Chapter 48 Prep U

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: nausea and vomiting. dyspnea and cyanosis. fatigue and weakness. thrush and circumoral pallor.

Fatigue an weakness

A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply. Penicillin Gentamycin Tobramycin Neomycin Ceftriaxone

Gentamycin Tobramycin Neomycin

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? Hemodialysis Peritoneal dialysis Continuous arteriovenous hemofiltration (CAVH) Continuous venovenous hemofiltration (CVVH)

Hemodialysis

A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value? Elevated urea levels Hyperkalemia Hypocalcemia Elevated white blood cells

Hyperkalemia

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated serum creatinine Hyperkalemia Hyperphosphatemia Elevated urea and nitrogen

Hyperphosphatemia

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Abdominal distention owing to reflex cessation of intestinal peristalsis Hypovolemic shock caused by hemorrhage Paralytic ileus caused by manipulation of the colon during surgery Pneumonia caused by shallow breathing because of severe incisional pain

Hypovolemic shock caused by hemorrhage

What is a characteristic of the intrarenal category of acute renal failure? Decreased creatinine Increased BUN High specific gravity Decreased urine sodium

Increased BUN

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys." "Draining of the cysts and antibiotic therapy will cure your disease." "Genetic testing will determine the best treatment for your condition."

"As the disease progresses, you will most likely require renal replacement therapy."

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is important to use strict aseptic technique." "It is appropriate to warm the dialysate in a microwave." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity."

"It is appropriate to warm the dialysate in a microwave."

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? "The risk of peritonitis is greater with this type of dialysis." "This type of dialysis will provide more independence." "Peritoneal dialysis will require more work for you." "Peritoneal dialysis does not work well for every client."

"This type of dialysis will provide more independence."

Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective? "There are few complications with renal replacement therapies." "A family member can help me perform hemodialysis in my home." "Ultrafiltration methods take much longer than hemodialysis." "A special access is created in my vein for peritoneal dialysis."

"Ultrafiltration methods take much longer than hemodialysis."

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? "Squamous cell carcinomas do not present with detectable symptoms." "You should have sought treatment earlier." "Very few symptoms are associated with renal cancer." "Painless gross hematuria is the first symptom in renal cancer."

"Very few symptoms are associated with renal cancer."

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 500 mL of fluid 1,000 mL of fluid 1,500 mL of fluid 2,000 mL of fluid

1,500 mL of fluid

A client with chronic kidney disease weighs 209 lbs (95 kg) and is prescribed 1.2 grams of protein per kg per day. Which amount of protein will the client ingest per day?

114 grams/day

The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.

4000 mL

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6 tabs/day

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2

A GFR of 30-59 mL/min/1.73 m2

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Acute renal failure Acute glomerulonephritis Chronic renal failure Nephrotic syndrome

Acute glomerulonephritis

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of an insulin drip Administration of a loop diuretic Administration of sodium bicarbonate Administration of sodium polystyrene sulfonate [Kayexalate])

Administration of sodium polystyrene sulfonate [Kayexalate])

The nurse is able to identify which condition as uremia?

An excess of urea in the blood

The nurse is caring for a 54-year-old male client that is admitted with chest pain, who has an AV fistula in the left arm for hemodialysis secondary to CKD. Which of the nursing interventions are indicated? SELECT ALL THAT APPLY Take blood pressure readings in the left arm. Assess for redness, swelling, and drainage at AV fistula site. Wrap the AV fistula site in the left arm with a compression dressing. Palpate for a thrill over the AV fistula every 8 hours. Use AV fistula site to draw blood. Auscultate for a bruit over AV fistula every 8 hours

Assess for redness, swelling, and drainage at AV fistula site. Palpate for a thrill over the AV fistula every 8 hours. Auscultate for a bruit over AV fistula every 8 hours

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Azotemia Proteinuria Hematuria Bacteremia

Azotemia

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Pats skin dry after bathing Uses moisturizing creams Keeps nails trimmed short Brief, hot daily showers

Brief, hot daily showers

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? Administer the medications as ordered. Hold the medications until after dialysis is completed. Check with the nephrologist to determine the best course of action. Ask if the client wants to take the medications.

Check with the nephrologist to determine the best course of action.

Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted. Citrus fruits White rice Salad oils Butter

Citrus fruits

The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? Butter Citrus fruits Cooked white rice Salad oils

Citrus fruits

A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication? Decrease in the blood flow through the kidneys Obstruction of urine flow from the kidneys Blood clot formed in the kidneys interfered with the flow Structural damage occurred in the nephrons of the kidneys

Decreased blood flow to kidneys

he nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? Dehydration Hyperkalemia Crackles Hypertension

Dehydration

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? Donors are selected from compatible living or deceased donors. Donors must be relatives. Donors with hypertension may qualify. The client is placed on a transplant list at the local hospital.

