Perioperative GU/GI Flashcards
What is a rapid, short-acting, sedative hypnotic benzodiazepine that is used to prevent recall of events under anesthesia because of its amnestic properties?
Midazolam (Versed) is a rapid, short-acting, sedative hypnotic benzodiazepine. It is used to reduce anxiety preoperatively and postoperatively. It also prevents recall of events under anesthesia because of its amnestic properties.
What is the reversal agent for benzodiazepine?
flumazenil
A 54-year-old patient in the PACU woke up wild, agitated, and kept on shouting. Which of the following should the nurse assess first?
Hypoxemia
During an endoscopy procedure, the client suddenly develops muscle rigidity and tachycardia. The nurse should anticipate administration of what medication?
Dantrolene
If the patient has the early manifestations or malignant hyperthermia, the surgery surgery must be terminated and administer I.V. Dantrolene.
You are caring for a client who arrived in the PACU following an abdominal surgery. You noticed that the client is not responding to verbal stimuli. How should you position the patient to decrease the risk for aspiration?
turn our patient to the side or lateral recovery position
This is going to be easier for them to expectorate if they are at high risk for aspiration. If they’re conscious, they’re okay to be supine or semi-fowlers because it’s expected that they can project whatever they need to if they are vomiting.
The CDC recommends health care workers use ____________ for hand washing when providing care to a client who is immunosuppressed.
chlorhexidine
A 25-year-old male is brought to the emergency department after a car accident. Patient name is unknown. He is unconscious with a severe head injury and multiple fractures. Which of the following is the best action knowing that an emergency craniotomy is required?
a. Instead of a signature on the consent, obtain the fingerprint of the patient.
b. Quickly secure a court order for the emergency operation.
c. Transfer the patient to the O.R. for surgery.
c. In some cases like in trauma situations where the patient comes in unidentified and is in a life threatening situation that requires surgery, the healthcare provider may begin treatment without written consent, as long as documentation and medical necessity for the procedure is indicated. The physician has the privilege to practice medicine and do treatment that he feels is necessary for saving the patient’s life.
Which of the following herbs can lead to excessive sedation?
a. Kava.
b. Garlic.
c. Aloe.
Kava and valerian can lead to excessive sedation. If the patient is taking any herbal products, we need to address that with our physician. The only person who can tell the patient when to stop the medication is the physician.
Checking for allergies is part of your preoperative nursing assessment. Patient who is allergic to eggs, avocado, banana, and kiwi have an increased risk for hypersensitivity reactions to what product?
Latex
While doing preoperative review of systems, the patient shared that he has a history of kidney problems. Which of the following preoperative diagnostic tests need to be done for this patient?
BUN, serum creatinine, and electrolytes are used to assess renal function and should be evaluated before surgery. ABGs are used to check oxygenation status and CBC is for fluid status, anemia, and immune status.
A patient scheduled for a surgery is NPO. but ingests a breakfast tray with clear liquids at 8 AM on the day of surgery. The procedure is scheduled at 1 PM. What response does the nurse expect when the anesthesia care provider is notified?
The preoperative fasting recommendations indicate that clear liquids may be taken up to 2 hours before surgery for healthy patients undergoing elective procedures.6 hours for solids
What is the first consideration in the physical environment of the surgical suite?
Although all of the factors listed are important to the safety and well-being of the patient, the first consideration in the physical environment of the surgical suite is primarily designed to maintain medical and surgical asepsis. We want to promote the prevention of transmission of infection to the patient.
You are transporting a patient for a left knee arthroscopy to the surgical department. Which area of the surgical department are you able to access?
The unrestricted areas are the locations where persons in street clothes or attire other than surgical scrub clothing can interact with personnel of the surgical suite. This includes the holding area, nursing station, control desk, or locker rooms.
The respiratory rate of the postoperative patient who has an epidural infusion of morphine sulfate is 8 breaths per minute. What is the medication that the nurse could anticipate administering?
