Renal prepU
The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching? "I'll take it every 4 hours around the clock." "I'll take it with meals and bedtime snacks." "I'll take it between meals and at bedtime." "I'll take it when I have an upset stomach."
"I'll take it with meals and bedtime snacks."
A nurse is about to admit a client to the medical surgical unit directly from the healthcare provider's office. Upon assessment, the nurse notes that the client has significant periorbital edema. Laboratory values indicate the presence of proteinuria and hypoproteinemia. Which action is the nurse's priority? Ensuring client compliance with a low-protein diet Frequent ambulation Monitoring of hemoglobin and hematocrit Strict intake and output assessment and documentation
Strict intake and output assessment and documentation
A nurse is providing instruction about peritoneal dialysis to a client. Which action warrants immediate action by the nurse? The client empties the bladder before the infusion. The client keeps the dialysate cold until ready for use. The client inspects the effluent. The client prepares to connect the tubing using aseptic technique.
The client keeps the dialysate cold until ready for use.
A client with a urinary tract infection is ordered co-trimoxazole. The nurse should provide which medication instruction? "Don't be afraid to go out in the sun." "Take the medication with food." "Avoid taking antacids during co-trimoxazole therapy." "Drink at least eight 8-oz (240 mL) glasses of fluid daily." SUBMIT ANSWER
"Drink at least eight 8-oz (240 mL) glasses of fluid daily."
A client is scheduled for a creatinine clearance test. The client needs further instruction about preparing for the test after making which statement? "I will restrict my protein intake for the day prior to the test to no more than 8 ounces." "I will be sure to fast from midnight until the test begins at 8:00 am the following day." "I will stay well hydrated prior to the test." "I can engage in normal activity the day before the test."
"I will be sure to fast from midnight until the test begins at 8:00 am the following day."
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? "Be sure to eat meat at every meal." "Drink plenty of fluids, and use a salt substitute." "Eat plenty of bananas." "Increase your carbohydrate intake."
"Increase your carbohydrate intake."
A client who weighs 207 lb (94.1 kg) is to receive 1.5 mg/kg of gentamicin sulfate IV three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number.
141
A client has a ureteral catheter in place after renal surgery. What should the nurse do to provide safe care of the ureteral catheter? Ensure that the catheter drains at least 15 mL/h. Clamp the catheter every 2 hours for 30 minutes. Irrigate the catheter with 30 ml of normal saline every 8 hours. Ensure that the catheter is draining freely.
Ensure that the catheter is draining freely.
Which action has the highest priority in the care of a client with chronic renal failure?
Maintain a low-sodium diet.
A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which sign of peritoneal infection? cloudy dialysate fluid redness at the catheter insertion site swelling in the legs poor drainage of the dialysate fluid
cloudy dialysate fluid
The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. The nurse should report which finding to the health care provider (HCP)? serosanguineous drainage on the dressing Absence of bowel sounds urine output: 20 mL/h temperature: 99.8°F (37.7°C)
urine output: 20 mL/h
A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? urine pH of 3.0 absence of glucose absence of protein specific gravity of 1.03
urine pH of 3.0
A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? checking the client's lungs for crackles during every shift weighing the client daily at the same time each day assessing the client's vital signs every 4 hours measuring and recording fluid intake and output
weighing the client daily at the same time each day
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: hematuria. increased blood pressure. weight loss. increased urine output.
weight loss.
Aluminum hydroxide gel is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of this drug? preventing Curling's stress ulcers relieving the pain of gastric hyperacidity reversing metabolic acidosis binding phosphate in the intestine
binding phosphate in the intestine
A client has nephrotic syndrome. To aid in the resolution of the client's edema, the health care provider prescribes 25% albumin. In addition to an absence of edema, the nurse should evaluate the client for which expected outcome? cool skin temperature in lower extremities blood pressure elevation cerebral edema crackles in the lung bases
blood pressure elevation
A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address? "I've had diabetes for 4 years." "I'm allergic to shellfish." "My physician diagnosed me with hypertension 3 months ago." "I haven't eaten since midnight."
"I'm allergic to shellfish."
During dialysis, the client has disequilibrium syndrome. What should the nurse do first? Place the client in modified Trendelenburg's position. Slow the rate of dialysis. Reassure the client that the symptoms are normal. Administer oxygen per nasal cannula.
Slow the rate of dialysis.
