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A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? A. "Why do you think you feel the need to give me money?" B. "I am here to provide care and cannot accept this from you" C. "I can request that your case manager discuss appropriate charity options with you" D. "You should know that giving away your money is inappropriate" --------- CORRECT ANSWER-----------------B ______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine. A. Urea B. Creatinine C. Potassium D. Magnesium ---------CORRECT ANSWER-----------------B
A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply: A. Hypervolemia B. Hypokalemia C. Increased BUN level D. Decreased Creatinine level ---------CORRECT ANSWER-----------------A, C You're assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician? A. Potassium level 4.2 mEq/L B. Creatinine clearance 35 mL/min C. BUN 20 mg/dL D. Blood pH 7.40 ---------CORRECT ANSWER-----------------B A 55 year old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? A. Post-renal B. Intra-renal C. Pre-renal D. Intrinsic renal ---------CORRECT ANSWER-----------------C
A. Encourage client to participate in group therapy on the unit B. Initiate one to one observation of the client C. Focus the client on reality D. Notify provider of client's statements ---------CORRECT ANSWER-----------------B A nurse is speaking with a client who has schizophrenia when the client suddenly seems to stop focusing on the nurses' questions and begins looking at the ceiling and talking to themselves. Which of the following actions should the nurse take? A. Stop the interview at this point, and resume later when the client is better able to concentrate B. Ask the client, "Are you seeing something on the ceiling?" C. Tell the client, "You seem to be looking at something on the ceiling. I see something there too.: D. Continue the interview without comment on the client's behavior --------- CORRECT ANSWER-----------------B A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first generation antipsychotics? (Select all that apply) A. Auditory hallucinations B. Withdrawal from social situations
C. Delusions of grandeur D. Severe agitation E. Anhedonia ---------CORRECT ANSWER-----------------A, C, D A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client concerns E. Use a firm approach with communication ---------CORRECT ANSWER----------------
- B, C, E A nurse is teaching a newly licensed nurse about the use of ECT for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder" B. "ECT is contraindicated for clients who have suicidal ideation" C. "ECT is effective for clients who are experiencing severe mania" D. "ECT is prescribed to prevent relapse of bipolar disorder" ---------CORRECT ANSWER-----------------C
A. Water intoxication B. Hypotension C. Low urine specific gravity D. Hypokalemia E. Normal GFR ---------CORRECT ANSWER-----------------B, C, D True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not all patients will progress through the diuresis stage. --------- CORRECT ANSWER-----------------B Which patient below with acute kidney injury is in the oliguric stage of AKI: A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day. C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day. D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day. ---------CORRECT ANSWER-----------------A You're developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing diagnosis would you include in the care plan?
A. Excess fluid volume B. Risk for electrolyte imbalance C. Urinary retention D. Acute pain ---------CORRECT ANSWER-----------------B While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last? A. 1-2 weeks B. 1-3 days C. Few hours to 2 weeks D. 12 months ---------CORRECT ANSWER-----------------A A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient? A. Low-sodium, high-protein, and low-potassium B. High-protein, low-potassium, and low-sodium C. Low-protein, low-potassium, and low-sodium D. High-protein and high-potassium ---------CORRECT ANSWER-----------------C
A. Do not allow BP to be taken in the affected arm B. Elevate affected arm, allowing for total arm rest of the extremity C. Assess for a bruit in the affected arm on a daily basis D. Sleep on the affected side to protect access device ---------CORRECT ANSWER--- --------------A Term for before the kidneys ---------CORRECT ANSWER-----------------Prerenal AKI Term for after the kidneys ---------CORRECT ANSWER-----------------Postrenal AKI Term for within the kidneys ---------CORRECT ANSWER-----------------Intrarenal AKI Group of antibiotics that cause intrarenal AKI ---------CORRECT ANSWER-------------- ---Aminoglycosides Primary cause of edema in AKI ---------CORRECT ANSWER----------------- Glomerulonephritis (fluid leakage causes lower GFR, oliguria, edema, hypertension, azotemia) Cause of acute tubular necrosis ---------CORRECT ANSWER-----------------Ischemia