Naloxone
Which of the following is a short-acting barbiturate that is most commonly used for induction of general anesthesia?
Thiopental is a short-acting barbiturate that is most commonly used for induction of general anesthesia. Nitrous oxide is a weak gaseous anesthetic that is rarely used alone. Isoflurane is a volatile liquid inhalation agent.
Inhalation agents have a fast onset and fast elimination. During the early in the anesthesia recovery period, what should the nurse anticipate the patient will need?
analgesic
The volatile liquid inhalation agents have very little residual analgesia and when the agents are discontinued, patients experience early onset of pain. Due to its fast elimination, prolonged respiratory depression is not common with low incidence of nausea and vomiting.
What is the method of local anesthetic administration where the anesthetic agent is injected into space around the vertebrae?
An epidural block involves injection of a local anesthetic into the epidural space via a thoracic or lumbar approach.
What is the method of local anesthetic administration where the anesthetic agent is injected into subarachnoid space?
Spinal anesthesia involves the injection of a local anesthetic into the cerebrospinal fluid found in the subarachnoid space, usually below the level of L2.
A 27-year-old patient needs realignment of a fracture in the emergency department. The patient is going to be placed under moderate sedation. The patient’s wife asks about this anesthesia. What should be the nurse’s response?
a. This anesthesia includes inhalation agents that enter the body through the alveoli in the lungs.
b. This anesthesia will keep the patient responsive and breathe without assistance.
c. This anesthesia causes loss of sensation, consciousness, and reflexes.
Moderate sedation uses sedative, anxiolytic, and/or analgesic medications. Inhalation agents are not used. It is not going to cause loss of sensation, consciousness, and reflexes.
Which of the following conditions should the nurse anticipate to occur during the administration of spinal anesthesia?
Patients receiving spinal anesthesia should be closely observed for signs of autonomic nervous system blockade. These include hypotension, bradycardia, nausea, and vomiting. A spinal headache may occur after, not during. Loss of consciousness and seizures indicate I.V. absorption overdose.
During your preoperative assessment with a patient for an abdominal surgery, you were able to take note that the patient has a family history of malignant hyperthermia. Which of the following is likely to happen next?
The patient known or suspected to be at risk for this disorder can be anesthetized with minimal risks if appropriate precautions are taken. Dantrolene (Dantrium) is given as a treatment for malignant hyperthermia, not as a preventive measure. The cooling blanket would have no effect.
During the patient’s recovery from anesthesia, when should the nurse begin orientation explanations?
The nurse should explain all activities from the time of admission to the PACU to prevent agitation during the patient’s recovery from anesthesia.
Which of the following actions should the nurse do in order to promote effective coughing, deep breathing, and ambulation postoperatively after the patient complains of discomfort to the incisional site?
pain meds
Syncope or fainting frequently occurs as a result of postural hypotension when the patient ambulates. How can the postoperative complication of syncope be prevented?
Syncope can be prevented by slowly making changes in the patient’s position.
The patient’s scheduled for surgery got delayed from noon to 2:00 PM. How will the nurse plan to administer the preoperative prophylactic antibiotic?
Antibiotics are usually given 60 minutes before the surgical procedures. Immunocompromised patients and geriatrics are at higher risk for infection. They may receive antibiotics prophylactically before the procedure versus somebody who may come in for elective breast reconstruction surgery.
A male patient who has arrived in the preoperative holding area is scheduled for computed tomography with contrast. When preparing the patient for this test, the nurse should:
Check contrast media that contain iodine as an ingredient. Shellfish also contain significant amounts of iodine. Therefore, a patient who is allergic to iodine will exhibit an allergic response to both iodine containing contrast media and shellfish. but may proceed with surgery
A diabetic patient had just undergone abdominal surgery. The wound edges separated and the intestines protruded through the wound. Which of the following is the most appropriate immediate nursing action after calling for help?
