Concepts II - Acid and Renal
Which drug is used to treat acute glomerulonephritis A - Defibrillators B - Diuretics C - Beat-Blockers D - Analgesics
B - Diuretics
A nurse is reviewing the lab and diagnostic test results of a 10-year-old child who has acute glomerulonephritis. Which of the following findings should the nurse expect? A - Decreased urine specific gravity B - Decreased serum creatinine C - Positive antistreptolysis O (ASO) titer D - Cardiac atrophy
C - Positive antistreptolysis O (ASO) titer
What organ controls the CO2 levels A - heart B - brain C - lungs D - Kidney
C - lungs
Metabolic Alkalosis - s/s
Gastric suction, Diuretics, Antacid ingestion, excess aldosterone, vomiting
What is the normal range for a pCO2 level A - 25-35 B - 45-55 C - 30-40 D - 35-45
D - 35-45
Which is a potential complication of acute glomerulonephritis? A - Polyuria B - Hypo-tension C - Hypervolemia D - Anuria
C - Hypervolemia
A nurse is caring for a client who has impaired renal function. The nurse should notify the provider if the client's hourly urine output falls below what amount?
30 mL Rational The nurse should report a urinary output that is less than 30 mL/hr to the provider. This indicates a fluid imbalance, a decreased circulating fluid volume, and possibly inadequate renal perfusion.
A pt with kidney failure misses his last dialysis appoint. He complains of feeling very sick A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic acidosis D - Metabolic alkalosis
C - Metabolic acidosis
A nurse in a dialysis center is caring for a client who has a new diagnosis of end-stage renal disease. At the first dialysis treatment, the client tells the nurse, "I decided to come today, but I am not sure if I will need to come back again this week. I am feeling much better since my discharge from the hospital and I think my kidneys are working again." The nurse should recognize the client is demonstrating which stage of Kubluer-Ross stages of grieving? 1 - Bargaining 2 - Denial 3 - Depression 4 - Anger
2 - Denial Rational 1 - In the bargaining stage of grief, the client attempts to bargain to avoid the loss. 2 - During the denial stage of Kübler-Ross's stages of grieving, the client acts as though nothing has happened and may refuse to believe or understand that a loss has occurred. 3 - In the depression stage of grief, the client grieves over the loss. 4 - In the anger stage of grief, the client directs anger towards the nurse or others.
pCO2 is acidic by nature A - true B - False
A - true
What laboratory test is used to diagnosis acute glomerulonephritis? A - Renal Scan B - CT C - BUN D - Flat plat
C - BUN
When assessing the skin of a pt with advanced end-stage kidney disease the nurse may notice A - Uremic frost B - Ecchymosis C - sallowness D - Pallor
A - Uremic frost
What imbalance would the nurse expect to see in a client with renal failure A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic acidosis D - Metabolic alkalosis
C - Metabolic acidosis
What imbalance would the nurse expect to see in a patient with starvation and renal failure. A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic acidosis D - Metabolic alkalosis
C - Metabolic acidosis
A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the provider? A - Sodium 144 mEq/L B - Urine output 120 mL in 4 hr C - Potassium 5.2 mEq/L D - Weight loss of 1 kg (2.2 lb)
C - Potassium 5.2 mEq/L
A nurse is completing discharge teaching about diet and fluid restrictions to a client who has a calcium oxalate-based kidney stone. Which of the following instructions should the nurse include in the teaching. A - Reduced intake of spinach B - Decrease broccoli intake C - Increase intake of vitamin C supplements D - Limit consumption of pruine substance
A - Reduced intake of spinach
What imbalance would the nurse expect in a client with chronic respiratory disease A - Respiratory Acidosis B - Metabolic Acidosis C - Respiratory Alkalosis D - Metabolic Alkalosis
A - Respiratory Acidosis
A 39 year old pt comes into the ER minimally responsive with suspected drug overdose A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic acidosis D - Metabolic alkalosis
A - Respiratory acidosis
What is inspected for edema A - legs B - arms C - feet D - eyes
D - eyes
A nurse is caring for a client who has metabolic acidosis. Which of the following components of the client's medical history should the nurse identify as a risk factor for this acid-base imbalance. A - Diabetic Ketoacidosis B - Sleep apnea C - Asthma D - Pulmonary edema
A - Diabetic Ketoacidosis
A postop abdominal surgery pt has has a nasogastric tube for 3 days. The nurse caring for the pt states "There is so much drainage from the tube. I wonder if this is why he feels sick." A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic acidosis D - Metabolic alkalosis
D - Metabolic alkalosis
Which compensatory mechanism responds third? And what is the response time? Select two A - Second to mintures B - Respiratory system C - Chemical buffers D - Minutes to a few hours E - Several hours to days F - Renal (Metabolic) system
F - Renal (Metabolic) system E - Several hours to days
Respiratory Alkalosis s-s
Hyperventilation, panic attack, high altitude, ASA overdose (early), asthma, brain injury
What is a normal bicarbonate range A - 22-26 B - 35-45 C - 30-40 D - 7.35 - 7.45
A - 22-26
A nurse on a med-surg unit is caring for a group of clients. The nurse should identify that which of the following clients is at risk for hypovolemia? A - A client who has nasogastric suctioning B - A client who has chronic constipation C - A client who has syndrome of inappropriate antidiuretic hormone D - A client who took an overdose of sodium bicarbonate antacids
A - A client who has nasogastric suctioning
A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? Select all A - A client who is at 32 weeks of gestation B - A client who has kidney calculi C - A client who has a urine pH of 4.2 D- A client who has a neurogenic bladder E - A client who has diabetes mellitus
A - A client who is at 32 weeks of gestation B - A client who has kidney calculi D- A client who has a neurogenic bladder E - A client who has diabetes mellitus
What is the normal pH rage for blood A - 7.54 - 7.8 B - 7.35 - 7.45 C - 7.25 - 7.35 D - 7.00 - 8.00
B - 7.35 - 7.45
A nurse on a med-surg unit is caring for a group of clients. For which of the following clients should the nurse anticipate a prescription for fluid restriction? A - A client who has a new diagnosis of adrenal insufficiency B - A client who has heart failure C - A client who is receiving treatment for diabetic ketoacidosis D - A client who has abdominal ascetics
B - A client who has heart failure
A pH level greater than 7.45 would yield what condition? A - acidosis B - Alkalosis
B - Alkalosis
A nurse is planning care for a client who has dehydration. Which of the following actions should the nurse include? A - Administer antihypertensive on schedule B - Check the client's weight each morning C - Notify the provider of a urine output great than 30 mL/hr D - Encourage independent ambulation four times a day
B - Check the client's weight each morning
To identify an early manifestation of infection related to PD, the nurse instructs the patient A - monitor temperature routinely B - Check the effluent for cloudiness C - Be aware of feeling of malaise D - Monitor for abdominal pain
B - Check the effluent for cloudiness
Metabolic Acidosis - s/s
diarrhea, renal disease, ASA overdose (late), Excess alcohol intake, DKA,
Respiratory Acidosis s-s
hypoventilation, narcotic overdose, cardiac arrest, loss of consciousness, paralyzed, weak, respiratory muscles, drowning
A nurse is reinforcing teaching with a client who takes prednisone orally to prevent organ rejection following a kidney transplant. Which of the following statements by the client indicates an understanding of the teaching? 1 - "I will plan to come to the clinic for periodic testing of my blood glucose." 2 - "I will avoid drinking grapefruit juice while taking this medication." 3 - "I will stop taking the medication immediately if I develop a fever." 4 - "I will avoid crushing the prednisone tablet."
1 - "I will plan to come to the clinic for periodic testing of my blood glucose." Rational 1 - Long-term use of prednisone can cause glucose intolerance even in clients who do not have diabetes. Therefore, periodic testing for blood glucose is recommended. 2 - Although clients should avoid drinking grapefruit juice while taking many medications, including statins, grapefruit juice does not alter the absorption of prednisone. 3 - A fever can indicate the presence of infection, which is a risk factor associated with prolonged prednisone therapy. The client should notify the provider. If discontinuation of the medication is necessary, the dose is tapered rather than stopped immediately to prevent withdrawal syndrome. 4 - Clients who have difficulty swallowing the tablet can crush it.
A nurse is planning a low-protein diet for a client who has chronic renal failure. The client states, "Why do I have to be concerned with protein?" Which of the following responses is appropriate? 1 - "Protein breakdown produces waste product that can build up in your body." 2 - "High protein intake can cause calcium retention." 3 - "Protein impairs the body's ability to store potassium." 4 - "A low-protein diet will help your body retain more fluid."
1 - "Protein breakdown produces waste product that can build up in your body." Rational 1 - The nurse should explain to the client that protein metabolism produces waste products, which the impaired kidneys are unable to excrete from the body. 2 - The nurse should instruct the client that high protein intake will worsen kidney disease, which leads to hypocalcemia. 3 - The nurse should explain that high protein intake will worsen kidney disease, which leads to hyperkalemia. 4 - The nurse should inform the client that a high protein intake can worsen kidney disease, which will cause fluid retention.
A nurse is reinforcing teaching about the prostate-specific antigen (PSA) test with a client. Which of the following statements should the nurse make? 1 - "You don't need to fast prior to the PSA test." 2 - "Annual PSA screening should begin at age 40." 3 - "Expected PSA values will decrease as you get older." 4 - "You should not ejaculate for 24 hours after the PSA test."
1 - "You don't need to fast prior to the PSA test." Rational 1 - Fasting is not required for the PSA test. The client may eat or drink up until the time of the test. 2 - The American Cancer Society recommends that all men begin annual PSA testing at the age of 50. Men who have a family history of prostate cancer or men of African descent should discuss with their provider the possible benefits of initiating testing at age 45. 3 - Expected PSA values increase with age. 4 - Ejaculation within 24 hours prior to the test can cause falsely elevated levels of PSA; however, the client can ejaculate after the PSA test.
A nurse is reinforcing dietary teaching with a client who has late-stage chronic kidney disease (CKD). Which of the following nutrients should the nurse instruct the client to increase in her diet. 1 - Calcium 2 - Phosphorous 3 - Potassium 4 - Sodium
1 - Calcium Rational 1 - A client who has CKD can develop hypocalcemia due to the reduced production of active vitamin D, which is needed for calcium absorption. The client should supplement her diet with dietary calcium. 2 - A client who has CKD can develop hyperphosphatemia because excretion of phosphorous by the kidneys is reduced. 3 - A client who has CKD can develop hyperkalemia because excretion of potassium by the kidneys is reduced. 4 - A client who has CKD can develop hypernatremia because excretion of sodium by the kidneys is reduced.
A nurse is assisting in the plan of care for a client who is scheduled to have a renal biopsy. Which of the following actions should the nurse include in the plan? Select all 1 - Collect a urine specimen prior to the procedure. 2 - Obtain an informed consent prior to the procedure. 3 - Administer diphenhydramine prior to the procedure. 4- Maintain a clear liquid diet 4 hr prior to the procedure. 5 - Complete coagulation studies prior to the procedure.
1 - Collect a urine specimen prior to the procedure. 2 - Obtain an informed consent prior to the procedure. 5 - Complete coagulation studies prior to the procedure. Rational 1 - Collect a urine specimen prior to the procedure is correct. A urine specimen is needed prior to the procedure to allow for postprocedure comparison. 2 - Obtain an informed consent is correct. Because the procedure is invasive it requires written, informed consent. 3 - Administer diphenhydramine prior to the procedure is incorrect. Benadryl is sometimes used prior to a procedure that uses dye, but not for a renal biopsy. 4 - Maintain a clear liquid diet 4 hr prior to the procedure is incorrect. NPO for 6 to 8 hr prior to the procedure is usually required. 5 - Complete coagulation studies prior to the procedure is correct. Coagulation studies are obtained prior to the procedure to evaluate the risk for bleeding from the biopsy site.
