Renal and Acid Base Balance exam
The registered nurse discusses normal renal function with the client. Which statements made by the client are correct regarding regulatory functions of the kidney? Select all that apply. 1 "They play a role in erythropoiesis." 2 "They play a role in acid-base balance." 3 "They play a role in vitamin D activation." 4 "They play a role in blood pressure regulation." 5 "They play a role in fluid and electrolyte balance."
2,5 Maintaining the acid-base balance of the body by selectively reabsorbing and secreting certain substances from the blood is a regulatory function of the kidneys. The kidneys also perform the regulatory function of electrolyte balance by regulating the reabsorption of certain electrolytes while eliminating others depending on their levels in the serum. The kidneys perform hormonal function by secreting a hormone called erythropoietin that aids in synthesis of red blood cells (erythropoiesis). Activation of vitamin D is a hormonal function of the kidneys. The kidneys perform hormonal function by secreting the hormone renin that assists in blood pressure control.
The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco 2 of 50 mm Hg, HCO 3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support what diagnosis? 1 Hypocapnia 2 Hyperkalemia 3 Metabolic alkalosis 4 Respiratory acidosis
3 Elevated plasma pH and elevated bicarbonate levels support metabolic alkalosis. The arterial carbon dioxide level of 50 mm Hg is elevated more than the expected value of 35 to 45 mm Hg; hypercapnia, not hypocapnia, is present. The client's serum potassium level is within the expected level of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). With respiratory acidosis the pH will be less than 7.35.
A client with end-stage renal disease is hospitalized. For which complications should the nurse monitor the client? Select all that apply. 1 Anemia 2 Dyspnea 3 Jaundice 4 Hyperexcitability 5 Hypophosphatemia
1,2 Anemia results from decreased production of erythropoietin by the kidneys, which causes decreased erythropoiesis by bone marrow. Dyspnea is a result of fluid overload, which is associated with chronic kidney failure. Jaundice occurs with biliary obstruction or liver disorders, not with kidney failure. Lethargy occurs as a result of general depression of the central nervous system. Hyperphosphatemia occurs with kidney failure, not hypophosphatemia.
A nurse assesses a client who is experiencing profound (late) hypovolemic shock. When monitoring the client's arterial blood gas results, which response does the nurse expect? 1 Hypokalemia 2 Metabolic acidosis 3 Respiratory alkalosis 4 Decreased carbon dioxide level
2 Decreased oxygen promotes the conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis. Arterial blood gases do not assess serum potassium levels. Hyperkalemia will occur with shock because of renal shutdown. Respiratory alkalosis may occur in early shock because of rapid, shallow breathing, but in late shock metabolic or respiratory acidosis occurs. The carbon dioxide level will be increased in profound shock.
A client has acute tubulointerstitial renal disease and is experiencing fluid and electrolyte imbalances. The client is confused and complains of nausea and muscle weakness. What does the nurse anticipate will be prescribed to help correct the electrolyte imbalance associated with this diagnosis? 1 Infuse normal saline intravenously. 2 Administer a cation-exchange resin. 3 Increase the intake of dairy products. 4 Restrict the intake of foods high in fiber.
2 Kayexalate, a potassium-exchange resin, permits sodium to be exchanged for potassium in the intestine, reducing the serum potassium level. Intravenous normal saline will cause fluid retention in the oliguric phase of acute tubular necrosis and is contraindicated. Dairy products will increase calcium levels, not reduce potassium levels. Foods high in fiber will not alter the electrolyte imbalance.