We need to always call for help first but stay with the patient. Wound evisceration should be covered with sterile dressings moistened with normal saline to prevent drying and necrosis of protruding abdominal organs.
A 35-year-old patient calls the clinic with complaints of severe abdominal pain, cramping, vomiting, bloating, and constipation. Looking at the patient’s history, he had abdominal surgery 3 months ago. What should the nurse most likely suspect as the cause of the patient’s problem?
A band of scar tissue that forms between organs that may occur in the abdominal cavity and cause intestinal obstruction is called adhesion. Contractures shorten the muscle or scar tissue but would not contribute to abdominal symptoms. Evisceration of an abdominal wound would occur sooner after surgery when the wound edges separate and the intestines protrude through the wound.
A 64-year-old patient is scheduled for a cataract surgery. Which of the following is an advantage of performing surgery at an ambulatory center?
Ambulatory surgery is usually more convenient and less expensive. It generally involves less laboratory tests, less preoperative and postoperative medications, less psychological stress, and less susceptibility to hospital acquired infections.
These herbal products are to be avoided because they increase the risk of what possible surgical problem?
Garlic, ginkgo biloba, and fish oils should be avoided by a patient before undergoing surgery.
You are taking care of a postoperative patient with a prescription for dressing changes every 4 hours and as needed. ______________ ______are adhesive strips that are to be used to reduce skin irritation around the incision area.
Montgomery straps are adhesive strips applied to the skin on either side of the surgical wound. The strips have holes so the two sides of the dressing can be tied together and re-opened for dressing changes without having to remove the adhesive strips. Montgomery straps are mostly for abdominal incisions but still require frequent dressing changes. If unavailable, the nurse can place strips of hydrocolloid dressing
A nurse taking care of an older adult postoperative patient who received a spinal anesthesia during knee surgery. The nurse understands that a systolic blood pressure change from 140 mm Hg to 110 mm Hg should be reported because it is a potential for ______.
shock
A patient who had an episode of intraoperative bleeding and now has increased in the heart rate from 86 to 110 per minute may be developing ________ shock.
hypovlolemic
A nurse is caring for a patient with an N.G. tube in place following abdominal surgery. The nurse determines that the assessment priority is monitoring the:
monitoring the surgical dressing. Hemorrhage is a major complication postoperatively, so the nurse should assess for early indications of bleeding, such as visible blood stains on the surgical dressing. Covert manifestations of bleeding include rapid, thready pulse, tachycardia, and decreased urine output.
A client who has a history of Crohn’s disease is admitted to the hospital with diarrhea, abdominal pain, fever, and weight loss. The nurse should monitor the client for what electrolyte imbalance
Hypokalemia
The highest priority we need to take with an exacerbation and frequent stools is fluid and electrolyte imbalances. Hypokalemia is the most expected laboratory finding owing to the diarrhea.
When providing diet teaching to a patient with ulcerative colitis, which foods below should the patient avoid?
high fiber
A 23-year-old patient who is experiencing an exacerbation of ulcerative colitis is to take sulfasalazine. Which of the following instructions should the nurse provide for the client about taking this medication at home?
a. Drink enough fluids to maintain a urine output of at least 1,200 to 1,500 milliliters per day.
b. Stop taking the medication if the urine turns orange-yellow.
c. If a dose is missed, skip and continue with the next dose.
Fluid intake should be sufficient to prevent crystalluria and stone formation. The nurse can inform the patient that this medication may cause orange-yellow discoloration of urine and skin. The nurse should also advise the client to take missed doses as soon as remembered unless it is almost time for the next dose.
A patient is going to undergo angiography using iodine-containing contrast dye. He is taking metformin for his type 2 diabetes mellitus. The nurse should withhold metformin for:
a. 48 hours before the procedure.
b. 48 hours after the procedure.
c. 48 hours before and after the procedure.
If the patient is on metformin and they’re receiving a procedure with contrast, Metformin must be held 24 to 48 hours before the procedure and 48 hours after. Monitor the patient for indications of acute renal failure or lactic acidosis, such as hyperventilation, decreased urine output, and abdominal pain.