A nurse is checking urinalysis results for four clients. Which of the following urinalysis results indicates a urinary tract infection? A - Postive for hyaline casts B - Positive for leukocyte esterase C - Positive for ketones D - Positive for crystals
B - Positive for leukocyte esterase
A nurse is reviewing data for a client who has chronic kidney disease. Which of the following data should the nurse identify as the best indicator of fluid volume status? 1 - Daily weight 2 - Serum sodium 3 - Skin turgor 4 - I&O
1 - Daily weight Rational 1 -According to evidence-based practice, the nurse should identify that the best indicator of fluid volume status is daily weight. Weight provides the most accurate indicator of fluid volume status. 2 - The nurse should monitor the client's serum sodium, because increased sodium can lead to increased fluid retention; however, evidence-based practice indicates that other data is the priority for the nurse to monitor. 3 - The nurse should monitor the client's skin turgor because sluggish skin turgor indicates decreased body fluid in the tissues; however, evidence-based practice indicates that other data is the priority for the nurse to monitor. 4 - The nurse should monitor the client's I&O to help determine changes in the treatment plan, such as required fluid restriction; however, evidence-based practice indicates that other data is the priority for the nurse to monitor.
A nurse is reviewing the medical record of a client who has metabolic acidosis. The nurse should realize that which of the following findings contributes to the development of metabolic acidosis? 1 - Diarrhea 2 - Vomiting 3 - Hyperventilation 4 - Salicylate intoxication
1 - Diarrhea Rational 1 - Diarrhea can cause bicarbonate loss, which can contribute to the development of metabolic acidosis. 2 - Vomiting can cause acid loss, which can contribute to the development of metabolic alkalosis. 3- Hyperventilation can cause carbon dioxide loss, which can contribute to the development of respiratory alkalosis. 4 - Salicylate intoxication can contribute to the development of respiratory alkalosis.
A nurse is collecting data for a client who has early manifestations of renal impairment. Which of the following findings should the nurse expect? 1 - Diluted urine 2 - Yellowish- gray skin 3 - Muscle cramps 4 - Weight gain
1 - Diluted urine Rational 1 - The nurse should expect the client to have diluted urine as an early manifestation of renal impairment because the kidneys are unable to concentrate urine. 2 - The nurse should expect the client to have dry, scaly, yellowish-gray skin as renal insufficiency progresses and the kidneys are not producing urine. 3 - The nurse should expect the client to have muscle cramping because calcium is not absorbed from the intestine leading to hypocalcemia when a client has kidney failure. 4 -The nurse should expect the client to have weight gain as renal insufficiency progresses and the kidneys are not producing urine.
A nurse is assisting with the care of a client who has hypertension and chronic kidney disease. The client is scheduled for hemodialysis. Which of the following actions should the nurse plan to take while caring for this client? Select all 1 - Document vital signs. 2 - Obtain the client's weight. 3 - Verify the glomerular filtration rate. 4 - Administer a sedative to the client. 5 - Check the graft site for a palpable thrill.
1 - Document vital signs. 2 - Obtain the client's weight. 5 - Check the graft site for a palpable thrill. Rational 1 - Document vital signs is correct. The client's vital signs should be taken and documented prior to dialysis for baseline data. The client's blood pressure, in particular, should be monitored prior to, during, and after dialysis due to the potential for hypotension during and after the treatment. If the blood pressure drops too low, an infusion of intravenous normal saline may be required to replace fluid volume and restore the blood pressure. 2 - Obtain the client's weight is correct. Hemodialysis shunts the client's blood from the body through a dialyzer and back into the client's circulation. During hemodialysis, the blood is passed through the dialysis machine to remove waste products and excess fluid. The amount of fluid to be removed is determined by the client's weight immediately prior to dialysis. The client's dry weight, which is determined by the provider, is subtracted from the weight immediately prior to the start of dialysis. For example, if the dry weight is 70 kg (154.32 lb) and the current weight is 72 kg (158.73 lb), the dialysis machine is programmed to remove 2 kg (4.4 lb), or 2 L (0.5 gal) of fluid. 3 - Verify the glomerular filtration rate is incorrect. End-stage kidney disease (ESKD) is a progressive, irreversible kidney disease. End-stage kidney disease, also known as end-stage renal failure (ESRD), exists when 90% of the functioning nephrons have been destroyed and are no longer able to maintain fluid, electrolyte, or acid-base homeostasis. This means the kidneys are no longer able to sustain life, and the client will die if dialysis is not initiated. The client's glomerular filtration rate (GFR) is used to determine the severity of kidney damage. The GFR is expected to be greater than 90 mL/min. Chronic kidney disease (CKD) is comprised of five stages: Stage 1, minimal kidney damage with normal GFR; Stage 2, mild kidney damage with mildly decreased GFR; Stage 3, moderate kidney damage with a moderate decrease in GFR; Stage 4, severe kidney damage with a severe decrease in GFR; and Stage 5, kidney failure and end-stage kidney disease with little or no glomerular filtration and renal replacement therapy required. Glomerular filtration rate is an indicator of renal function and is checked to evaluate how well the kidneys are working. Because ESKD is irreversible, it is not necessary to check the GFR prior to dialysis because the GFR level in these clients is elevated and will remain that way unless a renal transplantation is performed. 4 - Administer a sedative is incorrect. The client is awake during hemodialysis and is a painless procedure for the client. Therefore, a sedative is not needed. 5 - Check the graft site for a palpable thrill is correct. Hemodialysis requires access to the client's blood by way of a graft, arteriovenous (AV) fistula, or central venous access device. The nurse should check patency of the access site (presence of bruit, palpable thrill, distal pulses, and circulation). This ensures vascular flow and proper functioning of the graft prior to the dialysis procedure. If a thrill is not found, this can indicate the graft has clotted and hemodialysis will not be possible. This would need to be reported to the provider. Measures to protect the graft include avoiding taking blood pressure, administering injections, performing venipuncture, or inserting IV lines on an extremity with an access site.
A nurse is caring for a client who has end-stage renal disease and must limit protein intake. Which of the following foods should the nurse plan to include in the client's diet? 1 - Eggs 2 - Lentils 3 - Nuts 4- Green vegetables
1 - Eggs Rational 1 - The protein in the protein-restricted diet of a client who has end-stage-renal disease must be of high biological value. A high biological value means the protein source should be a complete protein (providing a high percentage of amino acids), such as eggs, meat, fish, soy, or dairy products. 2 - Lentils are sources of incomplete proteins. Because lentils do not provide all the essential amino acids, they are a poor choice for clients who have end-stage renal disease. 3 - Nuts are sources of incomplete proteins. Because nuts do not provide all the essential amino acids, they are a poor choice for clients who have end-stage renal disease. 4 - Green vegetables are sources of incomplete proteins. Because green vegetables do not provide all the essential amino acids, they are a poor choice for clients who have end-stage renal disease.
A nurse is reinforcing teaching with a client who has chronic kidney disease (CKD). which of the following instructions should the nurse include? 1 - Limit fluid intake. 2 - Limit caloric intake. 3 - Eat a diet high in phosphorus. 4 - Eat a diet high in protein.
1 - Limit fluid intake. Rational 1 - A client who has CKD should limit fluid intake to prevent hypervolemia, or excessive fluid overload. 2 - A client who has CKD should increase caloric intake so that the body can use protein for protein synthesis instead of energy consumption. Using protein for energy can lead to a negative nitrogen balance and malnutrition. 3 - A client who has CKD should limit phosphorus intake because the kidneys are unable to excrete it. 4 - A client who has CKD should not eat excessive protein to prevent the build-up of protein waste products and uremia.
A nurse is caring for a client whose arterial blood gases include a pH of 7.30, and HCO3 of 18 mEq/L and a PaCO2 of 28 mm Hg. The nurse should suspect that the client has developed which of the following acid-base imbalances? 1 - Metabolic acidosis 2 - Respiratory acidosis 3 - Metabolic alkalosis 4 - Respiratory alkalosis
1 - Metabolic acidosis Rational 1 - With metabolic acidosis, the pH is below 7.35, the HCO3- is less than 22 mEq/L, and the PaCO2 is below 35 mm Hg if uncompensated. 2 - With respiratory acidosis, the client would have a higher PaCO2. 3 - With metabolic alkalosis, the client would have a higher HCO3-. 4 -With respiratory alkalosis, the client would have a higher pH.
A nurse is caring for a client following a renal biopsy. Which of the following actions should the nurse take? (Select all) 1 - Monitor for hematuria. 2 - Check for flank pain. 3 - Observe for extravasation of tissue surrounding the biopsy site. 4 - Encourage ambulation. 5 - Administer aspirin PRN for pain.
1 - Monitor for hematuria. 2 - Check for flank pain. Rational 1 - Monitor for hematuria is correct. The nurse should monitor the client for bleeding, such as hematuria, tachycardia, hypotension, or bleeding at the biopsy site. 2 - Check for flank pain is correct. Flank pain is a manifestation of internal bleeding from the renal biopsy. 3 - Observe for extravasation of tissue surrounding the biopsy site is incorrect. Extravasation is associated with the infiltration of dye or medication around an IV site and is not a risk following a renal biopsy. 4 - Encourage ambulation is incorrect. The client should be on strict bedrest following a renal biopsy. 5 - Administer aspirin PRN for pain is incorrect. Aspirin is contraindicated for a client who is postoperative renal biopsy due to the increased risk for bleeding.
A nurse is caring for a client who was in a motor-vehicle crash. The client reports chest pain and difficulty breathing. A chest x-ray indicates that the client has a pneumothorax. Which of the following ABG results should the nurse expect? A - pH - 7.06, PaCO2 - 52, HCO3 - 24 B - pH - 7.42, PaCO2 - 38, HCO3 - 23 C - pH - 7.20, PaCO2 - 39, HCO3 - 18 D - pH 7.58, PaCO2 - 38, HCO3 - 29
A - pH - 7.06, PaCO2 - 52, HCO3 - 24
A nurse is reinforcing nutrition teaching for a client who has chronic kidney disease about limiting foods high in potassium. Which of the following foods should the nurse instruct the client to avoid? select all 1 - Orange juice 2 - Watermelon 3 - Bananas 4 - Corn flakes cereal 5 - White rice
1 - Orange juice 3 - Bananas Rational 1- Orange juice is correct. Orange juice is high in potassium; 240 mL (8 oz) contains 496 mg of potassium 2 - Watermelon is incorrect. Watermelon is low in potassium; 152 g (1 cup) of diced watermelon contains 170 mg of potassium. 3 - Bananas is correct. Bananas are high in potassium; one medium banana contains 422 mg of potassium. 4 - Corn flakes cereal is incorrect.Corn flakes cereal is low in potassium; 34 g (1 cup) of corn flakes cereal contains 60 mg of potassium. 5 - White rice is incorrect. White rice is low in potassium; 158 g (1 cup) of cooked white rice contains 55 mg of potassium.
A nurse is assisting in the planning of care for a client who has acute glomerulonephritis. Which of the following interventions should the nurse recommend including in the plan of care. 1 - Place the client on a low-sodium diet. 2 - Encourage increased fluid intake. 3 - Obtain weekly weight. 4 - Encourage frequent ambulation.
1 - Place the client on a low-sodium diet. Rational 1 - The nurse should include placing the client on a low-sodium diet to reduce fluid retention resulting in edema. 2 - Clients who have acute glomerulonephritis are frequently on a fluid restriction due to fluid retention. 3 - Daily weights are appropriate for a client who has acute glomerulonephritis to provide information regarding the client's fluid balance. 4 - Clients who have acute glomerulonephritis should conserve energy to prevent further stress on the glomeruli.
A nurse is caring for a client who has diagnosis of renal calculi and reports severe flank pain. Which of the following is the priority nursing action? 1 - Relieve the client's pain. 2 - Encourage the client to increase fluid intake. 3 - Monitor the client's I&O. 4 - Strain the client's urine.
1 - Relieve the client's pain. Rational 1 - The nurse should apply the urgent versus non-urgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The pain associated with renal calculi is severe and can lead to shock; therefore, this is the nurse's priority action. 2 - Although the nurse should encourage fluid intake for a client who has renal calculi to maintain adequate fluid volume and blood flow to the kidneys, there is another action that is the priority. 3 - Although the nurse should measure the urine output for a client who has renal calculi to monitor for obstruction, there is another action that is the priority. 4 - Although the nurse should strain the urine of a client who has renal calculi to obtain stone fragments for laboratory analysis, there is another action that is the priority.
