Chapter 54 Practice Questions (MS 2)
A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply. a. Penicillin b. Gentamycin c. Tobramycin d. Neomycin e. Ceftriaxone
b. Gentamycin c. Tobramycin d. Neomycin
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? a. Asterixis b. Gray-bronze skin color c. Tremors d. Seizures
b. Gray-bronze skin color
The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? a. Administer the medications as ordered. b. Hold the medications until after dialysis. c. Check with the dialysis nurse about the medications. d. Ask if the client wants to take the medications.
b. Hold the medications until after dialysis.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a. Impaired urinary elimination b. Toileting self-care deficit c. Risk for infection d. Activity intolerance
c. Risk for infection
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? a. Keep the AV fistula site dry. b. Keep the AV fistula wrapped in gauze. c. Take the client's blood pressure in the left arm. d. Assess the AV fistula for a bruit and thrill.
d. Assess the AV fistula for a bruit and thrill.
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.
4000
At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? a. 0.5 lb b. 1.0 lb c. 1.5 lb d. 2 lb
b. 1.0 lb
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? a. The kidneys can improve over a period of months. b. Once on dialysis, the need will be permanent. c. Kidney function will improve with transplant. d. Acute renal failure tends to turn to end-stage failure.
a. The kidneys can improve over a period of months.
Which assessment finding is most important in determining the severity of client's acute glomerulonephritis? a. Presence of albumin in the urine b. Dark smoky colored urine c. Blurred vision d. Peripheral edema
c. Blurred vision
The nurse has identified the nursing diagnosis of "Risk for Infection" in a client 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 prescribed. d. Administer prophylactic antibiotics by mouth or IV as prescribed.
a. Maintain aseptic technique when administering dialysate.
Which of the following occurs late in chronic glomerulonephritis? a. Peripheral neuropathy b. Nosebleed c. Stroke d. Seizure
a. Peripheral neuropathy
A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action? a. Advance the catheter 2 to 4 cm further into the peritoneal cavity. b. Reposition the client to facilitate drainage. c. Aspirate from the catheter using a 60-mL syringe. d. Infuse 50 mL of additional dialysate.
b. Reposition the client to facilitate drainage.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)? A. Decreased creatinine B. Increased BUN C. High specific gravity D. Decreased urine sodium
B. Increased BUN
A nurse cares for an acutely ill client. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill client is: A. blood pressure. B. weight. C. pulse rate. D. edema.
B. weight
The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate? A. Oral intake B. Pain intensity C. Level of consciousness D. Radiation of pain
C. Level of consciousness
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? A. Pats skin dry after bathing B. Uses moisturizing creams C. Keeps nails trimmed short D. Brief, hot daily showers
D. Brief, hot daily showers
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? a. Azotemia b. Proteinuria c. Hematuria d. Bacteremia
a. Azotemia
The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? a. Hemodialysis b. Peritoneal dialysis c. Continuous arteriovenous hemofiltration (CAVH) d. Continuous venovenous hemofiltration (CVVH)
a. Hemodialysis
A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess? a. Hypertension b. Flank pain c. Fever d. Periorbital edema
a. Hypertension
A client with acute renal failure progresses through four phases. Which describes the onset phase? a. It is accompanied by reduced blood flow to the nephrons. b. Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. c. The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. d. Normal glomerular filtration and tubular function are restored.
a. It is accompanied by reduced blood flow to the nephrons
Which of the following is the most sensitive indicator of renal function? a. Serum creatinine b. Blood urea nitrogen (BUN) c. Creatinine clearance d. Potassium
a. Serum creatinine
A client is experiencing a decreasing glomerular filtration. What laboratory values should the nurse expect to follow the change? Select all that apply. a. Serum creatinine increases b. Blood urea nitrogen (BUN) increases c. Creatinine clearance decreases d. Hypokalemia e. Hypophosphatemia
a. Serum creatinine increases b. Blood urea nitrogen (BUN) increases c. Creatinine clearance decreases
Which of the following is the most accurate indicator of fluid loss or gain? a. Weight b. Urine output c. Caloric intake d. Body temperature
a. Weight
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a. Dehydration b. Hyperkalemia c. Crackles d. Hypertension
a. dehydration
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? a. Hypertension b. Extremity pain c. Fever d. Periorbital edema
a. hypertension
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? a. pH 7.20, PaCO2 36, HCO3 14- b. pH 7.31, PaCO2 48, HCO3 24- c. pH 7.47, PaCO2 45, HCO3 33- d. pH 7.50, PaCO2 29, HCO3 22-
a. pH 7.20, PaCO2 36, HCO3 14-
The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? a. Butter b. Citrus fruits c. Cooked white rice d. Salad oils
b. Citrus fruits
Which clinical finding should a nurse look for in a client with chronic renal failure? a. Hypotension b. Uremia c. Metabolic alkalosis d. Polycythemia
b. Uremia
What is a hallmark of the diagnosis of nephrotic syndrome? a. Hyponatremia b. Proteinuria c. Hyperalbuminemia d. Hypokalemia
b. proteinuria
The most accurate indicator of fluid loss or gain in an acutely ill client is: a. blood pressure. b. weight. c. pulse rate. d. edema.
