Neurology Disorders Quizzes

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Assessment and management of liver disorders

Assessment and management of liver disorders Quiz

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1. During the incubation period of viral hepatitis, what should the nurse expect the patient to report?

1. Dark urine and easy fatigability

2. No symptoms except diagnostic results

3. Anorexia and right upper quadrant discomfort

4. Constipation or diarrhea with light-colored stools

b. During the incubation period, there are no symptoms, but serologic and enzyme markers of the disease are present. Earliest symptoms may include anorexia and discomfort in the upper right quadrant of the abdomen. Pruritus, dark urine, and light-colored stools occur with the onset of jaundice in the acute phase. Easy fatigability and malaise are seen in the convalescent phase as jaundice disappears.

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2. In discussing long-term management with the newly diagnosed patient with alcoholic cirrhosis, what should the nurse teach the patient?

1. A daily exercise regimen is important to increase the blood flow through the liver

2. Cirrhosis can be reversed if the patient follows a regimen of proper rest and nutrition.

3. Abstinence from alcohol is the most important factor in improvement of the patient’s condition.

4. The only over-the-counter analgesic that should be used for minor aches and pains is acetaminophen.

c. Abstinence from alcohol is very important in alcoholic cirrhosis and may result in improvement if started when liver damage is limited. Although further liver damage may be reduced by rest and nutrition, most changes in the liver cannot be reversed. Exercise does not promote portal circulation, and very moderate exercise is recommended._x000d__x000d_Acetaminophen should not be used by the patient with alcoholic cirrhosis because this liver is more sensitive to the hepatotoxicity of acetaminophen.

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3. What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis?

1. Providing adequate nutritional intake

2. Promoting strict bed rest during the icteric phase

3. Providing pain relief without using liver-metabolized drugs

4. Providing quiet diversional activities during periods of fatigue

a. Adequate nutrition is especially important in promoting regeneration of liver cells, but the anorexia of viral hepatitis is often severe, requiring creative and innovative nursing interventions. Strict bed rest is not usually required, and the patient usually has only minor discomfort with hepatitis. Diversional activities may be required to promote psychologic rest but not during periods of fatigue.

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4. During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do?

1. Prepare the patient for immediate portal shunting surgery.

2. Perform guaiac testing on all stools to detect occult blood.

3. Maintain the patient’s airway and prevent aspiration of blood.

4. Monitor for the cardiac effects of IV vasopressin and nitroglycerin.

c. Bleeding esophageal varices are a medical emergency. During an episode of bleeding, management of the airway and prevention of aspiration of blood are critical factors. Portal shunting surgery may be done for esophageal varices but not during an acute hemorrhage._x000d__x000d_Occult blood as well as fresh blood from the GI tract would be expected. Vasopressin causes vasoconstriction, decreased heart rate, and decreased coronary blood flow._x000d__x000d_IV nitroglycerin may be given with the vasopressin to counter these side effects.

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5. Although HAV antigens are not tested in the blood, they stimulate specific IgM and IgG antibodies. Which antibody indicates there is acute HAV infection?

1. Anti-HBc IgG

2. Anti-HBc IgM

3. Anti-HAV IgG

4. Anti-HAV IgM

d. Anti-HAV IgM indicates acute HAV infection. Anti-HBc IgG indicates previous or ongoing infection with HBV. Anti-HBc IgM indicates acute HBV infection. Anti-HAV IgG indicates previous infection with HAV.

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6. The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply)

1. gastrointestinal (GI) bleeding.

2. hypokalemia.

3. renal function.

4. body image disturbances.

5. increased clotting tendencies.

b, c. With diuretic therapy, fluid and electrolyte balance must be monitored; serum levels of sodium, potassium, chloride, and bicarbonate must be monitored, especially for hypokalemia. Renal function must be monitored with blood urea nitrogen and serum creatinine. Water excess is manifested by muscle cramping, weakness, lethargy, and confusion._x000d_Gastrointestinal (GI) bleeding, body image disturbances, and bleeding tendencies seen with cirrhosis are not related to diuretic therapy.

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7. What test will be done before prescribing treatment for the patient with positive testing for HCV?

1. Anti-HCV

2. HCV genotyping

3. FibroSure (FibroTest)

4. HCV RNA quantitation

b. HCV genotyping is done to determine HCV drug choice, duration, and response to drug therapy. Anti-HCV and HCV RNA quantitation are tests completed to diagnose HCV. FibroSure (FibroTest) is used to assess the extent of hepatic fibrosis.

