Question 1

The nurse recognizes that primary manifestations of systolic failure include: a. decreased EF and increased PAWF b. decreased PAWF and increased EF c. decreased pulmonary hypertension associated with normal EF d. decreased afterload and decreased left ventricular end-diastolic pressure

Accepted Answer

A

Question 2

A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is a. ventricular dilation b. ventricular hypertrophy c. neurohormonal response d. sympathetic nervous system activation

Accepted Answer

C

Question 3

A drug used in the management of a patient with ADHF and pulmonary edema that will decrease both preload and afterload and provide relief of anxiety is a. amrinone b. furosemide c. dobutamine d. morphine sulfate

Accepted Answer

D

Question 4

A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, the nurse needs to a. monitor serum potassium levels b. keep an accurate measure of intake and output c. teach the patient about dietary restriction of potassium d. withhold digitalis and notify health care provider if heart rate is irregular

Accepted Answer

A

Question 5

Patients with a heart transplantation are at risk for which of the following complications in the first year after transplantation (select all that apply) a. cancer b. infection c. rejection d. vasculopathy e. sudden cardiac death

Accepted Answer

B,C,E

Question 6

A 50 year old woman weighs 85 kg and has a history of cigarette smoking, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease that need to be modified are: a. weight and diet b. activity level and diet c. cigarette smoking and high blood pressure d. sedentary lifestyle and high blood pressure

Accepted Answer

C

Question 7

A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. Which of the following signs and symptoms would suggest that his aneurysm has ruptured? a. sudden shortness of breath and hemoptysis b. sudden, severe low back pain and bruising along his flank c. gradually increasing substernal chest pain and diaphoresis d. sudden, patchy blue mottling on feet and toes and rest pain

Accepted Answer

B

Question 8

Priority nursing measures after an abdominal aortic aneurysm repair include a. assessment of cranial nerves and mental status b. administration of IV heparin and monitoring aPTT c. administration of IV fluids and monitoring kidney function d. elevation of the legs and application of graduated compression stockings

Accepted Answer

C

Question 9

The first priority of collaborative care of a patient with a suspected acute aortic dissection is to a. reduce anxiety b. control blood pressure c. monitor for chest pain d. increased myocardial contractility

Accepted Answer

B

Question 10

Rest pain is a manifestation of PAD that occurs due to a chronic a. vasospasm of small cutaneous arteries in the feet b. increase in retrograde venous blood flow in the legs c. decrease in arterial blood flow to the nerves of the feet d. decrease in arterial blood flow to the leg muscles during exercise

Accepted Answer

C

Question 11

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse\'s initial action should be to a. elevate the leg to promote venous return  b. start anticoagulant therapy with IV heparin c. notify the physician of the change in peripheral perfusion d. place the bed in reverse Trendelenburg to promote perfusion

Accepted Answer

C

Question 12

Which clinical manifestations are seen in both patients with Buerger\'s disease and Raynaud\'s phenomenon (select all that apply) a. intermittent fevers b. sensitivity to cold temperatures c. gangrenous ulcers on fingertips d. color changes of fingers and toes e. episodes of superficial vein thrombosis

Accepted Answer

B,C,D

Question 13

The patient at the highest risk for venous thromboembolism (VTE) is a. a 62 year old man with spider veins who is having arthroscopic knee surgery b. a 32 year old woman who smokes, takes oral contraceptives and is planning a trip to Europe c. a 26 year old woman who is 3 days postpartum and received IV maintenance IV fluids for 12 hours during her labor d. an active 72 year old man at home recovering from transurethral resection of the prostate for benign prostatic hyperplasia

Accepted Answer

B

Question 14

Which are probable clinical findings in a person with an acute VTE (select all that apply) a. pallor and coolness of foot and calf b. mild to moderate calf pain and tenderness c. grossly diminished or absent pedal pulses d. unilateral edema and induration of the thigh e. palpable cord along a superficial varicose vein

Accepted Answer

B,D

Question 15

The recommended treatment for an initial VTE in an otherwise healthy person with no significant co-morbidities would include a. IV agratoban (acova) as an inpatient b. IV unfractionated heparin as an inpatient c. subcutaneous unfractionated heparin as an outpatient d. subcutaneous low-molecular-weight heparin as an outpatient

