FUNDA LECTURIO Flashcards
1
Q
Before administering a diuretic to a client, what should the nurse assess?
A
Blood pressure
2
Q
What essential laboratory parameter should the nurse evaluate before administering fast-acting insulin
A
Blood sugar
3
Q
What should the nurse anticipate when digoxin is given to a client with low serum potassium?
A
An increased risk of toxicity from the medication
4
Q
What is a possible side effect of a rapid infusion of vancomycin?
A
Flushing
5
Q
What should the nurse ask the client about to properly evaluate the risk of drug interactions?
A
Over-the-counter medications or herbal supplements taken, Current medications prescribed by the health care provider, Vitamins and minerals taken without prescription, Nutritional and medication allergies
6
Q
What precautions should the nurse educate their client about when they prescribed a central acting antihistamine drug like diphenhydramine?
A
Do not mix diphenhydramine with other central nervous system depressants like alcohol
7
Q
What is the best source of information when a question arises regarding the potential interaction of a medication?
A
A pharmacist
8
Q
What should the nurse do when a client has an allergy or contraindication to a drug that a health care provider has prescribed?
A
Hold the medication and contact the health care provider
9
Q
What is the primary reason for evaluating the effectiveness of a drug after administration?
A
It confirms if the drug is achieving its intended action
10
Q
What blood test would the nurse expect a health care provider to order for a client’s partial pressure of oxygen (PaO2) levels?
A
Arterial blood gases (ABG)
11
Q
Supplemental oxygen is considered a medical treatment. What should the nurse understand about administering supplemental oxygen to a client?
A
It is a drug and must be ordered by a health care provider
12
Q
What are signs of significant respiratory problems?
A
Tachypnea, Wheezing stridor and moaning, Flaring of nostrils with breathing, Pursed-lip breathing
13
Q
What would the nurse expect when applying a pulse oximeter(SaO2) to a client with Raynaud’s disease?
A
Poor perfusion in fingers and toes will not give an accurate SaO2 reading
14
Q
What is less invasive and indirect measure to monitor a client’s ratio of oxyhemoglobin to deoxyhemoglobin level?
A
Pulse oximetry (SaO2)
15
Q
What does the pulse oximetry, or SaO2 represent?
A
The percentage of oxygen saturation of hemoglobin
16
Q
What type of oxygen delivery system would likely be needed by a client with chronic obstructive pulmonary disease and stable respiratory patterns and rate?
A
The client needs a low flow system, such as a nasal cannula
17
Q
What are the examples of high flow supplemental oxygen?
A
Mechanical ventilations, Continuous positive airway pressure(CPAP), Nebulizer, Bilevel positive airway pressure (BIPAP)
18
Q
What is the difference between low flow and high flow supplemental oxygen?
A
Low flow systems provide oxygen at flow rates that are lower than client’s inspiratory demands
19
Q
Which statements regarding the proper handling and storage of portable oxygen tanks are true?
A
Oxygen in a cylinder is stored under pressure and if damaged it can become a missile and shoot off at a high speed, Oxygen tanks should always be stored in a stand or cart, Portable oxygen tanks should never be left freestanding
20
Q
The flow meter is an instrument connected to the wall that is intended for delivering and measuring the amount of oxygen being administered. What do the numbers on the flow meter indicate?
A
Liters per minute
21
Q
What is the average percentage of oxygen in breathable room air (FiO2)?
A
21%
22
Q
If a client will receive high flow oxygen for more than 24 hours, what should the nurse consider an appropriate nursing intervention to help tolerate the oxygen?
A
Humidify the oxygen
23
Q
What are the indicated flow rates in liters per minute(LPM) when using nasal prongs?
A
1-6 LPM
24
Q
Which actions are appropriate for the nurse to take when applying a nasal cannula to a client?
A
Wrap the tubing with fabric or foam tape to help alleviate uncomfortable friction behind the ears, Check the cannula size is not too big or too small for the client’s nose, Turn the cannula so the prongs are curved downward into the client’s nose
25
Every increase of 1L/min oxygen equates to about what percentage increase in fraction of inspired oxygen (FiO2)?
4%
26
How many liters per minute of oxygen can be delivered when applying a simple face mask to a client?
5-10 LPM
27
Why are the partial rebreather oxygen masks not able to deliver 100% oxygen concentration?
They lack a one-way valve to prevent expired air from returning to the client
28
What features of a non-rebreather mask should the nurse understand when considering oxygenating clients with a non-rebreather mask?
Prolonged periods of over oxygenating at 15 liters per minute can be harmful, They can be used for clients who severely hypoxic but can ventilate well, They can be set between 10 and 15 liters per minute, Flow must be sufficient to keep the reservoir bag from deflating upon inspiration
29
Unlike simple masks what feature do reservoir masks have to prevent the client from inhaling expired air?
One-way valves
30
Which type of oxygen administration methods can deliver 100% oxygen?
Ventilator, Tightfitting non-rebreather masks
31
Partial rebreather and non-rebreather reservoir masks are indicated in which types of clients?
People with serious respiratory conditions in need of higher concentrations of oxygen
32
What are examples of low flow oxygen delivery methods?
Nasal cannulas, Reservoir masks, Simple face masks
33
What is another term for a Venturi mask?
Air entertainment mask
34
What is the medical term for surgically created opening in the neck where a tube is inserted to deliver air?
Tracheostomy
35
What is common non-invasive ventilation method used to treat clients with chronic obstructive pulmonary disease and acute respiratory distress syndrome exacerbations?
Bilevel positive airway pressure (BiPAP)
36
What is a common non-invasive ventilation method used to treat clients with obstructive sleep apnea and acute pulmonary edema?
Continuous positive airway pressure (CPAP)
37
What is a popular method of adult respiratory management in both the emergency department (ED) and the intensive care unit that is increasingly used in pediatric units?
Non-invasive ventilation
38
What is functional residual capacity(FRC)?
