UNIT 4 questions

Accumulation of nitrogenous wastes such a urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately which of the following? 60 mg/dL 20 mg/dL 100 mg/dL 80 mg/dL

20

What is the primary way that a nurse will evaluate the patency of an AVF? a. Palpate for pulses distal to the graft site. b. Auscultate for the presence of a bruit at the site. c. Evaluate the color and temperature of the extremity. d. Assess for the presence of numbness and tingling distal to the site.

b

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents :A need to increase water intake The kidneys are functioning normally Concentrated urine A loss of over half the client's normal kidney function

A loss of over half the client's normal kidney function Explanation: In clinical practice, GFR is usually estimated using the serum creatinine concentration. A GFR below 60 mL/minute/1.73 m2 represents a loss of one half or more of the level of normal adult kidney function. The GFR is not diagnostic for concentrated urine or the need to drink more water.

A client who has developed renal failure with associated high serum phosphate levels. To avoid the development of osteodystrophy, the healthcare provider will try to avoid phosphate-binding agents that contain which compound? Calcium acetate Aluminum salts Sevelamer hydrochloride Calcium carbonate

Aluminum salts

Chronic kidney disease impacts many systems in the body. What is the number one hematologic disorder caused by CKD? Anemia Polycythemia Leukocytosis Erythrocythemia

Anemia

A client with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat coexisting conditions that carry a high mortality? Opioid analgesics Nonsteroidal anti-inflammatory drugs (NSAIDs) Antiarrhythmic medications Antihypertensive medications

Antihypertensive medications Explanation: Hypertension is a common result of CKD, and the mechanisms that produce hypertension in CKD include increased vascular volume, elevation of peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system. NSAIDs, opioids, and antiarrhythmics are not as frequently indicated for the treatment of CKD.

In which type of dialysis does the patient dialyze during sleep and leave the fluid in the abdomen during the day? a. Long nocturnal hemodialysis b. Automated peritoneal dialysis (APD) c. Continuous venovenous hemofiltration (CVVH) d. Continuous ambulatory peritoneal dialysis (CAPD)

B

To prevent the most common serious complication of PD, what is important for the nurse to do? a. Infuse the dialysate slowly. b. Use strict aseptic technique in the dialysis procedures .c. Have the patient empty the bowel before the inflow phase. d. Reposition the patient frequently and promote deep breathing.

B

When caring for a client with cirrhosis, which of the following symptoms should a nurse report immediately? Select all that apply. a) Diarrhea or constipation b) Signs of GI bleeding c) Change in mental status d) Anorexia and dyspepsia

B C

A client with a long-standing diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis? Blood work for white cells and differential Assessment of pancreatic exocrine and endocrine function Blood work for hemoglobin, red blood cells, and hematocrit Cystoscopy and ureteroscopy

Blood work for hemoglobin, red blood cells, and hematocrit Explanation: Anemia is a frequent, and debilitating, consequence of CKD. The anemia may be due to chronic blood loss, hemolysis, bone marrow suppression due to retained uremic factors, and decrease in red cell production due to impaired production of erythropoietin and iron deficiency. Pancreatic function is not typically affected by CKD, and endoscopic examination is less likely to reveal a cause of fatigue. An infectious etiology is possible and would be informed by white cell assessment, but this is less likely than anemia given the client's complaints.

Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. Patient with diabetes mellitus b. Patient with hypertensive crisis c. Patient who tried to overdose on acetaminophen d. Patient with major surgery who required a blood transfusion

D

After undergoing a liver biopsy, a client should be placed in which position? a) Semi-Fowler's position b) Supine position c) Prone position d) Right lateral decubitus position

D

The nurse is instructing a patient with advanced kidney disease (AKD) about a dietary regimen. Which of the following restrictions should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD? Carbohydrates Foods high in calcium Fats Dietary protein

Dietary protein Explanation: Restriction of dietary proteins may decrease the progress of renal impairment in people with advanced renal disease. Proteins are broken down to form nitrogenous wastes, and reducing the amount of protein in the diet lowers the blood urea nitrogen and reduces symptoms.

