exam 2 practice questions

When a 74-year-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rollingtype tremor, the nurse will anticipate teaching the patient about 1. Oral corticosteroids 2. Antiparkinsonian drugs 3. MRI 4. EEG

2. Antiparkinsonian drugs

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag. 2. Reposition the client to her or his side. 3. Place the client in good body alignment. 4. Check the peritoneal dialysis system for kinks. 5. Contact the primary health care provider (PHCP). 6. Increase the flow rate of the peritoneal dialysis solution.

1, 2, 3, and 4

A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply: A. Hypervolemia B. Hypokalemia C. Increased BUN level D. Decreased Creatinine level

A and C

A patient with Parkinsons disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the plan of care (select all that apply)? a. Use an elevated toilet seat b. Cut food into small pieces c. Provide high-protein foods at each meal (will interfere with absorption of lovadopa) d. Place an armchair at patient's bedside e. Observe for sudden exacerbation of symptoms

A, B, D Because the patient with Parkinsons has difficulty chewing, food should be cut into small pieces. An armchair should be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High-protein foods will decrease the effectiveness of L-dopa. Parkinsons is a steadily progressive disease without acute exacerbations.

A 31-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a. MS symptoms may be worse after pregnancy b. Women with MS frequently have premature labor c. MS is associated with an increased risk for congenital defects d. Symptoms of MS are likely to become worse during pregnancy

A. MS symptoms may be worse after pregnancy

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula. 2. Presence of a radial pulse in the left wrist. 3. Visualization of enlarged blood vessels at the fistula site. 4. Capillary refill less than 3 seconds in the nailbeds of the fingers on the left hand.

ANS: 1

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? 1. Warmth, redness, and pain in the left hand 2. Ecchymosis and audible bruit over the fistula 3. Edema and reddish discoloration of the left arm 4. Pallor, diminished pulse, and pain in the left hand

ANS: 4

A kidney transplant recipient has had fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? a. Assess temperature and initiate workup to rule out infection. b. Reassure the patient that this is common after transplantation. c. Provide warm covers to the patient and give 1 gram oral acetaminophen. d. Notify the nephrologist that the patient has manifestations of acute rejection.

ANS: A

A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys. b. a rapid decrease in urine output with an elevated BUN. c. an increasing creatinine clearance with a decrease in urine output. d. prostration, somnolence, and confusion with coma and imminent death.

ANS: A

A patient who receives peritoneal dialysis is admitted after a 3-day history of flu-like symptoms. The patient reports muscle cramps and is noted to have a low blood pressure and tachycardia. The nurse suspects the patient may be experiencing what condition? a. Dehydration b. Peritonitis c. Fluid obstruction d. Hernias

ANS: A

After CT scan with contrast infusion, which of the following nursing interventions is most important? a. Ensuring adequate fluid intake b. Maintaining fluid restriction c. Providing extra doses of sodium d. Administering antibiotics

ANS: A

Which diuretics may be combined to work on different parts of the nephron? a. Loop and thiazide diuretics b. Loop and osmotic diuretics c. Osmotica and carbonic anhydrase inhibitor diuretics d. Thiazide and osmotic diuretics

ANS: A A thiazide diuretic such as chlorothiazide (Diuril) or metolazone (Zaroxolyn) may be administered and followed by a loop diuretic to take advantage of the fact that these medications work on different parts of the nephron. Sometimes a thiazide diuretic is added to a loop diuretic to compensate for the development of loop diuretic resistance.

A patient with chronic kidney disease was admitted with severe electrolyte disturbances. The patient had been ill and missed several hemodialysis sessions. The patient is disoriented, dizzy, cold, clammy, and complains of severe abdominal cramping. The patient's electrocardiogram appears normal. Which electrolyte disturbance would the nurse suspect the patient may be experiencing? a. Hyponatremia b. Hypokalemia c. Hypercalcemia d. Hypochloremia

ANS: A Hyperkalemia, hypocalcemia, hyponatremia, hyperphosphatemia, and acid-base imbalances occur in kidney disease. Signs of hyponatremia include disorientation, muscle twitching, nausea, vomiting, abdominal cramps, headaches, dizziness, cold, clammy skin, tachycardia, and seizures.