Increased volume of air present in the lungs at the end of passive expiration to reduce alveolar collapse
39
What are the usual settings for continuous positive airway pressure?
5, 7.5, and 10 cm of H2O
40
What is the purpose of continuous positive airway pressure?
Deliver continuous positive pressure to reduce alveolar collapse
41
With which interdisciplinary team member should the nurse collaborate regarding a client's bilevel positive airway pressure machine?
Respiratory therapy staff
42
What are the potential client risks when setting the inspiratory pressure > 20-25 cm H2O?
Aspiration, Decreased diaphragmatic excursion, Gastric distention
43
What is usually the expiratory pressure setting for bilevel positive airway pressure?
4-6 cm H2O
44
What does the acronym BiPAP stand for?
Bilevel positive airway pressure
45
What physician led intervention should the nurse anticipate if a client is not responding to bilevel positive airway pressure within the first 20-40 mins?
Perform endotracheal intubation
46
What are the benefits to non-invasive positive pressure ventilation?
Less need for invasive endotracheal intubation, Greater improvements in the first hour after treatment, Shorter length of stay in the hospital, A lower mortality rate
47
Why are Venturi masks especially helpful for clients with chronic obstructive pulmonary disease?
They offer precise O2 measurement
48
Which chamber of the heart pumps blood through the pulmonary circuit?
Right ventricle
49
Which chamber of the heart pumps blood through the systemic circuit?
Left ventricle
50
Which chamber of the heart receives blood returning from the systemic circuit?
Right atrium
51
Which chamber of the heart receives blood returned from the pulmonary circuit?
Left atrium
52
Which part of the heart receives oxygen-poor blood from the tissues?
Right side
53
Which part of the heart receives oxygenated blood from the lungs?
Left side
54
What is the most superficial layer of the heart?
Fibrous Pericardium
55
What is the function of the superior vena cava?
Returns blood from body regions above the diaphragm into the right atrium
56
What is the function of the inferior vena cava?
Returns blood from body regions below the diaphragm into the right atrium
57
What is the function of the coronary sinus?
Returns blood from coronary veins into the right atrium
58
What is the tricuspid valve's main function?
Atrioventricular valve that separates the right atrium and right ventricle
59
What is the bicuspid valve's main function?
Atrioventricular valve that separates the left atrium and the left ventricle
60
What is the aortic valve's main function?
Semilunar valve that separates the left ventricle and the aorta
61
What is the pulmonary valve's main function?
Semilunar valve that separates the right ventricle and the pulmonary trunk
62
What is contained within the myocardium?
Circular or spiral bundles of contractile cardiac muscle cells
63
What is the purpose of chordae tendineae?
To anchor the cusps of the atrioventricular valves to papillary muscles to promote stabilization of the valve as the heart pumps blood
64
Which structure returns blood below the diaphragm?
Inferior vena cava
65
Which characteristics are associated with the pulmonary circuit?
Transport of oxygenated blood, Short low-pressure circulation, Transport of deoxygenated blood
66
Which characteristics are associated with the coronary circulation?
It creates a functional blood supply to the heart, It has the shortest circulation in the body, It is delivered when the heart is relaxed
67
Which is the term used to describe the part of the heart that is encircled by the left and right coronary arteries?
Coronary sulcus
68
Which are the different types of myocytes?
Pacemaker and Contractile cells
69
Which characteristics are associated with cardiac muscles?
Interconnected, Striated, Branched
70
What holds cardiac cells together and prevents them from separating during contraction?
Desmosomes
71
How are cardiac muscles different from skeletal muscles?
Cardiac muscles have more mitochondria, Cardiac muscles are more adaptable to other fuels, Cardiac muscles need oxygen to function
72
Which part of the brain is responsible for sending signals to the heart?
Medulla oblongata
73
What part of the heart can be found in the inferior portion of the interatrial septum?
Atrioventricular node
74
What does cardioacceleratory center stimulate in the heart by sending signals through the sympathetic trunk?
Atrioventricular and Sinoatrial nodes
75
What nerve helps parasympathetic signals to decrease the heart rate?
Vagus nerve
76
What is the term for the process that opens fast voltage gated Na+ channels and allows Na+ to enter cardiac muscle cells?
Depolarization
77
What represents the depolarization of the SA node and atria on a ECG?
P wave
78
What represents the beginning of atrial excitation to the beginning of ventricular excitation on an ECG?
P-R interval
79
What represents depolarization of the ventricles on an ECG?
QRS complex
80
What represents the beginning of ventricular depolarization through ventricular repolarization on an ECG?
Q-T interval
81
What represents the time between ventricular depolarization and ventricular repolarization on an ECG?
S-T segment
82
What represents ventricular repolarization on an ECG?
T wave
83
The nurse places their stethoscope on the far left side of the client's chest, below the client's axilla and close to the client's nipple. The student nurse knows that the nurse will be able to hear the opening and closing of which valve the best in this location?
Mitral
84
What is the definition of a cardiac output?
the volume of blood pumped by each ventricle in 1 minute
85
What is the formula for calculating cardiac output?
CO = heart rate x stroke volume
86
What 3 main factors affect stroke volume?
Preload, Contractility, and afterload
87
What is the definition of a cardiac preload?
The degree to which cardiac muscle cells are stretched just before they contract
88
How is contractility defined?
The contractile strength at the given muscle length independent of muscle stretch and end-diastolic volume
89
What is the definition of a afterload?
The pressure that the ventricles must overcome to eject blood
90
Which events occur during isovolumetric relaxation?
Aortic valved is closed, Dicrotic notch occurs, Mitral valve is closed
91
Which mechanical events are part of the diastolic phase of a heartbeat?
Isovolumetric relaxation, Mitral and tricuspid valves are open, Rapid inflow of blood to ventricles
92
What factor that affects the stroke volume is increased by hypertension?
