Chapter 30- Patient Management Renal System

A patient on continuous venovenous hemofiltration with dialysis experiences a significant decrease in blood pressure. Which intervention would be most appropriate for the nurse to carry out? A) Decrease the amount of fluid removal. B) Decrease the infusion rate of replacement fluid. C) Administer heparin. D) Use a blood warmer to warm the dialysis lines.

A

A patient receiving a blood transfusion in the ICU has developed relative hypocalcemia. What is the most likely cause for the hypocalcemia? A) Citrate binding to calcium B) Loop diuretics C) Malabsorption syndrome D) Lack of vitamin D

A

The patient requires urgent hemodialysis or continuous renal replacement therapy after a suicide attempt with a variety of antidepressants. What access route for the dialysis does the nurse anticipate? A) Vascular catheter B) Arteriovenous fistula C) Synthetic vascular graft D) Peritoneal dialysis catheter

A

A patient has just had a dual-lumen venous catheter inserted in his subclavian vein for hemodialysis for acute renal failure. What intervention or interventions should the nurse make in working with this patient? Select all that apply. A) Verify central line catheter placement radiographically before use. B) Inject all medications directly into the catheter. C) Leave the catheter unclamped to prevent clotting. D) Maintain sterile technique in handling vascular access. E) Observe catheter exit site for signs of inflammation.

A, D, E

A critically ill patient has developed acute renal failure and needs dialysis. Under what circumstance would the nurse question the use of continuous renal replacement therapy (CRRT)? A) Patient requires large amounts of hourly intravenous fluids B) Metabolic imbalances can be corrected with 3 hours of dialysis per day C) High risk of hemodynamic instability with dialysis D) Unlikely to tolerate rapid fluid shifts without destabilizing

B

A patient has had an arteriovenous fistula placed for access for long-term hemodialysis. What nursing assessment result indicates a patent and functional fistula? A) Diminished intensity of palpated fistula thrill B) Clearly auscultated bruit over fistula C) Ability to draw blood from proximal vessel D) Full range of motion of joints below fistula

B

A patient in the ICU is scheduled to begin peritoneal dialysis for acute renal failure. The patient tells the nurse that he understands hemodialysis but is not familiar with peritoneal dialysis. He asks her what the difference between them is. The nurse explains that the biggest difference between these two approaches is which of the following? A) Peritoneal dialysis relies on diffusion whereas hemodialysis relies on active transport. B) The peritoneum of the body serves as the semipermeable membrane in peritoneal dialysis, whereas an extracorporeal semipermeable membrane is used in hemodialysis. C) Hemodialysis uses a Tenckhoff catheter, whereas peritoneal dialysis uses a venous catheter. D) Hemodialysis uses machines called cyclers to cycle the infusion and removal of blood, whereas peritoneal dialysis uses the bodys own vascular system to do this.

B

A patient in the ICU with severe hypotension is experiencing acute renal failure and uremia and needs dialysis. She requires a large infusion of intravenous fluids regularly. The nurse recognizes that which method of dialysis would be best for this patient? A) Continuous venovenous hemofiltration (CVVH) B) Continuous venovenous hemofiltration with dialysis (CVVH/D) C) Intermittent hemodialysis D) Peritoneal dialysis

B

A patient is severely hyponatremic. What would be the best nursing action? A) Put the patient on dialysis. B) Administer 3% saline. C) Administer 0.33% saline solution. D) Administer 5% dextrose in water.

B

A patient on peritoneal dialysis develops a low-grade fever and complains of abdominal pain when fluid is being inserted. The nurse also observes that the peritoneal drainage fluid is cloudy. What intervention should the nurse make? A) Measure the patients blood pressure. B) Begin the patient on antibiotic therapy. C) Assess the patient for signs of pulmonary congestion. D) Turn the patient from side to side.

