NURS Exemplar 6.B: Acute Kidney Injury NURS Exemplar 6.B: Acute Kidney Injury questions an, Exams of Nursing

Download NURS Exemplar 6.B: Acute Kidney Injury NURS Exemplar 6.B: Acute Kidney Injury questions an and more Exams Nursing in PDF only on Docsity! NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured 1) The nurse is caring for a client admitted with a diagnosis of acute kidney injury (AKI). The client asks the nurse, "Are my kidneys failing? Will I need a kidney transplant?" Which response by the nurse is the most appropriate? A) "No, don't think that. You're going to be fine." B) "In most cases, your condition can be reversed with prompt treatment and usually will not destroy the kidneys." C) "Kidney transplantation is highly likely, so it would be a good idea to start talking to your family members about organ donation." D) "When the doctor comes to see you, we can talk about whether you will need a transplant." Answer: B Explanation: A) Acute kidney injury (AKI) is often resolved without the need for transplant if treatment is initiated quickly. There is no need to start lining up donors or wait for the provider to arrive to explore options. Telling the client that everything will be fine is condescending, provides no information, and is not within the nurse's ability to know. 2) A client diagnosed with frequent urinary tract infections is seen in the urology clinic. The nurse reviews the client's medical history and determines that the client is at risk for acute kidney injury. Which items in the client's history support this conclusion? Select all that apply. A) Dehydration B) Renal calculi C) Ineffective wound healing D) Low serum albumin E) Hypertension Answer: A, B, E Explanation: A) Dehydration, renal calculi, and hypertension can all precipitate acute kidney injury (AKI). Ineffective wound healing has not been shown to cause renal failure unless the infection becomes systemic. A low serum albumin does not cause AKI. 3) A young school-age client is in the hospital with an acute kidney injury diagnosis following a streptococcus infection. The client's parents primarily speak Spanish but have a limited ability to understand English. Through an interpreter, the parents ask the nurse what mistake they made that caused their child to be so sick. Which response by the nurse is the most appropriate? A) "Your child does not eat enough dietary protein." B) "Your child has a congenital defect that led to renal failure." C) "Your child's renal failure has been caused by a low calcium level." D) "Your child's recent infection may have caused the renal failure." NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured Answer: D Explanation: A) Clients with streptococcus are at risk for kidney and cardiac sequelae. In this case, the child has no evidence of a congenital defect leading to acute kidney injury (AKI). A low-protein or low-calcium diet will not lead to AKI. 4) The nurse is planning care for a client diagnosed with acute kidney injury (AKI). The nurse plans the client's care based on the nursing diagnosis of Excess Fluid Volume. Which assessment data supports this nursing diagnosis? A) Pitting edema in the lower extremities B) Bowel sounds positive in four quadrants C) Wheezing in the lungs D) Generalized weakness Answer: A Explanation: A) The client in acute kidney injury (AKI) will likely be edematous, because the kidneys are not producing urine. Wheezing in the lungs is an assessment consistent with asthma, not AKI. Bowel sounds in four quadrants is a normal assessment finding. Generalized weakness may be due to whatever disease process precipitated the kidney failure. 5) A client diagnosed with acute kidney injury (AKI) is receiving peritoneal dialysis. The nurse is explaining the dialysis process to the client and family. Which statement should the nurse include in this discussion? A) "The peritoneum is more permeable because of the presence of excess metabolites." B) "The metabolites will diffuse from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration." C) "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." D) "The solutes in the dialysate will enter the bloodstream through the peritoneum." Answer: C Explanation: A) The peritoneum acts as a semipermeable membrane, allowing substances to move from an area of high concentration (the blood) to an area of lower concentration (the dialysate). Metabolic waste products and excess water can be eliminated through osmosis and diffusion using the peritoneum as the semipermeable membrane. 6) The nurse is caring for a client diagnosed with acute kidney injury (AKI). When reviewing the client's laboratory data, which findings should indicate to the nurse that the client has met the expected outcomes? Select all that apply. A) Decreasing serum creatinine B) Decreasing blood urea nitrogen (BUN) C) Decreasing neutrophil count D) Decreasing lymphocyte count E) Decreasing erythrocyte count NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured 12) A client diagnosed with acute kidney injury (AKI) has jugular vein distention, lower extremity edema, and elevated blood pressure. Based on this data, which nursing diagnosis is most appropriate? A) Ineffective Renal Tissue Perfusion B) Excess Fluid Volume C) Risk for Decreased Cardiac Tissue Perfusion D) Risk for Infection Answer: B Explanation: A) Jugular vein distention, edema, and elevated blood pressure are all indications of excess fluid. Thus, the diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Decreased Cardiac Tissue Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection. 13) A client agrees to receive long-term hemodialysis to treat acute kidney injury (AKI). Based on this information, the nurse should prepare the client for which surgical procedure? A) Insertion of a double-lumen catheter into the subclavian artery B) Placement of a peritoneal catheter C) Insertion of a subarachnoid-peritoneal shunt D) Placement of an arteriovenous fistula Answer: D Explanation: A) For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis, not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebrospinal fluid and not for hemodialysis. 14) A client with acute kidney failure is complaining of a metallic taste in the mouth and has no appetite. Based on this data, which intervention by the nurse is the most appropriate? A) Provide mouth care before meals. B) Administer an antiemetic as prescribed. C) Restrict fluids. D) Encourage the intake of protein, salt, and potassium. Answer: A Explanation: A) A metallic taste in the mouth is due to uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic would be prescribed for nausea. Restricting fluids would not reduce the metallic taste NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured in the mouth. Encouraging intake of protein, salt, and potassium would exacerbate the uremia that is causing the metallic taste in the mouth. 