Afterload
93
What is a common manifestation of right-sided heart failure?
Peripheral congestion
94
What is a common manifestation of left sided heart failure?
Pulmonary congestion
95
What congenital heart defect is defined by part of a vessel being narrowed therefore increasing the workload of the left ventricle?
Coarctation of the aorta
96
What progressive condition results in cardiac output so low that the blood circulation cannot meet the tissue requirements?
Congestive heart failure
97
How does age affect a client's heart rate?
As age increases the heart rate decreases
98
How does body temperature affect heart rate?
As body temperature increases heart rate increases
99
What are the 2 main ions that directly affect normal heart function?
Calcium and potassium
100
When the sympathetic nervous is activated, what happens with the parasympathetic nervous system?
It is inhibited
101
When norepinephrine is released, what receptors does it bind to in order to affect the heart rate?
Beta 1-adregenic receptors on the heart
102
How many valves are in the heart?
2 atrioventricular valves and 2 semilunar valves
103
What are the types of circulation?
Pulmonary, Systemic, Coronary
104
What is best description of the function of blood vessels?
To be the delivery system of dynamic structures that begins and ends at the heart and work with the lymphatic system to circulate fluids
105
What is the function of the veins?
To carry deoxygenated blood toward the heart except for pulmonary circulation and the umbilical vessels of a fetus
106
What is the function of the arteries?
To carry oxygenated blood away from the heart except for pulmonary circulation and umbilical vessels of a fetus
107
What is the function of the capillaries?
To have direct contact with tissue cells and directly serve cellular needs
108
What are the terms for the 3 layers that most vessels have?
Tunica intima, tunica media, and tunica externa
109
What is an accurate description of the tunica intima?
The innermost layer that is in intimate contact with blood
110
What is an accurate description of the tunica media?
The middle layer composed mostly of smooth muscle and sheets of elastin
111
What is best description of the tunica externa?
The outermost layer of the vessel wall
112
What are the three groups of arteries?
Elastic arteries, muscular arteries, and arterioles
113
Which group of arteries allows for continuous blood flow downstream even between heartbeats?
Elastic arteries
114
What is another name for arterioles?
Resistance arteries
115
What is another name for muscular arteries?
Distributing arteries
116
Which structures are described as continuous, fenestrated, and sinusoidal?
Capillaries
117
Which type of capillary makes up the blood-brain barrier?
Continuous
118
Which type f capillary is found only in the liver, bone marrow, spleen and adrenal medulla?
Sinusoidal
119
How is capillary bed best defined?
An interwoven network of capillaries between arterioles and venules
120
Which vessels are also called capacitance vessels?
Veins
121
What prevents the backflow of blood in veins?
Venous valves
122
What type of anastomoses provides an alternative pathway to ensure continuous systemic blood flow even if one artery is blocked?
Arterial anastomoses
123
What does the force per unit area exerted on the walls of blood vessels by the blood refer to?
Blood pressure
124
Which term describes the sources that come from blood viscosity, total blood vessel length, and blood vessel diameter?
resistance
125
If the blood pressure gradient increases, what impact does it have on blood flow?
It speeds up
126
If peripheral resistance increases how does that impact blood flow?
It decreases
127
Which term describes the throbbing of arteries due to the difference in pulse pressures that can be felt under the skin?
Pulse
128
Which two factors determine arterial blood pressure?
Elasticity of arteries close to the heart and the volume of blood forced into them at any time
129
What best describes systolic blood pressure?
Pressure exerted in the aorta during ventricular contraction
130
Which best describes diastolic blood pressure?
The lowest level of aortic pressure when the heart is at rest
131
Which formula is utilized to calculate mean arterial pressure?
MAP = diastolic pressure + 1/3 x pulse pressure
132
What is considered the normal pressure measurement for systolic blood pressure?
90-120 mm Hg
133
What is considered the normal pressure measurement for diastolic blood pressure?
60-80 mm Hg
134
Which factors are responsible for aiding the return of venous blood?
Respiratory pump, muscular pump, sympathetic venoconstriction
135
What are the three main factors that regulate blood pressure?
Total peripheral resistance, cardiac output, blood volume
136
What can decrease blood pressure by antagonizing aldosterone?
Atrial natriuretic peptide
137
Which structures are involved in neural control of blood pressure via reflex arcs?
Baroreceptors, Cardiovascular center of medulla, chemoreceptors
138
What is the cardiovascular center composed of?
Parasympathetic and sympathetic neurons, medulla oblongata
139
Which functions are directly stimulated by arteriolar vasodilation?
reduces peripheral resistance, decreases mean arteriole pressure
140
Which renal blood pressure mechanism functions independent from hormones?
Direct
141
What is the difference between primary and secondary hypertension?
Primary hypertension has no underlying cause and secondary hypertension has an identifiable disorder causing the hypertension
142
What type of shock occurs when blood vessels inadequately fill and blood distribution through the body is impaired?
Circulatory shock
143
Which factors listed can influence blood pressure?
Weight, stress, changes in physical exertion, changes in posture
144
What is usually a hint of poor nutrition and a warning sign of Addison's disease?
Chronic hypotension
145
Which hormone directly causes increased NaCl absorption in the kidney in response to low blood pressure?
Aldosterone
146
What type of shock is a result of extreme vasodilation and decreased peripheral resistance?
Vasogenic shock
147
What happens in the brain when the pH decreases or carbon dioxide concentrations increase?
Marked vasodilation
148
Which parts of the body are involved in the systemic circulation?
Aorta, superior vena cava, inferior vena cava
149
Which tunics are contained in blood vessels?
tunica media, intima, externa
150
Where is the velocity of blood flow fastest?
Aorta
151
What type of pressure is inconsequential?
Interstitial fluid colloid osmotic pressure
152
What system returns interstitial fluid to the blood?
Lymphatic system
153
The QRS complex reflects which event?
