NURSING MANAGEMENT : MEDICAL SURGICAL NURSING

MULTIPLE CHOICE 1. The nurse is caring for a client who has had an insertion of an arteriovenous graft (AVG) in the right forearm and has symptoms of pain and coldness of the right fingers. Which of the following actions should the nurse take? a. Elevate the client’s arm above the level of the heart. b. Report the client’s symptoms to the health care provider. c. Remind the client about the need to take a daily low-dose Aspirin tablet. d. Educate the client about the normal vascular response after AVG insertion. ANS: B The client’s complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 2. The nurse is caring for a client with acute kidney injury (AKI) who has an arterial blood pH of 7.30. Which of the following assessment findings should the nurse anticipate? a. Vasodilation b. Poor skin turgor c. Bounding pulses d. Rapid respirations ANS: D Clients with metabolic acidosis caused by AKI may have Kussmaul’s respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the client is likely to have fluid retention, poor skin turgor would not be a finding in AKI. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 3. The nurse is caring for a client with severe heart failure who develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet which of the following goals of treatment? a. Replace fluid volume b. Prevent hypertension c. Maintain cardiac output d. Dilute nephrotoxic substances ANS: C NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NURSING MANAGEMENT : MEDICAL SURGICAL NURSING NU RS IN GT B.CO M The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this client’s heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct. DIF: Cognitive Level: Application TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 4. The nurse is caring for a client with acute glomerulonephritis, acute kidney injury (AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the following parameters should the nurse assess to evaluate the effectiveness of the medication? a. Urine output b. Calcium level c. Cardiac rhythm d. Neurological status ANS: C The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate. DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 5. The nurse is caring for a client with stage 2 chronic kidney disease (CKD) who is scheduled for an intravenous pyelogram (IVP). Which of the following prescriptions for the client should the nurse question? a. NPO for 6 hours before IVP procedure b. Normal saline 500 mL IV before procedure c. Ibuprofen 400 mg PO PRN for pain d. Dulcolax suppository 4 hours before IVP procedure ANS: C The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 6. The nurse is teaching a client with stage 5 chronic kidney disease (CKD) about management of CKD. Which of the following client statements indicate that the teaching was effective? a. “I need to try to get more protein from dairy products.” b. “I will try to increase my intake of fruits and vegetables.” c. “I will measure my urinary output each day to help calculate the amount I can drink.” d. “I need to take the erythropoietin to boost my immune system and help prevent infection.” ANS: C NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M The client with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the client with CKD. DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 7. The nurse is caring for a client with chronic kidney disease (CKD) who is prescribed calcium carbonate. Which of the following parameters should the nurse assess in order to determine the effectiveness of the treatment? a. Blood pressure b. Phosphate level c. Neurological status d. Creatinine clearance ANS: B Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in clients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium