MS4

The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. What should the nurse explain to the client about this procedure?

No special preparation is required for the examination. Explanation: A KUB radiographic examination ordinarily requires no preparation. It is usually done while the client lies supine and does not involve the use of radiopaque substances. It is not necessary for the client to withhold fluids; the client will not need to take a tranquilizer; an enema is not included in the preparation.

Prior to initiating hemodialysis therapy on a client, the nurse notes that the client's heart rate is 50 beats/min, blood pressure is 110/78 mm Hg, and respirations are 14 breaths/min. What is the best action by the nurse?

Notify the healthcare provider. Explanation: The best action by the nurse is to contact the healthcare provider because a new onset of bradycardia can be indicative of hyperkalemia, which may require an adjustment in the dialysate. Documenting the findings is important but the nurse needs to contact the healthcare provider first. Holding the client's medications and/or assessing for orthostatic hypotension will not address the fact that the dialysate may need to be adjusted.

A nurse is managing the care of a client with continuous bladder irrigation after having a transurethral resection of the prostate (TURP). The nurse is recording the intake and output for an 8-hour shift and notes 600 ml normal saline via CBI was infused and 800 cc was emptied from the Foley. What will be the priority action by the nurse?

Notify the healthcare provider. Explanation: This net urine output was 200 ml, which is less than 30 ml/hr required to perfuse the kidneys. This is the priority and requires immediate follow-up by the nurse to contact the healthcare provider. Although recording I & O and properly securing the catheter are important they are not the priority of care. Advancing the catheter after a TURP would be contraindicated.

A nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse would be alert for which signs and symptoms? Select all that apply.

Trousseau's sign cardiac arrhythmias fractures Explanation: Chronic renal failure is the slow process of losing kidney function over time. At some point, the kidney will not be able to remove excess fluid and wastes from the body causing fluid and electrolyte complications. Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting times, anxiety, and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures. Drowsiness and lethargy are not typically associated with hypocalcemia.

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis disequilibrium syndrome causes:

confusion, headache, and seizures. Explanation: Dialysis disequilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiological functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, what should the nurse ask the client about experiencing recently?

constipation Explanation: Constipation may contribute to reduced urine outflow in part because peristalsis facilitates drainage outflow. For this reason, bisacodyl suppositories can be used prophylactically, even without a history of constipation. Diarrhea, vomiting, and flatulence typically do not cause decreased outflow in a peritoneal dialysis catheter.

The nurse in the urology clinic is teaching a 76-year-old male client with benign prostatic hyperplasia (BPH) about finasteride, a newly prescribed medication.

decrease libido reduce urinary retention cause breast enlargement Explanation: Finasteride, a 5-alpha reductase inhibitor, is prescribed to improve symptoms of BPH and reduce acute urinary retention. The nurse should explain to the client taking finasteride for BPH that this drug can cause erectile dysfunction and decreased libido. Finasteride can cause breast enlargement and the client should be instructed to contact the provider if they develop breast enlargement, breast soreness or pain, or nipple discharge.Finasteride is prescribed to reduce urinary retention, one of the symptoms of BPH. Finasteride may increase the risk of high-grade prostate cancer.Finasteride may cause hypotension, not hypertension.The client should be aware that finasteride can decrease the PSA level.

A sexually active male client has burning on urination and a milky discharge from the urethral meatus. What documentation should be included in the client's medical record? Select all that apply.

history of unprotected sex (sex without a condom) length of time since symptoms presented history of fever or chills presence of any enlarged lymph nodes on examination allergies to any medications Explanation: The client is suspected of having a sexually transmitted infection. Therefore, the client's sexual history, assessment, and examination must be documented, including symptoms (such as fever, chills, and enlarged glands) and their onset and duration. Allergies are critical to document for every client, but are especially noteworthy in this case because antibiotics will be prescribed. If a sexually transmitted infection is confirmed, sexual contacts need to be treated. To protect privacy, the names and phone numbers should never be placed in the medical record. The public health department will also assist in obtaining information and treating known sexual contacts.

A client admitted to the unit with a diagnosis of end-stage renal disease is scheduled to undergo hemodialysis. The client voices anxiety over shunt placement and managem

home health nurse, nutritionist, and social worker Explanation: Home care for a client with end-stage renal disease requires ongoing education and referral; team members include the home health nurse, the nutritionist, and social services in this process. The home health nurse assists with client teaching and support, completion of physical assessments, and evaluation of outcomes. The nutritionist explains dietary needs and necessary changes in the diet. The social worker assists with finding resources and provides counseling and support to the client and family members. Physical and occupational therapy and dialysis aren't components of home care. Family members aren't part of the interdisciplinary healthcare team.

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?

nephrotoxic injury secondary to use of contrast media Explanation: Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.

