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NUR 213 test 3

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B, C, and D. This patient is in the DIURESIS stage of AKI. The nephrons are now starting to filter out waste but cannot concentrate the urine. There is now a high amount of urea in the filtrate (because the nephrons can filter the urea out of the blood) and this causes osmotic diuresis. Urinary output will be excessive (3 to 6 L/day). Therefore, the patient is at risk for hypotension, diluted urine (low urine specific gravity), and hypokalemia (waste potassium in the urine). The patient is not at risk for water intoxication and will not have a normal GFR until the recovery stage.

A 36-year-old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply:* A. Water intoxication B. Hypotension C. Low urine specific gravity D. Hypokalemia E. Normal GFR

C. This is known as Stage 4 of CKD because the GFR (glomerular filtration rate) for this stage is 15-29 mL/min (patient's GFR is 25 mL/min). The other stage's criteria are as follows:

A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as?* A. Stage 1 B. Stage 3 C. Stage 4 D. Stage 5

C. Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding...patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged.

A 55-year-old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury?* A. Post-renal B. Intra-renal C. Pre-renal D. Intrinsic renal

A. There are two types of drugs that can be used to treat hypertension and protect the kidneys in patients with CKD. These drugs include angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). The only drug listed here that is correct is Lisinopril. This drug is known as an ACE inhibitor. Metoprolol is a BETA BLOCKER. Amlodipine and Verapamil are calcium channel blockers.

A 65 year old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys?* A. Lisinopril B. Metoprolol C. Amlodipine D. Verapamil

A client is scheduled to take a serum creatinine test and she asks the nurse what this test shows. The most appropriate response would be: a. This test will tell your doctor how your kidneys are functioning. b. You'll have to ask your doctor. c. It will tell if you have severe renal impairment or a disease. d. Results will indicate if certain drugs, such as steroids, are interfering with kidney functioning.

1, 4 Silence is a therapeutic communication technique that allows the nurse and client to reflect on what has taken place or been said. By waiting quietly and attentively, the nurse encourages the client to initiate and maintain a conversation. By reflecting on the client's implied feelings, the nurse promotes communication. Using such platitudes as "We all have days when we don't feel like going on" fails to address the client's needs. The nurse would not leave the client alone abruptly stopping therapeutic communication. Negotiating treatment frequency is not in the scope of practice of the nurse.

A client with chronic renal failure was recently told by the health care provider of being a poor candidate for a transplant because of chronic uncontrolled hypertension and diabetes mellitus. Now the client tells the nurse, "I want to go off dialysis. I'd rather not live than be on this treatment for the rest of my life." Which responses are appropriate? Select all that apply. 1. Take a seat next to the client and sit quietly to reflect on what was said. 2. Say to the client, "We all have days when we don't feel like going on." 3. Leave the room to allow the client privacy to collect thoughts. 4. Say to the client, "You're feeling upset about the news you got about the transplant." 5. Say to the client, "The treatments are now 3 days a week. Would you be willing to do two days per week?"

4, 3, 1, 2 The first symptom of acute renal failure is oliguria (urine output less than 1 ml/kg of the child's body weight per hour). The inability to produce urine causes azotemia, an accumulation of nitrogen waste in the bloodstream, which leads to rising blood urea nitrogen levels. This leads to acidosis because of the body's inability to excrete H+ ions. The acidotic state results in hyperphosphatemia (high phosphorus levels), which in turn causes hypocalcemia (low calcium levels). When hypocalcemia is severe, muscle twitching and tetany can occur.

A nurse is caring for a 4-year-old child who developed acute renal failure after a traumatic injury with hemorrhaging. Place the following events in the order in which they most likely occurred during progression of the severe renal deterioration. All options must be used. 1. acidosis 2. severe hypocalcemia 3. azotemia 4. oliguria

1, 2, 4, 5 The client is exhibiting signs and symptoms of autonomic dysreflexia, a potentially life-threatening emergency caused by an uninhibited response from the sympathetic nervous system resulting from a lack of control over the autonomic nervous system. The nurse would immediately elevate the head of the bed to 90° and place the legs in a dependent position to decrease venous return to the heart and increase venous return from the brain. Because tactile stimuli can trigger autonomic dysreflexia, any constrictive clothing should be loosened. The nurse would also assess for distended bladder and bowel impaction—which may trigger autonomic dysreflexia—and correct any problems. Morphine, a narcotic, is not prescribed. Elevated blood pressure is the most life-threatening complication of autonomic dysreflexia because it can cause stroke, myocardial infarction, or seizure activity. If removing the triggering event does not reduce the client's blood pressure, intravenous antihypertensives would be administered. A fan would not be used because a cold draft may trigger autonomic dysreflexia.

A nurse is caring for a client with a T5 complete spinal cord injury. Upon assessment, the nurse notes flushed skin, diaphoresis above T5, and blood pressure of 174/100 mm Hg. The client reports a severe, pounding headache. Which nursing interventions would be appropriate for this client? Select all that apply. 1. Elevate the head of the bed to 90°. 2. Loosen constrictive clothing. 3. Use a fan to reduce diaphoresis. 4. Assess for bladder distention and bowel impaction. 5. Administer antihypertensive medication as ordered. 6. Administer morphine as ordered.

1, 2, 6 Chronic renal failure is the slow process of losing kidney function over time. At some point, the kidney will not be able to remove excess fluid and wastes from the body causing fluid and electrolyte complications. Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting times, anxiety, and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures. Drowsiness and lethargy are not typically associated with hypercalcemia.

A nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse would be alert for which occurrence? Select all that apply. 1. Trousseau's sign 2. cardiac arrhythmias 3. constipation 4. decreased clotting time 5. drowsiness and lethargy 6. fractures

2 Check to be certain that the bladder is not distended, which would trigger autonomic dysreflexia.

A nurse working in the neuro-intensive care unit has a patient with a spinal cord injury at T4. The patient suddenly becomes dangerously hypertensive and bradycardic. Which of the following interventions is appropriate in this situation? 1. Call the neurosurgeon immediately, as this sounds like sudden intracranial hypertension. 2. Check to be certain that the patient's bladder is not distended. 3. Administer Hyperstat to treat the blood pressure. 4. Administer atropine for bradycardia.

C. The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein, low-potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products, excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown (creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for hyperkalemia and fluid overload (needs low-potassium and sodium foods).

A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient?* A. Low-sodium, high-protein, and low-potassium B. High-protein, low-potassium, and low-sodium C. Low-protein, low-potassium, and low-sodium D. High-protein and high-potassium

B. EPO (erythropoietin) helps create red blood cells in the bone marrow. The kidneys produce EPO and when the kidneys are damaged in CKD they can decrease in the production of EPO. Therefore, the patient is at risk for anemia.

A patient with CKD has a low erythropoietin (EPO) level. The patient is at risk for?* A. Hypercalcemia B. Anemia C. Blood clots D. Hyperkalemia

B. This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this.

A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood?* A. Calcium B. Urea C. Phosphate D. Erythropoietin

D. This patient is in the recovery stage of AKI. The patient's labs and urinary output indicate the renal function has returned to normal. Remember the recovery stages starts when the GFR (glomerular filtration rate) has returned to normal (normal GFR 90 mL/min or higher), which will allow waste levels and electrolyte levels to be maintained.