b. weight
The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching? a. "I should limit foods high in potassium in my diet, such as bananas." b. "I should limit the amount of protein in my diet." c. "I should drink as much as possible to keep my kidneys working." d. "My intake of high sodium foods should be limited."
c. "I should drink as much as possible to keep my kidneys working."
A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? a. "Try washing clothes with a strong detergent to ensure that all impurities are gone." b. "When you shower, use really warm water and an antibacterial soap." c. "Keep your showers brief, patting your skin dry after showering." d. "Liberally apply alcohol to the areas of your skin where you itch the most."
c. "Keep your showers brief, patting your skin dry after showering."
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: a. nausea and vomiting. b. dyspnea and cyanosis. c. fatigue and weakness. d. thrush and circumoral pallor.
c. fatigue and weakness.
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? a. Administration of an insulin drip b. Administration of a loop diuretic c. Administration of sodium bicarbonate d. Administration of sodium polystyrene sulfonate [Kayexalate])
d. Administration of sodium polystyrene sulfonate [Kayexalate])
A client requires hemodialysis. Which type of drug should be withheld before this procedure? a. Phosphate binders b. Insulin c. Antibiotics d. Cardiac glycosides
d. Cardiac glycosides
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a. Serum potassium level of 4.9 mEq/L b. Serum sodium level of 135 mEq/L c. Temperature of 99.2° F (37.3° C) d. Urine output of 20 ml/hour
d. Urine output of 20 ml/hour
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? a. Acute pyelonephritis c. Osmotic dieresis. d. Dysrhythmias e. Renal calculi
e. Renal calculi
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures
c. limiting fluid intake
A patient has acute kidney injury (AKI) with a negative nitrogen balance. How much weight does the nurse expect the patient to lose? A. 0.5 kg/day B. 1.0 kg/day C. 1.5 kg/day D. 2.0 kg/day
A. 0.5 kg/day
Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? A. Palpate the abdominal wall for rebound tenderness. B. Inspect the catheter site for leakage of dialysate. C. Observe for evidence of bleeding. D. Measure fluid drainage to estimate incomplete recovery of fluid.
A. Palpate the abdominal wall for rebound tenderness.
A client has been diagnosed with acute glomerulonephritis. This condition causes: a. proteinuria. b. pyuria. c. polyuria. d. No option is correct.
a. proteinuria
A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. What outcome will the decrease in erythropoietin have? A. Anemia from the decrease in maturation of red blood cells B. Decrease in blood sugar levels due to alteration in insulin levels C. Increase in blood sugar levels due to alteration in insulin levels D. Development of male sex characteristics
A. Anemia from the decrease in maturation of red blood cells
history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? a. Acute renal failure b. Acute glomerulonephritis c. Chronic renal failure d. Nephrotic syndrome
b. Acute glomerulonephritis
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering: a. sodium polystyrene sulfonate (Kayexalate) b. Sorbitol c. IV dextrose 50% d. Calcium supplements
a. sodium polystyrene sulfonate (Kayexalate)
The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?
1,000 mL
A client develops acute renal failure (ARF) after receiving IV 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: a. cardiac arrhythmia. b. paresthesia. c. dehydration. d. pruritus.
a. cardiac arrhythmia.