A nurse is collecting data from a client who is postoperative following extracorporeal shockwave lithotripsy (ESWL). The nurse should identify that which of the following findings is the priority? 1 - Report of palpitations 2 - Pink-tinged urine 3 - Bruising on the flank area 4 - Stone fragments in the urine
1 - Report of palpitations Rational 1 - The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning - having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority-setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. ESWL is the application of sound, laser, or dry shock wave energies to break a kidney stone into small pieces. The shock waves are initiated during the R wave of the ECG to prevent dysrhythmias. When using the airway, breathing, circulation approach to client care, the nurse should determine report of palpitations is a manifestation of dysrhythmias and is the priority finding. 2 - Pink-tinged urine is an expected finding following ESWL and the nurse should continue to monitor the urine for bleeding; however, another finding is the priority. 3 - Bruising on the flank area is an expected finding following ESWL and the nurse should continue to monitor the client signs of bleeding; however, another finding is the priority. 4 - Stone fragments in the urine are an expected finding following ESWL and the nurse should continue to monitor the urine for stone fragments for laboratory analysis; however, another finding is the priority.
A nurse is collecting data from a client who has shallow respirations and a respiratory rate of 9/min. Which of the following acid-base imbalances should the nurse expect? 1 - Respiratory acidosis 2 - Respiratory alkalosis 3 - Metabolic acidosis 4 - Metabolic alkalosis
1 - Respiratory acidosis Rational 1 - Respiratory acidosis represents an increase in the acid component, carbon dioxide, due to inadequate excretion, and an increase in the hydrogen ion concentration (decreased pH) of the arterial blood. A major cause of this imbalance is hypoventilation. 2 - Hyperventilation, not hypoventilation, causes respiratory alkalosis. 3 - Metabolic acidosis results from a metabolic disturbance, such as diarrhea or diuresis, not a respiratory disturbance. 4 - Metabolic alkalosis results from a metabolic disturbance, such as vomiting, not a respiratory disturbance.
A nurse is collecting data from a newborn who has respiratory distress syndrome and is experiencing respiratory acidosis. Which of the following risk factors predisposes the newborn to respiratory difficulties. 1 - Small for gestational age 2 - Maternal history of asthma 3 - Cesarean birth 4 - Ventricular septal defect
1 - Small for gestational age Rational 1 - Newborns who are small for gestational age, have a low birth weight, are postterm, have a maternal history of diabetes, and have cord prolapse are at increased risk for respiratory difficulties. 2 - A maternal history of diabetes, not asthma, can predispose the newborn to respiratory difficulties. 3 - Newborns who are small for gestational age, have a low birth weight, are postterm, have a maternal history of diabetes, or have cord prolapse are at increased risk for respiratory difficulties. However, a cesarean birth is not a risk factor. 4 - Newborns who are small for gestational age, have a low birth weight, are postterm, have a maternal history of diabetes, or have cord prolapse are at increased risk for respiratory difficulties.. However, a ventricular septal defect is not a risk factor.
A nurse is caring for a client who has respiratory acidosis. Which of the following pH levels should the nurse expect 1 - pH 7.31 2 - pH 7.39 3 - pH 7.48 4 - pH 7.50
1 - pH 7.31 Rational 1-A client who has respiratory acidosis will have a pH level less than 7.35 and a PaCO2 greater than 45 mm Hg. 2 - A pH level of 7.39 is within the expected reference range. 3 - A client who has a pH of 7.48, which is above the expected reference range, more likely has respiratory alkalosis or metabolic alkalosis. 4 - A client who has a pH of 7.48, which is above the expected reference range, more likely has respiratory alkalosis or metabolic alkalosis.
A patient who is over sedated with narcotic might have what imbalance? A - respiratory acidosis B - Respiratory alkalosis C - Metabolic Acidosis D - Metabolic Alkalosis
A - respiratory acidosis
A nurse is planning a menu for a client who has folic acid deficiency anemia and is selecting food high in folic acid. Which of the following should the nurse include? 1 - Asparagus 2 - Strawberries 3 - Tuna 4 - Milk
1 - Asparagus Rational 1 - The nurse should recognize that asparagus is a food high in folic acid. Half a cup of cooked asparagus contains 134 mcg of folic acid per serving, 34% of the daily-recommended requirement of 400 mcg. 2 - The nurse should recognize that strawberries are an excellent source of vitamin C. Half a cup of whole strawberries contains 42 mg per of vitamin C per serving, 47% of the daily recommended amount of 90 mg; however, they are not a good source of folic acid, as they contain only 17 mcg per serving. 3 - The nurse should recognize that tuna is a good source of vitamin B6. 3 oz of tuna contains 0.9 mg per serving, 70% of the daily recommended amount of 1.3 mg; however, it is not a good source of folic acid. 4 - The nurse should recognize that milk is a good source of riboflavin. 1 cup of 2% milk contains 0.5 mg of riboflavin per serving, 29% of the daily recommended amount; however, it is not a good source of folic acid.
A nurse is collecting data for a middle aged client who has pyelonephritis. Which of the following findings should the nurse expect? 1 - Flank pain 2 - Hypotension 3 - Confusion 4 - Weight gain
1 - Flank pain Rational 1 - The nurse should expect the client to have flank pain due to inflammation and infection in the kidney pelvis. 2 - The nurse should expect the client to have hypertension, rather than hypotension, which is a significant manifestation of kidney damage from chronic pyelonephritis. 3 - The nurse should expect the client to have confusion associated with end-stage kidney disease rather than from pyelonephritis. 4 - The nurse should expect the client to have weight loss, not weight gain, during the chronic phase of pyelonephritis.
A nurse is caring for a school-age child who has acute glomerulonephritis. The child has peripheral edema and is producing 35 mL of urine per hour. Which of the following diets should the nurse anticipate the provider will prescribe? 1 - Low-sodium, fluid-restricted 2 - Regular diet, no added salt 3 - Low-carbohydrate, low-protein diet 4 - Low-protein, low-potassium diet
1 - Low-sodium, fluid-restricted Rational 1 -A low-sodium, fluid-restricted diet prevents complications of glomerulonephritis. 2 - A regular diet with no added salt is not appropriate for a client who has acute glomerulonephritis and peripheral edema. 3 - A low-carbohydrate, low-protein diet is not appropriate for a client who has acute glomerulonephritis, peripheral edema, and a urinary output of 35 mL/hr. 4 - A low-protein, low-potassium diet is not appropriate for a client who has acute glomerulonephritis, peripheral edema, and a urinary output of 35 mL/hr. Potassium intake is restricted in periods of oliguria.
A nurse is reinforcing nutrition teaching to a client who has chronic kidney disease about limiting foods high in phosphorus. Which of the following foods should the nurse instruct the client to avoid? Select all 1 - Milk 2 - Sunflower seeds 3 - Orange juice 4 - Frozen kale 5 - Poultry
1 - Milk 2 - Sunflower seeds 5 - Poultry Rational 1 - Milk is correct. All animal products, including dairy, are a source of phosphorus and should be avoided by a client who is on a phosphorus restricted diet. 2 - Sunflower seeds is correct. Sunflower seeds are a food source high in phosphorus and should be avoided by a client who is on a phosphorus restricted diet. 3 - Orange juice is incorrect. Orange juice is not a food source high in phosphorus and is safe for clients on a phosphorus restricted diet. 4 - Frozen kale is incorrect. Frozen kale is not a food source high in phosphorus and is safe for clients on a phosphorus restricted diet. 5 - Poultry is correct. All animal products, including poultry, are a source of phosphorus and should be avoided by a client who is on a phosphorus restricted diet.
A nurse is assisting in the care of a client who has acute onset pulmonary edema and is experiencing dyspnea with low oxygen saturation rates. The nurse should recognize the client is at risk for which of the following acid-base imbalances? 1 - Respiratory acidosis 2 - Respiratory alkalosis 3 - Metabolic acidosis 4 - Metabolic alkalosis
1 - Respiratory acidosis Rational 1 - The nurse should expect a client who has an acute respiratory condition—such as pneumonia, pulmonary edema, or respiratory arrest—to have respiratory acidosis. Respiratory acidosis develops when the lungs do not expel carbon dioxide adequately. Decreased ventilation (hypoxemia) causes carbon dioxide retention, resulting in respiratory acidosis. 2 - The nurse should expect a client experiencing hyperventilation, such as from acute pain or anxiety, to have respiratory alkalosis. 3 - The nurse should expect a metabolic imbalance in a client experiencing an impairment in the metabolic system, such as uncontrolled diabetes, kidney failure, or gastrointestinal disturbance. 4 - The nurse should expect a metabolic imbalance in a client experiencing an impairment in the metabolic system, such as uncontrolled diabetes, kidney failure, or gastrointestinal disturbance.
A nurse is reviewing the ABG values of a client who has chronic bronchitis and reports dyspnea with minimal exertion. Which of the following acid-base imbalances should the nurse suspect? 1 - Respiratory acidosis 2 - Respiratory alkalosis 3 - Metabolic acidosis 4 - Metabolic alkalosis
1 - Respiratory acidosis Rational 1 - The nurse should expect a client who has chronic bronchitis, a form of chronic obstructive pulmonary disease, to have respiratory acidosis. An increased respiratory rate and an inability to fully exhale increases retention of carbon dioxide. Carbon dioxide builds up and causes chronic respiratory acidosis. 2 - The nurse should expect a client experiencing hyperventilation, such as from acute pain or anxiety, to have respiratory alkalosis. 3 - The nurse should expect a client experiencing ketoacidosis or kidney failure to have metabolic acidosis. 4 - The nurse should expect a client experiencing vomiting or excess bicarbonate buildup to have metabolic alkalosis.
A nurse in the emergency department is assisting with the care of a client who is comatose. The provider suspects ketoacidosis. Which of the following findings should the nurse expect? 1 - Malignant hypertension 2 - Acetone odor to breath 3 - Cheyne-Stokes breathing 4 - Blood glucose level below 40 mg/dL
2 - Acetone odor to breath Rational 1 - Hypotension is an expected finding for ketoacidosis. 2 - Acetone odor to breath is an expected finding for ketoacidosis. 3 - Kussmaul respirations are an expected finding for ketoacidosis. 4 - A blood glucose level greater than 250 mg/dL is an expected finding for ketoacidosis.
A nurse is reinforcing teaching about urinary tract infections (UTI) with a client. Which of the following manifestations should the nurse include? 1 - Weight gain 2 - Back pain 3 - Vaginal discharge 4 - Muscle cramps
2 - Back pain Rational 1 - Weight gain is not a manifestation of a UTI, because a UTI does not cause fluid retention. Weight gain can be a manifestation of acute kidney injury and fluid overload. 2 - Back pain and flank pain are manifestations of a UTI. Other manifestations include frequency, urgency, and cloudy, foul-smelling urine. 3 - Vaginal discharge is a manifestation of a vaginal infection, not a UTI. 4 - Muscle cramps can be a manifestation of uremia, not a UTI.
A nurse is collecting data from a client who is 1 week postoperative following a living donor kidney transplant. Which of the following findings should indicate to the nurse that the client is experiencing cute kidney rejection 1 - Creatinine 0.8 mg/dL 2 - Blood pressure 160/90 mm Hg 3 - Sodium 137 mg/dL 4 - Urinary output 100 mL/hr
2 - Blood pressure 160/90 mm Hg Rational 1- Manifestations of acute kidney rejection can include an increase in serum creatinine. This finding is within the expected reference range. 2 - Due to the kidney's role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension. 3 - Manifestations of acute kidney rejection can include an increase in sodium. This finding is within the expected reference range. 4 - Manifestations of acute kidney rejection can include decreased urine output, anuria (no urine output) or oliguria (less than 30 mL/hr), and weight gain.
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the dialysate output is less than the input, and the client's abdomen is distended. Which of the following actions should the nurse take? 1 - Insert an indwelling urinary catheter. 2 - Change the client's position. 3 - Administer pain medication to the client. 4 - Place the drainage bag above the client's abdomen.
2 - Change the client's position. Rational 1 - Peritoneal dialysis is used for clients who have acute or chronic kidney disease. An indwelling urinary catheter will not relieve the client's discomfort. 2 - The client is retaining the dialysate solution after the dwell time. The nurse should ensure that the clamp is open and the tubing is not kinked, and reposition the client to facilitate the drainage of the solution from the peritoneal cavity. 3 - The client is retaining the dialysate solution after the dwell time. Pain medication will not correct the cause of the client's discomfort. 4 - The nurse should position the drainage bag lower than the client's abdomen to promote gravity drainage.
