NURS 309 Quiz 12
233. A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end stage renal disease (ESRD) a. fluid b. protein c. sodium d. potassium
b
30. The nurse requests a dietary consult to address the patient's high rate of catabolism. Which nutritional element is directly related to this metabolic process? a. Carbohydrates b. Proteins c. Liquids d. Fats
b
3. What are common causes of pre renal kidney injury? (select all that apply) a. Uretral cancer b. Hypovolemic shock c. Enlarged prostate gland d. Sepsis e. Severe burns
b,d,e
36. The nurse is taking a history on a patient with diabetes and hypertension. Because of the patient's high risk for developing kidney problems, which early sign of chronic kidney disease (CKD) does the nurse assess for? a. Decreased output with subjective thirst b. Urinary frequency of very small amounts c. Pink or blood-tinged urine d. Increased output of very dilute urine
d
21. The nurse is caring for a patient with AKI that developed after a severe anaphylactic reaction. What is the primary treatment goal of the initial phase that will help to prevent permanent kidney damage for this patient? a. Correct fluid volume by administering IV normal saline b. Maintain a mean arterial pressure (MAP) of 65 mm Hg c. Prevent kidney infections by administering antibiotics d. Give antihistamines to prevent allergic response
b
22. A patient sustained extensive burns and depletion of vascular volume. The nurse expects which changes in vital signs and urinary function? a. Decreased urine output, hypotension, tachycardia b. Increased urine output, hypertension, tachycardia c. Bradycardia, hypotension, polyuria d. Dysrhythmias, hypertension, oliguria
a
232. A client is admitted to a medical unit with the dx of acute kidney failure. The nurse reviews the client's lab data, performs a physical assessment, and obtains the client's vital signs. What should the nurse conclude the client is most likely experiencing? a. hyperkalemia b. hyponatremia c. hypouricemia d. hypercalcemia
a
29. A patient with AKI has a high rate of catabolism. What is this related to? a. Increased levels of catecholamines, cortisol, and glucagon b. Inability to excrete excess electrolytes c. Conversion of body fat into glucose d. Presence of retained nitrogenous wastes
a
58. The nurse is reviewing the medication list and appropriate dose adjustments made for a patient with CKD. The nurse would question the use and/or dosage adjustment of which type of medication? a. Antibiotics b. Magnesium antacids c. Oral antidiabetics d. Opioids
b
6. as team leader, you observe the UAP perform all of these actions for ms j. Which action must you intervene? a. assisting her to replace the oxygen nasal cannula b. measuring vs after the pt drinks fluids c. ambulating with the pt to the bathroom and back d. washing her back, legs and feet with warm water
b
64. As a patient with ESKD experiences isosthenuria. What must the nurse be alert for? a. The diuretic stage b. Fluid volume overload c. Dehydration d. Alkalosis
b
75. The nurse is assessing a patient's extremity with an arteriovenous graft. The nurse notes a thrill and a bruit, and the patient reports numbness and a cool feeling in the fingers. How does the nurse interpret this information in regard to the graft? a. The graft is functional and these symptoms are expected b. The patient has "steal syndrome" and may need surgical intervention c. The graft is patent. but the blood is flowing in the wrong direction. d. The patient needs to increase active use of hands and fingers.
b
95. The nurse is caring for the kidney transplant patient who is 3 days postsurgery. The nurse notes a sudden and abrupt decrease in urine. The nurse alerts the health care provider because this is a sign of which anomaly? a. Rejection b. Thrombosis c. Stenosis d. Infection
b
78. The nurse is caring for a patient with an arteriovenous fistula. What is included on the nursing care for this patient? (select all that apply) a. Keep small clamps handy by the bedside. b. Encourage routine range-of-motion exercises. c. Avoid venipuncture or IV administration on the arm with the access device d. Instruct the patient to carry heavy objects to build muscular strength e. Assess for manifestations of infection of the fistula f. Instruct the patient to sleep on the side with the affected arm in the dependent position.
b,c,e
689. A nurse is caring for a client with chronic kidney failure. Which clinical findings should the nurse expect when assessing this client? select all a. polyuria b. lethargy c. hypotension d. muscle twitching e. respiratory acidosis
bd
13. For a patient with AKI, the nurse would consider questioning the order for which diagnostic test? a. Kidney biopsy b. Ultrasonography c. Computed tomography with contrast dye d. Kidney, ureter, bladder (KUB) x-ray
c
2. which task associated with 24hr urine collection is appropriate to delegate to the UAP? a. instructing ms. j to collect all urine with each voiding b. teaching ms j the purpose of collecting urine for 24hrs c. ensuring that all urine obtained for the test is kept on ice d. assessing ms j's urine for color, odor and sediment
c
41. The nurse is assessing a patient with kidney injury and notes a marked increase in the rate and depth of breathing. The nurse recognizes this as Kussmaul respiration, which is the body's attempt to compensate for which condition? a. Hypoxia b. Alkalosis c. Acidosis d. Hypoxemia
c
2. The community health nurse is designing programs to reduce kidney problems and kidney injury among the general public. In order to do so, the nurse targets health promotion and compliance with therapy for people with which conditions? a. Diabetes mellitus and hypertension b. Frequent episodes of sexually transmitted disease c. Osteoporosis and other bone diseases d. Gastroenteritis and poor eating habits
a
68. The nurse is assessing a patient with uremia. Which gastrointestinal changes does the nurse expect to find? (select all that apply) a. Halitosis b. Hiccups c. Anorexia d. Nausea e. Vomiting f. Salivation
a,b,c,d,e
7. The nurse reads in the patient's chart that he has acute-on-chronic kidney disease. How does the nurse interpret this information? a. Kidney disease has progressed to the need for dialysis transplant. b. Patient has chronic kidney disease and has sustained an acute kidney injury. c. Acute kidney injury requires aggressive management to prevent chronic disease. d. The condition could be acute or chronic; further diagnostic testing is needed.
