Exam 3 Renal - NRSG 230

A patient who has been receiving hemodialysis for 1.5 years tells the nurse I really don't want to have him dialysis, I am tired and ready to stop treatment. Which of the following descriptions best explains the client statement? The client is experiencing affects of pain medication and not thinking clearly. The client would like to stop receiving hemodialysis. The client is experiencing a diminished cognitive level due to a buildup of toxins. The client is experiencing a normal response to fear associated with loss of control.

The client would like to stop receiving hemodialysis.

The nurse should administer 500 mL of IV solution over three hours to a client. Using tubing with a drip factor of 12 calculate the gravity flow rate.

33 GTT/min.

Which of these findings identified in a client in the oliguric phase of acute kidney injury should a nurse report to a physician? 4+ edema present in the feet and legs. Urine output of 500 mL over 24 hours. Sodium level of 135. Specific gravity of 1.025.

4+ edema present in the feet and legs. Everything else is still ok and "normal" for this phase... EXCEPT the edema

The nurse is caring for a client with acute kidney disease. The client weighs 60 kg. The physician prescribed dopamine 2 mcg/kg/min. Pharmacy sends dopamine 400 mg in 250 ML of D5W. What rate will the nurse said the IV pump?

4.5 mL/hour.

A client is ordered a dose of a Procrit. The recommended dose is 100 units/kg. The client raise weighs 70 kg. The vial is labeled 10,000 units per milliliter. How many milliliters should the nurse administer?

0.7 mL

The client with acute renal failure asks the nurse for a snack. Which of the following snacks is most appropriate? Cottage cheese. Yogurt. Jello Orange juice.

Jello

A client is to receive 250 mL of IV fluid to be administered over 120 minutes using 20 GTT /mL tubing. What flow rate will the nurse at the IV pump?

125 mL/hour.

A nurse is developing a plan of care to replace fluids for a patient in the oliguric phase of acute kidney disease. The client has 24 hour fluid output of 300 emesis and 200 mL of urine. How much fluid will the nurse replaced? 1100 mL. 900 mL. 1000 mL. 450 mL

1100 mL. all output in 24 hours + 600 mL for insensible loss = fluid replacement

A nurse is calculating the output of a client at the end of the shift. The nurse notes the following:: client avoided 400 mL at 11 o'clock and 350 mL at 2:30. The closed chest drainage system was previously marked at 155 mL and is now 175. The NG tube has 575 mL in the drainage container, and 25 mL is emptied out of the Jackson-Pratt drainage tube. How many milliliters should the nurse record into the medical record as the clients output?

1370 mL.

Based on the glomerular filtration rate GFR, which of the following clients medical treatment plan would include preparing for hemodialysis? A client who is GFR was: 76. 17. 95. 42.

17 GFR of <15-29 is stage 4 which is where you would start preparing for hemodialysis.

A client who is receiving outpatient hemodialysis treatment arrives at the hospital with the following clinical manifestations: crackles in bilateral posterior lower lungs, blood pressure of 180/89, respiratory rate of 30, SPO2 89%. The client received hemodialysis two days ago. Which of the following prescribed order should the nurse implement first? Fluid restriction 1000 mL in 24 hours. Elevate the foot of the foot of the bed. Administer 3 L oxygen nasal cannula. Obtain weight.

Administer 3 L oxygen nasal cannula. The main concern is SPo2 at the moment, so first thing to do is put on O2 !!!

A client with chronic kidney disease is scheduled for hemodialysis and is scheduled to receive a daily dose of lisinopril. When should the nurse plan to administer this medication? Two hours prior to dialysis. The day after dialysis. After dialysis. Just prior to dialysis.

After dialysis.

A client with chronic kidney disease is scheduled for hemodialysis and is scheduled to receive a daily dose of lisinopril Zestril. When should the nurse plan to administer this medication? Just prior to dialysis. Two hours prior to dialysis. The day after dialysis. After dialysis.

After dialysis. BC like she said in class BP meds should not be taken before, but should be taken when they come back if all VS are stable !!

20 days following a kidney transplant. The patient develops a temperature of 102.2 Fahrenheit, pain at the transplant, site and oliguria. Which of the following post kidney transplant complications does the nurse suspect is present? Hyper acute rejection, which will necessitate the removal of the transplanted kidney. An infection of the kidney, which can be treated with IV antibiotics. An acute rejection, which is not uncommon and usually reversible. Development of chronic rejection of the kidney with eventual failure of kidney.

