Nursing Process and Clinical Judgment Quiz

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Questions and Answers

Which of the following symptoms is NOT typically associated with hypophosphatemia?

  • Confusion
  • Tingling in lips, tongue, fingers, and/or feet (correct)
  • Muscle weakness
  • Bone pain and fractures

What is the primary role of the kidneys in maintaining acid-base balance?

  • Regulating the rate of respiration to eliminate carbon dioxide
  • Producing bicarbonate to neutralize excess acid
  • Reabsorbing filtered bicarbonate, generating bicarbonate, and excreting acid (correct)
  • Excretion of all excess acids through urine

What is the underlying cause of metabolic acidosis?

  • Excessive loss of acids from body fluids
  • Excessive accumulation of acids in body fluids (correct)
  • Excessive accumulation of bicarbonate in body fluids
  • Excessive loss of bicarbonate from body fluids

Which of the following is a potential cause of metabolic alkalosis?

<p>Repeated vomiting (A)</p> Signup and view all the answers

Which of the following is NOT a typical symptom of metabolic acidosis?

<p>Muscle spasms in the throat (A)</p> Signup and view all the answers

Which of the following conditions is characterized by the accumulation of calcium deposits in the skin or soft tissues?

<p>Hyperphosphatemia (D)</p> Signup and view all the answers

Which of the following treatments is commonly used for metabolic acidosis?

<p>Administration of sodium bicarbonate (B)</p> Signup and view all the answers

Which of the following IV fluid solutions is classified as hypotonic?

<p>0.45% sodium chloride (B)</p> Signup and view all the answers

Which of the following statements accurately describes respiratory acidosis?

<p>It is characterized by a decrease in blood pH due to the inability of the lungs to effectively remove carbon dioxide. (D)</p> Signup and view all the answers

Which of the following IV fluid solutions is considered isotonic?

<p>5% dextrose in water (C)</p> Signup and view all the answers

Which of the following is NOT a common complication of conditions affecting the heart, liver, and kidneys?

<p>Respiratory alkalosis (B)</p> Signup and view all the answers

Which of the following solutions is commonly used to treat hypernatremia?

<p>0.45% sodium chloride (B)</p> Signup and view all the answers

What is the primary function of the detrusor muscle?

<p>To contract and expel urine from the bladder (D)</p> Signup and view all the answers

Which of the following statements accurately describes osmotic pressure as it relates to fluid balance?

<p>The pressure exerted by plasma proteins that helps pull fluid back into capillaries (B)</p> Signup and view all the answers

Which of the following IV fluid solutions is commonly used for fluid resuscitation in patients with hypovolemia?

<p>Lactated Ringer's solution (C)</p> Signup and view all the answers

What is the primary cause of respiratory alkalosis?

<p>Hyperventilation, which leads to a decrease in carbon dioxide levels in the blood (A)</p> Signup and view all the answers

Which of the following is NOT a potential complication of fluid overload in a patient with acute kidney injury?

<p>Hypokalemia (C)</p> Signup and view all the answers

A patient with acute kidney injury (AKI) presents with a fixed specific gravity of 1.010 and an osmolality of 300 mOsm/kg. What phase of AKI is this most consistent with?

<p>Oliguric Phase (C)</p> Signup and view all the answers

Which of these is NOT a contributing factor to the formation of kidney stones?

<p>Increased urinary flow rate (C)</p> Signup and view all the answers

What is the primary mechanism by which metabolic acidosis develops in a patient with AKI?

<p>Decreased excretion of hydrogen ions (D)</p> Signup and view all the answers

Which of the following is a clinical manifestation of AKI that is NOT directly related to fluid overload?

<p>Leukocytosis (D)</p> Signup and view all the answers

Which type of kidney stone is most commonly associated with Jewish men?

<p>Uric acid (D)</p> Signup and view all the answers

A patient experiencing sudden, severe pain in the flank area, back, or lower abdomen with symptoms of nausea, vomiting, dysuria, and fever could be suspected of having:

<p>Renal Colic (C)</p> Signup and view all the answers

Which of the following is a characteristic of the diuretic phase of AKI?

<p>Decreased BUN and creatinine levels (B)</p> Signup and view all the answers

What is the most common bacterium responsible for a urinary tract infection (UTI) acquired in a healthcare setting (HAI)?

<p>Escherichia coli (C)</p> Signup and view all the answers

Which of the following is a potential pre-renal risk factor for AKI?

<p>Severe dehydration (D)</p> Signup and view all the answers

Which of the following is an example of an intrarenal risk factor for AKI?

<p>Acute tubular necrosis (D)</p> Signup and view all the answers

Which of the following is NOT a defense mechanism protecting the urinary tract from infection?

<p>Ureterovesical junction incompetence (D)</p> Signup and view all the answers

What is the primary goal of conservative management in a patient with chronic kidney disease (CKD)?

<p>To slow the progression of CKD (B)</p> Signup and view all the answers

Which of these is a common site of obstruction in the urinary tract, potentially leading to kidney stone pain?

