chapter 68

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? 1. Client with chronic kidney failure who was just admitted with shortness of breath 2. Client with kidney insufficiency who is scheduled to have an arteriovenous (AV) fistula inserted 3. Client with azotemia whose blood urea nitrogen and creatinine are increasing 4. Client receiving peritoneal dialysis who needs help changing the dialysate bag

1

The nurse is caring for a client with a peritoneal dialysis catheter. What action does the nurse take? 1. Remove the old dressing and assess the area for infection. 2. Use clean technique while cleaning the site. 3. Clean the site from the abdomen towards the insertion site. 4. Clean the area twice with cotton swabs.

1

The nurse teaches a client who is recovering from acute kidney disease to avoid which medication? 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) 2. Angiotensin-converting enzyme (ACE) inhibitors 3. Opiates 4. Calcium channel blockers

1

What does the nurse identify as a possible cause of postrenal acute kidney injury (AKI) in a client? 1. Urethral stricture 2. Exposure to nephrotoxins 3. Acute tubular necrosis 4. Pulmonary embolism

1

What intervention is appropriate for the client with stage 4 chronic kidney disease (CKD)? 1. Managing complications and preparing for renal replacement 2. Implementing strategies to slow CKD progression 3. Focusing on reduction of risk factors 4. Implementing kidney transplantation

1

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? 1. Eggs 2. Ham 3. Eggplant 4. Macaroni

1

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? 1. Abrupt decrease in urine output 2. Blood-tinged urine 3. Incisional pain 4. Increase in urine output

1

Which nephrotoxic nonsteroidal anti-inflammatory drug (NSAID) can cause acute kidney injury (AKI) in clients? 1. Tolmetin (Tolectin) 2. Cisplatin (Platinol) 3. Rifampin (Rifadin) 4. Vancomycin (Vancocin)

1

the nurse is caring for a dialysis client with a very poor appetite. What action does the nurse take? 1. Administer total parenteral nutrition as prescribed. 2. Provide 40 g/day of prescribed protein in the diet. 3. Allow fluid intake equal to urine output plus 200 mL. 4. Allow dietary potassium intake up to 90 mEq.

1

A client with chronic kidney disease (CKD) has developed the Kussmaul pattern of respiration. What causes this breathing pattern? 1. Increased acid retention 2. Increased pH 3. Increased bicarbonate 4. Decreased rate and depth of breathing

1

The nurse is caring for a client who has been prescribed digoxin (Lanoxin) for acute kidney injury (AKI). What manifestations are likely to be observed in the client experiencing digoxin toxicity? Select all that apply. 1. Color vision changes 2 .Halos around bright lights 3. High blood pressure 4. Rapid weight gain 5. Changes in mental ability

1, 2, 5

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to the unlicensed assistive personnel (UAP)? Select all that apply. 1. Obtain the client's predialysis weight. 2. Check the arteriovenous (AV) fistula for a thrill and bruit. 3. Document the amount the client drinks throughout the shift. 4. Auscultate the client's lung sounds every 4 hours. 5. Explain the components of a low sodium diet.

1, 3, Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by a UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

While assisting a client during peritoneal dialysis, the nurse observes the drainage discontinue after 200 mL of peritoneal effluent. What action should the nurse implement first? 1. Instruct the client to deep breathe and cough. 2. Document the effluent as output. 3. Turn the client to the opposite side. 4. Reposition the catheter.

3

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? 1. Adherence to therapy 2. Handwashing 3. Monitoring for low-grade fever 4. Strict clean technique

2

The nurse is caring for a client with prerenal failure. What is the cause of this AKI? 1. Damage to kidney tissue 2. Reduced perfusion 3. Obstruction of urine flow 4. Chronic kidney disease

2

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? 1. "Should we filter air circulation?" 2. "Can we use less radiographic contrast dye?" 3. "Should we add low-dose dopamine?" 4. "Should we decrease IV rates?"

