Kidney failure Nclex Questions

Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective?

"I will measure my urinary output each day to help calculate the amount I can drink."

A cllient with chronic renal failure has been prescribed calcium carbonate. What is the rationale for this particular medication? 1) Diminishes incidence of gastric ulcer formation 2) Alleviates constipation 3) Binds with phosphorus to lower concentration 4) Increase tubular reabsorption of sodium

3: Clients with ARF have hyperphosphatemia. Clients are prescribed calcium-based phosphate binders to improve excretion of phosphorus.

A client with acute renal failure develops sever hyperkalemia. What would the nurse anticipate to be used to treat this imbalance? 1) Furosemide (Lasix) 2) Amphojel (aluminum hydroxide) 3) 50% glucose and regular insulin 4) Epoetin (Procrit)

3: Hyperkalemia can develop into an emergency situation (Cardia Arrest). It is important to quickly move the potassium back into the cells by administering 50% glucose and regular insulin, usually in conjunction with some type of base to correct the acidosis, such as sodium bicarbonate or calcium gluconate given IV. Insulin assists in the movement of potassium into the cells and helps to reduce the serum potassium level. Amphojel is used for the treatment of hyperphosphatemia that occurs with ARF. Procrit is used for the treatment of anemia caused by a decrease in erythropoietin production by the kidneys. A diuretic, such as Lasix, may lead to a loss of potassium, but the rate is too slow.

A client with chronic renal failure has an internal venous access site for hemodialysis on her left forearm. What action will the nurse take to protect this access site? 1) Irrigate with heparin and NS q8 hrs 2) Apply warm moist packs to the area after hemodialysis 3) Do not use the left arm to take blood pressure readings. 4) Keep the arm elevated above the level of the heart.

3: Protect the arm with the functioning shunt. No blood pressure readings should be taken from that arm, and there should be no needle sticks. The access is not irrigated with Heparin.

Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?

Calculated glomerular filtration rate (GFR)

A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?

Cardiac rhythm

After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first? a. Document the QRS interval. b. Notify the patient's health care provider. c. Look at the patient's current blood urea nitrogen (BUN) and creatinine levels. d. Check the chart for the most recent blood potassium level.

Check the chart for the most recent blood potassium level.

During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Obtain blood to check the blood urea nitrogen (BUN) level. c. Check the patient's blood pressure. d. Give prescribed PRN antiemetic drugs.

Check the patient's blood pressure.

The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?

Joint pain

A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required?

Milk of magnesia 30 mL

When a patient who has had progressive chronic kidney disease (CKD) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. Unlimited fluids are allowed since retained fluid is removed during dialysis. c. More protein will be allowed because of the removal of urea and creatinine by dialysis. d. Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.

More protein will be allowed because of the removal of urea and creatinine by dialysis.

Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?

Phosphate level

After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take?

Report the patient's symptoms to the health care provider.

Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?

The patient cleans the catheter while taking a bath every day.

When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation?

The patient has metastatic lung cancer.

The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which information should be reported immediately to the health care provider?

The patient's peritoneal effluent appears cloudy.

Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse? a. The blood glucose is 144 mg/dL. b. The patient's blood pressure is 150/92. c. There is a nontender lump in the axilla. d. The patient has a round, moonlike face.

There is a nontender lump in the axilla.

Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation?

Urine output

A patient complains of leg cramps during hemodialysis. The nurse should first a. massage the patient's legs. b. reposition the patient supine. c. give acetaminophen (Tylenol). d. infuse a bolus of normal saline.

infuse a bolus of normal saline.

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a. is much less likely to clot. b. increases patient mobility. c. can accommodate larger needles. d. can be used sooner after surgery.

is much less likely to clot.

Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the ______________

patient's bowel sounds.

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for _________________

rapid respirations.

Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check the laboratory value for _______________

serum phosphate.