PRACTICE QUESTIONS • RENAL SYSTEM •

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. Administer normal saline IV Rationale: 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 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. BUN and creatinine Rationale: Blood urea nitrogen 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 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 check a unit of blood prior to hanging 4. Administer a cation-exchange resin enema

1. Collect a clean voided midstream urine specimen Rationale: 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 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. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting Rationales: 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 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

1. Teach the client to carry heavy objects with the right arm. Rationale: Carry 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 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

2. African American Rationale: 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 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 small feedings a day.

3. A high-carbohydrate and restricted protein diet Rationale: 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 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 the metabolic rate during the acute stage. Rationale: 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 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. Rationale: Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal failure (before the kidney).

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 in the client in this condition 4. Explain this is normal and do not do anything for the client

2. Instruct the UAP to bathe the client in cool water. Rationale: 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 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. The client who does not have a palpable thrill or auscultated bruit. Rationale: This client's dialysis access is compromised and he or she should be assessed first.

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. Your angry at not being on the list, and you want to quit dialysis? Rationale: Reflecting the client's feelings and restating them are therapeutic responses the nurse should use when addressing the client's issues.

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. Prepare the client for dialysis. Rationale: Normal potassium level is 3.5-5.5 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 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. Electrolytes are within normal limits. Rational: Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits.

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

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 HCP? 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. The client reports an elevation in his blood pressure. Rationale: After 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 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. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate This is the correct scientific rationale for metabolic acidosis occurring in the client with CKD.

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 Rationale: 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 admitting a client diagnosed with acutre renal failure (ARF). Which question is most imporant for the nurse to ask during the admission interview? 1. Have you recently traveled outside of the United States? 2. Did you recently begin a vigorous exercise program? 3. Is there a chance you've been exposed to a virus? 4. What over-the-counter medication do you take regularly?

4. What OTC medications do you take regularly? Rationale: Medications such as nonsteroidal anti-inflammatory drugs and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate

The client with CKD is placed on a fluid restriction of 1500 mL/day. On the 0700 to 1900 shift the client drank an eight 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 nurse give to the client?

720 mL The nurse must add up how many mL of fluid the client drank on the shift then subtract that number from 1500 mL. One ounce is equal to 30 mL.