The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which snack is most appropriate? an orange yogurt peanuts a gelatin dessert
a gelatin dessert
Which abnormal blood value would not be improved by dialysis treatment? decreased hemoglobin concentration hypernatremia elevated serum creatinine level hyperkalemia
decreased hemoglobin concentration
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? risk for infection toileting self-care deficit impaired urinary elimination activity intolerance
risk for infection
The nurse is caring for a client with chronic renal failure. The nurse should monitor the client for which adverse effects of hypermagnesemia? severe thirst lethargy tremors flushed skin
lethargy
A graduate nurse is asking for information about chronic renal failure. Which statement by the nurse would be most accurate when providing teaching? "It results in an increase in erythropoietin, leading to chronic anemia and fatigue." "It results in an inability of the kidneys to convert waste products to creatinine and blood urea nitrogen." "It is most commonly caused by recurrent pyelonephritis." "It is characterized by azotemia, fluid volume excess, and hyperkalemia."
"It is characterized by azotemia, fluid volume excess, and hyperkalemia."
A client was treated for a streptococcal throat infection 2 weeks ago. The client now has been diagnosed with acute poststreptococcal glomerulonephritis. The client asks the nurse how he could have prevented this condition. What should the nurse tell the client? "Unscented bar soap may be used in showers." "See your health care provider (HCP) for an early diagnosis and treatment of a sore throat." As long as you don't have a fever, it's sufficient to gargle daily with an antibacterial mouthwash." "You may continue to utilize the previously prescribed antibiotics until they're gone."
"See your health care provider (HCP) for an early diagnosis and treatment of a sore throat."
After transurethral resection of the prostate, the nurse notices that the urine draining from the catheter is bright red, has numerous clots, and is viscous. Which nursing action is most appropriate? Irrigate the catheter to remove clots. Increase the client's fluid intake. Assess vital signs and notify the surgeon. Milk the catheter tube vigorously.
Assess vital signs and notify the surgeon.
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as: anuria. oliguria. hematuria. polyuria.
anuria.
The client is having peritoneal dialysis. During the exchange, the nurse observes that the flow of dialysate stops before all the solution has drained out. What should the nurse do next? Have the client sit in a chair. Turn the client from side to side. Have the client walk. Reposition the peritoneal catheter.
Turn the client from side to side.
An unlicensed assistive personnel (UAP) tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that's not possible because he has a catheter in place that is draining well." What should the nurse tell the UAP? "The urge to void is usually created by the large catheter, and he may be having some bladder spasms." "That is a common concern after prostate surgery. The client only imagines the urge to void." "I think he may be somewhat confused." "His catheter is probably plugged. I will irrigate it in a few minutes."
"The urge to void is usually created by the large catheter, and he may be having some bladder spasms."
The client with acute renal failure asks the nurse, "Will my kidneys ever function normally again?" What should the nurse tell the client? "You will have more kidney damage in several years." "You will continue to improve over a period of weeks." "You will likely need dialysis." "You will improve when you have a kidney transplant."
"You will continue to improve over a period of weeks."
The nurse is completing an intake and output record for a client who is receiving continuous bladder irrigation after transurethral resection of the prostate. How many milliliters of urine should the nurse record as output for her shift if the client received 1,800 ml of normal saline irrigating solution and the output in the urine drainage bag is 2,400 ml?
600
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? Take the client's blood pressure in the left arm. Keep the AV fistula wrapped in gauze. Assess the AV fistula for a bruit and thrill. Keep the AV fistula site dry.
Assess the AV fistula for a bruit and thrill.
A nurse is concerned because an unlicensed assistive personnel (UAP) stated that a client has a discrepancy of > 350 mL in liquid intake and output for the shift. Which action is the most appropriate for the nurse to take? Administer a bolus of 350 mL normal saline. Document the difference between intake and output as a normal finding. Assume the client voided and discarded the urine. Assess the client's daily weight patterns.
Assess the client's daily weight patterns.
An older adult client diagnosed with end-stage renal disease (ESRD) presents with fluid volume excess. Which nursing intervention is the priority? Place the client on intake and output measurement. Weigh the client. Assess the client's heart rate and blood pressure. Assess the client's lung sounds.
Assess the client's lung sounds.
A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing the changes? Assess the client's mental status regularly. Restrict foods that are high in potassium. Allow the client to grieve for body image changes. Restrict fluid intake to 1,000 mL/day.
Assess the client's mental status regularly.
