Renal Nclex

The nurse recognizes that the client with end-stage kidney disease has difficulty adhering to the fluid restriction when which of these is found? A. Blood pressure 118/78 B. Weight loss of 3 lbs during hospitalization C. Dyspnea and anxiety at rest D. Central venous pressure (CVP) of 6 mm Hg

C. Dyspnea and anxiety at rest: Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse assists the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Excess fluid intake and fluid retention are manifested by elevated CVP (>8 mm Hg). Excess fluid intake and fluid retention are manifested by weight gain, not loss. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 is a normal blood pressure.

Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? A. Rub the skin vigorously with a towel B. Take frequent baths C. Apply alcohol-based emollients to the skin D. Keep fingernails short and clean

D Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the risk of infection.

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a. Perform deep-breathing exercises vigorously. b. Avoid carrying heavy items. c. Auscultate the lungs frequently. d. Wear a mask when performing exchanges

D The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

When caring for a client who receives peritoneal dialysis (PD), which of these findings must the nurse report to the provider immediately? A. Pulse oximetry reading of 95% B. Sinus bradycardia, rate of 58 C. Blood pressure of 148/90 D. Temperature of 101.2 F

D. Temperature of 101.2 F: Peritonitis is the major complication of PD caused by intra-abdominal catheter site contamination; use meticulous aseptic technique when caring for PD equipment.

A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care? A. Apply pressure to the needle site upon discontinuing hemodialysis B. Keep the head of the bed elevated 45 degrees C. Place the left arm on an arm board for at least 30 minutes D. Keep the left arm dry

A Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.

Which of the following is the most significant sign of peritoneal infection? A. Cloudy dialysate fluid B. Swelling in the legs C. Poor drainage of the dialysate fluid D. Redness at the catheter insertion site

A Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may be indicative of congestive heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.

The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following nursing diagnoses is appropriate? A. Excess fluid volume related to the kidney's inability to maintain fluid balance B. Increased cardiac output related to fluid overload C. Ineffective tissue perfusion related to interrupted arterial blood flow D. Ineffective therapeutic Regimen Management related to lack of knowledge about therapy

A Crackles in the lungs, weight gain, and elevated blood pressure are indicators of excess fluid volume, a common complication in chronic renal failure. The client's fluid status should be monitored carefully for imbalances on an ongoing basis.

What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure? A. 15 minutes B. 30 minutes C. 1 hour D. 2 to 3 hours

A Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours.

The nurse in the transplantation unit assesses for which of these signs and symptoms of rejection of the transplanted kidney. Select all that apply. A. Blood urea nitrogen (BUN) 21, creatinine 0.9 B. Crackles in lung fields C. Temperature 98.8 D. Blood pressure 164/98 E. +3 edema of lower extremities

B. Crackles in lung fields, D. Blood pressure 164/98, E. +3 edema of lower extremities

When caring for the client with acute kidney injury and a temporary subclavian hemodialysis catheter, which of these should the nurse report to the provider? A. Crackles at lung bases B. Temperature of 100.8 F C. +1 ankle edema D. Anorexia

B. Temperature of 100.8 F: Infection is a major complication of temporary catheters. Report all symptoms of infection, including fever, to the provider. The catheter may have to be removed. Some degree of fluid retention is expected. Rising blood urea nitrogen (BUN) may result in anorexia, nausea, and vomiting.

A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was useD. When providing postprocedure care, the nurse should: A. keep the client's knee on the affected side bent for 6 hours. B. apply pressure to the puncture site for 30 minutes. C. check the client's pedal pulses frequently. D. remove the dressing on the puncture site after vital signs stabilize

C After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse shouldn't remove this dressing for several hours — and only if instructed to do so.

A client undergoing long-term peritoneal dialysis is experiencing a problem with reduced outflow from the dialysis catheter. The nurse assessing the client would inquire whether the client has had a recent problem with: a) vomiting b) diarrhea c) constipation d) flatulence

C - Reduced outflow may be caused by catheter position and adherence to the omentum, infection, or constipation. Constipation may contribute to reduced outflow in part because peristalsis seems to aid in drainage. For this reason, bisacodyl suppositories are sometimes used prophylactically, even without a history of constipation. The other options are unrelated to impaired catheter drainage.

While reading the product literature regarding ofloxacin (Floxin), the nurse notes that the medication could cause crystalluria. The nurse decides to tell the client taking the medication to do which of the following to decrease the likelihood of this adverse effect? a) avoid beverages that contain salts, such as mineral water b) avoid carbonated soft-drink beverages c) drink at least 1500 to 2000 ml of fluid per day d) drink at least three glasses of milk per day

C - To prevent crystalluria, the client should drink at least 1500 to 2000 mL of fluid per day. Milk interferes with the absorption of the medication and should be avoided. Consumption of carbonated beverages or mineral water is not harmful.

A client with acute renal failure has an elevated blood urea nitrogen (BUN). The client is experiencing difficulty remembering information due to uremia. The nurse avoids which of the following when communicating with this client? a) giving simple, clear directions b) including the family in discussions related to care c) giving thorough, lengthy explanations of procedures d) explaining treatments using understandable language

C - the client with acute renal failure nay have difficulty remembering information and instructions because of anxiety and the increased level of the BUN. The nurse should avoid giving lengthy explanations about procedures because this information may not be remembered by the client and could increase client anxiety.