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: a. restricting sources of potassium. b. allowing liberal use of sodium. c. limiting iron and folic acid intake. d. eating protein liberally.
a. restricting sources of potassium.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? a. Glomerulonephritis b. Hypovolemia c. Ureteral calculus d. Dysrhythmia
a. Glomerulonephritis
The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurse's best response? a. Assess the client for signs of bleeding and inform the primary provider. b. Monitor the client's vital signs every 15 minutes for the next hour. c. Reposition the client and reassess vital signs. d. Palpate the client's flanks for pain and inform the primary provider.
a. Assess the client for signs of bleeding and inform the primary provider.
During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? a. Dehydration b. Hypokalemia c. Oliguria d. Renal calculi
a. Dehydration
The nurse is caring for a client whose acute kidney injury has prerenal cause. What most likely caused this client's health problem? a. Heart failure b. Glomerulonephritis c. Ureterolithiasis d. Aminoglycoside toxicity
a. Heart failure
The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.
0.5
Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?
6
The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula? A. "A vein and an artery in your arm will be attached surgically." B. "The arm should be immobilized for 4 to 6 days." C. "One needle will be inserted into the fistula for each dialysis treatment." D. "The fistula can be used 5 to 7 days after the surgery for dialysis treatment."
A. "A vein and an artery in your arm will be attached surgically."
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? A. Donors are selected from compatible living or deceased donors. B. Donors must be relatives. C. Donors with hypertension may qualify. D. The client is placed on a transplant list at the local hospital.
A. Donors are selected from compatible living or deceased donors.
Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply. A. Hyperkalemia B. Metabolic alkalosis C. Anemia D. Hyperalbuminemia E. Hypocalcemia
A. Hyperkalemia C. Anemia E. Hypocalcemia
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? A. Hyperalbuminemia B. Peripheral neuropathy C. Cola-colored urine D. Hypotension
C. Cola-colored urine
A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase? A. Hypokalemia B. Hypocalcemia C. Dehydration D. Acute flank pain
C. dehydration
Which of the following would a nurse classify as a prerenal cause of acute renal failure? A. Polycystic disease B. Ureteral stricture C. Prostatic hypertrophy D. Septic shock
D. septic shock
A change that occurs during chronic glomerulonephritis is termed a. hypokalemia. b. anemia. c. metabolic alkalosis. d. hypophosphatemia.
b. anemia
The nurse is caring for a client who underwent a kidney transplant. The client appears anxious and tearful and states, "My body is going to reject the new kidney; I know I'm going to die." What is the best response by the nurse? a. "Don't think like that; I'm certain you will be fine." b. "If your body rejects the kidney, you can go back on dialysis; you are not going to die." c. "You've waited years for this transplant, you need to think positively." d. "I understand your concerns, let's talk about them."
d. "I understand your concerns, let's talk about them."
Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply. A. Limit protein to 1.6 g/kg/day. B. Eat foods such as milk, fish, and eggs. C. Restrict sodium to 2,000 to 3,000 mg daily. D. Increase potassium to prevent cardiac problems. E. Restrict fluid to daily urinary output plus 500 to 800 mL.
B. Eat foods such as milk, fish, and eggs. C. Restrict sodium to 2,000 to 3,000 mg daily. E. Restrict fluid to daily urinary output plus 500 to 800 mL.
The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed: A. acute rejection. B. hyperacute rejection. C. chronic rejection. D. Simple rejection.
B. hyperacute rejection
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? a. "Even a perfect match does not guarantee organ success." b. "Immunosuppressive drugs guarantee organ success." c. "The doctor may decide to delay the use of immunosuppressant drugs." d. "Let's wait until after the surgery to discuss your treatment plan."
a. "Even a perfect match does not guarantee organ success."
Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator? a. Blood pressure b. Urine protein c. Serum glucose d. pH and HCO3
c. Serum glucose
A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate? A. Lasix 80 mg IVP B. Normal saline bolus of 500 mL C. Chest x-ray D. Mannitol 12.5 g IVP
A. Lasix 80 mg IVP
Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted. A. Citrus fruits B. White rice C. Salad oils D. Butter
A. citrus fruits
Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit: A. no symptoms. B. fever. C. headache. D. polyuria.
