NSG 4100 Final Certification Exam 1,2,3 and 4
Questions and Answers 2023/2024
Patient teaching with levothyroxine - correct answer lifelong, take in AM on empty
stomach, need levels checked
Best positioning for post-op thyroidectomy - correct answer semi fowlers with pillows-
HOB 30 degrees
Meds for pheochromocytoma - correct answer alpha adrenergic blockers- causes
nasal stuffiness and hypotension
What do you give to treat CAH - correct answer steroids
What medications would you expect to a patient with cirrhosis? - correct answer
Vitamins and supplments, milk thistle, potassium sparing diuretics (spirinolactone),
antibiotics
Patient teaching with patients with cirrhosis. - correct answer Their diet will be high
carb, low protein, NO ALCOHOL. Patient will need to try to avoid constipation and will
need to rest. The patient can no longer take Tylenol and only use electric razors.
What causes ascites in cirrhosis? - correct answer Portal obstruction causing backup
in the spleen and GI system. The increase amount of protein accumulates in the
peritoneal cavity. Pulling fluid into peritoneal cavity causing it be hypertonic.
Nursing interventions to reduce ammonia levels in hepatic encephalopathy. - correct
answer Safety, prevent injury, encourage deep breathing to blow off ammonia.
Treatment for a patient to reduce ammonia levels in hepatic encephalopathy. - correct
answer Lactulose (IV glucose) to decrease ammonia levels. Will see a decrease in
confusions. Give vancomycin
,What are priority nursing assessment findings in abdominal trauma and how would you
respond? - correct answer In infection we will see increase WBC and increase temp
In bleeding we need to look at the decrease Hgb and the Hct.
When taking care of patients when do we need to call the MD - correct answer We the
condition begins to worsen. We need to use the ABC's of Maslow's Hierarchy of Needs.
What are basic post-op interventions? - correct answer Need to turn patient, have
patient cough and use deep breathing, use the incentive spirometer, monitor vital signs
for bleeding (decrease BP), and infection (increase temp), do pain control, and DVT
prevention (SCD's)
What medication is used for bladder cancer? - correct answer Bacillus Calmette-
Guerin (BCG) it is an early-stage treatment that targets cancer cells inside the bladder
without having a negative impact on the rest of the body.
In renal/liver diseases what do the labs look like? - correct answer Increased ALT/AST,
BUN and creatinine are increased, an increase in Na and K, and increase in Mag and
Phos BUT a decrease in Calcium.
Liver and Kidney transpant patient will be on what type of medications? - correct
answer Immunosupressants (cylosporine) and steroids (dexamethasone) after surgery.
Signs and Symptoms of Uremia - correct answer Fatigue, SOB, unexplained weight
loss, N/V, muscle cramps. Change in mental status, metallic taste in mouth, pruritus.
Pathophysiology of End Stage Renal Disease (ESRD) - correct answer Renal function
declines and end products of protein metabolism accumulate in the blood. Uremia
develops and adversely affects every system in the body. Usually associated with a low
GFR. The more waste products in the system the more severe the symptoms.
Uremic Pericarditis - correct answer Inflammation and irritation of the visceral and
parietal layers of the pericardium by metabolic toxins that accumulate due to renal
failure.
,Uremic Treatment - correct answer Diuretics and Hemodialysis and if the patient is
already on hemodialysis we need to intensify it.
Clinical manifestations of fluid overload in ESRD - correct answer Pericarditis,
pericardial effusions/tamponade, pulmonary infiltrates, JVD, edema, HF, hypertension,
hyperkalemia, metabolic acidosis
BUN normal range - correct answer 10-20
Creatinine normal range - correct answer 0.5-1.2
Sodium normal range - correct answer 135-145
Potassium Normal range - correct answer 3.5-5
Magnesium normal range - correct answer 1.5-2.5 (high in ESRD pt)
Normal urine output range - correct answer 30ml/hr
Dietary restrictions for patients with ESRD - correct answer Low protein, low
potassium, no potatoes or oranges or citrus fruits, no salt substitute, fluid restrictions
How much protein is allowed in a patient with ESRD? - correct answer 1.2-1.5
mg/kg/day
What medications are used to treat ESRD? - correct answer Calcium
acetate/carbonate, Phosphate-binding agents (Phoslo, Renagel), Erythropoeitin,
Antihypertensive and cardiac medication, Ionotropes, Anticonvulsants
What are important topics for patient education in ESRD? - correct answer Dietary
education, S/S of hyperkalemia (muscle cramps, urine abnormalities, respiratory
, distress, decrease cardiac contractility, EGK changes, decrease reflexes, tingling in
hands and feet, paralysis), worsening S/S of kidney disease (anemia, difficulty
breathing, nocturia, swelling and puffiness of feet and ankles, high BP, changes in
mental status, poor digestion
Possible complications after Hemodialysis - correct answer Bleeding, Infection, and
Hypotension
What type of medication should be held before dialysis? - correct answer
Antihypertensive and antiarrhythmic medications
What metabolic imbalance is common with ESRD? - correct answer Metabolic
Acidosis (ph lower than 7.35, HCO3 lower than 22, CO2 normal 35-45)
What type of patient is a candidate for CRRT? - correct answer Clinically unstable
patient who are hypotensive, patient with fluid overload secondary to oliguric kidney
disease, patient who kidneys cannot handle their acutely high metabolic or nutritional
needs.
Nursing interventions/Care of a post nephrectomy patient. - correct answer Assess
Respiratory status, loot at drainage tubes and incision sites frequently to watch for blood
loss and infection, DVT, pain, urinary drainage look at color and amount, circulation,
auscultate heart and lungs every shift, DW
What education should a patient receive if they are being discharged home with an
indwelling catheter? - correct answer Need to learn the adequacy of urine output, need
to use asepsis technique while cleaning and never irrigate regularly, only change when
there is leakage, blockage or encrustation, clean with soap and water, the tube needs to
be anchor to minimize manipulation, wash the perineal area twice a day
Explain the surgical procedure of a kidney transplant. - correct answer For the
individual receiving the kidney the old ones are not removed. The new kidney is placed
on patient iliac fossa anterior to the iliac crest because it allows easier blood flow. The
renal artery of the donated kidney is sutured to the iliac artery and the renal vein to the
iliac vein. The ureter of the donated kidney is sutured to the bladder and once the blood
supply as been established in the OR urine should flow showing a success.