A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL. The patient's 24 hour urinary output is 1.75 Liters. Based on these findings, what stage of AKI is this patient in?* A. Initiation B. Diuresis C. Oliguric D. Recovery

A and C. The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney's ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood...hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine.

A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply:* A. Hypervolemia B. Hypokalemia C. Increased BUN level D. Decreased Creatinine level

A. The patient should follow this type of diet because protein breaks down into urea (remember patient will have increased urea levels), low sodium to prevent fluid excess, low potassium to prevent hyperkalemia (remember glomerulus isn't filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia.

A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a:* A. Low protein, low sodium, low potassium, low phosphate diet B. High protein, low sodium, low potassium, high phosphate diet C. Low protein, high sodium, high potassium, high phosphate diet D. Low protein, low sodium, low potassium, high phosphate diet

2 The sympathetic nervous system responds to a full bladder or bowel resulting from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc. This response is usually from stimulation of sensory receptors (e.g., distended bladder or bowel). Because the efferent pulse cannot pass through the spinal cord, the vagus nerve is not "turned off," and profound symptomatic bradycardia may occur.

After spinal cord surgery, a patient suddenly complains of a severe headache. What should be the nurse's first action? 1. Check the blood pressure. 2. Check for a full bladder. 3. Ask if pain is present somewhere else. 4. Ask if other symptoms are present

2, 3, 5 Autonomic dysreflexia may be caused by abdominal pressure from a fecal impaction.An over distended bladder is usually the precipitating factor causing an increase in abdominal pressure. Tight clothing can increase pressure to the central core of the body.

Children with high-level spinal cord injuries may be afflicted with many complications, a serious one being autonomic dysreflexia due to unregulated sympathetic hyperactivity. Some of the causes of autonomic dysreflexia that the nurse should be aware of include which of the following? Select all that apply. 1. Decrease in blood pressure. 2. Abdominal distention. 3. Bladder distention. 4. Diarrhea. 5. Tight clothing. 6. Hypothermia.

2 Autonomic dysreflexia results from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc due to stimulation of the sympathetic nervous system. It is a response that typically results from stimulation of sensory receptors such as a full bladder or bowel.

Concerning a child with post-traumatic spinal cord injury, the nurse knows teaching has been successful when the parent states that which of the following can cause autonomic dysreflexia? 1. Exposure to cold temperatures. 2. Distended bowel or bladder. 3. Bradycardia. 4. Headache.

1 Spinal shock associated with SCI represents a sudden depression of reflex activity below the level of the injury. T12 is just above the waist; therefore, no reflex activity below the waist would be expected.

In assessing a client with a T12 SCI, which clinical manifestations would the nurse expect to find to support the diagnosis of spinal shock? 1. No reflex activity below the waist. 2. Inability to move upper extremities. 3. Complaints of a pounding headache. 4. Hypotension and bradycardia.

C, E, and F. These patients are at risk for an intra-renal injury, which is where there is damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury because there is an obstruction that can cause back flow of urine into the kidney, which can lead to decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is an issue with perfusion to the kidney.

Select all the patients below that are at risk for acute intra-renal injury?* A. A 45 year old male with a renal calculus. B. A 65 year old male with benign prostatic hyperplasia. C. A 25 year old female receiving chemotherapy. D. A 36 year old female with renal artery stenosis. E. A 6 year old male with acute glomerulonephritis. F. An 87 year old male who is taking an aminoglycoside medication for an infection

1 Spinal cord injury without radiographic abnormality results from the spinal cord sliding between the vertebrae and then sliding back into place without injury to the bony spine. It is thought to be the result of immature spines that allow for reduction after momentary subluxation.

Spinal cord injuries are frequently misdiagnosed in children because of a phenomenon called spinal cord injury without radiographic abnormality. This occurs because of which of the following? 1. Children can suffer momentary severe subluxation and trauma to the spinal cord. 2. The immature spinal column in children does not allow for quality films. 3. Children are more prone to spinal cord injuries because of their size. 4. Children are unable to quantify pain and do not report symptoms appropriately.

4 This is a therapeutic response which allows the client to ventilate feelings.

The 25-year-old client who has a C6 spinal cord injury is crying and asks the nurse, "Why did I have to survive? I wish I was dead." Which statement is the nurse's best response? 1. "Don't talk like that. At least you are alive and able to talk." 2. "God must have something planned for your life. Pray about it." 3. "You survived because the people at the accident saved your life." 4. "This must be difficult to cope with. Would you like to talk?"

2 The rehabilitation commission of each state will help evaluate and determine if the client can receive training or education for another occupation after injury.

The 34-year-old male client with an SCI is sharing with the nurse that he is worried about finding employment after being discharged from the rehabilitation unit. Which intervention should the nurse implement? 1. Refer the client to the American Spinal Cord Injury Association (ASIA). 2. Refer the client to the state rehabilitation commission. 3. Ask the social worker about applying for disability. 4. Suggest that the client talk with his significant other about this concern.

2. These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost.

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1. Have the assistant apply a moisture barrier cream to the skin. 2. Instruct the UAP to bathe the client in cool water. 3. Tell the UAP not to turn the client in this condition. 4. Explain this is normal and do not do anything for the client.

2 These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost.

1 This client with dyspnea and a respiration rate of 12 has signs/symptoms of a respiratory complication and should be assessed first because ascending paralysis at the C-6 level could cause the client to stop breathing.

The charge nurse, along with the registered nurse (RN) staff, in the critical care unit is caring for clients with a spinal cord injury (SCI). Which client should the charge nurse assess first after receiving the change-of-shift report? 1. The client with a C-6 SCI who is complaining of dyspnea and has a respiratory rate of 12 breaths/minute. 2. The client with an L-4 SCI who is frightened about being transferred to the rehabilitation unit. 3. The client with an L-2 SCI who is complaining of a headache and feeling very hot all of a sudden. 4. The client with a C-4 SCI who is on a ventilator and has a pulse oximeter reading of 98%.

4. Normal potassium level is 3.5 to 5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-care provider order, so it is a collaborative intervention.

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1. Administer a phosphate binder. 2. Type and crossmatch for whole blood. 3. Assess the client for leg cramps. 4. Prepare the client for dialysis.

4 Normal potassium level is 3.5 to5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-care provider order, so it is a collaborative intervention.

3. Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products.

The client diagnosed with ARF is admitted to the intensive care unit and placed on a therapeutic diet. Which diet is most appropriate for the client? 1. A high-potassium and low-calcium diet. 2. A low-fat and low-cholesterol diet. 3. A high-carbohydrate and restricted-protein diet. 4. A regular diet with six (6) small feedings a day.

3 Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products.

3. Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1. Erythropoietin. 2. Calcium gluconate. 3. Regular insulin. 4. Osmotic diuretic.

3 Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily.

2. Bedrest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine).

The client diagnosed with ARF is placed on bedrest. The client asks the nurse, "Why do I have to stay in bed? I don't feel bad." Which scientific rationale supports the nurse's response? 1. Bedrest helps increase the blood return to the renal circulation. 2. Bedrest reduces the metabolic rate during the acute stage. 3. Bedrest decreases the workload of the left side of the heart. 4. Bedrest aids in reduction of peripheral and sacral edema.

