complex 1 practice questions (final)

A patient on continuous venovenous hemofiltration with dialysis experiences a significant decrease in blood pressure. Which intervention would be most appropriate for the nurse to carry out? A) Decrease the amount of fluid removal. B) Decrease the infusion rate of replacement fluid. C) Administer heparin. D) Use a blood warmer to warm the dialysis lines.

A

A patient with a history of diabetes mellitus has had a procedure using radiocontrast dye. The patients laboratory results include high urine sodium, urine with muddy-brown granular casts and tubular epithelial cells, and increased blood urea nitrogen (BUN) and serum creatinine. Renal ultrasonography is normal. Urine volume is normal. Which treatment does the nurse anticipate? A) Increased fluids B) Renal stent placement C) Irrigation of urinary catheter D) Diuretic therapy

A

A patient with chronic kidney disease has a serum potassium level of 5 mEq/L and no changes on the ECG. What is the proper nursing intervention? A) Administer sodium polystyrene as an enema. B) Administer IV calcium gluconate. C) Administer IV insulin and dextrose. D) Begin dialysis.

A

A patient receiving a blood transfusion in the ICU has developed relative hypocalcemia. What is the most likely cause for the hypocalcemia? A) Citrate binding to calcium B) Loop diuretics C) Malabsorption syndrome D) Lack of vitamin D

A) Citrate binding to calcium

A patient with acute kidney injury (AKI) demonstrates oliguria, a urine osmolality of 550 mOsm/kg H2O, increased urine specific gravity, urine sodium of 15 mEq/L, and a BUN:creatinine ratio of 23:1. Which of the following is a cause of AKI that would best fit with these findings? A) Congestive heart failure B) Nephrotoxicity due to aminoglycoside antibiotics C) Hypertension D) Retroperitoneal tumor

A) Congestive heart failure

The patient requires urgent hemodialysis or continuous renal replacement therapy after a suicide attempt with a variety of antidepressants. What access route for the dialysis does the nurse anticipate? A) Vascular catheter B) Arteriovenous fistula C) Synthetic vascular graft D) Peritoneal dialysis catheter

A) Vascular catheter

A patient has been diagnosed with chronic renal failure. What closely associated pathophysiologies should the nurse assess for? Select all that apply. A) Hypertension B) Arteriosclerotic disease C) Traumatic injury D) Type 2 diabetes mellitus E) Preeclampsia F) Type 1 diabetes mellitus

A, B, D, F

A patient has just had a dual-lumen venous catheter inserted in his subclavian vein for hemodialysis for acute renal failure. What intervention or interventions should the nurse make in working with this patient? Select all that apply. A) Verify central line catheter placement radiographically before use. B) Inject all medications directly into the catheter. C) Leave the catheter unclamped to prevent clotting. D) Maintain sterile technique in handling vascular access. E) Observe catheter exit site for signs of inflammation.

A, D, E

A critically ill patient has developed acute renal failure and needs dialysis. Under what circumstance would the nurse question the use of continuous renal replacement therapy (CRRT)? A) Patient requires large amounts of hourly intravenous fluids B) Metabolic imbalances can be corrected with 3 hours of dialysis per day C) High risk of hemodynamic instability with dialysis D) Unlikely to tolerate rapid fluid shifts without destabilizing

B

A patient has had an arteriovenous fistula placed for access for long-term hemodialysis. What nursing assessment result indicates a patent and functional fistula? A) Diminished intensity of palpated fistula thrill B) Clearly auscultated bruit over fistula C) Ability to draw blood from proximal vessel D) Full range of motion of joints below fistula

B

A patient in intensive care with acute tubular necrosis from a toxic ingestion has been started on renal replacement therapy. The family expresses concern that the patient will not be able to afford dialysis after discharge from the hospital. In responding to the family, what should the nurse consider? A) The family is in crisis and unable to respond rationally. B) Toxic acute tubular necrosis has a higher likelihood of complete healing. C) Since the patient is currently oliguric, renal replacement therapy is indicated. D) The patient is unlikely to survive this illness, so the cost of long-term dialysis is not an issue.

