Kidney Failure NCLEXs
A client with chronic renal failure has an internal venous access site for hemodialysis on her left forearm. What action will the nurse take to protect this access site? 1) Irrigate with heparin and NS q8 hrs 2) Apply warm moist packs to the area after hemodialysis 3) Do not use the left arm to take blood pressure readings. 4) Keep the arm elevated above the level of the heart.
3: Protect the arm with the functioning shunt. No blood pressure readings should be taken from that arm, and there should be no needle sticks. The access is not irrigated with Heparin.
What nursing measure would be included in the plan of care for a client with acute renal failure? 1) Observe for signs of a secondary infection 2) Provide a high protein, low carbohydrate diet 3) In and out catheterization for residual urine 4) Encourage fluids to 2000 mL in 24 hours
1: Secondary infections are the cause of death in 50-90% of clients with acute renal failure. A low protein diet is most often offered. Catheterizations are avoided. Fluids may be limited if the client is in ARF.
A client in renal failure is to have a serum blood urea nitrogen level determined. What will this diagnostic test measure? 1) Concentration of urine osmolarity and electrolytes 2) Serum level of the end products of protein 3) Ability of kidneys to concentrate urine 4) Levels of C-reactive protein to determine inflammation
2: Urea is an end product of protein metabolism. In renal failure, the kidneys cannot clear all of the urea from the blood, and the creatinine and BUN level will be elevated. The C-reactive protein is a diagnostic test used in assessing clients with inflammatory bowel disease, rheumatoid arthritis, autoimmune diseases, and PID. A specific gravity test of the urine would assess the ability of the kidneys to concentrate urine. The urine osmolarity (concentration of particles in urine) and electrolytes assess fluid balance. The kidneys play an important role in the balance of electrolytes and fluids.
A cllient with chronic renal failure has been prescribed calcium carbonate. What is the rationale for this particular medication? 1) Diminishes incidence of gastric ulcer formation 2) Alleviates constipation 3) Binds with phosphorus to lower concentration 4) Increase tubular reabsorption of sodium
3: Clients with ARF have hyperphosphatemia. Clients are prescribed calcium-based phosphate binders to improve excretion of phosphorus.
A client with acute renal failure develops sever hyperkalemia. What would the nurse anticipate to be used to treat this imbalance? 1) Furosemide (Lasix) 2) Amphojel (aluminum hydroxide) 3) 50% glucose and regular insulin 4) Epoetin (Procrit)
3: Hyperkalemia can develop into an emergency situation (Cardia Arrest). It is important to quickly move the potassium back into the cells by administering 50% glucose and regular insulin, usually in conjunction with some type of base to correct the acidosis, such as sodium bicarbonate or calcium gluconate given IV. Insulin assists in the movement of potassium into the cells and helps to reduce the serum potassium level. Amphojel is used for the treatment of hyperphosphatemia that occurs with ARF. Procrit is used for the treatment of anemia caused by a decrease in erythropoietin production by the kidneys. A diuretic, such as Lasix, may lead to a loss of potassium, but the rate is too slow.