A nurse is caring for a child who has acute glomerulonephritis. Which of the following actions is the nurse's priority? 1 - Place the child on a no-salt-added diet. 2 - Check the child's weight daily. 3 - Educate the parents about potential complications. 4 - Maintain a saline-lock.
2 - Check the child's weight daily Rational 1 - Placing the child on a no-salt-added diet is appropriate; however, it is not the priority. 2 - The first action the nurse should take using the nursing process is to collect data. Therefore, checking the child's weight daily is the priority. 3 - Educating the parents about potential complications is appropriate; however, it is not the priority. 4 - Maintaining a saline-lock is appropriate; however, it is not the priority.
A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury. The client report diarrhea, a dull headache, palpitations, and muscle tingling and weakness. Which of the following actions should the nurse take first? 1 - Administer an analgesic to the client. 2 - Check the client's electrolyte values. 3 - Measure the client's weight. 4 - Restrict the client's protein intake.
2 - Check the client's electrolyte values. Rational 1 - Administering an analgesic for a dull headache is important to manage the client's pain; however, there is another action that the nurse should take first. 2 - The nurse should apply the urgent versus non-urgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should check the client's most recent potassium value because these findings are manifestations of hyperkalemia, which can lead to cardiac dysrhythmias; therefore, this is the priority action. 3 - Measuring the client's weight is important to monitor the client's fluid balance; however, there is another action the nurse should take first. 4 - Restricting the client's protein intake is important to manage the client's acute kidney injury; however, there is another action the nurse should take first.
A nurse is collecting data for a client who has pneumonia and is experiencing acute respiratory acidosis. Which of the following manifestations should the nurse expect to find? 1 - Cool, clammy skin 2 - Decreased level of consciousness 3 - Muscle flaccidity 4 - Circumoral numbness and tingling
2 - Decreased level of consciousness Rational 1 - The nurse should expect to find warm, flushed skin in a client who is experiencing respiratory acidosis. 2 - The nurse should expect to find a decreased level of consciousness in a client who is experiencing respiratory acidosis. The rise in carbon dioxide dilates the cerebral vessels causing a feeling of fullness in the head, leading to mental cloudiness and a decreased level of consciousness. 3 - The nurse should expect to find muscle twitching, dizziness, and possibly seizures in a client who is experiencing respiratory acidosis. 4 - The nurse should expect to find circumoral numbness and tingling in a client who is experiencing respiratory alkalosis.
A nurse is collecting data from a client who has an injury to the lower abdomen following a motor-vehicle crash. The nurse should identify that which of the following findings is a manifestations of bladder trauma? 1 - Stress incontinence 2 - Hematuria 3 - Pyuria 4 - Fever
2 - Hematuria Rational 1 - Leakage of urine during coughing, jogging, or lifting, also known as stress incontinence, is caused by weakened pelvic muscles. It is not a manifestation of bladder trauma. 2 - Manifestations of bladder trauma include hematuria, or blood in the urine; blood at the urinary meatus; pelvic pain; and anuria, or the absence of urine. 3 - Pyuria, or WBCs in the urine, is a manifestation of a urinary tract infection. It is not a manifestation of bladder trauma. 4 - Fever is a manifestation of an infection. It is not a manifestation of bladder trauma.
A nurse is collecting data from a client who has alcohol use disorder and is experiencing metabolic acidosis. Which of the following manifestations should the nurse expect? 1 - Cool, clammy skin 2 - Hyperventilation 3 - Increased blood pressure 4 - Bradycardia
2 - Hyperventilation Rational 1 - The nurse should expect to find warm, flushed skin in a client who is experiencing metabolic acidosis. 2 - The nurse should expect to find hyperventilation in a client who is experiencing metabolic acidosis. The system attempts to compensate or return the pH to normal by increasing the rate and depth of respirations. 3 - The nurse should expect to find hypotension in a client who is experiencing metabolic acidosis. 4 - The nurse should expect to find tachycardia in a client who is experiencing metabolic acidosis.
A nurse is collecting data from a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? Select all A - Weight gain B - Fruity odor of breath C - Abdominal pain D - Kussmaul respirations E - Metabolic acidosis
B - Fruity odor of breath C - Abdominal pain D - Kussmaul respirations E - Metabolic acidosis
A nurse is collecting data from a client who reports persistent vomiting, dizziness, palpitations, and numbness and tingling in his fingers and toes and around his mouth. The nurse notes the client's respirations are slow and shallow the nurse should suspect that the client has developed which of the following acid-base imbalances? 1 - Metabolic acidosis 2 - Metabolic alkalosis 3 - Respiratory acidosis 4 - Respiratory alkalosis
2 - Metabolic alkalosis Rational 1- Manifestations of metabolic acidosis include lethargy, confusion, deep and rapid respirations, weakness, and abdominal pain. 2 - Manifestations of metabolic alkalosis include slow and shallow respirations, dizziness, paresthesias, lightheadedness, cardiac dysrhythmias, and hypertonic muscles. 3 - Manifestations of respiratory acidosis include confusion, lethargy, headache, lightheadedness, and muscle twitching. 4 - Manifestations of respiratory alkalosis include deep and rapid respirations, lightheadedness, confusion, and paresthesias.
A nurse is caring for a client who is experiencing severe nausea and vomiting following chemotherapy. The nurse should monitor the client for which of the following acid-base imbalances? 1 - Metabolic acidosis 2 - Metabolic alkalosis 3 - Respiratory acidosis 4 - Respiratory alkalosis
2 - Metabolic alkalosis Rational 1 - Metabolic acidosis occurs following diarrhea or during diabetic ketoacidosis and is not expected in a client who is vomiting. 2 - Metabolic alkalosis can occur with excessive vomiting, gastric suctioning, with hypokalemia, or with excess bicarbonate ingestion. The client who has metabolic alkalosis might be dizzy, display hyperactive reflexes, and might have numbness or tingling in the extremities and around the mouth. 3 - Respiratory acidosis occurs when there is an alteration in respiratory function due to retention of carbon dioxide, and is not an expected finding in the client who is vomiting. 4 - Respiratory alkalosis occurs when there is an alteration in respiratory function through hyperventilation and is not an expected finding in the client who is vomiting.
A nurse is reviewing the chart of a client who is scheduled to have radiologic studies of the kidneys performed with the use of IV contrast dye. Which of the following client medications should the nurse withhold prior to the examination? 1 - Simvastatin 2 - Metformin 3 - Valsartan 4 - Pantoprazole
2 - Metformin Rational 1 - The nurse should recognize that simvastatin is a medication used to treat dyslipidemia; however, it does not require withholding prior to radiological studies. 2 - The nurse should recognize that metformin is used to treat type 2 diabetes and can cause lactic acidosis and renal failure when given along with IV contrast dye. It should be held for 24 hr prior to and 48 hr following the procedure. 3 - The nurse should recognize that valsartan is used to treat hypertension; however, it does not require withholding prior to radiological studies. 4 - The nurse should recognize that pantoprazole is used to treat GERD; however, it does not require withholding prior to radiological studies.
A nurse is collecting data from a client who has end-stage kidney disease and is waiting for transport to dialysis. Which of the following findings should the nurse expect? 1 - Hypotension 2 - Peripheral edema 3 - Diaphoresis 4 - Facial flushing
2 - Peripheral edema Rational 1 - The nurse should expect the client's blood pressure to be elevated due to fluid overload. The nurse should monitor the client for hypotension following dialysis. 2 - Clients who have kidney disease experience fluid overload, which is relieved by dialysis. Prior to dialysis, the nurse should expect the client to exhibit findings of fluid overload, such as edema and weight gain. 3 - The nurse should expect a client who has kidney disease to have dry skin. 4 - The nurse should expect a client who has kidney disease to have pale skin.
A nurse is reviewing laboratory findings for a client who has acute kidney disease. Which of the following findings should the nurse expect? 1 - BUN 8 mg/dL 2 - Serum creatinine 6 mg/dL 3 - Hemoglobin 19 g/dL 4 - Serum potassium 3.0 mEq/L
2 - Serum creatinine 6 mg/dL Rational 1 - BUN 8 mg/dL is below the expected reference range. A client who has acute kidney disease will have an elevated BUN level due to decreased renal function. 2 - Serum creatinine 6 mg/dL is above the expected reference range. A client who has acute kidney disease will have an elevated serum creatinine level, and glomerular filtration rate decreases with decreased renal function. 3 - Hemoglobin 19 g/dL is above the expected reference range. A client who has acute kidney disease will have decreased erythropoietin production from the kidney, which will decrease the production of RBCs, leading to a decreased hemoglobin level. 4 - Serum potassium 3.0 mEq/L is below the expected reference range. A client who has acute kidney disease will have an elevated serum potassium level from decreased excretion by the kidneys.
A nurse is reinforcing teaching with a client who wants to increase her daily intake of omega-3 fatty acids. Which of the following foods should the nurse suggest the client increase? 1- Blueberries 2 - Soybean oil 3 - Citrus fruits 4 - Green tea
2 - Soybean oil Rational 1 - Blueberries are an excellent source of antioxidants, but they do not contain omega-3 fatty acids. 2 - Soybean oil is a good source of the omega-3 fatty acids. 3 - Citrus fruits contain vitamin C, which is an antioxidant, but they do not contain omega-3 fatty acids. 4 - Green tea contain potent antioxidants called catechins that promote healthy blood flow, but it is not a source of omega-3 fatty acids.
A nurse is reviewing the medication record of a client who has chronic renal disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity? 1 - Omeprazole 2 - Vancomycin 3 - Ondansetron 4- Diphenhydramine
2 - Vancomycin Rational 1 - Omeprazole, a proton pump inhibitor, does not cause nephrotoxicity. 2 - Vancomycin, an anti-infective, can cause nephrotoxicity. 3 - Ondansetron, an antiemetic, does not cause nephrotoxicity. 4 - Diphenhydramine, an antihistamine, does not cause nephrotoxicity.
A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a new left arteriovenous fistula. Which of the following statements should the nurse make? 1 - "Check the fistula daily for a vibration." 2 - "Instruct the client to restrict movement of his left arm." 3 - "Avoid taking blood pressures on the client's left arm." 4 - "Instruct the client to sleep on his left side."
3 - "Avoid taking blood pressures on the client's left arm." Rational 1 - The nurse should check the fistula every 4 hr for blood flow. 2 - The client should perform range-of-motion exercises of the left arm. 3 - The nurse should avoid taking blood pressure measurements on the client's left arm, which can decrease blood flow and cause clotting. 4 - Sleeping on top of the extremity with the access site can cause impairment of blood flow and possible clotting.
A nurse is caring for a client who has a new diagnosis of chronic renal failure. The nurse should recognize which of the following client statements as an indication of anticipatory grief? 1 - "I know that I will get a kidney transplant. I am a good candidate." 2 - "I can now eat whatever I want. It will be dialyzed out of my system." 3 - "I just can't believe that my whole life is going to be ruined by dialysis." 4 - "I know that renal failure runs in my family and I can prevent it."
3 - "I just can't believe that my whole life is going to be ruined by dialysis." Rational 1 - This statement does not indicate anticipation of an upcoming loss, which is characteristic of anticipatory grief. 2 - This statement does not indicate anticipation of an upcoming loss, which is characteristic of anticipatory grief. 3 - This statement is an example of anticipatory grief, which is often exhibited through anger and denial at the fear of an upcoming loss. 4- This statement does not indicate anticipation of an upcoming loss, which is characteristic of anticipatory grief.
A nurse is reinforcing teaching with a client who has a history of urinary tract infections (UTIs). Which of the following statements should indicate to the nurse the need for additional instructions? 1 - "I will empty my bladder every 2 to 4 hours." 2 - "I will drink 2 liters of fluids per day." 3 - "I will use a vaginal douche daily." 4 - "I will wear cotton underwear."
3 - "I will use a vaginal douche daily." Rational 1 - The client should empty her bladder every 4 hr to prevent urinary stasis, which can cause UTIs. 2 - The client should maintain a daily fluid intake of 2 to 3 L to flush the kidneys and prevent urinary stasis. 3 - The client should avoid vaginal douches, bubble baths, and any substances that can increase the risk for UTIs. The client should use mild soap and water to wash the perineal area. 4 - The client should wear loose-fitting cotton underwear, instead of nylon, to prevent irritation.