The nurse is unable to hear bowel sounds during an abdominal assessment. Before reporting this finding as absent bowel sounds, how much time should the nurse listen per quadrant?
5 minute
You are about to administer a bolus of intermittent tube feeding to a patient with a percutaneous endoscopic gastrostomy or P.E.G. You’ve aspirated 215 milliliters of gastric contents. What will be your next step?
a. Return the residual to the stomach and continue with the tube feeding as planned.
b. Discard the residual and continue with the tube feeding as planned.
c. Return the residual to the stomach then recheck the volume of aspirate after 30 minutes.
a
A 46-year-old patient is receiving 1000 milliliters of parenteral nutrition solution that has been over 24 hours. You are about to change the solution and notice that 150 milliliters is still in the bottle. What would be your next step?
a. Discard the unused solution and then hang the new one.
b. Speed up the infusion of the remaining solution and then hang the new one.
c. Wait to finish the infusion of the remaining 150 milliliters and then hand the new one.
Bacterial growth occurs at room temperature in nutritional solutions. Every 24 hours, the bag and tubing needs to be changed. The pharmacist is going to make a new bag every 24 hours. The nurses discard whatever is left over in that bag.
You are planning the nursing education for a patient with gastroesophageal reflux disease (GERD). Which of the following decreases lower esophageal sphincter (LES) pressure?
a. Cola sodas.
b. Citrus fruits.
c. Banana.
a
Which of the following nursing teachings will you share to a patient with gastroesophageal reflux disease or GERD?
a. The head of the bed needs to be elevated 6 to 8 inches when sleeping.
b. Suggest six small meals a day between breakfast and bedtime.
c. Hydrate with 10 to 12 ounces of water with each meal.
The use of pillows or blocks to elevate the head of the bed promotes gastric emptying by gravity and prevents nighttime reflux. Small frequent meals are recommended but patients should not eat at bedtime or lie down for 2 to 3 hours after eating. Liquids should be taken between meals preventing gastric distention with meals.
A 19-year-old patient comes to the clinic due to persistent diarrhea. He has a history of Crohn’s disease. Which of the following is a characteristic of Crohn’s disease?
a. Weight loss.
b. Toxic megacolon.
c. Bloody stools.
In Crohn’s disease, diarrhea and weight loss occurs from malabsorption are common symptoms especially if the small intestine is involved. Toxic megacolon and rectal bleeding are more often seen with ulcerative colitis
Which of the following manifestations should the nurse expect to find in a client diagnosed with a severe exacerbation of ulcerative colitis?
a. Twenty bloody stools a day.
b. Rigid abdomen.
c. Urinary stress incontinence.
The colon is ulcerated and unable to absorb water, resulting in bloody diarrhea. Ten to twenty bloody diarrhea stools is the main common symptom of ulcerative colitis.
The alpha cells in the islets of Langerhans in the pancreas release a hormone called:
Insulin and Glucagon are hormones for maintaining blood glucose. Insulin is released by beta cells while glucagon is released by alpha cells.
Our adrenal cortex is an endocrine gland that sits on top of our kidneys, releases of which hormone?
a. Adrenaline.
b. Thyroid.
c. Cortisol.
Cortisol is the primary stress hormone produced by adrenal glands. Adrenaline is produced by adrenal medulla. Thyroid hormones produced by thyroid glands using iodine from food.
Insulin promotes glucose transport from the bloodstream across the cell. What additional function does insulin have?
a. It is a fluid that breaks down fats into fatty acids.
b. Serves to digest proteins in the food during digestion.
c. It increases protein synthesis.
Show HintShow Hint
c. Insulin is an anabolic, or storage, hormone. Overnight fasting facilitates the release of stored glucose from the liver, protein from muscle and fat from adipose tissue. Bile is a fluid that breaks down fats into fatty acids while Pepsin digest proteins in food during digestion.