Ventricular depolarization
154
The T wave corresponds to which of the following?
Ventricular repolarization
155
The P wave corresponds to which of the following?
Atrial depolarization
156
Which of the following is true of the U wave?
Commonly seen in hypokalemia
157
Which of the following describes the electrical conduction pathway of the heart?
SA node --> atrium -->AV node --> His-Purkinje system --> ventricles
158
Which of the following is the normal pacemaker of the heart?
The SA node
159
Which of the following statements regarding the precordial ECG lead system is FALSE?
All of the leads are placed on the same side of the sternum
160
On an ECG what is the range in degrees of a normal axis?
between -30 and 90 degrees
161
On an ECG how many small boxes are in each large box?
5
162
On an ECG how many seconds does each large box represent?
0.20 seconds
163
On an ECG how many seconds does each small box represent?
0.04 seconds
164
Which of the following is the most appropriate way to ascertain the heart rate on an ECG?
Counting the big boxes between 2 QRS complexes and dividing 300 by that number
165
The standard voltage calibration is such that 10 mm is equal to how many mV?
1.0 mV
166
Interpreting an ECG requires a systemic approach. Which of the following would not be included in such an approach?
Avoiding comparison with prior tracings
167
A 22 year old man presents to the emergency department with anterior chest pain. He is the captain of his university boxing team. The chest discomfort occurs several times each day and lasts for 1-2 hours. On physical exam, his sternal area is tender, and he admits to receiving several blows there during a recent boxing match. His ECG is unremarkable. Which of the following statements regarding this case is false?
There is still suspicion of myocardial infarction
168
Which of the following indicates the proper order of the waves in an electrocardiogram?
P wave --> PR segment --> QRS complex --> ST segment --> T wave
169
A Q wave that develops in an ECG during an MI represents which of the following?
Regions of infarcted myocardial tissue
170
What is the percentage distribution of body fluids?
60% intracellular / 40% extracellular
171
What are three types of IV solutions?
Isotonic, Hypertonic, Hypotonic
172
What can occur if hypotonic fluid acutely rushes into the cell?
Edema from third spacing, Hypotension, Increased Intracranial pressure
173
What is the normal osmolality range?
270 - 300 mOsm/L
174
What is the term for the concentration of dissolved molecules within a solution?
Tonicity
175
What factors are considered before giving an isotonic solution?
Client's weight, Cardiac function, Age, Amount of fluids
176
Which solution is considered to be the most appropriate to avoid fluid shift?
Normal saline
177
Which solution is isotonic in the bag but hypotonic in the body?
5% Dextrose in water (DW5)
178
Which solutions are hypotonic?
0.45% NS, 0.33% NS, and D2.5W
179
What are the uses for 0.45%(1/2 NS)?
Water replacement, Elevated sodium level, Gastric fluid loss
180
Why are hypertonic solutions useful after surgery?
Provide electrolyte replacement, Reduce the risk of edema, Stabilize blood pressure, Regulate urine output
181
Which solutions are hypertonic?
5% Dextrose in 0.45% Normal saline(D5 1/2 NS) and 5% Dextrose in 0.9% Normal saline(D5NS)
182
What causes hypotonic dehydration?
Salt loss > water loss
183
What is the benefit of 5% Dextrose in Lactated Ringers (D5LR)?
It replaces electrolytes( sodium, potassium, calcium, and sodium lactate)
184
For a patient who has sustained severe abdominal trauma, what is the first concern?
Internal bleeding
185
The nurse cares for a client in ER who was admitted with abdominal trauma following a motor vehicle accident. The client's vital signs are HR 126 bpm, BP 90/58, RR 24 and temp 98.9 degree Fahrenheit. What IV fluid is contraindicated for this trauma client?
0.45% Saline at 100 mL/h
186
What are the classifications of IV solutions?
Hypotonic, Isotonic, Hypotonic
187
Which organ primarily controls the CO2 level in the body?
Lungs
188
Which organ primarily controls the HCO3 level in the body?
Kidneys
189
To differentiate between acidosis and alkalosis, which 3 values from arterial blood gas should the nurse primarily review?
CO2, pH, HCO3-
190
What would lead to acidosis in the body?
An increase in CO2 causing the pH to decrease below 7.35
191
What is the normal range of pH levels in the body?
7.35 - 7.45
192
What is the pH level in a metabolic alkalosis?
Greater than 7.45
193
What is the pH level of respiratory acidosis?
Less than 7.35
194
What does an abnormal arterial blood gas level with an HCO3- greater than 26 mmol/L indicate?
The ABG is more basic and the pH will be greater than 7.45
195
What can a CO2 level greater than 45 mmol/L indicate when interpreting an arterial blood gas test? The nurse is interpreting an arterial blood gas and notices a CO2 level greater than 45 mmol/L. The nurse understands that this means the pH is likely what?
Becoming more acidic
196
A pH level of 7.20 can be described as?
Acidotic
197
What are the causes of not enough CO2 in the body?
Hyperventilation and Overoxygenation
198
What causes a buildup of excess CO2 in the body?
Holding the breath, Suffocation, COPD
199
What is the expected range of HCO3 under normal physiologic conditions?
22 - 26 mmol/L
200
An arterial blood gas level was obtained from a client. Laboratory studies shows:
pH: 7.25 (7.35 - 7.45)
HCO3: 18 (22-26 mEq/L)
CO2: 37 (35-45 mmHg)
The nurse knows that this indicates what?