A nurse is reinforcing teaching with a client prior to renal biopsy. Which of the following statements should the nurse make? 1 - "You will be NPO for 8 hours following the procedure." 2 - "An allergy to shellfish is a contraindication for this procedure." 3 - "You will need to be on bed rest following the procedure." 4 - "A creatinine clearance is needed prior to the procedure."
3 - "You will need to be on bed rest following the procedure." Rational 1 - The client is NPO for 4 to 8 hr prior to the procedure; however, food and fluids can resume following the procedure. 2 - An allergy to shellfish is not a contraindication for this procedure, because contrast media is not used. 3 - A renal biopsy involves a tissue biopsy through needle insertion into the lower lobe of the kidney. The client should maintain bed rest in a supine position with a back roll for support for 2 to 24 hr following the procedure to reduce the risk for bleeding. The nurse can elevate the head of the bed. 4 - Because of the risk for post-procedure bleeding, preliminary lab tests include coagulation studies such as platelet count and prothrombin time. Tests for anemia are also done to evaluate whether a pre-procedure blood transfusion is needed. Creatinine clearance is not required.
A nurse is caring for a client who has a diagnosis of acute glomerulonephritis. Which of the following should be reported immediately to the provider? 1 - Hematuria 2 - Pedal edema 3 - Blood pressure 162/90 mm Hg 4 - Urinary output of 280 mL during previous 8 hr
3 - Blood pressure 162/90 mm Hg Rational 1 - Hematuria is an expected finding as a result of glomerular-capillary membrane damage and is non-urgent; therefore, another finding is the nurse's priority. 2 - Pedal edema is an expected finding due to fluid retention and is non-urgent; therefore, another finding is the nurse's priority. 3 - When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding to report to the provider is a blood pressure of 162/90 mm Hg . Acute glomerular nephritis is classified as an immunologic kidney disorder. Fluid retention due to injury to the glomeruli leads to hypertension. To prevent complications, the nurse should monitor the blood pressure and report elevated blood pressure to the provider immediately as antihypertensive therapy may be needed. 4 - Urinary output of 280 mL during the previous 8 hr is an expected finding for a client who has acute glomerulonephritis and is non-urgent. The urinary output should be a minimum of 30 mL/hr. Output for 8 hr should be a minimum of 240 mL (30 mL/hr x 8 hr = 240 mL); therefore, another finding is the nurse's priority.
A nurse is collecting data from a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider? 1 - WBC 6,000/mm3 2 - Potassium 4.0 mEq/L 3 - Cloudy, yellow drainage 4 - Report of abdominal fullness
3 - Cloudy, yellow drainage Rational 1 - A WBC count of 6,000/mm3 is within the expected reference range. 2 - A potassium level of 4.0 mEq/L is within the expected reference range. 3 - Cloudy drainage is an early manifestation of peritonitis and the nurse should report this finding to the provider. Other manifestations include fever and abdominal tenderness. 4 - Abdominal fullness is an expected finding during the dwell period, when the dialysate stays in the peritoneal cavity. A supine, low-Fowler's position can reduce abdominal pressure.
A nurse is reviewing the arterial blood gas (ABG) results of a client. The client's ABG's are pH: 7.6 PPaCO2: 40 mm Hg HCO3: 32 mEq/L Which of the following acid base conditions should the nurse identify the client is experiencing? 1 - Metabolic acidosis 2 - Respiratory acidosis 3 - Metabolic alkalosis 4 - Respiratory alkalosis
3 - Metabolic alkalosis Rational 1 - With metabolic acidosis, the pH is below 7.35, the PaCO2 is with the expected reference range and the HCO3 is below 22 mEq/L. 2 - With respiratory acidosis the pH is below 7.35, the PaCO2 is above 45 mm Hg and the HCO3 is within the expected reference range. 3 - The nurse should identify that the client is experiencing metabolic alkalosis. The client's pH is above 7.45, the PaCO2 is within the expected reference range and the HCO3 is above 26 mEq/L. 4 - With respiratory alkalosis the pH is above 7.45, the PaCO2 is below 35 mm Hg and the HCO3 is within the expected reference range.
A nurse is caring for a client who is in the oliguric phase of acute kidney injury. Which of the following actions should the nurse take? 1 - Provide a diet high in protein. 2 - Provide ibuprofen for retroperitoneal discomfort. 3 - Monitor intake and output hourly 4 - Encourage the client to consume at least 2 L of fluid daily.
3 - Monitor intake and output hourly Rational 1 - The client with acute kidney injury is limited on their protein intake as this decreases the risk of the client developing chronic renal failure. 2 - The nurse should avoid administering medications that are nephrotoxic to a client who has acute kidney injury. The injury to the kidney causes an increase in drug excretion which can lead to toxic levels. 3 - The nurse should closely monitor the client for signs of fluid imbalance. This includes hourly monitoring of intake and output, along with daily weights. If there are sudden changes, or the urinary output is less than 30 mL/hr, the provider must be notified immediately. 4 - The client who is in the oliguric stage of acute kidney injury is not producing urine and will be placed on fluid restrictions, often less than 1,200 mL daily which includes intravenous fluids. Excessive fluid intake can result in fluid overload.
A nurse is reinforcing teaching about collecting a 24-hour urine specimen for creatinine clearance with a newly licensed nurse. Which of the following instructions should the nurse include 1 - Include the first voided specimen at the start of the collection period. 2 - Discard the last voided specimen at the end of the collection period. 3 - Place signs in the bathroom as a reminder about the test in progress. 4 - Instruct the client to increase exercise during the 24-hr period.
3 - Place signs in the bathroom as a reminder about the test in progress. Rational 1 - The nurse should have the client void first thing in the morning, discard the specimen, and collect all subsequent specimens for 24 hr. 2 - The nurse should include the last voided specimen at the end of the collection period. 3 - The nurse should place signs in the bathroom and alert family members of the test in progress so that everyone saves the specimens appropriately throughout the test. 4 - The nurse should instruct the client to avoid vigorous exercise, cooked meat, tea, and coffee during the 24-hr period.
A nurse is reinforcing dietary instructions with a client who has chronic kidney disease. Which of the following information should the nurse include? 1 - Maintain a low carbohydrate diet. 2 - Eliminate ingestion of foods high in protein. 3 - Reduce intake of foods high in potassium. 4 - Increase intake of sodium-containing food.
3 - Reduce intake of foods high in potassium. Rational 1 - The client is at risk for malnutrition from increased metabolic demands; the nurse should include information for the client to obtain adequate calories to prevent wasting of body proteins. 2 - The nurse should include information for the client to include foods high in protein according to the degree of renal impairment. 3 - The nurse should include information for the client to reduce foods high in potassium, because potassium levels can increase dangerously high with impaired kidney function. 4 - The nurse should include information for the client to decrease sodium intake, which can help decrease blood pressure.
A nurse is collecting data from a client whose arterial blood gas values reveal a pH of 7.24, PaCO2 of 53, and an HCO3 of 24. The nurse should prepare to treat the client for which of the following acid-base imbalances? 1 - Metabolic acidosis 2 - Respiratory alkalosis 3 - Respiratory acidosis 4- Metabolic alkalosis
3 - Respiratory acidosis Rational 1 - An expected finding for a client who has metabolic acidosis is HCO3- less than 22 mEq/L. 2 - An expected finding for a client who has respiratory alkalosis is a pH higher than 7.45 and PaCO2 lower than 35 mmHg. 3 - In analyzing blood gases, the nurse should first determine if the result is acidosis (pH less than 7.35) or alkalosis (pH greater than 7.45). A pH of 7.24 is decreased. Therefore, this is acidosis. The next step is to look at the PaCO2 (expected reference range 35 to 45) and the HCO3- (expected reference range 22 to 26). A PaCO2 of 53 is elevated (greater than 45) and the HCO3- of 24 is within the expected reference range. Therefore, if the pH is decreased, the PaCO2 is elevated and the HCO3- is within the expected reference range, the client is experiencing respiratory acidosis. 4 - An expected finding for a client who has metabolic alkalosis is a pH higher than 7.45 and an HCO3- higher than 26 mEq/L.
A nurse is caring for a client whose arterial blood gas results show the following results: pH: 7.2 PaCo2: 50 mm Hg HCO3: 24 mEq/L The nurse should identify the client is experiencing which of the following acid-base conditions? 1 - Metabolic acidosis 2 - Metabolic alkalosis 3 - Respiratory acidosis 4 - Respiratory alkalosis
3 - Respiratory acidosis Rational 1 - With metabolic acidosis, the client's pH is below 7.35, the PaCO2 is within the expected reference range, and the HCO3 is below 22 mEq/L. 2 - With metabolic alkalosis, the client's pH is above 7.45, the PaCO2 is within the expected reference range, and the HCO3 is above 26 mEq/L or average. 3 - With uncompensated respiratory acidosis, the client's pH is below 7.35, the PaCO2 is above 45 mm Hg, and the HCO3 is within the expected reference range. 4 - With respiratory alkalosis, the client's pH is above 7.45, the PaCO2 is below 35 mm Hg, and the HCO3 is within the expected reference range.
A nurse is reinforcing teaching with a client about the oliguric phase of acute kidney injury. Which of the following information should the nurse include in the teaching? 1 - The oliguric phase lasts for 2 days. 2 - The oliguric phase begins within 1 month of the injury. 3 - The client's urine output is less than 400 mL per 24 hours. 4 - The client's BUN and creatinine decreases during this phase.
3 - The client's urine output is less than 400 mL per 24 hours. Rational 1 - The client who has acute kidney injury will remain in the oliguria phase for an average of 10 to 14 days. 2 - The client who has acute kidney injury will start the oliguria phase immediately or within 1 week. 3 - The client who has acute kidney injury will have urine output of 100 to 400 mL per 24 hours. 4 - The client who has acute kidney injury will have an elevation of the BUN and creatinine levels during the oliguric phase.
A nurse is reinforcing teaching about renal transplant with a newly licensed nurse. Which of the following clients should the nurse identify as having a contraindication for this procedure? 1 - A client who has a body mass index (BMI) of 25 2 - A client who has a pacemaker 3 - A client who is 65 years old 4 - A client who has a history of IV drug abuse
4 - A client who has a history of IV drug abuse Rational 1 - Severe obesity, a BMI of greater than 30, is a contraindication for renal transplantation. 2 - An uncorrectable cardiac disease is a contraindication for a renal transplantation. Having a pacemaker is not a contraindication for renal transplantation. 3 - A client who is older than 70 can be considered for a transplant if the client meets other criteria for renal transplantation 4 - A history of IV drug abuse is a contraindication for renal transplantation. Other contraindications include malignancy and a chronic infection.
A nurse is reinforcing teaching for a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CABD). Which of the following should the nurse include in the teaching? 1 - The dialyzing solution infuses using an infusion pump. 2 - CAPD dialysis is the treatment of choice for a client who has a history of abdominal trauma. 3 - The dialysis is continuous 24 hr a day, 7 days a week. 4 - The dialyzing solution is suspended at the level of the umbilicus during the infusion.
3 - The dialysis is continuous 24 hr a day, 7 days a week. Rational 1 - The client who does CABD infuses the dialyzing solution by gravity. 2 - The client who has had abdominal surgery or trauma is not a candidate for peritoneal dialysis because of possible adhesion in the abdominal cavity. 3 - The client who is treated with CAPD is using a self-dialysis method that is continuous 24 hr a day, 7 days a week. The dialyzing solution has a dwelling time of 4 to 8 hr before the fluid is drained. 4 - The client should suspend the dialyzing solution above the level of the abdomen for gravity infusion after attaching the tubing to the permanent implantable peritoneal dialysis catheter.
A nurse is reinforcing teaching about monitoring weight with a client who has chronic kidney disease. Which of the following instructions should the nurse include in the teaching? 1 - Use several different scales to obtain the weight. 2 - Calibrate weight scales every week. 3 - Weigh at the same time each day. 4 - Measure weight just prior to voiding.
3 - Weigh at the same time each day. Rational 1- The nurse should instruct the client use the same scale to weigh for a more accurate reading. 2 - The nurse should instruct the client to calibrate the scale every day. 3 - The nurse should instruct the client to weigh at the same time each day for a more accurate reading. 4 - The nurse should instruct the client to void before obtaining the weight for a more accurate reading.