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8. Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices?

1. Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction

2. Loss of the small bile ducts and cholestasis and cirrhosis in patients with other autoimmune disorders

3. Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension

4. Scarring and nodular changes in the liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein

c. Esophageal varices occur when collateral channels of circulation develop inelastic fragile veins from portal hypertension. Portal hypertension is from scarring and nodular changes in the liver leading to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein. It contributes to peripheral edema and ascites. Jaundice is from the inability of the liver to conjugate_x000d_bilirubin. Biliary cirrhosis causes the loss of small bile ducts and ultimate cholestasis in patients with other autoimmune disorders.

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9. The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse?

1. “No immunization is available for hepatitis A, nor are you likely to get the disease.”

2. “Those who have had household or close contact with the patient should receive IG.”

3. “All family members should receive the hepatitis A vaccine to prevent or modify the infection.”

4. “Only those people who have had sexual contact with the patient should receive immunization.”

b. People who have been exposed to hepatitis A through household contact or foodborne outbreaks should be given IG within 1 to 2 weeks of exposure to prevent or modify the illness. Hepatitis A vaccine is used to provide pre-exposure immunity to the virus. Although hepatitis A may be spread by sexual contact, the risk is higher for transmission with the oral-fecal route

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10. Following a needle stick, what is used as prophylaxis against HBV?

1. Interferon

2. HBV vaccine

3. Hepatitis B immune globulin (HBIG)

4. HBIG and HBV vaccine

d. HBV vaccine and hepatitis B immune globulin (HBIG) are used together prophylactically after a needle stick. Interferon is used to treat chronic HBV.

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11. What patient manifestation does the nurse recognize as an early sign of hepatic encephalopathy?

1. Manifests asterixis

2. Becomes unconscious

3. Has increasing oliguria

4. Impaired computational skills

d. Early signs (grade 1) of this neurologic condition include impaired computational skills, short attention span, personality change, decreased short-term memory, mild confusion, depression, and incoordination. Loss of consciousness (grade 4) is usually preceded by asterixis, abnormal reflexes, and disoriented to time (grades 2 and 3); inappropriate behavior, deficient executive function, marked confusion, loss of meaningful conversation, and incomprehensible speech. Increasing oliguria is a sign of hepatorenal syndrome.

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12. A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse?

1. “If you are interested in a transplant, you really should talk to your doctor about it.”

2. “Liver transplants are indicated only in young people with irreversible liver disease.”

3. “Rejection is such a problem in liver transplants that it is seldom attempted in patients with cirrhosis.”

4. “Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?”

d. Liver transplantation is indicated for patients with cirrhosis as well as for many adults and children with other irreversible liver diseases._x000d_Liver transplantation is contraindicated with severe extrahepatic disease, cancers, ongoing drug or alcohol use, and inability to comprehend or comply with the rigorous posttransplant care._x000d__x000d_Nurses should be knowledgeable about the indications for transplantation and be able to discuss the patient’s questions and concerns related to transplantation. Rejection is less of a problem in liver transplants than with other organs, such as the kidney.

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13. Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer?

1. HAV

2. HBV

3. HCV

4. HEV

B: Hepatitis B virus (HBV) is a DNA virus that is transmitted via infectious blood and body products and is required for hepatitis D virus (HDV) replication, and chronic HBV along with chronic hepatitis C virus (HCV) accounts for 80% of hepatocellular cancer cases. Hepatitis A virus (HAV), HCV, HDV, and HEV are all RNA viruses.

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14. The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant?

1. Alcohol intake is now okay.

2. HBIG will be required to prevent rejection.

3. Elevate the head 30 degrees to improve ventilation when sleeping.

4. Monitor closely for infection because of the immunosuppressive medication.

d. Monitoring for viral, fungal, and bacterial infection after the liver transplant is essential, as only fever may be present with an infection. Alcohol will not be any better for the patient after the transplant than it was before the transplant. HBIG is given for postexposure protection from HBV. The head of the bed is elevated to improve ventilation with severe ascites.

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15. What causes the systemic effects of viral hepatitis?