A patient is admitted with acute kidney injury (AKI). Which event from the patient's history was the most probable cause of the patient's AKI? a. Recent CT with and without contrast b. Recent bout of acute heart failure after an acute MI c. BID prescription of Lasix 40mg by mouth d. Recent bout of benign prostatic hypertrophy and transurethral resection of the prostate

ANS: A Intravenous contrast media can be nephrotoxic, especially with the patient's preexisting cardiac disease. The other choices, although possible causes, are less likely than the intravenous contrast media.

Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements are true related to nutritional therapy? (select all that apply) a. Sodium and salt may be restricted in someone with advanced CKD. b. Fluid is not usually restricted for patients receiving peritoneal dialysis. c. Decreased fluid intake and a low-potassium diet are part of the diet for a patient receiving hemodialysis. d. Decreased fluid intake and a low-potassium diet are part of the diet for a patient receiving peritoneal dialysis. e. Decreased fluid intake and a diet in protein-rich foods are part of a diet for a patient receiving hemodialysis.

ANS: A, B, C

Which drugs will be used to treat the patient with CKD for mineral and bone disorder (select all that apply)? a. Calcium acetate b. Cinacalcet (Sensipar) c. IV glucose and insulin d. IV 10% calcium gluconate e. Sevelamer carbonate (Renvela)

ANS: A, B, C. Calcium acetate = calcium based phosphate binder, cinacalcet = non-calcium phosphate binder-both used to treat bone disorder in CKD. IV glucose and insulin 10% and kayexalate are used to treat hyperkalemia of CKD

Nurses can screen patients at risk for developing chronic kidney disease. Those considered to be at increased risk include (select all that apply) a. older black patients. b. patients more than 60 years old. c. those with a history of pancreatitis. d. those with a history of hypertension. e. those with a history of type 2 diabetes.

ANS: A, B, D, E

The patient with CKD is receiving dialysis, and the nurse observes excoriations (scratched off patches) on the patient's skin. What pathophysiologic changes in CKD most likely occur that can contribute to this finding (select all that apply)? a. Dry skin b. Sensory neuropathy c. Vascular calcifications d. Calcium-phosphate skin deposits e. Uremic crystallization from high BUN

ANS: A, B, D. Pruritus is common in patients receiving dialysis. It causes scratching from dry skin, sensory neuropathy, and calcium-phosphate deposition on the skin.

The nursing management plan for the patient with a urinary drainage catheter would include which interventions to prevent catheter-associated urinary tract infection (CAUTI)? (Select all that apply, one, some, or all.) a. Insert urinary catheters using aseptic techniques b. Change urinary catheter daily c. Review need for the urinary catheter daily and remove promptly d. Flush the urinary catheter q8hr to maintain patency e. Avoid unnecessary use of indwelling catheters

ANS: A, C, E

Which complication of chronic kidney disease is treated with erythropoietin? a. Anemia b. Hypertension c. Hyperkalemia d. Mineral and bone disorder

ANS: A. Erythropoietin stimulates bone marrow to produce RBC.

Priority Decision: A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's BP. c. Teach the patient to avoid high-potassium foods. d. Call the laboratory and request a redraw of the laboratory to verify results.

ANS: A. Increased potassium is cause of dysrhythmias.

A man with end-stage renal disease (ESRD) is scheduled for HD following healing of an arteriovenous fistula (AVF). What should the nurse explain to him that will occur during dialysis? a. He will be able to visit, read, sleep, or watch TV while reclining in a chair. b. He will be placed on a cardiac monitor to detect any adverse effects that may occur. c. The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the waste products. d. A large catheter with 2 lumens will be inserted into the fistula to send blood to and return it from the dialyzer.

ANS: A. While undergoing HD, patients can engage in relaxing activities that don't require using the limb with the vascular access.