A nurse is assisting in the post-dialysis plan of care for a client who is receiving hemodialysis treatment for chronic kidney disease. Which of the following interventions should the nurse include in the plan of care? 1 - Monitor the client for hypertension. 2 - Check the client's temperature for hypothermia. 3 -Monitor the client for bleeding. 4 - Check the client for increased urine output.
3 -Monitor the client for bleeding. Rational 1 -The nurse should monitor for hypotension during the post-dialysis period and require rehydration with IV fluids because of fluid removal. 2 - The nurse should check the client's temperature for an elevation because the dialysis machine warms the blood slightly. The nurse should also check the temperature for manifestations of an infection. 3 - The nurse should monitor for bleeding at least for 1 hr after the procedure because heparin is administered during the hemodialysis treatment and places the client at risk for bleeding. 4 - The nurse should expect the client to continue to have oliguria when the client has chronic kidney disease.
A nurse is reinforcing teaching with a client prior to a cystoscopy. Which of the following statements should the nurse make? 1 - "You will need to keep the sutures clean after this procedure." 2 - "You will be placed on your left side for this procedure." 3 - "Expect to be on bed rest for 24 hours after this procedure." 4 - "Expect to have pink-tinged urine after this procedure."
4 - "Expect to have pink-tinged urine after this procedure." Rational 1 - There are no surgical incisions made during a cystoscopy; therefore, no sutures are used. 2 - The client will be placed in a lithotomy position. This position provides exposure of the genitalia and facilitates insertion of the cystoscope. 3 - A client can undergo a cystoscopy as an outpatient. Bed rest for 24 hr is not indicated. 4 - A cystoscopy is a procedure in which a scope is inserted into the urethra to diagnose or treat bladder problems. Following the procedure, pink-tinged urine is expected.
A nurse is reinforcing teaching with a client who is preoperative prior to a transurethral resection of the prostate (TUPR). Which of the following statements indicates an understanding of the information? 1 - "I will not need to have a urinary catheter following this procedure." 2 - "I will expect my urine to be cloudy after having this procedure." 3 - "At least I won't have leakage of urine after having this procedure." 4 - "I will feel the urge to urinate following this procedure."
4 - "I will feel the urge to urinate following this procedure." Rational 1 - The client will require an indwelling urinary catheter following a TURP to monitor urine output and bleeding. 2 - Cloudy urine can be a manifestation of retrograde ejaculation or infection. The client should report cloudy urine to the provider. 3 - The client might have temporary dribbling and leakage of urine following a TURP. The nurse should reassure the client that these manifestations will resolve. 4 - After a TURP, the client will feel the urge to urinate. The nurse should reassure him that he will receive analgesics to help relieve this discomfort.
A nurse is reinforcing teaching with a client who will have an x-ray of the kidney, ureters, and bladder. Which of the following statements should the nurse include? 1 - "You will receive contrast due during the procedure." 2 - "An enema is necessary before the procedure." 3 - "You will need to lie in a prone position during the procedure." 4 - "The procedure determine whether you have a kidney stone."
4 - "The procedure determine whether you have a kidney stone."
A nurse is reinforcing teaching with a client who has acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? 1 - "You should avoid taking NSAIDs for pain." 2 - "You should maintain complete bed rest until manifestations decrease." 3 - "You should drink 1,000 milliliters of fluid per day." 4 - "You should complete the entire cycle of antibiotic therapy."
4 - "You should complete the entire cycle of antibiotic therapy." Rational 1 - A client who has acute pyelonephritis can take NSAIDs as needed for pain, unless otherwise contraindicated. 2 - The client should balance rest and activity, and does not require complete bed rest. Ambulation can prevent complications of bed rest such as constipation and urinary stasis. 3 - A client who has acute pyelonephritis should drink at least 2,000 mL per day, unless otherwise contraindicated. 4 - The client should complete the full prescription of the antibiotic therapy to decrease the chance of regrowth of the causative organism.
A nurse is monitoring a client who had a kidney biopsy for postoperative complications, which of the following complications should the nurse identify as causing the greatest risk to the client. A - Infection B - Hemorrhage C- hematuria D - pain
B - Hemorrhage
A nurse is reviewing the laboratory reports for a client who has chronic kidney disease. Which fo the following laboratory reports should the nurse expect to find? 1 - BUN 10 mg/dL, serum creatinine 0.3 mg/dL 2 - BUN 45 mg/dL, serum creatinine 1.0 mg/dL 3 - BUN 11 mg/dL, serum creatinine 10 mg/dL 4 - BUN 35 mg/dL, serum creatinine 8 mg/dL
4 - BUN 35 mg/dL, serum creatinine 8 mg/dL Rational 1 - The client who has chronic kidney disease will not have a BUN that is within the expected reference range combined with a decreased serum creatinine. 2 - The client who has chronic kidney disease will not have a BUN that is elevated combined with a serum creatinine that is within the expected reference range. 3 - The client who has chronic kidney disease will not have a BUN that is in the expected reference range combined with a serum creatinine that is elevated. 4 - A client who has chronic kidney disease will have an elevation of both the BUN and serum creatinine. The goal for a client who has chronic kidney disease is to keep the BUN below 100 mg/dL and the creatinine below 8 mg/dL.
A nurse is collecting data from a client who is postoperative following a transurethral resection of the prostate (TURP). After the nurse discontinues the client's urinary catheters, which of the followings should the nurse report to the provider. 1 - Pink-tinged urine 2 - Report of burning upon urination 3 - Stress incontinence 4 - Decreased urine output
4 - Decreased urine output Rational 1 - Pink-tinged urine and blood clots are an expected finding for several days following a TURP. 2 - Burning upon urination and urinary frequency are expected findings after a TURP and should decrease after several days. 3 - Stress incontinence is an expected finding following a TURP due to poor sphincter control. 4 - A decrease in urine output after a TURP indicates obstruction to urine flow by a clot or residual prostatic tissue and should be reported to the provider.
A nurse is conducting a preoperative interview with a client who is scheduled for surgery. The client states that he takes acetylsalicylic acid 81 mg by mouth daily. Prior to the client's upcoming surgery, the nurse should instruct the client to do which of the following? 1 - Decrease the dose by half 2 weeks before surgery. 2 - Take the originally prescribed dose the week of surgery. 3 - Double the dose the week of surgery. 4 - Discontinue the dose 2 weeks before surgery.
4 - Discontinue the dose 2 weeks before surgery. Rational 1- The dose should not be decreased by half 2 weeks before surgery. This can increase the client's risk for bleeding. 2 - The originally prescribed dose should not be resumed the week of surgery. This can increase the client's risk for bleeding. 3 - The dose should not be doubled the week of surgery. This can increase the client's risk for bleeding. 4 - The dose should be discontinued 2 weeks before surgery to prevent the risk for bleeding.
A nurse is caring for a client who has acute kidney injury. The client's ABGs are pH: 7.26 PaCO2: 30 mm Hg HCO3: 14 mEq/L Which of the following acid-imbalances should the nurse identify the client is experiencing 1 - Metabolic alkalosis 2 - Respiratory alkalosis 3 - Respiratory acidosis 4 - Metabolic acidosis
4 - Metabolic acidosis Rational 1 - With metabolic alkalosis the pH is above 7.45, the PaCO2 is within the expected reference range and the HCO3 is above 26 mEq/L. 2 - With respiratory alkalosis the pH is above 7.45, the PaCO2 is below 35 mm Hg, and the HCO3 is within the expected reference range. 3 - With respiratory acidosis the pH is below 7.35, the PaCO2 is above 45 mm Hg, and the HCO3 is within the expected reference range. 4 - Acute renal failure causes metabolic acidosis because clients cannot process and excrete the acidic substances the usual bodily functions produce every day. With metabolic acidosis, the pH is below 7.35, the PaCO2 is below 35 mm Hg or in the expected range, and the HCO3 is below 22 mEq/L.
A nurse is caring for a client diagnosed with chronic glomerulonephritis. The nurse would expect to find a decrease in which of the following serum laboratory values? 1 - Potassium 2 - Phosphate 3 - Creatinine 4 - RBC
4 - RBC Rational 1 - Serum potassium levels are increased with chronic glomerulonephritis. 2 - Serum phosphate levels are increased with chronic glomerulonephritis. 3 - Serum creatinine levels are increased with chronic glomerulonephritis. 4 - Serum RBC is decreased with chronic glomerulonephritis due to the decreased production of erythropoietin, the factor that stimulates production of erythrocytes.
A nurse is caring for a client who is receiving peritoneal dialyisis. The nurse should monitor the client for which of the following adverse effects? 1 - Diarrhea 2 - Increased serum albumin 3 - Hypoglycemia 4 - Respiratory distress
4 - Respiratory distress Rational 1 - Diarrhea is not an adverse effect of peritoneal dialysis. The nurse should instruct the client to increase fiber intake to prevent constipation, which can reduce dialysate flow. 2 - Decreased serum albumin is an adverse effect of peritoneal dialysis. Protein can be lost through the dialysis exchange, resulting in protein wasting. A decreased serum albumin level is a manifestation of protein wasting. 3 - Hyperglycemia is an adverse effect that can occur in clients who have diabetes mellitus and clients who absorb glucose from the dialysate. 4 - Respiratory distress can occur during peritoneal dialysis due to fluid overload.
A nurse is preparing a client for a kidney biopsy. Which of the following actions should the nurse take? 1 - Instruct the client to remain NPO 8 hr before the procedure. 2 - Inform the client that the biopsy is performed while lying supine during the procedure. 3 - Administer a cleansing enema before the procedure. 4 - Review the coagulation studies before the procedure.
4 - Review the coagulation studies before the procedure. Rational 1 - The nurse should instruct the client to remain NPO 4 to 6 hr before the procedure because mild sedation, not general anesthesia, is administered at the time of the procedure. 2 - The nurse should inform the client that the biopsy is performed while lying prone for easy access of the kidney. 3- The nurse should not administer a cleansing enema to the client because it is not needed as preparation for a kidney biopsy. 4 - The nurse should review the coagulation studies before the procedure because of the risk of bleeding during a kidney biopsy.
A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? select all A - Identify an allergy to seafood B - Withhold metformin for 24 hr C - Administer an enema D - Obtain a serum coagulation profile E - Check for asthma
A - Identify an allergy to seafood B - Withhold metformin for 24 hr C - Administer an enema E - Check for asthma
A nurse is contributing to the plan of care for a client who is has a new prescription for torsemide. The nurse should suggest monitoring for which of the following as adverse effects of this medication Select all A - Hypernatremia B - Hypokalemia C - Hypotension D - Ototoxicity E - Dehydration
B - Hypokalemia C - Hypotension D - Ototoxicity E - Dehydration
A nurse is collecting data from a client who has systemic lupus erythematosus (SLE). Which of the following laboratory values should the nurse review to determine the client's renal function? 1 - Antinuclear antibody 2 - C-reactive protein 3 - Erythrocyte sedimentation rate 4 - Serum creatinine
4 - Serum creatinine Rational 1 - The nurse should identify the antinuclear antibody test is used in the diagnosis of SLE and indicates the presence of an autoimmune disease; however, this test does not reflect renal function. 2 - Although this test is elevated during acute exacerbations of SLE, it is reflective of inflammation but does not indicate renal function 3 - Although the client's erythrocyte sedimentation rate might be prolonged during exacerbations (indicating active inflammation), the nurse should recognize that this test does not reflect renal function. 4 - Many clients with SLE have deposits of protein within the glomeruli of the kidneys and may develop lupus nephritis (persistent inflammation in the kidneys) or chronic renal failure. A disorder of renal function reduces the excretion of creatinine, resulting in increased levels of serum creatinine. The nurse should identify serum creatinine as a sensitive indicator of renal function
A nurse is reviewing the health record of a client who asks about taking propranolol to treat hypertension. Which of the following is a contraindication for taking propranolol A - Asthma B - Glaucoma C - Hypertension D - Tachycardia
A - Asthma
A nurse is assisting in the planning of care for a client who has chronic kidney disease. Which of the following actions should the nurse include in the plan of care Select all A - Auscultate lungs for pulmonary edema B - Provide frequent mouth rinses C - Restrict fluids based on urinary output D - Provide a high-sodium diet E - Monitor for weight-gain trends.
