D454 Adult Health III
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Free D454 Adult Health III Questions
1. Which descriptions characterize acute kidney injury? (select all that apply)
- Primary cause of death is infection
- It almost always affects older people
- Disease course is potentially reversible
- Most common cause is diabetic neuropathy
- Cardiovascular disease is most common cause of death
Explanation
Acute kidney injury (AKI) is characterized by a sudden decrease in kidney function and is often potentially reversible with prompt treatment, distinguishing it from chronic kidney disease. While older adults are at higher risk, AKI can occur at any age. Infection is the primary cause of death in AKI patients due to immunosuppression and complications, whereas cardiovascular disease is the leading cause of death in chronic kidney disease. Diabetic neuropathy is a major cause of chronic kidney disease, not AKI.
2. Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first?
- 22-year-old who has noticed a firm, nontender lump on his scrotum
- 35-year-old who is concerned that his scrotum "feels like a bag of worms"
- 40-year-old who has pelvic pain while being treated for chronic prostatitis
- 70-year-old who is reporting frequent urinary dribbling after a prostatectomy
Explanation
A firm, nontender lump on the scrotum in a young adult is highly suspicious for testicular cancer, which requires prompt evaluation to prevent progression and ensure timely treatment. Although a "bag of worms" sensation may indicate a varicocele, and pelvic pain or urinary dribbling are concerning, they are generally less urgent than ruling out malignancy in a young adult. Early detection of testicular cancer is critical for prognosis.
3. A young patient who is trying to become pregnant asks the nurse how to determine when she is most likely to conceive. The nurse explains that
- Ovulation is unpredictable unless there are regular menstrual periods.
- Ovulation prediction kits can provide accurate information about ovulation.
- She will need to bring a specimen of cervical mucus to the clinic for testing.
- She should take her body temperature daily and have intercourse when it drops.
Explanation
Ovulation prediction kits detect the luteinizing hormone (LH) surge that occurs before ovulation, allowing patients to accurately identify their most fertile days. This method is more reliable than tracking basal body temperature alone or assessing cervical mucus in a clinic setting. While regular menstrual cycles can provide some estimation of ovulation, kits offer precise timing for conception.
4. Patients with chronic kidney disease have an increased incidence of cardiovascular disease related to (select all that apply)
- Hypertension
- Vascular calcification
- A genetic predisposition
- Hyperinsulinemia causing dyslipidemia
- Increased high-density lipoprotein levels
Explanation
CKD is strongly associated with cardiovascular disease due to multiple interrelated factors. Hypertension and vascular calcification contribute to arterial stiffness and atherosclerosis. Hyperinsulinemia can lead to dyslipidemia, further increasing cardiovascular risk. While genetic predisposition may play a role, it is not as prominent as the other factors listed. Increased high-density lipoprotein (HDL) is protective rather than a risk factor, so it does not contribute to cardiovascular complications in CKD patients.
5. After a hypophysectomy for acromegaly, postoperative nursing care should focus on
- Frequent monitoring of serum and urine osmolarity.
- Parenteral administration of a GH-receptor antagonist.
- Keeping the patient in a recumbent position at all times.
- Patient teaching regarding the need for lifelong hormone therapy.
Explanation
After a hypophysectomy, the posterior pituitary can be affected, increasing the risk of diabetes insipidus due to antidiuretic hormone deficiency. Therefore, frequent monitoring of serum and urine osmolarity is crucial to detect imbalances early and prevent complications such as dehydration or electrolyte disturbances. While hormone therapy and positioning are important in long-term care, the immediate postoperative priority is monitoring for fluid and electrolyte disturbances.
6. A female patient being admitted with pneumonia has a history of neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first?
- a. Ask about the usual urinary pattern and any measures used for bladder control.
- b. Assist the patient to the toilet at scheduled times to help ensure bladder emptying.
- c. Check the patient for urinary incontinence every 2 hours to maintain skin integrity.
- d. Use intermittent catheterization on a regular schedule to avoid risk of infection.
Explanation
The first step in caring for a patient with a neurogenic bladder is to obtain a thorough history about usual urinary patterns and methods of bladder management. This information guides individualized care and helps prevent complications such as urinary retention, infection, or incontinence. Interventions like scheduled toileting or intermittent catheterization are implemented based on the patient’s established pattern and current needs.
7. A 25-yr-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be the most important to report to the health care provider?
- Serum creatinine level of 2.1 mg/dL
- Serum potassium level of 6.5 mEq/L
- White blood cell count of 11,500/microliter
- Blood urea nitrogen (BUN) of 56 mg/L
Explanation
Crushing injuries put patients at high risk for rhabdomyolysis, which can lead to the release of potassium from damaged muscle cells. A serum potassium level of 6.5 mEq/L indicates hyperkalemia, a potentially life-threatening condition that can cause cardiac arrhythmias or cardiac arrest. This laboratory finding requires immediate reporting and intervention. Elevated creatinine and BUN indicate impaired kidney function but are not as acutely life-threatening as severe hyperkalemia. A mildly elevated white blood cell count reflects stress or inflammation but is not immediately critical in comparison to high potassium levels.
8. RIFLE defines three stages of AKI based on changes in:
- Blood pressure and urine osmolality
- Fractional excretion of urinary sodium
- Estimation of GFR with the MDRD equation
- Serum creatinine or urine output from baseline
Explanation
The RIFLE criteria for acute kidney injury (AKI) classify the severity of kidney injury into three stages—Risk, Injury, and Failure—based on changes in serum creatinine or urine output relative to baseline. These measures reflect the kidney’s filtration and excretory function and provide an objective method to assess the degree of renal impairment. Blood pressure, urine osmolality, fractional sodium excretion, or estimated GFR by the MDRD equation are not used directly in the RIFLE classification.
9. To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should (select all that apply)
- Monitor for any increase of BP in the affected arm
- Irrigate the graft daily with low-dose heparin
- Palpate the area of the graft to feel a normal thrill
- Listen with a stethoscope over the graft for presence of a bruit
- Frequently monitor the pulses and neurovascular status distal to the graft
Explanation
Patency of an arteriovenous (AV) graft is assessed by palpating for a thrill and auscultating for a bruit, which indicate proper blood flow through the graft. Additionally, it is important to monitor distal pulses and neurovascular status to detect signs of ischemia. Irrigating the graft daily with heparin or monitoring for increased blood pressure in the affected arm is not part of routine patency assessment. Careful assessment helps identify early complications such as thrombosis or stenosis.
10. A 19-yr-old patient has been diagnosed with primary dysmenorrhea. How will the nurse suggest that the patient manage the discomfort?
- Avoid aerobic exercise during her menstrual period.
- Use cold packs on her abdomen and back for pain relief.
- Talk with her health care provider about beginning antidepressant therapy.
- Take nonsteroidal antiinflammatory drugs (NSAIDs) when her period starts.
Explanation
Primary dysmenorrhea is caused by prostaglandin-mediated uterine contractions. NSAIDs inhibit prostaglandin synthesis and are most effective when taken at the onset of menstrual bleeding or pain. Cold packs are generally less effective and may exacerbate discomfort for some patients, and aerobic exercise can actually help reduce pain by increasing circulation and releasing endorphins. Antidepressants are not indicated for typical primary dysmenorrhea.
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