Metabolic acidosis
201
pH: 7.54
HCO3: 35
CO2: 45
Metabolic alkalosis
202
pH: 7.49
HCO3: 22
CO2 : 24
Respiratory alkalosis
203
pH: 7.29
HCO3: 26
CO2: 68.2
Respiratory acidosis
204
pH: 7.23
CO2: 63
HCO3: 32
Respiratory acidosis, partial compensation
205
pH: 7.50
CO2: 28
HCO3: 18
Respiratory alkalosis, partial compensation
206
pH; 7.22
CO2: 61
HCO3: 24
Respiratory acidosis, no compensation
207
pH: 7.10
CO2: 20
HCO3: 12
Metabolic acidosis, partial compensation
208
pH; 7.51
CO2: 55
HCO3: 41
Metabolic alkalosis, partial compensation
209
pH: 7.20
CO2: 65
HCO3: 29
Respiratory acidosis, partial compensation
210
What is the normal range for PaO2?
80 - 100 mm Hg
211
What can cause respiratory acidosis?
Asthma, Respiratory failure, Pneumonia, COPD
212
What interventions are appropriate for clients with respiratory acidosis?
Steroids/bronchodilators, Monitoring ABG levels, BiPAP/ventilators
213
Which nursing interventions are appropriate for a client in respiratory alkalosis?
Adjust the tidal volume on the ventilator, Address the cause of the client's anxiety if hyperventilating, Have the client breathe into a paper bag
214
What are the causes of metabolic acidosis?
Aspirin overdose, Renal failure, Diabetic ketoacidosis, Indigestion of antifreeze
215
What are the nursing interventions for the prevention and management of metabolic alkalosis?
Using intermittent suction for clients with a long-term nasogastric tube, Using IV fluids for volume replacement, Addressing the underlying cause
216
Which symptoms are considered non-obvious signs of potential renal impairment?
Edema, Hypertension, Uremia
217
Which obvious sign may indicate that a client has a kidney problem?
Gross hematuria and flank pain
218
Which organ is involved in the production and elimination of urea?
Kidneys and Liver
219
Which is the purpose of the blood urea nitrogen test?
Measure how well the kidneys and liver are functioning
220
Which is the normal range for BUN levels?
7-20 mg/dL (2.5 -7.1 mmol/L)
221
Which is the potential cause of high creatinine level?
Chronic kidney disease, Intense exercise, High dietary protein intake
222
What does the serum creatinine level estimate?
Glomerular filtration rate
223
A client who has an estimated glomerular filtration rate of less than 15mL/min may indicate which stage of kidney disease?
Stage 5: end stage renal disease
224
Which statement about the eGFR is correct?
The eGFR can determine the extent of the kidney disease, The eGFR is higher in men than in women, The eGFR is influenced by age sex and body size
225
A urinalysis report can determine which potential condition?
Chronic glomerulonephritis, Nephrotic disease, Asymptomatic hematuria or proteinuria
226
Which urine characteristic can identify on a client's urinalysis report?
Presence of bilirubin and ketones, The pH level, Presence of blood and glucose, Odor and appearance
227
The nurse develops a plan of care for a client diagnosed with renal failure. Which interventions are included in the care plan?
Emphasize the importance of fluid management, Encourage monitoring of blood pressure at home, Discuss ways to manage risks factors of kidney disease
228
Which condition is a potential cause of high blood urea nitrogen levels?
Dehydration, Chronic kidney disease, Duodenal bleeding ulcer
229
For which reason is a BUN test used as a parameter to assess liver function?
The liver breaks down into ammonia which is converted into urea for excretion in urine.
230
Ammonia is excreted from the body by which method?
Ammonia is changed into urea and is excreted by the kidneys
231
Which statement accurately describes deamination?
Removal of the amino group
232
Which complication may result from too much ammonia in the blood?
Brain damage
233
For which reason does the ammonia need to be converted to urea?
Urea is water soluble
234
The nurse reviews the laboratory results of a client diagnosed with liver disease. Which potential changes does the nurse observe in this client's lab result?
Decreased blood urea nitrogen levels, Increased ammonia levels
235
Which statement about the urea cycle is correct?
Urea is produced by the liver and is excreted by the kidneys, The kidneys can excrete urea as it is water soluble, Ammonia is a product of protein metabolism
236
Which assessment findings may indicate high ammonia levels?
Short term memory loss
237
Which assessment findings may indicate that the client is at risk for high blood urea nitrogen levels?
The nurse notes poor skin turgor, A client states "I noticed that my urine is foamy and dark brown in color"
238
The nurse assesses a client who states, "I noticed that my urine is orange in color". Which question is most important for the nurse to ask?
Which medication are you taking?
239
Which is a potential effect of severe dehydration on the kidneys?
The kidneys are not getting adequately perfused with blood
240
Which factor can cause an elevated blood urea nitrogen level?
High protein diet, Urinary tract obstruction, Dehydration
241
Which client's vital sign may indicate dehydration and elevated blood urea nitrogen levels?
A heart rate of 148 beats/min and BP of 79/54 mm Hg
242
For which reason do burns cause elevated blood urea nitrogen level?
Fluid volume shifting
243
Which prerenal cause results in adequate perfusion of the kidneys?
Fluid volume shifting, Dehydration, Hemorrhage
244
Which condition is considered a postrenal cause of acute kidney injury?
Kidney stone
245
Which additional lab work can be used to determine the cause of elevated blood urea nitrogen levels?
Glomerular filtration rate, Albuminuria, Creatinine clearance
246
Which type of medication can falsely elevate BUN levels?
Diuretics, Antiseizure drugs, Antibiotics
247
The nurse reviews the laboratory results of a client who has no history of renal disease and notes an increase in blood urea nitrogen levels and decrease hemoglobin levels in the blood. Which potential condition doe the nurse anticipate this client is experiencing?
Upper gastrointestinal bleeding
248
The nurse is caring for a client diagnosed with severe dehydration. Which assessment finding does the nurse anticipate to observe in this client?
Blood urea nitrogen levels of 32 mg/dL, A heart rate of 140 beats/min, A blood pressure of 82/54 mm Hg
249
The nurse assesses several clients scheduled for follow-up. Which client needs the most urgent care?
A client who reports blood in urine
250
Which statement accurately describes serum creatinine?