15) A client diagnosed with recurrent urinary tract calculi would be at elevated risk for which of the following types of acute kidney injury (AKI)? A) Prerenal AKI B) Intrinsic AKI C) Postrenal AKI D) Intrarenal AKI Answer: C Explanation: A) Obstructive causes of AKI are classified as postrenal. Any condition that prevents urine excretion—including urinary tract calculi—can lead to postrenal AKI. In comparison, prerenal AKI results from conditions that affect renal blood flow and perfusion, and intrinsic AKI (also called intrarenal AKI) is characterized by acute damage to the renal parenchyma and nephrons. 16) Which symptom suggests that a client is entering the maintenance phase of acute kidney injury (AKI)? A) Onset of metabolic acidosis B) Onset of diuresis C) Increase in glomerular filtration rate D) Decrease in serum potassium levels Answer: A Explanation: A) The maintenance phase of AKI is characterized by a significant fall in glomerular filtration rate (GFR) and tubular necrosis. Oliguria, azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis may all develop. Also during this phase, impaired potassium excretion leads to hyperkalemia, or increased serum potassium levels. Onset of diuresis and an increasing glomerular filtration rate are suggestive of the recovery phase, not the maintenance phase. 17) Which laboratory finding suggests that a client is experiencing acute kidney injury (AKI) as a result of glomerular damage? A) Hyperkalemia B) Proteinuria C) Urine specific gravity of 1.010 D) Moderate anemia Answer: B Explanation: A) Proteinuria, or excess protein in the urine, is suggestive of glomerular damage as the cause of a client's AKI. Urine specific gravity of 1.010, moderate anemia, and hyperkalemia are common laboratory findings in clients with AKI, regardless of its cause. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured 18) Which medication is used to increase renal blood flow in clients with acute kidney injury? A) Furosemide (Lasix) B) Mannitol (Osmitrol) C) Bumetanide (Bumex) D) Dopamine (Intropin) Answer: D Explanation: A) In clients with acute kidney injury, dopamine (Intropin) is administered in low doses by intravenous infusion to increase renal blood flow. If restoration of renal blood flow does not improve urinary output, a potent loop diuretic, such as furosemide (Lasix) or bumetanide (Bumex), or an osmotic diuretic, such as mannitol (Osmitrol), may be given with intravenous fluids. These medications help "wash" nephrotoxins out of the kidneys and reestablish urine output. Module 15 Oxygenation 1) The nurse recognizes that which pathophysiologic changes are occurring when caring for the client with respiratory acidosis? Select all that apply. A) Increased CO2 B) Vasoconstriction C) Decreased O2 D) Decreased intracranial pressure (ICP) E) Increased pulse rate Answer: A, C, E Explanation: A) Respiratory acidosis is an alteration of acid-base imbalance that is caused by decreased oxygen intake, resulting in an excess of dissolved carbon dioxide (increased CO2). Vasodilatation, not vasoconstriction, occurs as a low pH results in relaxation of vascular smooth muscle by interrupting the normal function of calcium channels. Cerebral vasodilation results in increased intracranial pressure. The pulse rate increases in an attempt to compensate for oxygen deprivation. 2) The nurse is providing care to a client diagnosed with chronic obstructive pulmonary disease (COPD). Which clinical manifestations are the direct result of altered perfusion? Select all that apply. A) Bounding pulse B) Pink nail beds C) Cyanosis D) Confusion E) Wheezing Answer: C, D Explanation: A) A client who is diagnosed with COPD may have alterations in both oxygenation and perfusion. Clinical manifestations associated with a decrease in perfusion include cyanosis NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured 9) The nurse assigned to the newborn nursery is conducting shift assessments. While assessing one newborn, the nurse notes the respiratory rate is 52 breaths per minute. Which action by the nurse is appropriate? A) Notify the healthcare provider of this assessment finding. B) Obtain an arterial blood gas for further respiratory assessment. C) Begin monitoring the respiratory rate every 5 minutes. D) Continue to monitor the newborn per facility policy. Answer: D Explanation: A) A respiratory rate of 52 breaths per minute is a normal finding in a newborn. Respiratory rates are highest and most variable in newborns. The respiratory rate of a neonate or newborn is 30-60 breaths per minute. Therefore, this client only needs monitoring. No other actions are necessary. 10) The nurse is conducting an assessment for a client on a medical-surgical unit. Which findings are indicative of a client who is experiencing tachypnea? Select all that apply. A) Excessive rapid breathing B) Chest pain C) Rapid breathing at rest D) Shallow breathing E) Cyanosis Answer: A, C, D Explanation: A) Excessive rapid breathing, rapid breathing at rest, and shallow breathing are all manifestations of tachypnea. Chest pain is a manifestation of a pneumothorax. Cyanosis is a late manifestation of hypoxemia. 11) The charge nurse is observing a newly licensed nurse conduct an admission assessment on a client with asthma. Which action by the newly licensed nurse requires immediate intervention? A) The newly licensed nurse is observed obtaining the pulse oximetry reading 10 minutes after the client used an albuterol inhaler. B) The newly licensed nurse is observed continuing to ask the client questions regarding history while the client demonstrates difficulty breathing and signs of respiratory impairment. C) The newly licensed nurse is observed assessing the client's thoracic wall, skin, and nail beds. D) The newly licensed nurse is observed auscultating breath sounds with a stethoscope. Answer: B Explanation: A) The charge nurse should intervene immediately if the nurse observes the client is demonstrating impairment at or near respiratory failure; the client will not be able to respond to questions. Assessment questions should be tailored and asked of any family member or friend accompanying the client. Although the pulse oximetry reading may not be a true indicator of the level of respiratory distress of the client because of the use of an albuterol inhaler within 30-60 NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured minutes of this assessment, it is still an appropriate action for the newly licensed nurse to take and does not require the charge nurse to intervene immediately. The charge nurse may speak to the newly licensed nurse later with regard to this assessment. Assessing the client's thoracic wall, skin, and nail beds is an appropriate action at this time. Auscultating the client's breath sounds with the use of a stethoscope is appropriate. 