NCLEX The client with Chronic Renal Failure

2. indicates abdominal blood vessel damage.

83. During the peritoneal dialysis, the nurse observes that the solution draining from the client abdomen is consistently blood tinged. The client a permanent peritoneal catheter in place. The nurse should recognize that the bleeding: 1. is expected with a permanent peritoneal catheter. 2. indicates abdominal blood vessel damage. 3. can indicate kidney damage. 4. is caused by too-rapid infusion of the dialysate.

3. binding phosphate in the intestine

89. Aluminum hydroxide gel is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of giving this drug? 1. relieving the pain of gastric hyperacidity 2. preventing Curling's stress ulcers 3. binding phosphate in the intestine 4. reversing metabolic acidosis

2. report the loss of a thrill or bruit on the arm with the fistula.

79. A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula, the nurse should: 1. take the blood pressure in the arm with the fistula. 2. report the loss of a thrill or bruit on the arm with fistula. 3. maintain a pressure dressing on the shunt. 4. start a second IV in the arm with the fistula.

2. turn the client from side to side.

84. During peritoneal dialysis, the nurse observes that the flow of dialysate stops before all the solutiọn has drained out. The nurse should: 1. have the client sit in a chair. 2. turn the client from side to side. 3. reposition the peritoneal catheter. 4. have the client walk.

3. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant."

95. The client asks about diet changes when using continuous ambulatory peritoneal dialysis (CAPD). Which response by the nurse would be best? 1. "Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique." 2. "Diet restrictions are the same for both CAPD and standard peritoneal dialysis." 3. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant." 4. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly."

2. observe respiratory status.

82. A client is receiving peritoneal dialysis. While the dialysis solution is dwelling in the client's abdomen, the nurse should: 1. assess for urticaria. 2. observe respiratory status. 3. check capillary refill time. 4. monitor electrolyte status.

2. Monitor the client's blood pressure.

86. Which should be included in the client's plan of care during dialysis therapy? 1. Limit the client's visitors. 2. Monitor the client's blood pressure. 3. Pad the side rails of the bed. 4. Keep the client on nothing-b: mouth (NPO) status.

2. Avoid sleeping on the left arm 3. Wear wristwatch on the right arm. 4. Assess fingers on the left arm for warmth.

77. A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? Select all that apply. 1. Remind healthcare providers (HCPS) to draw blood from veins on the left side. on the left arm. 2. Avoid sleeping on the left arm 3. Wear wristwatch on the right arm. 4. Assess fingers on the left arm for warmth. 5. Obtain BP from the left arm.

2, 4, 1, 3

78. A client with end-stage chronic renal failure is admitted to the hospital with a serum potassium level of 7 mEq/L. In what order of priority from first to last does the nurse perform the prescriptions? All options must be used. 1. Administer calcium gluconate. 2. Start an IV access site. 3. Administer sodium polystyrene sulfonate. 4. Attach the client to a cardiac monitor.

2. Have limited amounts of fluids only when thirsty. 4. Keep all dialysis appointments. 5. Eat smaller, more frequent meals.

80. A client with chronic renal failure who receives hemodialysis three times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply. 1. Drink fluids before eating solid foods. 2. Have limited amounts of fluids only when thirsty. 3. Limit activity. 4. Keep all dialysis appointments. 5. Eat smaller, more frequent meals.

1. encourage the removal of serum urea.

81. The dialysis solution is warmed before use in peritoneal dialysis primarily to: 1. encourage the removal of serum urea. 2. force potassium back into the cells. 3. add extra warmth to the body. 4. promote abdominal muscle relaxation.

4. constipation.

85. A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, the nurse should inquire whether the client has: 1. diarrhea. 2. vomiting. 3. flatulence. 4. constipation.

1. Broad-spectrum antibiotics may be administered to prevent infection. 2. Antibiotics may be added to the dialysate to treat peritonitis. 4. Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort. 5. Peritonitis is the most common and serious complication of peritoneal dialysis.

87. The client performs self peritoneal dialysis. What should the nurse teach the client about preventing peritonitis? Select all that apply. 1. Broad-spectrum antibiotics may be administered to prevent infection. 2. Antibiotics may be added to the dialysate to treat peritonitis. 3. Clean technique is permissible for prevention of peritonitis. 4. Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort. 5. Peritonitis is the most common and serious complication of peritoneal dialysis.

2. weight loss.

88. After completion of peritoneal dialysis, the nurse should assess the client for: 1. hematuria. 2. weight loss. 3. hypertension. 4. increased urine output.

4. "I will take it with meals and bedtime snacks."

90. The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching? 1. "I will take it every 4 hours around the clock." 2. "I will take it between meals and at bedtime." 3. "I will take it when I have an upset stomach." 4. "I will take it with meals and bedtime snacks."

2. Validate the client's understanding of the material frequently.

91. Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate? 1. Provide all needed teaching in one extended session. 2. Validate the client's understanding of the material frequently. 3. Conduct a one-on-one session with the client. 4. Use video clips to reinforce the material as needed.

3. low-protein, low-sodium, low-potassium

92. The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? 1. high-carbohydrate, high-protein 2. high-calcium, high potassium, high protein 3. low-protein, low-sodium, low-potassium 4. Low protein, high-potassium

2. Suggest using alternative forms of sexual expression and intimacy.

93. The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which strategy would be most useful? 1. Help the client to accept that sexual activity will be decreased. 2. Suggest using alternative forms of sexual expression and intimacy. 3. Tell the client to plan rest periods after sexual activity. 4. Refer the client to a counselor.

2. allows the client to be more independent.

94. 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: 1. is relatively low in cost. 2. allows the client to be more independent. 3. is faster and more efficient than standard peritoneal dialysis. 4. has fewer potential complications than does standard peritoneal dialysis.

1. cloudy dialysate fluid

96. A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which sign of peritoneal infection? 1. cloudy dialysate fluid 2. swelling in the legs 3. poor drainage of the dialysate fluid 4. Redness at the catheter insertion site