Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has a new arteriovenous (AV) graft in his left forearm. Which of the following techniques should the nurse use to assess the patency of this graft?
A. Measure the client's blood pressure to ensure it is higher in the left arm than the right.
Measuring blood pressure di?erences is not a method to assess the patency of an AV graft.
B. Check the brachial and radial pulses of the left arm simultaneously.
Checking pulses is important but does not confirm the patency of the AV graft.
C. Auscultate the antecubital fossa using a Doppler stethoscope.
Using a Doppler stethoscope at the antecubital fossa is not the standard method for assessing AV graft patency.
D. Auscultate the site for a bruit.
Auscultating for a bruit at the site of the AV graft is a common and non-invasive way to assess for patency.
This question is an excerpt from Nurse Dive's nursing test bank - Ati Med Surg Proctored Exam 2. Take the full exam now
Full Explanation
Choice A reason: Measuring blood pressure di?erences is not a method to assess the patency of an AV graft.
Choice B reason: Checking pulses is important but does not confirm the patency of the AV graft.
Choice C reason: Using a Doppler stethoscope at the antecubital fossa is not the standard method for assessing AV graft patency.
Choice D reason: Auscultating for a bruit at the site of the AV graft is a common and non-invasive way to assess for patency.
Similar Questions
A nurse is teaching a client who has chronic kidney disease and a new prescription for epoetin alfa. The nurse should instruct the client to increase dietary intake of which of the following substances?
A. Iron
Epoetin alfa is used to treat anemia associated with chronic kidney disease, and iron supplementation is often required to support red blood cell production.
B. Sodium
Sodium intake does not need to be increased with epoetin alfa therapy and should be monitored carefully in clients with chronic kidney disease.
C. Potassium
Potassium levels should be monitored in chronic kidney disease and not necessarily increased, as hyperkalemia can be a concern.
D. Protein
Protein intake should be managed carefully in chronic kidney disease to avoid excess nitrogen waste, which can be difficult for damaged kidneys to filter.
Full Explanation
Choice A reason: Epoetin alfa is used to treat anemia associated with chronic kidney disease, and iron supplementation is often required to support red blood cell production.
Choice B reason: Sodium intake does not need to be increased with epoetin alfa therapy and should be monitored carefully in clients with chronic kidney disease.
Choice C reason: Potassium levels should be monitored in chronic kidney disease and not necessarily increased, as hyperkalemia can be a concern.
Choice D reason: Protein intake should be managed carefully in chronic kidney disease to avoid excess nitrogen waste, which can be difficult for damaged kidneys to filter.
The nurse reviews data from a new client's kidney function test. Which of the following standards of transplant nursing practice is the nurse primarily performing?
A. Diagnosis
Diagnosis is the identification of a disease or condition, which is not directly related to reviewing kidney function test data.
B. Assessment
Assessment involves collecting and analyzing data, which is what the nurse is doing when reviewing kidney function test results.
C. Implementation
Implementation refers to carrying out interventions, not reviewing test data.
D. Outcomes identification
Outcomes identification involves setting goals and expected outcomes, not reviewing test data.
Full Explanation
Choice A reason: Diagnosis is the identification of a disease or condition, which is not directly related to reviewing kidney function test data.
Choice B reason: Assessment involves collecting and analyzing data, which is what the nurse is doing when reviewing kidney function test results.
Choice C reason: Implementation refers to carrying out interventions, not reviewing test data.
Choice D reason: Outcomes identification involves setting goals and expected outcomes, not reviewing test data.
A nurse is caring for a client in the clinic who has a distended bladder with discomfort over the area and a sense of fullness. Which of the following tests should the nurse expect the health care provider to order to determine if the client has urinary retention? (Select all that apply.)
A. Postvoid urine residual measurement
Postvoid urine residual measurement is a direct method to assess for urinary retention.
B. Blood urea nitrogen (BUN)
Blood urea nitrogen (BUN) levels may indicate kidney function but not specifically urinary retention.
C. Cystourethrogram
A cystourethrogram is used to visualize the bladder and urethra, which may not be the first choice for assessing urinary retention.
D. Creatinine
Creatinine levels indicate kidney function but not urinary retention.
E. Kidney, ureter, bladder (KUB) x-ray
A kidney, ureter, bladder (KUB) x-ray can show the size of the bladder and may indicate retention.
F. Bladder scan
A bladder scan is a non-invasive way to measure the amount of urine in the bladder and assess for retention.
Full Explanation
Choice A reason: Postvoid urine residual measurement is a direct method to assess for urinary retention.
Choice B reason: Blood urea nitrogen (BUN) levels may indicate kidney function but not specifically urinary retention.
Choice C reason: A cystourethrogram is used to visualize the bladder and urethra, which may not be the first choice for assessing urinary retention.
Choice D reason: Creatinine levels indicate kidney function but not urinary retention.
Choice E reason: A kidney, ureter, bladder (KUB) x-ray can show the size of the bladder and may indicate retention.
Choice F reason: A bladder scan is a non-invasive way to measure the amount of urine in the bladder and assess for
retention.