12) Which independent nursing interventions are appropriate for a client who is experiencing an alteration in oxygenation? Select all that apply. A) Encouraging deep breathing exercises B) Assisting with positioning C) Providing suctioning D) Prescribing bronchodilators E) Monitoring activity intolerance Answer: A, B, C, E Explanation: A) Examples of independent interventions that nurses can provide to clients with alterations in oxygenation include deep breathing exercises, positioning, encouraging smoking cessation, monitoring activity intolerance, promoting secretion clearance, suctioning, and assisting with activities of daily living (ADLs). It is outside the scope of nursing practice to prescribe a bronchodilator to a client. The nurse, however, can administer a prescribed bronchodilator. This is considered a collaborative nursing intervention. 13) The nurse is providing care to a client with arterial blood gas analysis as follows: PaO2 of 82, PaCO2 of 49, HCO3 of 26, and pH of 7.31. Which assessment by the nurse is correct? A) Respiratory acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Metabolic acidosis Answer: A Explanation: A) Both the pH and the carbon dioxide levels represent acidosis. The PaO2 of 82 is on the low end of normal and the bicarbonate level is normal, indicating that this is respiratory acidosis rather than metabolic acidosis. 14) While performing nasotracheal suctioning, the nurse notes the older adult client with an alteration in oxygenation is moving the head around and pulling at the nurse's hand to remove the suction catheter. Which actions by the nurse are appropriate? Select all that apply. A) Remove the suction catheter B) Lower the head of the bed C) Decrease the suction pressure D) Apply restraints to the client's arms and legs E) Hyperoxygenate the client NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured Answer: A, C, E Explanation: A) The older adult client is demonstrating signs of hypoxemia. The nurse should remove the suction catheter, decrease the suction pressure, and hyperoxygenate the client. Restraining the patient does not address the hypoxemia. The client should be in the Fowler or high-Fowler position. 15) The structure of the respiratory system that serves as the site of gas exchange is the A) macrophage. B) bronchi. C) alveoli. D) bronchiole. Answer: C Explanation: A) The alveoli comprise the terminal structures of the lower respiratory system. Alveoli serve as the sites of gas exchange, specifically, carbon dioxide and oxygen. Bronchi and bronchioles are larger structures in the respiratory system that serve as tracts for airflow. Macrophages are immune cells that keep the alveoli region free of microbes. 16) Vaccinations can help promote healthy oxygenation by A) reducing the transmission of preventable diseases. B) increasing the exchange of oxygen for carbon dioxide in the lungs. C) promoting adequate blood circulation to organs and tissues. D) preventing all respiratory infections. Answer: A Explanation: A) Vaccinations help decrease the transmission of preventable diseases, many of which are spread by respiratory secretions. Many of these diseases also affect the respiratory system and can alter oxygenation. Vaccinations do not directly increase the exchange of oxygen for carbon dioxide in the lungs, nor do they promote adequate blood circulation. Vaccinations can prevent some respiratory infections, but not all respiratory infections, and they can also prevent some nonrespiratory infections. Exemplar 15.A Acute Respiratory Distress Syndrome 1) Which clinical manifestation does the nurse correctly attribute to hypoxia in a client with acute respiratory distress syndrome (ARDS)? A) Fluid imbalance B) Hypertension C) Bradycardia D) Dyspnea Answer: D NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured 7) Which data supports the nurse's assessment that a newborn with acute respiratory distress syndrome (ARDS) is improving? A) Increased PaCO2 B) Oxygen saturation of 92% C) Pulmonary vascular resistance increases D) Thick secretions from the respiratory tract Answer: B Explanation: A) An expected outcome for a client being treated for ARDS is maintaining an oxygen saturation of greater than 90%. The newborn diagnosed with ARDS with an oxygen saturation of 92% is improving. Increased PaCO2, increased pulmonary vascular resistance, and thick secretions from the respiratory tract are indicative of continued distress. 8) The nurse educator prepares to speak to a group of nursing students about direct and indirect insults to the lungs that may lead to the development of acute respiratory distress syndrome (ARDS). Which conditions will the nurse include in the teaching session? Select all that apply. A) Sepsis B) Viral pneumonia C) Drug overdose D) Near drowning in saltwater E) Fractured humerus Answer: A, B, C, D Explanation: A) ARDS is a severe form of acute respiratory failure that occurs in response to pulmonary or systemic insults. Such insults include, but are not limited to, sepsis, pulmonary infections, saltwater inhalation, and drug overdose. A fractured humerus is not a risk factor for the development of ARDS. 9) The nurse is caring for a client admitted with septic shock. Which early clinical manifestation might indicate the development of ARDS? A) Intercostal retractions B) Cyanosis C) Tachypnea D) Tachycardia Answer: C Explanation: A) Dyspnea and tachypnea are early clinical manifestations of ARDS. As the distress progresses, the client would demonstrate an increasing respiratory rate, intercostal retractions, and use of accessory muscles, as well as tachycardia. Cyanosis is a late manifestation. 