quiz 4 practice questions

Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is: A. Call the doctor immediately B. Give the patient IV lidocaine (Xylocaine) C. Prepare to defibrillate the patient D. Check the patient's latest potassium level

D. Check the patient's latest potassium level The patient with ESRD may develop arrhythmias caused by hypokalemia. Call the doctor after checking the patient's potassium values. Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.

The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? A. Only when needed B. Daily at bedtime C. First thing in the morning D. With each meal

D. With each meal

The most common early sign of kidney disease is: A. Sodium retention B. Elevated BUN level C. Development of metabolic acidosis D. Inability to dilute or concentrate urine

B. Elevated BUN level Increased BUN is usually an early indicator of decreased renal function.

You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? A. Check for kinks in the outflow tubing B. Raise the drainage bag above the level of the abdomen C. Place the patient in a reverse Trendelenburg position D. Ask the patient to cough

A. Check for kinks in the outflow tubing Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement

Which sign indicates the second phase of acute renal failure? A. Daily doubling of urine output (4 to 5 L/day) B. Urine output less than 400 mL/day C. Urine output less than 100 mL/day D. Stabilization of renal function

A. Daily doubling of urine output (4 to 5 L/day) Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (diuresis) of acute renal failure.

What change indicates recovery in a patient with nephrotic syndrome? A. Disappearance of protein from the urine B. Decrease in BP to normal C. Increase in serum lipid levels D. Gain in body weight

A. Disappearance of protein from the urine With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more porous, leading to loss of protein in the urine. As the patient recovers, less protein is found in the urine.

The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? A. Hematuria B. Precipitous decrease in serum creatinine levels C. Hypotension unresolved by fluid administration D. Glucosuria

A. Hematuria

The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? A. Maintain strict aseptic technique. B. Add heparin to the dialysate solution. C. Change the catheter site dressing daily. D. Monitor the client's level of consciousness.

A. Maintain strict aseptic technique. The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option 3 may assist in preventing infection, this option relates to an external site. Options 2 and 4 are unrelated to the major complication of peritoneal dialysis.

A nursing student is assigned to care for a client with a diagnosis of acute renal failure, diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which of the following statements, if made by the nursing student would indicate an adequate understanding of the treatment plan for this client? A. Prevent loss of electrolytes. B. Reduce the urine specific gravity. C. Promote the excretion of wastes. D. Prevent fluid overload

A. Prevent loss of electrolytes. In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 2, 3, and 4 are not the primary concerns in this phase of renal failure.

You're developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this patient is to: A. Remain afebrile and have negative cultures B. Resume normal fluid intake within 2 to 3 days C. Resume the patient's normal job within 2 to 3 weeks D. Try to discontinue cyclosporine (Neural) as quickly as possible

A. Remain afebrile and have negative cultures The immunosuppressive activity of cyclosporine places the patient at risk for infection, and steroids can mask the signs of infection. The patient may not be able to resume normal fluid intake or return to work for an extended period of time and the patient may need cyclosporine therapy for life.

A nurse is giving general instructions to a client receiving hemodialysis. Which of the following statements would be appropriate for the nurse to include? A. Several types of medications should be withheld on the day of dialysis until after the procedure. B. Medications should be double-dosed on the morning of hemodialysis to prevent loss. C. It's acceptable to exceed the fluid restriction on the day before hemodialysis. D. It's acceptable to eat whatever you want on the day before hemodialysis.

A. Several types of medications should be withheld on the day of dialysis until after the procedure. Many medications are dialyzable, which means they are extracted from the bloodstream during dialysis. Therefore, many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be "double-dosed," because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.

A 52-year-old client is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply. A. Petechiae B. Pain C. Gastrointestinal symptoms D. Changes in voiding E. Jaundice

B, C, D

The nurse monitoring a client receiving peritoneal dialysis notes that the clietn's outflow is less than the inflow. Select all nursing actions in the situation that apply. A. Contact the physician. B. Check the level of the drainage bag. C. Reposition the client to his or her side. D. Place the client in good body alignment. E. Check the peritoneal dialysis system for kinks. F. Increase the flow rate of the peritoneal dialysis solution.

B, C, D, E If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the physician. Increasing the flow rate is an inappropriate action and is not associated with the amount of outflow solution.

A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the BUN drops to: A. 3 mg/dL B. 15 mg/dL C. 29 mg/dL D. 35 mg/dL

B. 15 mg/dL The normal blood urea nitrogen level is 8 to 25 mg/dL. Values such as those in options 3 and 4 reflect continued dehydration. Option 1 reflects a lower than normal value, which may occur with fluid volume overload, among other conditions.

