Exam III
During hemodialysis, toxins and wastes in the blood are removed by which of the following? a) Osmosis b) Diffusion c) Filtration d) Ultrafiltration
Diffusion Explanation: The toxins and wastes in the blood are removed by diffusion, in which particles move from an area of higher concentration in the blood to an area of lower concentration into the dialysate.
Which of the following is a characteristic of the intrarenal category of acute renal failure? a) Decreased creatinine b) Increased BUN c) High specific gravity d) Decreased urine sodium
Increased BUN Explanation: The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective? a) "Ultrafiltration methods take much longer than hemodialysis." b) "There are few complications with renal replacement therapies." c) "A family member can help me perform hemodialysis in my home." d) "A special access is created in my vein for peritoneal dialysis."
"Ultrafiltration methods take much longer than hemodialysis." Explanation: Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects.
The nurse is caring for a client immediately after a spinal cord injury. Which assessment finding is essential when caring for a client in spinal shock with injury in the lower thoracic region? a) Pain level b) Numbness and tingling c) Pulse and blood pressure d) Respiratory pattern
Pulse and blood pressure Explanation: Spinal shock is a loss of sympathetic reflex activity below the level of the injury within 30 to 60 minutes after insult. In addition to the paralysis, manifestations include pronounced hypotension, bradycardia, and warm, dry skin. Numbness and tingling and pain are not as high of a concern at this time due to the cord injury. Because the level of impairment is below the first thoracic vertebrae, respiratory failure is not a concern.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Temperature of 99.2° F (37.3° C) b) Serum potassium level of 4.9 mEq/L c) Urine output of 20 ml/hour d) Serum sodium level of 135 mEq/L
Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
Which of the following findings in the patient who has sustained a head injury indicate increasing intracranial pressure (ICP)? a) Increased pulse b) Widened pulse pressure c) Decreased body temperature d) Decreased respirations
Widened pulse pressure Explanation: Signs of increasing ICP include slowing of the heart rate (bradycardia), increasing systolic blood pressure, and widening pulse pressure (Cushing's reflex). As brain compression increases, respirations become rapid, the blood pressure may decrease, and the pulse slows further. This is an ominous development, as is a rapid fluctuation of vital signs. The temperature is maintained at less than 38°C (100.4°F). Tachycardia and arterial hypotension may indicate that bleeding is occurring elsewhere in the body.
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? a) "Drink plenty of fluids, and use a salt substitute." b) "Eat plenty of bananas." c) "Increase your carbohydrate intake." d) "Be sure to eat meat at every meal."
"Increase your carbohydrate intake." Explanation: A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.
Which of the following activities would the patient with a T4 spinal cord injury be able to perform independently? Select all that apply. a) Ambulating b) Eating c) Breathing d) Writing e) Transferring to a wheelchair
• Eating • Breathing • Transferring to a wheelchair • Writing Explanation: Eating, breathing, transferring to a wheelchair, and writing are functional abilities for those with a T4 injury. Ambulation can be performed independently by a patient with a T11-S5 injury.
The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output? a) 1.5 L b) Less than 400 mL c) Less than 50 mL d) 1.0 L
Less than 400 mL Explanation: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.
A patient arrives at the ED via ambulance following a motor cycle accident. The paramedics state the patient was found unconscious at the scene of the accident, but briefly regained consciousness during transport to the hospital. Upon initial assessment, the patient's GCS score is 7. The nurse anticipates which of the following? a) Intubation and mechanical ventilation b) An order for a head CT scan c) Immediate craniotomy d) Administration of propofol (Diprivan) IV
Immediate craniotomy Explanation: The patient is experiencing an epidural hematoma. An epidural hematoma is considered an extreme emergency; marked neurologic deficit or even respiratory arrest can occur within minutes. Treatment consists of making openings through the skull (burr holes) to decrease ICP emergently, remove the clot, and control the bleeding. A craniotomy may be required to remove the clot and control the bleeding. Epidural hematomas are often characterized by a brief loss of consciousness followed by a lucid interval in which the patient is awake and conversant. During this lucid interval, compensation for the expanding hematoma takes place by rapid absorption of CSF and decreased intravascular volume, both of which help to maintain the ICP within normal limits. When these mechanisms can no longer compensate, even a small increase in the volume of the blood clot produces a marked elevation in ICP. The patient then becomes increasingly restless, agitated, and confused as the condition progresses to coma.
