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What is the affect of ADH on urine formation? A. Retention of sodium & water, cxerction of potassium B. Excretion of sodium & water, excretion of potassium C. Retention of water, concentration of urine D. Excretion of water, dilution of urine ANSWERV V C. Retention of water, concentration of urine The releasing stimulus for ADI is normally? A. Decreased serum wall myocardial infarction B. Increased serum osmolarity (dehydrated) C. An elevated circulatory cortisol level D. Increased serum potassium levels ANSWER ¥ B. Increased serum osmolarity (dehydrated) The normal serum osmolarity is within the range of: A. 145-155 mOs./L B. 200-250 mOs./L C. 275-295 mOs./L D. 325-375 mOs./L ANSWERV V C, 275-295 mOs./L > 295 = dehydrated < 275 = dilute/fluid overload The syndrome of inappropriate antidiuretic hormone (SIADI) is manifested clinically as a: A. Ilyperosmolar state B. Low output state C. Myxedema state D. Water intoxication state ANSWERV V D. Water intoxication state because the body holds onto lots of water leading to dilutional hyponatremia In addition to its affect on body water equilibrium, ADH is also a: A. Vasopressor B. Cardiotonic C. Beta stimulator D. Carbonic anhydrase inhibitor ANSWERV V A. Vasopressor The symptomatology you would assess in the patient with SIADH results from: A. Elevated K+ levels B. Water intoxication C. Increased serum osmolality D. Precipitating factors of SSADH ANSWERY ¥ B. Water intoxication The "cardinal sign" of inappropriate ADH secretion is: A. Dilutional hyponatremia B. Urinary output of 10 L per day C. Hypotension D. Systemic edema ANSWERV V A. Dilutional hyponatremia The nurse understands a major complication of DI is: A. Hypovolemic shock B. Seizures C. Congestive heart failure D. Cardiac arrhythmias from hypokalemia ANSWERV V A. Ilypovolemic shock Evaluation of laboratory findings in a patient with DI would show: A. Increased urine osmolality B. Urine specific gravity between 1.001 to 1.005 C. Decreased serum sodium D. Decreased serum osmolarity ANSWERV V B. Urine specific gravity between 1.001 to 1.005 The most dangerous complication of DI is: A. Dilutional hyponatremia B. Hypovolemia C. Congestive heart failure D. Water intoxication syndrome ANSWERV ¥ B. Hypovolemia DI is characterized by all but which of the following? A, Urine specific gravity of 1.015 B. Tachycardia C. Urinary output of 2000 ce in three hours D. BP 90/40 ANSWERV V A. Urine specific gravity of 1.015 Which of the following is a characteristic of DI? A Low urinary osmolarity B. Serum osmolarity increased C. Serum sodium elevated D. All of the above ANSWERV ¥ D. All of the above A 68 y/o is admitted with a blood sugar of 1200 mg%, she is severely dehydrated, respirations are 18 per minute and shallow. You would first suspect? A. Hyperosmolar coma B. Diabetic ketoacidosis C. Either of the above D. Neither A or BANSWERVV A. Hyperosmolar coma It is important for the nurse to identify those patients at risk for developing HHNK. Which condition would NOT predispose a patient to develop HHNK? A. Pancreatitis B. Thiazide or steroid therapy C. TPN therapy D. CVA ANSWERVV D. CVA Nonketotic hyperosmolar coma (HHNK) is NOT usually associated with: A. Defects in ADH sceretion B. Mild diabetes of recent onset C. Older age C. Urinary sodium of 60 D. Bicarbonate level of 12 ANSWERV ¥ RB. Serum osmolarity of 340 Further assessment of diagnostic data in a patient with HHNK would reflect: A. ABG with a pH of 7.10 B. Four plus ketone in the urine C. Azotemia D. Hematocrit of 29% ANSWERV ¥ C. Azotemia (a temporary increase in BUN and creat. due to dehydration) Which of the following laboratory findings is NOT likely to be seen in patients with DKA? A. pH7.19 B. pco2 45 C. Base deficit 14 D. Serum K+ 5.5 mEq./L ANSWERV ¥ B. pCO2 45 (should be less than 35 with Kussmaul breathing) The single most important index of neurological state is the: A. Level of consciousness B. Pupillary reaction C. Extremity movement and strength D. Vital signs ANSWERV V A. Level of consciousness Quick rotation of the head back and forth while holding the eyes open causing the eyes of the comatose patient to rotate opposite the side toward which the head is turned is a positive response