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WorksheetsExam 1
Total questions: 50
Worksheet time: 2hrs 40mins
Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?
Restrict the patient’s oral protein intake.
Restrict physical activity to bed rest.
Discontinue the urethral retention catheter.
Start continuous pulse oximetry.
A 25-yr-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider?
Serum potassium level of 6.5 mEq/L
White blood cell count of 11,500/µL
Serum creatinine level of 2.1 mg/dL
Blood urea nitrogen (BUN) of 56 mg/dL
A 72-yr-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first?
Infuse normal saline at 50 mL/hour.
Insert urethral catheter.
Obtain renal ultrasound.
Draw a complete blood count.
A 62-yr-old female patient has been hospitalized for 4 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider?
The creatinine level is 3.0 mg/dL
Urine output over an 8-hour period is 2500 mL.
The glomerular filtration rate is less than 30 mL/min/1.73 m2.
The blood urea nitrogen (BUN) level is 67 mg/dL.
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first?
Notify the patient’s health care provider.
Review the chart for the patient’s current creatinine level
Document the QRS interval measurement.
Check the medical record for the most recent potassium level.
A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first?
Place the patient on a cardiac monitor.
Insert a urinary retention catheter.
Administer epoetin alfa (Epogen, Procrit).
Give sodium polystyrene sulfonate (Kayexalate).
A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician?
Teach the patient about fluid restrictions.
Determine the ultrafiltration rate for the hemodialysis.
Assess for causes of an increase in predialysis weight.
Check blood pressure before starting dialysis.
A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention?
The LPN/LVN administers the iron supplement and phosphate binder with lunch.
The LPN/LVN administers the erythropoietin subcutaneously.
The LPN/LVN assists the patient to ambulate out in the hallway.
The LPN/LVN carries a tray containing low-protein foods into the patient’s room
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider?
The patient’s peritoneal effluent appears cloudy.
The patient’s abdomen appears bloated after the inflow.
The patient has an outflow volume of 1800 mL.
The patient has abdominal pain during the inflow phase
The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider?
he blood urea nitrogen (BUN) and creatinine levels are elevated.
The patient’s central venous pressure (CVP) is decreased.
The patient has a level 7 (0- to 10-point scale) incisional pain.
The urine output is 900 to 1100 mL/hr.
The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?
The patient’s abdominal skin has multiple spider-shaped blood vessels.
The patient complains of right upper-quadrant pain with palpation.
The patient’s hands flap back and forth when the arms are extended.
The patient has ascites and a 2-kg weight gain from the previous day.
A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective?
The patient reports no chest pain.
Blood pressure is 140/90 mm Hg.
The apical pulse rate is 68 beats/minute.
Stools test negative for occult blood.
Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient admitted with bleeding esophageal varices?
The medication will inhibit development of gastric ulcers.
The medication will reduce the risk for aspiration.
The medication will prevent irritation of the enlarged veins.
The medication will decrease nausea and improve the appetite.
When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient’s right hand. Which action should the nurse take next?
Check the calcium level in the chart
Notify the health care provider immediately.
Ask the patient about any arm pain.
Retake the patient’s blood pressure.
A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective?
Bowel sounds are present
Electrolyte levels are normal.
Abdominal pain is decreased
Grey Turner sign resolves.
Which assessment finding is of most concern for a patient with acute pancreatitis?
Abdominal tenderness
Left upper quadrant pain
Palpable abdominal mass
Absent bowel sounds
Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?
Review the patient’s current medication list.
Teach symptoms of variceal bleeding.
Discuss the need to increase caloric intake.
Draw blood for hepatitis serology testing
A patient with chronic hepatitis C infection has several medications prescribed. Which medication requires further discussion with the health care provider before administration?
Dimenhydrinate (Dramamine) 50 mg PO every 6 hours PRN nausea
Diphenhydramine 25 mg PO every 4 hours PRN itching
Ribavirin (Rebetol, Copegus) 600 mg PO bid
Pegylated a-interferon (PEG-Intron, Pegasys) 1.5 mcg/kg PO daily
During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first?
A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C)
A 58-yr-old patient who has compensated cirrhosis and is complaining of anorexia
A 36-yr-old patient recovering from a laparoscopic cholecystectomy who has severe shoulder pain
A 40-yr-old patient with chronic pancreatitis who has gnawing abdominal pai
Which goal has the highest priority in the plan of care for a 26-yr-old patient who is homeless who was admitted with viral hepatitis who has severe anorexia and fatigue?
Establish a stable environment.
Maintain adequate nutrition.
Increase activity level.
Identify source of hepatitis exposure.
Which action should the nurse in the emergency department take first for a new patient who is vomiting blood?
Draw blood for coagulation studies.
Insert a large-gauge IV catheter.
Place the patient in the supine position.
Check blood pressure and heart rate.
The nurse is planning care for a patient with acute severe pancreatitis. The highest priority patient outcome is
expressing satisfaction with pain control.
having adequate fluid and electrolyte balance.
developing no ongoing pancreatic disease.
maintaining normal respiratory function.
The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority?
Administer prescribed opioids to relieve pain as needed
Teach about the need to avoid scratching any pruritic areas.
Offer high-calorie, high-protein dietary choices.
Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis?
The patient has increased pain after eating.
The patient complains of chronic heartburn.
The patient’s stools are tan colored.
The patient’s urine is bright yellow.
A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to
ambulate the evening of the operative day.
choose preferred low-fat foods from the menu
turn, cough, and deep breathe every 2 hours.
perform leg exercises hourly while awake.
Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?
Schedule for liver cancer screening every 6 months.
Monitor anti-hepatitis B surface antigen (anti-HBs) levels.
Initiate administration of the hepatitis C vaccine series.
Advise limiting alcohol intake to 1 drink daily.
A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical examination?
Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).
Start the hepatitis B immunization series.
Ask whether the patient has been screened for hepatitis C.
Teach the patient about hepatitis A immune globulin.
A 36-yr-old female patient is receiving treatment for chronic hepatitis C with pegylated interferon (PEG-Intron, Pegasys), ribavirin (Rebetol), and telaprevir (Incivek). Which finding is important to communicate to the health care provider to suggest a change in therapy?
Positive urine pregnancy test
Weight loss of 2 lb (1 kg)
Hemoglobin level of 10.4 g/dL
Complaints of nausea and anorexia
A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take?
Notify the health care provider.
Give prescribed proton-pump inhibitors.
Apply dressings to the sites.
Avoid other venipunctures.
A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature of 102° F (38.9° C), and severe back pain. Which prescribed action will the nurse implement first?
Administer morphine sulfate 4 mg IV.
Schedule complete blood count and coagulation studies.
Give acetaminophen (Tylenol) 650 mg.
Infuse normal saline 500 mL over 30 minutes.
The nurse determines that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient’s
peripheral edema is increased.
urinary output is increased.
urine specific gravity is increased.
weight has increased.
The nurse determines that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient makes which statement?
“I should eat foods high in potassium because diuretics cause potassium loss.”
“I need to limit my fluid intake to no more than 1 quart of liquids a day.”
“I need to shop for foods low in sodium and avoid adding salt to food.”
“I should weigh myself daily and report any sudden weight loss or gain.
A 56-yr-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n)
decreased serum sodium.
low urine specific gravity.
elevated hematocrit.
increased serum chloride.
An expected patient problem for a patient admitted to the hospital with symptoms of diabetes insipidus is
risk for impaired skin integrity related to generalized edema.
sleep pattern disturbance related to frequent waking to void.
impaired gas exchange related to fluid retention in lungs.
excess fluid volume related to intake greater than output.
The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobulin (IG) injection?
A caregiver who lives in the same household with the patient
A child living in the home who received the hepatitis A vaccine 3 months ago
A friend who delivers meals to the patient and family each week
A relative with a history of hepatitis A who visits the patient daily
The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect?
Left upper abdominal pain
Ascites and peripheral edema
Temperature over 102o F (38.9o C)
Hematochezia
The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobulin (IG) injection?
A friend who delivers meals to the patient and family each week
A relative with a history of hepatitis A who visits the patient daily
A child living in the home who received the hepatitis A vaccine 3 months ago
A caregiver who lives in the same household with the patient
The nurse instructs a 50-yr-old woman about cholestyramine to reduce pruritus caused by gallbladder disease. Which patient statement indicates understanding of the instructions?
“I will apply the medicated lotion sparingly to the areas where I itch.”
“The medication is a powder and needs to be mixed with milk or juice.”
“This medication will help me digest fats and fat-soluble vitamins.”
“I should take this medication on an empty stomach at the same time each day.”
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which response by the nurse is most appropriate?
“The hepatitis vaccine will provide immunity from this and future exposures.”
“An immunoglobulin injection will be given to prevent infection or limit symptoms.”
“You will need to be tested first; then treatment can be determined.”
“There is nothing you can do since the patient was infectious before admission.”
A patient with hepatitis B surface antigen (HBsAg) present in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question?
Tramadol
Oxycodone with aspirin (Percodan)
Hydromorphone (Dilaudid)
Hydrocodone with acetaminophen
The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer?
Abdominal girth measurement
Hepatic structure ultrasound
Ventilation/perfusion scan
Serum á-fetoprotein level
The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What is the nurse’s priority?
Prevent all oral intake
Control abdominal pain.
Provide enteral feedings.
Avoid dietary cholesterol.
A patient with cholelithiasis is being prepared for surgery. Which patient assessment represents a contraindication for a cholecystectomy?
Low-grade fever of 100°F and dehydration
Abscess in the right upper quadrant of the abdomen
Multiple obstructions in the cystic and common bile duct
Activated partial thromboplastin time (aPTT) of 54 seconds
The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?
“A scrotal support may be more comfortable when I have scrotal edema.”
“I need to take good care of my belly and ankle skin where it is swollen.
“If I notice a fast heart rate or irregular beats, this is normal for cirrhosis.”
“I can use pillows to support my head to help me breathe when I am in bed.”
A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient’s plan of care?
Initiate early prophylactic antibiotic therapy to prevent infection
Insert an NG and maintain NPO status to allow pancreas to rest
Administer acetaminophen (Tylenol) every 4 hours for pain relief.
Immediately start enteral feeding to prevent malnutrition.
Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis?
Decreasing the concentration of the dialysate
Increasing the pressure gradient
Increasing osmolality of the dialysate
Decreasing the glucose in the dialysate
During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first?
Administer a blood transfusion
Administer hypertonic saline.
Decrease the rate of fluid removal
Administer antiemetic medications.
Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD) (select all that apply.)?
Hypercalcemia
Hypertension
Dehydration
Increased risk for fractures
Anemia
Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI) (select all that apply.)?
Hypernatremia
Dehydration
Hypokalemia
BUN increases
Urine output increases
A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and an emesis of 100 mL in the past 24 hours. What is the patient’s fluid restriction for the next 24 hours? (Include ml after your answer).
(a)