A client with acute pyelonephritis receives a prescription for co-trimoxazole P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the ordered regimen? Flank and abdominal discomfort decreases. The red blood cell (RBC) count is normal. Urine output increases to 2,000 ml/day. Bacteria are absent on urine culture.
Bacteria are absent on urine culture.
A client has nephropathy. The health care provider (HCP) prescribes a 24-hour urine collection for creatinine clearance. Which action is necessary to ensure proper collection of the specimen? Determine the client's weight before beginning the collection of urine. Collect the urine in a preservative-free container and keep it on ice. Request a prescription for insertion of an indwelling urinary catheter. Inform the client to discard the last voided specimen at the conclusion of urine collection.
Collect the urine in a preservative-free container and keep it on ice.
A client diagnosed with chronic renal failure is undergoing hemodialysis. Post dialysis, the client weighs 59 kg. The nurse should teach the client to make which dietary changes? Limit the total number of calories consumed each day to 1,000. Increase fluid intake to 3,000 mL each day. Increase sodium in the diet to 4 g/day. Control the amount of protein intake to 59 to 70 g/day.
Control the amount of protein intake to 59 to 70 g/day
A client receiving total parenteral nutrition (TPN) is ordered to undergo a 24-hour urine test for creatinine clearance. Which actions should the client take to initiate this collection? Start with the first voiding of the day and then continue for exactly 24 hours. Discard the first morning void, then continue the collection for exactly 24 hours. Begin at 0800 and then continue until 0759 on the following day. Start immediately after initiation of TPN and then continue for exactly 24 hours.
Discard the first morning void, then continue the collection for exactly 24 hours.
Sulfamethoxazole/trimethoprim has been prescribed for a client who has a urinary tract infection. What should the nurse do when administering sulfonamides? Instruct the client that the urine may turn reddish orange. Instruct the client to drink at least eight glasses of water a day. Measure the client's urine output. Encourage the client to take the medication with meals.
Instruct the client to drink at least eight glasses of water a day.
The nurse is caring for a client with acute renal failure. Rank in chronological order the phases of acute renal failure. All options must be used.
Initial insult Oliguric phase Diuretic phase Recovery phase
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? Start hemodialysis after a temporary access is obtained. Administer furosemide 20 mg I.V. Encourage oral fluids. Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate? Provide all needed teaching in one extended session. Use video clips to reinforce the material as needed. Validate the client's understanding of the material frequently. Conduct a one-on-one session with the client.
Validate the client's understanding of the material frequently.
A client is to receive peritoneal dialysis. What should the nurse do to prepare the client for the procedure? Warm the dialysis solution in the warmer. Insert an indwelling urinary catheter and drain all urine from the bladder. Assess the dialysis access for a bruit and thrill. Ask the client to turn toward the left side.
Warm the dialysis solution in the warmer
A client with acute renal failure has the following laboratory results. Based on these findings, which of the following should the nurse administer? hemoglobin 9.2 g/dLblood urea nitrogen 22 mg/dL creatinine 0.7 mg/dL potassium 4.8 mEq/L erythropoietin furosemide calcium gluconate potassium chloride
erythropoietin
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: hypernatremia. hypercalcemia. hypokalemia. hyperkalemia.
hyperkalemia.
A nurse is assessing a client with nephrotic syndrome. The nurse should assess the client for which condition? increased serum albumin level hematuria massive proteinuria weight loss
massive proteinuria
A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. What should the nurse tell the client to expect when following this diet? help maintain urine acidity. act as a diuretic. prevent the development of ketosis. reduce demands on the liver.
prevent the development of ketosis.
A client is scheduled for a renal arteriogram. No allergies are recorded in the client's medical record, and the client is unable to provide allergy information. During the arteriogram, the nurse should be alert for which assessment finding that may indicate an allergic reaction to the dye used? nausea pruritus psoriasis hypoventilation
pruritus
The client is in the oliguric phase of acute renal failure. For which risk should the nurse assess the client? hypokalemia metabolic alkalosis hypotension pulmonary edema
pulmonary edema
A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about
recent streptococcal infection.
Which clinical finding should a nurse look for in a client with chronic renal failure? polycythemia uremia hypotension metabolic alkalosis
uremia
A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? obstruction of the urinary collecting system nephrotoxic injury secondary to use of contrast media damage to cells in the adrenal cortex poor perfusion to the kidneys
nephrotoxic injury secondary to use of contrast media
Which initial manifestation of acute renal failure is the most common? oliguria anuria dysuria hematuria
oliguria
A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include: polyuria. moderate to severe hypotension. periorbital edema. green-tinged urine.
periorbital edema.
Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateral crackles and observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcal glomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take? Provide a high-protein, fluid-monitored diet. Place the client on a sheepskin, and monitor for increasing edema. Encourage activity as tolerated. Monitor patient blood pressure.
Monitor patient blood pressure.
Which should be included in the client's plan of care during dialysis therapy? Monitor the client's blood pressure. Keep the client on nothing-by-mouth (NPO) status. Limit the client's visitors. Pad the side rails of the bed.
Monitor the client's blood pressure.
A client is receiving peritoneal dialysis. What should the nurse assess while the dialysis solution is dwelling in the client's abdomen? Monitor electrolyte status. Assess for urticaria. Observe respiratory status. Check capillary refill time.
Observe respiratory status
A client with acute kidney failure is placed on fluid restriction of 1000 mL of fluid over a 24-hour period. What is the priority nursing action? Divide the fluids equally among the three 8-hour nursing shifts. Eliminate the liquids between meal times. Notify the dietary department of a clear fluids order. Offer the client proportioned fluids in the day and less during the night.
Offer the client proportioned fluids in the day and less during the night.
A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the past several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse address? white blood cell count (WBC) 9,000 cells/mm3 blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL creatine phosphokinase (CPK) of 21 U/L sodium (Na+) of 145 mEq/L and potassium (K+) of 5.0 mEq/L
blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL
A client is receiving a blood transfusion, and 1 hour after starting the transfusion the client reports dyspnea and has crackles on lung auscultation. Which medication would be most important for the nurse to give? acetaminophen 600 mg PO furosemide 40 mg I.V. methylprednisolone 250 mg I.V. bolus diphenhydramine 50 mg PO
furosemide 40 mg I.V.
A client with chronic renal failure (CRF) has a hemoglobin of 10.2 g/dl and hematocrit of 40%. Which choice would be a primary assessment? presence of fatigue and weakness presence of thrush and circumoral pallor presence of dyspnea and cyanosis presence of edema and fluid volume overload
presence of fatigue and weakness
The client who is in acute renal failure has an elevated blood urea nitrogen (BUN). What is the likely cause of this finding? fluid retention below-normal metabolic rate hemolysis of red blood cells reduced renal blood flow
reduced renal blood flow
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: metabolic alkalosis secondary to retention of hydrogen ions. an increased serum calcium level secondary to kidney failure. a decreased serum phosphate level secondary to kidney failure. water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? white blood cell (WBC) count of 20,000/mm3 (0.02 L) potassium level of 3.5 mEq/L (3.5 mmol/L) hematocrit (HCT) of 35% blood glucose level of 200 mg/dl (11.1 mmol/L)
white blood cell (WBC) count of 20,000/mm3 (0.02 L)
A client receiving total parenteral nutrition is ordered a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should start with the first voiding. start after a known voiding. always be with the first morning urine. always be the evening's last void as the last sample.
start after a known voiding.
A client is having peritoneal dialysis. During the exchange, 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. What clinical judgment should the nurse make about the blood-tinged drainage? It is caused by too-rapid infusion of the dialysate. It indicates abdominal blood vessel damage. It can indicate kidney damage. It is expected with a permanent peritoneal catheter.
It indicates abdominal blood vessel damage.
A client who is to receive general anesthesia has a serum potassium level of 5.8 mEq/L (5.8 mmol/L). What should be the nurse's first response? Send the client to surgery. Make a note on the client's record. Call the operating room to cancel the surgery. Notify the anesthesiologist.
Notify the anesthesiologist.
A client is voiding small amounts of urine every 30 to 60 minutes. What should the nurse do first? Catheterize the client for residual urine. Palpate for a distended bladder. Encourage an increased fluid intake. Obtain a urine specimen for culture.
Palpate for a distended bladder.
Which is the correct order, from first to last, for proper placement of a urinary catheter? All options must be used.
Prepare a sterile field. Lubricate the catheter adequately with a water-soluble lubricant. Insert the catheter far enough into the bladder to prevent trauma to the urethral tissue. Ensure free flow of urine.
What should the nurse do to prevent catheter-associated urinary tract infection? Select all that apply. Provide perineal care at least once a day. Maintain a closed drainage system. Encourage the client to drink 3,000 mL of fluids a day. Change the catheter daily. Recommend the health care provider prescribe antibiotics.