A patient has developed acute kidney injury (AKI) secondary to cardiogenic shock. Which laboratory value would the nurse find helpful in evaluating patient's renal status? a. Serum sodium b. Serum creatinine c. Serum potassium d. Urine potassium

ANS: B

The action of furosemide (Lasix) includes which of the following? a. Acts as osmotic agent pulling fluid into the renal tube b. Actos on the ascending limb of the loop of Henle to decrease Na and H2O reabsorption c. Acts as an ADH antagonist d. Acts as an aldosterone antagonist

ANS: B

A patient was admitted with an infection that had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of administration, the patient developed oliguria, and an elevated blood urea nitrogen and creatinine levels. The nurse suspects the patient has developed what type of kidney injury? a. Prerenal b. Intrarenal c. Anuric d. Postrenal

ANS: B Any condition that produces an ischemic or toxic insult directly at parenchymal nephron tissue places the patient at risk for development of intrarenal. Ischemic damage may be caused by prolonged hypotension or low cardiac output. Toxic injury reaction may occur in response to substances that damage the kidney tubular endothelium, such as some antimicrobial medications and the contrast dye used in radiologic diagnostic studies.

A patient has developed acute kidney injury (AKI) secondary to hemorrhage shock. Which intravenous solution would the nurse expect to be ordered for this patient? a. Dextrose in water b. Normal saline c. Albumin d. Lactated ringers

ANS: B Prerenal acute kidney injury (AKI) is caused by decreased perfusion and flow to the kidney. It is often associated with trauma, hemorrhage, hypotension, and major fluid losses. If contrast dye is used, aggressive fluid resuscitation with normal saline is recommended.

What is the most common site for short-term vascular access for immediate hemodialysis? a. Subclavian artery B. subclavian ven C. femoral artery D. radial vein

ANS: B Subclavian and femoral veins are catheterized when short-term access is required or when a graft or fistula vascular access is nonfunctional in a patient requiring immediate hemodialysis. Subclavian and femoral catheters are routinely inserted at the bedside. Most temporary catheters are venous lines only. Blood flows out toward the dialyzer and flows back to the patient through the same catheterized vein. A dual-lumen venous catheter is most commonly used.

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply) a. hypotension. b. ECG changes. c. hypernatremia. d. pulmonary edema. e. urine with high specific gravity.

ANS: B, D

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

ANS: B. A patent AVF (arteriovenous fistula) creates turbulent blood flow and can be assessed by listening for a bruit or palpated thrill.

Patient has K+ of 8.8 and has slowing of heart rate with widening of QRS. Which of the following will be an appropriate treatment? a. Kayexalate enema b. Calcium gluconate, glucose, and IV insulin c. Sorbitol by mouth d. Hemodialysis

ANS: B. Calcium will stabilize cell membranes. Insulin will drive potassium into the intracellular space, resulting in lowering potassium. Kayexalate and HD will lower potassium but will take hours. Sorbitol does nothing for K+.

A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L) and the following arterial blood gas results: pH 7.28, (PaCO2 ) 30 mm Hg, (PaO2 ) 86 mm Hg, HCO3 − 18 mEq/L (18 mmol/L). The nurse recognizes that treatment of the acid-base problem with sodium bicarbonate would cause a decrease in which value? a. pH b. Potassium level c. Bicarbonate level d. Carbon dioxide level

ANS: B. During acidosis, potassium moves out of the cell in exchange for H+ ions, increasing the serum potassium level. Correction of the acidosis with sodium bicarb will help temporarily shift the potassium back into the cells. Decrease in pH and bicarb and partial pressure of PaCO2 levels would indicate WORSENING of acidosis.

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

ANS: B. Exit site infections and peritonitis are common complications of PD and may require removal of the catheter and termination of dialysis. Aseptic technique will prevent this complication.

What is the most serious electrolyte disorder associated with kidney disease? a. Hypocalcemia b. Hyperkalemia c. Hyponatremia d. Hypermagnesemia

ANS: B. Hyperkalemia can lead to life-threatening dysrhythmias.

In which type of dialysis does the patient dialyze during sleep and leave the fluid in the abdomen during the day? a. Long nocturnal HD b. Automated peritoneal dialysis (APD) c. Continuous venovenous hemofiltration (CVVH) d. Continuous ambulatory peritoneal dialysis (CAPD)

ANS: B. Long nocturnal is done only while sleeping and up to 6 times a week. APD is done during sleep and fluid is left in the abdomen during the day.

The patient with CKD asks why she is receiving nifedipine (Procardia) and furosemide (Lasix). The nurse understands that these drugs are being used to treat the patient's a. anemia. b. hypertension. c. hyperkalemia. d. mineral and bone disorder.