<p>Ureteropelvic junction (UPJ) (C)</p> Signup and view all the answers

Which of the following is NOT a type of renal replacement therapy that can be managed in the acute care setting?

<p>Kidney transplantation (A)</p> Signup and view all the answers

Which of the following is a typical characteristic of a UTI in older adults?

<p>General abdominal discomfort (A)</p> Signup and view all the answers

What is the recommended diagnostic test for a suspected kidney stone?

<p>Noncontrast helical (spiral) CT scan (C)</p> Signup and view all the answers

Which of the following is a characteristic of stage 3 CKD?

<p>GFR between 30 and 59 ml/min/1.73 m2 (D)</p> Signup and view all the answers

Which of the following is NOT a diagnostic test used to assess chronic pyelonephritis?

<p>Urine culture/sensitivity (D)</p> Signup and view all the answers

Which of the following is LEAST likely to contribute to the development of a UTI?

<p>Acidic urine pH (C)</p> Signup and view all the answers

A patient with Benign Prostatic Hyperplasia (BPH) presents with urinary frequency, urgency, and difficulty initiating urination. Which of the following diagnostic tests would be MOST helpful in monitoring the effectiveness of treatment for BPH?

<p>Prostate-Specific Antigen (PSA) test (C)</p> Signup and view all the answers

A patient with BPH is considering "watchful waiting" as an initial management approach. Which of the following factors would NOT be a typical indication for this approach?

<p>A recent history of urinary tract infection (UTI) (D)</p> Signup and view all the answers

A patient undergoing Transurethral Resection of the Prostate (TURP) is at risk for various complications. Which of the following complications is LEAST likely to occur after TURP?

<p>Acute renal failure (A)</p> Signup and view all the answers

A patient with BPH is advised to make lifestyle changes, including dietary modifications. Which of the following dietary recommendations would be MOST helpful in managing BPH symptoms?

<p>Limiting consumption of caffeine and artificial sweeteners (C)</p> Signup and view all the answers

A patient presents with symptoms of BPH. Which of the following factors would NOT be considered a risk factor for developing BPH?

<p>Regular exercise (B)</p> Signup and view all the answers

Flashcards

Symptoms of Hypophosphatemia

Confusion, muscle weakness, fatigue, bone pain, slow growth in children.

Symptoms of Hyperphosphatemia

Bone/joint pain, rash, itchy skin, calcium deposits in tissues.

Acid-Base Homeostasis

Maintained by respiration and kidneys, balancing bicarbonate and acids.

Metabolic Acidosis

Excess acid in the body due to toxins, kidney failure, or drug ingestion.

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Symptoms of Metabolic Acidosis

Nausea, vomiting, fast breathing, lethargy.

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Metabolic Alkalosis

Excess bicarbonate in body fluids, often due to digestive issues.

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Kidney Role in Acid-Base Balance

Reabsorbs bicarbonate, generates bicarbonate, excretes acid.

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Respiratory acidosis

Condition where lungs can't remove CO2, lowering blood pH.

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Respiratory alkalosis

Condition caused by hyperventilation, raising blood pH.

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Isotonic solutions

Fluids with same osmolality as cell interior, e.g. D5W, NS, LR.

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Hypertonic solutions

Fluids with greater sodium concentration than plasma, causing cell shrinkage.

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Hypotonic solutions

Fluids with lower sodium concentration than plasma, causing cell swelling.

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Osmotic pressure

Pressure exerted by plasma proteins that pulls fluid into capillaries.

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Detrusor muscles

Smooth muscle fibers in bladder, enabling stretch and contraction.

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Lactated Ringer's solution

Isotonic IV fluid that contains electrolytes, used for hydration.

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5% dextrose in water (D5W)

Isotonic IV solution providing sugar and hydration to patients.

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Acute Kidney Injury (AKI) Duration

Duration of AKI can last from 10 days to several months, affecting prognosis.

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Oliguria Definition

Oliguria is defined as urine output less than 400 ml per day.

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Urinalysis Findings in AKI

Common findings include casts, RBCs, WBCs, and protein in urine.

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Hypovolemia Impact on AKI

Hypovolemia can worsen AKI by reducing blood flow to kidneys.

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Signs of Fluid Retention

Symptoms include distended neck veins, bounding pulse, edema, and hypertension.

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Complications of Fluid Overload

Fluid overload may cause CHF, pulmonary edema, or effusions.

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Leukocytosis and Infection

Leukocytosis indicates infection, which can be life-threatening in AKI.

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Metabolic Acidosis in AKI

Kidneys fail to excrete hydrogen, leading to severe acidosis symptoms.

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BUN & Creatinine in AKI

Increased BUN (Blood Urea Nitrogen) and creatinine levels indicate kidney dysfunction.

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Renal Replacement Therapy Options

Options include dialysis and transplant for end-stage renal disease management in acute care.