The nurse is treating a patient with ESKD. The nurse is concerned that the patient is developing renal osteodystrophy. Upon review of the patient's laboratory values, it is noted the patient has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which of the following medications? a) Mylanta b) Phos-Lo (calcium carbonate) c) Os-Cal (calcium carbonate) d) Renagel (sevelamer)
Renagel (sevelamer) Explanation: Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. If calcium is high or the calcium-phosphorus product exceeds 55 mg/dL, a polymeric phosphate binder such as sevelamer hydrochloride (Renagel) may be prescribed. This medication binds dietary phosphorus in the intestinal tract; one to four tablets should be administered with food to be effective. Magnesium-based antacids are avoided to prevent magnesium toxicity.
A nurse is caring for a 16-year-old adolescent with a head injury resulting from a fight after a high school football game. A physician has intubated the client and written orders to wean him from sedation therapy. A nurse needs further assessment data to determine whether: a) to continue I.V. administration of other scheduled medications. b) nutritional protocol will be effective after the client sedation therapy is tapered. c) she'll have to apply restraints to prevent the client from dislodging the endotracheal (ET) tube. d) payment status will change if the client isn't sedated.
She'll have to apply restraints to prevent the client from dislodging the endotracheal (ET) tube. Explanation: When the client isn't sedated, he may make attempts to remove the ET tube without realizing what he's doing. The nurse needs to obtain information to determine whether it's necessary to request an order for restraints. The nurse doesn't need to obtain additional data to determine if the nutritional protocol will continue to reflect the client's needs because this aspect of care won't change. The client doesn't require additional assessments to continue I.V. administration of medications. I.V. medication clearly needs to continue because the client is intubated. The staff nurse doesn't need to monitor payment status because client sedation shouldn't affect payment status.
The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? (Select all that apply.) a) Red blood cells in the urine b) Polyuria c) White cell casts in the urine d) Proteinuria e) Hemoglobin of 12.8 g/dL
• Red blood cells in the urine • Proteinuria • White cell casts in the urine Explanation: The primary presenting features of an acute glomerular inflammation are hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria (excess protein in the urine). The urine may appear cola colored because of red blood cells (RBCs) and protein plugs or casts; RBC casts indicate glomerular injury.
Elevated ICP is most commonly associated with head injury. Which of the following are clinical signs of increased ICP that a nurse should evaluate? Select all that apply. a) Slow bounding pulse b) Widened pulse pressure c) Increased cerebral perfusion d) Respiratory irregularities e) Lowered systolic blood pressure
• Slow bounding pulse • Widened pulse pressure • Respiratory irregularities Explanation: In the early stages of cerebral ischemia, the vasomotor centers are stimulated and the systemic pressure rises to maintain cerebral blood flow. This is typically accompanied by a slow, bounding pulse and respiratory irregularities. These changes in blood pressure, pulse, and respiration are important clinically because they suggest increased ICP. A sympathetically mediated response causes an increase in the systolic blood pressure, with a widening of the pulse pressure and cardiac slowing.
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? a) "Painless gross hematuria is the first symptom in renal cancer." b) "Squamous cell carcinomas do not present with detectable symptoms." c) "You should have sought treatment earlier." d) "Very few symptoms are associated with renal cancer."
"Very few symptoms are associated with renal cancer." Explanation: Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%),whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.
At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? a) 1.5 lb b) 1.0 lb c) 0.5 lb d) 2 lb
1.0 lb Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg (2-lb) weight loss is equal to 1,000 mL.
At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? a) 1.5 lb b) 2 lb c) 1.0 lb d) 0.5 lb
1.0 lb Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg (2-lb) weight loss is equal to 1,000 mL.