b
65. The nurse is caring for a patient with CKD. The family asks about when renal replacement therapy will begin. What is the nurse's best response? a. "As early as possible to prevent further damage in stage I." b. "When there is reduced kidney function and metabolic wastes accumulate." c. "When the kidneys are unable to maintain a balance in body functions." d. "It will be started with diuretic therapy to enhance the remaining function."
c
37. Increased BUN and creatinine, hyperkalemia, and hypernatremia are all characteristics of which stage of kidney disease? a. Stage 1 CKD b. Mild CKD c. Moderate CKD d. ESKD
d
96. What might the nurse notice if the patient is experiencing reduced perfusion and altered urinary elimination related to AKI? (select all that apply) a. Hemodynamic instability, especially persistent hypotension and tachycardia b. Urine output of less than 0.5 mL/kg/hour for 6 or more hours c. Serum creatinine below baseline or admission values d. Urine may be clear or have a pale yellow color e. Abnormal serum and urine potassium and sodium values
a,b,e
91. Which patients are likely to be excluded from receiving a transplant? (select all that apply) a. Patient who has breast cancer 6 years ago b. Patient with advanced and uncorrectable heart disease c. Patient with a chemical dependency d. Patient who is 70 years of age and has a living related donor e. Patient with diabetes mellitus
b,c
39. The nurse is reviewing a patient's laboratory results. In the early phase of CKD, the patient is at risk for which electrolyte abnormality? a. Hyperkalemia b. Hyponatremia c. Hypercalcemia d. Hypokalemia
b
67. As a result of kidney failure, excessive hydrogen ions cannot be excreted. With acid retention, the nurse is most likely to observe what type of respiratory compensation? a. Cheyne-Stokes respiratory pattern b. Increased depth of breathing c. Decreased respiratory rate and depth d. Increased arterial carbon dioxide levels
b
687. A client with acute kidney failure states why am i twitching and my fingers and toes tingling? The nurse should respond "this is caused by" a. acidosis b. calcium depletion c. potassium retention d. sodium chloride depletion
b
9. you are supervising a new nurse on orientation to the unit who is providing care for ms j after her return from surgery to create a left forearm access for dialysis. which action by the nurse requires that you intervene? a. monitoring the pts operative site dressing for evidence of bleeding b. obtaining a BP reading by placing the cuff on the right arm c. drawing blood for lab studies from the temp dialysis line d. administering oxycodone PO for moderate postop pain
c
11. Which combination of drugs is the most nephrotoxic. a. Angiotensin-converting enzyme (ACE) inhibitors and aspirin. b. Angiotensin II receptor blockers and antacids c. Aminoglycoside antibiotics and non steroidal anti-inflammatory drugs (NSAIDS) d. Calcium channel blockers and antihistamines
c
42. A patient is diagnosed with renal osteodystrophy. What does the nurse instruct the unlicensed assistive personnel (UAP) to do in relation to the patient's diagnosis? a. Assist the patient with toileting every 2 hours. b. Gently wash the patient's skin with mild soap and rinse well. c. Handle the patient gently because of risk for fractures d. Assist the patient with eating because of loss of coordination
c
47. What type of breath odor is most likely to be noted in a patient with CKD? a. Fruity smell b. Fecal smell c. Smells like urine d. Smells like blood
c
50. The nurse notes an abnormal laboratory test finding for a patient with CKD and alerts the health care provider. The nurse also consults with the registered dietitian because of excessive dietary protein intake is directly related to what factor? a. Elevated serum creatinine level b. Protein presence in the urine c. Elevated BUN level d. Elevated serum potassium level
c
40. A patent with CKD has a potassium level of 8 mEq/L. The nurse notifies the health care provider after assessing for which signs/symptom? a. Cardiac dysrhythmias b. Respiratory depression c. Tremors or seizures d. Decreased urine output
a
43. A patient with CKD develops severe chest pain, an increased pulse, low-grade fever, and a pericardial friction rub wth a cardiac dysrhythmia and muffled heart tones. The nurse immediately alerts the health care provider and prepares for which emergency procedure? a. Pericardiocentesis b. CVVH c. Kidney dialysis d. Endotracheal intubation
a
70. The home health nurse is evaluating the home setting for a patient who wishes to have income hemodialysis. What is important to have in the home setting to support this therapy? a. Specialized water treatment system to provide a safe, purified water supply b. Large dust-free space to accommodate and store dialysis equipment c. Modified electrical system to provide high voltage to power the equipment d. Specialized cooling system to maintain strict temperature control
a
73. A patient is undergoing a dialysis treatment and exhibits a progression of symptoms which include headache, nausea, and vomiting, and fatigue. How does the nurse interpret these symptoms? a. Mild dialysis disequilibrium syndrome b. Expected manifestations of ESKD c. Transcient symptoms in a new dialysis patient d. Adverse reaction to dialysis