Individuals diagnosed with prediabetes are at increased risk for the development of type 2 diabetes. What could be the result of a patient that indicates prediabetes?
a. Glucose tolerance test result of 130 milligrams per decilitre.
b. Glucose tolerance test result of 250 milligrams per decilitre.
c. Fasting blood glucose level of 90 milligrams per decilitre.
d. Fasting blood glucose level of 115 milligrams per decilitre.
A diagnosis of Prediabetes is made if the 2-hour oral glucose tolerance test (O.G.T.T.) values are 140 to 199 milligrams per decilitre and Fasting blood glucose level of 100 to 125 milligrams per decilitre.
How many grams of glucose will be consumed by a patient during an oral glucose tolerance test or O.G.T.T.?
Diabetes mellitus is diagnosed if the two-hour plasma glucose level is greater than or equal to 200 milligrams per deciliter during an O.G.T.T., using a glucose load of 75 grams.
The physician ordered a Lispro insulin for a 31-year-old patient diagnosed with Type 1 Diabetes. The nurse should know its onset of action which is:
a. 30 minutes.
b. 60 minutes.
c. 15 to 30 minutes.
Lispro is also known as Humalog insulin. It is a rapid-acting insulin and has an onset of approximately 15 minutes. When you give Insulin Lispro, it is going to happen so fast. The patient must eat within 15 minutes of having this medication. This medication will be given before the meal but you have to first be sure that the patient will eat something in 15 minutes of administration of this medication.
You are teaching a 55-year-old patient with diabetes to learn how to mix NPH insulin and regular insulin in the same syringe. You know that the patient needs further teaching when:
a. The patient withdraws the dose of NPH into the syringe first.
b. Bubbles are removed after withdrawing the first insulin.
c. Equal amount of air based on the amount of units prescribed is pushed into the regular vial.
To prevent contamination of the regular insulin vial with intermediate-acting insulin additives, regular insulin should always be drawn into the syringe first. Inject air to the N.P.H. vial. Then, inject air to the regular vial and the regular insulin is withdrawn, bubbles removed, and the dose of N.P.H. is withdrawn.
What should be included in the nursing education for a patient who is learning about insulin administration?
a. Insulin glargine should not be mixed with any other insulin.
b. Ensure that the insulin glargine is cloudy.
c. Insulin glargine can be mixed with other insulin on the same vial.
Insulin glargine or Lantus should not be mixed with other insulin in the same vial and it should be clear.
This is the most common drug used for type 2 diabetes that reduces glucose production by the liver and enhances tissue uptake of glucose.
a. Sulfonylureas.
b. Biguanides.
c. Meglitinides.
Biguanides or Metformin is the most common drug used for type 2 diabetes that reduces glucose production from the liver and increases sensitivity at the tissue level that improves glucose transport into the cells. Sulfonylureas and Meglitinides increase production of insulin from the pancreas.
This is an oral hypoglycemic agent that is taken with the first bite of each meal. They are most effective in lowering postprandial blood glucose and slowing down the absorption of carbohydrate in the small intestine.
Acarbose is an oral hypoglycemic agent that is taken with the first bite of each meal. They are most effective in lowering postprandial blood glucose and slowing down the absorption of carbohydrate in the small intestine.
The adult client diagnosed with Type 1 diabetes is found lying unconscious on the bathroom floor. What will the nurse anticipate giving?
a. Administer the scheduled insulin.
b. Administer glucagon 1 milligram subcutaneously or intramuscular.
c. Prepare an IV line as soon as possible.
Oral carbohydrates cannot be given when patients are unconscious. After administering 1 milligram of glucagon, the patient should be transported to a medical facility for further treatment and evaluation. Insulin is contraindicated without knowledge of the patient’s glucose level. Preparing for an I.V. line is not the priority intervention in this situation.
Blood sugar is well controlled when Hemoglobin A.1.C. result is:
A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes.