A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. What should the nurse tell the client to expect when following this diet? The diet will:

prevent the development of ketosis. Explanation: High-carbohydrate foods meet the body's caloric needs during acute renal failure. Protein is limited because its breakdown may result in the accumulation of toxic waste products. The main goal of nutritional therapy in acute renal failure is to decrease protein catabolism. Protein catabolism causes increased levels of urea, phosphate, and potassium. Carbohydrates provide energy and decrease the need for protein breakdown. They do not have a diuretic effect. Some specific carbohydrates influence urine pH, but this is not the reason for encouraging a high-carbohydrate, low-protein diet. There is no need to reduce demands on the liver through dietary manipulation in acute renal failure.

Which laboratory value supports a diagnosis of pyelonephritis?

pyuria Explanation: Pyelonephritis is diagnosed by the presence of pyuria, leukocytosis, hematuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Myoglobinuria is seen with any disease process that destroys muscle. Ketonuria indicates a diabetic state. Because the client with pyelonephritis

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about

recent streptococcal infection. Explanation: A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.

A client is receiving hemodialysis for chronic kidney failure. The nurse understands the client is at an increased risk for which condition?

serum hepatitis Explanation: Serum hepatitis (hepatitis B) is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in renal failure constitute a great risk of exposure. Other answers are incorrect because dialysis is done through a dialysis catheter, not peritoneum. There is no reason for increased calculi or infection based on urine output.

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:

weight loss. Explanation: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

After meeting with the healthcare team about a pending urinary diversion procedure, the client states, "My life won't ever be the same. What am I going to do?" Which healthcare team member should the nurse consult to best help with the client's concerns?

wound ostomy continence nurse Explanation: The nurse should consult the wound ostomy continence nurse to help the client with fears and concerns. Providing the client with information about how to care for the urinary diversion can greatly allay the client's fears. The social worker can provide the client with services needed prior to and after discharge. Although the surgeon teaches the client about the surgery, the surgeon will not be the best person to help the client with their fears and concerns. The hospice nurse will not be a part of the team until care decisions are made after surgery.

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in

1 minute. Explanation: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

A client scheduled for hemodialysis is prescribed an oral antihypertensive daily. What is the correct action by the nurse regarding the medication?

Administer it after the hemodialysis treatment. Explanation: The nurse should administer the medication after the hemodialysis treatment to prevent a hypotensive episode. The medication should not be held on the days the client has dialysis unless the client's blood pressure contraindicates giving the medication. Administering the medication prior to the treatment may lead to the client becoming hypotensive during dialysis or having the medication filtered out of the bloodstream during the hemodialysis treatment.

Near the beginning of a hemodialysis treatment, a client reports a headache, nausea, vomiting, blurred vision, and muscle cramps. What is the best action by the nurse?

Contact the healthcare provider. Explanation: Headache, nausea, vomiting, blurred vision, and muscle cramps are symptoms of dialysis disequilibrium syndrome. The nurse should contact the healthcare provider immediately. There is no need to check the client's venous pressure or to check the color of the blood in the dialyzer at this time. Lowering the head of the bed will not address the disequilibrium syndrome.

Which statement best describes the therapeutic action of loop diuretics?

They block sodium reabsorption in the ascending loop and dilate renal vessels. Explanation: Loop diuretics block sodium reabsorption in the ascending loop of Henle, which promotes water diuresis. They also dilate renal vessels. Although loop diuretics block potassium reabsorption, this isn't a therapeutic action. Thiazide diuretics, not loop diuretics, promote sodium secretion into the distal tubule.

A nurse is caring for a client in renal failure who fell and sustained a head injury. The nurse is educating the client on the upcoming computed tomography (CT) scan of the brain requiring radiopaque dye. Which statement by the nurse is correct?

"Blood will be drawn and analyzed before the test to ensure your kidneys can remove the dye." Explanation: The radiopaque dye used in CT scans is filtered by the kidneys and then excreted from the body. If a client has renal impairment the kidneys may be unable to filter this dye. Therefore, a creatinine blood test is completed prior to the scan to ensure appropriate kidney function. Although it is important to remain still during this scan, a brain CT takes approximately 30 minutes. Instructing the client to lie still for 2 hours is unnecessary. Feeling flushed and warm after receiving the radiopaque dye is common; however, shortness of breath, pruritus, and dizziness can be signs of an allergic reaction. Metal objects such as hearing aids, piercings, and other jewelry are not allowed in the CT scan.

What are important nursing care measures for a client with diabetes who is admitted with end-stage renal failure?

Restrict sodium and potassium and restrict fluids as ordered. Explanation: In renal failure, there is retention of sodium and potassium, so these are restricted. Important care measures will also include fluid restrictions. The client will require permanent dialysis, not temporary as with acute renal failure. The diet will be restricted in protein to decrease waste products. Hypertension is associated with chronic renal failure.

The return for a client receiving peritoneal dialysis is sluggish. Which action should the nurse take to facilitate the drainage of the fluid? Select all that apply.