known as: A. Extraocular ophthalmoplegia B. Intranuclear extraocular ophthalmoplegia C. Oculocephalic reflex D. Dysconjugate lateral reflee ANSWERV ¥ C. Oculocephalic reflex (Dolls eyes) The response elicited when the neck is flexed. producing flexion of both thighs at the hips, as well as flexion movements of ankles and knees is called: A. Kernig's sign B. Babinski's sign C. Brudzinski's sign D. Trousseau's sign ANSWERV V C. Brudzinski's sign ‘The respiratory pattern seen in upper brainstem lesions (midbrain) is: A. Hyperventilation B. Ataxia C. Cluster D. Apneustic ANSWERV ¥ A. Hyperventilation A 26 year old male is complaining of a severe headache. On assessment he has nuchal rigidity & positive Kernig's sign. Which of the following conditions is most likely present? A. Epidural hematoma B. Subdural hematoma C. Subarachnoid hemorrhage Which of the following parameters are graded when using the Glasgow Coma Scale in the assessment of the patient with an altered state of consciousness’? A, Eye opening, sensory level, and verbal response B. Motor response, pupillary signs, and orientation C. Pupillary signs, orientation, and BP D. Eye opening, motor response, and verbal response ANS WERV V D. Eye opening, motor response, and verbal response Blindness in one half of both visual fields following a CVA is referred to as: A. Hlomonymous hemianopia B. Astereognosis C. Homonymous hemignosia D. Optic hemianopia ANSWERV V A. Homonymous hemianopia Patients with injury to the left cerebral hemisphere may exhibit: A. Left hemiparesis or hemiplegia B. Deviation of the eye to the left C. Left homonymous hemianopia D. All of the above ANSWERV ¥ B. Deviation of the eye to the left Pinpoint pupils that react to light if viewed with a magnifying glass are indicative of: A. A lesion in the pons B. A lesion in the basal ganglia C. Oculomotor dysfunction D. Sympathetic nervous stimulation ANSWERV V A. A lesion in the pons The nurse caring for a patient with a supratentorial herniation understands that the earliest sign would be: A Decerebrate posturing B. Wide and fixed pupils C. Lethargy and stupor D. Ipsilateral dilated pupil ANSWERV V C. Lethargy and stupor Which of the following treatment modalities would the nurse consider to be inappropriate for the ventilator dependent patient with increased intracranial pressure? A. Maintaining the CO2 between 29-33 B. Feeding the patient via NGT C. Administering D5W at 75 ce an hour D. Log roll when turning the patient ANSWERV ¥ C. Administering D5W at 75 cc an hour While assessing the laboratory data of a patient with head trauma, which finding necessitates notification of the physician? A.A serum osmolarity of 275 B. A serum sodium level of 138 C. A urine specific gravity of 1.005 D. A urine osmolarity of 400 ANSWERV V C. A urine specific gravity of 1.005 A basal skull fracture affecting the middle fossa may cause which of the following? A. Cranial nerve injuries B. Battle's sign Examination of the CSF in bacterial meningitis will reveal all but which of the following? A. Cloudiness B. Increased white blood cells C. Decreased protein D. Increased pressure and decreased glucose ANSWERV V C. Decreased protein Which statement is accurate regarding the differentiation of CSF in bacterial and viral meningitis: A. Higher level of protein in bacterial meningitis than viral B. Low sugar content seen in bacterial meningitis, usually normal in viral C. CSF is purulent and turbid in bacterial, may be clear with viral D. All of the above ANSWERV ¥ D. All of the above In order to most accurately establish that your patient has no bowel sounds, you must listen in each quadrant for at least: A. 30 seconds B. | full minute C. 1.5 minutes D. 2-5 minutes ANSWERV V D. 2-5 minutes The usual order for carrying out physical assessment of the abdomen is: A. Palpation, inspection, auscultation, percussion B. Auscullation, percussion, palpation, inspection C. Inspection, auscultation, percussion, palpation D. Percussion, auscultation, inspection, palpation ANSWER V C. Inspection, auscultation, percussion, palpation ‘The function of the liver includes all of the following except: A. Formation of ammonia to remove urea from the blood B. Hepatocytes secrete bile C. Synthesizes amino acids and albumin D. Synthesizes