A - Auscultate lungs for pulmonary edema B - Provide frequent mouth rinses C - Restrict fluids based on urinary output E - Monitor for weight-gain trends.
A nurse is reviewing information with a female client who has frequent urinary track infections. Which of the following information should the nurse include select all A - Avoid sitting in a wet bathing suit B - Wipe the perineal area back to front following eliminating C - Empty the bladder when there is an urge to void D - Wear synthetic fabric underwear E - Take a shower daily
A - Avoid sitting in a wet bathing suit C - Empty the bladder when there is an urge to void E - Take a shower daily
A nurse is contributing to the plan of care for a client who received hemodialysis. Which of the following interventions should the nurse recommend? Select all A - Check BUN and serum creatinine B - Administer medications the nurse withheld prior to dialysis C - Observe for manifestations of hypovolemia D - Monitor the access site for bleeding E - Measure blood pressure on the extremity with AV access
A - Check BUN and serum creatinine B - Administer medications the nurse withheld prior to dialysis C - Observe for manifestations of hypovolemia D - Monitor the access site for bleeding
A client who has an indwelling catheter reports a need to urinate. Which of the following actions should the nurse take? A - Check to see whether the catheter is patient B - Reassure the client that it is not possible for her to urinate C - Rea=catheterize the bladder with a larger-gauge catheter D- Collect a urine specimen for analysis
A - Check to see whether the catheter is patient
A nurse is teaching a client about protein needs when on dialysis. Which of the following instructions should the nurse include in the teaching? select all A - Consume 35 kcal/kg of body weight to maintain body protein stores B - Take phosphate binders when eating protein-rich foods C - Increase biologic sources of protein, such as eggs, milk, and soy D - Increase protein intake by 50% of the recommended dietary allowance (RDA) E - Consume daily protein intake in the morning
A - Consume 35 kcal/kg of body weight to maintain body protein stores B - Take phosphate binders when eating protein-rich foods C - Increase biologic sources of protein, such as eggs, milk, and soy D - Increase protein intake by 50% of the recommended dietary allowance (RDA)
A nurse is collecting data from a client who reports nausea, vomiting, and weakness. The client has dry oral mucous membranes. Which of the following findings should the nurse identify as manifestations of fluid volume deficit? Select all A - Decreased skin turgor B - Concentrated urine C - Bradycardia D - Low-grade fever E - Tachypnea
A - Decreased skin turgor B - Concentrated urine D - Low-grade fever E - Tachypnea
Patient who had extensive burns and vascular depletion may have what VS urinary changes A - Decreased urine output. postural hypotension, tachycardia B - Dysrhythmias, hypertension, oliguria C - Bradycardia, hypertension, and polyuria D - Increased urine output, bounding pulses, and tachycardia
A - Decreased urine output. postural hypotension, tachycardia
A nurse is caring for a client who has a prescription for a 24 hour urine collection. Which of the following actions should the nurse take? A - Discard the first void B - Keep the urine in a single container at room temperature C - Ask the client to urinate and pour the urine into a specimen container D - Ask the client to urinate into the toilet, stop midstream, and finish urinating into the specimen container.
A - Discard the first void
A nurse is observing an older adult client who is receiving packed RBCs. Which of the following findings should the nurse identify as a manifestation of fluid volume excess and report to the charge nurse? select all A - Dyspnea B - Edema C - Bradycardia D - Hypertension E - Weakness
A - Dyspnea B - Edema D - Hypertension E - Weakness
A nurse is reviewing the lab test results for a client who has an elevated temperature. The nurse should recognize which of the following findings is a manifestation of dehydration? Select all A - Hct 55% B - Serum osmolarity 260 mOsm/kg C - Serum sodium 150 mEq/L D - Urine Specific gravity 1.035 E - Serum creatinine 0.6 mg/dL
A - Hct 55% C - Serum sodium 150 mEq/L D - Urine Specific gravity 1.035
Which common infection can cause acute glomerulonephritis? A - Hemolytic streptococcus B - E. Coli C - Candida albicans D - UTI
A - Hemolytic streptococcus
How might the patient with metabolic acidosis compensate A - increase the depth and rate of respirations B - Decrease the depth and rate of respirations
A - increase the depth and rate of respirations
A nurse is reinforcing teaching with a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include? A - Increase the amount of dietary fiber in the diet B - Drink grapefruit juice daily to increase vitamin C intake C - Decrease the amount of calcium in the diet D - Withhold food for 1 hr after taking the medication.
A - Increase the amount of dietary fiber in the diet
What is acute glomerulonephritis? A - Inflammation of capillary loops in glomeruli B - Abnormal conditions of kidneys C - Inflammation of kidneys D - Inflammation of bladder
A - Inflammation of capillary loops in glomeruli
A nurse is reviewing sick-day management with a parents os a child who has type 1 diabetes mellitus. Which of the following instructors should the nurse include in the teaching Select all A - Monitor blood glucose levels every 3 hr B - Discontinue taking insulin until feeling better C - Drink 8 oz of fruit juice every hour D - Test urine for ketones E - Call the provider if blood glucose is greater than 240 mg/dL
A - Monitor blood glucose levels every 3 hr D - Test urine for ketones E - Call the provider if blood glucose is greater than 240 mg/dL
A nurse is contributing to the plan of care for a client who is receiving furosemide to treat peripheral edema. Which of the following interventions should the nurse suggest for inclusion in the plan of care? Select all A - Monitor for tinnitus B - Report urine output 50 mL/hr C - Monitor potassium levels D - Elevate the head of the bed slowly before ambulation E - Recommend eating a banana daily
A - Monitor for tinnitus C - Monitor potassium levels D - Elevate the head of the bed slowly before ambulation E - Recommend eating a banana daily
A nurse is caring for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse plan to take? Select all A - Monitor serum glucose levels B - Report cloud dialysate return C - Warm the dialysate in a microwave oven D - Monitor for shortness of breath E - Check the access site dressing for wetness F - Maintain medical asepsis when accessing the catheter insertion site.
A - Monitor serum glucose levels B - Report cloud dialysate return D - Monitor for shortness of breath E - Check the access site dressing for wetness
A nurse is planning care for a client who has ESKD. Which of the following should the nurse include in the plan of care? Select all A - Monitor the client's weight daily B - Encourage the client to comply with fluid restrictions C - Evaluate intake and output. D - Instruct the client on restriction calories from carbohydrates E - Monitor for constipation
A - Monitor the client's weight daily B - Encourage the client to comply with fluid restrictions C - Evaluate intake and output. E - Monitor for constipation
A nurse is contributing to the plan of care for a client who has postrenal AKI due to metastatic cancer. The client has a serum creatinine of 5 mg/dL. Which of the following interventions should the nurse recommend? Select all A - Provide a high-protein diet B - Check the urine for blood C - Monitor for intermittent anuria D - Weight the client once per week E - Provide NSAIDs for pain
A - Provide a high-protein diet B - Check the urine for blood C - Monitor for intermittent anuria
What imbalance can occur with hypoventilation A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic Acidosis D - Metabolic Alkalosis
A - Respiratory acidosis
A nurse is teaching a client who has stage 2 chronic kidney disease about dietary management. Which of the following information should the nurse include in the instructors? A - Restrict protein intake B - Maintain a high-phosphorus diet C - Increase intake of foods high in potassium D - Limit dairy products to 1 cup/day
A - Restrict protein intake
A nurse is caring for a client who has acute kidney injury and is scheduled for hemodialysis. Which of the following actions should the nurse take Select all A - Review the medications the client currently takes B - Check the AV fistula for a bruit C - Calculate the client's hourly urine output D - Measure the client's weight E - Check serum electrolytes F - Use the access site area for venipuncture.
A - Review the medications the client currently takes B - Check the AV fistula for a bruit D - Measure the client's weight E - Check serum electrolytes
Which compensatory mechanism responds first? And what is the response time? Select two A - Second to mintures B - Respiratory system C - Chemical buffers D - Minutes to a few hours E - Several hours to days F - Renal (Metabolic) system
A - Second to mintures C - Chemical buffers
A nurse is reinforcing teaching with a client who has a new prescription for metformin. The nurse should instruct the client to report which of the following manifestation has an adverse effect of metformin A - Somnolence B - Constipation C- Fluid retention D - Weight gain
A - Somnolence
A nurse is collecting data from a client who has pancreatitis. The client's ABGs indicate metabolic acidosis. Which of the following findings should the nurse expect? Select all A - Tachycardia B - Hypertension C - Bounding pulses D - Insomnia E - Dyrhythmias F - Tachypnea
A - Tachycardia E - Dyrhythmias F - Tachypnea
A nurse is reinforcing teaching with a client who has a new prescription for hydrocaholorothiazide. Which of the following information should the nurse include? A - Take the medication with food B - Plan to take the medication at bedtime C - Expect increased swelling of the ankles D - Limit fluid intake in the morning
A - Take the medication with food
A ph of less than 7.35 represents what imbalance A - acidosis B - alkalosis
A - acidosis
To reduce kidney problems/injury the nurse target promotion and compliance with which condition A - diabetes and hypertension B - Frequent episodes of sexually transmitted disease C - Osteoporosis and other bone diseases D - Gastroenteritis and poor eating habits.
A - diabetes and hypertension
A nurse is review factors that increase the risk of urinary track infections (UTIs) with a client who has recurrent UTIs. Which of the following factors should the nurse include? Select all A - frequent sexual intercourse B - Lowering of testosterone levels C - Wiping from front to back D - Location of the urethra in relation to the anus E - Frequent catheterization
A - frequent sexual intercourse D - Location of the urethra in relation to the anus E - Frequent catheterization
A nurse is contributing to the plan of care for a client who has chronic pyelonephritis. Which of the following actions should the nurse recommend? Select all A -Assist with a referral for nutrition counseling B - Encourage daily fluid intake of 1 L C - Palpate the costovertebral angle D - Monitor urinary output E - Administer antibiotics
A -Assist with a referral for nutrition counseling C - Palpate the costovertebral angle D - Monitor urinary output E - Administer antibiotics
Risk factors for kidney failure include all the following expect A - use of antibiotics, NSAIDs, or Ace inhibitors B - Leakage of urine when coughing or laughing C - History of diabetes, hypertension, or SLE D - Recent surgery, trauma, or transfusions
B - Leakage of urine when coughing or laughing
A nurse is collecting data from a child who has post-streptococcal glomerulonephritis (APSGN). Which of the following manifestations should the nurse expect? select all A - Frothy urine B - Periorbital edema C - Ill appearance D - Polyuria E - Hypertension
B - Periorbital edema C - Ill appearance E - Hypertension
A nurse in a provider's office is evaluating a client who reports losing control of urine whenever she coughs, laughs, or sneezes. The client related a history of three vaginal births, but no serious accidents or illnesses. Which of the following interventions should the nurse suggest for helping to control or eliminate the client's incontinence? Select all A - Limit total daily fluid intake B - Decrease or avoid caffeine C - Take calcium supplements D - Avoid drinking alcohol E - Use the Crede maneuver
B - Decrease or avoid caffeine D - Avoid drinking alcohol
A nurse is preparing to begin a 24- hour urine collection for a client. Which of the following actions should the nurse take? A - Store collected urine in a designated container at room temperature B - Discard the first voiding when beginning the test C - Post a notice on the client's door regarding the test D - Document any urine collection that was missed during the 24 hr of the test.
