Medical-Surgical Nursing Review Flashcards

Comprehensive practice Q&A flashcards based on medical-surgical nursing review questions covering renal, cardiac, GI, liver, and endocrine topics.

Which sequence lists the four phases of acute renal failure in the correct order?

Initiation, oliguria, diuresis, recovery

Acute tubular injury from a nephrotoxic drug is classified as which type of AKI?

Intrarenal

A client with sinus bradycardia is dizzy and hypotensive. Which prescribed medication should the nurse anticipate?

Atropine sulfate

Why do uremic manifestations develop in chronic renal failure?

Metabolic wastes accumulate because renal excretion is impaired

During treatment of HHNS, which assessment is especially important because severe dehydration can cause renal failure?

Frequent fluid status and urine output monitoring

When glucose falls to approximately 250 to 300 mg/dL during DKA treatment, why is dextrose added to the IV fluid?

To prevent an overly rapid glucose decline while insulin continues to correct acidosis

Which method is commonly used to estimate intra-abdominal pressure at the bedside?

Measurement of bladder pressure through a urinary catheter

A client with AKI has peaked T waves and a serum potassium of 6.8 mEq/L. What is the nurse's priority interpretation?

The client is at high risk for a life-threatening dysrhythmia

Which instruction is appropriate when instituting bleeding precautions for liver failure?

Use a soft-bristled toothbrush and avoid razor blades

Why is potassium monitored closely during DKA treatment?

Insulin and correction of acidosis can lower serum potassium and trigger dysrhythmias

The monitor shows a chaotic rhythm, and the client is unconscious, pulseless, and apneic. Which rhythm should the nurse suspect?

Ventricular fibrillation

Which laboratory test generally remains elevated longer in acute pancreatitis?

Serum lipase

Acute renal failure is now commonly called what?

Acute kidney injury

Which IV fluid is generally used first for marked dehydration in DKA?

0.9% normal saline

Which situation is a common precipitating cause of DKA?

A missed insulin dose

A client with atrial fibrillation is at increased risk for which serious complication?

Thromboembolic stroke

Which position can help improve breathing in a client with acute pancreatitis?

Semi-Fowler position

Which hematologic problem commonly occurs because diseased kidneys produce less erythropoietin?

Anemia

Which characteristic is expected in first-degree atrioventricular block?

A prolonged PR interval with every P wave followed by a QRS complex

Which nursing action helps prevent additional kidney damage in a client with AKI?

Review medications and avoid nephrotoxic agents when possible

A healthy adult generally needs a minimum urine output of approximately how much per day to excrete metabolic wastes?

400 mL

During the oliguric phase of AKI, which electrolyte abnormality poses an immediate risk for lethal dysrhythmias?

Hyperkalemia

Which feature more strongly favors HHNS over DKA?

Profound hyperosmolar dehydration with minimal or absent ketosis

Upper gastrointestinal bleeding occurs proximal to which landmark?

The ligament of Treitz

Which plan best promotes activity tolerance in a client with cardiomyopathy?

Alternate periods of activity with rest

Which client may normally have sinus bradycardia without symptoms?

A well-conditioned athlete

A client with diabetes has deep rapid respirations and fruity-smelling breath. Which complication should the nurse suspect?

Diabetic ketoacidosis

Chronic renal failure is best described as what process?

Gradual, progressive loss of kidney function

Severe hemorrhage lowers renal perfusion and causes AKI. How is this cause classified?

Prerenal

Which finding is most consistent with systemic venous congestion in cardiomyopathy?

Jugular vein distention and dependent pitting edema

A client enters the diuretic phase of AKI and produces 4 L of urine in 24 hours. Which complication requires close monitoring?

Dehydration and electrolyte loss

A premature atrial contraction originates from which location?

An ectopic focus in the atria

Which client is at greatest risk for abdominal compartment syndrome?

A client with major abdominal trauma and massive fluid resuscitation

Which finding may indicate the need for renal replacement therapy in severe AKI?

Refractory hyperkalemia with fluid overload

A febrile client has a regular heart rate of 124/min, normal PR interval, and normal QRS complexes. Which rhythm is most likely?

Sinus tachycardia

A young client with hypertrophic cardiomyopathy suddenly collapses during exercise. Which complication should the nurse suspect first?

Sudden cardiac arrest

A critically ill client has a tense distended abdomen, falling urine output, rising airway pressures, and hypotension. What should the nurse suspect?

Abdominal compartment syndrome

What is a major consequence of renin-angiotensin-aldosterone activation in cardiomyopathy?

Increased vascular resistance and sodium and fluid retention

An older client with type 2 diabetes has severe dehydration, glucose of 780 mg/dL, confusion, and no significant ketones. Which condition is most likely?