1. Toxins produced by the infected liver

2. Impaired portal circulation from fibrosis

3. Cholestasis from chemical hepatotoxicity

4. Complement system activation by antigen-antibody complexes

d. The systemic manifestations of rash, angioedema, arthritis, fever, and malaise in viral hepatitis are caused by the activation of the complement system by circulating immune complexes. Liver manifestations include jaundice from hepatic cell damage and cholestasis as well as anorexia. Impaired portal circulation usually does not occur in uncomplicated viral hepatitis but would be a liver manifestation.

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16. Which conditions contribute to the formation of abdominal ascites?

1. Esophageal varices contribute to 80% of variceal hemorrhages

2. Increased colloidal oncotic pressure caused by decreased albumin production

3. Hypoaldosteronism causes increased sodium reabsorption by the renal tubules

4. Blood flow through the portal system is obstructed, which causes portal hypertension

d. Blood flow through the portal system is obstructed and causes portal hypertension that increases the BP in the portal venous system. Decreased albumin production leads to decreased serum colloidal oncotic pressure that contributes to ascites. Hyperaldosteronism increases sodium and water retention and contributes to increased fluid retention, hypokalemia, and decreased urinary output. The retained fluid has low oncotic colloidal pressure. It escapes into the interstitial spaces, causing_x000d_peripheral edema. Portal hypertension contributes to esophageal varices. Reduced renal blood flow and increased serum levels of antidiuretic hormone (ADH) contribute to impaired water excretion and ascites.

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17. The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?

1. Turn the patient every 3 hours.

2. Encourage increasing ambulation.

3. Assist the patient to the bathroom.

4. Prevent constipation to reduce ammonia production.

c. The patient may not be oriented or able to walk to the bathroom alone because of hyperreflexia, asterixis, or decreased motor coordination. Turning should be done every 2 hours to prevent skin breakdown. Activity is limited to decrease ammonia as a by-product of protein metabolism. Although constipation will be prevented, it will not
_x000d_keep the patient safe.

_x000d_

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18. Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination?

1. Anti-HBc immunoglobulin (Ig)G

2. Surface antigen HBs Ag

3. Surface antibody anti-HBs

4. Core antigen anti-HBc IgM

c. Immunization to HBV after vaccination is identified with the hepatitis B surface antibody (anti-HBs). Anti-HBc immunoglobulin (Ig)G indicates previous or ongoing HBV infection. Surface antigen HBsAg is present in acute and chronic infection. Core antigen anti-HBc IgM indicates acute infection and does not appear after vaccination.

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19. To treat a cirrhotic patient with hepatic encephalopathy, lactulose, rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient’s family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patient’s family?

1. Use reduces portal venous pressure.

2. It will eliminate blood from the GI tract.

3. It traps ammonia and eliminates it in the feces.

4. It decreases bacteria to decrease ammonia formation.

c. Ammonia must be reduced to treat hepatic encephalopathy. The laxative, lactulose, decreases ammonia by trapping the ammonia and eliminating it in the feces. A β adrenergic blocker will be used to decrease portal venous pressure and decrease variceal bleeding. The proton pump inhibitor will decrease gastric acidity but will not eliminate blood already in the GI tract. Rifaximin will decrease bacterial flora and therefore decrease ammonia formation from protein metabolism.

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20. A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse?

1. “Only chronic hepatitis C is treatable and primarily with antiviral agents and interferon.”

2. “There are no specific drug therapies that are effective for treating acute viral hepatitis.”

3. “Lamivudine (Epivir) and interferon both decrease viral load and help prevent complications.”

4. “No drugs are used for the treatment of viral hepatitis because of the risk of additional liver damage.”

c. Nucleoside and nucleotide analogs (e.g., lamivudine) and pegylated interferon are used to treat chronic hepatitis B. No specific drugs are effective in treating acute viral hepatitis, although supportive drugs, such as antiemetics, sedatives, or antipruritics, may be used for symptom control.

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21. When caring for a patient with autoimmune hepatitis, the nurse understands that what about this patient is different from the patient who has viral hepatitis?

1. Does not manifest hepatomegaly or jaundice

2. Experiences less liver inflammation and damage

3. Is treated with corticosteroids or other immunosuppressive agents

4. Is an older adult who has used a wide variety of prescription and over-the- counter drugs

c. Immunosuppressive agents are indicated in hepatitis associated with immune disorders to decrease liver damage caused by autoantibodies. Autoimmune hepatitis is similar to viral hepatitis in presenting signs and symptoms and may become chronic and lead to cirrhosis.