A. no symptoms.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? a. Initiation b. Oliguria c. Diuresis d. Recovery
b. Oliguria
The nurse is able to identify which condition as uremia? a. An excess of urea in the blood b. An excess of protein in the blood c. An excess of blood in the urine d. An excess of protein in the urine
a. An excess of urea in the blood
The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? a. Only when needed b. Daily at bedtime c. First thing in the morning d. With each meal
d. With each meal
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a. "As the disease progresses, you will most likely require renal replacement therapy." b. "Dietary changes can reverse the damage that has occurred in your kidneys." c. "Draining of the cysts and antibiotic therapy will cure your disease." d. "Genetic testing will determine the best treatment for your condition."
a. "As the disease progresses, you will most likely require renal replacement therapy."
A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client 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. "Hemodialysis is a treatment option that is usually required three times a week."
A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient? a. Blood relationship b. Sex and size c. Compatible blood and tissue types d. Need
c. Compatible blood and tissue types
A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? a. Constipation related to immobility b. Risk for injury related to altered thought processes c. Hyperthermia related to the inflammatory process d. Excess fluid volume related to generalized edema
d. Excess fluid volume related to generalized edema
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? a. Poor perfusion to the kidneys b. Damage to cells in the adrenal cortex c. Obstruction of the urinary collecting system d. Nephrotoxic injury secondary to use of contrast media
d. Nephrotoxic injury secondary to use of contrast media
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? a. Hypotension b. Weight loss c. Polyuria d. Tenderness over transplant site
d. Tenderness over transplant site
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? a. Anemia b. Acidosis c. Hyperkalemia d. Pericarditis
a. Anemia
The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? a. Assessment of the quantity of the client's urine output b. Assessment of the client's incision c. Assessment of the client's abdominal girth d. Assessment for flank or abdominal pain
a. Assessment of the quantity of the client's urine output
A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client? a. Increasing oral intake b. Managing postoperative pain c. Managing dialysis d. Increasing mobility
b. Managing postoperative pain
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? a. Diuresis b. Oliguria c. Acute tubular necrosis d. Restored glomerular function
b. Oliguria
The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of a. hypokalemia. b. anemia. c. metabolic alkalosis. d. hypophosphatemia.
b. anemia.
A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what topic? a. Typical diet b. Allergy status c. Psychosocial stressors d. Current medication use
d. current medication use
The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? a. Avoiding heavy alcohol use b. Control of sodium intake c. Smoking cessation d. Adherence to recommended immunization schedules
c. Smoking cessation
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? a. Urine output of 35 to 40 mL/hour b. Pain of 3 out of 10, 1 hour after analgesic administration c. SpO2 at 90% with fine crackles in the lung bases d. Blood tinged drainage in Jackson-Pratt drainage tube
c. SpO2 at 90% with fine crackles in the lung bases
What is used to decrease potassium level seen in acute renal failure? a. Sodium polystyrene sulfonate b. Sorbitol c. IV dextrose 50% d. Calcium supplements
a. Sodium polystyrene sulfonate
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? a. With food b. 2 hours before meals c. 2 hours after meals d. At bedtime with 8 ounces of fluid
a. with food
A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What nursing diagnosis is suggested by this assessment finding? a. Imbalanced Nutrition: More than body requirements b. Excess Fluid Volume c. Sedentary Lifestyle d. Adult Failure to Thrive
b. Excess Fluid Volume
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? a. "I inherited this disorder from one of my parents." b. "The cysts can get quite large in size." c. "As long as I have one normal kidney, I should be fine." d. "If renal failure develops, I may need to consider dialysis."
c. "As long as I have one normal kidney, I should be fine."
The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? a. 1.5 L b. 1.0 L c. Less than 400 mL d. Less than 50 mL
c. Less than 400 mL
A nurse receives her client care assignment. Following the report, she should give priority assessment to the client: a. with pinkish mucus discharge in the appliance bag 2 days after an ileal conduit. b. who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant. c. who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L. d. who is experiencing mild pain from urolithiasis.
c. who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? a. Calcium b. Magnesium c. Phosphorus d. Sodium
a. calcium
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? a. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. b. BUN of 18 mg/dL. c. Serum creatinine of 1.2 mg/dL. d. Glomerular filtration rate (GFR) of 100 mL/min.
a. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.
Rejection of a transplanted kidney within 24 hours after transplant is termed a. acute rejection. b. hyperacute rejection. c. chronic rejection. d. simple rejection.
b. hyperacute rejection.