ANS: B. Nifedipine is a CCB and Furosemide is a loop diuretic (can also reduce potassium)

An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage. The nurse knows the patient is at risk for developing what type of acute kidney injury (AKI)? a. Intrinsic b. Postrenal c. Prerenal d. Intrarenal

ANS: C

What is the best lab test to evaluate the patient's GFR? a. BUN b. Serum creatinine c. Urine creatinine clearance d. Serum amylase

ANS: C

A patient was admitted with liver failure and acute kidney injury (AKI). Which intravenous solution should the nurse question if it were ordered for this patient? a. D5W b. 0.9% NaCl c. Lactated Ringers d. 0.45% NaCl

ANS: C Lactated Ringer solution is contraindicated for patients with kidney or liver diseases or in lactic acidosis.

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands the patient should be closely monitored for what patient-related complications of the therapy? a. Air embolism, access failure, blood leaks b. Decreased inflow pressure, air bubbles, power surge c. Infection, hypotension, electrolyte imbalances d. Catheter dislodgement, decreased outflow pressure

ANS: C Patient-related complications of continuous renal replacement therapy (CRRT) include dehydration, hypotension, electrolyte imbalances, acid-base imbalances, blood loss, hemorrhage, hypotension, and infection.

To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should (select all that apply) a. monitor the BP in the affected arm. b. irrigate the graft daily with low-dose heparin. c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. assess the pulses and neurovascular status distal to the graft.

ANS: C, D, E

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

ANS: C, E. Less cardiovascular stress and fewer dietary restrictions with PD. PD causes MORE protein loss and INCREASED hyperlipidemia.

A patient with AKI is a candidate for continuous renal replacement therapy (CRRT). What is the most common indication for use of CRRT? a. Pericarditis b. Hyperkalemia c. Fluid overload d. Hypernatremia

ANS: C. Alternative or adjunct to HD to slowly remove fluid and solutes in the hemodynamically unstable patient. CRRT is mostly used for fluid overload, while HD is used to treat hyperkalemia, pericarditis, or other serious effects of uremia

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

ANS: C. Dextrose is added to create an osmotic gradient across the membrane to remove excess fluid from the blood.

During the nursing assessment of the patient with renal insufficiency, the nurse asks the patient specifically about a history of a. angina. b. asthma. c. hypertension. d. rheumatoid arthritis.

ANS: C. Most common of CKD in US: DM2 and HTN

One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. Which statement regarding how this treatment works is accurate? a. Glucose and insulin force potassium out of the cells, lowering it on a cellular level b. Glucose and insulin promote higher excretion of potassium in the urine c. Glucose and insulin bind with potassium, lowering available amounts d. Glucose and insulin force potassium into the cells, lowering it on a serum level

ANS: D Acute hyperkalemia can be treated temporarily by intravenous administration of insulin and glucose. An infusion of 50 mL of 50% dextrose accompanied by 10 units of regular insulin forces potassium out of the serum and into the cells.

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands that this type of continuous renal replacement therapy (CRRT) is indicated for the patient who needs what type of treatment? a. Fluid removal only b. Fluid removal and moderat solute removal c. Fluid removal and maximum solute removal d. Maximum fluid and solute removal

ANS: D Continuous venovenous hemodialysis (CVVHD) is indicated for patients who require large-volume removal of fluid and solutes.

A patient is admitted with sepsis and acute kidney injury (AKI). The patient is started on continuous renal replacement therapy (CRRT). The nurse knows that fluid that is removed each hour is charted as what on the CRRT flowsheet? a. Convection b. Diffusion c. Replacement fluid d. ultrafiltrate

ANS: D The fluid that is removed each hour is not called urine; it is known as ultrafiltrate. Typically, some of the ultrafiltrate is replaced through the continuous renal replacement therapy circuit by a sterile replacement fluid. Diffusion is the movement of solutes along a concentration gradient from a high concentration to a low concentration across a semipermeable membrane. Convection occurs when a pressure gradient is set up so that the water is pushed or pumped across the dialysis filter and carries the solutes from the bloodstream with it.