A nurse is caring for a client with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples? A. A fasting serum potassium level and a random urine sample B. A 24 hour urine specimen and a serum creatinine level midway through the urine collection process C. A BUN and serum creatinine level on three consecutive mornings D. A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values

B. A 24 hour urine specimen and a serum creatinine level midway through the urine collection process

A nurse on a busy medical unit provides care for many clients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which client? A. A client whose diagnosis of chronic kidney disease requires a fluid restriction B. A client who has Alzheimer disease and who is acutely agitated C. A client who is on bed rest following a recent episode of venous thromboembolism D. A client who has decreased mobility following a transmetatarsal amputation

B. A client who has Alzheimer disease and who is acutely agitated

A 30 y/o female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device? A. Insert IV lines above fistula B. Avoid taking BPs in the arm with the fistula C. Palpate pulses above the fistula D. Report a bruit or thrill over the fistula to the doctor

B. Avoid taking BPs in the arm with the fistula Because the compression could damage the fistula. IV lines shouldn't be inserted in the arm used for hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill should be reported to the doctor.

Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? A. Infection B. Disequilibrium syndrome C. Air embolism D. Acute hemolysis

B. Disequilibrium syndrome Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased ICP. S/S include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.

The nurse is reviewing the client's record and notes that the physician has documented that the client has a renal disorder. On review of the lab results, the nurse most likely would expect to note which of the following? A. Decreased hemoglobin level. B. Elevated BUN C. Decreased red blood cell count. D. Decreased white blood cell count.

B. Elevated BUN Measuring the blood urea nitrogen level is a frequently used laboratory test to determine renal function. The blood urea nitrogen level starts to rise when the glomerular filtration rate falls below 40% to 60%. A decreased hemoglobin level and red blood cell count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired. An increased white blood cell count is most likely to be noted in renal disease.

A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120 mL. The drainage system has no obstructions. Which intervention has priority? A. Give a 500 mL bolus of isotonic saline B. Evaluate the patient's circulation and VS C. Flush the urinary catheter with sterile water or saline D. Place the patient in the shock position, and notify the surgeon

B. Evaluate the patient's circulation and VS A total UO of 120 mL is too low. Assess the patient's circulation and hemodynamic stability for signs of hypovolemia. A fluid bolus may be required, but only after further nursing assessment and a doctor's order.

Which cause of HTN is the most common in acute renal failure? A. Pulmonary edema B. Hypervolemia C. Hypovolemia D. Anemia

B. Hypervolemia Acute renal failure causes hypervolemia as a result of over expansion of extracellular fluid and plasma volume with the hyper secretion of renin. Therefore, hypervolemia causes HTN.

A patient with DM and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? A. Low-protein diet with unlimited amounts of water B. Low-protein diet with a prescribed amount of water C. No protein in the diet and use of a salt substitute D. No restrictions

B. Low-protein diet with a prescribed amount of water Patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used w/o a Dr's order b/c it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.

The client with acute renal failure has a serum potassium level of 6.0 mEq/L. The nurse would plan which of the following as a priority action? A. Check the sodium level. B. Place the client on a cardiac monitor. C. Encourage increased vegetables in the diet. D. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration.

B. Place the client on a cardiac monitor. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse also may assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action of the nurse.

A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly, and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action? A. Advance the catheter 2 to 4 cm further into the peritoneal cavity B. Reposition the client to facilitate drainage C. Aspirate from the catheter using a 60 mL syringe D. Infuse 50 mL of additional dialysate

B. Reposition the client to facilitate drainage

A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? A. Sequestering free hydrogen ions in the nephrons B. Returning bicarbonate to the body's circulation C. Retaining ammonium chloride D. Excreting bicarbonate in the urine

B. Returning bicarbonate to the body's circulation

A client with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the client's plan of care? A. Impaired physical mobility related to presence of an indwelling urinary catheter B. Risk for infection related to presence of an indwelling urinary catheter C. Deficient knowledge regarding indwelling urinary catheter care D. Disturbed body image related to urinary catheterization

B. Risk for infection related to presence of an indwelling urinary catheter

The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)? A. An inability to initiate voiding for 2 days B. The urine is cloudy and has visible sediment with a foul odor C. Average urine output has been 10 mL/hr for several hours D. Client reports left-sided flank pain