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? a. Encourage oral fluids. b. Administer furosemide (Lasix) 20 mg IV c. Start hemodialysis after a temporary access is obtained. d. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
d. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a. Blood urea nitrogen (BUN) level of 22 mg/dl b. Serum creatinine level of 1.2 mg/dl c. Temperature of 100.2° F (37.8° C) d. Urine output of 250 ml/24 hours
d. Urine output of 250 ml/24 hours
During hemodialysis, toxins and wastes in the blood are removed by which of the following? a. Diffusion b. Osmosis c. Ultrafiltration d. Filtration
a. Diffusion
Acute dialysis is indicated during which situation? a. Dehydration b. Impending pulmonary edema c. Metabolic alkalosis d. Hypokalemia
b. impending pulmonary edema
The nurse is caring for a client in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate? a. Hypernatremia b. Hypomagnesemia c. Hyperkalemia d. Hypercalcemia
c. Hyperkalemia
Patient education regarding a fistulae or graft includes which of the following? Select all that apply a. Check daily for thrill and bruit. b. Avoid compression of the site. c. No IV or blood pressure taken on extremity with dialysis access. d. No tight clothing. e. Cleanse site b.i.d.
a. Check daily for thrill and bruit. b. Avoid compression of the site. c. No IV or blood pressure taken on extremity with dialysis access. d. No tight clothing.
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a. Cola-colored urine b. Left upper quadrant pain c. Pyuria d. Low blood pressure
a. Cola-colored urine
Which phase of acute renal failure signals that glomerular filtration has started to recover? a. Diuretic b.Oliguric c. Initiation d. Recovery
a. Diuretic
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? a. Fluid volume excess b. Urinary retention c. Activity intolerance d. Disturbed body image
a. Fluid volume excess
A client is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, the client frequently suffers from breathing difficulty. Which measures should the nurse include in the care plan to relieve this distress? Select all that apply. a. Help the client to breathe deeply and cough every 2 hours. b. Provide firm support for the incision when the client coughs. c. Have client walk around the room as much as possible. d. Administer antibiotic therapy as prescribed.
a. Help the client to breathe deeply and cough every 2 hours. b. Provide firm support for the incision when the client coughs.
A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply. a. lethargy b. muscle cramps c. bleeding of the oral mucous membranes d. enhanced cognition
a. lethargy b. muscle cramps c. bleeding of the oral mucous membranes
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? a. Hyperphosphatemia b. Hypercalcemia c. Hypokalemia d. Metabolic alkalosis
a. Hyperphosphatemia
A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4
c. Stage 3
A nurse is caring for a client on bedrest with end-stage kidney disease. What major manifestation of uremia should the nurse expect to decrease with an exercise plan? a. A decreased serum phosphorus level b. Hyperparathyroidism c. Bone demineralization d. Increased secretion of parathormone
c. Bone demineralization
The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to do what? a. Wash hands carefully and frequently. b. Ensure immediate function of the donated kidney. c. Instruct the client to wear a face mask. d. Bar visitors from the client's room.
a. Wash hands carefully and frequently.
The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? a. Hematuria b. Precipitous decrease in serum creatinine levels c. Hypotension unresolved by fluid administration d. Glucosuria
a. Hematuria
A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would the nurse expect to find? Select all that apply. a. Hypertension b. Pain from retroperitoneal bleeding c. Normal urinalysis d. No renal stones e. Polyuria
a. Hypertension b. Pain from retroperitoneal bleeding e. Polyuria
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for: a. removal of the transplanted kidney. b. high-dose IV cyclosporine (Sandimmune) therapy. c. bone marrow transplant. d. intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol).
a. removal of the transplanted kidney.
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? a. A GFR of 90 mL/min/1.73 m2 b. A GFR of 30-59 mL/min/1.73 m2 c. A GFR of 120 mL/min/1.73 m2 d. A GFR of 85 mL/min/1.73 m2
b. A GFR of 30-59 mL/min/1.73 m2
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a. Perform deep-breathing exercises vigorously. b. Wear a mask when performing exchanges. c. Auscultate the lungs frequently. d. Avoid carrying heavy items.
b. Wear a mask when performing exchanges.