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22. The nurse identifies a need for further teaching when the patient with acute hepatitis B makes which statement?

1. “I should avoid alcohol completely for at least a year.”

2. “I must avoid all physical contact with my family until the jaundice is gone.”

3. “I should use a condom to prevent spread of the disease to my sexual partner.”

4. “I will need to rest several times a day, gradually increasing my activity as I tolerate it.”

b. The patient with acute hepatitis B is infectious for 4 to 6 months, and precautions to prevent transmission through percutaneous and sexual contact should be maintained until tests for Hbs Ag or anti-HBc IgM are negative. Close contact does not have to be avoided, but close contacts of the patient should be vaccinated. Alcohol should not be used for at least a year, and rest with increasing activity during convalescence is recommended.

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23. What laboratory test results should the nurse expect to find in a patient with cirrhosis?

1. Serum albumin: 7.0 g/dL (70 g/L)

2. Total bilirubin: 3.2 mg/dL (54.7 mmol/L)

3. Serum cholesterol: 260 mg/dL (6.7 mmol/L)

4. Aspartate aminotransferase (AST): 6.0 U/L (0.1 mkat/L)

b. Serum bilirubin, both direct and indirect, would be expected to be increased in cirrhosis. Serum albumin and cholesterol are decreased and liver enzymes, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), are initially increased but may be normal in end-stage liver disease.

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24. The patient is an older woman with cirrhosis who has anemia. What pathophysiologic changes may contribute to this patient’s anemia (select all that apply)?

1. Vitamin B deficiencies

2. Stretching of liver capsule

3. Vascular congestion of spleen

4. Decreased prothrombin production

5. Decreased bilirubin conjugation and excretion

a, c, d. The anemia of cirrhosis is related to overactivity of the enlarged spleen that removes blood cells from circulation. Vitamin B deficiencies from altered intake and metabolism of nutrients and decreased prothrombin production can increase bleeding tendencies. The other options do not contribute to anemia in the patient with cirrhosis.

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25. The occurrence of acute liver failure is most common in which situation?

1. A person with hepatitis A

2. A person with hepatitis C

3. Antihypertensive medication use

4. Use of acetaminophen with alcohol use

d. The most common cause of acute liver failure is drugs, usually acetaminophen in combination with alcohol. HBV is the second most common cause. HAV is a less common cause.

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26. The patient had a blood transfusion reaction. What is the best explanation the nurse can give the patient as to why hemolytic jaundice has occurred?

1. A malaria parasite has broken apart red blood cells (RBCs)

2. It results from liver’s altered ability from hepatocellular disease

3. Jaundice results from decreased flow of bile through the liver or biliary system

4. It is caused by increased breakdown of RBCs that increases serum unconjugated bilirubin

D: Hemolytic jaundice from a blood transfusion reaction is from increased breakdown of red blood cells (RBCs) producing increased unconjugated bilirubin in the blood. Hepatocellular jaundice results from damaged hepatocytes leaking bilirubin. Hemolytic jaundice occurs with malaria. Obstructive jaundice is from obstructed bile flow through the liver or biliary duct system.

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27. The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best explanation about the test for the nurse to explain to the patient?

1. Shows an ongoing infection with HBV

2. Indicates co-infection with HBV and HDV

3. Determines any previous infection or immunization to HBV

4. Indicates viral replication and effectiveness of therapy for chronic HBV

d. HBV DNA quantitation is the best indicator of viral replication and effectiveness of therapy for chronic HBV. HBsAg is present in acute or chronic infection. HBeAg shows high infectivity and can be used to determine clinical management of patients with chronic HBV. Anti-HBc IgM occurs with acute infection. Anti-HBc IgG indicates ongoing infection. Anti-HDV is present in past or current infection with HDV and therefore HBV. Anti-HBs indicate previous infection with HBV or_x000d_immunization.

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28. A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge?