2 Bedrest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine).

1 Carrying heavy objects in the left arm could cause the fistula to clot by putting undue stress on the site, so the client should carry objects with the right arm.

The client diagnosed with CKD has a new arteriovenous fistula in the left forearm. Which intervention should the nurse implement? 1. Teach the client to carry heavy objects with the right arm. 2. Perform all laboratory blood tests on the left arm. 3. Instruct the client to lie on the left arm during the night. 4. Discuss the importance of not performing any hand exercises.

4 Because the client is in ESRD, fluid must be removed from the body, so the output should be more than the amount instilled. These assessment data require intervention by the nurse.

The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate intervention by the nurse? 1. Inability to auscultate a bruit over the fistula. 2. The client's abdomen is soft, is nontender, and has bowel sounds. 3. The dialysate being removed from the client's abdomen is clear. 4. The dialysate instilled was 1,500 mL and removed was 1,500 mL.

1 A cloudy dialysate indicates an infection and must be reported immediately to prevent peritonitis.

The client diagnosed with chronic renal failure is receiving peritoneal dialysis. Which assessment by the nurse warrants immediate intervention? 1. The dialysate return is cloudy. 2. There is a greater dialysate return than input. 3. The client complains of abdominal fullness. 4. The client voided 50 mL during the day

3 The dialysate return should be colorless or straw colored but should never be cloudy, which indicates an infection; therefore, this data warrants immediate intervention.

The client diagnosed with end-stage renal disease (ESRD), also known as chronic kidney disease (CKD), who is on peritoneal dialysis is admitted to the critical care unit. Which assessment data warrants immediate intervention by the nurse? 1. The client's serum creatinine level is 2.4 mg/dL. 2. The client's abdomen is soft to touch and nontender. 3. The dialysate being removed from the abdomen is cloudy. 4. The dialysate instilled was 1500 mL and removed was 2100 mL.

4 The UAP can document the client's oral intake and urinary output, but the UAP cannot evaluate if the urine output is adequate and appropriate for the IVP procedure.

The client diagnosed with renal calculi has just had an intravenous pyelogram (IVP). Which task would be the most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Hang a new bag of intravenous fluid. 2. Discontinue the client's intravenous catheter. 3. Assist the client outside to smoke a cigarette. 4. Maintain the client's intake and output.

2 Assessment is the first part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypotension and syncope.

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when ambulating the client.

1 This is the correct position for the client when an epidural anesthesia is being inserted.

The client diagnosed with renal calculi is being scheduled for surgery. The client is having epidural anesthesia. Which intervention should the circulating nurse implement? 1. Have the client lie on the side in the fetal position. 2. Determine if the client has an advance directive. 3. Assess the client's gag and swallowing reflex. 4. Ensure that the head of the client's stretcher is elevated 30 degrees.

2 Assessing the client and ruling out any complications is the nurse's first intervention.

The client diagnosed with renal calculi is receiving pain medication via morphine patient-controlled analgesia (PCA). The client is still voicing excruciating pain and is requesting something else. Which intervention should the nurse implement first? 1. Administer the rescue dose of morphine intravenous push. 2. Check the client's urine for color, sediment, and output. 3. Determine the last time the client received PCA morphine. 4. Demonstrate how to perform guided imagery with the client.

1, 2, 3 The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result.

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. 4. Insert an indwelling catheter in client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

3 The UAP could assist the client to the car once the discharge has been completed

The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP? 1. Monitor the amount, color, and consistency of urine output. 2. Teach the client about care of the indwelling Foley catheter. 3. Assist the client to the car when being discharged home. 4. Take the client's postprocedural vital signs.

2 The client should not have this diagnostic test if the kidneys are not working properly. The intravenous dye could damage the kidneys if normal functioning is not present.

The client diagnosed with rule-out renal calculi is scheduled for an intravenous dye pyelogram (IVP). Which action should the nurse implement? 1. Keep the client NPO. 2. Check the serum creatinine level. 3. Assess for antibiotic allergy. 4. Insert an 18-gauge angiocatheter.

4 The white blood cell count is elevated; normal is 5,000 to 10,000/mm3

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000/mm3.

1. Preventing and treating shock with blood and fluid replacement will prevent acute renal failure from hypoperfusion of the kidneys. Significant blood loss is expected in the client with a gunshot wound.

The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF? 1. Administer normal saline IV. 2. Take vital signs. 3. Place client on telemetry. 4. Assess abdominal dressing.

1 Preventing and treating shock with blood and fluid replacement will prevent acute renal failure from hypoperfusion of the kidneys. Significant blood loss is expected in the client with a gunshot wound.

1 The PCA pump automatically administers a specific amount and has a lockout interval time in which the PCA pump cannot administer any morphine. The client can push the control button as often as needed and will not receive an overdose of pain medication.

The client is admitted to the surgical department diagnosed with renal calculi. The HCP prescribes a morphine patient-controlled analgesia (PCA). Which intervention should the nurse implement? 1. Instruct the client to push the control button as often as needed. 2. Explain that the medication will ensure the client has no pain. 3. Discuss that medication effectiveness is evaluated with the Wong-Baker FACES Pain Scale. 4. Inform the client to ambulate very carefully to the bathroom and to strain urine.

1, 2, 3 1. Renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity. 2. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit indicates the client is in the recovery period. 3. Nausea, vomiting, and diarrhea are common in the client with ARF; therefore, an absence of these indicates the client is in the recovery period.

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. 1. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting. 4. Decreased urine-specific gravity. 5. Increased serum creatinine level.

1, 2, 3 Renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit indicates the client is in the recovery period. Nausea, vomiting, and diarrhea are common in the client with ARF; therefore, an absence of these indicates the client is in the recovery period.

3 Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs.

4 MRI scans are often done in a very confined space; many people who have claustrophobia must be medicated or even rescheduled for the procedure in an open MRI machine, which may be available if needed.

The client is diagnosed with an SCI and is scheduled for a magnetic resonance imaging (MRI) scan. Which question would be most appropriate for the nurse to ask prior to taking the client to the diagnostic test? 1. "Do you have trouble hearing?" 2. "Are you allergic to any type of dairy products?" 3. "Have you eaten anything in the last eight (8) hours?" 4. "Are you uncomfortable in closed spaces?"

4 Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Alteration in comfort

2 The client will have bradycardia instead of tachycardia, which is seen in other forms of shock.

The client is diagnosed with neurogenic shock. Which signs/symptoms should the nurse assess in this client? 1. Cool moist skin. 2. Bradycardia. 3. Wheezing. 4. Decreased bowel sounds.

1 Autonomy implies the client has the right to make choices and decisions about his or her own care even if it may result in death or is not in agreement with the health-care team.

The client receiving dialysis for end-stage renal disease wants to quit dialysis and die. Which ethical principle supports the client's right to die? 1. Autonomy. 2. Self-determination. 3. Beneficence. 4. Justice.

1 The nurse should place the client's chair with the head lower than the body, which will shunt blood to the brain; this is the Trendelenburg position.