a
76. The nurse is providing post dialysis care for a patient. In comparing vital signs and weight measurements to the predialysis data, what does the nurse expect to find? a. Blood pressure and weight are reduced b. Blood pressure is increased and weight is reduced c. Blood pressure and weight are slightly increased d. Blood pressure is low and weight is the same
a
79. A patient has returned to the medical-surgical unit after having a dialysis treatment. The nurse notes that the patient is also scheduled for an invasive procedure on the same day. What is the primary rationale for delaying the procedure for 4 to 6 hours? a. The patient was heparinized during dialysis b. The patient will have cardiac dysrhythmias c. The patient will be incoherent and unable to give consent d. The patient needs routine medicine that were delayed
a
80. The nurse is talking to a patient with ESKD. The Patient frequently displays weight gain and increased blood pressure beyond the baseline of measurements. Which question is the nurse most likely to ask to determine if the patient is doing something that is contributing to these assessment findings? a. "Are you controlling your salt intake?" b. "Are you following the protein restrictions?" c. "Have you been eating a lot of sweets?" d. "Have you been exercising regularly.
a
84. What is the best action for the CAPD? a. Daily infusion of four 2 L exchanges of dialysate every 4 to 6 hours while awake b. Is a form of automated dialysis the uses an automated cycling machine c. Functions of the cycling machine are programmed to the patient's needs d. This form decreases the risk of peritonitis and poor dialysate flow.
a
9. The nurse is caring for a patient who had hypovolemic shock secondary to trauma in the emergency department (ED) 2 days ago. Based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess at least every hour? a. Urinary output b. Presence of edema c. Urine color d. Presence of pain
a
6. When shock or other problems cause an acute reduction in blood flow to the kidneys, how do the kidneys compensate? (select all that apply) a. Constrict blood vessels in the kidneys. b. Activate the renin-angiotensin-aldosterone pathway. c. Release beta blockers. d. Dilate blood vessels throughout the body. e. Release antidiuretic hormones.
a,b,e
46. The night shift nurse sees a patient with kidney failure sitting up in the bed. The patient states, "I feel a little short of breath at night or when I get up to walk to the bathroom." What assessment does the nurse do? a. Check for orthostatic hypotension because of potential volume depletion b. Auscultate the lungs for crackles, which indicate fluid overload. c. Check the pulse and blood pressure for possible decreased cardiac output d. Assess for normal sleep pattern and need for PRN sedative
b
52. A patient receives dialysis therapy and the health care provider has ordered sodium restriction to 3g daily. What does the nurse teach this patient? a. Add smaller amounts of salt at the table or during cooking. b. Identify foods that are high in sodium (e.g., bacon, potato chips, fast foods). c. Avoid foods that have a metallic, salty, or bitter taste d. Eat larger amounts of bland foods with very minimal amounts of spicing.
b
72. A patient and family are trying to plan a schedule that coordinates with the patient's dialysis regimen. The patient asks, " How often will I have to go and how long does it take? What is the nurse's best response? a. " If you are compliant with the diet and fluid restrictions. you spend less time in dialysis: about 12 hours a week." b. "Most patients requires about 12 hours per week: this is usually divided into three 4-hour treatments." c. " It varies from patient to patient. You will have to call your health care provider for the specific instructions." d. " If you gain a large amount of fluid weight, a longer treatment time may be needed to prevent severe side effects."
b
8. after discussing renal replacement therapies with the health care provider and nurse, ms j is considering hemodialysis (HD). which statement indicates that ms j needs additional teaching about HD? a. i will need surgery to create an access route for HD b. i will be able to eat and drink what i want once i start dialysis c. i will have a temporary dialysis catheter for a few months d. i will be having dialysis 3 times every week
b
87. During PD, the nurse notes slowed dialysate outflow. What does the nurse do to troubleshoot the system? (select all that apply) a. Ensure that the drainage bag is elevated b. Inspect the tubing for kinking or twisting c. Ensure that clamps are open d. Turn the patient to the other side e. Make sure the patient is in good body alignment f. Instruct the patient to stand or cough
b,c,d,e
92. A daughter is considering donating a kidney to her mother for organ transplant. What information does the nurse give to the daughter about the criteria for donation? (select all that apply) a. Age limit is at least 21 years old b. Systemic disease and infection must be absent c. There must be no history of cancer d. Hypertension or kidney disease must be absent e. There must be adequate kidney function as determined by diagnostic studies f. The donor must understand the surgery and be willing to give up the organ.
