute renal failure

Back 34

Physical assessment

History

Elevated blood chemistry test BUN and creatinine (azotemia)

Front 35

Medical management of ARF

Back 35

Administration of fluids and osmotic prep to prevent decreased renal perfusion, manage fluid volume and treat electrolytes imbalances .

Diet high in carbohydrates, protein sparing ; low in potassium and sodium.

Front 36

Drug therapy includes

Back 36

-Diuretics to increase urinary output

- Potassium lowering agents; sodium polystyrene sulfonate (Kayexalate)

Front 37

Azotemia

Back 37

(azot, "nitrogen" + -emia, "blood condition") is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood.

Front 38

A pt. with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care?

A.Apply pressure to the needle site upon discontinuing hemodialysis

B. Keep the head of the bed elevated 45 degrees

C. Place the left arm on an arm board for at least 30 minutes

D. Keep the left arm dry

Back 38

A.

Hint 38

Question 1 Explanation: Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.

Front 39

Immunosuppression following Kidney transplantation is continued:

AFor life

B.24 hours after transplantation

C.A week after transplantation

D.Until the kidney is not anymore rejected

Back 39

A. For life

Front 40

Which action is most important during bladder training in a patient with a neurogenic bladder?

A.Encourage the use of an indwelling urinary catheter

B.Set up specific times to empty the bladder

C.Encourage Kegel exercises

D.Force fluids

Back 40

B. Set up a specific time to empty the bladder

Front 41

The most common early sign of kidney disease is:

A. Sodium retention

B. Elevated BUN level

C. Development of metabolic acidosis

D. Inability to dilute or concentrate urine

Back 41

Elevated BUN levels

Front 42

Which drug is indicated for pain related to acute renal calculi?A.Narcotic analgesics

B.Nonsteroidal anti-inflammatory drugs (NSAIDS)

C.Muscle relaxants

D.Salicylates

Back 42

A. Narcotic analgesic

Hint 42

Narcotic analgesics are usually needed to relieve the severe pain of renal calculi. Muscle relaxants are typically used to treat skeletal muscle spasms. NSAIDS and salicylates are used for their anti-inflammatory and antipyretic properties and to treat less severe pain.

Front 43

Which sign indicated the second phase of acute renal failure?ADaily doubling of urine output (4 to 5 L/day)BUrine output less than 400 ml/dayCUrine output less than 100 ml/dayDStabilization of renal function

Back 43

Wait for the answer

Hint 43

Explanation: Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.

Front 44

Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect?A.Infection

B.Disequilibrium syndrome

C.Air embolus

D.Acute hemolysis

Back 44

Disequilibrium syndrome

Front 45

What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease?AActivity intoleranceBFluid volume excessCKnowledge deficitDPain

Back 45

Wait

Front 46

Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps?A. Increase the rate of dialysis

B.Infuse normal saline solution

C.Administer a 5% dextrose solution

D.Encourage active ROM exercises

Back 46

B. Infuse normal saline solution

Front 47

A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120ml. The drainage system has no obstructions. Which intervention has priority?AGive a 500 ml bolus of isotonic salineBEvaluate the patient’s circulation and vital signsCFlush the urinary catheter with sterile water or salineDPlace the patient in the shock position, and notify the surgeon

Back 47

Wait for the answer

Front 48

Which of the following causes the majority of UTI’s in hospitalized patients?

A.Lack of fluid intake

B.Inadequate perineal care

C.Invasive procedures

D.Immunosuppression

Back 48

C. Invasive procedure

Front 49

Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure?

A.Anuria

B.Diarrhea

C.Oliguria

D.Vomiting

Back 49

C. Oliguria

Front 50

You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi?

A.Increased calcium loss from the bones

B.Decreased kidney function

C.Decreased calcium intake

D High fluid intake

Back 50

A. Increased calcium loss from the bones

Front 51

A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects?

AOverflow

BReflex

CStress

DUrge

Back 51

C. Stress

Front 52

Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient?

A.Pneumonia

B.Hemorrhage

C.Urine retention

D.Deep vein thrombosis

Back 52

B. Hemorrhage

Hint 52

Hemorrhage is a potential complication. Urine retention isn’t a problem soon after surgery because a catheter is in place. Pneumonia may occur if the patient doesn’t cough and deep breathe. Thrombosis may occur later if the patient doesn’t ambulate.Question 17 WRONG

Front 53

A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching?

ATake cool baths

BAvoid tampon use

CAvoid sexual activity

DDrink 8 to 10 eight-oz glasses of water daily

Back 53

D. Drink 8 to 10 eight glasses of water daily

Hint 53

Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity.

Front 54

Your patient has complaints of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi?A.Pain radiating to the right upper quadrantB.History of mild flu symptoms last weekC.Dark-colored coffee-ground emesisD. Dark, scanty urine output

Back 54

D. Dark scanty urine output

Hint 54

Explanation: Patients with renal calculi commonly have blood in the urine caused by the stone’s passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.

Front 55

What is the most important nursing diagnosis for a patient in end-stage renal disease?

A. for injury

B.Fluid volume excess

C.Altered nutrition: less than body requirements

D.Activity intolerance

Back 55

B. Fluid volume excess

Hint 55

Explanation: Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.