Basic Questions Part 3

Liver biopsy is contraindicated in clients with bleeding disorders due to the risk of bleeding from the biopsy site. Incorrect answers: a, c, and d—A client with a bleeding disorder can safely undergo an intravenous pyelogram,
renal scan, or CT scan of the brain since, other than a venipuncture for administration of contrast dye or radioisotope, they are noninvasive.

With renal dysfunction, the glomerular filtrate membrane “leaks”, allowing large protein molecules to pass through
into the urine. Incorrect answers: a, b, and d—positive leukocyte esterase and nitrites are indicative of urinary tract infection. Positive urobilinogen occurs with liver dysfunction.

Low potassium levels (hypokalemia) cause confusion, anorexia, muscle weakness, paresthesias, hypotension, cardiac dysrhythmias, and decreased reflexes. Incorrect answers: a, b, and d—Abnormal levels of phosphorus, calcium, and sodium do not result in the triad of dysrhythmias, confusion, and weakness.

Midway through the 24-hour urine collection, a serum creatinine level is collected to help calculate the rate at which kidneys are clearing creatinine from the blood.
Incorrect answers: a, c, and d—urine cytology requires a urine sample only; bicarbonate levels can be done on either serum or urine samples; BUN requires a serum sample.

There is a narrow margin of safety between therapeutic drug effect and drug toxicity with digoxin.

Incorrect answers: a, b, and d—urine osmolality identifies the osmotic concentration; creatinine clearance determines the glomerular filtration rate; urine cytology detects urinary inflammatory diseases.

An ultrasound of the gallbladder involves only sound waves, not radiation.
Incorrect answers: a, b, and c—CT scans and X-rays involve exposure of the fetus to radiation

Hemoglobin A1C absorbs glucose and holds it for the lifespan of the red blood cell (up to 120 days). Incorrect answers: a, b, and d—The fasting plasma glucose, urine dipstick for glucose, and glucose tolerance test provide information on glucose levels at one point in time.

Specimen collection should occur prior to beginning antibiotic therapy.
Incorrect answers: a—treatment with antibiotics before obtaining the culture may produce false-negative results; b—the client is started on a broad spectrum antibiotic while awaiting the culture and sensitivity report. If the bacteria are found to be resistant to the prescribed antibiotic, the medication will be changed; d—the sensitivity report identifies the antibiotics to which the bacteria are susceptible.

ALT, an enzyme found primarily in the liver, is elevated in clients with hepatitis.

The client is most likely experiencing respiratory depression from the narcotic fentanyl. The antidote for fentanyl overdose is naloxone.
Incorrect answers: a, c, and d—Increasing the IV rate will not affect the respiratory depression. CPR is not neededsince the client is still breathing. Vital signs are to be monitored every 5 minutes during conscious sedation.

Target INR for clients with afib is 2.0–3.0. This client’s INR is within this range.

Creatinine is formed and excreted at a constant rate and is the ideal substance for measuring renal clearance. Incorrect answers: BUN reflects the balance between production and excretion of urea; Bence-Jones proteins are
positive for multiple myeloma; urine cytology detects urinary inflammatory diseases.

Clients undergoing CT scans using contrast media need adequate renal function to process the media. Elderly clients and clients with diabetes mellitus are at risk due to decreased renal function. Incorrect answers: a, b, and d—Abnormal liver function, electrolyte, or blood sugar tests do not typically prevent a
client from having a CT scan.

These signs are all indicators of possible complications and need to be reported immediately. Incorrect answers: a—the client should empty her bladder prior to the procedure to avoid accidental puncture during the amniocentesis; b—there are numerous possible complications of the procedure, including hemorrhage, infection, premature labor, and spontaneous abortion; d—the procedure involves transabdominal needle aspiration of amniotic fluid.

The client is not to have fluids until the nurse is certain the gag reflex is intact.
Incorrect answers: a, b, and d—After a bronchoscopy thenurse is to periodically monitor the vital signs and breath sounds to assess for development of complications such as pneumothorax. Due to receipt of sedation during the
procedure, the client is to remain in bed with the siderails up until fully conscious.

If there is no air leak, the water level in the water seal chamber will oscillate with the client’s respirations. Incorrect answers: a—pockets of air represent subcutaneous emphysema, the physician should be notified if it increases; b—bubbling in the water seal chamber indicates the presence of an air leak; c—increased drainage suggests new or increased bleeding and needs to be reported.

With a severe bacterial infection, the total white blood cell count would be above normal. Band neutrophils would be elevated because the body is trying to quickly fight the infection; so quickly, that the neutrophils are being released into the circulation before they are mature cells. Incorrect answer: a—WBC count is normal with elevated lymphocytes, indicating viral infection; b—WBC count is
above normal but segs are normal, thus indicating the infection is not severe; d—although the WBC count is elevated, the segs are still within normal limits, again
indicating the infection is not severe.

A chest X-ray is the most accurate method. Incorrect answers: a, and b—both of these methods are less reliable options; d—this option is not acceptable practice.

For health care workers, 10 mm and above of induration is considered positive.
Incorrect answers: a—Erythema is not considered as positive; b—5 mm of induration is positive if the person is immunocompromised; d—15 mm of induration is positive for persons with no known risk factors.

The renal ultrasound is done before any studies involving barium. Then the lower GI series is done so that barium from the upper GI series does not obscure the lower GI images. Incorrect answers: a, b, and d—lower GI series is done
before the upper GI series; renal ultrasound cannot be done within 2 days of barium studies, so it is best to complete this first.

Performing a colonoscopy in the presence of acute diverticulitis increases the risk of perforation of the colon wall during the procedure.
Incorrect answers: a, b, and c—none of these problems would prevent the client from having a colonoscopy.

Screening for women who are high-risk is to begin 10 years before the age of the diagnosis of breast cancer in a family member.

The NST is considered nonreactive if there is no fetal movement in 40 minutes. A contraction stress test is then scheduled.
Incorrect answers: a, b, c—Any fetal movement in less than 40 minutes is considered normal, even if external stimulation, such as rubbing the abdomen or a loud noise, is needed to stimulate the fetus.

Clients with renal disease lose the ability to concentrate urine. Incorrect answers: a—normal specific gravity is 1.005–1.030, this client’s SG is above normal; b—an increased SG indicates dilute, not concentrated urine; c—
urinary tract infection does not typically cause this increase in SG.