10) A client admitted with smoke inhalation injuries develops signs and symptoms of acute respiratory distress syndrome (ARDS). The nurse anticipates the healthcare provider will prescribe which course of action with regard to oxygenation? A) Oxygen via a nasal cannula NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured B) Mechanical ventilation C) Oxygen via a face mask D) Oxygen via a Venturi mask Answer: B Explanation: A) With ARDS, it is rarely possible to maintain adequate tissue oxygenation with oxygen therapy alone. Therefore, mechanical ventilation is often necessary. Oxygen administered via nasal cannula, face mask, or venture mask all require active and adequate breathing by the client, which may not be possible for the client with ARDS. 11) The nurse is caring for a client diagnosed with acute respiratory distress syndrome (ARDS). The client is intubated and placed on mechanical ventilation with positive pressure ventilation. Which assessment finding indicates a decrease of cardiac output secondary to positive pressure ventilation? A) Blood pressure increases from 88/58 mmHg to 90/60 mmHg B) Urine output decreases from 30 mL/hr to 25 mL/hr C) Heart rate drops from 108 bpm to 104 bpm D) Oxygen saturation increases from 82% to 90% Answer: B Explanation: A) Reduced cardiac output results in reduced perfusion of the kidneys, with a resulting decrease in urine output. Expected urine output is at least 30 mL/hr. This client's urine output is decreased; therefore, this finding supports the diagnosis of decreased cardiac output. Although hypotension and tachycardia are indicative of a decreased cardiac output, both indicate improvement from the previous assessment, suggesting that they are not contributing to decreased cardiac output. The oxygen saturation level is within normal limits for this client and improving from the previous assessment. 12) The nurse is providing care to a client with ARDS who has a tracheostomy. The nurse will monitor the client for complications related to the loss of which protective mechanism? A) The ability to cough B) Filtration and humidification of inspired air C) Decrease in oxygen-carrying capacity of the trachea D) The sneeze reflex initiated by irritants in the nasal passages Answer: B Explanation: A) When the nasal passages are bypassed, as they would be in the case of a client with a tracheostomy, the filtration, humidification, and warming provided by the nasal passages are also bypassed. The client can still cough and sneeze, and there is no decrease in the oxygen- carrying capacity of the trachea. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured 13) The client with ARDS who is likely to have the poorest outcome is A) a Hispanic male with pneumonia. B) an African American male with sepsis. C) a Caucasian female with sepsis. D) an African American female with chest trauma. Answer: B Explanation: A) The risk for mortality from ARDS is greater for men than for women, and it is greater for African Americans than people from other races. In addition, clients who develop ARDS from sepsis have poorer outcomes than clients who develop ARDS from pulmonary infections or trauma. Therefore, the African American male with ARDS from sepsis will likely have the poorest outcome. 14) One primary method for preventing ARDS in hospitalized clients is A) performing postural drainage for clients with respiratory congestion. B) elevating the head of the bed for clients who are ingesting food. C) providing smoking cessation literature to clients who smoke. D) administering oxygen as ordered by the healthcare provider. Answer: B Explanation: A) Aspiration of gastric contents is a major risk factor for developing ARDS. Therefore, simple interventions such as elevating the head of the bed for clients who are ingesting food can help prevent ARDS. Performing postural drainage and administering oxygen will not prevent ARDS. Although smoking may increase the risk for ARDS, it is not a direct cause of ARDS, so smoking cessation literature will not prevent ARDS in hospitalized clients. . 15) The nurse is caring for a woman who is 32 weeks pregnant and requires mechanical ventilation for ARDS. In addition to standard nursing interventions for adult clients with ARDS, what special interventions need to be implemented for this client? A) Inducing labor B) Administering nitric oxide and corticosteroids C) Providing nutritional support D) Fetal monitoring Answer: D Explanation: A) Care for pregnant clients with ARDS who are at least at 20-24 weeks' gestation should include close fetal monitoring for potential emergency delivery. If the ARDS leads to compromised placental oxygen transfer, the neonate should be delivered immediately for the best outcome. However, not all pregnant women with ARDS will need immediate emergency delivery of the neonate. Providing nutritional support and administering nitric oxide and corticosteroids are interventions for all adult clients with ARDS, not only pregnant women. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured use of hard candy or extra fluids to decrease dry mouth. The mouth does not need to be rinsed after taking this medication. This medication does not need to be taken with meals or a full glass of water, or on an empty stomach. 7) The nurse is planning care for a young adolescent client diagnosed with asthma. Which evidence-based age-appropriate interventions will the nurse include in the plan of care? Select all that apply. A) Referring to a peer-led support group B) Teaching the parents how to administer maintenance medication prior to teaching the client C) Assessing peer support when planning care D) Collaborating with teachers for support in the school setting E) Telling the client to avoid medication while at school Answer: A, C, D Explanation: A) Age-appropriate, evidence-based interventions for a young adolescent client diagnosed with asthma include referral to a peer-led support group, assessing peer support of the client, and collaborating with teachers to ensure the client has the necessary support in the school setting. While it is appropriate to include the parents in the educational process, the client should be taught how to administer medications prior to teaching the parents. Avoiding medication administration while in school could lead to an acute asthma attack. 8) The nurse instructs a client with asthma on bronchodilator therapy. Which statement indicates client understanding of how the drug works? A) "The medication widens the airways by causing airway muscle contraction." B) "The medication widens the airways by causing airway muscle relaxation." C) "The medication widens the airways by decreasing histamine production." D) "The medication widens the airways by decreasing mucus production." Answer: B Explanation: A) Bronchodilators stimulate bronchiolar smooth muscle relaxation, not contraction. Smooth muscle relaxation increases the diameter of the airway lumen to enhance airflow. Bronchodilators do not decrease the production of mucus or the production of histamine. 9) The nurse working on a pediatric unit is caring for a client newly diagnosed with asthma. Which assessment data indicate impending respiratory failure and the need for immediate intervention? Select all that apply. A) Shallow respirations B) Slightly diminished breath sounds C) Decreased wheezing D) Increased crackles E) Increased respiratory rate NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured Answer: A, C Explanation: A) Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of respiratory failure. An increased respiratory rate indicates respiratory compromise, but not respiratory failure. 