Renal nclex review questions

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a. is much less likely to clot. b. increases patient mobility. c. can accommodate larger needles. d. can be used sooner after surgery.

A AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility

32. The nurse has identified the nursing diagnosis of risk for infection in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk? A) Maintain aseptic technique when administering dialysate. B) Wash the skin surrounding the catheter site with soap and water prior to each exchange. C) Add antibiotics to the dialysate as ordered. D) Administer prophylactic antibiotics by mouth or IV as ordered.

A Feedback: Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.

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

79. 2. The nurse must always auscultate for a bruit and palpate for a thrill in the arm with the fistula and promptly report the absence of either a thrill or bruit to the healthcare provider (HCP) as it indicates an occlusion. The client should not have a pressure dressing on the shunt and should avoid wearing tight clothing or carrying heavy items such as purse over the area of the shunt to avoid restricting blood flow in the shunt. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.

79.A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula the nurse should: 1.Take the blood pressure in the arm with the fistula. 2.Report the loss of a thrill or bruit on the arm with the fistula. 3.Auscultate for a thrill and palpate for a bruit on the arm with the fistula. 4.Start a second IV in the arm with the fistula.

79. 3. The nurse must always palpate for a thrill and auscultate for a bruit in the arm with the fistula and promptly report the absence of either/or a thrill or bruit to the health care provider as it indicates an occlusion. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.

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

80. 2, 4, 5. To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty, eat food before drinking fluids to alleviate dry mouth, encourage strict follow-up for blood work, dialysis, and health care provider visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.

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

82. 2. During dwell time, the dialysis solution is allowed to remain in the peritoneal cavity for the time prescribed by the healthcare provider (HCP) (usually 20 to 45 minutes). During this time, the nurse should monitor the client's respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress. The dialysis solution would not cause urticaria or affect circulation to the fingers. The client's laboratory values are obtained before beginning treatment and are monitored every 4 to 8 hours during the treatment, not just during the dwell time.

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

84. 2. Fluid return with peritoneal dialysis is accomplished by gravity flow. Actions that enhance gravity flow include turning the client from side to side, raising the head of the bed, and gently massaging the abdomen. The client is usually confined to a recumbent position during the dialysis. The nurse should not attempt to reposition the catheter.

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

84. 2. Fluid return with peritoneal dialysis is accomplished by gravity flow. Actions that enhance gravity flow include turning the client from side to side, raising the head of the bed, and gently massaging the abdomen. The client is usually confined to a recumbent position during the dialysis. The nurse should not attempt to reposition the catheter.

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

85. 4. Constipation may contribute to reduced urine outflow in part because peristalsis facilitates drainage outflow. For this reason, bisacodyl suppositories can be used prophylactically, even without a history of constipation. Diarrhea, vomiting, and flatulence typically do not cause decreased outflow in a peritoneal dialysis catheter.

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

87. 1,2,4,5. Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. If peritonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Peritonitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.

89.Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of giving this drug? 1.Relieving the pain of gastric hyperacidity. 2.Preventing Curling's stress ulcers. 3.Binding phosphate in the intestine. 4.Reversing metabolic acidosis.

89. 3. A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.

90.The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel (Amphojel). Which of the following statements would indicate that the client understands the teaching? 1."I'll take it every 4 hours around the clock." 2."I'll take it between meals and at bedtime." 3."I'll take it when I have an upset stomach." 4."I'll take it with meals and bedtime snacks."

90. 4. Aluminum hydroxide gel (Amphojel) is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat an upset stomach caused by hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.

92.The nurse is determining which teaching approaches for the client with chronic renal failure and uremia would be most appropriate. The nurse should: 1.Provide all needed teaching in one extended session. 2.Validate the client's understanding of the material frequently. 3.Conduct a one-on-one session with the client. 4.Use videotapes to reinforce the material as needed.

92. 2. Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes because clients may not be able to maintain alertness during the viewing of the videotape.

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

93. 2. Altered sexual functioning commonly occurs in chronic renal failure and can stress marriages and relationships. Altered sexual functioning can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity. Unless the client provides additional information, it is not necessary to refer the client to counseling at this time.