The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first? 1. Place the client in the Trendelenburg position. 2. Turn off the dialysis machine immediately. 3. Bolus the client with 500 mL of normal saline. 4. Notify the health-care provider as soon as possible.

3 Uremic frost, which results when the skin attempts to take over the function of the kidneys, causes itching, which can lead to scratching possibly resulting in a break in the skin.

The client receiving hemodialysis is being discharged home from the dialysis center. Which instruction should the nurse teach the client? 1. Notify the HCP if oral temperature is 102 ̊F or greater. 2. Apply ice to the access site if it starts bleeding at home. 3. Keep fingernails short and try not to scratch the skin. 4. Encourage significant other to make decisions for the client.

720 mL.

The client with CKD is placed on a fluid restriction of 1,500 mL/day. On the 7 a.m. to 7 p.m. shift the client drank an eight (8)-ounce cup of coffee, 4 ounces of juice, 12 ounces of tea, and 2 ounces of water with medications. What amount of fluid can the 7 p.m. to 7 a.m. nurse give to the client? _____________

3 This is an acute emergency caused by exaggerated autonomic responses to stimuli and only occurs after spinal shock has resolved in the client with a spinal cord injury above T6. The most common cause is a full bladder.

The client with a C6 SCI is admitted to the emergency department complaining of a severe pounding headache and has a BP of 180/110. Which intervention should the emergency department nurse implement? 1. Keep the client flat in bed. 2. Dim the lights in the room. 3. Assess for bladder distention. 4. Administer a narcotic analgesic.

2 Reddened areas, especially under the brace, must be reported to the HCP because pressure ulcers can occur when wearing this appliance for an extended period.

The client with a cervical fracture is being discharged in a halo device. Which teaching instruction should the nurse discuss with the client? 1. Discuss how to correctly remove the insertion pins. 2. Instruct the client to report reddened or irritated skin areas. 3. Inform the client that the vest liner cannot be changed. 4. Encourage the client to remain in the recliner as much as possible.

3 A urinalysis can assess for hematuria, the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client's urine.

3 This is the scientific rationale for administering Calcibind to reduce the formation of calcium renal calculi.

The client with calcium renal calculi is prescribed cellulose sodium phosphate (Calcibind). The client asks the nurse, "How will this medication help prevent my stones from coming back?" Which statement is the nurse's best response? 1. "Calcibind reduces the uric acid level in your bloodstream and the uric acid excreted in your urine." 2. "This medication will decrease calcium levels in the bloodstream by increasing calcium excretion in the urine." 3. "It binds calcium from food in the intestines, reducing the amount absorbed in the circulation." 4. "The medication will help alkalinize the urine, which reduces the amount of cystine in the urine."

4 No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied which produces sound waves, resulting in a picture.

The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1. Ask if the client is allergic to shellfish or iodine. 2. Keep the client NPO eight (8) hours prior to the ultrasound. 3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive and there is no discomfort.

1 The client should notify the HCP if a skin rash or influenza symptoms (chills, fever, muscle aches and pain, nausea or vomiting) develop because these signs and symptoms may indicate hypersensitivity.

The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which medication teaching should the nurse discuss with the client? 1. Inform the client to report chills, fever, and muscle aches to the HCP. 2. Instruct the client to avoid driving or other activities that require alertness. 3. Tell the client that the medication must be taken on an empty stomach. 4. Explain the importance of not eating breads, cereals, and fruits

3 Salicylic acid (aspirin) increases the acidity of the urine, and the urine should be alkaline; therefore this statement warrants intervention by the nurse.

The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which statement would warrant intervention by the nurse? 1. "I had to take two Tylenol because of my headache." 2. "I drink at least eight glasses of water a day." 3. "My joints ache so I take a couple of aspirins." 4. "I do not drink wine or any type of alcoholic drinks."

1 Therapeutic communication addresses the client's feelings and attempts to allow the client to verbalize feelings; the nurse should be a therapeutic listener.

The home health nurse is caring for a 28-year-old client with a T10 SCI who says, "I can't do anything. Why am I so worthless?" Which statement by the nurse would be the most therapeutic? 1. "This must be very hard for you. You're feeling worthless?" 2. "You shouldn't feel worthless—you are still alive." 3. "Why do you feel worthless? You still have the use of your arms." 4. "If you attended a work rehab program you wouldn't feel worthless."

4 For the first two (2) weeks after an SCI above T7, the blood pressure tends to be unstable and low; slight elevations of the head of the bed can cause profound hypotension; therefore, the nurse should lower the head of the bed immediately.

The intensive care nurse is caring for a client with a T1 SCI. When the nurse elevates the head of the bed 30 degrees, the client complains of lightheadedness and dizziness. The client's vital signs are T 99.2 ̊F, P 98, R 24, and BP 84/40. Which action should the nurse implement? 1. Notify the health-care provider ASAP. 2. Calm the client down by talking therapeutically. 3. Increase the IV rate by 50 mL/hour. 4. Lower the head of the bed immediately.

3 Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract.

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water two (2) hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

3. After the initial administration of erythropoietin, a client's antihypertensive medications may need to be adjusted. Therefore, this complaint requires notification of the HCP. Erythropoietin therapy is contraindicated in clients with uncontrolled hypertension.

The male client diagnosed with CKD has received the initial dose of erythropoietin, a biologic response modifier, 1 week ago. Which complaint by the client indicates the need to notify the health-care provider? 1. The client complains of flu-like symptoms. 2. The client complains of being tired all the time. 3. The client reports an elevation in his blood pressure. 4. The client reports discomfort in his legs and back.

3 After the initial administration of erythropoietin, a client's antihypertensive medications may need to be adjusted. Therefore, this complaint requires notification of the HCP. Erythropoietin therapy is contraindicated in clients with uncontrolled hypertension.

2. Reflecting the client's feelings and restating them are therapeutic responses the nurse should use when addressing the client's issues.

The male client diagnosed with CKD secondary to diabetes has been receiving dialysis for 12 years. The client is notified he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis treatments. Which response by the nurse is most therapeutic? 1. "You cannot just quit your dialysis. This is not an option." 2. "Your angry at not being on the list, and you want to quit dialysis?" 3. "I will call your nephrologist right now so you can talk to the HCP." 4. "Make your funeral arrangements because you are going to die."

2 Reflecting the client's feelings and restating them are therapeutic responses the nurse should use when addressing the client's issues.

4 This medication is prescribed because it may reduce the amount of narcotic analgesia required for acute renal colic.

The male client diagnosed with renal calculi is receiving pain medication via a morphine patient-controlled analgesia (PCA) pump. The HCP prescribed the non- steroidal anti-inflammatory drug (NSAID) indomethacin (Indocin) in a rectal suppository. Which action should the nurse take? 1. Question and clarify the prescription with the health-care provider. 2. Give the suppository to the client and allow the client to insert it into the rectum. 3. Administer a Fleets enema to clear the bowel prior to administering the suppository. 4. Have the client lie on the side and insert the rectal suppository with nonsterile gloves.