1. Chemotherapy is highly successful in the treatment of liver cancer.

2. The patient will undergo surgery to remove the involved portions of the liver.

3. Supportive care that is appropriate for all patients with severe liver damage is indicated.

4. Metastatic cancer of the liver is more responsive to treatment than primary carcinoma of the liver.

c. Because the prognosis for cancer of the liver is poor and treatment is largely palliative, supportive nursing care is appropriate. The patient exhibits clinical manifestations of liver failure, as seen in any patient with advanced liver failure. Whether the cancer is primary or metastatic, there is usually a poor response to chemotherapy and surgery is indicated in the few patients that have localization of the tumor when there is no evidence of invasion of hepatic blood vessels.

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29. A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)?

1. Weight loss

2. Diabetes management

3. Ulcerative colitis dietary changes

4. Dietary management of hyperlipidemia

5. Maintaining blood pressure with increased sodium and fluid intake

6. Maintaining blood pressure with increased sodium and fluid intake

a, b, d. There is no treatment for nonalcoholic fatty liver disease (NAFLD) except to control the other diseases that are common in these persons. These measures include weight loss for obesity, control of blood glucose for diabetes, control of hyperlipidemia, and treating hypertension if it is present. Ulcerative colitis is unrelated to NAFLD.

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30. The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What is the most likely diagnosis the nurse should expect for this patient?

1. Cirrhosis

2. Acute liver failure

3. Hepatorenal syndrome

4. Primary sclerosing cholangitis

d. Most patients with primary sclerosing cholangitis (PSC) also have ulcerative colitis. The manifestations are otherwise similar to cirrhosis, and PSC may lead to cirrhosis, liver failure, and liver cancer.

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31. The patient has been newly diagnosed with Wilson’s disease. D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect?

1. Pruritus

2. Acute kidney injury

3. Corneal Fleischer rings

4. Increased serum iron levels

c. Corneal Fleischer rings, brownish red rings in the cornea near the limbus, are the hallmark of Wilson’s disease. Pruritus (not seen with Wilson’s disease) is commonly seen with jaundice or primary biliary cirrhosis. Renal failure associated with hepatorenal syndrome is not seen with Wilson’s disease. High serum iron levels are seen with hemochromatosis.

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32. Malnutrition can be a major problem for patients with cirrhosis. Which nursing intervention can help improve nutrient intake?

1. Oral hygiene before meals and snacks

2. Provide all foods the patient likes to eat

3. Improve oral intake by feeding the patient

4. Limit snack offers to when the patient is hungry

a. Oral hygiene may improve the patient’s taste sensation. Food preferences are important, but some foods may be restricted if the patient is on a low-sodium or low-fat diet. The patient will feel more independent with self-feeding and will be more likely to increase intake by having someone sit with the patient while the patient eats. Snacks and supplements should be available whenever the patient desires them but should not be forced on the patient.

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Assessment of kidney and urinary tract function

Assessment of kidney and urinary tract function Quiz

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1. A patient has sustained a minor kidney injury. Which structure must remain functional in order to form urine from blood?

1. Medulla

2. Nephron

3. Calyx

4. Capsule

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2. The nurse should inform a patient that preparation for intravenous urography includes:

1. a liquid restriction for 8 to 10 hours before the test.

2. liquids before the test

3. enemas until clear

4. remaining NPO from midnight before the test

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3. Nursing management after a renal brush biopsy includes:

1. assessing for the clinical manifestations of hemorrhage

2. encouraging a fluid intake of 3 L every 24

3. obtaining a sample of each voided urine to compare it with a prebiopsy specimen.

4. all of the above.

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4. . Oliguria is said to be present when urinary output is:

1. less than 30 mL/h.

2. about 100 mL/h.

3. between 300 and 500 mL/h.

4. between 500 and 1,000 mL/h.

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5. An elderly patient has been in bed for several days after a fall. The nurse encourages ambulation to stimulate the movement of urine through the ureter by what phenomenon?

1. Peristalsis

2. Gravity

3. Pelvic pressure

4. Backflow

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6. Impairment in the thirst mechanism associated with aging makes an older adult patient more vulnerable to which disorder?

1. Hypernatremia

2. Hypocalcemia

3. Hyperkalemia

4. Hypoglycemia

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7. Which personal action is most likely to cause the kidneys to produce and release erythropoietin?

1. Person moves to a low desert area where the humidity is very low

2. Person moves to a high-altitude area where atmospheric oxygen is low.

3. Person drinks an excessive amount of fluid that results in fluid overload.

4. Person eats a large high-protein meal after a rigorous exercise workout.

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8. Significant nursing assessment data relevant to renal function should include information about:

1. any voiding disorders.

