ATI Custom: AH2- FA25- Exam 3
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Free ATI Custom: AH2- FA25- Exam 3 Questions
A nurse is caring for a client with impaired glomerular function. Which of the following clinical manifestations are indicative the client may have glomerulonephritis? (Select All that Apply.)
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Periorbital edema
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Anorexia
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Dark and frothy urine
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Nausea and vomiting
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Elevated blood pressure
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Chest pain
Explanation
Explanation of Correct Answers
A. Periorbital edema
Periorbital (around the eyes) edema is one of the earliest and most characteristic signs of glomerulonephritis. It results from sodium and water retention due to decreased glomerular filtration and impaired kidney function. The edema may later progress to involve other parts of the body, including the legs and feet.
C. Dark and frothy urine
The dark color of the urine indicates hematuria (blood in the urine), while the frothy appearance reflects proteinuria. Both occur because inflammation of the glomeruli increases permeability, allowing red blood cells and proteins to leak into the urine—classic findings in glomerulonephritis.
E. Elevated blood pressure
Hypertension is common in glomerulonephritis due to fluid and sodium retention, as well as activation of the renin-angiotensin system. Uncontrolled hypertension worsens kidney damage and can lead to heart failure if not promptly managed.
A nurse is caring for a client who has end-stage kidney disease who will soon begin hemodialysis treatments. Which of the following restrictions should the nurse discuss with the client that may impact quality of life? (Select All that Apply.)
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Restricting fluid intake
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Driving restrictions
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Restricting airplane travel
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Restricting foods high in potassium, sodium, and phosphorus
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Limiting social activities to twice a week
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Time constraints associated with hemodialysis treatment
Explanation
Explanation of Correct Answers
A. Restricting fluid intake
Clients on hemodialysis must limit fluid intake because the kidneys can no longer eliminate excess water efficiently. Excessive fluid can cause hypertension, pulmonary edema, and heart failure. This restriction can affect social experiences and comfort, particularly in hot weather or social situations involving beverages.
D. Restricting foods high in potassium, sodium, and phosphorus
Dietary restrictions are crucial in hemodialysis to prevent dangerous electrolyte imbalances. High potassium foods (bananas, oranges, potatoes), high sodium foods (processed meats, canned soups), and high phosphorus foods (dairy, nuts) must be limited, which can make meal planning difficult and impact quality of life.
F. Time constraints associated with hemodialysis treatment
Hemodialysis typically requires 3–4 sessions per week, each lasting 3–5 hours, limiting work, travel, and social opportunities. The need for transportation and scheduling around treatments often disrupts daily routines and independence.
Based on the client’s clinical presentation and assessment findings, which findings are consistent with diabetic ketoacidosis (DKA) and which are consistent with hyperosmolar hyperglycemic state (HHS)?
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Polyuria/polydipsia – DKA and HHS
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Kussmaul respirations – DKA
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Altered mental status – DKA and HHS
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Serum bicarbonate less than 15 mEq/L – DKA
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Physiological stressor as precipitating factor – DKA and HHS
Explanation
Explanation of Correct Answers
Polyuria/polydipsia – DKA and HHS:
Both DKA and HHS result from severe hyperglycemia, which causes osmotic diuresis. The kidneys attempt to excrete excess glucose, leading to large volumes of urine output (polyuria). This loss of fluid triggers excessive thirst (polydipsia) as the body tries to compensate for dehydration.
Kussmaul respirations – DKA:
Deep, rapid breathing (Kussmaul respirations) occurs in DKA as a compensatory mechanism for metabolic acidosis caused by ketone buildup. This pattern helps blow off carbon dioxide to restore acid-base balance. Kussmaul respirations are a hallmark finding of DKA and are not seen in HHS, as acidosis is minimal or absent in HHS.
Altered mental status – DKA and HHS:
Both conditions can cause confusion, lethargy, or decreased consciousness due to dehydration and increased serum osmolality. However, altered mental status is usually more severe in HHS, as it typically develops gradually over several days, leading to profound hyperosmolarity and cerebral dehydration.