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

94. 2. Altered sexual functioning commonly occurs in chronic renal failure and can stress marriages and relationships. Altered sexual functioning can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity.

95.A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: 1.Is relatively low in cost. 2.Allows the client to be more independent. 3.Is faster and more efficient than standard peritoneal dialysis. 4.Has fewer potential complications than standard peritoneal dialysis.

95. 2. The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, health care personnel, and machines for life-sustaining treatment. This independence is a valuable outcome for some people. CAPD is costly and must be done daily. Adverse effects and complications are similar to those of standard peritoneal dialysis. Peritoneal dialysis usually takes less time but cannot be done at home.

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

96. 1. Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may indicate heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.

97.A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which of the following signs of peritoneal infection? 1.Cloudy dialysate fluid. 2.Swelling in the legs. 3.Poor drainage of the dialysate fluid. 4.Redness at the catheter insertion site.

97. 1. Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may indicate heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that: A. successful transplantation usually provides a better quality of life than that offered by dialysis B. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available C. the immunosuppressive therapy that is required following transplantation causes fatal malignancies in many patients D. hemodialysis replaces the normal functioning of the kidneys and patients do not have to live with the continual fear of rejection

A

The nurse has instructed a patient who is receiving hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful? a. Scrambled eggs, English muffin, and apple juice b. Oatmeal with cream, half a banana, and herbal tea c. Split-pea soup, whole-wheat toast, and nonfat milk d. Cheese sandwich, tomato soup, and cranberry juice

A Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.

A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. What should the nurse teach the patient about hemodialysis? A) Hemodialysis is a treatment option that is usually required three times a week. B) Hemodialysis is a program that will require you to commit to daily treatment. C) This will require you to have surgery and a catheter will need to be inserted into your abdomen. D) Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again.

A Feedback: Hemodialysis is the most commonly used method of dialysis. Patients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.

A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observe that the dialysate drainage fluid is cloudy. What is the nurses most appropriate action? A) Inform the physician and assess the patient for signs of infection. B) Flush the peritoneal catheter with normal saline. C) Remove the catheter promptly and have the catheter tip cultured. D) Administer a bolus of IV normal saline as ordered.

A Feedback: Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary care provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the physician would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patients diet to maximize the therapeutic effect and minimize the risks of complications. The patients diet should include which of the following modifications? Select all that apply. A) Decreased protein intake B) Decreased sodium intake

The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which information should be reported immediately to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient complains of feeling bloated after the inflow.

B Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient

Which nursing action for a patient who has arrived for a scheduled hemodialysis session is most appropriate for the RN to delegate to a dialysis technician? a. Educate patient about fluid restrictions. b. Check blood pressure before starting dialysis. c. Assess for reasons for increase in predialysis weight. d. Determine the ultrafiltration rate for the hemodialysis.

B Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.

A 71-year-old patient with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make? A. The decision is certainly yours to make, but be sure not to make a mistake. B. Kidney transplants in patients your age are as successful as they are in younger patients. C. I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare. D. Have you talked this over with your family?

B Feedback: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the elderly. However, the outcome is comparable to that of younger patients. The other listed options either belittle the patient or give the patient misinformation.

A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the patients abdomen is increasing in girth. What is the nurses most appropriate action? A) Advance the catheter 2 to 4 cm further into the peritoneal cavity. B) Reposition the patient to facilitate drainage. C) Aspirate from the catheter using a 60-mL syringe. D) Infuse 50 mL of additional dialysate.

B Feedback: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate.

During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Obtain blood to check the blood urea nitrogen (BUN) level. c. Check the patient's blood pressure. d. Give prescribed PRN antiemetic drugs.

C The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions also may be appropriate, based on the blood pressure obtained.

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse should know that ultrafiltration in peritoneal dialysis is achieved by which method? A.Increasing the pressure gradient B.Increasing osmolality of the dialysate C.Decreasing the glucose in the dialysate D.Decreasing the concentration of the dialysate

Increasing osmolality of the dialysate Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream.