1. The UAP can collect specimens. Collecting a midstream urine specimen requires the client to clean the perineal area, to urinate a little, and then collect the rest of the urine output in a sterile container.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task is most appropriate for the nurse to delegate? 1. Collect a clean voided midstream urine specimen. 2. Evaluate the client's 8-hour intake and output. 3. Assist in checking a unit of blood prior to hanging. 4. Administer a cation-exchange resin enema.

1 The UAP can collect specimens. Collecting a midstream urine specimen requires the client to clean the perineal area, to urinate a little, and then collect the rest of the urine output in a sterile container.

3 The nurse must maintain a patent airway. Airway is the first step in resuscitation.

The nurse arrives at the site of a one-car motor-vehicle accident and stops to render aid. The driver of the car is unconscious. After stabilizing the client's cervical spine, which action should the nurse take next? 1. Carefully remove the driver from the car. 2. Assess the client's pupils for reaction. 3. Assess the client's airway. 4. Attempt to wake the client up by shaking him.

4 Noncompliance is a choice the client has a right to make, but the nurse should determine the reason for the noncompliance and then take appropriate actions based on the client's rationale. For example, if the client has financial difficulties, the nurse may suggest how the client can afford the proper foods along with medications, or the nurse may be able to refer the client to a social worker.

The nurse caring for a client diagnosed with CKD writes a client problem of "noncompliance with dietary restrictions." Which intervention should be included in the plan of care? 1. Teach the client the proper diet to eat while undergoing dialysis. 2. Refer the client and significant other to the dietitian. 3. Explain the importance of eating the proper foods. 4. Determine the reason for the client not adhering to the diet.

2. This client's dialysis access is compromised and he or she should be assessed first.

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%. 2. The client who does not have a palpable thrill or auscultated bruit. 3. The client who is complaining of being exhausted and is sleeping. 4. The client who did not take antihypertensive medication this morning.

2 This client's dialysis access is compromised and he or she should be assessed first.

1, 3, 5 Oxygen is administered initially to prevent hypoxemia, which can worsen the spinal cord injury; therefore, the nurse should determine how much oxygen is reaching the periphery. Breathing exercises are supervised by the nurse to increase the strength and endurance of inspiratory muscles, especially those of the diaphragm. Corticosteroids are administered to decrease inflammation, which will decrease edema, and help prevent edema from ascending up the spinal cord, causing breathing difficulties.

The nurse in the neurointensive care unit is caring for a client with a new C6 SCI who is breathing independently. Which nursing interventions should be implemented? Select all that apply. 1. Monitor the pulse oximetry reading. 2. Provide pureed foods six (6) times a day. 3. Encourage coughing and deep breathing. 4. Assess for autonomic dysreflexia. 5. Administer intravenous corticosteroids.

1 Patients with complete spinal cord injury lose motor and sensory function below the level of the injury as a result of interruption of nerve pathways.

The nurse is admitting a child with a spinal cord injury. A plan of care should be based on the fact that a patient suffering from complete spinal cord injury will experience which of the following symptoms? 1. Loss of motor and sensory function below the level of the injury. 2. Loss of interest in normal activities. 3. Have extreme pain below the level of the injury. 4. Loss of some function, with sparing of function below the level of the injury.

4. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate.

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview? 1. "Have you recently traveled outside the United States?" 2. "Did you recently begin a vigorous exercise program?" 3. "Is there a chance you have been exposed to a virus?" 4. "What over-the-counter medications do you take regularly?"

4 Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate.

2, 3, 4, 5 The nurse assesses laboratory values that identify kidney function. Urine albumin is used to detect early kidney disease. Measuring the filtration rate of the glomerulus of the kidney is helpful in identifying the status of the kidney. The creatinine clearance measures blood levels being filtered by the kidney. Within the basic metabolic panel are tests identifying kidney function such as the BUN and creatinine. A urine culture determines if bacteria are present in the urine but is not a good indicator of kidney functioning. Hemoglobin AIC measures glucose in the blood over a 3- month period

The nurse is assessing laboratory values to identify if medical treatment and nursing interventions have improved kidney function in a client with renal disease. Which laboratory tests will the nurse monitor to determine the functioning status of the kidneys? Select all that apply. 1. urine culture 2. urine albumin 3. glomerular filtration rate (GFR) 4. creatinine clearance 5. basic metabolic panel (BMP) 6. hemoglobin A1C

1. Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure.

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most significant for diagnosing ARF? 1. BUN and creatinine. 2. WBC and hemoglobin. 3. Potassium and sodium. 4. Bilirubin and ammonia level.

1 Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure.

2. Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal failure (before the kidney).

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? 1. Diabetes mellitus. 2. Hypotension. 3. Aminoglycosides. 4. Benign prostatic hypertrophy.

2 Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal failure (before the kidney).

1, 2, 6 When evaluating renal functioning, the nurse would report to the health care provider information on the current urine output, the glomerular filtration rate, and serum creatinine levels, which identify the degree of kidney dysfunction. These objective data provide diagnostic information. Vital signs and pain level reflect the impact of the renal disease. Blood count reports do not assist in evaluating renal function.

The nurse is caring for a client who possibly may need kidney dialysis. When evaluating the client's renal function to report to the health care provider, which data will the nurse use? Select all that apply. 1. a client's 24-hour urinary output 2. glomerular filtration rate 3. trending vital signs 4. a client's flank pain level 5. the blood count report 6. serum creatinine level

3 This is the correct scientific rationale for metabolic acidosis occurring in the client with CKD.

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client? 1. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH. 2. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis. 3. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate. 4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

3. This is the correct scientific rationale for metabolic acidosis occurring in the client with CKD.

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) whois experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client? 1. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH. 2. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis. 3. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate. 4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

4. Excess fluid volume is priority because of the stress placed on the heart and vessels, which could lead to heart failure, pulmonary edema, and death.

The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is priority for the client? 1. Low self-esteem. 2. Knowledge deficit. 3. Activity intolerance. 4. Excess fluid volume.

4 Excess fluid volume is priority because of the stress placed on the heart and vessels, which could lead to heart failure, pulmonary edema, and death.

3. Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits.

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client? 1. Monitor intake and output every shift. 2. Decrease of pain by 3 levels on a 1-10 scale. 3. Electrolytes are within normal limits. 4. Administer enemas to decrease hyperkalemia.

3 Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits.

2 Many in the African American culture believe the body must be kept intact after death, and organ donation is rare among African Americans. This is also why a client of African American descent will be on a transplant waiting list longer than people of other races. This is because of tissue-typing compatibility. Remember, this does not apply to all African-Americans; every client is an individual.

The nurse is discussing kidney transplants with clients at a dialysis center. Which population is less likely to participate in organ donation? 1. Caucasian. 2. African American. 3. Asian. 4. Hispanic.

1, 2 Spinal cord injury patients experience many issues due to loss of innervation below the level of the injury. Skin integrity and incontinence are issues because of immobility and loss of pain receptors below the level of the injury. Skin integrity and incontinence are is- sues because of immobility and loss of pain receptors below the level of the injury.

The nurse is planning care for a patient with a T12 spinal cord injury. Which life-long complications should the patient and family know about? Select all that apply. 1. Skin integrity. 2. Incontinence. 3. Loss of large and small motor activity. 4. Loss of voice. 5. Flaccid paralysis.

