Pathophysiology II Acute kidney Injury and Chronic Kidney Disease (NCLEX Style Questions)

Which lab is most indicative of kidney damage? a. increased BUN b. decreased potassium c. decreased sodium d. increased creatinine

d. increased creatinine

What is the most common complication of peritoneal dialysis? a. hyperglycemia b. fluid retention c. peritonitis d. confusion

c. peritonitis

What is the most common complication of hemodialysis? a. hypokalemia b. hypotension c. pulmonary embolus d. bleeding

b. hypotension

What is a serious side effect to monitor for when a person is taking anti-rejection medication after a kidney transplant? a. cardiac dysrhythmias b. infection c. anemia d. decreased cardiac output

b. infection

A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make? A. "A low-protein diet reduces the risk for uremia." B. "A low-protein diet reduces the risk for edema." C. "A low -protein diet will reduce the risk for hyperkalemia." D. "A low-protein diet will increase the nitrogenous wastes in the blood."

A. "A low-protein diet reduces the risk for uremia." Rationale: Urea is a waste product of protein breakdown and can accumulate in clients who have kidney failure, causing uremia.

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

A. Dialysis disequilibrium Rationale: Dialysis disequilibrium syndrome can develop during or after hemodialysis. The syndrome is caused by the rapid decrease in fluid volume and BUN levels during dialysis. The change in urea levels can cause cerebral edema and increased intracranial pressure. Manifestations include headache, nausea, vomiting, restlessness, seizures, and coma.

A nurse is providing dietary teaching to a client who has chronic kidney disease (CKD).The nurse should instruct the client to limit which of the following nutrients? (Select all that apply.) A. Protein B. Calcium C. Calories D. Phosphorous E. Sodium

A. Protein D. Phosphorous E. Sodium Rationale: Protein is correct. A client who has CKD should restrict protein intake to prevent uremia that can develop as a result of the kidneys' inability to remove the waste products of protein.Calcium is incorrect. A client who has CKD is at risk for hypocalcemia due to an alteration in the conversion of vitamin D by the kidneys.Calories is incorrect. A client who has CKD requires adequate calories to meet metabolic needs.Phosphorous is correct. A client who has CKD is at risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys.Sodium is correct. A client who has CKD is at risk for hypernatremia, edema, and hypertension due to sodium retention

A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply). A. Slurred speech B. Bone pain C. Bradypnea. D. Pruritus E. Hypotension

A. Slurred speech B. Bone pain D. Pruritus Rationale:Slurred speech is correct. Slurred speech is an expected finding of ESKD.Bone pain is correct. Bone pain is an expected finding of ESKD.Bradypnea is incorrect. Tachypnea, rather than bradypnea, is an expected finding of ESKD.Pruritus is correct. Pruritus is an expected finding of ESKD. Hypotension is incorrect. Hypertension, rather than hypotension, is an expected finding of EKRD.

A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload? A. The client has a 5 lb weight gain since yesterday. B. Flattened neck veins C. Oxygen saturation 93% D. Return of skin to previous position when the client's shin is palpated

A. The client has a 5 lb weight gain since yesterday. Rationale: The nurse should identify that a gain of 2 lb per day is stable. A gain of more than 2 lb per day or 5 lb per week is an indication of fluid overload.

A nurse is teaching a client who has acute kidney disease about fluid restrictions. Which of the following statements by the client should the nurse identify as understanding of the teaching? A. "I should consume most of the fluid during the evening." B. "I will make a list of my favorite beverages." C. "I will put beverages in large containers to give the appearance of drinking a lot." D. "I will not add ice cream to the amount of fluid intake."

B. "I will make a list of my favorite beverages." Rationale: The nurse should work with the client to develop a schedule for fluid restrictions, and should attempt to include the client's favorite beverages when possible to promote satisfaction.

A nurse is caring for a client immediately following a hemodialysis treatment. For which of the following manifestations will the nurse administer a PRN dose of phenytoin? A. Decreased blood pressure, rapid pulse B. Headache, restlessness C. Pain and tingling at the access site D. Muscle cramps, chest heaviness

B. Headache, restlessness Rationale: Headache and restlessness are manifestations of disequilibrium syndrome, which occurs during or after hemodialysis due to the rapid shift of fluids, pH, and osmolarity between fluid and blood that occurs.. This condition can cause cerebral edema leading to seizures and coma, and a PRN dose of the anticonvulsant phenytoin should be administered.