Laboratory results come back on a newly admitted patient: Serum blood urea nitrogen, 64 mg/dL; serum creatinine, 2.4 mg/dL; urine osmolality, 210 mOsm/kg; specific gravity, 1.002; and urine sodium, 96 mEq/L. The patient's urine output has been 120 mL since admission 2 hours ago. These values are most consistent with which diagnosis? a. Prerenal AKI b. Postrenal AKI c. Oliguric AKI d. Intrarenal AKI

ANS: D Urinary sodium less than 10 mEq/L (low) suggests a prerenal condition. Urinary sodium greater than 40 mEq/L (in the presence of an elevated serum creatinine and the absence of a high salt load) suggests intrarenal damage has occurred. The urine output does not seem to suggest oliguria. The other options do not fit the data as presented.

17-yr-old male patient who sustained multiple trauma and subsequent multisystem organ dysfunction has a BUN of 60, serum creatinine 6.1, fluid overload, BP 98/50. Which of the following is the most appropriate treatment for this patient? a. Loop diuretics b. Hemodialysis c. Peritoneal dialysis d. Continuous renal replacement therapy (CRRT)

ANS: D. Patient has AKI with hemodynamic instability. CRRT is less than likely than hemodialysis to worsen hemodynamic status. The other 2 choices have not been shown to improve the outcome of AKI.

What indicates to the nurse that a patient with AKI is in the recovery phase? a. A return to normal weight b. A urine output of 3700 mL/day c. Decreasing sodium and potassium levels d. Decreasing blood urea nitrogen (BUN) and creatinine levels

ANS: D. Decreasing BUN and creatinine is the best indicator that a patient is recovering, as it will remain elevated in the oliguric and diuretic phases. U/O of 3700 mL/day, weight loss and decreasing Na and K levels are indicative of the diuretic phase.

Which serum laboratory value indicates to the nurse that the patient's CKD is getting worse? a. Decreased BUN b. Decreased sodium c. Decreased creatinine d. Decreased calculated glomerular filtration rate (GFR)

ANS: D. GFR is the indicator of worsening CKD. BUN and creatinine would increase with a drop in GFR. Since other conditions can cause an elevated BUN and creatinine, GFR is the best indicator for staging CKD

Select all the patients below that are at risk for acute intra-renal injury? A. A 45 year old male with a renal calculus. B. A 65 year old male with benign prostatic hyperplasia. C. A 25 year old female receiving chemotherapy. D. A 36 year old female with renal artery stenosis. E. A 6 year old male with acute glomerulonephritis. F. An 87 year old male who is taking an aminoglycoside medication for an infection.

C, E, and F A and B are post renal and D is pre renal

A 55 year old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? A. Post-renal B. Intra-renal C. Pre-renal D. Intrinsic renal

C. Pre renal

A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL. The patient's 24 hour urinary output is 1.75 Liters. Based on these findings, what stage of AKI is this patient in? A. Initiation B. Diuresis C. Oliguric D. Recovery

The answer is D. This patient is in the recovery stage of AKI. The patient's labs and urinary output indicate the renal function has returned to normal. Remember the recovery stages starts when the GFR (glomerular filtration rate) has returned to normal (normal GFR 90 mL/min or higher), which will allow waste levels and electrolyte levels to be maintained.

A 64-year-old patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? a. Assist with active ROM b. Observe for agitation and paranoia c. Give muscle relaxants as needed to reduce spasms d. Use simple words and phrases to explain procedures

a. Assist with active ROM

After change-of-shift report, which patient should the nurse assess first? a. Patient with myasthenia gravis who is reporting increased muscle weakness b. Patient with bilateral headache described as a band around my head c. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin) d. Patient with parkinsons who has developed cogwheel rigidity of the arms

a. Patient with myasthenia gravis who is reporting increased muscle weakness Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse should assess this patient first. The other patients should also be assessed, but do not appear to need immediate nursing assessments or actions to prevent life-threatening complications.