Accepted Answer

D

Question 16

A key aspect of teaching for the patient on anticoagulant therapy includes which instructions a. monitor for and report any signs of bleeding b. do not take acetaminophen (tylenol) for headache c. decrease you dietary intake of foods containing vitamin K d. arrange to have blood drawn routinely to check  drug levels

Accepted Answer

A

Question 17

In planning care and patient teaching for the patient with venous leg ulcers, the nurse recognizes that the most important intervention in healing and control of this condition is a. sclerotherapy b. taking horse chestnut extract daily c. using moist environment dressings d. applying graduated compression stockings

Accepted Answer

D

Question 18

A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with  a. structural support of the kidney b. regulation of the concentration of urine c. entry and exit of blood vessels at the kidney d. collection and drainage of urine from the kidney

Accepted Answer

D

Question 19

A patient with renal disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of a. tubular secretion b. glomerular filtration c. capillary permeability d. concentration of filtrate

Accepted Answer

B

Question 20

The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes a. adrenal insufficiency b. serotonin deficiency  c. hyperaldosteronism d. hyperparathyroidism

Accepted Answer

D

Question 21

Diminished ability to concentrate urine, associated with aging of the urinary system is attributed to a. a decreased in bladder sensory receptors b. a decrease in the number of functioning nephrons c. decreased function of the loop of Henle and tubules d. thickening of the basement membrane of Bowman\'s capsule

Accepted Answer

C

Question 22

During physical assessment of the urinary system, the nurse a. palpates an empty bladder as a small nodule b. auscultates over each CVA to detect impaired renal blood flow  c. finds a dull percussion sound when 100 mL of urine is present in the bladder d. palpates above the symphysis pubis to determine the level of urine in the bladder

Accepted Answer

B

Question 23

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply) a. nonpalpable left kidney b. auscultation of renal artery bruit c. CVA tenderness elicited by a kidney punch d. no CVA tenderness elicited by a kidney punch e. palpable bladder to the level of the pubic symphysis

Accepted Answer

A,D

Question 24

A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion is a (n) a. IVP b. VCUG c. Renal scan d. Loopogram

Accepted Answer

C

Question 25

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find a. a pH of 8.4 b. RBCs of 4/hpf c. color: yellow, cloudy d. specific gravity of 1.035

Accepted Answer

D

Question 26

In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through a. the bloodstream b. the lymphatic system c. a descending infection d. an ascending infection

Accepted Answer

D

Question 27

The nurse teaches the female patient who has frequent UTIs that she should a. take tub baths with bubble bath b. urinate before and after sexual intercourse c. take prophylactic sulfonamides for the rest of her life d. restrict fluid intake to prevent the need for frequent voiding

Accepted Answer

B

Question 28

The immunologic mechanisms involved in glomerulonephritis include a. tubular blocking by precipitates of bacteria and antibody reactions b. deposition of immune complexes and complement along the GBM c. thickening of the GBM from autoimmune microangiopathic changes d. destruction of glomeruli by proteolytic enzymes contained in the GBM

Accepted Answer

B

Question 29

One of the most important roles of the nurse in relation to cute poststreptococcal glomerulonephritis is to  a. promote early diagnosis and treatment of sore throats and skin lesions b. encourage patients to request antibiotic therapy for all upper respiratory infections c. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence  d. monitor patients for respiratory symptoms that indicate that the disease is affecting the alveolar basement membrane

Accepted Answer

A

Question 30

The edema that occurs in nephrotic syndrome is due to  a. increased hydrostatic pressure caused by sodium retention b. decreased aldosterone secretion from adrenal insufficiency c. increased fluid retention caused by decreased glomerular filtration d. decreased colloidal osmotic pressure caused by loos of serum albumin

Accepted Answer

D

Question 31

A patient is admitted to the hospital with severe renal colic caused by renal lithiasis. The nurse\'s first priority in management of the patient is to a. administer opioids as prescribed b. obtain supplies for straining all urine c. encourage fluid intake of 3 to 4 L/day d. keep the patient NPO in preparation for surgery