10) The nurse is providing care to a client with asthma. When developing the client's plan of care, which intervention would be most appropriate to promote effective gas exchange? A) Provide adequate rest periods B) Reduce excessive stimuli C) Assist with activities of daily living D) Place in Fowler position Answer: D Explanation: A) Placing the client in Fowler position facilitates breathing and lung expansion, promoting effective gas exchange. Providing adequate rest periods prevents fatigue and reduces oxygen demands. Reducing excessive stimuli promotes rest. Assisting with activities of daily living conserves energy and reduces oxygen demands. 11) The nurse is reviewing discharge instructions with a client who is newly diagnosed with asthma. Which client statement indicates a need for further teaching? A) "I need to rinse my mouth after every use of my inhaler." B) "I need to take my Singulair at least 1 hour before I eat." C) "When inhaling two different medications, I should use the bronchodilator last." D) "Because I am on theophylline, I will need to have therapeutic blood levels drawn." Answer: C Explanation: A) When using two different medications taken by inhalation, the bronchodilator should always be used first. This helps open the airways to enhance the effectiveness of the second medication. The other statements are accurate and require no further education. 12) The pathophysiologic stimulus that initiates asthma is A) bronchoconstriction. B) inflammation in the airways. C) airway edema. D) mucus secretion. Answer: B Explanation: A) In asthma, the airways are in a persistent state of inflammation. This inflammation can lead to bronchoconstriction, airway edema, and increased mucus secretion. Therefore, inflammation is the primary stimulus that initiates asthma. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured 13) Which of the following triggers can stimulate an acute asthma attack? Select all that apply. A) Stress B) Animal dander C) Loud noises D) Exercise E) Bright lights Answer: A, B, D Explanation: A) Stress, exercise, and animal dander are all known triggers of asthma. Loud noises may trigger hearing loss or headaches, but they will not trigger asthma. Bright lights are also not known to trigger asthma. 14) The nurse is collecting a health history for a 12-month-old child. The child lives in a home where both parents smoke, and the child has had respiratory syncytial virus twice since birth. The child's older sister was recently diagnosed with asthma. The nurse understands that this child's risk of developing asthma later in life is A) above average. B) average. C) below average. D) well below average. Answer: A Explanation: A) Risk factors for asthma include exposure to air pollution, including secondary smoke from cigarettes, and early exposure to respiratory syncytial virus. Genetic factors may also play a role in asthma development. Because of the presence of these risk factors, this child has an above average risk of developing asthma later in life. 15) The nurse is caring for a 72-year-old client who has presented to the emergency department for the third time in 8 months with acute asthma exacerbations. The client states that he has trouble holding his inhaler, and sometimes he forgets to take his medication. He is also worried because he thinks his new drugs are adversely interacting with medications for his other conditions. What nursing diagnosis is appropriate for this client? A) Deficient Knowledge B) Ineffective Health Management C) Risk for Aspiration D) Ineffective Coping Answer: B Explanation: A) Based on his repeated trips to the emergency department, his reported trouble holding his inhaler, and his inconsistency with taking his medications, an appropriate nursing diagnosis for this client is Ineffective Health Management. The client appears to have adequate knowledge about how to cope with his diseases; he is just unable to follow through with NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured this goal. Eating out would not be a goal for a client being treated for cholecystitis. The client would want to decrease fat intake. 7) Which of the following lifestyle changes would most likely increase a client's risk for cholelithiasis? A) Reducing intake of high-fat foods B) Increasing intake of high-cholesterol foods C) Beginning a regular exercise routine D) Discontinuing use of hormonal birth control Answer: B Explanation: A) Several factors increase a client's risk for gallbladder disease, including consuming foods that are high in fat and cholesterol and using medications that contain estrogen, such as hormonal birth control. Exercise can aid in weight control, thereby reducing a client's risk for gallbladder disease. 8) A client with cholelithiasis is in the clinic for a follow-up assessment after hospitalization. What lifestyle modification should the nurse teach the client to decrease the pain associated with the disease process? A) Reduce sodium intake B) Decrease fat consumption C) Increase fluids D) Decrease smoking Answer: B Explanation: A) A client who is experiencing cholelithiasis should be instructed on the relationship between increased fat consumption and the severity of pain associated with cholelithiasis. Although all clients should be instructed to reduce sodium intake, decreasing sodium will not assist in reducing cholelithiasis or its pain. Increasing fluids will not assist in reducing cholelithiasis or its pain. Also, while all clients should be encouraged to cease smoking, smoking has no relationship to cholelithiasis. 9) A nurse is caring for a client with severe acute abdominal pain secondary to cholelithiasis. Which nursing actions promote effective pain management? Select all that apply. A) Withhold oral food and fluids. B) Insert nasogastric tube and connect to high suction. C) Educate the client about decreasing protein in the diet, because protein increases gallbladder contractions. D) Administer morphine, meperidine, or another opioid analgesic as ordered. E) Place the patient in supine position to relieve abdominal pain. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured Answer: A, D Explanation: A) The pain associated with cholelithiasis can be severe. Nursing interventions that help promote effective pain management include withholding oral food and fluids and inserting a nasogastric tube connected to low suction if ordered. The nurse should educate the client about decreasing fat in the diet, because fat entering the duodenum initiates gallbladder contractions, causing pain when gallstones are in the ducts. Administering morphine, meperidine, or another opioid analgesic as ordered also aids in pain management. In addition, the nurse should place the patient in Fowler position, not supine, to decrease pressure on the inflamed gallbladder. 10) Which of the following medications is used to reduce the cholesterol content of gallstones and lead to their gradual dissolution? A) Cholestyramine B) Chenodiol C) Meperidine D) Amoxicillin Answer: B Explanation: A) Chenodiol (Chenix) is administered to reduce the cholesterol content of gallstones and lead to their gradual dissolution. These drugs act by reducing cholesterol production in the liver, thus reducing the cholesterol content of bile. In comparison, cholestyramine (Questran) is administered to relieve jaundice and pruritus related to accumulation of bile salts on the skin; meperidine is given to alleviate pain; and amoxicillin is given to reduce the likelihood of infection. 11) Which of the following lab results suggests that a client with gallbladder disease is experiencing obstructed bile flow in the biliary duct system? A) Decreased WBC count B) Elevated WBC count C) Decreased direct bilirubin D) Elevated direct bilirubin Answer: D Explanation: A) In clients with gallbladder disease, elevated direct bilirubin may indicate obstructed bile flow in the biliary duct system. Although clients with gallbladder disease often have an elevated WBC count, this result is suggestive of infection and inflammation rather than obstructed bile flow. Module 17 Perioperative Care The Concept of Perioperative Care 1) The nurse is providing teaching to a client who is scheduled to undergo surgery in 2 weeks. Which topics should the nurse include that will prepare the client to help reduce complications during the postoperative phase? Select all that apply. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured A) Maintaining a patent airway B) Deep breathing and coughing C) Caring for the surgical incision D) Managing constipation E) Managing pain Answer: B, C, D, E Explanation: A) Maintaining a patent airway is a nursing action that is performed during and after surgery; the client would not need client teaching about how to maintain a patent airway. In the preoperative phase, when the client is alert and oriented, the nurse should focus teaching on deep breathing and coughing exercises, care of the surgical incision, managing constipation, and managing pain. This knowledge will help the client reduce complications after the surgery. 2) The nurse is providing teaching to a client who is about to undergo surgery. When discussing whom the client can expect to see in the operating room suite, which individuals should the nurse include? Select all that apply. A) Surgeon B) Postoperative nurse C) Circulating nurse D) Anesthesiologist E) Social worker Answer: A, C, D Explanation: A) The surgeon performs the procedure. The postoperative nurse will provide care to the client after the surgery is completed. The circulating nurse is a perioperative registered nurse who cares for the client during the surgical procedure. The anesthesiologist provides the anesthesia during the surgery and continually monitors the client's physiologic status. The social worker will not be in attendance during the procedure but may become involved in the client's care during the preoperative and postoperative phases. 3) The postoperative nurse is planning care for a client recovering from major thoracic surgery. Which nursing diagnoses should the nurse select to plan for this client's immediate care needs? Select all that apply. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured B) Amount of anesthesia needed during surgery C) Teaching on deep breathing and coughing D) Plans for discharge care E) Actions to prevent pressure ulcers Answer: A, C, D, E Explanation: A) Clients do not need teaching related to intraoperative anesthesia amounts. For the older client, make sure the client can hear the information to be presented or provide information through alternative means. Deep breathing and coughing assist in the prevention of pneumonia and other respiratory conditions related to surgery, and deep breathing and coughing education should start in the preoperative phase. The older client is going to need assistance once discharged and should have the necessary medical equipment such as walkers and raised toilet seats, assistance with transportation, or extended care. The older client could be at risk for pressure ulcer formation because of poor nutritional status, diabetes, cardiovascular illness, or a history of steroid use. 9) A prothrombin time (PT) test measures which of the following? A) Time required for the client's blood to clot B) Time required for the client's plasma to clot C) Time required for platelets to effectively stop bleeding D) Time required for a surgical procedure Answer: B Explanation: A) A prothrombin time (PT) test measures the time required for the client's plasma to clot. A partial thromboplastin time (PTT) test measures the time required for the client's blood to clot. A bleeding time test measures the time required for platelets to effectively stop bleeding. No diagnostic test measures the time required for a surgical procedure. 10) What drug may be used to treat nausea and vomiting associated with operative procedures? A) Metoclopramide B) Acetaminophen C) Midazolam NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured D) Fentanyl Answer: A Explanation: A) An antiemetic such as metoclopramide may be used to treat nausea and vomiting associated with operative procedures. A nonopioid analgesic such as acetaminophen provides temporary analgesia for mild to moderate pain. An anxiolytic such as midazolam is a relaxant. An opioid analgesic such as fentanyl controls moderate to severe pain but does not alter the pain threshold. 11) What is characteristic of assessment in perioperative care? A) It is primarily a component of preoperative care. B) It is used most often during the intraoperative process. C) It primarily is involved in evaluating clients during postoperative care. D) It is involved in every part of the perioperative process. Answer: D Explanation: A) Assessment is the most significant concept during the perioperative process and encompasses most of the other concepts. In addition to monitoring the client's vital signs and taking into account the spiritual, cultural, and emotional aspects of a client's care, assessment may include a nurse's communication with the healthcare and surgical team. Assessing what other team members gather from a nurse's communication is vital to a client's safety. 