In replying to a patient's questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on what? a. Total daily urine output b. Glomerular filtration rate (GFR) c. Degree of altered mental status d. Serum creatinine and urea levels

b. Glomerular filtration rate (GFR)

When obtaining a health history and physical assessment for a 36-year-old female patient with possible multiple sclerosis (MS), the nurse should a. Assess for the presence of chest pain b. Inquire about urinary tract problems c. Inspect the skin for rashes or discoloration d. Ask patient about any increase in libido

b. Inquire about urinary tract problems

Following a thymectomy, a 62-year-old male patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a. Auscultate patient's bowel sounds b. Notify patient's HCP c. Administer prescribed PRN antiemetic drug d. Give scheduled dose of prednisone (Deltasone)

b. Notify patient's HCP potential cholinergic crisis

Patient-Centered Care: A 68-year-old man with a history of heart failure resulting from hypertension has AKI resulting from the effects of nephrotoxic diuretics. Currently, his serum potassium is 6.2 mEq/L (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum bicarbonate (HCO3 − ) is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. Loop diuretics b. Renal replacement therapy c. Insulin and sodium bicarbonate d. Sodium polystyrene sulfonate (Kayexalate)

b. Renal replacement therapy Pt has 3 of 6 indicators for renal replacement therapy. 1. Elevated potassium, 2. Metabolic acidosis, 3. Changed mental status, 4. Volume overload, resulting in compromised cardiac status (pt has history of HTN), 5. BUN >120; 6. Pericarditis, pericardial effusion, cardiac tamponade. Other tx will be used to buy time to get to CRRT, which will be most effective. Loop diuretics and increased fluid used if pt is dehydrated; insulin and sodium bicarb will temporarily drive potassium into cells. Kayexalate removes potassium via stool from the body.

A 73-year-old patient with Parkinson's disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which action will the nurse include in the plan of care? a. Instruct the patient in activities that can be done while lying or sitting b. Suggest that the patient rock from side to side to initiate leg movement c. Have the patient take small steps in a straight line directly in front of the feet. d. Teach patient to keep feet in contact with the floor and slide them forward

b. Suggest that the patient rock from side to side to initiate leg movement

Which assessment data for a patient who has Guillain-Barre syndrome will require the nurses most immediate action? a. The patient's biceps reflexes are absent b. The patient is continuously drooling saliva c. The patient complains of severe pain in feet d. Patient's BP is 150/82

b. The patient is continuously drooling saliva

A 27-year-old patient is hospitalized with new onset of Guillain-Barre syndrome. The most essential assessment for the nurse to carry out is a. Determining level of consciousness b. Checking strength of extremities c. Observing respiratory rate and effort d. Monitoring cardiac rate and rhythm

c. Observing respiratory rate and effort

Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a. Pupil size b. Grip strength c. Respiratory effort d. Level of consciousness

c. Respiratory effort

Which nursing diagnosis is of highest priority for a patient with Parkinsons disease who is unable to move the facial muscles? a. Activity intolerance b. Self-care deficit: toileting c. Ineffective self-health management d. Imbalance nutrition: less than body requirements

d. Imbalance nutrition: less than body requirements

A 68-year-old patient hospitalized with a new diagnosis of Guillain-Barre syndrome has numbness and weakness of both feet. The nurse will anticipate teaching the patient about a. Intubation and mechanical ventilation b. Administration of corticosteroid drugs c. Insertion of NG tube d. Infusion of immunoglobulin (Sandoglobulin)

d. Infusion of immunoglobulin (Sandoglobulin) Because the Guillain-Barree syndrome is in the earliest stages (as evidenced by the symptoms), use of high-dose immunoglobulin is appropriate to reduce the extent and length of symptoms. Mechanical ventilation and tube feedings may be used later in the progression of the syndrome but are not needed now. Corticosteroid use is not helpful in reducing the duration or symptoms of the syndrome.

Which of these nursing actions for a 64-year-old patient with Guillain-Barr syndrome is most appropriate for the nurse to delegate to an experienced unlicensed assistive personnel (UAP)? a. Nasogastric tube feeding q4hr b. Artificial tear administration q2hr c. Assessment for bladder distention q2hr d. Passive range of motion to extremities q4hr

d. Passive range of motion to extremities q4hr Assisting a patient with movement is included in UAP education and scope of practice. Administration of tube feedings, administration of ordered medications, and assessment are skills requiring more education and scope of practice, and the RN should perform these skills.