An infection of the kidney, which can be treated with IV antibiotics.

A client who has been receiving hemodialysis treatments three times a week for the past year is admitted to the hospital. The client receives hemodialysis through an arterial venous AV fistula. In the right arm. Which intervention is included in this clients daily care? Assess the AV fistula for a bruit and a thrill. Take the blood pressure in the right arm. Keep the AV fistula site wrapped in gauze guys. Assess the AV fistula for a blood return.

Assess the AV fistula for a bruit and a thrill. Eevrything else you DO NOT DO !!!!

a patient receiving peritoneal dialysis using 1.5 L of dialysate per exchange has an outflow of 1000 mL. Which action should the nurse perform? Assist the patient to change their body position. Administer sodium polysterene sulfonate Kayexalate to the patient. Notify the physician about the outflow problem. Infuse an additional 500 mL of dialysate.

Assist the patient to change their body position.

The nurse is developing a plan of care for a client experiencing stage five chronic kidney disease. Which goal should the nurse include in the plan of care? The client will: demonstrate the ability to independently perform hemodialysis in the home. Sign up to receive hospice care. Verbalized understanding of the need to make high potassium food choices. Begin dialysis treatment.

Begin dialysis treatment. Stage 4 and up or GFR <15 ,means that NEED to start dialysis GFR of <15-29 is stage 4 which is where you would start preparing for hemodialysis.

A nurse is preparing a client for a kidney biopsy. Which of the following client conditions should the nurse identify as a contraindication for this diagnostic test? Bleeding tendencies. Urinary retention. Flank pain. Elevated creatinine.

Bleeding tendencies. BC if you go in and poke them in the kidneyy they're going to bleed even more...

The nurse is teaching a client who has a chronic kidney disease about the process of continuous ambulatory peritoneal dialysis CAPD. Which of the following information should the nurse include in the teaching? CAPD filters the clients blood through an artificial device called a dialyzer. CAPD is a dialysis treatment for clients who have had abdominal surgery. CAPD requires fewer dietary and fluid restrictions than hemodialysis. CAPD requires a rigid schedule of exchange times.

CAPD requires fewer dietary and fluid restrictions than hemodialysis.

A nurse is caring for a client whose laboratory results show potassium level of 6.8. When assessing the client the nurse should be alert for which occurrence? Chovosteks sign. Constipation. Cardiac arrhythmias. Decreased clotting time.

Cardiac arrhythmias. Any abnomral K+ level, low or high, means Arrythmias !!!

The nurse administers regular insulin IV 50% dextrose IV and calcium gluconate IV to a client with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the medication? Calcium level. Blood pressure. Urine volume. Cardiac rhythm.

Cardiac rhythm. Anything K+ you need to monitor Cardiac Rhythm

The nurse providing care to a client in the oliguric stage of renal failure, notes the following assessment data. Respiratory rate of 20, SPO2 - 93% on room air, irregular heart rate. The client complains of nausea, adult, headache, palpitations, and general malaise. Which of the following nurse actions has the highest priority? Check the latest electrolyte values. Educate the client on the importance of in avoiding nephrotoxic medication's. Call the physician. Administer prescribed. Acetaminophen Tylenol.

Check the latest electrolyte values.

After receiving change of shift report, which client should the nurse assess first? Client with stage four chronic kidney disease who has a calcium level of 8.0. Client just returned from hemodialysis with pulse of 122 bpm and blood pressure of 86/43. Client with stage four chronic kidney disease who has an elevated phosphate level. Client who is scheduled for the drain phase of a peritoneal dialysis exchange.

Client just returned from hemodialysis with pulse of 122 bpm and blood pressure of 86/43. Everything else is normal for these pt. ? but these numbers are ABNORMAL

Which of the following serum lab values would a nurse anticipate to be increased in a client with chronic renal failure? Select all that apply. Creatinine. Hemoglobin. Calcium. Phosphorus. Potassium.

Creatinine Phosphorus. Potassium. This is why you have to limit K+ and Phos in your diet !!!! for AKI and CKD

A client was hospitalized with chronic kidney injury. Which data will be most useful to the kidneys in evaluating kidney function.? Daily weight. Blood urea nitrogen level. Creatinine level. Urine volume.