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Benign Prostatic Hyperplasia (BPH)

A non-cancerous enlargement of the prostate gland that can obstruct urinary flow.

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Irritative Symptoms of BPH

Symptoms include nocturia, urinary frequency, urgency, dysuria, and incontinence.

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Obstructive Symptoms of BPH

Symptoms including decreased force of stream, difficulty starting, and dribbling.

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Digital Rectal Exam (DRE)

A physical examination technique to assess the prostate's size and consistency.

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Transurethral Resection of Prostate (TURP)

A surgical procedure to remove prostate tissue causing obstruction.

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Kidney Stones

Hard deposits made of minerals and salts that form in the kidneys.

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Risk Factors for Kidney Stones

Factors increasing likelihood of developing kidney stones include metabolic, climate, dietary, genetics, and lifestyle.

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Calcium Oxalate

The most common type of kidney stone, formed from calcium and oxalate.

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Renal Colic

Severe pain caused by kidney stones, often felt in the flank area.

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Diagnostic Tests for Kidney Stones

Tests like noncontrast CT scans, ultrasounds, and urinalysis to diagnose kidney stones.

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UTI Etiology

Most UTIs are caused by bacteria like E. coli, which ascend the urethra from the GI tract.

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Lower UTI Symptoms

Common symptoms include dysuria, frequency, urgency, and hematuria.

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Upper UTI Symptoms

Symptoms may include flank pain, fever, and chills; may be asymptomatic in older adults.

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Urinalysis

A test performed to assess for signs of infection, such as nitrates and bacteria in urine.

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Struvite Stones

Kidney stones formed in response to urinary infection, often made of magnesium and ammonium.

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Study Notes

Objectives for Unit 1

  • Expect that N380 quizzes and exams will assess knowledge of critical-thinking and clinical decision models (nursing process) for applying theory to diagnoses.
  • This includes knowledge of diagnostics, expected findings, focused assessment, plans of care, interventions (pharmacologic and non-pharmacologic), expected outcomes, and evaluation effectiveness.
  • Specific objectives guide study for quiz 1.

Chapter 1: Professional Nursing

  • Describe the role of clinical judgment and interprofessional communication in assessing and planning for potential or actual needs for transfer or discharge to appropriate care levels.
    • Review the role of the clinical judgment in patient assessment.
    • Review interprofessional communication in decision-making processes.
  • Describe the phases of the clinical practice model and how they relate to steps in the nursing process.
    • The Clinical Practice Model (CPM) and Nursing Process (assessment, diagnosis, planning, implementation, and evaluation) start with thorough assessment of the patient's condition.
    • Diagnosis of patient's health issues determines appropriate care.
    • Planning involves strategy development, goal setting, and interventions necessary to achieve those goals.
    • Implementing the care plan involves putting the care plan into action.
    • Evaluation involves assessing the effectiveness of interventions.
  • Describe the roles and functions of healthcare team members who perform case management and utilization review.
    • Utilization review uses established criteria for insurance review and authorization of services.
    • Optimize hospital resources.
    • Reduce costs.
    • Improve patient satisfaction.
    • Provide care for as many people as possible.
    • Case management promotes appropriate utilization, high-quality care, and cost-effective outcomes through assessment, planning, intervention, and monitoring.

Chapter 4: Patient & Caregiver Teaching

  • Apply the teaching-learning process to diverse patient populations.
  • Describe how the Transtheoretical Model of Change can be used to identify appropriate teaching strategies and goals.
  • Identify measurable outcomes to demonstrate problem resolution in a plan of care.
  • Identify strategies to support patient learning.
  • Identify the role of the caregiver in patient teaching.
  • Describe patient and caregiver characteristics affecting the teaching-learning process.
  • Prioritize patient teaching goals.
  • Describe appropriate methods to evaluate patient and caregiver teaching.

Chapter 5: Chronic Illness & Older Adults

  • Explain the characteristics of chronic illnesses.
    • Prolonged illness, no cure, results in irreversible changes, possible disability, and often requires rehab and/or ongoing management.

Chapter 17: Fluid, Electrolyte & Acid-Base Imbalances

  • Describe the composition of the major body fluid compartments.
  • Define processes involved in regulating water and electrolyte movement between body fluid compartments.
  • Describe the etiology, manifestations, and interprofessional management of extracellular fluid volume imbalances (deficit and overload), and electrolyte imbalances.

Chapter 49: Assessment - Urinary System

  • Identify the anatomic location and function of the detrusor muscles.
  • Explain the physiologic events involved in urine formation and passage.
  • Differentiate subjective and objective data related to the urinary system.
  • Identify age-related changes in the urinary system and their effect on assessment findings.
  • Describe key assessments, expected findings, significance of results for urinary system diagnostic procedures.
    • Define common urologic conditions and their characteristics.

Chapter 7 or Further Chapters (Based on Page Numbers Provided)

  • [Further Content Summarized as needed] (The provided pages did not cover all chapters, this is a place holder).

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N380 Objectives to Guide Study for UNIT #1 PDF

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