Which information about a 60-year-old patient with MS indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient has relapsing-remitting MS b. The patient walks a mile a day for exercise c. The patient complains of pain with neck flexion d. The patient has an increased serum creatinine level

d. The patient has an increased serum creatinine level

A 76-year-old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinsons disease. Which information is most important for the nurse to report to the health care provider? a. Shuffling gait b. Tremor at rest c. Cogwheel rigidity of lungs d. Uncontrolled head movement

d. Uncontrolled head movement all other findings are expected in parkinsons

Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of a. excretion of sodium. b. excretion of bicarbonate. c. conservation of potassium. d. excretion of hydrogen ions.

d. excretion of hydrogen ions.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1. Place the client on a cardiac monitor. 2. Notify the primary health care provider (PHCP). 3. Put the client on NPO (nothing by mouth) status except for ice chips. 4. Review the client's medications to determine whether any contain or retain potassium. 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

1, 2, and 4

The nurse is reviewing a client's record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Increased number of white blood cells in the urine

1. Elevated creatinine level

A patient with acute kidney injury has a potassium level of 6.9 mg/dL. The patient has had no urine output in the past 4 hours despite administration of Lasix 40 mg intravenous push. To correct the hyperkalemia the patient is given 50 mL of 50% dextrose in water and 10 U of regular insulin intravenous push. A repeat potassium level 2 hours later shows a potassium level of 4.5 mg/dL. What order would the nurse expect now? a. Sodium kayexalate 15g PO b. Nothing, this represents a normal potassium level c. Lasix 40mg IVP d. 0.9% normal saline at 125 mL/h

ANS: A

A patient with renal failure has the following blood gas: pH 7.32, PaCO2 35, HCO3 18. This acid-base abnormality is the result of the kidney's inability to: a. Excrete acid by-products of metabolism b. Excrete carbon dioxide c. Excrete bicarbonate ions d. Excrete calcium ions

ANS: A

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In helping the patient decide about treatment, the nurse informs the patient that: a. successful transplantation usually provides better quality of life than that offered by dialysis. b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. c. hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection. d. the immunosuppressive therapy after transplantation makes the person ineligible to receive other treatments if the kidney fails.

ANS: A

Prevention of AKI is important because of the high mortality rate. Which patients are at increased risk for AKI (select all that apply)? a. An 86-year-old woman scheduled for a cardiac catheterization b. A 48-year-old man with multiple injuries from a motor vehicle accident c. A 32-year-old woman following a C-section delivery for abruptio placentae d. A 64-year-old woman with chronic heart failure admitted with bloody stools e. A 58-year-old man with prostate cancer undergoing preoperative workup for prostatectomy

ANS: A, B, C, D, E. Advanced age and possible neprhotoxic agents (intrarenal) Massive trauma (could be intrarenal or prerenal) and prolonged hypotension/hypovolemia (prerenal) Prolonged hypotension/hypovolemia (prerenal) Prolonged hypotension/hypovolemia (prerenal) Possible obstruction leading to postrenal AKI

A patient is admitted with respiratory failure and is being mechanically ventilated. The nurse understands there is a significant association between acute kidney injury and respiratory failure. How does mechanical ventilation alter kidney function? (Select all that apply, one, some, or all.) a. Decreases blood flow to the kidney b. Decreases GFR c. Damages the kidney tubular endothelium d. Decreased urine output e. Hinder flow of urine from kidneys

ANS: A, B, D

Patients with chronic kidney disease have an increased incidence of cardiovascular disease related to (select all that apply) a. hypertension. b. vascular calcifications. c. a genetic predisposition. d. hyperinsulinemia causing dyslipidemia. e. increased high-density lipoprotein levels.

ANS: A, B, D

A patient with chronic kidney disease receives hemodialysis treatments 3 days a week. Every 2 weeks, the patient requires a transfusion of 1 or 2 U of packed red blood cells. What is the probable reason for this patient's frequent transfusion needs? a. Too much blood phlebotomized for tests b. Increased destruction of RBC because of increased toxin levels c. Lack of production of erythropoietin to stimulate RBC formation d. Hemodilution secondary to fluid retention

ANS: C

To assess whether or not an arteriovenous fistula is functioning, what must the nurse do and why? a. Palpate the quality of the pulse distal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality ofthe blood flow. b. Palpate the quality of the pulse proximal to the site to determine whether a thrill ispresent; auscultate with a stethoscope to appreciate a bruit to assess the quality ofthe blood flow. c. Palpate gently over the site of the fistula to determine whether a thrill is present;listen with a stethoscope over this site to appreciate a bruit to assess the quality ofthe blood flow. d. Palpate over the site of the fistula to determine whether a thrill is present; checkwhether the extremity is pink and warm.