Serum bicarbonate less than 15 mEq/L – DKA:
A low bicarbonate level indicates metabolic acidosis, which occurs in DKA due to the accumulation of acidic ketone bodies. In contrast, clients with HHS maintain normal or near-normal bicarbonate levels because ketosis and acidosis are minimal. This lab value helps differentiate DKA from HHS.
Physiological stressor as precipitating factor – DKA and HHS:
Both conditions are commonly triggered by physiological stressors such as infections, illness, trauma, or surgery. These stressors increase cortisol and catecholamine release, raising blood glucose levels and worsening insulin deficiency or resistance. In both DKA and HHS, addressing the underlying stressor is essential to prevent recurrence.
A nurse is caring for a client who has end-stage liver disease and a recent diagnosis of thrombocytopenia. Which of the following statements provides the best recommendation to prevent complications of bleeding?
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Use a floss pick instead of the floss string to floss in between the teeth.
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Apply an ice pack over a bleeding wound.
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Only use a soft-bristle toothbrush.
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Wear sleeveless or short-sleeved shirts and shorts to better visualize any skin issues.
Explanation
Clients with thrombocytopenia have a significantly increased risk for bleeding because of low platelet counts, which impair clot formation. Using a soft-bristle toothbrush helps maintain oral hygiene while minimizing the risk of gum trauma and bleeding. The nurse should also instruct the client to avoid flossing, using toothpicks, or performing aggressive oral care, as even minor abrasions can lead to prolonged bleeding in thrombocytopenic patients.
Based on the client’s assessment findings, which potential condition, nursing actions, and parameters to monitor are most appropriate for this client?
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Potential Condition: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Actions to Take: Administer sodium tablets; Keep client NPO Parameters to Monitor: Serum sodium, Neurological status
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Potential Condition: Diabetic Ketoacidosis (DKA) Actions to Take: Administer insulin; Monitor for peripheral edema Parameters to Monitor: Serum glucose, Arterial blood gases
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Potential Condition: Diabetes Insipidus (DI) Actions to Take: Administer hypotonic fluids; Measure intake and output Parameters to Monitor: Serum sodium, Urine specific gravity
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Potential Condition: Thyroid Storm Actions to Take: Administer beta-blocker; Perform neurological assessments Parameters to Monitor: Temperature, Heart rate
Explanation
The client’s symptoms of confusion, lethargy, excessive thirst, excessive urination, dry skin, tenting, hypotension (80/60 mm Hg), tachycardia (120 bpm), and severe hypernatremia (Na 170 mEq/L) indicate diabetes insipidus (DI), likely caused by chronic lithium use. DI leads to an inability to concentrate urine, resulting in water loss and hypernatremia. The nurse should administer hypotonic fluids (e.g., 0.45% NaCl) to replace free water and measure intake and output closely to prevent dehydration. Monitoring serum sodium ensures gradual correction of hypernatremia, while urine specific gravity helps evaluate renal concentration ability and treatment effectiveness.
A nurse is reviewing the laboratory data of a client following a hemodialysis treatment. The nurse should expect to find a decrease in which of the following laboratory values?
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Potassium
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Calcium
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RBC count
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Protein
Explanation
Hemodialysis removes excess waste products and electrolytes from the blood through diffusion and ultrafiltration. Potassium levels decrease after dialysis because potassium freely moves across the dialysis membrane from the blood (where it is high) into the dialysate (where it is low). This correction helps prevent life-threatening cardiac dysrhythmias associated with hyperkalemia, which is common in renal failure. Regular monitoring of serum potassium before and after dialysis is essential to maintain safe electrolyte balance.
Which four findings are most concerning? (Select All that Apply.)