1 This client has signs/symptoms of a respiratory complication and should be assessed first.

The nurse on the rehabilitation unit is caring for the following clients. Which client should the nurse assess first after receiving the change-of-shift report? 1. The client with a C6 SCI who is complaining of dyspnea and has crackles in the lungs. 2. The client with an L4 SCI who is crying and very upset about being discharged home. 3. The client with an L2 SCI who is complaining of a headache and feeling very hot. 4. The client with a T4 SCI who is unable to move the lower extremities.

2 The client with the elevated potassium level and poor renal elimination is the client to assess first as the condition could develop into cardiac concerns of arrhythmias such a ventricular fibrillation. Because of the seriousness of the complication, this assessment is the priority. Intense thirst and a low urine specific gravity (1.001 to 1.003) are expected when diagnosed with diabetes insipidus. The blood glucose level of 175 mg/dl (9.71 mmol/L) is elevated, and insulin is given with morning breakfast. The blood glucose level is not at a critical level. The client with a serum calcium level of 8.2 mEq/dl (2.05 mmol/L) is low normal or slightly below normal (depending upon the source), and cramping may be an issue.

The nurse receives morning lab work after shift hand-off. Based on the analysis of lab values, which client would the nurse assess first? 1. a client diagnosed with diabetes insipidus with a urine specific gravity of 1.002 who is asking for morning coffee 2. a client diagnosed with renal disease and a serum potassium level of 6.1 mEq/dl (6.1 mmol/L) who has limited output 3. a client diagnosed with type 1 diabetes and a blood sugar level of 175 mg/dl (9.71 mmol/L) before breakfast 4. a client with diagnosed hypoparathyroidism with a serum calcium level of 8.2 mEq/dl (2.05 mmol/L) who is having cramping in the legs

2 Deep vein thrombosis (DVT) is a potential complication of immobility, which can occur because the client cannot move the lower extremities as a result of the L1 SCI. Low-dose anticoagulation therapy (Lovenox) helps prevent blood from coagulating, thereby preventing DVTs.

The rehabilitation nurse caring for the client with an L1 SCI is developing the nursing care plan. Which intervention should the nurse implement? 1. Keep oxygen via nasal cannula on at all times. 2. Administer low-dose subcutaneous anticoagulants. 3. Perform active lower extremity ROM exercises. 4. Refer to a speech therapist for ventilator-assisted speech.

1 This client is exhibiting signs of autonomic dysreflexia, which requires immediate intervention. A distended bladder may be causing the signs/ symptoms.

The rehabilitation nurse received the A.M. shift report on the following clients. Which client should the nurse assess first? 1. The client with a C-6 SCI who has an elevated blood pressure and has a headache. 2. The client diagnosed with a CVA who is crying and upset about being discharged home. 3. The client who is 1 week postoperative for right THR who has a temperature of 100.4°F. 4. The client who has full-thickness burns who needs to be medicated before being taken to whirlpool.

2 It would be most therapeutic to discuss with the mother and child the best foods to eat and to avoid on a renal diet. Bananas should be limited because of their high potassium content.

What would be the best response if the mother of a 10-year-old boy on kidney dialysis tells the nurse he has no appetite and only eats bananas? 1. "Right now his stomach is upset, and as long as he is eating something to give him strength, it is fine." 2. "Let's talk about your son and his diet." 3. "Bananas are good to eat; they are rich in needed nutrients." 4. "Did you try asking him what else he may want to eat?"

2 A throbbing headache is the classic sign of autonomic dysreflexia, which is caused by a stimulus such as a full bladder.

Which assessment data would make the nurse suspect that the client with a C7 spinal cord injury is experiencing autonomic dysreflexia? 1. Abnormal diaphoresis. 2. A severe throbbing headache. 3. Sudden loss of motor function. 4. Spastic skeletal muscle movement

3 Anaphylaxis leads to circulatory collapse, which decreases perfusion of the kidneys and can lead to acute renal failure.

Which client should the nurse consider at risk for developing acute renal failure? 1. The client diagnosed with essential hypertension. 2. The client diagnosed with type 2 diabetes. 3. The client who had an anaphylactic reaction. 4. The client who had an autologous blood transfusion.

2 The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin.

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. The client will be asymptomatic.

2 Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone.

Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi? 1. Assess the client's neurological status every two (2) hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.

4 Diuretics should be taken in the morning so that the client is not up all night urinating. Thiazide diuretics are prescribed because they decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in the bone. Most kidney stones (75% to 80%) are calcium stones, composed of calcium.

Which intervention should the nurse discuss with the client who has calcium/oxalate renal calculi and who has been prescribed a thiazide diuretic? 1. Tell the client to decrease the intake of fluids. 2. Explain the need to check the potassium level daily. 3. Inform the client to check the blood pressure daily. 4. Instruct the client to take the diuretic in the morning.

3 The assistant can place the client on the bedside commode as part of bowel training; the nurse is responsible for the training but can delegate this task.

Which nursing task would be most appropriate for the nurse to delegate to the unlicensed assistive personnel? 1. Teach Credé's maneuver to the client needing to void. 2. Administer the tube feeding to the client who is quadriplegic. 3. Assist with bowel training by placing the client on the bedside commode. 4. Observe the client demonstrating self-catheterization technique.

1 The reproductive system continues to function properly after a spinal cord injury. Much sexual activity and response occurs in the brain as well.

Which of the following should the nurse include when teaching sexuality education to an adolescent with a spinal cord injury? 1. "You can enjoy a healthy sex life and most likely conceive children." 2. "You will never be able to conceive if you have no genital sensation." 3. "Young men stop producing testosterone and sperm after their injury." 4. "Young women lack estrogen and no longer ovulate after their injury."

C. Options A, B, and D are all at risk for developing CKD. However, option C is not at risk for CKD.

Which patient below is NOT at risk for developing chronic kidney disease?* A. A 58 year old female with uncontrolled hypertension. B. A 69 year old male with diabetes mellitus. C. A 45 year old female with polycystic ovarian disease. D. A 78 year old female with an intrarenal injury.

A. During the oliguric stage of AKI the patient will have a urinary output of 400 mL/day or LESS. This is due to a decreased GRF (glomerular filtration rate), which will lead to increased amounts of waste in the blood (increased BUN/Creatinine), metabolic acidosis (decreased excretion of hydrogen ions), hyperkalemia, hypervolemia (edema/hypertension), and urinary output of <400 mL/day.

Which patient below with acute kidney injury is in the oliguric stage of AKI:* A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day. C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day. D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day.

1 An increased fluid intake ensuring2 to 3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate.

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. "I should increase my fluid intake, especially in warm weather." 2. "I should eat foods containing cocoa and chocolate." 3. "I will walk about a mile every week and not exercise often." 4. "I should take one (1) vitamin a day with extra calcium."

B. A normal phosphate level is 2.7-4.5 mg/dL. This patient is experiencing HYPERphosphatemia. When hyperphosphatemia presents the calcium level DECREASES because phosphate and calcium bind to each. When there is too much phosphate in the blood it takes too much calcium with it and it decreases the calcium in the blood. Therefore, the nurse would expect to find the calcium level decreased.