The patient with chronic kidney disease is considering whether to use peritoneal dialysis (PD) or hemodialysis (HD). What are advantages of PD when compared to HD (select all that apply)? a. Less protein loss b. Rapid fluid removal c. Less cardiovascular stress d. Decreased hyperlipidemia e. Requires fewer dietary restrictions

c. Less cardiovascular stress e. Requires fewer dietary restrictions Peritoneal dialysis is less stressful for the cardiovascular system and requires fewer dietary restrictions. Peritoneal dialysis actually contributes to more protein loss and increased hyperlipidemia. The fluid and creatinine removal are slower with peritoneal dialysis than hemodialysis.

A nurse is discussing hemodialysis with a newly licensed nurse. The nurse should identify that hemodialysis is contraindicated for which of the following clients?

A client who can not receive anticoagulants

A nurse is caring for a client who has received hemodialysis. The should identify for which of the following findings places the client at risk for seizures ?

A rapid decrease of fluid

Which statement by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure? A. "It is essential that you maintain aseptic technique to prevent peritonitis. B. "You will be allowed a more liberal protein diet once you complete CAPD." C."It is important for you to maintain a daily written record of blood pressure and weight." D."You will need to continue regular medical and nursing follow-up visits while performing CAPD."

"It is essential that you maintain aseptic technique to prevent peritonitis." Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of preventing this from occurring. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality as does peritonitis, thus making that statement of highest priority.

The home care nurse visits a 34-year-old woman receiving peritoneal dialysis. Which statement, if made by the patient, indicates a need for immediate follow-up by the nurse? A. "Drain time is faster if I rub my abdomen." B."The fluid draining from the catheter is cloudy." C."The drainage is bloody when I have my period." D."I wash around the catheter with soap and water."

"The fluid draining from the catheter is cloudy." The primary clinical manifestation of peritonitis is a cloudy peritoneal effluent. Blood may be present in the effluent of women who are menstruating, and no intervention is indicated. Daily catheter care may include washing around the catheter with soap and water. Drain time may be facilitated by gently massaging the abdomen.

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

88. 2. Weight loss is expected because of the removal of fluid. The client's weight before and after dialysis is one measure of the effectiveness of treatment. Blood pressure usually decreases because of the removal of fluid. Hematuria would not occur after completion of peritoneal dialysis. Dialysis only minimally affects the damaged kidneys' ability to manufacture urine.

A nurse on the renal unit is caring for a patient who will soon begin peritoneal dialysis. The family of the patient asks for education about the peritoneal dialysis catheter that has been placed in the patients peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply. A) The cuffs are made of Dacron polyester. B) The cuffs stabilize the catheter. C) The cuffs prevent the dialysate from leaking. D) The cuffs provide a barrier against microorganisms. E) The cuffs absorb dialysate

A, B, C, D Feedback: Most of these catheters have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate.

A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patients diet to maximize the therapeutic effect and minimize the risks of complications. The patients diet should include which of the following modifications? Select all that apply. A) Decreased protein intake B) Decreased sodium intake C)Increased potassium intake D) Fluid restriction E) Vitamin D supplementation

A, B, D Feedback: Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation.

Preparing the client for a (ESWL)for urolithiasis.

Apply electrodes for cardiac monitoring.

A nurse is teaching a client who has a new diagnosis of acute pyelinephritis. Which of following instructions should the nurse include in the teaching?

Avoid NASAID For pain

A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurses most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurses most appropriate response? A. Assess the patient for further signs or symptoms of rejection. B. Recognize this as an expected finding. C. Inform the primary care provider of this finding. D. Administer exogenous antidiuretic hormone as ordered.

B Feedback: A kidney from a living donor related to the patient usually begins to function immediately after surgery and may produce large quantities of dilute urine. This is not suggestive of rejection and treatment is not warranted. There is no obvious need to report this finding.

A patient with a history of end-stage kidney disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessments should the nurse prioritize before, during, and after his treatment? A.Level of consciousness B. Blood pressure and fluid balance C.Temperature, heart rate, and blood pressure D.Assessment for signs and symptoms of infection

Blood pressure and fluid balance Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of the procedure indicates a particular need to monitor the patient's blood pressure and fluid balance.