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis? A. Hyperactive bowel sounds B. Nausea and vomiting C. Bradycardia D. Increased urinary output

B. Nausea and vomiting Rationale:Peritonitis is an inflammation of the peritoneum and is a potential complication of peritoneal dialysis. The nurse should monitor the client for manifestations such as abdominal tenderness or pain, anorexia, nausea, vomiting, restlessness, and confusion.

A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity? A. Omeprazole B. Vancomycin C. Ondansetron D. Diphenhydramine

B. Vancomycin Rationale: The nurse should identify that vancomycin, an antibiotic, to be associated with nephrotoxic adverse effects.

A nurse is teaching a client who has pre-dialysis end-stage kidney disease about diet. Which of the following instructions should the nurse include? A. "Increase intake of dietary phosphorous." B. "Eliminate foods high in protein from your diet." C. "Reduce intake of foods high in potassium." D. "Increase intake of sodium-containing food."

C. "Reduce intake of foods high in potassium." Rationale: The client should reduce foods high in potassium

A nurse is providing discharge teaching for a client who is to perform peritoneal dialysis at home. Which of the following information should the nurse include? A. "You should avoid foods high in fiber." B. "You should expect redness at the catheter exit site." C. "You should anticipate pain the first week during the inflow of dialysate." D. "You should warm the dialysate in a microwave oven before instillation."

C. "You should anticipate pain the first week during the inflow of dialysate." Rationale:Abdominal pain is expected during inflow of the dialysate during the first few weeks of therapy.

A nurse is reviewing a client's laboratory values and discovers the client has a serum potassium of 6.2 mEq/L. Which of the following interventions should the nurse anticipate? A. Initiating an IV potassium infusion. B. Encouraging the client to eat bananas. C. Administering sodium polystyrene sulfonate. D. Administering a potassium-sparing diuretic

C. Administering sodium polystyrene sulfonate. Rationale: The nurse should expect to administer sodium polystyrene sulfonate, which absorbs excessive potassium and excretes it through the stool. Other treatments include hemodialysis and IV glucose and insulin.

A nurse is teaching a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CAPD). Which of the following information should the nurse include in the teaching? A. CAPD filters the client's blood through an artificial device called a dialyzer. B. CAPD is the dialysis treatment of choice for clients who have a history of abdominal surgery. C. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires. D. CAPD requires a rigid schedule of exchange times.

C. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires. Rationale: CAPD's advantages include fewer dietary and fluid restrictions as compared to hemodialysis.

A nurse is assessing a client who is 2 weeks postoperative following a kidney transplant. Which of the following manifestations should the nurse identify as possible organ rejection? A. Temperature 36.1° C (97.0° F) B. Insomnia C. Oliguria D. Weight loss

C. Oliguria Rationale: The nurse should identify little to no urine output as possible manifestations of kidney rejection.

A nurse is caring for a client who has a new arteriovenous (AV) graft in his left forearm. Which of the following techniques should the nurse use to assess the patency of this graft? A. Measure the client's blood pressure to ensure it is higher in the left arm than the right. B. Check the brachial and radial pulses of the left arm simultaneously. C. Palpate the site for a bruit. D. Auscultate the antecubital fossa using a Doppler stethoscope.

C. Palpate the site for a bruit. Rationale: The nurse should palpate the AV graft site for a thrill and auscultate for the presence of a bruit every 4 hr to assess for blood flow.

A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication? A. The leukocyte count B. The platelet count C. The hematocrit (Hct) D. The erythrocyte sedimentation rate (ESR)

C. The hematocrit (Hct) Rationale:Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct.

A nurse is providing teaching to a client about completing a creatinine clearance test. Which of the following instructions should the nurse include in the teaching? A. "You will need to collect all of your urine for the next 12 hours." B. "You will need to store the urine container in a dark location." C. "You will need to start the collection time with your first urine specimen of the day." D. "You will need to avoid rigorous exercise during the test."

D. "You will need to avoid rigorous exercise during the test." Rationale: The nurse should instruct the client to avoid exercising during the testing time because it can cause an increase in the creatinine values.

A nurse is discussing kidney transplant with a client who has end-stage renal disease (ESRD). Which of the following should the nurse identify as a contraindication for this treatment? A. Breast cancer survivor for 8 years B. Pacemaker C. 65-years of age D. Alcohol use disorder

D. Alcohol use disorder Rationale: The nurse should identify that a substance use disorder is a contraindication for kidney transplant.