2. the patient’s occupation

3. the presence of hypertension or diabetes mellitus.

4. all of the above

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9. Mastering voluntary micturition is a normal developmental task for which person?

1. A healthy 20-month-old toddler

2. A 56-year-old woman with stress incontinence

3. A healthy 8-year-old child

4. A 25-year-old with a spinal cord injury

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10. Which event is most likely to trigger renin production?

1. Patient participates in strenuous exercise.

2. Patient becomes anxious and nervous.

3. Patient has urge to urinate during the night

4. Patient sustains significant blood loss.

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11. Which renal change associated with aging does the nurse expect an older adult patient to report?

1. Nocturnal polyuria

2. Micturition

3. Hematuria

4. Dysuria

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12. The normal amount of sodium ingested and excreted in the urine is approximately

1. 2 to 3 g/day

2. 4 to 5 g/day

3. 6 to 8 g/day

4. 9 to 10 g/day

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13. . Nursing responsibilities after renal angiography include:

1. assessment of peripheral pulses.

2. color and temperature comparisons between the involved and uninvolved extremities

3. examination of the puncture site for swelling and hematoma formation.

4. all of the above.

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14. In which circumstance is the regulatory role of aldosterone most important in order for the person to maintain homeostasis?

1. Person is having pain related to a kidney stone.

2. Person has been hiking in the desert for several hours.

3. Person experiences stress incontinence when coughing.

4. Person experiences a burning sensation during urination.

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15. Based on the nurse’s knowledge of the normal function of the kidney, which large particles are not found in the urine because they are too large to filter through the glomerular capillary walls? (Select all that apply.)

1. Blood cells

2. Albumin

3. Other proteins

4. Electrolytes

5. Water

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16. Which hormone is released from the posterior pituitary and makes the distal convoluted tubule and the collecting duct permeable to water to maximize reabsorption and produce concentrated urine?

1. Aldosterone

2. Vasopressin

3. Bradykinins

4. Natriuretic

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17. Increased blood osmolality will result in:

1. antidiuretic hormone (ADH) stimulation

2. an increase in urine volume

3. diuresis.

4. less reabsorption of water.

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18. Vitamin D is converted to its active form in the kidney. If this function fails, which electrolyte imbalance will occur?

1. Hyperkalemia

2. Hypocalcemia

3. Hypernatremia

4. Hypoglycemia

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19. The nurse is talking to a group of older women about changes in the urinary system related to aging. What symptom is likely to be the common concern for this group?

1. Incontinence

2. Hematuria

3. Retention

4. Dysuria

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20. An older adult male patient has a history of an enlarged prostate. The patient is most likely to report which symptom associated with this condition?

1. Inability to sense the urge to void

2. Difficulty starting the urine stream

3. Excreting large amounts of very dilute urine

4. Burning sensation when urinating

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21. A major sensitive indicator of kidney disease is the

1. blood urea nitrogen level

2. creatinine clearance level

3. serum potassium level.

4. uric acid level.

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22. A cystoscope allows visualization of the:

1. bladder.

2. ureteral orifices.

3. urethra.

4. above areas.

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23. A major manifestation of uremia is:

1. a decreased serum phosphorus level.

2. hyperparathyroidism.

3. hypocalcemia with bone changes.

4. increased secretion of parathormone.

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Management of patients with kidney disorders

Management of patients with kidney disorders Quiz

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1. In most cases, the major stimulus to acute glomerulonephritis is

1. Escherichia coli.

2. group A streptococcal infection of the throat

3. Staphylococcus aureus

4. . Neisseria gonorrhoeae

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2. . The leading cause of end-stage renal disease is:

1. diabetes mellitus.

2. hypertension.

3. glomerulonephritis.

4. toxic agents

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3. Potassium intake can be restricted by eliminating high-potassium foods such as:

1. butter.

2. citrus fruits

3. cooked white rice.

4. salad oils

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4. The most accurate indicator of fluid loss or gain in an acutely ill patient is:

1. blood pressure

2. capillary refill

3. . serum sodium levels

4. weight.

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5. Oliguria is a clinical sign of ARF that refers to a daily urine output of:

1. 1.5 L

2. 1.0 L

3. less than 400 mL.

4. less than 50 mL.