A nurse is reviewing the laboratory reports of a client who has acute kidney injury. Which of the following findings should the nurse expect?

BUN 30mg/dL Urine output of 40mL in past 3 hr Hematocrit 30%

Measures indicated in the conservative therapy of chronic kidney disease include: A. decreased fluid intake, carbohydrate intake, and protein intake B. increased fluid intake, decreased carbohydrate intake and protein intake C. decreased fluid intake and protein intake, increased carbohydrate intake D. decreased fluid intake and carbohydrate intake, increased protein intake

C Water and any other fluids are not routinely restricted in the pre-end-stage renal disease (ESRD) stages. Patients on hemodialysis have a more restricted diet than patients receiving peritoneal dialysis. For those receiving hemodialysis, as their urinary output diminishes, fluid restrictions are enhanced. Intake depends on the daily urine output. Generally, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is allowed for a patient receiving hemodialysis. Patients are advised to limit fluid intake so that weight gains are no more than 1 to 3 kg between dialyses (interdialytic weight gain). For the patient who is undergoing dialysis, protein is not routinely restricted. The beneficial role of protein restriction in CKD stages 1 through 4 as a means to reduce the decline in kidney function is being studied. Historically, dietary counseling often encouraged restriction of protein for CKD patients. Although there is some evidence that protein restriction has benefits, many patients find these diets difficult to adhere to. For CKD stages 1 through 4, many clinicians encourage a diet with normal protein intake. However, you should teach patients to avoid high-protein diets and supplements because they may overstress the diseased kidneys.

A nurse is caring for a client who has continuous bladder irrigation following transurethral resection of the prostate. Upon detecting an output obstruction, which of the following actions should the nurse take first?

Check the irrigation tubing for kinks.

A nurse is assessing a client who has chronic kidney disease and has completed her third peritoneal dialysis treatment. Which of the following findings should the nurse report to the provider?

Cloudy dialysate effluent

The physician has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? A.Hemodialysis (HD) 3 times per week B.Automated peritoneal dialysis (APD) C.Continuous venovenous hemofiltration (CVVH) D. Continuous ambulatory peritoneal dialysis (CAPD)

Continuous venovenous hemofiltration (CVVH) CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection. HD 3 times per week would not be used for this patient because fluid and solutes build up and then are rapidly removed. With APD (used at night instead of during the day) fluid and solutes build up during the day and would not benefit this patient as much. CAPD will not as rapidly remove large amounts of fluid as CVVH can do.

A patient complains of leg cramps during hemodialysis. The nurse should first a. b. massage the patient's legs. c. give acetaminophen (Tylenol). d. infuse a bolus of normal saline.

D Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient slows the inflow rate when experiencing pain. b. The patient leaves the catheter exit site without a dressing. c. The patient plans 30 to 60 minutes for a dialysate exchange. d. The patient cleans the catheter while taking a bath every day.

D Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.

A nurse is caring for a client who has acute kidney injury. Which of the following laboratory findings should the nurse report to the provider?

Serum creatinine 4.0 mg/dL

A nurse is performing an admission assessment of a client who has acute glomerulonephritis. The nurse should expect which of the following findings?

Dark-colored urine

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do for the patient? A.Administer hypertonic saline. B.Administer a blood transfusion C.Decrease the rate of fluid removal. D.administer antiemetic medications.

Decrease the rate of fluid removal. The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.

Intravenous urography

Determine if the client has an allergy to iodine or shellfish

A nurse is reviewing the medical history of four clients . Which of the following conditions is at risk factor for chronic pyelinephritis?

Diabetes mellitus

A nurse is providing teaching for a client who has chronic kidney disease. Which of the following statements by the client indicates an understanding of the teaching?

I WILL decrease my intake of foods high in phosphorus

Number the following in the order of the phases of exchange in PD. Begin with 1 and end with 3. a. Drain b. Dwell c. Inflow

Inflow Dwell Drian

A nurse is caring for a client who has chronic kidney failure and the following laboratory results; BUN 196, sodium 152, and potassium 7.3. Which of the following interventions should the nurse implement?