prothrombin, fibrinogen, and albumin ANSWERV V A. Formation of ammonia to remove urea from the blood Nursing interventions for the patient with hepatic failure include: A. Restrict protein in the diet B. Avoid use of narcotics, sedatives, and tranquilizers C. Administer lactulose and neomycin as prescribed D. All of the above ANSWERV ¥ D. All of the above The underlying cause of most bleeding esophageal varices is: A. Acid pepsin erosion secondary to gastroesophageal reflux B. Portal hypertension due to liver disease C. High venous pressures at the esaphagogastric junction duc to systemic hypertension D. Traumatic esophageal damage ANSWER V V B. Portal hypertension due to liver disease The rationale for the use of neomycin in the setting of liver failure is to: D. Bilirubin ANSWERV V A. Ammonia Which of the following may precipitate the onset of hepatic encephalopathy in patients with severe liver dysfunction? A. Diuretics B. Acute infection C. GI bleeding D. All of the above ANSWERY ¥ D. All of the above Which of the following may contribute to the precipitation of encephalopathy in the patient with liver failure? A. GI bleeding B. Hypokalemia C. Hypotension D. All of the above ANSWERV ¥ D. All of the above LEcchymoses around the umbilicus indicative of peritoneal bleeding is called: A. Chvostek's sign B. Grey Turner's sign C. Cullen's Sign D. Trousseau's sign ANSWERV¥ C. Cullen's Sign Pulmonary complications of acute pancreatitis may include: A. Adult respiratory distress syndrome B. Elevation of the diaphragm and bilateral basilar rales C. Atelectasis, especially of the left base D. All of the above ANSWERV V D. All of the above Which of the following analgesics is the drug of choice in managing the pain of acute pancreatitis? A. Demerol B. Morphine C. Codeine D. Dilaudid ANSWERV V A. Demerol A bluish-green, brown discoloration in the flank and groin due to retroperitoneal bleeding is called: A. Grey-Tumers sign B. Cullen's sign C. Kernig's sign D. Welch's sign ANSWERV V A. Grey-Turners sign Patient assessment findings indicative of a bowel infarction would include: A. Hypoactive bowel sounds and Icukocytosis B. Hyperresonance and abdominal tenderness C. Absence of dullness in the liver area D. All of the above ANSWERV ¥ D. All of the above Which EKG finding would not be observed in the presence of hyperkalemia? A. Prolonged PR interval B. Absence of P waves C. Ventricular irritability D. Widened QRS complexes ANSWERV ¥ C. Ventricular irritability ‘The glomerular filtration rate (GFR) can be best measured by evaluating the patient's: A. Serum creatinine B. Blood urea nitrogen C. Serum osmolality D. Creatinine clearance ANS WERVV D. Creatinine clearance Approximately 60-80% of sodium and water is reabsorbed from the glomerular filtrate at the: A. Proximal tubule B. Loop of Henle C. Distal Tubule D. Collecting tubules ANSWERY ¥ A. Proximal tubule The major function of the loop of Henle is the: A. Reabsorption of electrolytes B. Concentration or dilution of urine C. Reabsorption of water under the control of ADH D. Secretion of hydrogen ion, ammonia, and potassium ANSWERV ¥ B. Concentration or dilution of urine Which of the following activities is performed at the distal convoluted tubule? A. Concentration of urine B. Active reabsorption of NaCl with passive water reabsorption C. Water absorption under ADH control D. Reabsorption of glucose, amino acids, phosphates, uric acid, and potassium ANSWERVV C. Water reabsorption under ADH control A patient has a urinary output of 1000 ce in 24 hours with a urine sodium level of 25 mEq/liter. These findings probably indicate: A. The patient is on a salt free diet B. The patient's kidneys have decreased blood perfusion C. The patient is in the beginning of renal failure D. The patient is progressing to the prerenal phase ANSWER¥ V A. The patient is ona salt free diet Ischemia injury to the kidneys will usually commence when the mean arterial blood pressure falls below: A. 100 mmHg for 30 minutes B. 90 mmllg for 2 hours C. 60 mmHg for 40 minutes ANSWERV ¥ C. 60 mmHg for 40 minutes The two most common causes of acute renal failure or (ATN) are: A. Nephrotoxic substances and ischemia B. Ischemia and urologic obstructions C. Nephrotoxic drugs and heavy metals 