A chemical waste product of muscle metabolism, It provides information about the kidney function, It helps estimate the client's glomerular filtration rate
251
Which laboratory value indicates poor kidney function?
Creatinine of 2.0mg/dL
252
Which glomerular filtration rate value indicates kidney failure?
10mL/min
253
Which data is needed for the glomerular filtration rate test?
Stable creatinine levels, client's age, race, gender
254
Which glomerular filtration rate indicates renal disease?
58 mL/min
255
Which factor causes an increase in serum creatinine levels?
Running a marathon, Medical history of chronic kidney disease, Kidney stone
256
Which medication category can increase the client's serum creatinine levels?
Chemotherapy , Histamine blockers, Nonsteroidal anti inflammatory drugs
257
Which statement best describes how intense exercise creatinine levels?
Muscle is broken down which releases creatinine into the serum
258
Which treatment is best for acute kidney injury caused by dehydration?
Intravenous fluids
259
Which condition results when kidney stone obstructs the flow of urine?
Hydronephrosis
260
Which laboratory test when abnormal indicates that half of the nephrons have stopped functioning?
Creatinine
261
Which factor is a potential cause of chronic kidney disease?
An autoimmune response that damages the kidneys, Reduced blood flow to the kidneys
262
Which laboratory test is used to monitor protein in the urine?
Albuminuria 24-hour sample
263
Which factor is a potential cause of elevated serum creatinine levels/
Kidney obstruction, Intense exercise, High amounts of dietary protein
264
Which factor is a possible cause of an elevated blood urea nitrogen levels?
Upper gastrointestinal bleed, Significant dehydration, Renal dysfunction
265
The nurse reviews the laboratory results of a client who has no history of kidney injury and notes an increase in blood urea nitrogen and creatinine levels. The nurse anticipates calculating the client's BUN to creatinine ratio for which reason?
To determine whether the cause is renal or nonrenal
266
A blood urea nitrogen-to-creatinine ratio <12 may indicate which condition?
Liver disease and Malnutrition
267
For which reason does the nurse take the client's BUN to creatinine ratio?
TO assess the cause of the elevated BUN and creatinine
268
Which statement about the creatinine clearance test is correct?
The creatinine clearance test measures the kidney's ability to remove creatinine, Creatinine clearance requires sufficient blood flow to the kidneys
269
Which factor needs to be considered when estimating the client's creatinine clearance?
The serum creatinine must be stable
270
The nurse provides teaching to a client for a 24-hour urine collection. Which instruction does the nurse provide to the client?
After the first void save all the urine that you pass out for 24 hours, At the end of the 24-hour period empty your bladder and collect your urine, Document the date and time that the 24-hour collection started and ended
271
Which factor is a potential cause of the low estimate of creatinine excretion?
Collecting the urine in less than 24 hours
272
Which creatinine clearance results may indicate kidney problems?
Creatinine levels are high in the blood and low in the urine
273
Which value is considered a normal range for creatinine clearance?
97-137 mL/min
274
For which reason does the urine need to be stored in the refrigerator?
to prevent bacterial growth
275
The nurse educates a client about the proper steps for a 24-hour urine collection. Which instruction by the nurse is correct?
At exactly 24-hour empty your bladder collect your urine and send it to the lab, Collect all the urine that pass out during the 24 hours after your first void, Document the date and start time of the collection
276
Which scenario may indicate that the 24-hour urine collection needs to start over?
Spilling some of the collected urine, Placing the urine only at a room temperature, Urine was collected at 0900 when the 24-collection ended at 0800
277
Which factor can impact the results of a 24-hour urine sample?
Drinking coffee, vigorous exercise, acute stress
278
The nurse receives the client's 24-hour urine sample and notes the start time is documented as 0800. For which reason does the nurse determine the client needs to restart the collection?
A client collects the final urine at 0600 the following day
279
For which reason does chronic hypertension cause damage to the nephron?
A high pressure damages the glomerulus
280
Which statement best describes the glomerular filtration rate?
The sum of filtration rates of all functioning nephrons
281
Which glomerular filtration rate may indicate a client has kidney disease?
Less than 60 mL/min
282
Which common factor decreases the client's glomerular filtration rate?
Aging
283
Which client's glomerular rate indicates an end-stage chronic kidney disease?
Less than or equal to 15mL/min
284
Which data is used to estimate the client's glomerular filtration rate?
Serum creatinine test, client's gender, age
285
Which statement about the glomerular filtration rate is correct?
actual numbers are only reported once eGFR is less than 60mL/min
286
The nurse provides instruction to a female client for collecting a clean-catch urine sample. Which instruction does the nurse provide to the client?
Start to urinate and then stop. Place the urine specimen cup and resume the stream
287
Which statement about clean catch urine collection is correct?
The target is to prevent external bacteria from contaminating the urine specimen, The nurse needs to put the label before giving the specimen cup to the client, Uncircumcised male clients must retract the foreskin before cleaning the head of the penis
288
Which statement about clean catch urine collection is true?
The clean catch urine sample is collected by the client
289
Which statement about a dipstick urinalysis?
The urinary dipstick is convenient but less accurate
290
Which factor may be considered an indication for cloudy urine?
There are extra particles in the urine
291
Which value is considered a normal range for urine-specific gravity?
1.010 - 1.030
292
Which statement best describes a urine specific gravity?
The ratio of the density of the substances to the density of water
293
Which factor can increase the specific gravity of urine?
Excessive secretion of antidiuretic hormone, Protein in the urine, Glucose in the urine
294
Which specific gravity result indicates the clearest and least concentrated urine?
1.006
295
Which findings does the nurse expect to observe in the urinalysis results of a client who has a history of chronic glomerulonephritis?
Fixed specific gravity regardless of fluid intake
296
Which statement best explains the reason for the occurrence of an excessive amount of glucose in the urine?