Infuse regular insulin dextrose 10% in water

A nurse is obtaining a voided urine culture and sensitivity for a client who has manifestations of a Urinary tract infection. Which of the following actions should the nurse take?

Instruct the client to initiate the flow of urine before collecting the specimen

A newly licensed nurse and a preceptor are caring for a client who has just had an arteriovenous shunt place in her left arm

Measuring blood pressure in the shunted arm every 4hr

A nurse is providing instructions regarding reduced dietary intake of potassium for a client who has chronic kidney disease. Which of the following food selections is appropriate for the nurse to recommend to the client?

One large apple

A nurse is caring for a client who has nephritc syndromes and has been taking prednisone for 3 days. Which of the following adverse effects should the nurse monitor for and report to the provider?

Sore throat

A nurse is caring for a client following extracorporeal shock wave litho trips for the treatment of calcium phosphate kidney stones which of the following actions is appropriate?

Strain all the client's urine

A nurse is performing assessment on a client who has severe chronic kidney disease. Which of the following findings should the nurse expect for the client?

Tachypnea

A nurse is caring for a client immediately following a kidney transplant. The nurse should identify which of the following client findings as a possible indication of a delay in functioning of the transplanted kidney?

Urine output 30 mL/2 hr

A nurse is caring for a hospitalized client who received hemodialysis 1hr ago. When evaluating the client's status after dialysis, which of the following information should the nurse assess for first?

Vital signs

A nurse working in the emergency department is caring for a client who reports costovertebral angle tenderness, nausea and vomiting. For which of the following laboratory values should the nurse notify the provider?

WBC 15,000/mm

A nurse is planning care for a client who has acute glomerulonephritis. The nurse should plan to provide which of the following interventions?

Weight the client daily

A nurse is preparing a teaching plan for a male client who has a continent internal ideal reservoir following surgery to treat bladder cancer. Which of the following statements should the nurse include in the teaching plan?

You must insert a catheter through your stoma to drain the urine

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

77. 2,3,4. The nurse instructs the client to protect the site of the fistula. The client should avoid pressure on the involved arm such as sleeping on it, wearing tight jewelry, or obtaining BP. The client is also advised to assess the area distal to the fistula for adequate circulation, such as warmth and color. When the client is hospitalized, the nurse posts a sign on the client's bed not to draw blood or obtain BP on the left side; the client is also instructed to be sure that none of the healthcare team members do so.

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

78. 2,4,1,3. The nurse first assures an IV access site in case the client has respiratory or cardiac arrest. Next, the nurse monitors the client's heart rate and rhythm: Cardiovascular signs of elevated serum potassium levels are irregular, slow heart rate; decreased BP; narrow, peaked T waves; widened QRS complexes, prolonged PR intervals, and flattened D waves; frequent ectopy; ventricular fibrillation; and ventricular standstill. The nurse then administers calcium gluconate, which has an immediate action to antagonize the effect of hyperkalemia on cardiac muscle. Last, the nurse administers polystyrene sulfonate, which is a cation-exchange resin that removes potassium from the body by exchanging sodium ion for potassium; potassium-containing resin is then excreted; onset is in several hours to days.

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

80. 2,4,5. To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty and eat food before drinking fluids to alleviate dry mouth, and encourage strict follow-up for blood work, dialysis, and healthcare provider (HCP) visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.

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

81. 1. The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.

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

81. 1. The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.

82.Which of the following assessments would be most appropriate for the nurse to make while the dialysis solution is dwelling within the client's abdomen? 1.Assess for urticaria. 2.Observe respiratory status. 3.Check capillary refill time. 4.Monitor electrolyte status.

82. 2. During dwell time, the dialysis solution is allowed to remain in the peritoneal cavity for the time prescribed by the physician (usually 20 to 45 minutes). During this time, the nurse should monitor the client's respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress. The dialysis solution would not cause urticaria or affect circulation to the fingers. The client's laboratory values are obtained before beginning treatment and are monitored every 4 to 8 hours during the treatment, not just during the dwell time.

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

83. 2. Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the healthcare provider (HCP) should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood-tinged drainage.

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

83. 2. Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood-tinged drainage.