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Ammonia
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ALT
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AST
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Blood pressure
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Platelets
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Hemoglobin
Explanation
Explanation of Correct Answers
A. Ammonia:
An ammonia level of 94 μmol/L (normal <30) is critically elevated and indicates impaired liver detoxification, consistent with hepatic encephalopathy. Elevated ammonia crosses the blood-brain barrier, leading to confusion, lethargy, and altered mental status. Immediate treatment with lactulose or rifaximin is required to reduce ammonia absorption and prevent progression to coma.
D. Blood pressure:
A blood pressure of 87/42 mm Hg reflects hypotension, suggesting possible circulatory collapse or hemorrhagic shock, likely related to liver dysfunction or gastrointestinal bleeding (common in liver failure). Hypotension compromises organ perfusion, including to the kidneys and brain, and requires immediate fluid resuscitation or vasopressor support.
E. Platelets:
A platelet count of 100 ×10³/μL (normal 150–450) indicates thrombocytopenia, commonly seen in liver failure due to splenomegaly or decreased hepatic synthesis of clotting factors. This significantly increases the risk for spontaneous bleeding, especially in the GI tract or from varices, making it a priority concern.
F. Hemoglobin:
A hemoglobin of 6 g/dL (normal 12–16) is critically low and suggests severe anemia, potentially due to internal bleeding or chronic disease. Such a low level severely reduces oxygen-carrying capacity, causing tachycardia and hypotension. Immediate blood transfusion and monitoring for active bleeding are indicated.
A nurse is caring for a client with liver failure. What is a common nursing intervention for a client with esophageal varices?
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Providing a high-fiber diet
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Administering vasopressin
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Encouraging the client to cough forcefully
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Administering anticoagulant medications
Explanation
Vasopressin is a potent vasoconstrictor used to reduce portal hypertension and control bleeding from esophageal varices in clients with liver failure. By constricting splanchnic blood vessels, vasopressin decreases portal blood flow and pressure, minimizing the risk of rupture or hemorrhage. This intervention is part of emergency management for variceal bleeding, often combined with endoscopic therapy and fluid or blood replacement as necessary.
A nurse is teaching a client who has hepatitis A. Which of the following information should the nurse include?
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A family history increases your risk for acquiring hepatitis A.
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Hepatitis A infects the kidneys.
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The incubation of the virus is 5 days.
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Manifestations of the virus are similar to flu-like symptoms.
Explanation
Hepatitis A is an acute viral infection that primarily affects the liver and is transmitted via the fecal-oral route, often through contaminated food or water. The early symptoms resemble those of influenza and include fatigue, malaise, anorexia, nausea, vomiting, fever, and right upper quadrant discomfort. Jaundice may develop later as liver inflammation progresses. The infection is usually self-limiting and does not cause chronic liver disease. Preventive measures include proper hand hygiene and vaccination.
A nurse is caring for a client with ascites secondary to liver dysfunction. Which of the following interventions are appropriate for a client experiencing complications of ascites? (Select All that Apply.)
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Administer diuretic medications as prescribed
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Initiate dialysis
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Paracentesis
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Albumin
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Encourage the client to lie flat on their back
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Administer opioid pain medications
Explanation
Explanation of Correct Answers
A. Administer diuretic medications as prescribed
Diuretics such as spironolactone and furosemide are used to promote fluid excretion and reduce abdominal swelling associated with ascites. By decreasing total body fluid and sodium retention, they help relieve discomfort and lower the risk of respiratory compromise caused by abdominal distention.
C. Paracentesis
Paracentesis is a procedure that removes excess ascitic fluid from the peritoneal cavity using a needle or catheter. It is indicated when ascites causes severe abdominal distention, pain, or respiratory distress. This procedure provides immediate symptom relief and can improve breathing and comfort.
D. Albumin
Albumin administration after paracentesis helps maintain intravascular volume and prevent circulatory collapse. In clients with liver dysfunction, low albumin levels contribute to fluid leakage into the abdomen, so albumin infusion helps restore oncotic pressure and stabilize blood pressure.
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