12) Which of the following statements best describes the vital signs the nurse collects during the preoperative phase? A) They are the only vital signs collected during the perioperative period. B) When later vital signs are taken, they are compared against the preoperative set. C) Generally preoperative vital signs are only relevant during the intraoperative process. D) These are not essential and may be omitted for emergency surgeries. Answer: B Explanation: A) Vital signs, including blood pressure, pulse, respiration, and oxygen saturation, should be taken throughout the perioperative period, with the baseline vital signs being obtained during the preoperative phase. Later vital signs will be compared against this baseline. Preoperative vital signs are not the only vital signs collected during the perioperative period, they are relevant through the perioperative period as a baseline, and they are important to record for NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured any client. 13) How often should a client be monitored during the intraoperative phase? A) Every 5 minutes B) Every 30 minutes C) Constantly D) Occasionally Answer: C Explanation: A) Constant monitoring of both the surgical environment and the client is necessary to ensure client safety. Monitoring the client every 5 minutes, every 30 minutes, or just occasionally could miss an important change in the client's status that could result in client harm or adverse complications. 14) A client with terminal cancer is undergoing surgery to partially remove a tumor that is pressing on a nerve and causing pain. This is classified as what type of surgery? A) Reconstructive B) Diagnostic C) Palliative D) Emergency Answer: C Explanation: A) Palliative surgery may be performed to alleviate pain or symptoms associated with a disease, and so this client's surgery, because it involves partially removing a tumor causing severe pain, is most illustrative of palliative surgery. Reconstructive surgery is to restore lost or reduced appearance or function. A diagnostic procedure would be conducted to determine or confirm a diagnosis. Emergency surgery is to save life or limb. 15) Which of the following situations demands that all perioperative staff cover their bodies with lead shields? A) The surgical team uses a bipolar handpiece to cauterize a client's tissue. B) The surgical team uses a class 3 laser to cut a client's kidney stone. C) The surgical team uses a pneumatic tourniquet to cut off circulation to a client's hand. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured body tissues. Encouraging ambulation every 30 minutes would negatively impact oxygenation. Periods of rest should occur between activities, and no activity should be too strenuous. The client with oxygenation issues will have tachycardia. The nurse should consider medications that would reduce instead of increase the heart rate. The client should be in the high-Fowler position to improve oxygenation. Positions to increase blood flow to the heart include Trendelenburg, which would negatively impact oxygenation. 3) An older adult client is diagnosed with cardiomyopathy and a cardiac dysrhythmia. What would the nurse expect to be prescribed for this client? A) Beta blocker B) Digoxin C) Nitrate medications D) Fluids Answer: A Explanation: A) Treatment for cardiomyopathy includes calcium channel blockers, beta blockers, and antiarrhythmics. Digoxin should be avoided because it increases the force of contractions. Nitrates should be avoided because they increase blood pressure. The client should be on a sodium and fluid restriction and not be encouraged to drink fluids. 4) The nurse is caring for a client admitted to the hospital with lower extremity edema and shortness of breath. Which electrocardiogram finding indicates the client is at risk for an alteration in perfusion? A) P wave smooth and round B) Absent U wave C) PR interval 0.30 seconds D) ST segment isoelectric Answer: C Explanation: A) The PR interval is normally 0.12-0.20 seconds. Intervals greater than 0.20 seconds indicate a delay in conduction from the SA node to the ventricles. A P wave should be smooth and round. The U wave is not normally seen. The ST segment should be isoelectric. 5) The nurse is instructing a client on lifestyle changes to promote a healthy cardiovascular system. Which of the following should be included in this teaching session? Select all that apply. A) Limit exercise to 15 minutes a day B) Reduce saturated fats in the diet C) Avoid cigarette smoking D) Wear elastic hose E) Limit fluid intake Answer: B, C Explanation: A) Interventions that help promote a healthy cardiovascular system are to avoid cigarette smoking and reduce saturated fats in the diet. Clients should exercise for at least 30 NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured minutes most days of the week to maintain a healthy cardiovascular system. Wearing elastic hose and limiting fluid intake are not known to contribute to a healthy cardiovascular system. 6) The nurse is preparing to conduct a cardiac assessment for a pediatric client. Which location will the nurse use when auscultating the apical pulse? A) At the fifth intercostal space B) At the left nipple C) At the right nipple D) At the eighth intercostal space Answer: B Explanation: A) When assessing a pediatric client, it may be more beneficial to auscultate the apical pulse in the area of the left nipple at the fourth intercostal space. The other answer options are not appropriate. 7) The nurse is caring for a client who is scheduled to receive metoprolol (Lopressor). What should the nurse teach the client about this medication? A) Expect a rapid heart rate. B) Change positions slowly. C) Reduce protein intake. D) Increase fluids. Answer: B Explanation: A) Metoprolol is a beta blocker. The client should be instructed to use care when ambulating and to change positions slowly because this medication causes orthostatic hypotension. This medication does not cause a rapid heart rate. Protein restriction is not indicated with this medication. The client should not be instructed to increase fluids. 