Creatinine level. Most reliable, esp. over BUN.

A client who is receiving hemodialysis is experiencing muscle cramps. Operating on standing protocols, which of the following interventions should the nurse perform? Stop the dialysis treatment. Administer Hydro more phone Dilaudid 0.5 mg IV push. Administer oxygen 2L by nasal canula. Decrease the ultrafiltration rate and administer IV fluids.

Decrease the ultrafiltration rate and administer IV fluids.

A nurse is caring for a client following his first hemodialysis treatment. The client reports a headache, nausea, restlessness. The nurse should identify these findings as manifestations of which of the following complications? Air embolism. Dialysis disequilibrium. Peritonitis. Sepsis.

Dialysis disequilibrium.

A client with renal failure returns from surgery to the for placement of an arterial venous AV fistula in the right arm. Which of the following instructions should the nurse give to the unlicensed assistive personnel, assigned to take the clients vital signs? Auscultate the AV fistula for a bruit. Do not take blood pressures in the right arm. Monitor intake and output. Elevate the left arm on two pillows.

Do not take blood pressures in the right arm. Do not do anything on the arm of a fistula + unlisnsnced personannel cannot assess, or teach...

A client with end-stage renal disease is receiving peritoneal dialysis. Which of the following clinical manifestations are signs of complications associated with an infection of the catheter exit site? Select all that apply. Oliguria. Bradycardia. Drainage at the site. Cloudy outflow of dialysis solution. Redness at the site.

Drainage at the site. Redness at the site. This is infection at the INFECTION cite !!!!! Cloudiness would be a systemic thing not LOCAL

A client with diabetes is receiving IV, gentamycin, which of the following data off will the nurse monitor to evaluate if the client is experiencing adverse effects from the medication? Glomerular, filtration rate. Blood glucose levels. Serum magnesium levels. Serum potassium levels.

Glomerular, filtration rate. GFR

An hour after a kidney transplant, the nurse obtains the following data when assessing the client. Which information is most important to communicate to the healthcare provider? The urine output is 200 mL /hour. BUN and creatinine levels are abnormal. Heart rate of 114 and blood pressure of 87/48. The client reports and incisional pain of eight out of 10 when coughing.

Heart rate of 114 and blood pressure of 87/48. Hypotension and tachycardia indicates bleeding.

A client with chronic renal failure is receiving epoetin (epogen, Procrit). Which lab result would indicate a therapeutic affect of the medication? Hemoglobin 13.5. Platelet count of 400,000. WBC 6000. Creatinine 1.2.

Hemoglobin 13.5. This effects RBC's, and SE: bone pain....

A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? Creatinine 1.6 mg/dL Oxygen saturation 89% Hemoglobin level 13 g/dL Blood pressure 98/56 mm Hg Blood pressure 98/56 mm Hg Hemoglobin level 13 g/dL Oxygen saturation 89% Creatinine 1.6 mg/dL

Hemoglobin level 13 g/dL

A nurse is assessing a client who has pre-renal acute kidney injury. AKI. Which of the following findings should the nurse expect? Delayed capillary refill. Hypotension. Clear lung sounds. Restlessness.

Hypotension

A client with chronic kidney disease brings all home medication's to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that further patient teaching is required? Ibuprofen Advil 800 mg QID. Ferrous sulfate iron 325 mg PO every day. Calcium acetate phosLo 667 mg with meals. Acetaminophen Tylenol 650 mg every six hours PRN fever.

Ibuprofen Advil 800 mg QID. BC this is an NSAID which is neuphrotoxic

A nurse is caring for a client who has received hemodialysis. Client returned from dialysis, lethargic, not hungry, tried to eat a few crackers but vomited them up. Capillary blood glucose 134 mg/dL. AV fistula site skin warm, bruit and thrill noted, brachial and radial pulses palpable. Upon reassessment 4 hours later, the nurse notes crackles in left lower lobe; unproductive cough; AV fistula site ecchymotic, warm, bruit and thrill noted. Oriented to person, place, and time. Which of the following assessment findings require follow-up? Select 2 options Lung sounds Blood Glucose AV fistula assessment Weight Level of consciousness

Lung sounds AV fistula assessment

The nurse is planning care for a patient with severe heart failure who has developed increased blood urea nitrogen (BUN) and creatinine levels. What will be the primary treatment goal in the plan? Increase fluid volume Diluting nephrotoxic medications Preventing hypertension Maintaining cardiac output

Maintaining cardiac output

A client with acute kidney injury is scheduled for an IV pyelogram IVP in the outpatient setting. Which medication should the nurse instruct the client to hold 48 hours prior to the IVP. Ergocalciferol vitamin D. Glipizide Glucotrol Metformin Glucophage. Lisinopril.