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? a) Polyuria b) Abdominal pain c) Weight loss d) Hypotension
Abdominal pain Explanation: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Chronic renal failure b) Nephrotic syndrome c) Acute glomerulonephritis d) Acute renal failure
Acute glomerulonephritis Explanation: Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
Which of the following stimuli is known to trigger an episode of autonomic dysreflexia in the patient who has suffered a spinal cord injury? a) Diarrhea b) Applying a blanket over the patient c) Placing the patient in a sitting position d) Voiding
Applying a blanket over the patient Explanation: An object on the skin or skin pressure may precipitate an autonomic dysreflexic episode. In general, constipation or fecal impaction triggers autonomic dysreflexia. When the patient is observed to be demonstrating signs of autonomic dysreflexia, he is placed in a sitting position immediately to lower blood pressure. The most common cause of autonomic dysreflexia is a distended bladder
You are a neuro trauma nurse working in a neuro ICU. What would you know is an acute emergency and is seen in clients with a cervical or high thoracic spinal cord injury after the spinal shock subsides? a) Paraplegia b) Tetraplegia c) Autonomic dysreflexia d) Areflexia
Autonomic dysreflexia Explanation: Autonomic dysreflexia is an acute emergency and is seen in clients with a cervical or high thoracic spinal cord injury, usually after the spinal shock subsides. Tetraplegia results in the paralysis of all extremities when there is a high cervical spine injury. Paraplegia occurs with injuries at the thoracic level. Areflexia is a loss of sympathetic reflex activity below the level of injury within 30 to 60 minutes of a spinal injury.
What is the term for the concentration of urea and other nitrogenous wastes in the blood? a) Uremia b) Azotemia c) Proteinuria d) Hematuria
Azotemia Explanation: Azotemia is the concentration of urea and other nitrogenous wastes in the blood. Uremia is an excess of urea and other nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine.
Which of the following terms is used to describe the concentration of urea and other nitrogenous wastes in the blood? a) Azotemia b) Hematuria c) Proteinuria d) Uremia
Azotemia Explanation: Azotemia is the concentration of urea and other nitrogenous wastes in the blood. Uremia is an excess of urea and other nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine.
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? a) Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. b) Glomerular filtration rate (GFR) of 100 mL/min. c) BUN of 18 mg/dL. d) Serum creatinine of 1.2 mg/dL.
Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. Explanation: The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.
Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis? a) Blurred vision b) Peripheral edema c) Dark smoky colored urine d) Presence of albumin in the urine
Blurred vision Explanation: Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis. Severe hypertension needs prompt treatment to prevent convulsions. Presence of albumin (protein) and RBCs in the urine, along with periorbital and peripheral edema, are common symptoms associated with glomerulonephritis.
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? a) Hypotension b) Hyperalbuminemia c) Peripheral neuropathy d) Cola-colored urine
Cola-colored urine Explanation: Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.
Which type of brain injury has occurred if the patient may be aroused with effort, but soon slips back into unconsciousness? a) Intracranial hemorrhage b) Diffuse axonal injury c) Contusion d) Concussion
Contusion Explanation: A patient with a contusion may be aroused with effort but soon slips back into unconsciousness. A concussion is a temporary loss of neurologic function with no apparent structural damage. A diffuse axonal injury involves widespread damage to the axons in the cerebral hemispheres, corpus callosum, and brain stem. An intracranial hemorrhage is a collection of blood that develops within the cranial vault.
A client who is blind is admitted for treatment of gastroenteritis. Which nursing diagnosis takes highest priority for this client? a) Impaired physical mobility b) Deficient fluid volume c) Activity intolerance d) Risk for injury
Deficient fluid volume Explanation: Because the client has gastroenteritis and is probably dehydrated, Deficient fluid volume takes highest priority. A sensory deficit such as blindness puts the client at risk for injury from the environment; however, a potential problem doesn't take highest priority. Although Activity intolerance or Impaired physical mobility also may be relevant, these nursing diagnoses don't take precedence over the client's dehydration.
Which phase of acute renal failure signals that glomerular filtration has started to recover? a) Oliguric b) Recovery c) Diuretic d) Initiation
Diuretic Explanation: The oliguric period is accompanied by an increase in the serum concentration of wastes such as urea, creatinine, organic acids, and the electrolytes potassium, phosphorous, and magnesium. The initiation period begins with the initial insult and ends when cellular injury and oliguria develops. The diuretic phase is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The recovery period signals the improvement of renal function and energy level and may take 6 to 12 months.
A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief? a) Encourage frequent ambulation. b) Encourage deep-breathing exercises. c) Restrict the client's sodium intake. d) Encourage the client to void every 2 to 3 hours.