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6. A patient is admitted with electrolyte imbalance. He has carpopedal spasm, ECG changes, and a positive Chvostek’s sign. The nurse suspects a deficit of:

1. calcium

2. magnesium.

3. phosphorus.

4. sodium.

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7. A fall in CO2- combining power and blood pH indicates what state accompanying renal function?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. . Respiratory alkalosis

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8. In chronic renal failure (end-stage renal disease), decreased glomerular filtration leads to

1. increased pH

2. decreased creatinine clearance.

3. increased blood urea nitrogen (BUN).

4. all of the above

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9. Dietary intervention for renal deterioration includes limiting the intake of:

1. fluid

2. Protein

3. sodium and potassium

4. all of the above.

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10. With peritoneal dialysis, urea and creatinine pass through the peritoneum by:

1. active transport

2. diffusion and osmosis

3. filtration.

4. ultrafiltration.

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11. A patient with ARF and negative nitrogen balance is expected to lose about:

1. 0.5 kg/day

2. 1.0 kg/day

3. 1.5 kg/day

4. 2.0 kg/day

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12. An incomplete protein not recommended for the diet of a patient managed by long-term hemodialysis is that found in:

1. eggs.

2. fish.

3. milk.

4. nuts.

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13. Acute glomerulonephritis refers to a group of kidney diseases in which there is:

1. an inflammatory reaction

2. an antigen–antibody reaction to streptococci that results in circulating molecular complexes.

3. cellular complexes that lodge in the glomeruli and injure the kidney

4. a combination of all of the above.

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14. A patient with stage 3, chronic renal failure would be expected to have:

1. a GFR of 90 mL/min/1.73 m2

2. a GFR 30 to 59 mL/min/1.73 m2

3. severe decreases in GFR.

4. kidney failure.

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Tissue

Tissue Quiz

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1. What is the tissue that covers the body surface and lines internal tubes called?

1. Epithelial tissue

2. Connective tissue

3. Glandular epithelium

4. Muscle tissue

A: Epithelial tissue has one surface “open” to the exterior or to the contents of the tube.

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2. Which of the following is NOT a cell found in connective tissue?

1. Adipocytes

2. Chondroblasts

3. Keratinocytes

4. Osteoblasts

C: Keratinocytes are in the epidermis which is epithelial tissue. The other cell types occur in fat, cartilage and bone.

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3. Which list below contains the four types of tissue?

1. Extracellular fluid, skeletal tissue, glandular tissue, connective tissue

2. Extracellular fluid, muscle tissue, glandular tissue, cartilaginous tissue

3. Neural tissue, skeletal tissue, epithelial tissue, cartilaginous tissue

4. Neural tissue, muscle tissue, epithelial tissue, connective tissue

D: These are the four types. Extracellular fluid is not a tissue. Cartilage is a type of connective tissue.

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4. Which of the following cells would be found in connective tissue?

1. Mucous cells

2. Goblet cells

3. Chondrocytes

4. Neurons

C: Chondro- refers to cartilage, so chondrocytes are cells found in cartilage. Cartilage is a connective tissue. The other choices are found in epithelial tissue, or nervous tissue.

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5. Which of the following is NOT an example of connective tissue?

1. Blood

2. Bone

3. Tendon

4. Epidermis

D: The epidermis (on top of the dermis) is epithelial tissue.

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6. What is “deep fascia”?

1. Connective tissue that surrounds muscle

2. Epithelial tissue that lies under the skin

3. Connective tissue of the hypodermis

4. Epithelial tissue of the abdominal serous membranes

A: Deep fascia is a fibrous connective tissue that surrounds and penetrates into the muscles, as well as surrounding bones, nerves and blood vessels._x000d_Muscle epimysium is an example of deep fascia. Choice C is referring to superficial fascia.

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7. Which one of the following cell types is found in epithelial tissue?

1. Mast cells

2. Adipocytes

3. Chondroblasts

4. Melanocytes

D: Melanocytes produce melanin to protect the skin from ultraviolet radiation, and it results in tanning of the skin.

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8. What tissue has cells that are closely packed and that have one surface attached to a basement membrane and the other free to a space?

1. Epithelial tissue

2. Muscle tissue

3. Connective tissue

4. Nervous tissue

A: This is a definition of epithelial tissue.

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9. Choose the tissue below that is one of the four primary types of body tissue.