8) Which statements are correct regarding the various layers of the heart? Select all that apply. A) The endocardium covers the entire heart and great vessels. B) The endocardium is the muscular layer of the heart that contracts during each heartbeat. C) The outermost layer of the heart is the epicardium. D) The myocardium consists of myofibril cells. E) The myocardium has four layers. Answer: C, D Explanation: A) The heart wall consists of three layers of tissue: the epicardium, the myocardium, and the endocardium. The epicardium covers the entire heart and great vessels, and then folds over to form the parietal layer lining the pericardium and adheres to the heart surface. The myocardium, the middle layer of the heart wall, consists of specialized cardiac muscle cells (myofibrils). The endocardium, which is the innermost layer, is a thin membrane composed of NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured three layers. The myocardium is the muscular layer of the heart that contracts during each heartbeat. The outermost layer of the heart is the epicardium. 9) A client's stroke volume (SV) is 85mL/beat and the heart rate (HR) is 71 beats per minute (bpm). What is the client's cardiac output (CO) rounded to the nearest liter? Answer: 6 Liters (L) Explanation: CO = SV × HR 85mL = 0.085 L CO = 0.085 × 71 = 6.035 = 6 L 10) Blood pressure is influenced by all except which factor? A) Pumping action of the heart B) Peripheral vascular resistance C) Heart rate D) Blood volume Answer: C Explanation: A) The factors that determine blood pressure include the pumping action of the heart, peripheral vascular resistance, and blood volume and viscosity. Heart rate by itself does not determine blood pressure. 11) Which nursing intervention related to perfusion can be performed independently? A) Administration of drug regimens B) Insertion of device to measure central venous pressure (CVP) C) Teaching relaxation techniques D) Thoracentesis Answer: C Explanation: A) The nurse can teach relaxation techniques as an independent intervention to provide psychosocial support to the client. The nurse must administer drug regimens only under the order of a physician or nurse practitioner. Although nurses can monitor central venous pressure, they are not responsible for inserting the device to measure CVP. A physician or nurse practitioner usually performs a thoracentesis. 12) The nurse is reviewing objective data obtained during the assessment of a pregnant woman in her 34th week of gestation. Which finding would be cause for concern? A) Pulse 103 bpm B) Blood pressure 108/70 C) Hematocrit 24% D) WBC count 10,340/mm3 Answer: C Explanation: A) During pregnancy, red blood cell (RBC) production and plasma volume increase, but because plasma volume increases more than RBC volume, the hematocrit decreases NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured Answer: B Explanation: A) It is very important for clients to understand that medication must be taken as directed, even if the client is feeling well. The beta-adrenergic blocking drugs cause bradycardia, not group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken on an empty stomach or with food. 7) A client is scheduled for temporary pacemaker insertion. What instruction will this client need prior to discharge? A) Dizziness is to be expected. B) There are no special precautions. C) Wear a tight-fitting shirt to help hold the pacemaker in place. D) Use battery- powered equipment. Answer: D Explanation: A) When available, battery-powered equipment should be used instead of electrical equipment. Dizziness is not to be expected and should be reported to the healthcare provider. The client should wear loose-fitting clothing. 8) A client with sepsis has a temperature of 40°C. Which dysrhythmia is most likely to occur in this client? A) Bradydysrhythmia B) Tachydysrhythmia C) Wolff-Parkinson-White dysrhythmia D) Long QT dysrhythmia Answer: B Explanation: A) Stressors such as fever, sepsis, and hyperthyroidism may precipitate paroxysmal supraventricular tachycardia, which is a tachydysrhythmia. Fever does not cause bradydysrhythmia. Wolff-Parkinson-White and long QT are both syndromes which are caused by genetic cardiac problems. 9) A nurse caring for a client in the in the intensive care unit (ICU) notes that the client is experiencing a ventricular tachycardia dysrhythmia. Which rhythm is a type of ventricular tachycardia? A) Sinus tachycardia B) Atrial flutter C) Junctional escape D) Torsades de Pointes Answer: D Explanation: A) Torsades de Pointes is a type of ventricular tachycardia. Sinus tachycardia, atrial flutter, and junctional escape are all supraventricular rhythms, not ventricular rhythms. NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured 10) A nurse working in the emergency department is participating in the resuscitation of a client experiencing sudden cardiac death. After five cycles of CPR, the nurse evaluates the client's cardiac rhythm as asystole. What is the next action by the nurse? A) Administer epinephrine B) Immediately defibrillate the client C) Assess the cardiac monitor electrodes D) Assess the client's pulse Answer: D Explanation: A) According to the American Heart Association (AHA) CPR guidelines, after five rounds of CPR, the nurse should assess the client's pulse. All other choices are incorrect actions by the nurse. 11) Which property of cardiac cells is mechanical in nature? A) Automaticity B) Excitability C) Conductivity D) Contractility Answer: D Explanation: A) Cardiac cells have five unique properties. Four of these properties are electrical: automaticity, excitability, conductivity, and refractoriness. The fifth property is cardiac muscle's mechanical response to electrical stimulation: contractility. 12) Which dysrhythmia is most commonly associated with sudden cardiac death (SCD)? A) Atrial flutter B) Ventricular fibrillation C) Paroxysmal supraventricular tachycardia D) Junctional escape rhythm Answer: B Explanation: A) Ventricular fibrillation most commonly leads to sudden cardiac death. The other dysrhythmias are not normally associated with SCD. 13) The nurse is caring for a 6-year-old child when the child goes into cardiac arrest. When performing compressions for CPR, what should the nurse do? A) Place thumbs side by side and perform compressions below the nipple line B) Use two fingers in the upright position to perform compressions C) Use two fingers plus the heel of the other hand to perform compressions D) Use both hands on the lower half of the breastbone to perform compressions NURS Exemplar 6.B: Acute Kidney Injury questions and answers A+2023 Pass assured Answer: C Explanation: A) When performing CPR on neonates, thumbs should be placed side by side, or overlapping in very small neonates, and compressions should be performed below the nipple line. For infants, two fingers placed in the upright position should be used for compressions. For children, the provider should use two fingers plus the heel of the other hand to perform compressions. For adults, use both hands on the lower half of the breastbone to perform compressions.