B

A patient in the ICU is scheduled to begin peritoneal dialysis for acute renal failure. The patient tells the nurse that he understands hemodialysis but is not familiar with peritoneal dialysis. He asks her what the difference between them is. The nurse explains that the biggest difference between these two approaches is which of the following? A) Peritoneal dialysis relies on diffusion whereas hemodialysis relies on active transport. B) The peritoneum of the body serves as the semipermeable membrane in peritoneal dialysis, whereas an extracorporeal semipermeable membrane is used in hemodialysis. C) Hemodialysis uses a Tenckhoff catheter, whereas peritoneal dialysis uses a venous catheter. D) Hemodialysis uses machines called cyclers to cycle the infusion and removal of blood, whereas peritoneal dialysis uses the bodys own vascular system to do this.

B

A patient on peritoneal dialysis develops a low-grade fever and complains of abdominal pain when fluid is being inserted. The nurse also observes that the peritoneal drainage fluid is cloudy. What intervention should the nurse make? A) Measure the patients blood pressure. B) Begin the patient on antibiotic therapy. C) Assess the patient for signs of pulmonary congestion. D) Turn the patient from side to side.

B

A patient with chronic renal disease is involved in a motor vehicle crash and experiences severe hypovolemia. In caring for this patient in the CCU, which of the following is the most important for the nurse to monitor? A) Blood pressure B) Fluid volume recovery C) Urine output D) Cardiac dysrhythmias

B

A patient with chronic renal failure also has chronic anemia, arteriosclerotic disease, and diabetes mellitus. The patient asks the nurse why the anemia is persisting. In answering the patients question, what should the nurse most consider? A) The patient most likely has preexisting chronic anemia. B) Erythropoietin is primarily produced in the kidney. C) The patient is receiving low-dose aspirin therapy. D) Chronic renal failure results in persistent uremia.

B

An elderly male patient in the ICU is diagnosed with acute kidney injury. This patient demonstrates a decreased glomerular filtration rate and lowered urine sodium concentration, as well as increased BUN and serum creatinine levels. The nurse observes that the patient takes several minutes to empty his bladder when he uses the bathroom. His blood pressure and blood glucose levels are normal. What should the nurse suspect as the cause of this patients acute kidney injury? A) Tubular necrosis as a result of accumulation of radiocontrast dye in the renal tubular cells B) Obstruction of the flow of urine due to benign prostatic hypertrophy C) Lack of perfusion due to congestive heart failure D) Hypotension due to systemic inflammatory response to sepsis

B

A patient is severely hyponatremic. What would be the best nursing action? A) Put the patient on dialysis. B) Administer 3% saline. C) Administer 0.33% saline solution. D) Administer 5% dextrose in water.

B) Administer 3% saline.

A patient in the ICU with severe hypotension is experiencing acute renal failure and uremia and needs dialysis. She requires a large infusion of intravenous fluids regularly. The nurse recognizes that which method of dialysis would be best for this patient? A) Continuous venovenous hemofiltration (CVVH) B) Continuous venovenous hemofiltration with dialysis (CVVH/D) C) Intermittent hemodialysis D) Peritoneal dialysis

B) Continuous venovenous hemofiltration with dialysis (CVVH/D)

The nurse is explaining the underlying principles of dialysis to a patient who is starting peritoneal dialysis for the management of chronic renal failure. As part of the teaching, what physiologic process does the nurse explain produces the most waste product removal? A) Water molecule movement by osmosis B) Diffusion to a less concentrated area C) Active transport by an energy-driven process D) Increased osmotic gradient from the abdomen

B) Diffusion to a less concentrated area

A patient with chronic kidney disease is receiving an ACE inhibitor. The nurse understands that this medication helps slow the progression of this disease through what process? A) It lowers the level of blood glucose. B) It prevents nephron hyperfiltration. C) It increases the urine output. D) It filters waste from the blood.