These two chronic diseases increase risk of CKD ---------CORRECT ANSWER----------- ------Diabetes, hypertension Modifiable risk factors for CKD ---------CORRECT ANSWER-----------------Obesity, cardiovascular disease, uncontrolled diabetes, smoking, exposure to nephrotoxic meds Nephrotoxic medications (Examples) ---------CORRECT ANSWER----------------- NSAIDS, aminoglycosides, cephalosporins Lab value that determines staging of chronic kidney disease ---------CORRECT ANSWER-----------------GFR Tall peaked T waves with widened QRS complex and disappearing P waves on ECG indicate what? ---------CORRECT ANSWER-----------------Hyperkalemia GFR <15-29 mL/min/1.73 m^2 indicates what stage of CKD? ---------CORRECT ANSWER-----------------Stage 5 or end stage kidney disease
Urine output <400 mL in 24 hr or <0.5mL/kg/hr over 6 hours ---------CORRECT ANSWER-----------------Oliguria This ratio represents what? : (5-20):1 ---------CORRECT ANSWER-----------------BUN to creatinine ratio Term for high concentration of urea and creatinine in the blood ---------CORRECT ANSWER-----------------Azotemia Values obtained in a BMP? ---------CORRECT ANSWER-----------------Potassium, sodium, BUN, creatinine, chloride, bicarbonate, glucose Medication used to treat anemia in CKD ---------CORRECT ANSWER----------------- Erythropoietin One pound of weight gain in acutely ill patients indicates---- retained fluid --------- CORRECT ANSWER-----------------1000 mL Also known as the silent disease ---------CORRECT ANSWER-----------------CKD
Optimal diet for renal failure ---------CORRECT ANSWER-----------------High calories, low protein, no extra sodium and no extra potassium Best practice to monitor weight ---------CORRECT ANSWER-----------------Same amount of clothing, same time of day, same scale Acute renal failure will demonstrate---- BUN level and ------serum creatinine level - --------CORRECT ANSWER-----------------Increased/ Increased Physiologic renal changes associated with aging include what? ---------CORRECT ANSWER-----------------Reduced kidney size/weight, lower GFR, decreased sodium reabsorption and decreased potassium excretion Medication used to treat metabolic acidosis ---------CORRECT ANSWER----------------
- Sodium bicarbonate Name one benefit of peritoneal dialysis ---------CORRECT ANSWER-----------------Can be done at home
A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply) A. Auditory hallucination B. Lack of motivation C. Use of clang associations D. Delusion of persecution E. Constantly waving arms F. Flat affect ---------CORRECT ANSWER-----------------A, C, D, E A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (Select all that apply) A. Use caffeine in moderation to prevent relapse B. Difficulty sleeping can indicate a relapse C. Begin taking your meds as soon as relapse begins D. Participating in psychotherapy can help prevent a relapse E. Anhedonia is a clinical manifestation of a depressive relapse ---------CORRECT ANSWER-----------------B, D, E
A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? A. The client has a family history of seasonal depression B. The client currently smokes 1.5 packs of cigarettes per day C. The client had a motor vehicle crash last year and sustained a head injury D. The client had a BMI of 25 and has gained 10 pounds over the last year --------- CORRECT ANSWER-----------------C A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. "That is a good choice. Ibuprofen does not interact with lithium" B. "Regular aspirin would be a better choice" C. "Lithium decreases the effectiveness of ibuprofen" D. "The ibuprofen will make your lithium level fall too low" ---------CORRECT ANSWER-----------------B A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (Select all that apply) A. Constipation
A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? A. "Current medical conditions include diabetes that is controlled by diet" B. "Recent meds include a course of prednisone for acute bronchitis" C. "Current vaccinations include a flu vaccine last month" D. "Current meds include furosemide for congestive heart failure" --------- CORRECT ANSWER-----------------D A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (Select all that apply) A. "My family will be better off if I'm dead" B. "The stress in my life is too much to handle" C. "I wish my life was over" D. "I don't feel like I can ever be happy again" E. "If I kill myself then my problems will go away" ---------CORRECT ANSWER--------- --------A, C, E A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority?
A. Client's educational and economic background B. Lethality of the method and availability of means C. Quality of client's social support D. Client's insight into the reasons for decision ---------CORRECT ANSWER------------- ----B A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following interventions should the nurse include as a primary intervention? (Select all that apply) A. Conducting a suicide risk screening on all new clients B. Creating a support group for family members of clients who completed suicide C. Educating high school teens about suicide prevention D. Initiating one on one observation for a client who has current suicidal ideation E. Teaching middle school educators about warning indicators of suicide --------- CORRECT ANSWER-----------------A, C, E A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? A. Assign the client to a private room B. Document the client's behavior every hour