Julia Lee, a 57-year-old financial officer, has been exhibiting signs and symptoms which lead her urologist to suspect the adequacy of her urinary function. Beginning with the least invasive tests, which of the following would you expect the physician to prescribe to assess kidney function? Choose all correct options. a. Blood urea nitrogen (BUN) level b. Creatinine clearance c. Angiography d. All options are correct

C Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.

A clinic nurse is reviewing the laboratory results of an adult client seen in the health care clinic. The nurse determines that the blood urea nitrogen (BUN) level is normal if which of the following is noted on the laboratory results? a) 35 mg/dL b) 29 mg/dL c) 15 mg/dL d) 3 mg/dL

C The normal BUN ranges from 5 to 25 mg/dL. Options A and B reflect elevated values, which may indicate renal abnormalities or dehydration. Option D reflects a lower than normal value, which may not be clinically significant.

A female client is admitted for treatment of chronic renal failure (CRF). Nurse Julian knows that this disorder increases the client's risk of: A. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. B. a decreased serum phosphate level secondary to kidney failure. C. an increased serum calcium level secondary to kidney failure. D. metabolic alkalosis secondary to retention of hydrogen ions

A A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

A male client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, Nurse Billy suspects that the client is at risk for: A. cardiac arrhythmia B. paresthesia C. dehydration D. pruritus

A As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In a client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.

You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi? A. Increased calcium loss from the bones B. Decreased kidney function C. Decreased calcium intake D. High fluid intake

A Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones form calculi, a concentration of mineral salts also known as a stone, in the renal system.

A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: A. confusion, headache, and seizures B. acute bone pain and confusion C. weakness, tingling, and cardiac arrhythmias D. hypotension, tachycardia, and tachypnea

A Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action? A. Notify the physician B. Monitor the client C. Elevate the head of the bed D. Medicate the client for nausea

A Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbituates may be necessary to prevent a life-threatening situation. The physician must be notified.

The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because: A. MOM can cause magnesium toxicity B. MOM is too harsh on the bowel C. Metamucil is more palatable D. MOM is high in sodium

A Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. MOM is harsher than Metamucil, but magnesium toxicity is a more serious problem. A client may find both MOM and Metamucil unpalatable. MOM is not high in sodium.

Which drug is indicated for pain related to acute renal calculi? A. Narcotic analgesics B. Nonsteroidal anti-inflammatory drugs (NSAIDS) C. Muscle relaxants D. Salicylates

A Narcotic analgesics are usually needed to relieve the severe pain of renal calculi. Muscle relaxants are typically used to treat skeletal muscle spasms. NSAIDS and salicylates are used for their anti-inflammatory and antipyretic properties and to treat less severe pain.

Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions? A. Osmosis and diffusion B. Passage of fluid toward a solution with a lower solute concentration C. Allowing the passage of blood cells and protein molecules through it D. Passage of solute particles toward a solution with a higher concentration

A Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and creatinine) from an area of higher concentration to an area of lower concentration. Fluid passes to an area with a higher solute concentration. The pores of a semipermeable membrane are small, thus preventing the flow of blood cells and protein molecules through it.

A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client? A. Polyuria B. Polydipsia C. Oliguria D. Anuria

A Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria, and the client loses all normal functions of the kidney. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic 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 (Neoral) as quickly as possible

A 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.

The dialysis solution is warmed before use in peritoneal dialysis primarily to: A. Encourage the removal of serum urea B. Force potassium back into the cells C. Add extra warmth into the body D. Promote abdominal muscle relaxation

A The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.

A male client is scheduled for a renal clearance test. Nurse Sheldon should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: A. 1 minute B. 30 minutes C. 1 hour D. 24 hours

A The renal clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

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

A 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.

A client with chronic renal failure has started receiving epoetin alfa (Epogen). The nurse reminds the client about the importance of taking which prescribed medication to enhance the effects of this therapy? a) ferrous gluconate b) aluminum carbonate c) aluminum hydroxide gel d) calcium carbonate (Tums)

A - In order to form healthy red blood cells, which is the purpose of epoetin alfa, the body needs adequate stores of iron, folic acid, and vitamin B12. The client should take these supplements regularly to enhance the hematocrit-raising benefit of this medication. The other options are incorrect.

A client with chronic renal failure has a protein restriction in the diet. The nurse should include in a teaching plan to avoid which of the following sources of incomplete protein in the diet? a) nuts b) eggs c) milk d) fish

A - The client whose diet has a protein restriction should be careful to ensure that the proteins eaten are complete proteins with the highest biological value. Foods such as meat, fish, milk, and eggs are complete proteins, which are optimal for the client with chronic renal failure.

A client has just been diagnosed with acute renal failure. The laboratory calls the nurse to report a serum potassium level of 6.1 mEq/L on the client. The nurse takes which immediate action? a) calls the physician b) checks the sodium level c) encourages an extra 500ml of fluid intake d) teaches the client about foods low in potassium

A - The client with hyperkalemia is at risk of developing cardiac dysrhythmias and resultant cardiac arrest. Because of this, the physician must be notified at once so that the client may receive definitive treatment. Fluid intake would not be increased because it would contribute to fluid overload and wouldn't effectively lower the serum potassium level. Dietary teaching may be necessary at some point, but this action is not the priority. The nurse might also check the result of a serum sodium level, but this is not a priority action of the nurse.

A nurse is caring for a client who has begun using peritoneal dialysis. The nurse determines that which manifestation indicates the onset of peritonitis? a) oral temperature of 100F b) history of gastrointestinal (GI) upset 1 week ago c) clear dialysate output d) presence of crystals in dialysate output

A - Typical symptoms of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output. The complaint of GI upset is too vague to be correct. Peritonitis would cause cloudy dialysate but would not cause crystals to appear in the dialysate.