C. Average urine output has been 10 mL/hr for several hours

A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? A. Hemodialysis B. Peritoneal dialysis C. Continuous venovenous hemodialysis (CVVHD) D. Plasmapheresis

C. Continuous venovenous hemodialysis (CVVHD)

Polystyrene sulfonate (Kayexalate) is used in renal failure to: A. Correct acidosis B. Reduce serum phosphate level C. Exchange potassium for sodium D. Prevent constipation from sorbitol use

C. Exchange potassium for sodium In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium

You suspect kidney transplant rejection when the patient shows which symptoms? A. Pain in the incision, general malaise, and hypotension B. Pain in the incision, general malaise, and depression C. Fever, weight gain, and diminished urine output D. Diminished urine output and hypotension

C. Fever, weight gain, and diminished urine output Symptoms of rejection include fever, rapid weight gain, HTN, pain over the graft site, peripheral edema, and diminished urine output.

The nurse is caring for a client suspected of having renal dysfunction. When reviewing laboratory results for this client, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? A. Potassium and sodium B. Bicarbonate and urea C. Glucose and protein D. Creatinine and chloride

C. Glucose and protein

A client has had a indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the client informs the nurse that the client is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response? A. Inform the client that urgency and occasional incontinence are expected for the first few weeks post-removal. B. Obtain an order for a loop diuretic in order to enhance urine output and bladder function. C. Inform the client that this is not unexpected in the short term and scan the client's bladder following each void. D. Obtain an order to reinsert the client's urinary catheter and attempt removal in 24 to 48 hours.

C. Inform the client that this is not unexpected in the short term and scan the client's bladder following each void.

The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information if the client states to record daily the: A. Amount of activity. B. Pulse and respiratory rate. C. Intake and output and weight. D. Blood urea nitrogen and creatinine levels.

C. Intake and output and weight. The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight/day.

Which of the following causes the majority of UTI's in hospitalized patients? A. Lack of fluid intake B. Inadequate perineal care C. Invasive procedures D. Immunosuppression

C. Invasive procedures Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection.

A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient's diet? A. Carbohydrates B. Fats C. Protein D. Vitamin C

C. Protein Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so this patient's protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient's tissues.

Results of a client's 24-hour urine sample indicate osmolality of 510 mOsm/kg (510 mmol/kg), which is within reference range. What conclusion can the nurse draw from this assessment finding? A. The client's kidneys are capable of maintaining acid-base balance B. The client's kidneys reabsorb most of the potassium that the client ingests C. The client's kidneys can produce sufficiently concentrated urine D. The client's kidneys are producing sufficient erythropoietin

C. The client's kidneys can produce sufficiently concentrated urine

A geriatric nurse is performing an assessment of body systems on an older adult client. The nurse should be aware of what age-related change affecting the renal and urinary systems? A. Increased ability to concentrate urine B. Increased bladder capacity C. Urinary incontinence D. Decreased glomerular filtration rate

D. Decreased glomerular filtration rate

The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for: A. Hypertension, tachycardia, and fever. B. Hypotension, bradycardia, and hypothermia. C. Restlessness, irritability, and generalized weakness. D. Headache, deteriorating level of consciousness, and twitching.

D. Headache, deteriorating level of consciousness, and twitching. Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse normally anticipate? A. Decrease in blood urea nitrogen (BUN) B. Less antidiuretic hormone (ADH) released C. Decreased urine osmolality D. Increased urine specific gravity

D. Increased urine specific gravity

What is the best way to check for patency of the arteriovenous fistula for hemodialysis? A. Pinch the fistula and note the speed of filling on release B. Use a needle and syringe to aspirate blood from the fistula C. Check for capillary refill of the nail beds on that extremity D. Palpate the fistula throughout its length to assess for a thrill

D. Palpate the fistula throughout its length to assess for a thrill The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow. Pinching the fistula could cause damage. Aspirating blood is a needless invasive procedure.

A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced? A. The kidneys will excrete increased quantities of acid B. Bicarbonate will be released from the adrenal medulla C. Alveoli in the lungs will synthesize new bicarbonate D. Renal tubular cells will generate new bicarbonate

D. Renal tubular cells will generate new bicarbonate

Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient? A. The patient shouldn't feel pain during initiation of dialysis. B. The patient feels best immediately after the dialysis tx. C. Using a stethoscope for auscultating the fistula is contraindicated. D. Taking a BP reading on the affected arm can cause clotting of the fistula.

D. Taking a BP reading on the affected arm can cause clotting of the fistula. Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking BP on the affected arm.