B - Discard the first voiding when beginning the test
A patient who is receiving Vancomycin should have what lab result monitored A - Prothrombin time B - Drug peak and though levels C - Hemoglobin and hematocrit D - Platelet count
B - Drug peak and though levels
A nurse is collecting data from a child who has nephrotic syndrome. Which of the following findings should the nurse expect select all A - Dipstick protein of 1+ B - Edema in the ankles C - Hyperlipidemia D - Weight loss E - Anorexia
B - Edema in the ankles C - Hyperlipidemia E - Anorexia
A student is nervous about a big test. The student is panting and says "I feel dizzy and light headed" A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic acidosis D - Metabolic alkalosis
B - Respiratory alkalosis
What imbalance would the nurse expect in a patient with extreme anxiety A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic acidosis D - Metabolic alkalosis
B - Respiratory alkalosis
Which compensatory mechanism responds second? And what is the response time? Select two A - Second to mintures B - Respiratory system C - Chemical buffers D - Minutes to a few hours E - Several hours to days F - Renal (Metabolic) system
B - Respiratory system D - Minutes to a few hours
What color is urine during acute glomerulonephritis? A - Red-tinged B - Tea-colored C - Amber D - Clear
B - Tea-colored
What is not a common cause of intrarenal kidney injury A - Vasculitis B - UTI C - rhabdomyolysis D - Exposure to nephrotoxins
B - UTI
Bicarbonate is acidic by nature A - true B - false
B - false
A nurse is reinforcing teaching with an adolescent who has diabetes mellitus about manifestations of hypoglycemia. Which of the following findings should the nurse include select all A - Increased urination B - hunger C - Manifestations of dehydration D - irritability E - Sweating and pallor F - Kussmaul reparations
B - hunger D - irritability E - Sweating and pallor F - Fussmaul reparation
A nurse is preparing to initiate a bladder-retaining program for a client who has incontinence. Which of the following actions should the nurse take? Select all A - Establish a schedule of urinating prior to meal times B- Have the client record urination times C - Gradually increase the urination intervals D - Remind the client to hold urine until the next scheduled urination time E - Provide a sterile container for urine.
B- Have the client record urination times C - Gradually increase the urination intervals D - Remind the client to hold urine until the next scheduled urination time
A nurse is planning to administer a first dose of captopril to a client how has hypertension. The nurse should monitor the client for an intendification of first-dose hypertension if the client is also taking which of the following medications Select all A - Simvastatin B- Hydrochlorothiazide C - Phenytoin D - Clonidine E- Aliskiren
B- Hydrochlorothiazide D - Clonidine E- Aliskiren
A nurse is assisting with the care of a client who has increased intracranial pressure and is receiving mannitol. Which of the following findings should the nurse report to the provider? A - Blood glucose 120 mg/dL B - Urine output 40 mL/hr C - Dyspnea D - Bilateral equal pupil size
C - Dyspnea
What signs should the patient know A - Lethargy B - Fatigue C - Edema D - Lesions
C - Edema
A patient with kidney injury has incrased rate and depth of breathing to compensate for A - Alkalosis B - Hypoexmia C - Acidosis D - Hypoxia
C - Acidosis
A nurse is contributing to the plan of care for a client who has prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 ml in the past 2 hr, and blood pressure is 92/58 mm Hg. The nurse should anticipate which of the following interventions A - Prepare the client for a CT scan with contrast dye B - Administer ketorolac for pain C - Administer a fluid challenge D - Position the client in revere Trendelenburg
C - Administer a fluid challenge
Which combination of drugs in the most nephrotoxic A - Calcium channel blockers and antihistamines B - Angiotensin II receptor blockers and antacids C - Amino-glycoside antibiotics and NSAIDs D - ACE inhibitors and bronchodilator
C - Amino-glycoside antibiotics and NSAIDs
A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? A - Administer an opioid medication B - Monitor for hypertension C - Check level of consciousness D - Recommend an increase in the dialysis exchange rate.
C - Check level of consciousness
A nurse is reviewing the medical record for a client who has intrarenal acute kidney injury (AKI). Which of the following factors should the nurse identify as the cause of this form of AKI. A - Shock B - Prostate hyperplasia C - Cocaine use disorder D - Liver failure
C - Cocaine use disorder
A nurse is teaching about diet restrictions to a client who has acute kidney injury an is on hemodialysis. Which of the following recommendations should the nurse include in the teaching? A - Limit calcium intake to 2,500 mg/day B - decrease total fat intake to 45% of daily calories C - Decrease potassium intake to 60 to 70 mEq/kg D - Limit sodium intake to 4.5 g/day
C - Decrease potassium intake to 60 to 70 mEq/kg
A nurse is caring for a child who has type 1 diabetes mellitus. The nurse should identify which of the following findings are manifestation of diabetic ketoacidosis? select all A -Blood glucose 58 mg/dL B - Weight gain C - Dehydration D -Mental confusion E - Fruity Breath
C - Dehydration D -Mental confusion E - Fruity Breath
A nurse in a acute care facility is caring for a client who is receiving IV nitroprusside for hypertension crisis. The nurse should monitor the client for which of the following adverse reactions. A - Intestinal ileus B - Neutropenia C - Delirium D - Hyperthermia
C - Delirium
What intervention might the nurse expect in a patient with respiratory acidosis? A - Give a sedative B - Have then breathe in a paper bag C - Encourage deep breathing and coughing D - Increase the CO2 level
C - Encourage deep breathing and coughing
What intervention is appropriate for respiratory alkalosis? A - Give bicarbonate B - Increase the respirations C - Have then breathe in a paper bag D - Adequate hydration
C - Have then breathe in a paper bag
A nurse is contributing to the plan of care for a toddler who has nephrotic syndrome. Which of the following interventions should the nurse recommend? A - Provide frequent play periods in the activity room B - Place a urinary collection bag on the toddler C - Measure abdominal girth daily D - Keep lower extremities below the level of the heart.
C - Measure abdominal girth daily
A nurse is checking ABG results for a client who has vomited repeatedly during the past 24 hr. Which of the following acid-base imbalance should the nurse expect? A - Respiratory acidosis B - Respiratory alkalosis C - Metabolic acidosis D - Metabolic alkalosis
C - Metabolic acidosis
A nurse is performing an admission assessment on a client who has hypovolemia due to vomiting and diarrhea. The nurse should expect which of the following findings? Select all A - Distended neck vein B - Hyperthermia C - Tachycardia D - Syncope E - Deceased skin turgor
C - Tachycardia D - Syncope E - Deceased skin turgor
What is not a common cause of prerenal AKI A - Dehydration B - Septic shock C - Urethral cancer D - Heart failure
C - Urethral cancer
A nurse is caring for a client who has confusion and lethargy. The client was unresponsive at home, with an empty bottle of aspirin lying next to her bed. Vital signs are blood pressure 104/72 mm Hg, heart rate 116/min and regular, and respiratory rate 42/min with deep respirations. Which of the following arterial blood gas (ABG) results should the nurse expect? A - pH -7.68, PaCo2 - 28, HCO3 - 28 B - pH - 7.48, PaCo2 - 28, HCO3 - 23 C - pH - 7.16, PaCo2- 38, HCO3 - 18 D - pH -7.58 PaCo2 - 38, HCO3 - 29
C - pH - 7.16, PaCo2- 38, HCO3 - 18
A nurse is caring for a client who has a new prescription for captopril for hypertension. The nurse should monitor the client for which of the following adverse effects? A - Hypokalemia B - Hypernatremia C- Neutropenia D - Bradycardia
C- Neutropenia
Which patient with kidney problems is the best candidate for peritoneal dialysis A - A pt with a history of peritoneal membrane fibrosis B - A pt with history of extensive abdominal surgery C - A pt with peritoneal adhesions D - A pt with a history of difficulty with anticoagulants.
D - A pt with a history of difficulty with anticoagulants.
A nurse is caring for a client who has a urinary track infection (UTI). Which of the following is the priority intervention by the nurse A - Offer a warm sitz bath B - Recommend drinking cranberry juice C - Encourage increased fluids D - Administer an antibiotic
D - Administer an antibiotic
What can be ordered to prevent heart failure A - Catheter insertion B - Decreased activities C - Full liquid diet D - Bed rest
D - Bed rest
What two body systems are evaluated for evidence of fluid excess? A - skeletal and msucular B - GU & GI C - Integumentary and Endocrine D - Cardio and Respiratory
D - Cardio and Respiratory
A nurse is collecting data from a child who has chronic kidney disease. Which of the following findings should the nurse expect? A - Flushed face B - Hyperactivity C - Weight gain D - Delayed growth
D - Delayed growth
Which is indication of excessive fluid volume A - Increased output B - hypo-tension C - Bradycardia D - Dyspnea
D - Dyspnea
A nurse is reinforcing teaching with a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include? A - Hemodialysis restores kidney function B - Hemodialysis replace hormonal function of the renal system C - Hemodialysis allows an unrestricted diet D - Hemodialysis return a balance to serum electrolytes
D - Hemodialysis return a balance to serum electrolytes
What imbalance would the nurse expect with prolonged vomiting? A - Respiratory acidosis B - REspiratory alkalosis C - Metabolic Acidosis D - Metabolic Alkalosis
D - Metabolic Alkalosis
A nurse is caring for an older adult client in a long-term care facility who is dehydrated. Which of the following actions should the nurse take? A - Initiate fluid restrictions to limit the client's intake B - Observe for indications of peripheral edema C - Encourage the client to promote oxygenation by ambulating D - Monitor for orthostatic hypertension
D - Monitor for orthostatic hypertension
A nurse is collecting data fro a client who has returned to the medical-surg unit following a CT scan of the kidneys with IC contrast. Which of the following findings should the nurse identify as an indication the client is experience an allergic reaction to the contrast material A - Bradycardia B - Pink-tinged urine C - Hyperpyrexia D - Pruritus
D - Pruritus
Which is an outcome criteria for nursing interventions for the pt with acute glomerulonephritis? A - Retention of fluid B - I/O equal C - Improve urinary elimination D - Restoration of normal fluid
D - Restoration of normal fluid
A nurse is checking a client's laboratory findings. Which of the following finds is expected for a client who has stage 3 chronic kidney disease? A - Blood urea nitrogen (BUN 15 mg/dL) B - Hemoglobin 14.4 g/dL C - Serum creatinine 1.1 mg/dL D - Serum potassium 6.0 mEq/L
D - Serum potassium 6.0 mEq/L
A nurse is collecting data from a client who is dehydrated due to fluid volume deficit. Which of the following findings should the nurse expect? A - moist skin B - Distended neck veins C - Increase urinary output D - Thready pulse
D - Thready pulse
A kidney transplant patient 3 days post-surgery suddenly has a decrease in urine, this may be A - Infection B - Chronic rejection C - Stenosis D - Thrombosis
D - Thrombosis
What orang regulated the bicarbonate level A - heart B - brain C - lungs D - kidney
D - kidney
A nurse is checking the laboratory tests for a client who has glomerulonephritis. The nurse should expect to find an increase in which of the following test results? 1 - Creatinine clearance 2 - RBC 3 - BUN 4 -Specific gravity
3 - BUN Rational 1 - The client's creatinine clearance will be low due to the reduced glomerular filtration rate. However, the serum creatinine level would be increased. 2 - The client's RBC will be decreased due to the decreased production of erythropoietin, the factor that stimulates production of erythrocytes. 3 - The client's BUN will be increased due to the kidney's decreased ability to secrete these materials. 4 - The client's specific gravity will remain at a constant level, and typically shows evidence of dilution, or is low.
A nurse is reviewing the laboratory results for a client who has chronic kidney disease. Which of the following laboratory findings should the nurse expect? 1 - Hypokalemia 2 - Decreased urine specific gravity 3 - Decreased BUN 4 - Elevated creatinine
4 - Elevated creatinine Rational 1 - The nurse should expect the client to have hyperkalemia, which is an expected finding of chronic renal failure because the kidneys are not able excrete potassium. 2 - The nurse should expect the client to have increased urine specific gravity, which is an expected finding of chronic renal failure because the kidneys are not able to remove excess fluids in the circulatory system. 3 - The nurse should expect the client to have increased BUN, which is an expected finding of chronic renal failure and requires dietary restrictions of protein. 4 - The nurse should expect the client to have elevated creatinine, which is an expected finding of chronic renal failure because of the gradual damage to the kidneys that occurs over time.
A nurse is collecting data on a client who has end-stage kidney disease (ESKD). Which of the following is an expected finding? 1 - Hypokalemia 2 - Hypotension 3 - Euphoria 4 - Pruritus
4 - Pruritus Rational 1 - The nurse should expect the client to have hyperkalemia, rather than hypokalemia, because the kidneys are unable to excrete potassium. 2 - The nurse should expect the client to have hypertension, rather than hypotension, because the kidneys are unable to excrete the circulating fluid. 3 - The nurse should expect the client to signs of anxiety and depression because of the changes in body image and sense of worth. 4 - The nurse should expect the client to have pruritus because of uremic syndrome from the kidneys' poor ability to excrete waste through the urine.