A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse? a. Renal circulation b. Urine production c. Kidney function d. Kidney structure

A A renal angiogram (renal arteriogram) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.

A patient with an obstruction of the renal artery causing renal ischemia exhibits HTN. One factor that may contribute to HTN: a. increase renin release b. increased ADH secretion c. decreased aldosterone secretion d. increased synthesis and release of prostaglandins

A Renin is released in resonse to decreased B/P, renal ischemia, eosinophil chemotactic factor (ECF) depletion, and other factors affecting blood suppy to the kidney. It is they catalyst of the renin-angiotensin-aldosterone system, which raises B/P when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted within the renin-angiotensin II, and kidney prostaglandins lower B/P by causing vasodilation.

The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses are most appropriate for this client? Select all that apply. A. Excess Fluid Volume B. Imbalanced Nutrition; Less than Body Requirements C. Activity Intolerance D. Impaired Gas Exchange E. Pain

A,B,C Appropriate nursing diagnoses for clients with chronic renal failure include excess fluid volume related to fluid and sodium retention; imbalanced nutrition, less than body requirements related to anorexia, nausea, and vomiting; and activity intolerance related to fatigue. The nursing diagnoses of impaired gas exchange and pain are not commonly related to chronic renal failure

The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a client's outflow is less than the inflow. Select actions that the nurse should take. A. Place the client in good body alignment B. Check the level of the drainage bag C. Contact the physician D. Check the peritoneal dialysis system for kinks E. Reposition the client to his or her side

A,B,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 the peritoneal dialysis system is 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.

A client with chronic renal failure has completed a hemodialysis treatment. The nurse measures which parameters at the completion of the hemodialysis procedure to monitor for hemodynamic stability and to determine effectiveness of fluid extraction? a) vital signs and blood urea nitrogen (BUN) b) vital signs and weight c) sodium and potassium levels d) BUN and creatinine levels

B - Following dialysis, the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's "dry weight" to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol, but are not necessarily done after the hemodialysis treatment has been ended.

The nurse is administering epoetin alfa (Epogen) to a client with chronic renal failure. The nurse monitors the client for which adverse effect of this therapy? a) anemia b) hypertension c) iron intoxication d) bleeding tendencies

B - The client taking epoetin alfa is at risk of hypertension and seizure activity as the most serious adverse effects of therapy. This medication is used to treat anemia. The medication does not cause iron intoxication. Bleeding tendencies is not an adverse effect of this medication.

A client who has been diagnosed with chronic renal failure has been told that hemodialysis will be required. The client becomes angry and withdrawn, and states, "I'll never be the same now." The nurse formulates which of the following nursing diagnoses for this client? a) disturbed thought processes b) disturbed body image c) anxiety d) noncompliance

B - The client with any renal disorder, such as renal failure, may become angry and depressed because of the permanence of the alteration. Because of the physical change and the change in lifestyle that may be required to manage a severe renal condition, the client may experience Disturbed body image. Options A, C, and D are unrelated to the client's statement.

A client with chronic renal failure has received dietary counseling about potassium restriction in the diet. The nurse determines that the client has learned the information correctly if the client states to do which of the following for preparation of vegetables? a) eat only fresh vegetables b) boil them and discard the water c) use salt substitute on them liberally d) buy frozen vegetables whenever possible

B - The potassium content of vegetables can be reduced by boiling them and discarding the cooking water. Options 1 and 4 are incorrect. Clients with renal failure should avoid the use of salt substitutes altogether, because they tend to be high in potassium content.

A client undergoing hemodialysis becomes hypotensive. The nurse immediately prepares to take which action? a) administer 1000 ml 5% dextrose in water b) administer a 250 ml normal saline bolus c) increase the blood flow into the dialyzer d) lower the client's legs and feet

B - To treat hypotension during hemodialysis, a normal saline bolus of up to 500 mL may be given. The client's feet and legs are raised to enhance cardiac return. Albumin may be given as per protocol to increase colloid oncotic pressure. The blood flow rate into the dialyzer may be decreased. All of these measures should improve the circulating volume and blood pressure. Five percent dextrose in water is not prescribed because it is less likely to improve the circulating volume and blood pressure.

An adult with renal insufficiency has been placed on a fluid restriction of 1200 mL per day. The nurse discusses the fluid restriction with the dietitian and then plans to allow the client to have how many milliliters of fluid from 7:00 AM to 3:00 PM? a) 400 b) 600 c) 800 d) 1000

B - When a client is on a fluid restriction, the nurse informs the dietary department and discusses the allotment of fluid per shift with the dietitian. When calculating how to distribute a fluid restriction, the nurse usually allows half of the daily allotment (600 mL) during the day shift, when the client eats two meals and takes most medications. Another two-fifths (480 mL) is allotted to the evening shift, with the balance (120 mL) allowed during the nighttime.

A nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse should take which action? a) stop the peritoneal dialysis b) obtain a culture and sensitivity of the drainage c) institute hemodialysis temporarily d) add antibiotics to the next several dialysis bags

B - When the drainage becomes cloudy, peritonitis is suspected. A culture and sensitivity is obtained, and broad-spectrum antibiotics are added to the dialysis solution, pending culture and sensitivity results. The dialysis solution may also be heparinized to prevent catheter occlusion. Some clients must switch to hemodialysis if peritonitis is severe or recurring, but the nurse does not make this decision. The peritoneal dialysis is not stopped.