There is too much glucose for the tubules in the nephrons to reabsorb
297
Which client is at risk for glycosuria?
A client receiving high doses of prednisone daily
298
A client has a bilirubin result of 2mg/dL in a recent urinary analysis. Which potential condition does the nurse associate with this finding?
Gallstones in the biliary tract, Liver cirrhosis, Hepatitis, Biliary tract disease
299
Which condition can cause a lower level of urobilinogen in the urine?
Blockage in the common bile duct
300
Which urine analysis result may indicate a client needs further assessment?
Positive ketones, Positive leukocyte esterase, Presence of nitrites, Positive for bacteria
301
Which factor causes nitrites to appear in urine?
Bacteria in the urinary tract
302
The nurse reviews the urinalysis result of a client and notes positive ketones. For which reason does the nurse associate with this finding?
Glucose cannot be used for energy
303
The nurse assessment several clients who have positive bacteria results in urine analysis. Which client needs to be treated for bacteriuria?
A client who reports needing to urinate more frequently than usual, A client who is pregnant and reports no symptoms, A client who reports burning and pain during urination
304
Which is the purpose of microscopic urine analysis?
To clarify urine dipstick findings, To follow up on abnormal findings
305
Which statement about urinary analysis is correct?
Persistent proteinuria requires further evaluation, Urinary dipstick analysis is convenient but not as accurate as urinary analysis, Urine specimens must be examined within two hours of collection
306
Who is at risk for proteinuria?
Clients that are Hispanic, Clients diagnosed with diabetes, Clients diagnosed with hypertension
307
Which statements about proteinuria are true?
Sustained proteinuria is a sign of kidney disease, Protein maintains intravascular fluid pressure
308
What should be the maximum amount of protein present in urine?
30 mg/g
309
Which statements about using the urine dipstick to test for proteinuria are true?
The urine dipstick grading grading ranges from negative to 4+, The urine dipstick can detect proteinuria at concentration of 10-20 mg/dL, The urine dipstick proteinuria results are impacted by urine concentration
310
What information can a urine dipstick give on proteinuria?
The amount of protein in the urine, The sample is positive in the urine
311
What is the range of protein for a 24-hour urine test?
<150 mg in 24 hours
312
What conditions can cause proteinuria?
Excessive hemoglobin in the blood, Preeclampsia, Injury to the prostate or urethra
313
Which statement about preeclampsia is true?
Preeclampsia can result in seizures
314
Which clients should be tested regularly for proteinuria?
A client whose mother has chronic kidney disease, a client diagnosed with diabetes, A client diagnosed with hypertension
315
Why do neonates have lower urine specific gravity results?
Neonates' kidneys cannot efficiently concentrate urine
316
What does it mean when a urine specific gravity result is high?
The urine is more concentrated
317
What is the purpose of the urine specific gravity test?
Compares the ratio of the concentration of urine to the concentration of water
318
A client has a urine specific gravity result of 1.053. What condition could cause this result?
Hypovolemic shock
319
What urine specific gravity result reflects excessive fluid intake?
1.004
320
Which statement about urine specific gravity test is true?
It compares the density of urine to the density of water
321
What vital signs would the nurse anticipate in a client that severely dehydrated?
Blood pressure of 90/60 and heart rate of 124 bpm
322
A client has a heart rate of 142 bpm and blood pressure of 84/56. What urine specific gravity result would correspond with this data?
1.045
323
What urine specific gravity results corresponds to urine that appears to be pale straw color?
1.010
324
What assessment findings are expected in a severely dehydrated client?
High urine specificity gravity and Dark urine
325
What medication can cause a client to develop a fluid imbalance in the hospital setting?
Receiving normal saline intravenously
326
Which statement about urine specific gravity is true?
The higher the specific gravity the more concentrated the urine is
327
A client has urine that appears to be syrupy brown. What urine specific gravity would correspond to the urine's appearance?
1.048
328
What intravenously administered medications should be discontinued before testing urine specific gravity?
Dextran, Sucrose, Contrast dye
329
What substances in urine can cause a high urine specific gravity?
Bacteria, Protein, Red and white blood cells
330
Which serum lab result could indicate that the client's urine specific gravity is high?
Glucose 345 mg/dL
331
What can cause a high urine specific gravity?
Multiple bouts of vomiting and diarrhea, Atherosclerosis of the renal artery, Increased secretion of antidiuretic hormone
332
How does congestive heart failure cause a high urine specific gravity?
The kidneys do not get perfused
333
What can cause a high urine specific gravity result?
Dehydration
334
A client has a urine specific gravity result of 1.010 for three days in a row. WHat is this an indicator of?
The kidneys cannot concentrate urine
335
The client's urine appears transparent. What urine specific gravity result will support this assessment?
1.003
336
What is psychogenic polydipsia?
Psychological disorder that result in extreme thirst
337
What are causes of low urine specific gravity?
Decreased secretion of antidiuretic hormone, Inflammation in the kidneys, Extreme thirst
338
What is fixed urine specific gravity?
A client's result are the same multiple times in a row regardless of fluid intake
339
Which statements about low urine specific gravity are true?
Hypertension causes damage to the kidney which results in low urine specific gravity, Fixed urine specific gravity is an unchanged result regardless of fluid intake, Decreased secretion of antidiuretic causes a low urine specific gravity
340
Religion and spirituality are the same
False
341
Which of the following is true of the resting metabolic rate?
It is easier to calculate than basal metabolic rate because the patient is not fasting
342
Which of the following statements concerning basal metabolic rate is correct?
Body fat % is essential to use the Katch-McArdle formula
343
What percentage of total energy expenditure is accounted for by the thermic effect of feeding?
10
344
How many calories are there in a 1 gram fat?
9
345
Which of the following effects makes disulfiram a good choice for treatment of alcohol dependence?
It discourages drinking by inhibiting the breakdown of acetaldehyde
346
At rest, which organ consumes as many calories as all the skeletal muscle?