Accepted Answer

A

Question 32

The nurse recommends genetic counseling for the children of a patient with  a. nephrotic syndrome b. chronic pyelonephritis c. malignant nephrosclerosis d. adult-onset polycystic renal disease

Accepted Answer

D

Question 33

The nurse encourages strict diabetic control in the patient prone to diabetic nephropathy knowing that the renal tissue changes that may occur in this condition include a. uric acid calculi and nephrolithiasis b. renal sugar-crystal calculi and cysts c. lipid deposits in the glomeruli and nephrons d. thickening of the GBM and glomerulosclerosis

Accepted Answer

D

Question 34

The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of  a. aspirin use b. tobacco use c. chronic alcohol abuse d. use of artificial sweeteners

Accepted Answer

B

Question 35

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes a. teaching the patient to use kegel exercises b. clamping and releasing a catheter to increase bladder tone c. teaching the patient biofeedback mechanisms to suppress the urge to void d. counseling the patient concerning choice of incontinence containment device

Accepted Answer

A

Question 36

A patient with a ureterolithotomy returns from surgery with a neprostomy tube in place. Postoperative nursing care of the patient includes  a. encouraging the patient to drink fruit juices and milk b. forcing fluids of at least 2 to 3 L per day after nausea has subsided c. irrigating the neprostomy tube with 10 mL of normal saline solution as needed d. notifying the physician if neprostomy tube drainage is more than 30 mL per hour.

Accepted Answer

B

Question 37

A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should a. notify the physician b. notify the charge nurse c. irrigate the drainage tube d. chart is as a normal observation

Accepted Answer

D

Question 38

Which of the following characterize acute kidney injury (select all that apply) a. primary cause of death is infection b. almost always affects older people c. disease course is potentially reversible d. most common cause is diabetic nepropathy e. cardiovascular disease is most common cause of death

Accepted Answer

A,C

Question 39

RIFLE defines three stages of AKI based on changes in  a. blood pressure and urine osmolality b. fractional excretion of urinary sodium c. estimation of GFR with the MDRD equation d. serum creatinine or urine output from baseline

Accepted Answer

D

Question 40

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply) a. hypotension b. ECG changes c. hypernatremia d. pulmonary edema e. urine with high specific gravity

Accepted Answer

B,D

Question 41

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances  a. hyperkalemia and hypnatremia b. hyperkalemia and hypernatremia c. hypokalemia and hyponatremia d. hypokalemia and hypernatremia

Accepted Answer

C

Question 42

A patient is admitted to the hospital with chronic kidney disease, the nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys b. rapid decrease in urinary output with an elevated BUN c. an increasing creatinine clearance with a decrease in urinary output d. prostration, somnolence, and confusion with coma and imminent death

Accepted Answer

A

Question 43

Nurses need to educate patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply)  a. older African Americans b. individuals more than 60 years old c. those with a history of pancreatitis d. those with a history of hypertension e. those with a history of type 2 diabetes

Accepted Answer

A,B,D,E

Question 44

Patient with chronic kidney disease experience an increased incidence of cardiovascular disease related to (select all that apply) a. hypertension  b. vascular calcifications  c. a genetic predisposition d. hyperinsulinemia causing dyslipidemia  e. increased high-density lipoprotein levels

Accepted Answer

A,B,D

Question 45

Measures indicated in the conservative therapy of chronic kidney disease include a. decreased fluid intake, carbohydrate intake, and protein intake  b. increased fluid intake, decreased carbohydrate intake and protein intake  c. decreased fluid intake and protein intake, increased carbohydrate intake d. decreased fluid intake and carbohydrate intake, increased protein intake

Accepted Answer

C

Question 46

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs that patient that a. successful transplantion usually provides better quality of life than that offered by dialysis b. if rejection of the transplanted kidney occurs, no further treatment for renal failure is available c. the immunosuppresive therapy that is require following transplantation causes fatal malignancies in many patients d. hemodialysis replaces the normal functions of the kidneys and patients do not have to live with continual fear of rejection