The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for a. muscle cramping. b. hypertension. c. dysrhythmias. d. air embolism.
b. hypertension
The nurse treats a client with end-stage kidney disease (ESKD). The nurse is concerned that the client is developing renal osteodystrophy. Upon review of the client's laboratory values, it is noted the client has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which medication? a. Calcium carbonate b. Mylanta c. Calcium acetate d. Sevelamer hydrochloride
d. Sevelamer hydrochloride
A client 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 client 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. Assess for a thrill or bruit over the vascular access site each shift.
The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client's siblings, parents, and grandparents. This assessment addresses the client's risk of what kidney disorder? a. Nephritic syndrome b. Acute glomerulonephritis c. Nephrotic syndrome d. Polycystic kidney disease (PKD)
d. Polycystic kidney disease (PKD)
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a. Diuresis b. Fever c. Absence of pain d. Weight loss
b. Fever
What is a characteristic of the intrarenal category of acute renal failure? a. Decreased creatinine b. Increased BUN c. High specific gravity d. Decreased urine sodium
b. Increased BUN
The nurse is caring for a client's status after a motor vehicle accident. The client has developed AKI. What are the nurse's roles in caring for this client? Select all that apply. a. Providing emotional support for the family b. Monitoring for complications c. Participating in emergency treatment of fluid and electrolyte imbalances d. Providing nursing care for primary disorder (trauma) e. Directing nutritional interventions
a. Providing emotional support for the family b. Monitoring for complications c. Participating in emergency treatment of fluid and electrolyte imbalances d. Providing nursing care for primary disorder (trauma)
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? a. Decrease in the blood flow through the kidneys b. Obstruction of urine flow from the kidneys c. Blood clot formed in the kidneys interfered with the flow d. Structural damage occurred in the nephrons of the kidneys
a. Decrease in the blood flow through the kidneys
A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's 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. Decreased protein intake b. Decreased sodium intake d. Fluid restriction
A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the client reviews the initial orders and notes an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? a. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. b. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this client. c. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. d. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.
a. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a. Increased serum creatinine level b. Decreased serum potassium level c. Increased red blood cell count d. Increased serum calcium level
a. Increased serum creatinine level
A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? a. Inform the health care provider and assess the client 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 prescribed.
a. Inform the health care provider and assess the client for signs of infection.
The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should assess what parameters? Select all that apply. a. Quantity of output b. Color of the output c. Visible characteristics of the output d. Odor of the output e. pH of the output
a. Quantity of output b. Color of the output c. Visible characteristics of the output
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. b. a decreased serum phosphate level secondary to kidney failure. c. an increased serum calcium level secondary to kidney failure. d. metabolic alkalosis secondary to retention of hydrogen ions.
a. water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? a. "It is important to use strict aseptic technique." b. "It is appropriate to warm the dialysate in a microwave." c. "The infusion clamp should be open during infusion." d. "The effluent should be allowed to drain by gravity."
b. "It is appropriate to warm the dialysate in a microwave."
A 76-year-old client with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The client 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. "Kidney transplants in patients your age are as successful as they are in younger patients."
The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? a. Initiation b. Oliguria c. Diuresis d. Recovery
b. Oliguria
A client is scheduled for a CT scan of the abdomen with contrast. The client has a baseline creatinine level of 2.3 mg/dL (203 µmol/L). In preparing this client for the procedure, the nurse anticipates what orders? a. Monitor the client's electrolyte values every hour before the procedure. b. Preprocedure hydration and administration of acetylcysteine c. Hemodialysis immediately prior to the CT scan d. Obtain a creatinine clearance by collecting a 24-hour urine specimen.
b. Preprocedure hydration and administration of acetylcysteine
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? a. Notify the health care provider. b. Turn the client from side to side. c. Lower the head of the bed. d. Push the catheter further into the abdomen.
b. Turn the client from side to side.
A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? a. Sore throat 2 weeks ago b. Red blood cells in the urine c. Elevation of blood pressure d. Protein elevation in the urine
a. Sore throat 2 weeks ago
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. a. Tall, peaked T waves b. Shortened QRS complex c. Multiple spiked P waves d. Prolonged ST segment
a. Tall, peaked T waves
The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all that apply. a. Red blood cells in the urine b. Polyuria c. Proteinuria d. White blood cell casts in the urine e. Hemoglobin of 12.8 g/dL
a. Red blood cells in the urine c. Proteinuria
The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? a. Serum creatinine of 1.5 mg/dL b. BUN of 20 mg/dLb c. Creatinine clearance of 90 mL/min d. Urinary protein level of 150 mg/24h.
a. Serum creatinine of 1.5 mg/dL
A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? a. Psychosocial stress b. Hypersensitivity to an immunization c. Menarche d. Streptococcal infection
a. Streptococcal infection
A nurse on the renal unit is caring for a client who will soon begin peritoneal dialysis. The family of the client asks for education about the peritoneal dialysis catheter that has been placed in the client's 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. 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.
