Exam Review
- A nurse is teaching a client with a partial-thickness wound how to wear the elastic pressure garment. How often should the nurse instruct the client to wear this garment?A)During waking hours for 2 to 3 months after the injuryB)4 to 6 hours a day for 6 monthsC)Only at night while sleeping for a year after the injuryD)Continuously
- The nurse assesses a 72 kg client six hours after a thermal burn covering 50% of the client's total body surface area. Of the findings listed below, which is the most important to communicate to the health care provider?A)Cardiac monitor shows a pulse rate of 204B)Serous exudate is leaking from the burnsC)Urine output is 20 mL for the past 2 hoursD)Blood pressure is 94/50 per arterial line.
- The nurse is assessing the client with a circumferential burn to the left upper extremity. The nurse anticipates the performance of an escharotomy with which of the following assessment findings?A)Loss of distal pulsesB)Increased capillary refillC)Increased sensitivity to pain in the areaD)Limited range of motion
- A 72 kg client with 60% severe thermal burns has crystalloid fluid replacement ordered using the American Burn Association (ABA) formula. The nurse will initially set the IV pump at ________ mL/hr for the first 8 hours.A)4320B)1667C)540D)1080
Exam Review
- A nurse is caring for a client with 25% full thickness burns on the arms, face, neck and shoulders. The client's voice is hoarse and has a brassy cough. These finding indicate that the client most likely hasA)pulmonary edema.B)pneumonia.C)inhalation injury.D)carbon-monoxide poisoning
- The severity of each burn injury is determined by which of these factors?A)Depth of the burn, weight of the clientB)Gender of the client, duration of the burnC)Depth of the burn, presence of inhalation injuryD)Amount of surface area of the body that is burned, gender of the client
- A client is brought to the emergency department with partial-thickness and full-thickness burns on the anterior surface of both arms and anterior trunk. Using the Rule of Nines, what is the total body surface area that has been burned?A)36%B)18%C)30%D)27%
- A client in the emergent/resuscitative phase of a burn injury has had blood work and arterial blood gases drawn. Upon analysis of the client's laboratory studies, the nurse will expect the results to indicate what?A)Hypokalemia, hypernatremia, and hypoalbuminemiaB)Hyperkalemia, hypernatremia, and hyperalbuminemiaC)Hyperkalemia, hyponatremia, and metabolic alkalosisD)Hyperkalemia, hyponatremia, and metabolic acidosis
Exam Review
- Twenty hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client forA)bone marrow transplantB)immediate dialysis to prevent damage to the new kidney.C)high-dose intravenous cyclosporin therapy.D)removal of the transplanted kidney.
- A client in neurogenic shock secondary to a spinal cord injury continues to have a mean arterial pressure (MAP) of 50 mmHg. To assess for the onset of acute kidney injury, what laboratory findings should be reviewed?A)Creatinine level, blood urea nitrogen (BUN) level, and urine specific gravityB)Alkaline phosphatase level, creatinine level, and blood urea nitrogen levelC)Urine specific gravity, albumin level, and alkaline phosphate levelD)Serum albumin level, alkaline phosphate level, and blood urea nitrogen level
- A client who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?A)Phosphate levelB)Cardiac rhythmC)Urine outputD)Calcium level
- A client with severe heart failure develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal ofA)preventing hypertensionB)diluting nephrotoxic substances.C)replacing fluid volume.D)maintaining adequate cardiac output.
Exam Review
- When a client is in the diuretic phase of acute kidney injury, the nurse must monitor for which serum electrolyte imbalances?A)Hyperkalemia and hypernatremiaB)Hypokalemia and hypernatremiaC)Hyperkalemia and hyponatremiaD)Hypokalemia and hyponatremia
- Which condition most likely caused pre-renal acute kidney injury?A)UreterolithiasisB)Heart failureC)lomerulonephritisD)Aminoglycoside toxicity
- You are caring for a client who has suffered a severe crush injury yesterday and now has decreasing urine output. The urine is now a dark cola color. You suspect the client is developing acute kidney injury as a direct result ofA)acute glomerulonephritisB)myoglobinuria.C)embolus in a renal artery.D)bilirubinemia.
- Which of the following assessment findings or results will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate for a client with chronic kidney disease?A)Creatinine clearanceB)Blood pressureC)Neurologic statusD)Phosphate level
Exam Review
- A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?A)Aspirate from the catheter using a 60 ml syringeB)Flush the catheter with 50 mL of additional dialysateC)Advance the catheter 2 to 4 cm further into the peritoneal cavityD)Reposition the client to facilitate drainage
- Which of the following are complications the nurse should monitor for during dialysis?A)Hyperphosphatemia, a change in the LOC, and dysrhythmiasB)Dysrhythmias, hypertension, and a change in the LOCC)Hypertension, muscle cramping, and nauseaD)Muscle cramping, dysrhythmias, and hypotension
- A 55-year-old male client is admitted with a diagnosis of acute hepatitis B with fever. Which of the following orders should the nurse question?A)Encourage fluid intake as tolerated.B)Acetaminophen 1 gm Q4 hrs for feverC)Low protein dietD)Bed rest
- Which of the following clients are at risk for hepatitis D?A)Clients with hepatitis BB)Clients with hepatitis EC)Clients with hepatitis CD)Clients with non viral hepatitis
Exam Review
- A client who has advanced cirrhosis is receiving lactulose. Which finding by the nurse indicates that the medication is effective?A)The client denies nausea or anorexia.B)The client's bilirubin level decreases.C)The client is alert and oriented.D)The client has at least one stool daily.
- When assessing a client with portal hypertension, the nurse should be alert for life threatening indications ofA)hemorrhage from esophageal varices.B)liver abscess.C)hemorrhage from duodenal diverticulitisD)small bowel obstruction
- Which of the following drugs is administered to promote hemostasis and control active bleeding in esophageal varices?A)LactuloseB)VasopressinC)PropranololD)Neomycin sulfate
- A client with cirrhosis has an episode of bleeding esophageal varices that is controlled with administration of vasopressin and endoscopic sclerotherapy. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor serumA)ammonia levelsB)potassium levels.C)bilirubin levels.D)creatinine levels