You are caring for a patient who has a new diagnosis of gastroesophageal reflux disease or GERD. What is the medication that you could anticipate the provider to prescribe to neutralize gastric acid which irritates the esophagus during reflux?
Antacids work to neutralize the acid in the stomach which irritates the esophagus during reflux. It is best to take the antacid 1 to 3 hours after eating and at bedtime.
The nurse found a male patient with a history of Type 1 diabetes confused, sweating and shaky, but able to follow commands. Upon checking blood glucose, it is below 60 milligrams per decilitre. Which of the following most likely the nurse will prioritize?
a. Call for emergency help.
b. Check blood glucose every 15 minutes.
c. Give the patient 4 ounces of regular soda (not diet soda).
Signs of patients having hypoglycemia are confused, sweating, shaky, dizziness, sleepy, anxious, tachycardia, and cool, clammy skin. Give 4 ounces of fruit juice or regular soda and check the blood glucose level after 15 minutes. When hypoglycemia isn’t treated, call for emergency assistance.
What should be the appropriate nursing considerations when preparing insulin glargine (Lantus)?
a. Never mix the insulin glargine with any type of insulin in the same vial or syringe.
b. When cloudy insulin goes into the regular insulin vial, medication can still be used.
c. Insulin glargine can be mixed with regular insulin.
In preparing insulin glargine nurses should not mix it with any other type of insulin.
When regular insulin (clear) becomes cloudy it should be discarded because it is considered contaminated.
Your patient is unable to swallow foods but has a G.I. tract that is functioning. Which of the following is the preferred method of feeding for your patient?
a. T.P.N.
b. P.P.N.
c. N.G. feeding
Because the G.I. tract is functioning, feeding methods involve the enteral route which bypasses the mouth. In order to be qualified for enteral feeding, the patient needs to have a functional G.I. tract.
You are assessing for correct placement of a nasogastric tube by aspirating the stomach contents and checking the gastric pH. You can verify correct tube placement if which pH value is noted?
0-4
Which of the following describes why the nurse needs to elevate the head of the bed to 30 degrees for a patient receiving an intermittent tube feeding?
a. It promotes the patient’s digestion.
b. It reduces the risk for aspiration.
c. It improves absorption of nutrients.
b
You are preparing to wean a patient from parenteral nutrition. The patient is expected to begin taking solid food today. The current parenteral nutrition is 100 milliliters per hour. Which of the following prescriptions regarding parenteral nutrition can you expect?
a. Discontinue parenteral nutrition today.
b. Decrease parenteral nutrition rate to 50 milliliters per hour.
c. Continue parenteral nutrition rate of 100 milliliters per hour.
Decrease parenteral nutrition rate to 50 milliliters per hour. Parenteral nutrition is decreased gradually to allow the client to remain adequately nourished during the transition to a normal diet and prevents the occurrence of hypoglycemia.
A nurse is teaching a client with diverticulitis about preventing acute attacks. The nurse advises the patient to eat food low in fat and ______ in fiber.
A high-fat, low-fiber diet is the main culprit in diverticulosis. Therefore, to prevent acute attacks of diverticulitis, the patient should be advised to eat food low in fat and high in fiber.
A patient is about to undergo an abdominal paracentesis. The nurse should place the patient in ________ position.
After having the client void, the nurse should place the client sitting upright in a chair with feet elevated to allow peritoneal fluid to pool and drain optimally. The nurse can use Fowler’s position if the client is unable to get out of bed.
A patient scheduled for an outpatient barium swallow shows an understanding of the nursing teaching when he says that he should expect _______ stools after the procedure.
Barium swallow is a precedure where the patient will drink liquid contrast then get x-ray pictures of the esophagus or the upper gastrointestinal. It should not take any longer than 15 to 20 minutes. The nurse should instruct the patient to have nothing to eat or drink 8 hours prior to the procedure. The patient should expect bowel movements after the barium swallow procedure to appear light-colored or white, which indicates presence of the barium.