A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is: a. anaphylaxis b. myoglobinuria secondary to burns c. polycystic disease d. ureteral stricture
a. anaphylaxis
An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? a. "The risk of peritonitis is greater with this type of dialysis." b. "This type of dialysis will provide more independence." c. "Peritoneal dialysis will require more work for you." d. "Peritoneal dialysis does not work well for every client."
b. "This type of dialysis will provide more independence."
The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD? a. A client with a history of polycystic kidney disease b. A client with diabetes mellitus and poorly controlled hypertension c. A client who is morbidly obese with a history of vascular disorders d. A client with severe chronic obstructive pulmonary disease
b. A client with diabetes mellitus and poorly controlled hypertension
The critical care nurse is monitoring the client's urine output and drains following renal surgery. What should the nurse promptly report to the primary provider? a. Increased pain on movement b.Absence of drain output c. Increased urine output d. Blood-tinged serosanguineous drain output
b. Absence of drain output
The nurse is caring for a client with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply. a. Percuss for pain in the right lower abdominal quadrant. b. Assess for the presence of peripheral edema. c. Auscultate the client's apical heart rate for dysrhythmias. d. Assess the client's BP. e. Assess the client's orientation and judgment.
b. Assess for the presence of peripheral edema. d. Assess the client's BP.
The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. a. Magnesium 1.5 mg/dL; mood changes and insomnia b. Calcium 7.5 mg/dL; hypotension and irritability c. Chloride 90 mEq/L; irritability and seizures d. Potassium 6.4 mEq/L; dysrhythmias and abdominal distention e. Phosphate 5.0 mg/dL; tachycardia and nausea and emesis
b. Calcium 7.5 mg/dL; hypotension and irritability d. Potassium 6.4 mEq/L; dysrhythmias and abdominal distention e. Phosphate 5.0 mg/dL; tachycardia and nausea and emesis
The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? a. Azotemia b. Diminished erythropoietin production c. Impaired immunologic response d. Electrolyte imbalances
b. Diminished erythropoietin production
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? a. Elevated urea levels b. Hyperkalemia c. Hypocalcemia d. Elevated white blood cells
b. Hyperkalemia
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a. Abdominal distention owing to reflex cessation of intestinal peristalsis b. Hypovolemic shock caused by hemorrhage c. Paralytic ileus caused by manipulation of the colon during surgery d. Pneumonia caused by shallow breathing because of severe incisional pain
b. Hypovolemic shock caused by hemorrhage
A client on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this client? a. The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life. b. The client's disease is incurable and the nurse's interventions will be supportive. c. The client will eventually require surgical removal of his or her renal cysts. d. The client is likely to respond favorably to lithotripsy treatment of the cysts.
b. The client's disease is incurable and the nurse's interventions will be supportive.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? a. Blood glucose level of 200 mg/dl b. White blood cell (WBC) count of 20,000/mm3 c. Potassium level of 3.5 mEq/L d. Hematocrit (HCT) of 35%
b. White blood cell (WBC) count of 20,000/mm3
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: a. hematuria. b. weight loss. c. increased urine output. d. increased blood pressure.
b. weight loss.
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? a. "Be sure to eat meat at every meal." b. "Eat plenty of bananas." c. "Increase your carbohydrate intake." d. "Drink plenty of fluids, and use a salt substitute."
c. "Increase your carbohydrate intake."
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective? a. "There are few complications with renal replacement therapies." b. "A family member can help me perform hemodialysis in my home." c. "Ultrafiltration methods take much longer than hemodialysis." d. "A special access is created in my vein for peritoneal dialysis."
c. "Ultrafiltration methods take much longer than hemodialysis."
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? a. "Squamous cell carcinomas do not present with detectable symptoms." b. "You should have sought treatment earlier." c. "Very few symptoms are associated with renal cancer." d. "Painless gross hematuria is the first symptom in renal cancer."
c. "Very few symptoms are associated with renal cancer."