After reviewing the laboratory reports, the nurse anticipates that the client has renal impairment. Which test reports support the nurse's concern? Select all that apply. 1 Serum albumin: 4.7 g/dL(6.815 µmol/L) 2 Serum creatinine: 2.0 mg/dL (176.8 µmol/L) 3 Serum potassium: 5.9 mEq/L (5.9 mmol/L) 4 Serum cholesterol: 120 mg/dL (3.108 mmol/L) 5 Blood urea nitrogen: 32 mg/dL (11.424 mmol/L)
2,3,5 Renal impairment is marked by increased serum creatinine concentration, blood urea nitrogen, and potassium ion concentration levels. The normal serum creatinine concentration lies between 0.5 and 1.5 mg/dL (44.2-132.6 µmol/L). A serum creatinine value of 2.0 mg/dL (176.8 µmol/L) indicates renal impairment. The normal concentration of potassium ions in serum ranges from 3.5 to 5 mEq/L (3.5-5 mmol/L). A potassium ion concentration of 5.9 mEq/L(5.9 mmol/L) indicates kidney dysfunction. The normal value of blood urea nitrogen (BUN) lies between 7 and 20 mg/dL (2.45-7.14 mmol/L). A BUN value of 32 mg/dL (11.424 mmol/L) indicates renal impairment. The normal range of serum albumin concentration lies between 3.5 to 5.5 g/dL (5.075-7.975 µmol/L). A cholesterol value less than 200 mg/dL (5.18 mmol/L) is normal.
A nurse is caring for a 6-year-old child with a diagnosis of glomerulonephritis. The child's urine output decreases to less than 100 mL/24 hr, the creatinine clearance is 60 mL/min, and there is an irregular apical pulse. A diagnosis of acute renal failure is made. Blood is drawn for testing. Which serum level requires immediate intervention? 1 Sodium 126 mEq/L (126 mmol/L) 2 Bilirubin 0.3 mg/dL (5.1 mcmol/L) 3 Creatinine 1.3 mg/dL (114.4 mcmol/L) 4 Potassium 6.1 mEq/L (6.1 mmol/L)
4 A high potassium level can cause cardiac dysrhythmias; the expected range for serum potassium in a child is 3.4 to 4.7 mEq/L (3.4 to 4.7 mmol/L). The expected range for serum sodium is 136 to 146 mEq/L (136 to 146 mmol/L). Hyponatremia is expected with acute renal failure. In a child the expected range for both total and direct bilirubin is 0.2 to 0.8 mg/dL (3.4 to 12.0 mcmol/L); indirect bilirubin is expected to be 0.1 to 1.0 mg/dL (1.7 to 17 mcmol/L). The bilirubin level is not related to renal failure. The expected range for serum creatinine is 0.3 to 0.7 mg/dL (26 to 62 mcmol/L). An increase is expected with acute renal failure.
A nurse is caring for a client with end-stage renal disease who has a mature arteriovenous (AV) fistula. Which nursing care should be included in the client's plan of care? Select all that apply. 1 Auscultate for a bruit. 2 Palpate the site to identify a thrill. 3 Irrigate with saline to maintain patency. 4 Avoid drawing blood from the affected extremity. 5 Keep the fistula clamped until ready to perform dialysis.
1,2,4 The presence of a bruit indicates patency of the AV fistula. The presence of a vibration or thrill indicates patency of the AV fistula. Drawing blood is avoided to prevent damage to the AV fistula. An AV fistula is internal and is not irrigated. The AV fistula is under the skin and is not clamped.
A client's arterial blood gas report indicates that pH is 7.25, Pco 2 is 35 mm Hg, and HCO 3 is 20 mEq/L (20 mmol/L). Which client should the nurse consider is most likely to exhibit these results? 1 A 54-year-old with vomiting 2 A 17-year-old with panic attacks 3 A 24-year-old with diabetic ketoacidosis 4 A 65-year-old with advanced emphysema
3 The low pH and bicarbonate levels are consistent with metabolic acidosis, which can be caused by excess ketones, a result of diabetic ketoacidosis. A 54-year-old with vomiting most likely will experience metabolic alkalosis from loss of gastric hydrochloric acid. A 17-year-old with panic attacks most likely will experience metabolic alkalosis from hyperventilation. A 65-year-old with advanced emphysema most likely will experience respiratory acidosis.
A diet that contains restricted amounts of protein, sodium, and potassium has been prescribed for a client with end-stage renal disease who is receiving dialysis. The nurse is providing dietary instructions. Which statement by the client indicates that the teaching is effective? 1 "I should avoid using salt substitutes." 2 "I should exclude meat from my diet." 3 "I may not add seasoning to my food." 4 "I may eat low-sodium canned vegetables."