b,c,d,e,f
10. assessment of ms j after dialysis reveals all of these findings. which assessment finding necessitates immediate action? a. weight decrease of 4.5lbs b. systolic bp decrease of 14mmHg c. decreased LOC d. small blood spot near the center of the dressing
c
83. The health care provider ordered intraperitoneal heparin for a patient with a new PD catheter to prevent clotting of the catheter by blood and fibrin formation. How does the nurse advise the patient? a. Watch for bruising or bleeding from the gums b. Make a follow-up appointment for coagulation studies c. Intraperitoneal heparin does not affect clotting times d. Heparin will be given with a small subcutaneous needle.
c
88. A patient has recently started PD therapy and reports some mild pain when the dialysate is flowing in. What does the nurse do next? a. Immediately report the pain to the health care provider. b. Try warming the dialysate in the microwave oven. c. Reassure that pain should subside after the first week or two. d. Assess the connection tubing for kinking or twisting.
c
89. The nurse is caring for a patient requiring PD. In order to monitor the patient's weight, what does the nurse do? a. Check the weight after a drain and before the next fill to monitor the patient's "dry weight." b. Calculate the "dry weight" by weighing the patient every day and comparing the measurements to baseline. c. Determine "dry weight" by comparing the patient's weight to a standard weight chart based on height and age. d. Weigh the patient each day and count fluid intake and dialysate volume to determine the patient's "dry weight"
a
19. You are providing nursing care for a patient with acute kidney failure for whom a nursing dx of excess fluid volume related to compromised regulatory mechanisms has been identified. Which actions should you delegate to an experienced UAP? select all a. measuring and recording vital sign values every 4 hours b. weighing the pt every morning using a standing scale c. administering furosemide (lasix) 40 mg orally twice a day d. reminding the pt to save all urine for intake and output measurement e. assessing breath sounds every 4 hours f. ensuring that the pts urinal is within reach
abdf
1. During admission assessment, Ms J has all of these findings. For which finding should you notify the health care provider immediately? a. bilateral pitting ankle and calf edema 2+ b. crackles in both lower and middle lobes c. dry and peeling skin on both feet d. faint but palpable pedal and post tibial pulses
b
86. The nurse is teaching a patient about performing PD at home. In order to identify the earliest manifestation of peritonitis what does the nurse instruct the patient to do? a. Monitor temperature before starting PD. b. Check the effluent for cloudiness. c. Be aware of feeling of malaise. d. Monitor for abdominal pain
b
71. The nursing student is explaining principles of hemodialysis to the nursing instructor. Which statement made by the student indicates a need for additional study and research on the topic? a. " Dialysis works as molecules from an area of higher concentration move to an area of lower concentration." b. " Blood and dialyzing solution flow in opposite directions across an enclosed semipermeable membrane." c. " Excess water, waste products, and excess electrolytes are removed from the blood." d. " Bacteria and other organisms can also pass through the membrane, so the dialysate must be kept sterile."
d
74. The nurse is caring for a patient with an arteriovenous fistula. What instructions are given to the UAP regarding the care of this patient? a. Palpate for thrills and auscultate for bruits every 4 hours. b. Check for bleeding at needle insertion sites c. Assess for patients distal pulses and circulation d. Do not the blood pressure reading in the arm with the fistula.
