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, Which assessment finding indicates to the nurse that the desired outcome of the calcium
acetate has been achieved?
Serum phosphorous of 4.0 mg/dL (1.29 mmol/L)5
After the nurse completes the assessment, what findings are most important to report to the
healthcare provider (HCP) ? (Select all that apply. One, some, or all options may be correct.)
Blood pressure of 178/92 mmHg - Respiratory rate of 28 breaths per minute- Bibasilar
crackles - Edema
The client's hemoglobin level is 7.8 g/dL (78 g/L). What action should the nurse take?
Obtain an order to start an erythropoietin stimulating agent (ESA)
What assessment data supports the diagnosis of acute organ rejection? (Select all that apply.
One, some, or all options may be correct.)
- Blood pressure of 178/96 mm Hg.
- Sub therapeutic immunosuppression levels
- Acute pain rated 6/10
- Temperature of 100.6 F(38.1 C).
- BUN of 56 mg/dL (19.99 mmol/L)
- Creatinine of 1.9 mg/dL (167.96 mcmol/L
What is the correct interpretation of these ABG's?
Metabolic acidosis (compensated)
Which lab value would the nurse be MOST concerned about?
Glomerular filtration rate (GFR) of 9mL/min/1.73m2.
The nurse is teaching the client about progression of chronic kidney disease (CKD). Which
evaluation statement documented by the nurse indicates the client's understanding of the
disease process?
The client acknowledges that renal replacement therapy will need to be initiated immediately
to rid the body of waste and maintain fluid balance.
Based on the client's symptoms, what should the nurse suspect?
The client has uremia and may need to start dialysis.
Which additional symptoms should the nurse ask about? (Select all that apply. One, some, or
all options may be correct.)
- Nausea - Decreased attention span - Itching
, The nurse reviews the client's medical history. What part of the medical history should the
nurse consider relevant to the client's current history? (Select all that apply. One, some, or all
options may be correct.)
- Hypertension - Polycystic kidney disease - Diabetes Mellitus-
The nurse palpates a weak pedal pulse in the client's right foot. Which assessment findings
should the RN document that are consistent with diminished peripheral circulation? (Select
all that apply.)
Diminished hair on legs
Bruising on extremities
Skin cool to touch
Capillary refill less than 3 seconds
Darkened skin on extremities
Diminished hair on legs
Skin cool to touch
The registered nurse (RN) uses the mini-mental state examination (MMSE) when assessing a
client for admission to an assisted living facility. Which finding is the RN assessing when
requesting the client to count by 7s?
A. Recall of information.
B. Orientation to surroundings.
C. Attention to details.
D. Ability to follow complex commands.
C
The registered nurse (RN) palpates a weak pedal pulse in the client's right foot. Which
assessment findings should the RN document that are consistent with diminished peripheral
circulation? (Select all that apply.)
A. Diminished hair on legs.
, B. Bruising on extremities.
C. Skin cool to touch.
D. Capillary refill less than 3 seconds.
E. Darkened skin on extremities.
A, C
Which action should the registered nurse (RN) implement to complete an assessment for a
client while using an interpreter?
A. Ask closed-ended questions with the assistance of the interpreter.
B. Maintain eye contact with the client while listening to the translation.
C. Instruct interpreter to answer questions from interpreter's point of view.
D. Protect the client's privacy by asking a limited number of questions.
B
A client with progressive hearing loss appears distressed when the registered nurse (RN) asks
open-ended questions about the client's health history. Which forms of communication
should the RN use? (Select all that apply.)
A. Face the client so the client can see the RN's mouth.
B. Increase one's speech volume when interacting with the client.
C. Repeat information to the client if misunderstood.
D. Check if the client's hearing aides are working properly.
E. Reduce environmental noise surrounding the client.
A, D, E
Registered nurse (RN) is performing a mini-mental state examination (MMSE) for a client
who is being admitted to an assisted living community. Which communication techniques
should the RN implement to decrease anxiety in the client? (Select all that apply.)
A. Use simple sentences during the examination.
B. Move to another question if the client seems confused.
C. Reduce environmental detractors during the examination.
D. Allow family to answer for the client to decrease frustration.
E. Ask questions one at a time to decrease confusion.
A, C, E