Accepted Answer

A

Question 47

To assess the patency of a newly places arteriovenous graft for dialysis, the nurse should a. irrigate the graft daily with low-dose heparin b. monitor for any increase in BP in the affected arm c. listen with a stethoscope over the graft for the presence of a bruit d. frequently monitor the pulses and neurovascular status distal to the graft

Accepted Answer

C

Question 48

One of the major advantages of peritoneal dialysis is that  a. no medications are required because of the enhanced efficiency b. the diet is less restricted and dialysis can be performed at home c. the dialysate is biocompatible and causes no long term consequences d. high glucose concentrations of the dialysate cause a reduction in appetite promoting weight loss

Accepted Answer

B

Question 49

A kidney transplant recipient complains of having fever, chills and dysuria over the course of the past 2 days. What is the first action that the nurse should take?  a. assess the temperature and intiate workup to rule out infection  b. provide warm cover for the patient and give 1 g acetaminophen orally c. reassure the patient that this common after transplantation d. notify the nephrologist that the patient has developed symptoms of acute rejection

Accepted Answer

A

Question 50

What are clinical manifestations of Right Sided Heart Failure?

Accepted Answer

Fatigue, dependent edema, increased peripheral venous pressure & distended jugular veins

Question 51

What is an important lab test in determining severity of heart failure (ie decompensated heart failure)?

Accepted Answer

Elevated B-Type Natiuretic Peptide (BNP)

Question 52

What is the treatment for patients with heart failure in fluid overload?

Accepted Answer

Furosamide (Lasix) - loop diuretic administered IV push

Question 53

What are nursing discharge instructions/education for HF patients?

Accepted Answer

Weigh daily, before breakfast, after urinating, without clothes, take medication as prescribed, take daily pulse if on digoxin, keep appointments for follow-up labs ... CALL THE DOCTOR IF...  >3 pound weight gain in a day SOB, palpitations, persistent cough, decrease in urine output Pulse < 60 if on digoxin, or signs of toxicity

Question 54

What are nursing priorities for a patient with heart failure in fluid overload?

Accepted Answer

Assess, sit patient in semi-fowlers or high-fowlers position, apply oxygen, administer diuretics per HCP orders, monitor Potassium, monitor I&Os closely...

Question 55

What are the risk factors for PAD?

Accepted Answer

Smoking, Hyperlipidemia, Cardiovascular Disease, HTN, DM

Question 56

What are the clinical manifestations of PAD?

Accepted Answer

Patient presents with no pedal pulses in the right foot, right lower leg shiny without hair. The patient\'s main complaint is \"Extreme pain every time\" he walks his dog... within minutes of resting pain is relieved.

Question 57

What are clinical manifestations of DVT?

Accepted Answer

Post - Op day #3 the nurse completes the initial head to toe assessment: +1 bilateral pedal pulses, LLE +2 NP edema, red, warm, swollen left calf.

Question 58

What is the treatment for venous stasis ulcers?

Accepted Answer

Provide patient with ted hose if closed or ointment with ace wrap if open.

Question 59

What is post procedure care for arterial revascularization?

Accepted Answer

Monitor I & Os (urine output most important), monitor serum BUN/Cr within the first 24hours post this procedure.

Question 60

The steps for proper collection of a 24hour urine.

Accepted Answer

dump first urine, start time initiated until the final 24 hours is completed, maintaining on ice at all times including sending down to lab

Question 61

What is an IV Pyelogram?

Accepted Answer

This test injects dye to assess the kidneys for renal calculi, strictures, etc..

Question 62

What is cystitis?

Accepted Answer

Chronic bladder pain

Question 63

What are the clinical manifestations of a Renal Calculi?  What is the RN\'s priority discharge instruction for a patient with a Renal Calculi? & WHY?

Accepted Answer

Patient diagnosed with this complains of back pain radiating down the groin. Patient commonly has blood in the urine AKA RBCs in the UA.    Ask the patient to strain their urine. This allows for testing to identify the cause of the kidney stones so that preventative changes to the diet can be achieved.

Question 64

This is the nursing priority for a post-nephrectomy patient.

Accepted Answer

Monitor for clinical manifestations of bleeding

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