1 Commercially prepared salt substitutes are high in potassium. Some complete protein foods must be included in the diet. Seasoning that contains neither sodium nor potassium, such as lemon juice, pepper, and herbs, can be used to make food more palatable. Low-sodium canned vegetables contain high potassium concentrations.
The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? 1 Increase in blood pressure 2 Decrease in erythropoietin 3 Increase in serum phosphate levels 4 Decrease in serum sodium concentration
2 The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure there is a deficiency of erythropoietin that often results in the client developing anemia. Therefore the nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to done demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.
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 that apply. 1 Polyuria 2 Jaundice 3 Azotemia 4 Hypertension 5 Polycythemia
3,4 Azotemia is an increase in nitrogenous waste, particularly urea, in the blood; this is common in end-stage renal disease. Hypertension occurs as a result of fluid and sodium overload and dysfunction of the rennin-angiotensin-aldosterone system. Excessive nephron damage in end-stage renal disease causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency from an inability to concentrate urine. Jaundice is common with biliary obstruction, not end-stage renal disease. Anemia, not polycythemia, occurs because of decreased erythropoietin, decreased red blood cell (RBC) production, and decreased RBC survival time.
Surgery is performed on a client with a parotid tumor. Postoperative arterial blood gas values are pH 7.32, PCO 2 53 mm Hg, and HCO 3 25 mEq/L (25 mmol/L). Which action should the nurse take? 1 Administer a potent diuretic 2 Obtain a prescription for an alkalinizing agent 3 Have the client breathe into a rebreather bag at a slow rate 4 Encourage the client to cough and then take deep breaths between coughs
4 The client is in respiratory acidosis, probably caused by depressant effects of the anesthetic or a plugged airway; coughing clears the airway, and deep breaths blow off carbon dioxide. Administering a diuretic will not correct respiratory acidosis and may aggravate hypokalemia if present. An alkalinizing agent is not necessary if clearing the airway rectifies the problem. Having the client breathe into a rebreather bag at a slow rate is the treatment for respiratory alkalosis; the client is in respiratory acidosis.
The nurse is assessing a newborn and anticipates that the newborn has renal impairment. Which finding supports the nurse's conclusion? 1 The newborn has odorless urine. 2 The newborn has colorless urine. 3 The newborn first voids after 76 hours. 4 The newborn's urine has a specific gravity of 1.020.
3. A newborn should void within 24 hours. However, in this case, the newborn first voids after 76 hours, indicating renal impairment. The urine should be colorless and odorless. This indicates that the urine is normal and the child has normal renal function. The normal specific gravity of urine is 1.020.
A preterm infant with respiratory distress syndrome (RDS) has blood drawn for an arterial blood gas analysis. Which test result should the nurse anticipate for this infant? 1 Increased Po 2 2 Lowered HCO 3 3 Decreased Pco 2 4 Decreased blood pH
4 In addition to increased Pco 2, hypoxia from inadequate oxygen/carbon dioxide exchange leads to anaerobic metabolism with an accumulation of acid by-products; both lower blood pH. Po 2 is decreased, because inadequate lung surface area is available for diffusion of gases. Acidosis, not alkalosis, is present; bicarbonate will be normal or increased in the body's attempt to compensate. Pco 2 increases, because inadequate lung surface area is available for the diffusion of gases.
A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse identify when monitoring this client's laboratory values? 1 Increased pH 2 Decreased PO 2 3 Increased PCO 2 4 Decreased HCO 3
4 The bicarbonate-carbonic acid buffer system helps maintain the pH of body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids. The pH is decreased. The PO 2 is not decreased in diabetic acidosis. The PCO 2 may be decreased by the body's attempt to eliminate CO 2 to compensate for a decreased pH.
Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1 pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L) 2 pH 7.35, CO 2 47 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 3 pH 7.46, CO 2 30 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 4 pH 7.50, CO 2 50 mm Hg, HCO 3 - 22 mEq/L (22 mmol/L)
1 A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO 3 - will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO 2 ranges from 35 to 45 mm Hg, and HCO 3 - ranges from 22 to 26 (22 to 26 mmol/L). A pH of 7.35 and a CO 2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.
The nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results are associated with this diagnosis? 1 pH: 7.28; PCO 2: 28; HCO 3: 18 2 pH: 7.30; PCO 2: 54; HCO 3: 28 3 pH: 7.50; PCO 2: 49; HCO 3: 32 4 pH: 7.52; PCO 2: 26; HCO 3: 20
1 A low pH and bicarbonate reflect metabolic acidosis; a low PCO 2 indicates compensatory hyperventilation. A low pH and elevated PCO 2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated PCO 2 indicates compensatory hypoventilation. An elevated pH and low PCO 2 reflect hyperventilation and respiratory alkalosis.
An arterial blood gas report indicates the client's pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis
1 A low pH and low bicarbonate level are consistent with metabolic acidosis. The pH indicates acidosis, not alkalosis. The CO 2 concentration is within normal limits, which is inconsistent with respiratory acidosis; it is elevated with respiratory acidosis.
A diet that contains restricted amounts of protein, sodium, and potassium has been prescribed for a client with end-stage renal disease who is receiving dialysis. The nurse is providing dietary instructions. Which statement by the client indicates teaching is effective? 1 "I should avoid using salt substitutes." 2 "I should exclude meat from my diet." 3 "I may not add seasoning to my food." 4 "I may eat low-sodium canned vegetables."
1 Commercially prepared salt substitutes are high in potassium. Some complete protein foods must be included in the diet. Seasoning that contains neither sodium nor potassium, such as lemon juice, pepper, and herbs, can be used to make food more palatable. Low-sodium canned vegetables contain high potassium concentrations.
A nurse in the pediatric unit is reviewing the arterial blood gas values of a 4-year-old child recovering from severe dehydration. Which results most accurately reflect the child's recovery? 1 pH 7.40, Po 2 85 mm Hg, Pco 2 40 mm Hg 2 pH 7.50, Po 2 85 mm Hg,Pco 2 35 mm Hg 3 pH 7.25, Po 2 60 mm Hg, Pco 2 50 mm Hg 4 pH 7.45, Po 2 70 mm Hg, Pco 2 25 mm Hg
1 Expected arterial blood gas values are pH of 7.35 to 7.45, Po 2 of 83 to 108 mm Hg, and Pco 2 of 35 to 45 mm Hg; thus these gases are within normal limits. A pH of 7.5 indicates alkalosis. A pH of 7.25 indicates acidosis, a Po 2 of 60 mm Hg indicates hypoxia, and a Pco 2 of 50 mm Hg indicates hypercapnia. A Po 2 of 70 mm Hg indicates hypoxia, and a Pco 2 of 25 indicates hypocapnia.
While the nurse is at the bedside of a client in acute renal failure, the client states, "My healthcare provider said that I will be getting some insulin. Do I also have diabetes?" What is the best nursing response? 1 "No, the insulin will help your body handle the increased potassium level." 2 "I suggest that you ask your healthcare provider that question." 3 "You probably had an elevated blood glucose level, so your healthcare provider is being cautious." 4 "No, but insulin will reduce the toxins in your blood by lowering your metabolic rate."
1 Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. The response "I suggest that you ask your healthcare provider that question" halts communication and is not supportive. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.
A 3-year-old child is admitted to the pediatric unit with a diagnosis of acute asthma. The child is short of breath, with a respiratory rate of 56 breaths/min; the pulse is 102, and the child has a nonproductive cough. What blood gas value does the nurse expect to see? 1 pH of 7.32 2 Po 2 of 95 mm Hg 3 Pco 2 of 30 mm Hg 4 HCO 3 - of 20 mEq/L (20 mmol/L)
1 Respiratory acidosis is expected. A pH of 7.32 is below the expected range of 7.35 to 7.45; hypoxia causes hypercapnia, resulting in a decreased pH. A Po 2 of 95 mm Hg is within the expected range of 80 to 100 mm Hg. An HCO 3 - level of 20 mEq/L (20 mmol/L) is lower than the expected range of 21 to 28 mEq/L (21 to 28 mmol/L). In respiratory acidosis, the bicarbonate level is expected to be normal or higher if compensation is present. A Pco 2 of 30 mm Hg is below the expected range of 35 to 45 mm Hg. In respiratory acidosis, the Pco 2 is expected to increase.