B) It prevents nephron hyperfiltration.

In a patient with acute ischemic tubular necrosis, urine output has increased from below normal to very high. What is the nursing priority of care during this phase of renal failure? A) Restrict fluid intake B) Monitor serum potassium C) De-emphasize dialysis D) Monitor serum creatinine

B) Monitor serum potassium

The patient is in hypovolemic shock, with mean arterial pressures below 90 mm Hg and a very low urine output. An IV drip of norepinephrine is prescribed to keep blood pressure above 90 mm Hg. No other therapy is initiated. What effect on kidney function does the nurse expect? A) Improvement in renal perfusion secondary to improved blood pressure B) Reduction in urine output secondary to constriction of renal arteries C) Augmentation of water reabsorption from distal tubular fluid D) Decrease in urine sodium concentration to critically low levels

B) Reduction in urine output secondary to constriction of renal arteries

A patient with chronic renal failure has an arteriovenous fistula in her forearm for dialysis access. What intervention or interventions should the nurse make in working with this patient? Select all that apply. A) Take the patients blood pressure on the forearm containing the fistula. B) Palpate the fistula for thrill every 8 hours. C) Draw blood samples from the vein that forms the fistula. D) Avoid placing any restraints on the access arm. E) Check access patency less frequently in hypotensive patients. F) Occlude the fistula vein using firm pressure in the event of postdialysis bleeding from the needle site.

B, D

A patient has been diagnosed with prerenal acute renal failure. What condition most likely caused this situation? A) Toxic levels of medications B) Poststreptococcal glomerulonephritis C) Severe sepsis and shock D) Benign prostatic hypertrophy

C

A patient who developed chronic renal failure after a severe hypotensive episode has just been told that dialysis will be necessary for the rest of her life. She and her family are very upset and crying. What is the best nursing intervention? A) Ask the family to leave, as they are upsetting the patient. B) Administer intravenous sedation to the patient. C) Encourage patient and family to express their feelings. D) Begin dialysis education immediately.

C

A patient with acute kidney injury (AKI) demonstrates blue mottling of the skin in her fingers. What other finding would tend to indicate that the cause of this condition is intrarenal? A) Distended bladder B) Edema C) Strep throat infection D) Kinked Foley catheter

C

A patient with chronic renal disease has mild metabolic acidosis with a pH 7.30 and bicarbonate level 16 mEq/L. What treatment does the nurse anticipate? A) IV sodium bicarbonate B) Reduction of respiratory rate C) Sodium citrate and citric acid (Bicitra) D) Massive IV fluids

C

An elderly patient in the ICU with chronic renal failure has just undergone surgery for a synthetic arteriovenous graft in her left forearm for dialysis access. The nurse recognizes that the most likely reason this patient received a graft instead of a fistula is which of the following? A) Thrombosis is less likely to occur with grafts than with fistulas. B) Fistulas are more prone to infection than are grafts. C) The patients own blood vessels were not adequate for fistula formation. D) An aneurysm is more likely to occur in a fistula than in a graft.

C

The patient is receiving continuous renal replacement therapy (CRRT). The rate of ultrafiltration shows a downward trend and coagulation of the filter is suspected. What is the most appropriate first nursing action? A) Immediately disconnect circuit from the patient. B) Decrease the rate of blood flow by pump. C) Use a saline bolus to diagnosis clot location and extent. D) Raise the ultrafiltration collection device.