Prolonged nasogastric suctioning, use of diuretic, diarrhea, and vomiting could result to an electrolyte imbalance called _____________ .
Hypokalemia
Which of the following actions should be taken first by a nurse taking care of a patient who has gastrointestinal bleeding?
a. Educate patient about upper gastrointestinal series.
b. Administer pain medication.
c. Measure the patient’s orthostatic blood pressure.
Using the nursing process, the first action the nurse should take is to assess the client by measuring the client’s orthostatic blood pressure. This action determines if the client is hypovolemic and establishes a baseline for further measurements.
A nurse caring for a patient with peptic ulcer disease who reported sudden abdominal pain understands that it is an indication of ____________ _____________.
Classic indications of gastrointestinal perforation include sudden sharp abdominal pain with a rigid abdomen, declining peristalsis, and progression to septicemia and hypovolemic shock.
With the ____ _____________ procedure, the patient receives an iodide-containing contrast agent 10 to 12 hours before the procedure. Then, the examiner can evaluate the gallbladder for filling, contracting, and emptying and can also see the gallstones on the x-rays.
With the oral cholangiography precedure, the patient receives an iodide-containing contrast agent 10 to 12 hours before the procedure. Then, the examiner can evaluate the gallbladder for filling, contracting, and emptying and can also see the gallstones on the x-rays.
A nurse in an emergency department is caring for a patient with diabetic ketoacidosis and a blood glucose level of 925 mg/dL. The nurse should anticipate a prescription of ____ ____________ __________ IV bolus.
The nurse should expect a prescription for an IV bolus of 0.9% sodium chloride to be administered at 15 to 20 mL/kg/hr for the first hour to restore volume and maintain perfusion to the vital organs.
Which diagnostic study would include assessing for iodine sensitivity and holding metformin for 24 hours before and after the procedure?
a. Cystometrogram.
b. Intravenous pyelogram (IVP).
c. Kidneys, ureters, bladder (KUB).
Metformin and contrast together results in nephrotoxicity. The client who has an allergy to seafood or iodine is at higher risk for an allergic reaction to the contrast dye used in the procedure. The cystometrogram involves filling the bladder with water or saline to measure tone and stability. The kidneys, ureters, and bladder (KUB) is an x-ray that may have bowel preparation.
A young female patient came into the clinic with chief complaints of urgency, frequency, and dysuria. She has no history of UTI and urinalysis results indicate bacteriuria. The nurse can anticipate to prepare the patient for:
a. Empirical therapy with Bactrim.
b. Urine culture and sensitivity test.
c. CBC and kidney function tests.
Empiric therapy is defined as evidenced based suggested routine of medications. For uncomplicated U.T.I, empiric therapy suggests broad spectrum antibiotics specifically Bactrim. Asymptomatic bacteriuria does not justify treatment but symptomatic U.T.Is should always be treated.
Acute pyelonephritis resulting from an ascending lower urinary tract infection is most commonly due to:
a. The organism that is resistant to antibiotics treatment.
b. A preexisting condition of the urinary tract like vesicoureteral reflux.
c. The patient not taking all of the antibiotics for treatment of a U.T.I.
b
You are taking care of a 52-year-old hypertensive female patient. Her serum potassium level acutely rose to 5.9 mEq/L. Which of the following orders should the nurse bring into the health care provider’s attention?
a. Spironolactone everyday.
b. Administer I.V. insulin and glucose.
c. Avoid potassium rich foods.
Spironolactone is a potassium-sparing diuretic which is contraindicated in a patient with hyperkalemia.
Your patient’s urinalysis findings indicate that the urine is positive for leukocyte esterase and nitrites. Which of the following nursing actions are you going to take?
a. Redo the urinalysis first thing the next morning.
b. Initiate a 24-hour urine collection for creatinine clearance.
c. Review the urine specimen for culture and sensitivity.