A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco 2 is 35 mm Hg, and HCO 3 - is 17 mEq/L (17 mmol/L). Physical assessment includes Lethargic and irritable; dry skin and mucous membranes; inelastic tissue turgor; and dark amber urine. Vital signs are rectal temp of 99.4, apical pulse 155, and respirations of 40 breaths per minute. What complication does the nurse conclude has developed? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis
1 The blood pH indicates acidosis; the bicarbonate (HCO 3 -) level is further from the expected range than is the partial pressure of carbon dioxide (Pco 2), indicating a metabolic origin (losses from diarrhea), not a respiratory origin. The blood pH indicates acidosis, not alkalosis.
A client's arterial blood gas report indicates that pH is 7.25, Pco 2 is 60 mm Hg, and HCO 3 is 26 mEq/L (26 mmol/L). Which client should the nurse consider is most likely to exhibit these blood gas results? 1 A 65-year-old with pulmonary fibrosis 2 A 24-year-old with uncontrolled type 1 diabetes 3 A 45-year-old who has been vomiting for 3 days 4 A 54-year-old who takes sodium bicarbonate for indigestion
1 The low pH and elevated Pco 2 are consistent with respiratory acidosis, which can be caused by pulmonary fibrosis, which impedes the exchange of oxygen and carbon dioxide in the lung. A 24-year-old with uncontrolled type 1 diabetes most likely will experience metabolic acidosis from excess ketone bodies in the blood. A 45-year-old who has been vomiting for 3 days most likely will experience metabolic alkalosis from the loss of hydrochloric acid from vomiting. A 54-year-old who takes sodium bicarbonate for indigestion most likely will experience metabolic alkalosis from an excess of base bicarbonate.
A registered nurse writes a care plan for a client undergoing a renal scan. Which of the following interventions should the nurse include? Select all that apply. 1 Administering furosemide after initial imaging 2 Asking the client to fast before the scan 3 Taking precautions related to radioactive exposure 4 Telling the client to avoid drinking fluids after the imaging 5 Inserting the peripheral intravenous (IV) catheter to give the radioisotope
1, 5 A renal scan is performed to examine the structure, function, and perfusion of the kidneys using the intravenous (IV) administration of a radioisotope. During the procedure, furosemide should be administered after initial imaging to better visualize kidney function and blood flow. A peripheral intravenous (IV) catheter should be inserted to deliver the radioisotope. Fasting is not required before the procedure. Because the procedure utilizes only trace doses of radioisotopes, no precautions related to radioisotope exposure are required. The client should be encouraged to drink fluids after the procedure to help excrete the isotope.
`The nurse plans interventions for a client with smoke inhalation based on a negative chest x-ray and arterial blood gases that show a PO 2 of 85 mm Hg, a PCO 2 of 45 mm Hg, and a pH of 7.35. Which interventions should the nurse anticipate will be prescribed? Select all that apply. 1 Coughing 2 Deep breathing 3 Bronchodilators 4 Humidified oxygen 5 Bronchial suctioning
1,2,4 Coughing moves secretions toward the mouth to be expectorated. Deep breathing expands the alveoli and increases the amount of oxygen being delivered to the alveolar capillary beds. Humidified oxygen increases the amount of oxygen that is being delivered to the alveolar capillary beds. Bronchodilators are not indicated at this time because the x-ray, PCO 2, and pH are still within acceptable limits. Bronchial suctioning is not indicated at this time because the x-ray, PCO 2, and pH results are still within acceptable limits.