Brain
347
which of the following is a criticism of BMI?
It does not account for lean body mass
348
After two weeks of dieting, your patient is in a 7000 calorie deficit. Approximately how many pounds of fat should he have lost?
2
349
A patient with BMI > 40 is at risk for all of the following diseases expect?
Type I diabetes mellitus
350
What is the BMI of a woman with a height of 153cm and weight of 60 kg?
25.63
351
Which of the following would a man with waist to hip ratio of 1.2 be more likely to have than a female with a waist to hip ratio of 0.7?
Insulin resistance
352
What is the major side effect of using orlistat?
Steatorrhea
353
A patient comes to you with the complaint of foul smelling greasy tools for the past 6 months. She has no history of melena. Which of the following vitamins would not become deficient in this patient?
Ascorbic acid
354
Which of the following vitamins is most likely to lead to toxicity when ingested in large amounts?
A
355
Which of the following vitamins is not fat soluble
C
356
A patient presents with cracks and sores around the corners of the mouth. He also complains of fatigue and sensitivity to light. A peripheral blood smear reveals normocytic normochromic anemia. Which vitamin is most likely deficient in this patient?
Riboflavin
357
A patient presents to you with ataxia, nystagmus, and is confused. He also consumes large quantities of alcohol. A deficiency in which vitamin is most likely responsible?
Thiamin
358
Which of the following enzymes uses vitamin B1 as a cofactor?
Pyruvate dehydrogenase
359
Which vitamin is a cofactor in niacin production?
Pyridoxine (B6)
360
A person complains that he has a rash around the mouth and neck. He also has diarrhea and has great difficulty remembering things. Which vitamin is most likely deficient in this patient?
B3
361
Which vitamin is used in transamination processes?
B6
362
A patient being treated for tuberculosis comes to you with complaints of walking on pins and needles for the last two weeks. On exam, he has bilateral numbness on the plantar surface of his feet. Most recent labs reveal anemia. Which vitamin is most likely deficient in this patient?
Pyridoxine
363
Which vitamin acts as a co-factor in fatty-acid synthesis?
B7
364
Which vitamin B9 metabolite is needed for the conversion of homocysteine to methionine?
methyltetrahydrofolate
365
Which vitamin is given to pregnant women to prevent neural tube defects in the developing fetus?
Folic acid
366
In which of the following processes is vitamin B9 is involved?
Nucleotide production
367
A person is undergoing chemotherapy with methotrexate. Their complete blood profile revealed and decreased red cell count, decreased hematocrit and raised MCV. They also have high levels of homocysteine. Which of the following vitamins is most likely deficient?
B9
368
Which of the following substances accumulates and ultimately produces demyelination in cobalamin deficiency?
Methylmalonic acid
369
Which of the following anemias is caused by an autoimmune disorder that decrease the stomach's ability to prduce intrinsic factor?
Pernicious anemia
370
A patient had to undergo a gastrectomy due to gastric carcinoma. Which of the following vutamins is likely to become deficient?
B12
371
A vegan patient suffers from macrocytic megaloblastic anemia. Which vitamn is most likely deficient in this patient?
B12
372
a man comes to you with the complaint of poor wound healing and arthralgia. On exam he has bruises all over his body. His gums are bleeding and swollen. Which of the following vitamins is mst likely dificient?
Ascorbic acid
373
A patient presents with fever , bone pain, and lethargy. He also suffers from frequent infections and bleeding from the gums and nose. BLast cells were found on bone marrow biopsy. Which of the following vitamins will be helpful in the treatment of his disease?
A
374
A female trying to conceive comes to you with acne problems. You will avoid giving her which vitamin for acne treatment due to its tetragenic effects on the fetus?
A
375
Which of the following is a common symptom of vitamin A deficiency?
Nyctalopia
376
Newborn are given injections of which vitmamin to prevent bleeding?
K
377
Which clotting factor does not require vit k as a co-factor for its activiation?
Factor XIII
378
Which of the following is a possible manifestation of vit E deficiency?
Premature destruction of red blood cells
379
A mother comes to you with her young son. She has noticed that his forehead looks larger and his legs seems bowed. On exam you notice he has scoliosis. His lab work reveals hypocalcemia.
Rickets
380
Which vitamin can become deficient in infants who are exclusively breastfed?
D
381
What is the recommendned daily amount of carbohydrate consumption in a pregnant lady?
175 grams
382
Which of the following water soluble vits should be taken in greater quantities during the duration of the pregnancy?
B6
383
Which of the following effects in the fetus can come from iodine deficiency during pregnancy?
Mental retardation
384
What amount of additiona calories per day are recommended for a pregnant woamn during the second nd thrd trimesters?
350-450
385
WHich mineral is required in greatest amount in rpregnant women?
Iron
386
WHICh immunoglobulin is present in grreat ammount i breast milk?
IgA
387
How many months should an infant be exclusively breastfed?
Six months
388
Which of the following micronutrients are most essential to considerfor supplementation in older adults?
Vit B12, D, and calcium
389
Which of the following is a complication of nutritioa deficiencies in the elderly?
Slower recovery from illness
390
a young irritable boy comes to you with a protuberant belly thin hair and ulcerating dermatoses. on exmaination he has pitting edema.
Protein
391
Which of the following is not present in Kwashiorkor/
Loss of subcutaneous fat
392
Density in which of the following stages increases to replace REM sleep as we age?
Stage 2
393
When do K-complexes occur during sleep? S
Stage 2 of non-REM sleep
394
Vivid dreams are more likely to occur in which of the following stages?
REM sleep
395
Which of the folowwing drugs is the most appropriate for ptients with narcolepsy and sleepiness severe enough to require medication?
MEthylphenidate
396
Which of the folowwing condutions is associated with decreased iron stores?
Restless leg syndrome
397
Obstructive sleep apea is associated with all except
Weight loss