While assessing morning labs on your patient with CKD. You note the patient's phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be?* A. Elevated B. Low C. Normal D. Same as the phosphate level

A. The oliguric stage can last 1-2 weeks. Regarding the other stages of AKI: Initiation: few hours to several days, diuresis: 1-3 weeks, and recovery: 12 months or more.

While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last?* A. 1-2 weeks B. 1-3 days C. Few hours to 2 weeks D. 12 months

B and D. Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient's phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.

You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply:* A. "This medication will help keep my calcium level normal." B. "I will take this medication with meals or immediately after." C. "It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication." D. "This medication will help prevent my phosphate level from increasing."

B. During the diuresis stage of AKI, the patient will be losing an excessive amount of urine (3-6 Liters/day) and is at risk for fluid volume deficient and electrolyte imbalance. The nurse must monitor the patient's electrolyte levels, especially potassium (hypokalemia).

You're developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing diagnosis would you include in the care plan?* A. Excess fluid volume B. Risk for electrolyte imbalance C. Urinary retention D. Acute pain

D. The patient's potassium level is extremely elevated. A normal potassium level is 3.5-5.1 mEq/L. This patient is experiencing hyperkalemia, which can cause tall peak T-waves. Remember in CKD (especially prior to dialysis), the patient will experience electrolyte imbalances, especially hyperkalemia.

Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality?* A. Phosphate 3.2 mg/dL B. Calcium 9.3 mg/dL C. Magnesium 2.2 mg/dL D. Potassium 7.1 mEq/L

a 10 year old client with ESRD is receiving hemodialysis and experiences chills. which of the following is the most appropriate nursing intervention? a. provide blankets or extra clothing b. increase the temperature in the room c. notify the physician immediately d. stop dialysis

a client is admitted after an MVC resulting in SCI with paraplegia. the nurse recognizes that which of the following will be an early problem for this client? a. nutrition b. the use of assistive devices for ambulation c. bladder control d. need for rehab of quadricep muscles

a client is scheduled for a voiding cystogram. which nursing intervention would be essential to carry out several hours before the test? a. maintain NPO status b. medicating with urinary antiseptics c. administering bowel preparation d. forcing fluids

a client who is to begin continuous ambulatory peritoneal dialysis asks the nurse what this entails. what information should the nurse include when answering the clients questions? a. hemodialysis and peritoneal dialysis will be done together b. peritoneal dialysis is performed in an ambulatory care clinic c. about a quarter of a liter of dialysate is maintained in the peritoneal cavity d. constant contact is maintained between the dialysate and the peritoneal membrane

a client with chronic renal failure is on CAPD. which nursing diagnosis should have the highest priority? a. powerlessness b. high risk for infection c. altered nutrition: less than body requirements d. high risk for fluid volume deficit

a football player suffered a spinal cord injury that left him paraplegic. he continuously talks about his past participation in sports. the most therapeutic response to this clients behavior is: a. wanting to escape and relieve happier times is normal b. your denial about your current condition is not healthy c. reviewing your former accomplishments and your current loss is a way to work through your grief d. would you like the chaplain to visit?

a nurse at a hemodialysis center is caring for a client who has a new order for erythropoietin to be administered subcutaneously. which of the following side effects should the nurse advise the client to report to the HCP? a. anuria b. pruritus c. nausea d. severe headache

a nurse in the ED is caring for a client with a SCI. which intervention should the nurse prioritize? a. place a small pillow under the clients head for comfort b. move the client gently to decrease pain c. restrain the clients arms and legs to limit movement d. immobilize the clients head and neck

a, d, e

a nurse is admitting a client who has been immobile due to a SCI. which of the following findings should the nurse identify as complications of immobility? select all that apply a. contractures of the extremities b. polyuria c. diarrhea d. crackles in the lungs e. pressure ulcers

c, d

a nurse is assessing a client who has experienced a rapid loss of renal function and is determined to be in the prerenal stage of AKI. which of the following findings should the nurse expect? select all that apply a. reduced BUN b. elevated cardiac enzymes c. reduced urine output d. elevated serum creatinine e. increased sodium in the urine

a nurse is assessing a client who has just completed hemodialysis. which of the following signs indicates an increased risk for hemorrhage? a. redness, warmth and tenderness at the vascular site b. cool, pale skin distal to the access site c. auscultation of a swishing sound at the access site d. the presence of blebs or bulging at the vascular access site

a, b, c

a nurse is assessing a client who has manifestations characteristic of end stage renal disease. which of the following findings should the nurse expect? select all that apply a. proteinuria b. marked azotemia c. crackles in the lungs d. decreased potassium level e. moist, oily skin

a nurse is assessing an adolescent female who has CRF. which of the following findings should the nurse expect? a. flushed face b. hyperactivity c. weight gain d. amenorrhea

a nurse is caring for a client transported to the ED by ambulance after a motorcycle accident. the client has a GCS of 13 and a suspected cervical spinal injury. there is a cervical collar in place. which of the following nursing interventions is a priority intervention? a. place the client on a back board b. avoid moving the client c. turn the client on side incase of seizure d. obtain an order for a foley catheter

a nurse is caring for a client who had a cervical spine injury 24 hours ago. which of the following prescribed medications should the nurse clarify with the provider? a. calcium supplements b. plasma expanders c. H2 antagonist d. muscle relaxants

a nurse is caring for a client who had a cervical spine injury 24 hr ago. which of the following prescribed medications should the nurse clarify with the provider? a. calcium supplements b. plasma expanders c. H2 antagonist d. muscle relaxants

a nurse is caring for a client who is undergoing peritoneal dialysis. which of the following is a complication associated with this procedure? a. anemia b. peritonitis c. hypoglycemia d. hypertension

a nurse is caring for a client who sustained a severe SCI 2 days ago involving a T12 fracture. the client has no muscle control of the lower limbs, bowel, or bladder. in planning care which of the following outcomes should be the nurses highest priority? a. prevention of further damage to the spinal cord b. prevention of UTIs c. prevention of skin breakdown of areas that lack sensation d. prevention of contractures to the lower extremities

a nurse is caring for a client with ARF who is undergoing hemodialysis. what should the nurse consider when educating the client on healthy food? a. increase in dairy products to maintain phosphorus balance b. decrease total fat intake to 45% of daily calories c. decrease potassium intake to 40mg/kg/day d. limit sodium intake to 4.5 g/day

a nurse is caring for a client with a AV fistula in his right arm. which of the following is a correct nursing action when caring for the client? a. use the shunt to draw pre-dialysis labs b. take the BP in the right arm c. keep the cannula patent by injecting heparin every 8 hours d. gently palpate the shunt for a bruit

a nurse is caring for a client with a traumatic SCI as a result of a diving accident. the client has lost motor function below the injury but has some preserved sensory function at and below the level of the injury. how is this injury classified according to the American Spinal Injury Associations scale? a. grade A SCI b. grade B SCI c. grade C SCI d. grade D SCI

a nurse is caring for a client with diabetic neuropathy who is receiving peritoneal dialysis and experiences abdominal pain and chills. the client has a temperature of 100.3 and a glucose level of 180. which of the following is priority nursing intervention? a. assist the client to the high fowlers position b. administer IV insulin c. obtain peritoneal fluid for C&S d. warm the dialysate