Donors are selected from compatible living or deceased donors.

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? Wear a mask while handling any dialysate solutions Keep the catheter stabilized to the abdomen, below the belt line Keep the dialysis supplies in a clean area, away from children and pets Clean the catheter insertion site daily with soap

Keep the dialysis supplies in a clean area, away from children and pets

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? 1.5 L 1.0 L Less than 400 mL Less than 50 mL

Less than 400 mL

A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status? Observing the client's fluid intake. Checking for a thrill or a bruit daily. Observing the client's urinary output. Observing the skin color and nail beds.

Observing the client's urinary output.

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is CONTRAINDICATED? Obtaining blood samples from the left arm Palpating the fistula for a "thrill" Obtaining a blood pressure reading from the right arm Placing the client's watch on the left wrist

Obtaining a blood pressure reading from the right arm

What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Proteinuria Hyperalbuminemia Hypokalemia

Proteinuria

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Previous episode of acute pyelonephritis History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis

Recent Hx of streptococcal infection

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Impaired urinary elimination Toileting self-care deficit Risk for infection Activity intolerance

Risk for infection

The nurse is caring for a postoperative client who reports difficulty urinating. The client does not have a urinary catheter in place. Which nursing action(s) are most appropriate at this time? Select all that apply. Run water to assist in the let-down reflex. Assist to the bathroom. Place a urinary catheter. Assist the client to stand. Measure urinary output.

Run water to assist in the let-down reflex. Assist to the bathroom. Assist the client to stand. Measure urinary output.

The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client? Urine output of 35 to 40 mL/hour Pain of 3 out of 10, 1 hour after analgesic administration SpO2 at 90% with fine crackles in the lung bases Blood tinged drainage in Jackson-Pratt drainage tube

SpO2 at 90% with fine crackles in the lung bases

The nurse is caring for a 54-year-old male client that is admitted with chest pain, who has an AV fistula in the left arm for hemodialysis secondary to CKD. Which of the nursing interventions are contraindicated? SELECT ALL THAT APPLY Take blood pressure readings in the left arm. Assess for redness, swelling, and drainage at AV fistula site. Wrap the AV fistula site in the left arm with a compression dressing. Palpate for a thrill over the AV fistula every 8 hours. Use AV fistula site to draw blood. Auscultate for a bruit over AV fistula every 8 hours

Take blood pressure readings in the left arm. Wrap the AV fistula site in the left arm with a compression dressing. Use AV fistula site to draw blood.

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury? The kidneys can improve over a period of months. Once on dialysis, the need will be permanent. Kidney function will improve with transplant. Acute kidney injury tends to turn to end-stage failure.

The kidneys can improve over a period of time

The nurse is caring for a client with blood loss from esophageal varices. Which assessment finding indicates that the client is exhibiting signs of acute kidney injury (AKI) related to the loss of volume? An inability to initiate voiding Cloudy urine with a foul odor Urine output that has been <0.5 mL/kg/hr for several hours Reports of acute flank pain

Urine output that has been <0.5 mL/kg/hr for several hours

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? Wear a mask while handling any dialysate solutions. Keep the catheter stabilized to the abdomen, below the belt line. Use an aseptic technique during the procedure. Clean the catheter insertion site daily with soap.

Use an aseptic technique during the procedure.

The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, which action(s) will the nurse take? Select all that apply. Wash hands carefully and frequently Assess vital signs frequently Instruct staff to always wear a mask Perform skin hygiene Perform oral care

Wash hands carefully and frequently Perform skin hygiene Perform oral care

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? Perform deep-breathing exercises vigorously. Wear a mask when performing exchanges. Auscultate the lungs frequently. Avoid carrying heavy items.

Wear a mask when performing exchanges.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Blood glucose level of 200 mg/dl White blood cell (WBC) count of 20,000/mm3 Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35%

White blood cell (WBC) count of 20,000/mm3

The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? With food 2 hours before meals 2 hours after meals At bedtime with 8 ounces of fluid

With food

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? Cola-colored urine Left upper quadrant pain Pyuria Low blood pressure

cola-colored urine

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? Penicillin Gentamicin Tobramycin Neomycin

penicillin

A client has been diagnosed with acute glomerulonephritis. This condition causes: proteinuria. pyuria. polyuria. No option is correct.

proteinuria

One of the roles of the nurse in caring for clients with chronic kidney disease is to help them learn to minimize and manage potential complications. This would include: restricting sources of potassium. allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally.

restricting sources of potassium