A nurse is preparing to obtain a daily weight from a client who has chronic kidney disease. Which of the following actions should the nurse implement? A. Use any available scale to weigh the client. B. Balance the scale at minus two before weighing the client. C. Obtain the weight each day at a time most convenient for the client. D. Weigh the client after he has voided.

D. Weigh the client after he has voided. Rationale: The nurse should have the client void before obtaining a daily weight.

A nurse is reviewing the BUN and creatinine levels of an older adult client who has chronic kidney disease. The nurse should expect which of the following findings? A. BUN 10 mg/dL and creatinine 0.3 mg/dL B. BUN 23 mg/dL and creatinine 1.0 mg/dL C. BUN 8 mg/dL and creatinine 0.7 mg/dL D. BUN 45 mg/dL and creatinine 8 mg/dL

D. BUN 45 mg/dL and creatinine 8 mg/dL Rationale:An elevation of both BUN and creatinine is an expected finding of chronic kidney disease

A nurse is reviewing the laboratory data of a client following a hemodialysis treatment. The nurse should expect to find a decrease in which of the following laboratory values? A. RBC count B. Protein C. Calcium D. Potassium

D. Potassium Rationale:Potassium levels are reduced by the process of diffusion during dialysis

A post-kidney transplant patient experiences an elevated temperature, elevated BUN and creatinine, and sudden weight gain 2 months after the transplant. Which kind of rejection is the patient experiencing? a. acute b. hyperacute c. none of the above d. chronic

d. chronic

What is most likely to be elevated in the urine for a person with acute kidney injury? a. albumin b. ketones c. nitrates d. calcium

a. albumin

A patient has been diagnosed with renal osteodystrophy. What is priority concern of the nurse? a. bone fracture b. muscle weakness c. tetany d. dysrhthymias

a. bone fracture

Symptom a person will experience with disequilibrium syndrome? a. confusion b. SOB c. weakness d. abdominal pain

a. confusion

What would an increased potassium level do to digoxin effectiveness for a person with AKI? a. decreases it b. may increase or decrease it c. increase it d. no effect on it

a. decreases it

What effect does kidney disease have on a person's blood pressure? a. raises it b. does not affect it c. lowers it d. none of the above

a. raises it

Which type of dialysis can remove fluids and wastes from the system more quickly? a. peritoneal dialysis b. hemodialysis c. both can remove waste quickly d. none of the above

b. hemodialysis

What is a major risk factor of end-stage-renal disease? a. hyponatremia b. hypertension c. hypoglycemia d. hypercalcemia

b. hypertension

Why must ACE inhibitors be monitored if given to a patient with acute kidney injury? a. can increase the risk of bleeding b. can cause increased potassium levels c. can increase the risk of respiratory infection d. can cause decreased calcium levels

b. can cause increased potassium levels

An increase in which electrolyte would indicate the use of sevelamer for a person with acute kidney injury? a. sodium b. phosphorous c. potassium d. calcium

b. phosphorous

What would alert the nurse that a patient undergoing peritoneal dialysis may be experiencing peritonitis? a. complaints of nausea b. return of cloudy dialysate c. patients complains of SOB d. return of less dialysate than what was infused

b. return of cloudy dialysate

What GFR classifies a person to be in end-stage-renal-disease? a. less than 30 mL/min b. less than 60 mL/min c. less than 15 mL/min d. less than 50 mL/min

c. less than 15 mL/min

A renal diet would include which restriction? a. decreased fats b. c. decreased potassium d.

c. decreased potassium

What is the main ingredient of dialysate for most patients undergoing peritoneal dialysis? a. hypertonic solution b. protein c. glucose d. hypotonic saline

c. glucose

How is the patency of an AV fistula checked? a. flush with saline b. take an x-ray c. aspirate blood return d. auscultate bruit

d. auscultate bruit

What is the action of calcitrol? a. decrease renal secretion of calcium b. increase calcium production in bones c. decreases serum calcium levels d. increases absorption calcium from gut

d. increases absorption calcium from gut

Which type of dialysis is able to remove protein from the blood? a. neither type b. hemodialysis c. both types d. peritoneal dialysis

d. peritoneal dialysis

Which medication is used to treat the acid base imbalance common in persons with acute kidney injury? a. calcium carbonate b. aluminum hydroxide c. magnesium oxide d. sodium bicarbonate

d. sodium bicarbonate

Medication used to decrease the serum potassium level? a. sodium bicarbonate b. epoietin alpha c. sevelamar d. sodium polystyrene sultanate (PSP)

d. sodium polystyrene sultanate (PSP)