Leukocyte esterase and nitrites in the urine indicate the client has U.T.I. Obtaining a clean-catch urine specimen for culture and sensitivity is an appropriate nursing action because we’ll need to identify the bacteria and what type of antibiotic is needed to treat infection. Due to the urinalysis already completed, the lab technician will take the specimen and perform a culture and sensivity. R.N. will review and inform provider results are available.
A 40-year-old female patient with a suspected urinary tract infection is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will instruct the patient to:
a. Urinate first, then obtain a specimen on the next urine.
b. Clean the urethral area, void a small amount into the toilet, and then void into the sterile specimen cup.
c. Clean the area around the meatus first and then have the patient void into a sterile container.
The proper way to collect urine specimen is to advise the patient to clean the urethral area, void a small amount into the toilet, and then void into the sterile specimen cup. And they can finish voiding into the toilet afterwards.
You are reviewing the morning laboratory findings for urinalysis of a patient who reported nocturia and urgency. Which of the following findings should you report to the provider?
a. Positive for epithelial cells.
b. Positive leukocyte esterase.
c. Positive for casts.
Presence of leukocyte esterase and/or nitrate in the urine indicates infection. The patient may have a few epithelial cells and casts in the urine, which is a normal finding.
You see a new order for I.V. replacement of potassium for a patient with severe hypokalemia. The proper way of administering this is:
a. Intravenous push.
b. Diluted in 10 milliliters over 10 minutes.
c. Diluted in 100 milliliters over 1 hour.
Potassium must be well diluted and given slowly. Never give potassium through the I.V. as a push because potassium itself is a tissue irritant. Direct push of potassium into the bloodstream is going to burn the patient as well as cause cardiac dysrhythmia where it can quickly become fatal if not treated properly.
The nurse monitors the fluid and electrolyte balance of an 84-year-old male patient. Which of the following is a normal change of aging?
a. Increased serum sodium.
b. Decreased serum sodium.
c. Decreased insensible fluid loss
Decreased circulating renin and aldosterone in geriatric patients lead to decreased sodium reabsorption and increased water retention by the kidney, both of which lead to hyponatremia. Skin changes lead to increased insensible water loss.
The nurse would expect administration of which I.V. solution for a patient who is N.P.O. going into surgery?
a. Dextrose 5% in normal saline (0.9%).
b. Dextrose 5% in water.
c. Dextrose 10% in water.
D.5.W. is also known as dextrose 5 percent in water. It is considered an isotonic solution where it doesn’t cause any fluid or electrolyte imbalance because the dextrose 5 percent component eventually gets metabolized. Indications include hypovolemia, hypernatremic, dehydrated, or NPO patients going into surgery.
You were assigned to a medical unit to take care of several patients. Which of the following patients has the lowest risk for developing pyelonephritis?
a. A patient who is 32 weeks of gestation.
b. A patient who has a urine pH of 4.2.
c. A patient who has diabetes mellitus.
b
Which of the following I.V. solutions is contraindicated for patients who have hyperkalemia?
a. D5W.
b. D5W in half normal saline
c. Lactated Ringer’s solution.
A common I.V. fluid given for patients who have a fluid and electrolytes problem is Lactated Ringer’s. The benefit with Lactated Ringer is that it contains electrolytes such as sodium, potassium, calcium and even lactate. However, this specific solution is very contraindicated for somebody who has hyperkalemia because we don’t want them to have an increase in potassium if they’re already high.
The nurse received the morning laboratory results of the patient admitted for congestive heart failure. Which of the following blood test results is of greatest concern?
a. Magnesium level of 1.1 mEq/L
b. Calcium level of 9.1 mg/dL
c. Potassium level of 4.5 mg/dL
Magnesium’s expected range is 1.3 - 2.1 milliequivalents per liter. A deficit in magnesium is called hypomagnesemia and the patient may have a positive Trousseau’s sign, positive Chvostek’s sign, and tetany.