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: a. 500 mL of fluid b. 1,000 mL of fluid c. 1,500 mL of fluid d. 2,000 mL of fluid
c. 1,500 mL of fluid
An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment. The client has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to AKI? Select all that apply. a. Anxiety b. Low BMI c. Age-related physiologic changes d. Chronic systemic disease e. NPO status
c. Age-related physiologic changes d. Chronic systemic disease
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? a. Increased pH with decreased hydrogen ions b. Increased serum levels of potassium, magnesium, and calcium c. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL d. Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75%
c. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL
A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? a. Hemodialysis b. Peritoneal dialysis c. Continuous venovenous hemodialysis (CVVHD) d. Plasmapheresis
c. Continuous venovenous hemodialysis (CVVHD)
A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? a. Administer isotonic fluid therapy as ordered. b. Keep the drainage catheter below the level of insertion. c. Encourage use of incentive spirometer every 2 hours. d. Monitor temperature every 4 hours.
c. Encourage use of incentive spirometer every 2 hours.
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? a. Performing the test without contrast b. Administering Garamycin (gentamicin) prophylactically c. Hydrating with saline intravenously before the test d. Administering sodium bicarbonate after the procedure
c. Hydrating with saline intravenously before the test
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? a. Elevated serum creatinine b. Hyperkalemia c. Hyperphosphatemia d. Elevated urea and nitrogen
c. Hyperphosphatemia
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a. Increase fat intake and limit carbohydrates. b. Eliminate fat intake and increase protein intake. c. Increase carbohydrates and limit protein intake. d. Increase protein, carbohydrates, and fat intake.
c. Increase carbohydrates and limit protein intake.
The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan? a. The importance of increased fluid intake b. Signs and symptoms of rejection c. Inspection and care of the incision d. Techniques for preventing metastasis
c. Inspection and care of the incision
The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? a. Wear a mask while handling any dialysate solutions b. Keep the catheter stabilized to the abdomen, below the belt line c. Keep the dialysis supplies in a clean area, away from children and pets d. Clean the catheter insertion site daily with soap
c. Keep the dialysis supplies in a clean area, away from children and pets
A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status? a. Observing the client's fluid intake. b. Checking for a thrill or a bruit daily. c. Observing the client's urinary output. d. Observing the skin color and nail beds.
c. Observing the client's urinary output.
The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated? a. Obtaining blood samples from the left arm b. Palpating the fistula for a "thrill" c. Obtaining a blood pressure reading from the right arm d. Placing the client's watch on the left wrist
c. Obtaining a blood pressure reading from the right arm
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a. Previous episode of acute pyelonephritis b. History of hyperparathyroidism c. Recent history of streptococcal infection d. History of osteoporosis
c. Recent history of streptococcal infection
The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this client? a. Using a stethoscope for auscultating the fistula is contraindicated. b. The client feels best immediately after the dialysis treatment. c. Taking a BP reading on the affected arm can damage the fistula. d. The client should not feel pain during initiation of dialysis.
c. Taking a BP reading on the affected arm can damage the fistula.
A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD? a. The client is blind in his right eye. b. The client has a history of severe anemia during hemodialysis. c. The client has a history of diverticulitis. d. The client is on the kidney transplant waiting list.
c. The client has a history of diverticulitis.
The nurse is caring for acutely ill client. What assessment finding should prompt the nurse to inform the physician that the client may be exhibiting signs of acute kidney injury (AKI)? a. The client reports an inability to initiate voiding. b. The client's urine is cloudy with a foul odor. c. The client's average urine output has been 10 mL/hr for several hours. d. The client complains of acute flank pain.
c. The client's average urine output has been 10 mL/hr for several hours.
A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened? a. The dialysis was performed too rapidly. b. The patient is having an allergic reaction to the dialysate. c. The patient is experiencing a cerebral fluid shift. d. Too much fluid was pulled off during dialysis.
c. The patient is experiencing a cerebral fluid shift.
The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? a. Wear a mask while handling any dialysate solutions. b. Keep the catheter stabilized to the abdomen, below the belt line. c. Use an aseptic technique during the procedure. d. Clean the catheter insertion site daily with soap.
c. Use an aseptic technique during the procedure.