Encourage frequent ambulation. Explanation: When a client with urinary calculi complains of excruciating pain, the client should be encouraged to ambulate. This is because the supine position increases colic, while ambulation relieves it. Also, adequate fluid intake should be suggested to promote the passage of stones and to prevent urinary stasis, or the formation of new stones. The client should be encouraged to void when there is a risk of infection related to urinary stasis. The suggestion for restricting sodium intake is offered to a client with chronic glomerulonephritis, not urinary calculi. The nurse should promote deep-breathing exercises to provide relief to a client recovering from surgery who has an ineffective breathing pattern.
A patient diagnosed with chronic renal failure is receiving continuous peritoneal dialysis (PD). The nurse instructs the patient about which of the following diet plans? a) Low-protein diet b) High-calorie diet c) Low-sodium diet d) High-protein diet
High-protein diet Explanation: Because of protein loss with continuous PD, the patient is instructed to eat a high-protein, nutritious diet. The patient is also encouraged to increase his or her daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity. A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for patients with acute renal failure
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? a) Hydrating with saline intravenously before the test b) Performing the test without contrast c) Administering Garamycin (gentamicin) prophylactically d) Administering sodium bicarbonate after the procedure
Hydrating with saline intravenously before the test Explanation: Radiocontrast-induced nephropathy (CIN) is a major cause of hospital-acquired AKI. This is a potentially preventable condition. Baseline levels of creatinine greater than 2 mg/dL identify patients at high risk. Limiting the patient's exposure to contrast agents and nephrotoxic medications will reduce the risk of CIN. Administration of N-acetylcysteine and sodium bicarbonate before and during procedures reduces risk, but prehydration with saline is considered the most effective method to prevent CIN
A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? a) Elevated serum creatinine b) Hyperkalemia c) Hyperphosphatemia d) Elevated urea and nitrogen
Hyperphosphatemia Explanation: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? a) Periorbital edema b) Extremity pain c) Hypertension d) Fever
Hypertension Explanation: Hypertension is present in approximately 75% of clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.
The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase? a) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. b) It is accompanied by reduced blood flow to the nephrons. c) Normal glomerular filtration and tubular function are restored. d) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine.
It is accompanied by reduced blood flow to the nephrons. Explanation: The initiation phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? a) Encouraging coughing and deep breathing b) Promoting carbohydrate intake c) Limiting fluid intake d) Providing pain-relief measures
Limiting fluid intake Explanation: During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.
Which of the following is the earliest sign of increasing intracranial pressure (ICP)? a) Headache b) Vomiting c) Posturing d) Loss of consciousness
Loss of consciousness Explanation: The earliest sign of increasing ICP is loss of consciousness. Other manifestations of increasing ICP are vomiting, headache, and posturing.
Treatment of metabolic acidosis in chronic renal failure includes: a) Hemodialysis b) Sodium bicarbonate supplements c) Peritoneal dialysis d) No treatment
No treatment Explanation: The metabolic acidosis of chronic renal failure usually produces no symptoms and requires no treatment.
A patient sustained a head injury and has been admitted to the neurosurgical intensive care unit (ICU). The patient began having seizures and was administered a sedative-hypnotic medication that is ultra-short acting and can be titrated to patient response. What medication will the nurse be monitoring during this time? a) Midazolam (Versed) b) Lorazepam (Ativan) c) Phenobarbital d) Propofol (Diprivan)
Propofol (Diprivan) Explanation: If the patient is very agitated, benzodiazepines are the most commonly used sedative agents and do not affect cerebral blood flow or ICP. Lorazepam (Ativan) and midazolam (Versed) are frequently used but have active metabolites that my cause prolonged sedation, making it difficult to conduct a neurologic assessment. Propofol ( Diprivan), on the other hand, a sedative-hypnotic agent that is supplied in an intralipid emulsion for intravenous (IV) use, is the sedative of choice. It is an ultra-short acting, rapid onset drug with elimination half-life of less than an hour. It has a major advantage of being titratable to its desired clinical effect but still provides the opportunity for an accurate neurologic assessment (Hickey, 2009).
The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? a) Creatinine clearance of 90 mL/min b) Serum creatinine of 1.5 mg/dL c) BUN of 20 mg/dLb d) Urinary protein level of 150 mg/24h.