A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: A. hematuria B. weight loss C. increased urine output D. increased blood pressure

B 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.

A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine? a. Repeated diarrhea b. Excess fluid intake c. Frequent vomiting d. Urine retention

B Excess fluid intake results in low specific gravity of urine. Excessive fluid intake will result in formation of dilute urine. When the urine is diluted, it results in low specific gravity of urine. Frequent vomiting, repeated diarrhea, and urine retention will result in high specific gravity of urine.

For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? A. Encouraging coughing and deep breathing B. Promoting carbohydrate intake C. Limiting fluid intake D. Providing pain-relief measures

C 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.

A male client who has been treated for chronic renal failure (CRF) is ready for discharge. Nurse Billy should reinforce which dietary instruction? A. "Be sure to eat meat at every meal." B. "Monitor your fruit intake, and eat plenty of bananas." C. "Increase your carbohydrate intake." D. "Drink plenty of fluids, and use a salt substitute.

C 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. Extra carbohydrates are needed to prevent protein catabolism.

A client is undergoing hemodialysis and receives heparin during the dialysis procedure. The nurse monitors the results of which of the following laboratory tests during the dialysis procedure? a) thrombin time b) bleeding time c) partial thromboplastin time (PTT) d) prothrombin time (PT)

C - Heparin is used as an anticoagulant during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by measuring the PTT, which measures heparin effect. The PT is measured to monitor the effect of warfarin (Coumadin) therapy. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities.

A client is being discharged to home while recovering from acute renal failure (ARF). The client indicates an understanding of the therapeutic dietary regimen if the client states the need to eat foods that are lower in: a) fats b) vitamins c) potassium d) carbohydrates

C - Most of the excretion of potassium and the control of potassium balance are normal functions of the kidneys. In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50 mEq/day). The primary mechanism of potassium removal during ARF is dialysis. Options A, B, and D are not normally restricted in the client with ARF unless a secondary health problem warrants the need to do so.

A nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the nurse the reason for renal biopsy when other tests such as computed tomography (CT) scan and ultrasound are available. In formulating a response, the nurse incorporates the knowledge that renal biopsy : a) helps differentiate between a solid mass and a fluid-filled cyst b) provides an outline of the renal vascular system c) gives specific cytological information about the lesion d) determines if the mass is growing rapidly or slowly

C - Renal biopsy is a definitive test that gives specific information about whether the lesion is benign or malignant. An ultrasound discriminates between a fluid-filled cyst and a solid mass. Renal arteriography outlines the renal vascular system. Although some types of cancer grow more quickly than others, it is not possible to determine this by biopsy.

The nurse is reviewing a urinalysis report for a client with acute renal failure and notes that the results are highly positive for proteinuria. The nurse interprets that this client has which type of renal failure? a) prerenal failure b) postrenal failure c) intrinsic renal failure d) atypical renal failure

C - With intrinsic renal failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In prerenal failure, the specific gravity is high, and there is very little or no proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. There is no such classification as atypical renal failure.

Discharge teaching has been provided for the client recovering from kidney transplantation. Which information indicates that the client understands the instructions? A. "I can stop my medications when my kidney function return to normal." B. "If my urine output is decreased, I should increase my fluids." C. "The anti-rejection medications will be taken for life." D. "I will drink 8 ounces of water with my medications."

C. "The anti-rejection medications will be taken for life." Adherence to immune suppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately.

A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should nurse Olivia assess first? A. Blood pressure B. Respirations C. Temperature D. Pulse

D An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also can delay assessing respirations and temperature because these aren't affected by the serum potassium level.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female client's uremia. Which finding signals a significant problem during this procedure? A. Potassium level of 3.5 mEq/L B. Hematocrit (HCT) of 35% C. Blood glucose level of 200 mg/dl D. White blood cell (WBC) count of 20,000/mm3

D An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure? A. Phosphate binders B. Insulin C. Antibiotics D. Cardiac glycosides

D Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

A client with chronic renal failure has learned about managing diet and fluid restriction between dialysis treatments. The nurse determines that the client is compliant with the therapeutic regimen of the client gains no more than how much weight between hemodialysis treatments? a) 2 to 4kg b) 5 to 6kg c) 0.5 to 1kg d) 1 to 1.5kg

D - A limit of 1 to 1.5 kg of weight gain between dialysis treatments helps prevent hypotension that tends to occur during dialysis with the removal of larger fluid loads. The nurse determines that the client is compliant with fluid restriction if this weight gain is not exceeded.

A client with chronic renal failure has been on dialysis for 4 years and has been taking aluminum hydroxide (Amphojel tablets) as prescribed as part of the medication regimen. The client develops confusion and dementia, and complains of bone pain. The nurse interprets that this client is at risk for developing: a) advancing uremia b) folic acid defieciency c) phosphate overdose d) aluminum intoxication

D - Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. Symptoms include mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This complication is treated with aluminum chelating agents, which make aluminum available to be dialyzed from the body. It is prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum.

A nurse is assessing the renal function of a client. The nurse checks which item as the best indirect indicator of renal status? a) bladder distention b) level of conciousness c) pulse rate d) blood pressure

D - The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. In order for kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The pulse rate affects the cardiac output, but can be altered by factors unrelated to kidney function. Bladder distention reflects a problem or obstruction that is most often distal to the kidneys. Level of consciousness is an unrelated item.