Hyperglycemic hyperosmolar nonketotic syndrome

Which assessment is most useful for tracking day-to-day fluid balance in AKI?

Daily weight measured under consistent conditions

A client with cardiomyopathy becomes dyspneic while walking to the bathroom. What should the nurse do first?

Assist the client to rest in a sitting position, usually with the legs down

Which type of cardiomyopathy is identified in the module as the most common?

Dilated cardiomyopathy

Dysrhythmias are disorders involving which cardiac process?

Formation or conduction of the electrical impulse, or both

HHNS occurs most frequently in which population?

Older adults with type 2 diabetes or previously unrecognized diabetes

Which insulin is used for continuous IV infusion in DKA?

Regular insulin

A client arrives with massive hematemesis, tachycardia, and hypotension. Which nursing action has the highest priority?

Support airway and circulation while establishing large-bore IV access

Acute pancreatitis is commonly described as what process?

Autodigestion of the pancreas

Which statement best defines cardiomyopathy?

A disease of the heart muscle associated with cardiac dysfunction

A client with cardiomyopathy gains 2 kg in two days and develops ankle edema. What is the nurse's best interpretation?

The client may be retaining fluid and developing worsening heart failure

Fulminant hepatic failure includes severe hepatic injury with which major findings?

Encephalopathy and severe coagulopathy

Which discharge instruction is most appropriate after acute pancreatitis?

Avoid alcohol, high-fat foods, and heavy meals

The priority management of sinus tachycardia is generally to do what?

Identify and treat the underlying cause

Which finding most clearly distinguishes atrial fibrillation on an ECG?

An irregular ventricular rhythm with no distinct P waves

A client is unresponsive and the monitor shows ventricular tachycardia. No pulse is present. What is the nurse's priority action?

Begin CPR and follow the defibrillation algorithm

Which condition is a common direct cause of upper GI bleeding?

Peptic ulcer erosion

Which arterial blood gas pattern is expected in DKA?

Low pH, low bicarbonate, and low PaCO2

Which neurologic finding is associated with hepatic encephalopathy?

Asterixis

Hypocalcemia developing two to three days after the onset of pancreatitis may indicate what complication?

Fat necrosis and possible pancreatic necrosis

Which medication is identified as the most common culprit in acute liver failure?

Acetaminophen

Which medication history increases the risk for erosive gastritis and upper GI bleeding?

Frequent NSAID use

Hypertrophic cardiomyopathy is most accurately described as which type of condition?

A rare autosomal dominant condition

Intra-abdominal hypertension becomes abdominal compartment syndrome when elevated pressure is accompanied by what finding?

New organ dysfunction or failure

Which ECG characteristic is expected in sinus tachycardia?

A regular rhythm with a P wave before every QRS complex

Esophageal varices associated with upper GI bleeding most commonly develop secondary to what condition?

Hepatic failure with portal hypertension

Which diagnostic study is especially useful for evaluating cardiac structure and function in cardiomyopathy?

Echocardiography

Which critically ill client has a heightened risk for stress-related mucosal disease?

A mechanically ventilated client with coagulopathy

Which three features characterize diabetic ketoacidosis?

Hyperglycemia, dehydration with electrolyte loss, and metabolic acidosis

A client develops hematemesis after repeated severe retching. Which cause is most likely?

A Mallory-Weiss tear

Before adding potassium to IV fluids during DKA treatment, what should the nurse confirm?

The kidneys are functioning and urine output is adequate

Which pancreatic enzyme is particularly involved in pancreatic autodigestion?

Trypsin

Bilateral ureteral obstruction causing AKI is classified as what type?

Postrenal

When advanced heart failure no longer responds to treatment, which intervention may support the client while awaiting a donor heart?

A left ventricular assist device

Before administering prescribed IV potassium to a client with liver failure, what must the nurse verify?

Adequate urine output

Which stool description is classically associated with an upper GI bleed?

Black, tarry stool

A client develops a rapid supraventricular rhythm and becomes hypotensive with chest pain. Which intervention should the nurse prepare for?

Synchronized cardioversion

The compensatory response to decreased stroke volume in cardiomyopathy commonly activates which systems?

The sympathetic nervous system and renin-angiotensin-aldosterone system

Which pair represents major common causes of chronic kidney disease?

Diabetes mellitus and hypertension

A client reports severe epigastric pain with nausea and vomiting. The abdomen is rigid, and bruising is present around the umbilicus. Which condition is most likely?

Severe acute pancreatitis

A client with liver failure has petechiae, ecchymoses, and prolonged clotting studies. Which problem best explains these findings?

Reduced synthesis of clotting factors

A client has ventricular tachycardia with a pulse and remains hemodynamically stable. Which medication may be prescribed according to the module?

Amiodarone