1. Epidermal tissue

2. Epithelial tissue

3. Interstitial tissue

4. Osseous tissue

B: Epithelial is a major tissue type (as is muscle, nervous and connective).

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10. Which of the following is ONE major function of epithelial cells?

1. Movement

2. Secretion

3. Support of other cell types

4. Transmit electrical signals

B: Glandular tissues are one type of epithelial tissue, and their function is to produce material to secrete.

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11. Choose the membrane that is NOT a serous membrane.

1. Pleura

2. Peritoneum

3. Peritoneum

4. Lamina propria

D: The lamina propria is a “basement membrane” attached to epithelial tissue. The others are serous membranes.

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12. What are tendons and ligaments composed of?

1. Dense connective tissue

2. Liquid connective tissue

3. Muscular tissue

4. Epithelial tissue

A: Tendons and ligaments are dense connective tissue. This is strong as there is a high proportion of fibres.

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13. What is the composition of the intercellular matrix in connective tissue?

1. Cells and fibres

2. Serous and mucous membranes and lamina propria

3. Protein fibres and ground substance

4. Interstitial fluid

C: “Intercellular” means between cells. Matrix is composed of fibres and ground substance (but no cells).

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14. What is the difference between simple squamous cells and simple columnar cells?

1. Squamous cells are flattened, while columnar cells are taller than they are wide.

2. Simple squamous cells are one layer thick, while simple columnar cells are several layers thick.

3. Simple squamous cells are epithelial tissue, while simple columnar cells are connective tissue.

4. Squamous cells are flattened, while columnar cells are cuboidal.

A: The names of the cells contain a description of their shape: either flat or like columns. Simple refers to a single layer of cells.

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15. Which one of the following cell types is found in epithelial tissue?

1. Mast cells

2. Adipocytes

3. Chondroblasts

4. Keratinocytes

D: These cells produce keratin, the protein of the stratum corneum.

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16. What is the name of the membrane that surrounds the lungs?

1. Visceral peritoneum

2. Parietal peritoneum

3. Visceral pleura

4. Dura mater

C: Pleura is around the lungs, while visceral refers to the layer of the pleura that is attached to the lung surface. Dura mater is a membrane that surrounds and protects the brain.

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17. What does simple columnar epithelial tissue refer to? Tissue with___

1. A single layer of cells longer than they are wide.

2. A single layer of cells whose length, breadth and depth are about the same size.

3. Several layers of cells, all of the same type

4. Several layers of cells but without a basement membrane

A: Simple = one layer. Columnar means oblong or shaped like a column.

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18. Which of the tissue types below consists of a single layer of cells?

1. Stratified squamous epithelial tissue

2. Glandular epithelium

3. Areolar connective tissue

4. Simple columnar epithelial tissue

D: The word “simple” indicates a single layer of cells. Stratified means several layers (or strata) of cells.

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19. Adipocytes are found in which type of tissue?

1. Muscle tissue

2. Epithelial tissue

3. Nervous tissue

4. Connective tissue

D: Adipocytes are found in fat (adipose tissue) which is a type of connective tissue.

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20. Which of the following is a connective tissue?

1. Pancreas

2. Spinal cord

3. Muscle

4. Blood

D: Blood contains cells separated by a liquid matrix. Choices A and B are epithelial and nervous tissues.

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21. Which is NOT true of connective tissue (CT)?

1. The cells are closely packed.

2. The tissue contains protein fibres and ground substance.

3. Types include loose connective tissue, dense connective tissue and liquid connective tissue.

4. Connective tissue contains white blood cells.

A: Being close packed is a property of epithelial tissue. In connective tissues the cells are widely spaced, being separated by the ground substance.

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22. Which of the following is NOT a connective tissue?

1. Blood

2. Mesothelium

3. Fat

4. Tendon

B: Mesothelium is simple squamous epithelium that is found in serous membranes.

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23. Which one of the following is NOT a serous membrane?

1. Pleura

2. Peritoneum

3. Mucosa

4. Pericardium

C: Mucosa is a mucous membrane (and secretes mucus).

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24. Which one of the following cell types is found in epithelial tissue?

1. Plasma cells

2. Leucocytes

3. Keratinocytes

4. Chondroblasts

C: Keratinocytes produce keratin, the protein of the epidermis, which is epithelial tissue.

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