d
77. The nurse is assessing a patient who has just returned from hemodialysis. Which assessment finding is cause for greatest concern? a. Feeling of malaise b. Headache c. Muscle cramps in the legs d. Bleeding at the access site
d
81. Which patient with kidney problems is the best candidate for peritoneal dialysis (PD)? a. Patient with peritoneal adhesions b. Patient with a history of extensive abdominal surgery. c. Patient with peritoneal membrane fibrosis d. Patient with a history of difficulty with anticoagulants
d
53. In order to assist a patient in the prevention of osteodystrophy, which intervention does the nurse perform? a. Administer phosphate binders with meals b. Encourage high-quality protein foods c. Administer iron supplements d. Encourage extra milk at mealtimes
a
27. Which signs/symptoms does the nurse expect to see in the patient with AKI that has progressed in severity? (select all that apply) a. Oliguria b. Hypotension c. Shortness of breath d. Pulmonary crackles e. Weight loss
a,c,d
69. Which patients with CKD are candidates for intermittent hemodialysis? (select all that apply) a. Patient with fluid overload who does not respond to diuretics b. Patient with injury stage according to RIFLE classification c. Patient with symptomatic toxin ingestion d. Patient with uremic manifestations. such as decreased cognition e. Patient with symptomatic hyperkalemia and calciphylaxis
a,c,d,e
28. A patient has AKI related to nephrotoxins. In order to maintain cell integrity, improve GFR, and improve blood flow to the kidneys, which type of mediation does the nurse anticipate the health care provider will prescribe? a. Loop diuretics b. Alpha-adrenergic blockers c. Beta blockers d. Calcium channel blockers
d
33. The nurse and the dietitian are planning dietary intake for a patient with AKI who is currently not on dialysis therapy. The dietitian informs the nurse that 0.6 g/kg of body weight of protein are needed. The patient weighs 130 pounds. How many grams of protein should the patient receive? (Round grams to the nearest whole number.)___________grams
35
55. The nurse is caring for a patient with ESKD and dialysis has been initiated. Which drug order does the nurse question? a. Erythropoietin b. Diuretic c. Ace inhibitor d. Calcium channel blocker
b
82. Place the sequence of steps of continuous ambulatory peritoneal dialysis (CAPD) in the correct order using the numbers 1 through 4. _______a. Fluid stays in the cavity for a specific time prescribed by the health care provider. _______b. 1 to 2 L of dialysate is infused by gravity over a 10-to 20-mintue period _______c. Fluid flows out of the body by gravity into a drainage bag. _______d. Warm the dialysate bags before instillation by using a heating pad to wrap the bag.
a.3; b.2; c.4; d.1
676. A nurse is caring for a client with end stage renal disease. Which clinical indicators of end stage renal disease should the nurse expect? select all a. polyuria b. jaundice c. azotemia d. hypertension e. polycythemia
cd
15. The nurse is caring for a patient receiving gentamicin. Because this drug has potential for nephrotoxicity. which laboratory results does the nurse monitor? (select all that apply) a. Blood urea nitrogen (BUN) b. Creatine c. Drug peak and trough levels d. Prothrombin time (PT) e. Platelet count f. Hemoglobin and hematocrit
a,b,c
85. The home health nurse is visiting a patient who independently performs PD. Which question does the nurse ask the patient to assess for the major complication associated with PD? a. "Have you noticed any signs or symptoms of infection." b. "Are you having any patin during the dialysis treatment." c. "Is the dialysis fluid slow or sluggish." d. "Have you noticed any leakage around the catheter."
a
11. 6 months later ms j is readmitted to the unit. she has just returned from HD. Which nursing care action should you delegate to the UAP? a. measuring vs and postdialysis weight b. assessing the HD access site for bruit and thrill c. checking the access site dressing for bleeding d. instructing the pt to request assistance getting out of bed
a
13. you are caring for ms j 1 day postop. On assessment her temp is 100.4F, bp is 168/92, and the pt tells you she has pain around the transplant site. what is the best interpretation of these findings? a. hyperacute rejection b. acute rejection c. chronic rejection d. transplant site infection
a
14. The nurse is caring for a postoperative patient and is evaluating the patient's intake and output as a measure to prevent AKI. The patient weighs 60 kilograms and has produced 180 mL of urine in the past 4 hours. What should the nurse do? a. Perform other assessments related to fluid status and record the output. b. Call the health care provider and obtain an order for a fluid bolus. c. Encourage the patient to drink more fluid, so that the output is increased. d. Compare the patient's weight to baseline to determine fluid retention.
a
16. According to the RIFLE classification (Risk. Injury, Failure, Loss, End-stage kidney failure). How would the nurse interpret the following date? Serum creatine increased x 1.5 or glomerular filtration rate (GFR) decrease > 25%; Urine output is < 0.5mL/kg/hr for ≥ 6 hours. a Risk stage b. Injury stage c. Failure stage d. End-stage kidney disease (ESKD)
a
3. you review ms js lab results. which finding is of most concern? a. serum potassium level of 7.1 b. serum creatinine of 15 c. BUN of 180 d. serum calcium of 7.8
a
90. The nurse is monitoring a patient's PD treatment. The Total output is slightly less than the inflow. What does the nurse do next? a. Instruct the patient to ambulate b. Notify the health care provider c. Record the difference as intake d. Put the patient on fluid restriction.