B

The nurse is explaining the underlying principles of dialysis to a patient who is starting peritoneal dialysis for the management of chronic renal failure. As part of the teaching, what physiologic process does the nurse explain produces the most waste product removal? A) Water molecule movement by osmosis B) Diffusion to a less concentrated area C) Active transport by an energy-driven process D) Increased osmotic gradient from the abdomen

B

A patient with chronic renal failure has an arteriovenous fistula in her forearm for dialysis access. What intervention or interventions should the nurse make in working with this patient? Select all that apply. A) Take the patients blood pressure on the forearm containing the fistula. B) Palpate the fistula for thrill every 8 hours. C) Draw blood samples from the vein that forms the fistula. D) Avoid placing any restraints on the access arm. E) Check access patency less frequently in hypotensive patients. F) Occlude the fistula vein using firm pressure in the event of postdialysis bleeding from the needle site.

B, D

A patient who developed chronic renal failure after a severe hypotensive episode has just been told that dialysis will be necessary for the rest of her life. She and her family are very upset and crying. What is the best nursing intervention? A) Ask the family to leave, as they are upsetting the patient. B) Administer intravenous sedation to the patient. C) Encourage patient and family to express their feelings. D) Begin dialysis education immediately.

C

An elderly patient in the ICU with chronic renal failure has just undergone surgery for a synthetic arteriovenous graft in her left forearm for dialysis access. The nurse recognizes that the most likely reason this patient received a graft instead of a fistula is which of the following? A) Thrombosis is less likely to occur with grafts than with fistulas. B) Fistulas are more prone to infection than are grafts. C) The patients own blood vessels were not adequate for fistula formation. D) An aneurysm is more likely to occur in a fistula than in a graft.

C

The patient is receiving continuous renal replacement therapy (CRRT). The rate of ultrafiltration shows a downward trend and coagulation of the filter is suspected. What is the most appropriate first nursing action? A) Immediately disconnect circuit from the patient. B) Decrease the rate of blood flow by pump. C) Use a saline bolus to diagnosis clot location and extent. D) Raise the ultrafiltration collection device.

C

The patient is receiving maintenance IV fluids, has no active fluid loss site, and has normal renal function. Based on the physiology of fluid volume balance, what IV fluid use does the nurse anticipate? A) Dextrose 5% in water B) 0.9% saline C) 0.45% saline D)3% saline

C

A critically ill patient is receiving continuous renal replacement therapy (CCRT) by continuous venovenous hemofiltration with dialysis (CVVHD) or continuous venovenous hemofiltration (CVVH). What difference in care of this patient does the nurse anticipate when compared with other methods of CCRT? A) Filtrate lost is equal to patient weight loss B) Differences are in brands of machines used C) Produced ultrafiltrate is not replaced D) Replacement fluid is necessary to maintain fluid balance

D

A patient in the ICU has acute renal failure and is an alcoholic. Which electrolyte imbalance would the nurse most expect to find in this patient? A) Hypokalemia B) Hyperkalemia C) Hypermagnesemia D) Hypomagnesemia

D

A patient receiving continuous renal replacement therapy (CRRT) is placed on low-dose heparin for anticoagulation of the CRRT circuit. What laboratory result would cause the nurse to question the use of heparin? A) Normal total platelet count B) Partial thromboplastin time two times control C) Partial thromboplastin time normal D) Critically low total platelet count

D

A patient with severe vascular fluid loss from third spacing is being treated with intravenous hypertonic saline in an attempt to pull fluid from the extravascular space to the vascular space. What nursing assessment result is most indicative of a serious complication of the use of intravenous hypertonic saline? A) Increased urine output B) Decreased peripheral edema C) Slightly elevated blood pressure D) Pulmonary adventitious sounds

D

The patient is scheduled to receive hemodialysis for 4 hours this morning, and several medications for chronic diseases are scheduled to be given now. All of the medications will be at least partially removed by dialysis. What is the best nursing action? A) Give all medications as scheduled. B) Give double doses of all medications. C) Withhold medications for today only. D) Administer medications after dialysis.

D