ATI MED SURG FINAL EXAM PRACTICE QUESTIONS AND ANSWERS TEST BANK

What is miliary TB - CORRECT ANSWER Where the infection invades the bloodstream and can lead to MODS What are symptoms/complications of miliary TB - CORRECT ANSWER Headaches Neck stiffness Drowsiness Pericarditis Chapter 56 - CORRECT ANSWER What is the only condition that increases serum creatinine levels - CORRECT ANSWER Kidney disease What is the purpose of a VCUG - CORRECT ANSWER To detect whether urine refluxes into ureters as an x-ray is taken while the patient is voiding What should you do as a nurse after a patient has a VCUG - CORRECT ANSWER 1. Monitor the patient for infection for the first 72 hours after 2. Encourage increased fluid intake 3. Monitor urine output What are preprocedure nursing interventions for a patient that is going to have a kidney biopsy - CORRECT ANSWER 1. Review coagulation studies 2. NPO for 4 to 6 hours before What are post procedure nursing interventions for a patient that has had a kidney biopsy - CORRECT ANSWER 1. Monitor vitals 2. Assess dressings and urinary output (hematuria) 3. Review HGB and HCT values 4. Administer PRN pain medication A cystography or cystourethrography are used to discover abnormalities of bladder wall and/or a occlusions of ureter or urethra. What are pre-procedure nursing interventions for these procedures? - CORRECT ANSWER 1. NPO after midnight 2. Administer laxative/enema for bowel preparation the night before the procedure What position should a patient be in for a cystography or Cystourethrography - CORRECT ANSWER Lithotomy position What color urine may come out after a cystography or cystourethrography - CORRECT ANSWER Urine maybe pink tinged What should you do if blood clots are present or urine output is decreased or absent after a cystography or Cystourethrography - CORRECT ANSWER Irrigate urinary catheter with NS What are a retrograde pyelogram, Cystogram, or urethrogram used for - CORRECT ANSWER To identify obstruction or structural disorders of the ureters and renal pelvis of the kidneys by instilling contrast dye during a cystoscopy What is a renography used for - CORRECT ANSWER To assess renal bloodflow and estimate GFR after IV injection of radioactive material to produce a scanned image of the kidneys What should you assess frequently during and after A renography if captopril is given to change blood flow to the kidneys - CORRECT ANSWER BP What is an excretory urography used for - CORRECT ANSWER To detect obstruction, assess for a parenchymal mass, and assess size of the kidney. IV contrast dye is used to enhance images What are preprocedure nursing interventions for a patient that is having an excretory urography - CORRECT ANSWER 1. Increased fluids the day before the procedure 2. Bowel prep 3. NPO after midnight 4. Hold Metformin for 24 hours before procedure What are post procedure nursing interventions for a patient that has had an excretory urography - CORRECT ANSWER 1. Administer parenteral fluid or encourage oral fluids to flush dye 2. Diuretics may be administered to increase dye secretion 3. Follow up creatinine and bun serum levels before Metformin is resumed A nurse is reviewing a patient's laboratory findings for urinalysis. The findings indicate the urine is positive for leukoesterase and nitrates. Which of is an appropriate nursing action? - CORRECT ANSWER Obtain a clean catch urine specimen for culture and sensitivity because this determines the antibiotic that will be most effective for treatment of the urinary tract infection Why would a patient with a history of asthma be at risk for a complication when undergoing excretory urography? - CORRECT ANSWER A patient who has a history of asthma has a higher risk of having an asthma attack as an allergic response to the contrast dye used during the procedure Chapter 57 - CORRECT ANSWER How do you estimate a patient's amount of fluid removed after dialysis - CORRECT ANSWER By comparing the patients preprocedure weight to the post procedure weight How long should invasive procedures be avoided after dialysis - CORRECT ANSWER 4 to 6 hours due to the risk of bleeding related to an anticoagulant How do you check an AV fistula or AV graft for patency - CORRECT ANSWER By checking for thrill or bruit When should you contact the provider after dialysis - CORRECT ANSWER 1. If bleeding from the insertion site last longer than 30 minutes 2. Absence of thrill/bruit 3. Signs of infection What kind of diet should a patient be on after dialysis - CORRECT ANSWER high folate, high protein diet What is disequilibrium syndrome - CORRECT ANSWER Caused by too rapid of a decrease in BUN and circulating fluid volume. It may result in cerebral edema and increased ICP What are signs/symptoms of disequilibrium syndrome - CORRECT ANSWER nausea Vomiting Change in LOC Seizures Agitation Blank, is a risk factor for dialysis disequilibrium and hypotension due to rapid changes in fluid and electrolyte status - CORRECT ANSWER Advanced age What can a nurse do to decrease the risk of disequilibrium syndrome - CORRECT ANSWER 1. Use a slow dialysis exchange rate, especially for older adults and those being treated with hemodialysis for the first time 2. Administer anticonvulsants/barbiturates if needed What is something that a nurse should do for a patient experiencing hypotension from dialysis other than administer IV fluids - CORRECT ANSWER Lower the head of the patient's bed What is peritoneal dialysis - CORRECT ANSWER Involves instillation of a hypertonic solution into the peritoneal cavity. The solution dwells in the peritoneal cavity as ordered by the provider. Drain the solution that includes the waste products. The peritoneum serves as the filtration membrane What color should the dialysate solution be - CORRECT ANSWER Clear, light yellow is expected How much should the outflow be compared to the inflow - CORRECT ANSWER Expected to equal or exceed amount of dialysate inflow (insufficient outflow could mean infection) If a fibrin clot has formed in the peritoneal dialysis catheter what should you do? - CORRECT ANSWER Carefully milk the catheter What are two conditions caused by dialysis - CORRECT ANSWER Hyperglycemia and hyperlipidemia Blank, is a common cause of poor inflow or outflow - CORRECT ANSWER Constipation What position should a patient be in during CCPD and APD treatment - CORRECT ANSWER Supine with head slightly elevated If medications are held before dialysis can they be administered after it is done - CORRECT ANSWER Yes, medications that can be partially dialysed during the treatment should be withheld. After the treatment, the nurse should administer the medication. Why should a patient that is experiencing shortness of breath not receive peritoneal dialysis - CORRECT ANSWER Because they may not be able to tolerate excessive fluids being instilled into their abdomen Chapter 58 - CORRECT ANSWER What are patient indications of end-stage kidney disease necessitating kidney transplant - CORRECT ANSWER 1. Anuria 2. Proteinuria 3. Marked azotemia 4. Severe electrolyte imbalance 5. Fluid volume excess conditions (heart failure, pulmonary edema) 6. Uremic lung What are subjective signs/symptoms of end-stage kidney disease - CORRECT ANSWER Anorexia Fatigue Paresthesia SOB Dry, itchy skin Metallic taste Muscle cramping What are object of signs/symptoms of end-stage kidney disease - CORRECT ANSWER Decreased attention span, seizures, tremor, HF, Edema, dyspnea, hypertension, distended jugular vein's, anemia, vomiting, pulmonary edema, cardiac dysrhythmias, pallor, dry itchy skin, bruising, halitosis and diminished or dark colored urine What is methylprednisone sodium succinate - CORRECT ANSWER An anti-inflammatory and immunosuppressant used to decrease the immune system response of inflammation and rejection of donor kidney What is another immunosuppressant medication used to prevent rejection of the donor kidney - CORRECT ANSWER Cyclosporine A patient has had a kidney transplant is usually dialyzed within blank of the surgery - CORRECT ANSWER 24 hours