c
94. The intensive care nurse is caring for the kidney transplant patient who was just transferred from the recovery unit. Which finding is the most serious within the first 12 hours after surgery and warrants immediate notification of the transplant surgeon? a. Diuresis with increased output b. Pink and bloody urine c. Abrupt decrease in urine d. Small clots in bladder irrigation fluid
c
93. The nurse is caring for the kidney transplant patient in the immediate postoperative period. During the initial period, the nurse will assess the urine output at least every hour for how many hours? a. First 8 hours b. First 12 hours c. First 24 hours d. First 48 hours
d
35. Which characteristics are associated with ESKD? (select all that apply) a. Severe fluid overload b. Renal osteodystrophy c. Nephrons compensate d. Dialysis or transplant needed to maintain homeostasis e. Excessive water products
a,b,d,e
66. Which are the most accurate ways to monitor kidney function in the patient with CKD? (select all that apply) a. Monitoring intake and output b. Checking urine specific gravity c. Reviewing BUN and serum creatinine levels d. Reviewing x-ray reports e. Consulting dietitian's notes
a,b,c
1. Which problems occur with acute kidney injury (AKI)? (select all that apply) a. Decreased peristalsis b. Anemia c. Metabolic acidosis d. Hypokalemia e. Peripheral edema
a,b,c,e
51. In collaboration with the registered dietitian, the nurse teaches the patient about which diet recommendations for management of CKD? (select all that apply) a. Controlling protein intake b. Limiting fluid intake c. Restricting potassium d. Increasing sodium e. Restricting phosphorus f. Reducing calories
a,b,c,e
4. A patient can develop intrarenal kidney injury from which causes? (select all that apply.) a. Vasculitis b. Pyelonephritits c. Strenuous exercise d. Exposure to nephrotoxins e. Bladder cancer
a,b,d
57. A patient with CKD is taking digoxin (Lanoxin). Which symptoms of digoxin toxicity does the nurse vigilantly monitor for? (select all that apply) a. Nausea and vomiting b. Visual changes c. Respiratory depression d. Restlessness or confusing e. Headache or fatigue f. Tachycardia
a,b,d,e,f
12. The nurse is caring for several patients on a medical-surgical unit. None of the patients currently has any acute or chronic kidney problems. Which patient has the greatest risk to develop AKI? a. 73-year-old male who has hypertension and peripheral vascular disease b. 32-year-old female who is pregnant and has gestational diabetes c. 49-year-old male who is obese and has a history of skin cancer d. 23-year-old female who has been treated for urinary tract infection
a
20. The nurse is caring for a patient with AKI and notes a trend of increasingly elevated BUN levels. How does the nurse interpret this information? a. Breakdown of muscle for protein which leads to an increase in azotemia. b. Sign of urinary retention and decreased urinary output. c. Expected trend that can be reversed by increasing dietary protein. d. Ominous sign of impending irreversible kidney failure.
a
31. The nurse is caring for a patient in the intensive care unit who sustained a blood loss during a traumatic accident. For early identification of sings and symptoms would suggest the development of kidney dysfunction, what does the nurse observe for? (select all that apply) a. Hypotension b. Bradycardia c. Decreased urine output d. Decreased cardiac output e. Increased central venous pressure
a,c,d
38. A patent's laboratory results show an elevated creatinine level. The patient's history reveals no risk factors for kidney disease. Which question does the nurse ask the patient to shed further light on the laboratory result? a. " How many hours of sleep did you get the night before the test?" b. " How much fluid did you drink before the test?" c. " Did you take any type of antibiotics before taking the test?" d. " When and how much did you last urinate before having the test?"
c
61. Which behavior is the strongest indicator that a patient with ESKD is not coping well with the illness and may need a referral for a psychological counseling? a. Displays irritability when the meal tray arrives. b. Refuses to take one of the drugs because it causes nausea c. Repeatedly misses dialysis appointments d. Seems distracted when the health care provider takes about the prognosis
c
63. Which patient is the most likely candidate for CVVH? a. Patient with fluid volume overload b. Patient who needs long-term management c. Patient who is critically ill d. Patient who is ready for discharge to home
c
686. A nurse is caring for a client with acute kidney failure who is receiving a protein restricted diet. The client asks why this diet is necessary. What information should the nurse include in a response to the clients questions? a. a high protein diet ensures an adequate daily supply of amino acids to compensate for losses b. essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis c. this supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys d. urea nitrogen can't be used to synthesize amino acids in the body so the nitrogen for amino acid synthesis must come from the dietary protein
c
8. The nurse is talking to a group of healthy young college students about maintaining good kidney health and preventing AKI. Which health promotion point is the nurse most likely to emphasize with this group? a. " Have your blood pressure checked regularly." b. " Find out if you have a family history of diabetes." c. " Avoid dehydration by drinking at least 2 to 3 L of water daily." d. " Have annual testing for microalbuminuria and urine protein."