Provide perineal care at least once a day. Maintain a closed drainage system. Encourage the client to drink 3,000 mL of fluids a day.
Which statement best describes the therapeutic action of loop diuretics? They block reabsorption of potassium on the collecting tubule. They promote potassium secretion into the distal tubule and constrict renal vessels. They block sodium reabsorption in the ascending loop and dilate renal vessels. They promote sodium secretion into the distal tubule.
They block sodium reabsorption in the ascending loop and dilate renal vessels.
A client with diabetes mellitus has had declining renal function over the past several years. Which diet regimen should the nurse recommend to the client on days between dialysis? no protein in the diet and use of salt sparingly a low-protein diet with an unlimited amount of water a high-protein diet with a prescribed amount of water a low-protein diet with a prescribed amount of water
a low-protein diet with a prescribed amount of water
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: is faster and more efficient than standard peritoneal dialysis. allows the client to be more independent. has fewer potential complications than standard peritoneal dialysis. is relatively low in cost.
allows the client to be more independent.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? increased pH with decreased hydrogen ions uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75% blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl increased serum levels of potassium, magnesium, and calcium
blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl
A client returns to the intensive care unit after coronary artery bypass graft surgery, which was complicated by a prolonged cardiopulmonary bypass and hypotension. After 3 hours in the unit, the client's condition stabilizes. Which assessment finding indicates a potential complication related to this occurrence? blood urea nitrogen level (BUN) of 40 mg/dL reports of "stomach pain" hypoactive bowel sounds urinary output of 30 mL/hour
blood urea nitrogen level (BUN) of 40 mg/dL
A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for: paresthesia. dehydration. pruritus. cardiac arrhythmia.
cardiac arrhythmia.
A client requires hemodialysis. Which type of drug should be withheld before this procedure? phosphate binders insulin cardiac glycosides antibiotics
cardiac glycosides
A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN) of 100 mg/dL, serum creatinine of 6.5 mg/dL, potassium of 6.1 mEq/L, and lethargy. What is the priority nursing assessment? weight changes cardiac rhythm blood pressure arterial blood gases
cardiac rhythm
A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: apply pressure to the puncture site for 30 minutes. remove the dressing on the puncture site after vital signs stabilize. check the client's pedal pulses frequently. keep the client's knee on the affected side bent for 6 hours.
check the client's pedal pulses frequently.
When teaching a client with chronic renal failure who is taking antibiotics about which signs and symptoms of potential nephrotoxicity to report, the nurse should encourage the client to promptly report which changes in the color of the urine? Select all that apply. straw-colored cloudy smoky pink pale yellow
cloudy smoky pink
After teaching the mother of a young child with a peritoneal catheter about the signs and symptoms of peritonitis, the nurse determines that the mother has understood the teaching when she identifies which finding as an important sign? shortness of breath distended abdomen weight gain of 3 lb (1.36 kg) in 2 days cloudy dialysate drainage return
cloudy dialysate drainage return
A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis disequilibrium syndrome causes: confusion, headache, and seizures. weakness, tingling, and cardiac arrhythmias. acute bone pain and confusion. hypotension, tachycardia, and tachypnea.
confusion, headache, and seizures.
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? liver function studies GI absorption rate therapeutic index creatinine clearance
creatinine clearance
The nurse receives the preoperative blood work report for a client who is scheduled to undergo surgery. Which laboratory finding should the nurse report to the surgeon and anesthesiologist? red blood cells, 4.5 million/mm3 (4.5 X 1012/L) hemoglobin, 12.2 g/dL (122 g/L) creatinine, 2.6 mg/dL (230 µmol/L) blood urea nitrogen, 15 mg/dL (5.4 mmol/L)
creatinine, 2.6 mg/dL (230 µmol/L)
The most significant sign of acute renal failure is: increased urine specific gravity. elevated body temperature. increased blood pressure. decreased urine output.
decreased urine output.