Which teaching by the nurse will help the client prevent renal osteodystrophy? A. Low-calcium diet B. Avoiding peas, nuts, and legumes C. Drinking cola beverages only once daily D. Avoiding dairy enriched with vitamin D

Kidney failure causes hyperphosphatemia. Client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Kidney failure decreases serum calcium, resulting in demineralization of the bone; do not restrict calcium in the diet. Cola beverages are high in phosphorus and are to be avoided. Dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2. A. 10 B. 5 C. 30 D. 45 E. 15

E

What is the most important nursing diagnosis for a patient in end-stage renal disease? A. Risk for injury B. Fluid volume excess C. Altered nutrition: less than body requirements D. Activity intolerance

B Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.

A nurse is caring for a client who is receiving immunosuppressant therapy including corticosteroids following a renal transplant. The nurse would plan to carefully monitor which laboratory result for this client? a) serum albumin b) blood glucose c) magnesium d) potassium

B - Corticosteroid therapy can result in glucose intolerance, leading to elevated blood glucose levels. The nurse monitors these levels to detect this side effect of therapy. With successful transplant, the client's serum electrolyte levels should be better regulated, although corticosteroids could also cause sodium retention.

What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease? A. Activity intolerance B. Fluid volume excess C. Knowledge deficit D. Pain

B Fluid volume excess because the kidneys aren't removing fluid and wastes. The other diagnoses may apply, but they don't take priority.

You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: A. 200ml B. 400ml C. 800ml D. 1000ml

B Oliguria is defined as urine output of less than 400ml/24hours.

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

C 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.

Immunosuppression following Kidney transplantation is continued: A. For life B. 24 hours after transplantation C. A week after transplantation D. Until the kidney is not anymore rejected

A

A nurse is working on a renal unit in a local hospital. The nurse interprets that which client with renal failure is best suited for peritoneal dialysis as a treatment option? a) a client with severe congestive heart failure b) a client with a history of ruptured diverticuli c) a client with a history of herniated lumbar disk d) a client with a history of three previous abdominal surgeries

A - Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease, which would be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with hemodialysis. Contraindications to peritoneal dialysis include diseases of the abdomen, such as ruptured diverticuli or malignancies, extensive abdominal surgeries, history of peritonitis, obesity, and history of back problems, which could be aggravated by the fluid weight of the dialysate. Severe disease of the vascular system also may be a contraindication.

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? A. Abrupt decrease in urine output B. Blood-tinged urine C. Incisional pain D. Increase in urine output

A. Abrupt decrease in urine output: An abrupt decrease in urine output may indicate complications such as rejection, acute tubular necrosis (ATN), thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output is an expected finding after kidney transplantation.

The client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A. Auscultate for pericardial friction rub B. Assess for crackles C. Monitor for decreased peripheral pulses D. Determine whether the client is able to ambulate

A. Auscultate for pericardial friction rub The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present

The client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? A. Avoiding venipuncture and blood pressure measurements in the affected arm B. Discussion on modifications to allow for complete arm rest C. Information on how to assess for bruit D. Information on proper nutrition

A. Avoiding venipuncture and blood pressure measurements in the affected arm: Compression of vascular access causes decreased blood flow and may cause occlusion; dialysis will not be possible. The arm is exercised to encourage venous dilation, not rested.

Which of these interventions is essential for the client in the oliguric phase of acute kidney injury (AKI)? A. Restrict fluids B. Replace potassium C. Administer blood transfusions D. Monitor arterial blood gases (ABGs)

A. Restrict fluids: During the oliguric phase of AKI, the client will be at risk for fluid overload; fluid restriction is necessary to limit this problem. Hyperkalemia results from kidney injury; do not replace potassium unless clearly decreased. Blood transfusions replace the oxygen-carrying capacity of the blood and are used for shortness of breath or chest pain; use is not specific to the oliguric phase.

A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120ml. 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 vital signs C. Flush the urinary catheter with sterile water or saline D. Place the patient in the shock position, and notify the surgeon

B A total UO of 120ml 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 hypertension is the most common in acute renal failure? A. Pulmonary edema B. Hypervolemia C. Hypovolemia D. Anemia

B Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of renin. Therefore, hypervolemia causes hypertension.

Which of the following nursing interventions should be included in the client's care plan during dialysis therapy? A. Limit the client's visitors B. Monitor the client's blood pressure C. Pad the side rails of the bed D. Keep the client NPO

B Because hypotension is a complication of peritoneal dialysis, the nurse records intake and output, monitors VS, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on PD does not need to be placed in bed with padded side rails or kept NPO.

When caring for the client with a left forearm arteriovenous (AV) fistula created for hemodialysis, the nurse must do which of these? Select all that apply. A. Check brachial pulses daily B. Auscultate for a bruit each shift C. Teach the client to palpate for a thrill over the site D. Elevate the arm above heart level E. Ensure that no blood pressures are taken in that arm

B. Auscultate for a bruit each shift, C. Teach the client to palpate for a thrill over the site, and E. Ensure that no blood pressures are taken in that arm

A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects? A. Overflow B. Reflex C. Stress D. Urge

C Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as with coughing or sneezing.

A female adult client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? A. Blood urea nitrogen (BUN) level of 22 mg/dl B. Serum creatinine level of 1.2 mg/dl C. Serum creatinine level of 1.2 mg/dl D. Urine output of 400 ml/24 hours

D ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is demonstrated by a urine output of 400 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

Which intervention do you plan to include with a patient who has renal calculi? A. Maintain bed rest B. Increase dietary purines C. Restrict fluids D. Strain all urine

D All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Ambulation may help the movement of the stone down the urinary tract. Encourage fluid to help flush the stones out.