c
12. ms j is preparing for discharge. you are supervising a student nurse who is teaching the pt about her discharge meds. which statement by the SN will you intervene? a. sevelamer prevents your body from absorbing phosphorus b. take your folic acid after dialysis on dialysis days c. the docusate is to prevent constipation that may be caused by ferrous sulfate d. you must take the epoetin alfa 3 times a week by mouth to treat anemia
d
14. what intervention is required at this time? a. increased doses of immunosuppressive drugs b. IV antibiotics c. conservative management including dialysis d. immediate removal of the transplanted kidney
d
17. A patient has been diagnosed with AKI, but the cause is uncertain. The nurse prepares patient educational material about which diagnostic test? a. Flat plate of the abdomen b. Renal ultrasonography c. Computed tomography d. Kidney biopsy
d
25. A patient with AKI is ill and has a poor appetite. What would the health care team try first? a. Iv normal saline to prevent dehydration b. Familiar foods brought by the family c. Nasogastric tube for enteral feedings d. Oral supplements designed for kidney patients
d
25. you are caring for a pt admitted with dehydration secondary to deficient antidiuretic hormone (ADH). Which specific gravity value supports this dx? a. 1.010 b. 1.035 c. 1.020 d. 1.002
d
4. which med should you be prepared to administer to lower the pts potassium level? a. furosemide (lasix) 40mg IV push b. epoetin alfa (Epogen) 300 units/kg subQ c. calcium 1 tab PO d. sodium polystyrene sulfonate (Kayexalate) 15g PO
d
44. All patients with hypertension or diabetes should have yearly screenings for which factor? a. Creatinine b. BUN c. Glycosuria d. Microalbuminuria
d
49. The nurse is assessing the skin of a patient with ESKD. Which clinical manifestation is considered a sign of very late, premorbid, advanced uremic syndrome? a. Ecchymoses b. Sallowness c. Pallor d. Uremic frost
d
688. a client with acute kidney failure becomes confused and irritable. Which does the nurse determine is the most likely cause of this behavior? a. hyperkalemia b. hypernatremia c. a limited fluid intake d. an increased BUN level
d
23. The nurse is taking a history of a patient at risk for kidney failure. What does the nurse ask the patient about during the interview? (select all that apply) a. Exposure to nephrotoxic chemicals b. Increased appetite c. History of diabetes mellitus, hypertension, systemic lupus erythematous d. Recent surgery, trauma, or transfusions e. Leakage of urine when coughing or laughing f. Recent or prolonged use of antibiotics and NSAIDS
a,c,d,f
54. The home health nurse is reviewing the medication list of a patient with CKD. The nurse calls the health care provider as a reminder that the patient might need which nutritional supplements? (select all that apply) a. Iron b. Magnesium c. Phosphorus d. Calcium e. Vitamin D f. Water-soluble vitamins
a,d,e,f
20. A UAP reports to you that a pt with acute kidney failure has had a urine output of 350ml over the past 24 hrs after receiving furosemide 40mg IV push. The UAP asks you how this can happen. What is your best response? a. during the oliguric phase of acute kidney failure, pts often don't respond well to either fluid challenges or diuretics b. there must be some sort of error. Someone must have failed to record the urine output c. a pt with acute kidney failure retains sodium and water, which counteracts the action of the furosemide d. the gradual accumulation of nitrogenous waste products results in the retention of water and sodium
a
22. your pt is receiving IV piggyback doses of gentamicin every 12 hrs. Which would be your priority for monitoring during the period that the pt is receiving this drug? a. serum creatinine and BUN levels b. pt weight every morning c. I and O every shift d. temperature
a
24. Which disorder could be a complication of AKI? a. Heart failure b. Diabetes mellitus c. Kidney cancer d. Compartment syndrome
a
24. a pt on the med-surg unit with acute kidney failure is to begin continuous arteriovenous hemofiltration (CAVH) asap. What is the priority action at this time? a. call the charge nurse and transfer the pt to the ICU b. develop a teaching plan for the pt that focuses on CAVH c. assist the pt with morning bath and mouth care before transfer d. notify the physician that the pts mean arterial pressure is 68 mm Hg
a
26. The nurse is caring for a patient with AKI who does not have signs or symptoms of fluid overload. A fluid challenge is performed to promote kidney perfusion by doing what? a. Administering normal saline 500 to 1000 mL infused over 1 hour b. Administering drugs to suppress aldosterone release c. Instilling warm, sterile normal saline into the bladder d. Having the patient drink several large glasses of water
a
26. you are supervising a senior nursing student who is caring for a 78yr old scheduled for an IV pyelography. What info would you be sure to stress about this procedure to the nursing student? a. after the procedure, monitor urine output because the contrast dye increases the risk for kidney failure in older adults b. the purpose of this procedure is to measure kidney size c. because this procedure assesses kidney function, there is no need for a bowel prep d. keep the pt NPO after the procedure because during the procedure the pt will receive drugs that affect the gag reflex
a
32. A patient with AKI is receiving total parenteral nutrition (TPN). What is the therapeutic goal of using TPN? a. Preserve a lean body mass b. Promote tubular reabsorption c. Create a nitrogen balance d. Prevent infection
a
45. The nurse is reviewing urinalysis results for which patient who is in the early stages of CKD. What results might the nurse expect to see? a. Excessive protein, glucose, red blood cells, and white blood cells b. Increased specific gravity with a dark amber discoloration c. Dramatically increased urine osmolarity d. Pink-tinged urine with obvious small blood clots
a
48. The patient with CKD reports chronic fatigue and lethargy with weakness and mild shortness of breath with dizziness when rising to a standing position. In addition, the nurse notes pale mucous membranes. Based on the patient's illness and the presenting symptoms, which laboratory result does the nurse expect to see? a. Low hemoglobin and hematocrit b. Low white cell count c. Low blood glucose d. Low oxygen saturation
a
5. you are the team leader supervising an lpn/lvn. which nursing care action for ms j should you delegate to the lpn/lvn? a. inserting a catheter intermittently to assess for residual urine b. planning restricted fluid amounts to be given with meals c. assessing breath sounds and noting increased presence of crackles d. discussing renal replacement therapies with the pt
a
56. The nurse monitors a CKD patient's daily weights because of the risk for fluid retention. What instructions does the nurse give to the UAP? a. Weigh the a patient daily at the same time each day, same scale, with the same amount of clothing. b. Weigh the patient daily and add 1 kilogram for the intake of each liter of fluid c. Weight the patient in the morning before breakfast and weigh the patin at night just before bedtime d. Ask the patient what his or her normal weight is and then weigh the patient before and after each voiding
a
59. The nurse is evaluating a patient's treatment response to erythropoietin (Epogen). Which hemoglobin reading indicates that the goal is being met? a. Around 10 g/dL b. Greater than 20 g/dL c. Upward trend d. At baseline for gender
a
60. A patient has been receiving erythropoietin (Epogen). Which statement by the patient indicates that the therapy is producing the desired effect? a. "I can do my housework with less fatique" b. " I have been passing more urine that I was before." c. " I have less pain and discomfort now." d. " I can swallow and eat much better than before."