Which of the following integumentary problems most often accompanies chronic kidney disease? Alopecia Dry skin and pruritus Petechiae and purpura Hirsutism and psoriasis

Dry skin and pruritus

The health care provider is reviewing lab results of a client. Select the test that is the best measurement of overall kidney function? Urine albumin levels Blood urea nitrogen (BUN) Glomerular filtration rate (GFR) Serum creatinine levels

Glomerular filtration rate (GFR) Explanation: GFR is the best overall measure of kidney function. GFR is usually estimated using the serum creatinine concentration. Creatinine, a by-product of muscle metabolism, is produced at a fairly constant rate, is freely filtered in the glomerulus, and is not reabsorbed in the renal tubules. Essentially all of the creatinine filtered by the kidneys is lost in the urine; therefore, serum creatinine is an indirect measure of GFR. Proteinuria serves as a key adjunctive tool for measuring nephron injury and repair. Urine normally contains small amounts of protein. Blood tests for BUN and creatinine provide information regarding the ability to remove nitrogenous wastes from the blood.

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display? Impotence Terry nails Asterixis Hypertension

HypertensionExplanation: Hypertension is commonly an early manifestation of CKD. The mechanisms that cause the hypertension are multifactorial; they include increased vascular volume, increased peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increase activity of the renin-angiotensin-aldosterone system. Impotence occurs in as many as 56% of males on dialysis. Terry nails are dark band just behind the leading edge of a fingernail followed by a white band that occur in the late stages. Asterixis, a sign of hepatic encephalopathy, is due to the inability of the liver to metabolize ammonia to urea.

A nurse, caring for a client with acute tubular necrosis (ATN) caused by myoglobinuria, knows this may be caused by which finding in their medical history? Select all that apply. Hyperkalemia Hyperthermia Prolonged seizures Alcohol abuse Muscle damage

Muscle damage Hyperthermia Alcohol abuse Prolonged seizures Explanation: Myoglobin, which stores oxygen in muscle fibers, is released when muscle is damaged. Large amounts of myoglobin, as in myoglobinuria, will cause tubular obstruction and damage to nephrons. Myoglobin is released from muscle by muscle trauma including extreme physical exercise, prolonged seizures, hyperthermia, potassium depletion, and alcohol abuse.The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:A need to increase water intakeThe kidneys are functioning normallyConcentrated urineA loss of over half the client's normal kidney function

While assessing a peritoneal dialysis client in his or her home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as: Too much sugar in the dialysis solution Bowel perforation Peritonitis Bladder erosion

Peritonitis

An 86-year-old female patient is admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to prevent urinary incontinence. The patient's most recent laboratory results are suggestive of acute renal failure. The nurse recognizes that this patient has which type of failure? Prerenal Postrenal Intrinsic Intrarenal

Prerenal

A patient in renal failure has marked decrease in renal blood flow caused by hypovolemia, caused by gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which of the following forms of acute renal injury does this patient have? Chronic renal failure Intrarenal failure Prerenal failure Postrenal failure

Prerenal failure Explanation: Prerenal failure, the most common form of acute renal failure, is characterized by a marked decrease in renal blood flow. It is reversible if the cause of the decreased renal blood flow can be identified and corrected before kidney damage occurs.

The nurse is reviewing the diagnosis of four male clients. Select the diagnosis that places the clients at risk for developing postrenal kidney failure. Prostatic hyperplasia Acute pyelonephritis Severe hypovolemiaIntra tubular obstruction

Prostatic hyperplasia

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? Serum creatinine Albumin level Serum protein BUN

Serum creatinine Explanation: In clinical practice, GFR is usually estimated using the serum creatinine concentration. The other answers are not used to estimate the GFR.

The nurse assesses a client for prerenal failure. Which conditions increase the risk for developing this type of kidney failure? Select all that apply. Prolonged renal ischemia Severe burns Septic shock Glomerulonephritis Severe dehydration

Severe burns Septic shock Severe dehydration Explanation: Prerenal failure occurs with conditions such as burns, septic shock and dehydration, which decrease renal perfusion. Glomerulonephritis and prolonged renal ischemia will result in intrarenal kidney injury.

A 56-year-old woman has been diagnosed with CKD. She first went to the doctor due to complications of hypertension. How are hypertension and CKD related? The mechanisms that produce hypertension in CKD are due to decreases in vascular volume, elevation of peripheral vascular resistance, increased levels of renal vasodilator prostaglandins, and decreased activity of the renin--angiotensin system. The mechanisms that produce hypertension in CKD are directly related to sporadic increases in the activity of the renin--angiotensin system .The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin--angiotensin system. The mechanisms relate to increases in hydrostatic pressure on the renal vasculature causes inflammation and irreversible damage.

The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin--angiotensin system. Explanation: Hypertension commonly is an early manifestation of CKD. The mechanisms that produce hypertension in CKD are multifactorial; they include an increased vascular volume, elevation of peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin--angiotensin system.