Serum creatinine of 1.5 mg/dL Explanation: As glomerular filtration decreases, the serum creatinine and BUN levels increase and the creatinine clearance decreases. Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body. The BUN is affected not only by renal disease but also by protein intake in the diet, tissue catabolism, fluid intake, parenteral nutrition, and medications such as corticosteroids.
Based on her knowledge of the primary cause of ESRD, the nurse knows to assess the most important indicator. What is that indicator? a) Serum glucose b) Urine protein c) Blood pressure d) pH and HCO3
Serum glucose Explanation: The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.
Autonomic dysreflexia can occur with spinal cord injuries above which of the following levels? a) T10 b) T6 c) S2 d) L4
T6 Explanation: Any patient with a lesion above T6 segment is informed that autonomic dysreflexia can occur and that it may occur even years after the initial injury.
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a) Tea-colored urine b) Low blood pressure c) Left upper quadrant pain d) Pyuria
Tea-colored urine Explanation: Tea-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Temperature of 99.2° F (37.3° C) b) Urine output of 20 ml/hour c) Serum sodium level of 135 mEq/L d) Serum potassium level of 4.9 mEq/L
Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
The most accurate indicator of fluid loss or gain in an acutely ill patient is a) pulse rate. b) blood pressure. c) edema. d) weight.
Weight. Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.
The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder? a) pH 7.31, PaCO2 48, HCO3 24- b) pH 7.47, PaCO2 45, HCO3 33- c) pH 7.20, PaCO2 36, HCO3 14- d) pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for: a) intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol). b) high-dose I.V. cyclosporine (Sandimmune) therapy. c) removal of the transplanted kidney. d) bone marrow transplant.
removal of the transplanted kidney. Explanation: Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue. Although cyclosporine is used to treat acute transplant rejection, it doesn't halt hyperacute rejection. Bone marrow transplant isn't effective against hyperacute rejection of a kidney transplant. Methylprednisolone sodium succinate may be given I.V. to treat acute organ rejection, but it's ineffective against hyperacute rejection
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a) increased urine output b) hematuria. c) weight loss. d) increased blood pressure.
weight loss. Explanation: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.
Patient education regarding a fistulae or graft includes which of the following? Select all that apply. a) No tight clothing. b) Cleanse site b.i.d. c) No IV or blood pressure taken on extremity with dialysis access. d) Avoid compression of the site. e) Check daily for thrill and bruit.
• Check daily for thrill and bruit. • Avoid compression of the site. • No IV or blood pressure taken on extremity with dialysis access. • No tight clothing. Explanation: The nurse teaches the patient with fistulae or grafts to check daily for a thrill and bruit. Further teaching includes avoiding compression of the site; not permitting blood to be drawn, an IV to be inserted, or blood pressure to be taken on the extremity with the dialysis access; not to wear tight clothing, carry bags or pocketbooks on that side, and not lie on or sleep on the area. The site is not cleansed unless it is being accessed for hemodialysis.
In a spinal cord injury, neurogenic shock develops due to loss of the autonomic nervous system functioning below the level of the lesion. Which of the following indicators of neurogenic shock would the nurse expect to find? Select all that apply. a) Venous pooling b) Tachypnea c) Hypotension d) Diaphoresis e) Tachycardia f) Hypothermia
• Hypotension • Venous pooling • Tachypnea • Hypothermia Explanation: The vital organs are affected in a spinal cord injury, causing the blood pressure and heart rate to decrease. This loss of sympathetic innervation causes a variety of other clinical manifestations, including a decrease in cardiac output, venous pooling in the extremities, and peripheral vasodilation resulting in mild hypotension, bradycardia, and warm skin. In addition, the patient does not perspire on the paralyzed portions of the body because sympathetic activity is blocked; therefore, close observation is required for early detection of an abrupt onset of fever.
Ms. Linden is in end-stage chronic renal failure and is being added to the transplant list. You are explaining to her how donors are found for clients needing kidneys. You would be accurate in telling her which of the following? a) Donors with hypertension may qualify. b) Donors are selected from compatible living donors. c) The client is placed on a transplant list at the local hospital. d) Donors must be relatives.
Donors are selected from compatible living donors. Explanation: Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. The client is placed on a national computerized transplant waiting list.