a turning self in bed or position changes will help reduce the complications that go along with immobility

a nurse is caring for a hospitalized adult client who was injured in a MVA and suffered a SCI 3 days ago. the client has been paralyzed below the level of T5 on the spinal cord. based on the information provided which of the following nursing interventions is most important? a. increase the clients activity level as quickly as possible b. teach the client to promote circulation through ankle rotation and foot pumping c. administer vasodilator medications as ordered d. place an abdominal binder on the client and remove it every 24 hours

a, b, c, e

a nurse is planning care for a client who has EDKD and is receiving hemodialysis. which of the following actions should the nurse include in the plan of care? select all that apply a. monitor the clients daily weight b. encourage the client to comply with fluid restrictions c. evaluate I&O d. instruct the client about restricting calories from carbohydrates e. monitor the client for elevated potassium levels

a, b, c, e

a nurse is planning care for a client who has ESRD. which of the following interventions should the nurse include in the plan? select all that apply a. assess for jugular vein distention b. provide frequent mouth rinses c. observe for the development of Kussmaul respirations d. provide a diet high in potassium e. monitor for melena

a, b, d

a nurse is planning care for a client who has intrarenal AKI due to aminoglycoside antibiotic therapy. the client has a serum creatinine of 5. which of the following interventions should the nurse include in the plan? select all that apply a. provide proteins from animal sources b. bathe the client with cool water c. ambulate the client 4 times a day d. weigh the client daily e. provide NSAIDs for pain

a nurse is planning care for a client who has prerenal AKI following an MI. the clients urinary output is 60mL the past 2 hr and BP is 92/58. which of the following interventions should the nurse anticipate a prescription for? a. a CT scan with dye b. administer nitroprusside 0.3mcg/kg/min IV c. a fluid challenge with 0.9% NaCl d. addition of 40 mEq potassium to iv fluids

a nurse is planning care for a client who has prerenal AKI following an acute MI. the clients urinary output is 60ml in the past 2 hours, and BP is 98/58. which of the following interventions should the nurse anticipate a prescription for? a. a CT scan with dye b. administer nitroprusside 0.3 mcg/kg/min IV c. a fluid challenge with 0.9% NaCl d. addition of 40 mEq of potassium to IV fluids

a, b, d

a nurse is preparing to initiate hemodialysis through an AV fistula for a client who has ESRD. which of the following actions should the nurse take? select all that apply a. review the clients current medications b. assess the AV fistula for a bruit c. calculate the clients hourly urine output d. measure the clients weight e. administer heparin SQ f. obtain pre-dialysis serum lab from a site distal to the fistula

a, b, d, e

a nurse is preparing to initiate peritoneal dialysis for a client who has CKD. which of the following actions should the nurse take? select all that apply a. monitor the clients glucose levels b. report cloudy dialysate return c. warm the dialysate in a microwave oven d. assess the client for the presence of SOB e. position the drainage bag lower than the clients abdomen f. maintain medical asepsis when accessing the catheter insertion site

a nurse is providing a meal tray to a client who has just returned from a hemodialysis treatment. which best describes the dietary choices most likely to be included in the clients meal? a. high calorie, high protein b. low calorie, high sodium c. high calorie saturated fats d. low calorie, low protein

a, b, c, d

a nurse is providing discharge teaching to a client who is to begin dialysis. which of the following instructions about protein intake should the nurse include? select all that apply a. consume 1.2 g of protein per kg of body weight b. take phosphate binders when eating protein rich foods c. increase intake of complete sources of protein d. increase protein intake by 50% of the recommended dietary allowance e. consume daily protein intake in the morning

a nurse is receiving change of shift report about a group of clients. which of the following actions should the nurse perform first? a. evaluate each clients progress toward meeting the goals of the client b. collect and organize data about the clients c. establish priorities of care for each client and among the clients d. deliver interventions that will improve the clients outcomes

a nurse is reviewing the lab results of a middle aged client who has stage 4 CKD. which of the following findings should the nurse expect? a. BUN 15 b. GFR 20 c. Creatinine 1.1 d. potassium 5.0

a nurse is teaching a client who has CKD about dietary management. what should the nurse include in the teaching instructions? a. restrict protein intake b. maintain a high phosphorus diet c. increase intake of foods high in potassium d. calcium intake should be increased

a nurse is teaching a newly licensed nurse about hemodialysis for clients who have chronic kidney disease. which of the following statements by the newly licensed nurse indicates an understanding of the teaching? a. hemodialysis restores kidney function b. hemodialysis requires the placement of the catheter into a peritoneal space c. hemodialysis allows an unrestricted diet d. hemodialysis returns a balance to serum electrolytes

as part of an annual physical exam a 60 year old adult male has had lab work done. which of the following serum creatinine levels would indicate that the client has a mild degree of renal insufficiency? a. 4.0 b. 3.3 c. 1.7 d. 0.8

conditions known to predispose to renal calculi formation include: a. polyuria b. dehydration, immobility c. glycosuria d. presence of an indwelling urinary catheter

d atonic bladder is a complication of SCI and increasing fluid will decrease the incidence of UTI

following a SCI the nurse instructs the client to drink fluids primarily to: a. maintain fluid and electrolyte balance b. prevent dehydration c. prevent skin breakdown d. prevent UTI

following a SCI the nurse instructs the client to drink fluids primarily to: a. maintain fluid and electrolyte balances b. prevent dehydration c. prevent skin breakdown d. prevent infection of the urinary tract

one of the most common causes of end stage renal disease requiring hemodialysis is: a. PVD b. diabetes mellitus c. rheumatoid arthritis d. hepatic encephalopathy

the nurse is caring for a client with a SCI. the nurse understands that which of the following SCI complications is accurately paired with its description? a. poikilothermia: a type of neurogenic shock that occurs in clients with a SCI above T6 b. autonomic dysreflexia: a life threatening complication that occurs in clients with a SCI above T6 c. autonomic dysreflexia: poikilothermia is the body's loss of ability to control and regulate body temperature d. neutropenia: an abnormally low neutrophil count

the nurse is planning care for a client who has sustained a SCI at the level of the lumbar spine. the nurse should assess the client for: a. anesthesia below the level of the injury b. tingling in the fingers c. pain below the site of injury d. loss of arm movement

the nurse would expect to find an improvement in which of the blood values as a result of dialysis treatment? a. high serum creatinine levels b. low hemoglobin c. hypocalcemia d. hypokalemia

b, e

while caring for a client who has a SCI, the nurse decides to turn the client on his side. they use the logrolling technique. which of the following statements are true regarding this turning method? select all that apply a. logrolling should be performed carefully when only 1 person is moving the client b. the nurse at the clients head controls the turn c. the nurse at the head turns first followed by the staff at the clients waist d. the neck is extended during the turn e. the client remains in alignment while turning

while performing daily peritoneal dialysis and catheter exit site care with the mother of a child with CRF, the importance of which is the most important to emphasize to the mother? a. applying the occlusive dressing after cleaning the site b. changing the dressing when the peritoneal space is dry c. examining the area while cleaning it for any sign of infection d. pulling on the catheter to hold it taut while cleaning the skin

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