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

85. 4. Constipation may contribute to reduced urine outflow in part because peristalsis facilitates drainage outflow. For this reason, bisacodyl suppositories can be used prophylactically, even without a history of constipation. Diarrhea, vomiting, and flatulence typically do not cause decreased outflow in a peritoneal dialysis catheter.

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

86. 2. Because hypotension is a complication associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status.

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

86. 2. Because hypotension is a complication associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status.

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

87. 1, 2, 4, 5. Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. If peritonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Peritonitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.

88.After completion of peritoneal dialysis, the nurse should assess the client for which of the following? 1.Hematuria. 2.Weight loss. 3.Hypertension. 4.Increased urine output.

88. 2. Weight loss is expected because of the removal of fluid. The client's weight before and after dialysis is one measure of the effectiveness of treatment. Blood pressure usually decreases because of the removal of fluid. Hematuria would not occur after completion of peritoneal dialysis. Dialysis only minimally affects the damaged kidneys' ability to manufacture urine.

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

89. 3. A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.

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

90. 4. Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat an upset stomach caused by hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.

91.The client with chronic renal failure takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because: 1.Milk of magnesia can cause magnesium intoxication. 2.Milk of magnesia is too harsh on the bowel. 3.Metamucil is more palatable. 4.Milk of magnesia is high in sodium.

91. 1. Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. Milk of magnesia is harsher than Metamucil, but magnesium toxicity is a more serious problem. A client may find both milk of magnesia and Metamucil unpalatable. Milk of magnesia is not high in sodium.

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

91. 2. Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videos because the client may not be able to maintain alertness during the viewing of the videotape

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

92. 3. Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the by-products of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.

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

93. 3. Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.

94. A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: 1. is relatively low in cost. 2. allows the client to be more independent. 3. is faster and more efficient than standard peritoneal dialysis. 4. has fewer potential complications than does standard peritoneal dialysis.

94. 2. The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, healthcare personnel, and machines for life-sustaining treatment. This independence is a valuable outcome for some people. CAPD is costly and must be done daily. Adverse effects and complications are similar to those of standard peritoneal dialysis. Peritoneal dialysis usually takes less time but cannot be done at home.

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

95. 3. Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.

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

96. 3. Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.

One of the major advantages of peritoneal dialysis is that: A. no medications are required because of the enhanced efficiency of the peritoneal membranes in removing toxins B. the diet is less restricted and dialysis can be performed at home C. the dialysate is biocompatible and causes no long term consequences D. high glucose concentration of the dialysate causes a reduction in appetite promoting weight loss

B

A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the patients chronic kidney disease is at what stage? A. Stage 1 B. Stage 2 C. Stage 3 D>. Stage 4

C Feedback: Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR

The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient? A) Using a stethoscope for auscultating the fistula is contraindicated. B)The patient feels best immediately after the dialysis treatment. C) Taking a BP reading on the affected arm can damage the fistula. D) The patient should not feel pain during initiation of dialysis.

C Feedback: When blood flow is reduced through the access for any reason (hypotension, application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful.

36. A patient with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care? A) Ensure that the patient moves the extremity with the vascular access site as little as possible. B) Change the dressing over the vascular access site at least every 12 hours. C) Utilize the vascular access site for infusion of IV fluids. D) Assess for a thrill or bruit over the vascular access site each shift.

D Feedback: The bruit, or thrill, over the venous access site must be evaluated at least every shift. Frequent dressing changes are unnecessary and the patient does not normally need to immobilize the site. The site must not be used for purposes other than dialysis.

A nurse working in a women's health clinic is caring for a client who reports Urinary urgency and dysuria. Which of the following findings should the nurse identify as an indication of a Urinary tract infection?

Pyuria

A nurse is providing education regarding cyclo sportiness for a client who had a kidney transplant 2 days ago. Which of the following statements by the nurse is appropriate?