A nurse assesses a patient diagnosed in the prerenal stage of ARF. The nurse expects to find the following signs and symptoms. Select all that apply. a) Urine specific gravity of 1.029 b) Urine sodium <20 mEq/L c) Urine osmolality of 350 mOsm/Kg d) BUN value of <10 mg/dL e) Creatinine level of 1.3 mg/dL f) Increase in urinary sediment
• Creatinine level of 1.3 mg/dL • Urine sodium <20 mEq/L • Urine specific gravity of 1.029 Explanation: The BUN reading is within normal range, the urine osmolality would be greater than 500 mOsm/kg, and there would be few hyaline casts. Refer to Table 27-2 in the text.
The nurse is caring for a patient following an SCI who has a halo device in place. The patient is preparing for discharge. Which of the following statements made by the patient indicates the need for further instruction? a) "I will change the vest liner periodically." b) "I can apply powder under the liner to help with sweating." c) "If a pin becomes detached, I'll notify the surgeon." d) "I'll check under the liner for blisters and redness."
"I can apply powder under the liner to help with sweating." Explanation: The areas around the four pin sites of a halo device are cleaned daily and observed for redness, drainage, and pain. The pins are observed for loosening, which may contribute to infection. If one of the pins becomes detached, the head is stabilized in a neutral position by one person while another notifies the neurosurgeon. The skin under the halo vest is inspected for excessive perspiration, redness, and skin blistering, especially on the bony prominences. The vest is opened at the sides to allow the torso to be washed. The liner of the vest should not become wet because dampness causes skin excoriation. The liner should be changed periodically to promote hygiene and good skin care. Powder is not used inside the vest because it may contribute to the development of pressure ulcers.
Mr. Billings is being seen as a client in the urology practice. He has a family history of polycystic kidney disease. Of the following assessment findings, which would you expect to find as you gather information and complete an assessment related to a polycystic kidney diagnosis? Select all that apply. a) Hypertension b) Normal urinalysis c) No renal stones d) Pain from retroperitoneal bleeding
• Hypertension • Pain from retroperitoneal bleeding Explanation: Hypertension is present in approximately 75% of affected clients at the time of diagnosis. Pain from retroperitoneal bleeding is caused by the size and effects of the cysts. Urinalysis shows mild proteinuria, hematuria, and pyuria. Renal stones are common.
The nurse is passing out medications on a medical-surgical unit. A male patient is preparing for hemodialysis. The patient is ordered to receive numerous medications including antihypertensives. Which of the following is the best action for the nurse to take? a) Hold the medications until after dialysis. b) Ask the patient if he wants to take his medications. c) Administer the medications as ordered. d) Check with the dialysis nurse about the medications.
Hold the medications until after dialysis. Explanation: Antihypertensive therapy, often part of the regimen of patients on dialysis, is one example when communication, education, and evaluation can make a difference in patient outcomes. The patient must know when—and when not—to take the medication. For example, if an antihypertensive agent is taken on a dialysis day, hypotension may occur during dialysis, causing dangerously low blood pressure. Many medications that are taken once daily can be held until after dialysis treatment.
Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply. a) Restrict sodium to 2,000 to 3,000 mg daily. b) Restrict fluid to daily urinary output plus 500 to 800 mL. c) Limit protein to 1.6 g/kg/day. d) Eat foods such as milk, fish, and eggs. e) Increase potassium to prevent cardiac problems.
• Eat foods such as milk, fish, and eggs. • Restrict sodium to 2,000 to 3,000 mg daily. • Restrict fluid to daily urinary output plus 500 to 800 mL. Explanation: With hemodialysis, protein should be limited to 1.2 to 1.3 g/kg/24 hr. Potassium, along with sodium and phosphorus should be restricted.
Which of the following symptoms are indicative of a rapidly expanding acute subdural hematoma? Select all that apply. a) Coma b) Tachypnea c) Decreased reactivity of the pupils d) Hemiparesis e) Hypotension f) Bradycardia
• Hemiparesis • Decreased reactivity of the pupils • Bradycardia • Coma Explanation: Signs and symptoms include changes in the level of consciousness (LOC), changes in the reactivity of the pupils, and hemiparesis (weakness on one side of the body). There may be minor or even no symptoms, with small collections of blood. Coma, increasing blood pressure, decreasing heart rate, and slowing respiratory rate are all signs of a rapidly expanding mass requiring immediate intervention