a
7. ms j's nursing care plan includes the nursing dx excess fluid volume. What interventions are appropriate for this nursing dx? select all a. measure weight daily b. review daily I and O c. restrict sodium intake with meals d. restrict fluid to 1500ml plus urine output e. assess for crackles and edema every shift
abce
10. The nurse is talking to an older adult male patient who is reasonably healthy for his age, but has benign prostatic hyperplasia (BPH). What condition does the BPH potentially place him at risk for? a. Prerenal acute kidney injury b. Postrenal acute kidney injury c. Polycystic kidney disease d. Acute glomerulonephritis
b
18. A patient is in the diuretic phase of AKI. During this phase, what is the nurse mainly concerned about? a. Assessing for hypertension and fluid overload b. Monitoring for hypovolemia and electrolyte loss c. Adjusting the dosage of diuretic medications d. Balancing diuretic therapy with intake
b
19. A patient with prerenal azotemia is administered a fluid challenge. In evaluating response to the therapy, which outcome indicates the goal was met? a. Patient reports feeling better and indicates an eagerness to go home. b. Patient produces urine soon after the initial bolus. c. The therapy is completed without adverse effects. d. The health care provider orders diuretic when the challenge is completed.
b
21. you are the charge nurse. Which pt will you assign to a nurse floated to your unit from the surgical ICU? a. pt with kidney stones scheduled for lithotripsy this morning b. pt who has just undergone surgery for renal stent placement c. newly admitted pt with an acute UTI d. pt with chronic kidney failure who needs teaching on peritoneal dialysis
b
23. A pt in whom acute kidney failure has been dx has had a urine output of 1560ml for the past 8hrs. The lpn/lvn who is caring for this pt, under your supervision, asks you how a pt with kidney failure can have such a large urine output. What is your best response? a. the pts kidney failure was due to hypovolemia and we have given him IV fluids to correct the problem b. acute kidney failure pts go through a diuretic phase when their kidneys begin to recover and may put out as much as 10L of urine per day c. with that much urine output, there must have been a mistake in the pts dx d. an increase in urine output like this is an indicator that the pt is entering the recovery phase of acute kidney failure
b
234. What should the nurse do when caring for a client who is receiving peritoneal dialysis? a. maintain the client in the supine position during the procedure b. position the client from side to side if fluid isn't draining adequately c. remove the cannula at the end of the procedure and apply a dry, sterile dressing d. notify the health care provider if there is a deficit of 200mL in the drainage return
b
62. A patient with CKD is restless, anxious, and short of breath. The nurse hears crackles that begin at the base of the lungs. The pulse rate is increased and the patient has frothy, blood-tinged sputum. What does the nurses do first? a. Facilitate transfer to the ICU for aggressive treatment. b. Place the patient in a high-Fowler's position c. Continue to monitor vital signs and assess breath sounds. d. Administer a loop diuretic such as furosemide (Lasix).
b
34. What are the characteristics of continuous venovenous hemofiltration (CVVH)? (select all that apply) a. Requires placement of arterial and venous access b. Uses a pump to drive blood from the patient catheter into the dialyzer c. Risk of air embolus d. More commonly used for patients who are critically ill e. Most convenient method for home care patients
b,c,d
5. Post-renal kidney injury can result from which conditions? (select all that apply) a. Septic shock b. Cervical cancer c. Nephrolithiasis or ureterolithiasis d. Heart failure e. Neurogenic bladder f. Prostate cancer
b,c,e,f
690. A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? a. it provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration b. it exchanges and cleanses blood by correction of electrolytes and excretion of creatinine c. it decreases the need for immobility because it clears toxins in short and intermittent periods d. it uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion
d