C

The patient is receiving maintenance IV fluids, has no active fluid loss site, and has normal renal function. Based on the physiology of fluid volume balance, what IV fluid use does the nurse anticipate? A) Dextrose 5% in water B) 0.9% saline C) 0.45% saline D) 3% saline

C) 0.45% saline

A patient is concerned about her steadily worsening chronic kidney disease and asks the nurse at what point she will require dialysis or renal transplantation. Which of the following should the nurse mention? A) When your urine albumin-to-creatinine ratio is greater than 25 mg/g B) When your urine output is less than 0.5 mL/kg/h 6 h C) When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2 D) When your urine osmolality is greater than 500 mOsm/kg H2O

C) GFR

A patient with acute kidney injury (AKI) complains of a headache. He vomits several times and breathes deeply and rapidly. His heart rate is 110 bpm, and his serum potassium level is elevated. The nurse recognizes in this patient which condition commonly associated with AKI? A) Fluid overload B) Anemia C) Metabolic acidosis D) Pericarditis

C) Metabolic acidosis

A patient in oliguric renal failure is receiving IV furosemide (Lasix). What nursing assessment has the highest priority? A) Daily weights B) Intake and output C) Serum potassium D) Blood urea nitrogen

C) Serum potassium

A critically ill patient is receiving continuous renal replacement therapy (CCRT) by continuous venovenous hemofiltration with dialysis (CVVHD) or continuous venovenous hemofiltration (CVVH). What difference in care of this patient does the nurse anticipate when compared with other methods of CCRT? A) Filtrate lost is equal to patient weight loss B) Differences are in brands of machines used C) Produced ultrafiltrate is not replaced D) Replacement fluid is necessary to maintain fluid balance

D

A patient develops toxic acute tubular necrosis (ATN) as a result of exposure to a radiocontrast dye. Which of the following should the nurse most expect to observe in this patient as this condition progresses beyond the onset phase? A) Normal potassium levels B) Duration of 7 to 14 days C) Normal urine concentrating function D) Normal urine volume

D

A patient has just been diagnosed with type 2 diabetes mellitus. During teaching, what strategy should the nurse emphasize as protective of kidney cells? A) Monitoring glycosylated hemoglobin every 3 months B) Strict adherence to prescribed weight-loss diet C) Restriction of sodium-containing beverages and food D) Strict control of serum glucose levels with diet and medication

D

The nurse is teaching a patient with chronic renal failure and diabetes mellitus about nutrition. What should be included? A) Calorie restriction based on ideal body weight is necessary. B) Sodium and potassium should be supplemented while on dialysis. C) Renal diet restrictions take the place of those for diabetes mellitus. D) Moderate protein restriction is recommended while otherwise healthy.

D

The patient is scheduled to receive hemodialysis for 4 hours this morning, and several medications for chronic diseases are scheduled to be given now. All of the medications will be at least partially removed by dialysis. What is the best nursing action? A) Give all medications as scheduled. B) Give double doses of all medications. C) Withhold medications for today only. D) Administer medications after dialysis.

D

A patient receiving continuous renal replacement therapy (CRRT) is placed on low-dose heparin for anticoagulation of the CRRT circuit. What laboratory result would cause the nurse to question the use of heparin? A) Normal total platelet count B) Partial thromboplastin time two times control C) Partial thromboplastin time normal D) Critically low total platelet count

D) Critically low total platelet count

A patient in the ICU has acute renal failure and is an alcoholic. Which electrolyte imbalance would the nurse most expect to find in this patient? A) Hypokalemia B) Hyperkalemia C) Hypermagnesemia D) Hypomagnesemia

D) Hypomagnesemia

A patient with prerenal acute kidney injury is oliguric. The nurse is administering an IV bolus to the patient. What should be of primary concern to the nurse while performing this task? A) Restricting the patients protein intake B) Monitoring the patients potassium level C) Evaluating the patient for signs of nephrotoxicity D) Preventing fluid overload

D) Preventing fluid overload

A patient with severe vascular fluid loss from third spacing is being treated with intravenous hypertonic saline in an attempt to pull fluid from the extravascular space to the vascular space. What nursing assessment result is most indicative of a serious complication of the use of intravenous hypertonic saline? A) Increased urine output B) Decreased peripheral edema C) Slightly elevated blood pressure D) Pulmonary adventitious sounds

D) Pulmonary adventitious sounds