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? a) Fatigue during ambulation b) Irritability and drowsiness c) Jaundice d) Pruritus of the arms and legs

b

A patient with chronic kidney disease (CKD) will be managed with peritoneal dialysis. The nurse will give the patient which of the following descriptions of this type of dialysis? The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes. Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt. Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time .Treatments typically occur three times each week for three to four hours.

Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time. Explanation: In peritoneal dialysis, a sterile dialyzing solution is instilled into the peritoneum through a catheter over approximately 10 minutes. The solution remains ("dwells") in the peritoneal cavity for a determined time interval, then drains into a sterile bag. Shunts, fistulas, and artificial dialyzers are associated with hemodialysis, which is usually performed three times weekly. The frequency of peritoneal dialysis varies, but is normally performed more often than hemodialysis and can be done at home.

A man with end-stage kidney disease is scheduled for hemodialysis following healing of an arteriovenous fistula (AVF). What should the nurse explain to him that will occur during dialysis? a. He will be able to visit, read, sleep, or watch TV while reclining in a chair. b. He will be placed on a cardiac monitor to detect any adverse effects that might occur. c. The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the waste products. d. A large catheter with two lumens will be inserted into the fistula to send blood to and return it from the dialyzer

a

A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply. a) Administering prescribed spironolactone (Aldactone)' b) Instructing the client to remove salty and salted foods from the diet c) Assisting with placement of a transjugular intrahepatic portosystemic shunt d) Mobilizing the client every 2 hours e) Taking the client's weight every 3 to 4 days

a b c

The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. a) Insomnia b) Complaints of headache c) Decreased deep tendon reflexes d) Agitation e) Alterations in mood

a d e

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? a) Irritability b) Asterixis c) Negative Babinski reflex d) Increased motor activity

b

What is the most serious electrolyte disorder associated with kidney disease?a. Hypocalcemia b. Hyperkalemia c. Hyponatremia d. Hypermagnesemia

b

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver? a) Convert urea into ammonia b) Excrete bile c) Breakdown amino acids d) Break down coagulation factors

b

Timothy is a client being treated for hepatitis in the infectious disease office where you practice nursing. He has a history of IV drug use. He presents today with jaundice and arthralgias. Timothy most likely has which type of hepatitis?a) Hepatitis Cb) Hepatitis Bc) Hepatitis Ad) Hepatitis E

b

A nurse is caring for a client with acute pancreatitis. His physical examination reveals that he has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, his lab results indicate that he is hypovolemic. Which of the following will his healthcare provider consider ordering to treat the large amount of protein-rich fluid that has been released into his tissues and peritoneal cavity? a) Sodium b) Albumin c) Diuretics d) Dextrose solution

b c

A 67-year-old client is returning for a follow-up appointment to the primary care group where you practice nursing. At his last appointment, he received the diagnosis of portal hypertension. What is the primary aim of portal hypertension treatment? Select all that apply. a) Reduce blood coagulation. b) Reduce venous pressure. c) Reduce fluid output. d) Reduce fluid accumulation.

b d

A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention? a) Discuss the importance of eliminating caffeine in the diet. b) Discuss meals that have a high-fiber, high-protein content. c) Discuss meals that include low-fat high-carbohydrate content. d) Discuss the importance of drinking at least 64 oz (1,893 ml) of water daily.

c

For a patient with CKD the nurse identifies a nursing diagnosis of risk for injury: fracture related to alterations in calcium and phosphorus metabolism. What is the pathologic process directly related to the increased risk for fractures? a. Loss of aluminum through the impaired kidneys b. Deposition of calcium phosphate in soft tissues of the body c. Impaired vitamin activation resulting in decreased GI absorption of calcium d. Increased release of parathyroid hormone in response to decreased calcium levels

c

The primary care provider for a newly admitted hospital patient has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The patient's GFR will be extrapolated from serum levels of: myoglobin .urea. protein .creatinine.

creatinine.Explanation: In clinical practice, GFR is usually estimated using the serum creatinine concentration. The presence of myoglobin or large amounts of protein in the urine is suggestive of renal failure. Serum blood urea nitrogen levels are clinically useful; however, GFR is not calculated from these values.

What are intrarenal causes of acute kidney injury (AKI) (select all that apply)? a. Anaphylaxis b. Renal stones c. Bladder cancer d. Nephrotoxic drugs e. Acute glomerulonephritis f. Tubular obstruction by myoglobin

d e f

Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which of the following types of drugs? Sulfonylureas Diuretics Calcium channel blockers Beta adrenergic blockers

diuretics