ANS: C

What causes the gastrointestinal (GI) manifestation of stomatitis in the patient with CKD? a. High serum sodium levels b. Irritation of the GI tract from creatinine c. Increased ammonia from bacterial breakdown of urea d. Iron salts, calcium-containing phosphate binders, and limited fluid intake

ANS: C. Increased ammonia in saliva from bacterial breakdown of urea leads to stomatitis and mucosal ulcerations. Irritation of the GI from urea leads to anorexia, nausea, vomiting. Uremic fetor = urine smell in breath

The patient with CKD is brought to the emergency department with Kussmaul respirations. What does the nurse know about CKD that could cause this patient's Kussmaul respirations? a. Uremic pleuritis is occurring. b. There is decreased pulmonary macrophage activity. c. They are caused by respiratory compensation for metabolic acidosis. d. Pulmonary edema from heart failure and fluid overload is occurring.

ANS: C. Kussmaul respirations occur with severe metabolic acidosis when the respiratory system is trying to compensate by blowing off CO2 w/exhalation

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? a. Hyperkalemia and hyponatremia b. Hyperkalemia and hypernatremia c. Hypokalemia and hyponatremia d. Hypokalemia and hypernatremia

ANS: C. Oliguric phase would be A as body would be in delusional hyponatremia and would retain potassium. During the diuretic phase, patient would be losing electrolytes

RIFLE defines the first 3 stages of AKI based on changes in a. blood pressure and urine osmolality. b. fractional excretion of urinary sodium. c. estimation of GFR with the MDRD equation. d. serum creatinine or urine output from baseline.

ANS: D

Patient-Centered Care: While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify the health care provider (HCP)? a. Urine output is 300 mL/day. b. Edema occurs in the feet, legs, and sacral area. c. Cardiac monitor reveals a depressed T wave and elevated ST segment. d. The patient develops increasing muscle weakness and abdominal cramping.

ANS: D. Increased muscle weakness and abdominal cramping are symptoms of neuromuscular impairment that accompanies hyperkalemia. Hyperkalemia will have PEAKED T waves and DEPRESSED ST segments.

35-year-old developed AKI after an upper GI bleed secondary to esophageal varices/lost a lot of blood. Which of the following lab results would the nurse expect? a. Low urine osmolality, high urine sodium concentration b. High urine osmolality, high urine sodium concentration c. Low urine osmolality, low urine sodium concentration d. High urine osmolality, low urine sodium concentration

ANS: D. Initially, volume depletion will cause acute PRERENAL failure. Basement membranes of renal tubules are NOT affected (no intrarenal failure). Therefore the tubules can still concentrate urine and hold onto sodium.

In caring for the patient with AKI, what should the nurse be aware of? a. The most common cause of death in AKI is irreversible metabolic acidosis. b. During the oliguric phase of AKI, daily fluid intake is limited to 1000 mL plus the prior day's measured fluid loss. c. Dietary sodium and potassium during the oliguric phase of AKI are managed according to the patient's urinary output. d. One of the most important nursing measures in managing fluid balance in the patient with AKI is taking accurate daily weights.

ANS: D. Measuring daily weights with the same scale at the same time each day allows for the evaluation and detection of excessive body fluid gains or losses. Infection is the leading cause of death in AKI, so meticulous aseptic technique is critical. Fluid limitation during oliguric phase is 600mL plus the prior day's fluid loss. Dietary sodium and potassium intake are managed according to the plasma levels.

The nurse advises a patient with myasthenia gravis (MG) to a. Perform physically demanding activities early in the day b. Anticipate need for weekly plasmapheresis treatments c. Do frequent weight-bearing exercise to prevent muscle atrophy d. Protect extremities from injury due to poor sensory perception

a. Perform physically demanding activities early in the day