A nurse is caring for a client receiving peritoneal dialysis and notes a brownish tinge to the dialysate output. The nurse interprets that this finding could be a result of: a) early infection b) insufficient fluid instillation c) bladder perforation d) bowel perforation

D - Brown-tinged or bloody drainage could indicate perforation of the bowel by the peritoneal dialysis catheter. If noted, this must be reported to the physician immediately. Early signs of infection include cloudy dialysate output or fever and, most likely, abdominal discomfort. Bladder perforation could yield yellow or bloody drainage. Insufficient fluid instillation is an incorrect option. The client would have no signs as a result of insufficient fluid instillation except outflow of smaller amounts of dialysate.

A hemodialysis client has a newly created left arm fistula. The nurse monitors the affected extremity for which signs and symptoms that indicate a complication related to steal syndrome? a) edema and purplish discoloration b) aching pain, pallor, and edema c) warmth, redness, and pain d) pallor, diminished pulse. and pain

D - Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula from tissue ischemia. Warmth, redness, and pain would more likely characterize a problem with infection. The patterns described in options A and B are not usually observed because they do not relate to a complication following fistula creation.

After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated? A. Disequilibrium syndrome B. Respiratory distress C. Hypervolemia D. Peritonitis

A Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can diffuse from the body's cells into the vascular system.

The nurse carefully observes for toxicity of drugs excreted through the kidney. Which of these represents a sign or symptom of digoxin toxicity? A. Serum digoxin level of 1.2 ng/mL B. Polyphagia C. Anorexia D. Serum potassium of 5.0 mEq/L

C. Anorexia: Anorexia, nausea, and vomiting are symptoms of digoxin toxicity.

Which criterion is required before a patient can be considered for continuous peritoneal dialysis? A. The patient must be hemodynamically stable B. The vascular access must have healed C. The patient must be in a home setting D. Hemodialysis must have failed

A Hemodynamic stability must be established before continuous peritoneal dialysis can be started.

A patient who received a kidney transplant returns for a follow-up visit to the outpatient clinic and reports a lump in her breast. Transplant recipients are: A. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral) B. Consumed with fear after the life-threatening experience of having a transplant C. At increased risk for tumors because of the kidney transplant D. At decreased risk for cancer, so the lump is most likely benign

A Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors.

Which sign indicated 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 the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.

A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first? A. Administer oxygen B. Elevate the foot of the bed C. Restrict the client's fluids D. Prepare the client for hemodialysis

A Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first interventions should be aimed at the immediate treatment of hypoxia. The foot of the bed may be elevated to reduce edema, but this isn't the priority.

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 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.

The nurse assists the client with acute kidney injury (AKI) to modify the diet in which way? Select all that apply: A. Restricted protein B. Liberal sodium C. Fluid restriction D. Low potassium E. Low fat

A, C, and D: Restricted protein (Breakdown of protein leads to azotemia and increased blood urea nitrogen (BUN). Fluid is restricted during the oliguric phase of acute renal failure. Potassium intoxication may occur; dietary potassium is restricted.

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? A. A client with chronic kidney failure who was just admitted with shortness of breath B. A client with kidney insufficiency who is scheduled to have an arteriovenous (AV) fistula inserted C. A client with azotemia whose blood urea nitrogen and creatinine are increasing D. A client receiving peritoneal dialysis who needs help changing the dialysate bag

A. A client with chronic kidney failure who was just admitted with shortness of breath: This client's dyspnea may indicate pulmonary edema and should be assessed immediately.

Which clinical manifestation indicates the need for increased fluids in the client with kidney failure? A. Increased blood urea nitrogen B. Increased creatinine C. Pale urine D. Decreased sodium

A. Increased blood urea nitrogen: An increase in blood urea nitrogen can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment.

The nurse teaches the client recovering from acute kidney disease to avoid which of these? A. Nonsteroidal anti-inflammatory drugs B. Angiotensin-converting enzyme (ACE) inhibitors C. Opiates D. Acetaminophen

A. Non-steroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs may be nephrotoxic. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Acetaminophen is hepatotoxic, not generally nephrotoxic.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of: A. Infection B. Hyperglycemia C. Fluid overload D. Disequilibrium syndrome

B An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.

During the client's dialysis, the nurse observes that the solution draining from the abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct? A. Bleeding is expected with a permanent peritoneal catheter B. Bleeding indicates abdominal blood vessel damage C. Bleeding can indicate kidney damage D. Bleeding is caused by too-rapid infusion of the dialysate

B Because the client has a permanent catheter in place, blood tinged drainage should not occur. Persistent blood tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too rapid infusion of the dialysate can cause pain.

The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client spills water on the catheter dressing while bathing. The nurse should immediately: A. Reinforce the dressing B. Change the dressing C. Flush the peritoneal dialysis catheter D. Scrub the catheter with povidone-iodine

B Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for bacteria for bacteria to reach the catheter insertion site. The nurse assures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnecting of peritoneal dialysis.

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 embolus D. Acute hemolysis

B 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 intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.

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 I.V. lines above the fistula. B. Avoid taking blood pressures 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 Don't take blood pressure readings 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.

The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should: A. Continue the dialysis at a slower rate after checking the lines for air B. Discontinue dialysis and notify the physician C. Monitor vital signs every 15 minutes for the next hour D. Bolus the client with 500 ml of normal saline to break up the air embolism

B If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed.