Metformin Glucophage.

A nurse is developing a plan of care for a client who is scheduled to begin hemodialysis. Which of the following nursing action should the nurse be included in the care? Select all that apply. Monitor serum, creatinine, BUN, and hemoglobin levels. Give antihypertensive medication prior to dialysis. Instruct the client to drink 3 L of fluid every day. instill 2 L of dialysate fluid into peritoneum four times a day. Obtain weight and vital signs prior to dialysis

Monitor serum, creatinine, BUN, and hemoglobin levels. Obtain weight and vital signs prior to dialysis Antihyperntensives should be given right after, is VS are stable. 4th one is for peritoneal dialysis, and 3 L is way to much fluid for someone with kidney failure.

A client is five days postop from a kidney transplant. The nurse assesses the clients, Foley bag and notes that the urine is cloudy. What action should the nurse perform? Increase the IV flow rate. Irrigate the urinary catheter. Notify the physician. Record the findings in the intake record.

Notify the physician.

A nurse is giving the nursing assistant report on the patients that they have both been assigned to for the day. Which of the following tasks would be appropriate for the nurse to delegate to the nursing assistant? Provide peritoneal dialysis instructions to a patient with chronic kidney injury. Calculate the amount of fluid to be replaced for a patient with chronic kidney disease. Obtain vital signs on a client who has just returned from a renal biopsy. Provide a client with education regarding an IV pyelogram.

Obtain vital signs on a client who has just returned from a renal biopsy. Never let them assess, or teach, or calculate.

A client with renal cell carcinoma of the left kidney is scheduled for a nephrectomy. The right kidney appears normal at this time. The client is anxious about whether dialysis is ultimately be necessity. How will the nurse respond? There is no chance of needing dialysis because the body can function with one kidney. One kidney is adequate to meet the needs of the body as long as the kidney is functioning normal. Dialysis could become likely, but it depends on how well you are complete comply with fluid restriction after surgery. There is strong likelihood that you will need dialysis within 5 to 10 days.

One kidney is adequate to meet the needs of the body as long as the kidney is functioning normal. All the other statements are true

When assessing a client who is receiving peritoneal dialysis.... Which of these findings would indicate a peritoneal infection? Outflow of dialysis solution is cloudy. Elevated blood glucose levels. In complete draining of dialysis solution from peritoneum. Decreased body temperature.

Outflow of dialysis solution is cloudy.

A nurse is reviewing the arterial blood gas levels of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect? PH 7.3. HCO3 26. PAC02-50. PH 7.5 HCO3-20 PACO2-32. PH 7.5 HCO3-30 PACO2-31. PH 7.25, HCO3-19 PAC02-30.

PH 7.25, HCO3-19 PAC02-30. Metabolic Acidosis !!! which is shown for AKI and CKD !!! The other ones are not metabolic Acidosis...

Client is scheduled to start taking corticosteroids after receiving a kidney transplant. Which of the following side effects should the nurse teach the client to report? Changes in the character of the urine. Dizziness with position change. Pain at the donor kidney site. Pain in the hips, knees, and other joints.

Pain in the hips, knees, and other joints. A common side effect of Corticosteroids is joint necrosis (pain and arthritis of the joints

A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid? Select all that apply. Asparagus. Potatoes. Green beans. Bread. Bananas.

Potatoes Bananas

Which assessment findings should the nurse expect when a patient with acute kidney injury has an arterial blood pH of 7.28? Weak peripheral pulses. Dry, mucous membranes. Hot flushed face and neck. Rapid, deep, respirations.

Rapid, deep, respirations. AKI means metabolic Acidosis, which means the S/S would be Kussmaul Respirations which are deep and fast !!!!

The nurse is planning to teach the client with chronic kidney disease about dietary restrictions. Which of the following dietary changes should the nurse include in the plan? Increased sodium intake. Increase intake of potassium, rich fluids foods. Decrease intake of complex carbohydrates. Restrict intake of foods. High in phosphorus.