A client returns to an intensive care unit after coronary artery bypass graft surgery, which was complicated by prolonged cardiopulmonary bypass and hypotension. After 3 hours in the unit, the client's condition stabilizes. However, the urine output has decreased despite adequate filling pressures. The nurse expects the physician to add which drug, at which flow rate, to the client's regimen? norepinephrine, 8 mcg/minute epinephrine, 4 mcg/kg/minute dobutamine, 10 mcg/kg/minute dopamine, 3 mcg/kg/minute
dopamine, 3 mcg/kg/minute
A client with type 2 diabetes mellitus who is taking metformin is scheduled for a computed tomography (CT) with contrast of the abdomen tomorrow. Which priority nursing assessment is done before the procedure? ensuring that client has taken nothing by mouth for 24 hours ensuring that the metformin has been withheld for 48 hours prior to the scan administering a sodium biphosphate and sodium phosphate enema until clear the evening before administering polyethylene glycol electrolyte solution over 12 hours until stools are clear and liquid
ensuring that the metformin has been withheld for 48 hours prior to the scan
A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). The most therapeutic pharmacologic intervention would be to administer filgrastim. epoetin alfa ferrous sulfate enoxaparin.
epoetin alfa
The client is on a fluid restriction of 500 mL/day plus replacement for urine output. Because the client's 24-hour urine output yesterday was 150 mL, the total fluid allotment for the next 24 hours is 650 mL. How should the nurses distribute this fluid over the next 24 hours? supplemented with gelatin and ice cream given in small amounts throughout each shift given in its entirety in the morning to minimize the client's thirst during the rest of the 24 hour period given with meals, divided equally between breakfast and lunch
given in small amounts throughout each shift
The nurse is assessing a client who is restless and agitated, has dry mucous membranes, and has intense thirst. The nurse should assess the client further for which electrolyte imbalance? hypomagnesemia hypernatremia hypercalcemia hypokalemia
hypernatremia
A nurse encourages a client to increase fluid intake, based on which laboratory test results? Select all that apply. increased blood-urea-nitrogen (BUN) level decreased urine osmolality increased serum creatinine level decreased urine specific gravity decreased blood glucose level
increased serum creatinine level increased blood-urea-nitrogen (BUN) level
The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? high-carbohydrate, high-protein low-protein, low-sodium, low-potassium low-protein, high-potassium high-calcium, high-potassium, high-protein
low-protein, low-sodium, low-potassium
A client is admitted with fever and flank pain and is diagnosed with pyelonephritis. What is a priority nursing intervention in a client with this disorder? monitoring laboratory values, especially WBCs obtaining a clean catch urine specimen for specific gravity initiating a 24-hour urine collection after the first morning void straining all urine
monitoring laboratory values, especially WBCs
A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome. Which assessment is the priority? vital signs pain in the flank region neurological status laboratory values
neurological status
A nurse is obtaining assessment data on a client diagnosed with acute renal failure. Which finding warrants calling the healthcare provider? sodium level 145 mEq/L blood urea nitrogen (BUN) 25 mg/dl peaked T waves on electrocardiogram respiratory rate of 16 breaths per minute
peaked T waves on electrocardiogram
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? temperature respirations pulse blood pressure
pulse
A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. SUBMIT ANSWER
A nurse is reviewing a client's laboratory test results. Which electrolyte is the major cation controlling a client's extracellular fluid (ECF) osmolality? chloride potassium sodium calcium
sodium
Which client will the nurse prioritize to assess first? the client admitted 24 hours earlier with mild chest pain and negative serial levels of troponin T in the range of 0-0.1 µg/L the client 2 days post-laparoscopic cholecystectomy the client with type 1 diabetes mellitus and a morning blood glucose level of 110 mg/dL the client with ESRD (end-stage renal disease) just admitted the night before
the client with ESRD (end-stage renal disease) just admitted the night before SUBMIT ANSWER
When teaching the client with a urinary tract infection about taking a prescribed antibiotic for 7 days, the nurse should tell the client to report which symptoms to the health care provider (HCP)? Select all that apply. rash blood in the urine fever above 100° F (37.8° C) mild nausea cloudy urine for the first few days urinating every 3 to 4 hours
• rash • blood in the urine • fever above 100° F (37.8° C)
A client is scheduled for a creatinine clearance test. What should the nurse do to prepare the client? Insert an indwelling urethral catheter. Tell the client to obtain 3,000 mL fluids the day before the test. Instruct the client about the need to collect urine for 24 hours. Provide the client with a sterile urine collection container.
Instruct the client about the need to collect urine for 24 hours.
Which action would be most appropriate for preventing urinary tract infections in an elderly female client? Insert an indwelling urethral catheter. Instruct the client to avoid tight-fitting underwear. Have the client urinate at least every 6 hours. Administer prophylactic antibiotics.
Instruct the client to avoid tight-fitting underwear.