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

The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents? A. Alu-cap (aluminum hydroxide) B. Tums (calcium carbonate) C. Amphojel (aluminum hydroxide) D. Basaljel (aluminum hydroxide)

B Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid the occurrence of dementia related to high intake of aluminum. Phosphate binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.

The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations? A. Warmth, redness, and pain in the left hand B. Pallor, diminished pulse, and pain in the left hand. C. Edema and reddish discoloration of the left arm D. Aching pain, pallor, and edema in the left arm

B Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue ischemia. Warmth, redness, and pain more likely would characterize a problem with infection.

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 given if the client states to record the daily: A. Pulse and respiratory rate B. Intake, output, and weight C. BUN and creatinine levels D. Activity log

B 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 per day.

A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: A. Is relatively low in cost B. Allows the client to be more independent C. Is faster and more efficient than standard peritoneal dialysis D. Has fewer potential complications than standard peritoneal dialysis

B The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, home health care personnel, and machines for life-sustaining treatment. The independence is a valuable outcome for some people. CAPD is costly and must be done daily. Side effects and complications are similar to those of standard peritoneal dialysis.

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. Monitor the clients level of consciousness B. Maintain strict aseptic technique C. Add heparin to the dialysate solution D. Change the catheter site dressing daily

B The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option 4 may assist in preventing infection, this option relates to an external site.

A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent? A. Absence of bruit on auscultation of the fistula B. Palpation of a thrill over the fistula C. Presence of a radial pulse in the left wrist D. Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand

B The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.

A patient with diabetes mellitus 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 The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used without a doctor's order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.

A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include which of the following instructions? A. Follow a high potassium diet B. Strictly follow the hemodialysis schedule C. There will be a few changes in your lifestyle D. Use alcohol on the skin and clean it due to integumentary changes

B To prevent life-threatening complications, the client must follow the dialysis schedule. Alcohol would further dry the client's skin more than it already is. The client should follow a low-potassium diet because potassium levels increase in chronic renal failure. The client should know hemodialysis is time-consuming and will definitely cause a change in current lifestyle.

Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? A. Increase the rate of dialysis B. Infuse normal saline solution C. Administer a 5% dextrose solution D. Encourage active ROM exercises

B Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.

In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate? A. Providing all needed teaching in one extended session B. Validating frequently the client's understanding of the material C. Conducting a one-on-one session with the client D. Using videotapes to reinforce the material as needed

B Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lesions are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes, because the clients may not be able to maintain alertness during the viewing of the videotape.

When administering medications to the client with chronic kidney disease, the nurse recognizes that which of these medications is most effective in slowing the progression of kidney failure? A. Diltiazem (Cardizem) B. Lisinopril (Zestril) C. Clonidine (Catapres) D. Doxazosin (Cardura)

B. Lisinopril (Zestril): Angiotensin-converting enzyme (ACE) inhibitors appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers (diltiazem/Cardizem) may indirectly prevent kidney disease by controlling hypertension but are not specific to slowing progression of kidney disease.

To gain access to the vein and artery, an AV shunt was used for Mr. Roberto. The most serious problem with regards to the AV shunt is: A. Septicemia B. Clot formation C. Exsanguination D. Vessel sclerosis

C

When caring for Mr. Roberto's AV shunt on his right arm, you should: A. Cover the entire cannula with an elastic bandage B. Notify the physician if a bruit and thrill are present C. User surgical aseptic technique when giving shunt care D. Take the blood pressure on the right arm instead

C

Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure? A. To relieve the pain of gastric hyperacidity B. To prevent Curling's stress ulcers C. To bind phosphorus in the intestine D. To reverse metabolic acidosis

C A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.

The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the following statements would indicate that the client understands the teaching? A. "I'll take it every 4 hours around the clock." B. "I'll take it between meals and at bedtime." C. "I'll take it when I have a sour stomach." D. "I'll take it with meals and bedtime snacks

C Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat hyperacidity in clients with CRF and therefore is not prescribed between meals.

The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: A. Just before dialysis B. During dialysis C. On return from dialysis D. The day after dialysis

C Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting a full day to resume the medication. This would lead to ineffective control of the blood pressure.

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 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.

The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction? A. Cantaloupe B. Spinach C. Lima beans D. Strawberries

C Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1 ¼ cups) are high potassium foods and average 7 mEq per serving. Lima beans (1/3 c) averages 3 mEq per serving.

The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure? A. High carbohydrate, high protein B. High calcium, high potassium, high protein C. Low protein, low sodium, low potassium D. Low protein, high potassium

C Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.

The client asks whether her diet would change on CAPD. Which of the following would be the nurse's best response? A. "Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique." B. "Diet restrictions are the same for both CAPD and standard peritoneal dialysis." C. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant." D. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly."

C Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.

A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate? A. Slow the infusion B. Decrease the amount to be infused C. Explain that the pain will subside after the first few exchanges D. Stop the dialysis

C Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.

Which statement correctly distinguishes renal failure from prere.nal failure? A. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure B. With prerenal failure, there is less response to such diuretics as furosemide (Lasix) C. With prerenal failure, an IV isotonic saline infusion increases urine output D. With prerenal failure, hemodialysis reduces the BUN level

C Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase blood pressure in both conditions.

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

The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action? A. Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration B. Encourage increased vegetables in the diet C. Place the client on a cardiac monitor D. Check the sodium level

C The client with hyperkalemia is at risk for 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 may also assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action at this time.