Restrict intake of foods. High in phosphorus. Limit foods high in phos, k+, and Na+. Phos: milk and cheese K+: POTATOES, green leafy veggies, bananas, avacodos.

The nurse administered sodium polystyrene Kayexalate to a client with renal failure. Which change indicates the treatment has not had the desired effect? Serum calcium increases from 5.0 - 7.5. Apical pulse decreases from 125 to 100. Serum potassium increases from 5.8 to 6. Urinary output increases from 15 to 50 mL an hour.

Serum potassium increases from 5.8 to 6.

A charge nurse, observes a nurse performing all of these actions when providing care to a client with arterial venous AV graft. Which of the actions would require the charge nurse to intervene? Palpating the AV graft. Auscultating the graft for a bruit. Measuring the blood pressure in the unaffected arm. Starting an IV in the arm with the AV graft.

Starting an IV in the arm with the AV graft. You arent supposed to do anything in the arm that has a fistula or a graft. All the other statements you can do.

Which information should a nurse provide to a client who is taking sodium polystyrene sulfonate (Kayexalate)? This medication may cause diarrhea. Take the medication with meals. Take the medication on an empty stomach. This medication will increase the acidity of gastric juices.

This medication may cause diarrhea.

A nurse is working with an outpatient client triaging phone calls. Which client warrants notifying the healthcare provider? The client with: type two diabetes, receiving hemodialysis, who has gained 6 pounds since the last dialysis treatment. Syndrome of inappropriate antidiuretic hormone, who is very upset because no one has returned the previous phone call. Type one diabetes who had a kidney transplant and reports decreased urine output in flu like symptoms. Type one diabetes who has early stage, chronic renal disease and reports having to go to the bathroom several times a night.

Type one diabetes who had a kidney transplant and reports decreased urine output in flu like symptoms. Might be a kidney issue...

Which of the following data would a nurse use to evaluate a client's fluid status after hemodialysis? Potassium level and weight. Vital signs and weight. Creatinine level and weight. Sodium level and weight.

Vital signs and weight. Always get the BP and weight after dialysis

A 45-year-old male with a history of hypertension and chronic kidney disease has arrived at the clinic for a follow-up appointment with his nephrologist. The patient's kidney disease was treated conservatively with drug therapy and diet up until 6 weeks ago, but then it was determined that the patient's uremia could no longer be adequately managed in that manner. After consultation with his family and healthcare provider, the patient decided to begin peritoneal dialysis (PD). A peritoneal catheter was placed a month ago and the patient has been using an automated peritoneal dialysis system at home since then. After reviewing the patient's medical record, the clinic nurse performs a physical assessment. Indicate which patient assessment findings require follow-up by the nurse. Select all that apply Abdomen is round and soft. Weight gain of 5 pounds since dialysis began. Patient reports the drained effluent was pink the first 2 days after catheter insertion. Patient reports lower back pain. Catheter insertion site slightly reddened with small amount serosanguinous drainage.

Weight gain of 5 pounds since dialysis began. Patient reports lower back pain. Catheter insertion site slightly reddened with small amount serosanguinous drainage.

A client has developed. chronic renal failure. And says to the nurse this means that I will die very soon. The nurse makes which appropriate response to the client? Why do you think that? You don't need to worry you will do just fine with hemodialysis. Are you tired of following the diet restrictions. You sound discouraged today.

You sound discouraged today.

Which action by a client who is receiving peritoneal dialysis indicates that the client needs further instructions? The client states: it will take five hours to drain the dialysis solution from my abdomen. I will check the dialysis solution that drains from my abdomen for cloudiness. I will inspect the catheter exit site daily for signs of infection. I will take showers instead of taking my daily baths.

it will take five hours to drain the dialysis solution from my abdomen. Everything else is true EXCEPT this one

A client received IV contrast day and has now developed acute renal failure. The client asked the nurse why she has developed acute renal failure. Which of these statements would the nurse include in the explanation? You experienced: structural damage to the kidneys, resulting in decreased kidney tissue function. A blood clot that formed in the kidneys. A decrease in the blood flow through the kidneys. An obstruction of urine flow from the kidneys.

structural damage to the kidneys, resulting in decreased kidney tissue function. This would be a "neuphrotoxin" which is directed toward the kidney itself, which is intrarenal stage of AKI.