You will need to continue taking this medication to protect your new kidneys

DELTEPriority Decision: During the immediate postoperative care of a recipient of a kidney transplant, what should the nurse expect to do? a. Regulate fluid intake hourly based on urine output. b. Monitor urine-tinged drainage on abdominal dressing. c. Medicate the patient frequently for incisional flank pain. d. Remove the urinary catheter to evaluate the ureteral implant.

a. Fluid and electrolyte balance is critical in the transplant recipient patient, especially because diuresis often begins soon after surgery. Fluid replacement is adjusted hourly based on kidney function and urine output. Urine-tinged drainage on the abdominal dressing may indicate leakage from the ureter implanted into the bladder and the health care provider should be notified. The donor patient may have a flank or laparoscopic incision(s) where the kidney was removed. The recipient has an abdominal incision where the kidney was placed in the iliac fossa. The urinary catheter is usually used for 2 to 3 days to monitor urine output and kidney function.

A man with end-stage kidney disease is scheduled for hemodialysis following healing of an arteriovenous fistula (AVF). What should the nurse explain to him that will occur during dialysis? a. He will be able to visit, read, sleep, or watch TV while reclining in a chair. b. He will be placed on a cardiac monitor to detect any adverse effects that might occur. c. The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the waste products. d. A large catheter with two lumens will be inserted into the fistula to send blood to and return it from the dialyzer.

a. While patients are undergoing hemodialysis, they can perform quiet activities that do not require the limb that has the vascular access. Blood pressure is monitored frequently and the dialyzer monitors dialysis function but cardiac monitoring is not usually indicated. The hemodialysis machine continuously circulates both the blood and the dialysate past the semipermeable membrane in the machine. Graft and fistula access involve the insertion of two needles into the site: one to remove blood from and the other to return blood to the dialyzer.

What is the primary way that a nurse will evaluate the patency of an AVF? a. Palpate for pulses distal to the graft site. b. Auscultate for the presence of a bruit at the site. c. Evaluate the color and temperature of the extremity. d. Assess for the presence of numbness and tingling distal to the site.

b. A patent arteriovenous fistula (AVF) creates turbulent blood flow that can be assessed by listening for a bruit or palpated for a thrill as the blood passes through the graft. Assessment of neurovascular status in the extremity distal to the graft site is important to determine that the graft does not impair circulation to the extremity but the neurovascular status does not indicate whether the graft is open.

To prevent the most common serious complication of PD, what is important for the nurse to do? a. Infuse the dialysate slowly. b. Use strict aseptic technique in the dialysis procedures. c. Have the patient empty the bowel before the inflow phase. d. Reposition the patient frequently and promote deep breathing.

b. Peritonitis is a common complication of peritoneal dialysis (PD) and may require catheter removal and termination of dialysis. Infection occurs from contamination of the dialysate or tubing or from progression of exit-site or tunnel infections and strict sterile technique must be used by health professionals as well as the patient to prevent contamination. Too-rapid infusion may cause shoulder pain and pain may be caused if the catheter tip touches the bowel. Difficulty breathing, atelectasis, and pneumonia may occur from pressure of the fluid on the diaphragm, which may be prevented by elevating the head of the bed and promoting repositioning and deep breathing.

A patient on hemodialysis develops a thrombus of a subcutaneous arteriovenous (AV) graft, requiring its removal. While waiting for a replacement graft or fistula, the patient is most likely to have what done for treatment? a. Peritoneal dialysis b. Peripheral vascular access using radial artery c. Silastic catheter tunneled subcutaneously to the jugular vein d. Peripherally inserted central catheter (PICC) line inserted into subclavian vein

c. A more permanent, soft, flexible Silastic double-lumen catheter is used for long-term access when other forms of vascular access have failed. These catheters are tunneled subcutaneously and have Dacron cuffs that prevent infection from tracking along the catheter.

What does the dialysate for PD routinely contain? a. Calcium in a lower concentration than in the blood b. Sodium in a higher concentration than in the blood c. Dextrose in a higher concentration than in the blood d. Electrolytes in an equal concentration to that of the blood

c. Dextrose or icodextrin or amino acid is added to dialysate fluid to create an osmotic gradient across the membrane to remove excess fluid from the blood. The dialysate fluid has no potassium so that potassium will diffuse into the dialysate from the blood. Dialysate also usually contains higher calcium to promote its movement into the blood. Dialysate sodium is usually less than or equal to that of blood to prevent sodium and fluid retention.