client with kidney dysfunction is about to undergo renal testing using a contrast medium. Which nursing interventions should be conducted before the procedure to ensure the client's safety? Select all that apply. 1 Assessing the client for a history of cirrhosis 2 Asking the client if he or she has a known shellfish allergy 3 Assessing the client for a history of lactic acidosis 4 Assessing the client's hydration status by checking blood pressure and respiratory rate 5 Asking the client to discontinue metformin 12 hours before the procedure
1,2,4 While interviewing a client who is about to undergo kidney procedure using a contrast medium, the nurse should assess for a history of cirrhosis. Clients with cirrhosis have an increased chance of developing kidney failure after the procedure. The nurse should confirm any known shellfish allergies because contrast dye administered during the study may cause nephrotoxicity. It is not necessary to check the client for a history of lactic acidosis when ensuring the client's safety for renal testing. If the client had lactic acidosis currently, then this would be a significant factor when ensuring the client's safety for renal testing. The nurse should also assess the client's hydration status by checking blood pressure and respiratory rate. The nurse should ask the client to discontinue metformin 24 hours before the procedure to prevent lactic acidosis.
A client who is obtunded has a blood pressure of 80/35 mm Hg after a blood transfusion. In an effort to support renal perfusion, the nurse administers dopamine at 2 mcg/kg/min as prescribed. What is the most relevant outcome indicating effectiveness of the medication for this client? 1 A decrease in blood pressure 2 An increase in urinary output 3 A decrease in core temperature 4 An increase in level of consciousness
2 As renal perfusion increases, urinary output also should increase; doses greater than 10 mcg/kg/min can cause renal vasoconstriction and decreased urinary output. A change in blood pressure is not a direct predictor of the effectiveness of dopamine given at a level of 2 mcg/kg/min; at 10 mcg/kg/min a client will experience an increased cardiac output and an increased blood pressure. Body temperature does not indicate improved renal perfusion. In this situation, improvement of renal perfusion is not directly related to the client's level of consciousness.
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)? 1 Fluid 2 Protein 3 Sodium 4 Potassium
2 The waste products of protein metabolism are the main cause of uremia. The degree of protein restriction is determined by the severity of the disease. Fluid restriction may be necessary to prevent edema, heart failure, or hypertension; fluid intake does not directly influence uremia. Sodium is restricted to control fluid retention, not uremia. Potassium is restricted to prevent hyperkalemia, not uremia.
A nurse is caring for a client with end-stage renal disease. For which clinical indicator should the nurse monitor the client? 1 Polyuria 2 Jaundice 3 Azotemia 4 Hypotension
3 Azotemia is an increase in nitrogenous waste (particularly urea) in the blood, which is common with end-stage renal disease. Excessive nephron damage in end-stage renal disease causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency because of the inability to concentrate urine. Jaundice is common to biliary obstruction, not to end-stage renal disease. The blood pressure may be elevated as a result of hypervolemia associated with increased total body fluid.
A client who experienced smoke inhalation has a negative chest x-ray and arterial blood gases that demonstrate PaO 2 of 75 mm Hg, PaCO 2 of 45 mm Hg, and pH of 7.35. Which intervention should the nurse anticipate will be prescribed by the healthcare provider? 1 Deep suctioning 2 Bronchodilators 3 Breathing exercises 4 Mechanical ventilation
3 Breathing exercises are needed. The client has hypoxemia; the expected range for PaO 2 is 80 to 100 mm Hg. This intervention expands the alveoli, moves secretions toward the mouth to be expectorated, and increases the amount of oxygen that is delivered to alveolar capillary beds. Routine suctioning may injure already traumatized tissues and is contraindicated. Bronchodilators and mechanical ventilation are not indicated at this time based upon the x-ray results and PaCO 2 and pH results.
A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. Which test result should the nurse anticipate? 1 Arterial pH of 7.5 2 Hematocrit of 54% 3 Potassium of 6.3 mEq/L (6.3 mmol/L) 4 Creatinine of 1.2 mg/dL (106 mcmol/L)
3 Clients with end-stage renal disease have impaired potassium excretion, so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). Clients with end-stage renal disease usually have a serum pH that is less than 7.35 because of metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated because this is alkalosis. Clients with end-stage renal disease have decreased erythropoietin, which leads to decreased red blood cell production and hematocrit; a hematocrit of 54% exceeds the expected range, which is 39% to 50% for males and 35% to 47% for females; therefore, it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL (106 mcmol/L) is within the expected range of 0.7 to 1.4 mg /dL (62 to 124 mcmol/L) and therefore is not anticipated.