2

What term does the nurse use to document a condition where the ability to produce dilute urine is reduced, resulting in urine with a fixed osmolarity? 1. Azotemia 2. Isosthenuria 3. Uremia 4 .Hyponatremia

2

When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? 1. Mild discomfort at the insertion site 2. Temperature 100.8° F 3. +1 ankle edema 4. Anorexia

2

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? 1. Diltiazem (Cardizem) 2. Lisinopril (Zestril) 3. Clonidine (Catapres) 4. Doxazosin (Cardura)

2

which signs and symptoms indicate rejection of transplanted kidney? select all that apply 1. BUN 21, creatinine 0.9 2. crackles in lung fields 3. temp. of 98.8 4. BP of 164/98 5. +3 edema of lower extremities

2, 4, 5

A client is receiving a loop diuretic for chronic kidney disease. Which drug does the nurse recognize as a loop diuretic? 1. Digoxin (Lanoxin) 2. Folic acid (Folvite) 3. Epoetin alfa (Epogen) 4. Furosemide (Lasix)

4

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen (BUN) requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? 1. RN who has floated from pediatrics for this shift 2. LPN/LVN with experience working on the medical unit 3. RN who usually works on the general surgical unit 4. New graduate RN who just finished a 6-week orientation

3

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? 1. "Your diseased kidneys will be removed at the same time the transplant is performed." 2. "The new kidney will be placed directly below one of your old kidneys." 3. "It is essential for you to wash your hands and avoid people who are ill." 4. "You will receive dialysis the day before surgery and for about a week after."

3

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? 1. "I can stop my medications when my kidney function returns to normal." 2. "If my urine output is decreased, I should increase my fluids." 3. "The antirejection medications will be taken for life." 4. "I will drink 8 ounces of water with my medications."

3

The caregiver of a client receiving dialysis reports increased fatigue in the client. What does the nurse suggest to the caregiver? 1. Avoid giving the client iron supplements. 2. Provide 0.55 to 0.60 g of protein per kg of body weight. 3. Administer subcutaneous erythropoietin as prescribed. 4. Provide vitamin supplements before dialysis.

3

The nurse is assessing the key features of severe chronic kidney disease (CKD) in a client. What term does the nurse use to document the presence of black and tarry stools? 1. Tachypnea 2. Hyperpnea 3. Melena 4. Purpura

3

A client has chronic kidney disease (CKD) and pericarditis. What manifestations of pericarditis does the nurse find on assessment? 1. Mild chest pain 2. High fever 3. Decreased pulse rate 4. Pericardial friction rub

4

A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? 1. "All of this is new. What can't you do?" 2. "Are you afraid of dying?" 3. "How are you doing this morning?" 4. "What concerns do you have about your kidney disease?"

4

The nurse instructor is teaching a group of nursing students about acute rejection of kidney transplantation. What statement made by the nurse instructor is accurate? 1. "Acute rejection manifests as pain at the transplant site." 2. "Acute rejection can occur within 48 hours after transplantation." 3 ."A gradual increase in blood urea nitrogen (BUN) levels occurs as a result of acute rejection." 4. "Increased doses of immunosuppressive drugs are used to treat and manage acute rejection."

4

The nurse is teaching a client with acute kidney injury (AKI) how to take prescribed ferrous sulfate (Feosol). What statement made by the client indicates a need for further teaching? 1. "I have to take the drug after dialysis." 2. "The drug should be taken along with meals." 3. "I must take a stool softener daily along with this drug." 4. "My pulse should be taken daily before I take this drug."

4

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? 1. Hematocrit of 26.7% 2. Potassium within normal range 3. Absence of spontaneous fractures 4. Less fatigue

4

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? 1. History of hiatal hernia 2. Presence of diabetes and HbA1c of 6.8 3. History of basal cell carcinoma on the nose 5 years ago 4. Presence of tuberculosis

4

client receiving hemodialysis is prescribed folic acid and ferrous sulfate orally. What does the nurse teach the client about folic acid therapy? 1. Avoid antacids within 2 hours of taking folic acid. 2. Report any change in the color of stool. 3. Take stool softeners. 4. Take the drug after dialysis.

4