What is the primary disadvantage of using peritoneal dialysis for long term management of chronic renal failure? A. The danger of hemorrhage is high B. It cannot correct severe imbalances C. It is a time consuming method of treatment D. The risk of contracting hepatitis is high

C The disadvantages of peritoneal dialysis in long-term management of chronic renal failure is that is requires large blocks of time. The risk of hemorrhage or hepatitis is not high with PD. PD is effective in maintaining a client's fluid and electrolyte balance.

A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first? A. Change the client's position B. Call the physician C. Check the catheter for kinks or obstruction D. Clamp the catheter and instill more dialysate at the next exchange time

C The first intervention should be to check for kinks and obstructions because that could be preventing drainage. After checking for kinks, have the client change position to promote drainage. Don't give the next scheduled exchange until the dialysate is drained because abdominal distention will occur, unless the output is within parameters set by the physician. If unable to get more output despite checking for kinks and changing the client's position, the nurse should then call the physician to determine the proper intervention.

Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure? A. Anuria B. Diarrhea C. Oliguria D. Vomiting

C Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.

The main indicator of the need for hemodialysis is: A. Ascites B. Acidosis C. Hypertension D. Hyperkalemia

D

Which of the following factors causes the nausea associated with renal failure? A. Oliguria B. Gastric ulcers C. Electrolyte imbalances D. Accumulation of waste products

D Although clients with renal failure can develop stress ulcers, the nausea is usually related to the poisons of metabolic wastes that accumulate when the kidneys are unable to eliminate them. The client has electrolyte imbalances and oliguria, but these don't directly cause nausea.

The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of the following as a priority action to prevent this complication from occurring? A. Check the results of the PT time as they are ordered B. Observe the site once per shift C. Check the shunt for the presence of a bruit and thrill D. Ensure that small clamps are attached to the AV shunt dressing

D An AV shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental connection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site to use if needed. The shunt site should be assessed at least every four hours.

A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client's plan of care? A. Keep the AV fistula site dry B. Keep the AV fistula wrapped in gauze C. Take the blood pressure in the left arm D. Assess the AV fistula for a bruit and thrill

D Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. No blood pressures or venipunctures should be taken in the arm with the AV fistula. When not being dialyzed, the AV fistula site may get wet. Immediately after a dialysis treatment, the access site is covered with adhesive bandages.

Which of the following clients is at greatest risk for developing acute renal failure? A. A dialysis client who gets influenza B. A teenager who has an appendectomy C. A pregnant woman who has a fractured femur D. A client with diabetes who has a heart catheterization

D Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catherization must be eliminated by the kidneys, which further stresses them and may produce acute renal failure. A teenager who has an appendectomy and a pregnant woman with a fractured femur isn't at increased risk for renal failure. A dialysis client already has end-stage renal disease and wouldn't develop acute renal failure.

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 Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and 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.

A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client's status after dialysis? A. Potassium level and weight B. BUN and creatinine levels C. VS and BUN D. VS and weight

D Following dialysis, the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.

In a client in renal failure, which assessment finding may indicate hypocalcemia? A. Headache B. Serum calcium level of 5 mEq/L C. Increased blood coagulation D. Diarrhea

D In renal failure, calcium absorption from the intestine declines, leading to increased smooth muscle contractions, causing diarrhea. CNS changes in renal failure rarely include headache. A serum calcium level of 5 mEq/L indicates hypercalcemia. As renal failure progresses, bleeding tendencies increase.

The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose: A. Prevents excess glucose from being removed from the client B. Decreases risk of peritonitis C. Prevents disequilibrium syndrome D. Increases osmotic pressure to produce ultrafiltration

D Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution, the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.

Your patient has complaints of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi? A. Pain radiating to the right upper quadrant B. History of mild flu symptoms last week C. Dark-colored coffee-ground emesis D. Dark, scanty urine output

D Patients with renal calculi commonly have blood in the urine caused by the stone's passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.

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 treatment C. Using a stethoscope for auscultating the fistula is contraindicated D. Taking a blood pressure reading on the affected arm can cause clotting of the fistula

D Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm.

Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium). A. If the urine turns orange-red, call the doctor. B. Take phenazopyridine just before urination to relieve pain. C. Once painful urination is relieved, discontinue prescribed antibiotics. D. After painful urination is relieved, stop taking phenazopyridine

D Pyridium is taken to relieve dysuria because is provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. The urine may temporarily turn red or orange due to the dye in the drug. The drug isn't taken before voiding, and is usually taken 3 times a day for 2 days.

The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client's temperature is 100.2. Which of the following is the most appropriate nursing action? A. Encourage fluids B. Notify the physician C. Monitor the site of the shunt for infection D. Continue to monitor vital signs

D The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity purposes.

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 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.

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 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.

When caring for the client hoping to receive a kidney transplant, the nurse recognizes that which of these problems will exclude the client from transplantation? A. History of hiatal hernia B. Client with diabetes and HbA1c of 6.8 C. Basal cell carcinoma removed from nose 5 years ago D. Client with tuberculosis

D. Client with tuberculosis: Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with immune suppressants required to prevent rejection.

Which of the following represents a positive response to administration of erythropoietin (Epogen, Procrit)? A. Hematocrit of 26.7% B. Potassium within normal range C. Free from spontaneous fractures D. Less fatigue

D. Less fatigue: Treatment of anemia with erythropoietin will result in increased (H&H) and decreased shortness of breath (SOB) and fatigue.