A client suspected of a renal disorder is scheduled for an imaging procedure. The nurse instructs the client to drink lots of fluids after the procedure and informs that a contrast dye will be administered before the procedure. Which imaging procedure is the client undergoing? 1 Renal scan 2 Electromyography 3 Computed tomography 4 Kidney ultrasonography
3 Computed tomography (CT) may or may not require administration of an oral or intravenous contrast dye. However, when the dye is used, an adequate fluid intake helps to dilute and excrete the dye. A renal scan does not use contrast dye and is used in preference to a CT scan; this test uses a radioisotope. Electromyography tests the strength of muscles used in voiding. This procedure does not involve administration of any contrast dye. In this procedure (ultrasonography) sound waves are applied to structures of different densities to visualize them. The clients are asked to drink water to fill the bladder before the procedure. However, contrast dye is not used for this procedure.
The arterial blood gases of a client with chronic obstructive pulmonary disease (COPD) deteriorate, and respiratory failure is impending. Which clinical indicator should the nurse assess first? 1 Cyanosis 2 Bradycardia 3 Mental confusion 4 Distended neck veins
3 Decreased oxygen to the vital centers in the brain results in restlessness and confusion. Cyanosis is a late sign of respiratory failure. Tachycardia, not bradycardia, will occur as a compensatory mechanism to help increase oxygen to body cells. Distended neck veins occur with fluid volume excess (e.g., pulmonary edema).
A nurse is caring for an infant with severe dehydration. Which blood gas report most likely reflects the acid-base balance of this infant? 1 pH of 7.50 and Pco 2 of 34 mm Hg 2 pH of 7.23 and Pco 2 of 70 mm Hg 3 pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) 4 pH of 7.56 and HCO 3 - of 30 mEq/L (30 mmol/L)
3 Low blood pH and bicarbonate levels indicate metabolic acidosis, which occurs with severe dehydration because the reduced urine output causes retention of hydrogen ions. The other options include findings that indicate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis, respectively.
A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet. What is the rationale for the nurse's instruction? 1 A person's body tends to retain fluid when a salt substitute is included in the diet. 2 Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. 3 Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. 4 A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca.
3 Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen (BUN) and creatinine levels; these are the result of protein metabolism. There is no such substance in salt substitutes that interferes with the transfer of fluid across capillary membranes.
A 5-year-old child is admitted to the pediatric intensive care unit with a diagnosis of acute asthma. A blood sample is obtained to measure the child's arterial blood gases. What finding does the nurse expect? 1 High oxygen level 2 Increased alkalinity 3 Decreased bicarbonate 4 Increased carbon dioxide level
4 Gas exchange is limited because of narrowing and swelling of the bronchi; the carbon dioxide level increases. The oxygen level will be decreased, not increased. The pH will decrease; the child is in respiratory acidosis, not alkalosis. The bicarbonate level will be increased to compensate for acidosis.
A 5-year-old child in renal failure who has undergone creation of an arteriovenous fistula access begins hemodialysis three times a week. The nurse teaches the mother the specific care her child needs. What statement indicates that further teaching is necessary? 1 "I'll offer more drinks in warm weather." 2 "I should call the clinic if he vomits or has diarrhea." 3 "I'll check his pulse at the wrist on each arm every day." 4 "It's OK to take his blood pressure on the arm with the fistula."
4 Taking the blood pressure on the arm with the arteriovenous fistula is contraindicated because the pressure of the inflated cuff may disrupt the integrity of the fistula. Consumption of more fluids is desirable because inadequate fluid intake can result in dehydration and an acid-base imbalance. Calling the clinic is desirable because vomiting or diarrhea may lead to dehydration and an acid-base imbalance. Not only should the pulse be monitored to assess vascular function distal to the arteriovenous fistula, but it should be done on both extremities and the results compared.