Raise the head of the bed. Inspect the tubing for kinks. Turn the client from side to side. Explanation: The care of the client receiving peritoneal dialysis includes monitoring the client during the draining phase of the treatment. If the fluid does not drain, the head of the bed can be raised or the client turned from side to side. Inspecting the tubing for kinks should also be done. The catheter is not irrigated and should never be pushed further into the peritoneal cavity.

A client has been admitted with acute kidney injury. What should the nurse do while admitting the client? Select all that apply.

Elevate the head of the bed 30 to 45 degrees. Take vital signs. Establish an intravenous (IV) access site. Call the admitting health care provider (HCP) for prescriptions. Explanation: When admitting a client with acute kidney injury (acute renal failure), the nurse should raise the head of the bed to promote ease of breathing. Respiratory manifestations of acute renal failure include shortness of breath, orthopnea, crackles, and the potential for pulmonary edema. Therefore, priority is placed on the facilitation of respiration. The nurse should assess the vital signs because the pulse and respirations will be elevated. Establishing a site for IV therapy will become important because fluids will be administered IV in addition to orally. The HCP will need to be contacted for further prescriptions; there is no need to contact the hemodialysis unit.

The client is having peritoneal dialysis. During the exchange, the nurse observes that the flow of dialysate stops before all the solution has drained out. What should the nurse do next?

Turn the client from side to side. Explanation: Fluid return with peritoneal dialysis is accomplished by gravity flow. Actions that enhance gravity flow include turning the client from side to side, raising the head of the bed, and gently massaging the abdomen. The client is usually confined to a recumbent position during the dialysis, so having the client sit in a chair or walk w

A client with acute kidney injury is to receive peritoneal dialysis. What should the nurse do to prepare the client for the procedure?

Warm the dialysis solution in the warmer. Explanation: When the nurse is preparing a solution for a client with acute kidney injury receiving peritoneal dialysis, the solution should be warmed to body temperature in a warmer or with a heating pad; do not use the microwave. Cold dialysate increases discomfort. Assessment for a bruit and thrill is necessary with hemodialysis when the client has a fistula, graft, or shunt. An indwelling urinary catheter is not required for this procedure. The nurse should position the client in a supine or low Fowler position.

The nurse is planning care for a client with pain associated with renal colic. Which nursing action will provide the most relief?

administering morphine Explanation: During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics such as morphine to control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.

The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which statement(s) would indicate that the client has correctly understood the teaching? Select all that apply.

"I can usually keep my ostomy pouch on for 3 to 7 days before changing it." "I must use a skin barrier to protect my skin from urine." Explanation: The client with an ileal conduit must learn self-care activities related to the care of the stoma and ostomy appliances. The client should be taught to increase their fluid intake to about 101 oz (3000 mL) a day and should not limit their intake. Adequate fluid intake helps flush mucus from the ileal conduit. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential for protecting the skin from the irritation of the urine. An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight of the urine from pulling the appliance away from the skin.

The nurse is assessing the urine of a client who has had an ileal conduit and notes that there is a moderate amount of mucus in the urine. What should the nurse do next?

Encourage a high fluid intake. Explanation: Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or notify the HCP. The mucus is not an indication of an infection, so a urine culture is not necessary.

A client who had a transurethral resection of the prostate (TURP) has a three-way indwelling urinary catheter with continuous bladder irrigation. In which circumstance should the nurse increase the flow rate of the continuous bladder irrigation? Increase it when drainage:

becomes bright red. Explanation: The decision by the surgeon to insert a catheter after TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so that clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating solution.

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Increase your carbohydrate intake." Explanation: A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.

The nurse is teaching a client with chronic renal failure who is taking antibiotics about which signs and symptoms of potential nephrotoxicity to report. The nurse should tell the client to report which change(s) in the color of the urine? Select all that apply.

cloudy smoky pink Explanation: The client who is taking potentially nephrotoxic antibiotics should notify the health care provider (HCP) if the urine is cloudy, smoky, or pink; early signs of nephrotoxicity are manifested by changes in urine color. Straw-colored and pale-yellow-colored urine is normal.

A client has cystitis. The nurse should ask the client about experiencing which symptom?

foul-smelling urine Explanation: Foul-smelling urine is indicative of cystitis. Other symptoms include dysuria and urinary frequency and urgency. Flank pain, nausea, and vomiting indicate pyelonephritis.

The nurse is caring for a client with chronic renal failure. The nurse should monitor the client for which adverse effects of hypermagnesemia?

lethargy Explanation: Early signs and symptoms of hypermagnesemia include drowsiness, lethargy, nausea, and vomiting. Flushed skin is a sign of hypernatremia. Severe thirst is associated with hyperglycemia. Tremors are associated with hypomagnesemia.

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome. Which assessment is the priority?

neurological status Explanation: Clients experiencing dialysis for the first time often have confusion and even seizures and should be monitored closely. Vital signs and laboratory values are important assessments but do not specifically address dialysis disequilibrium syndrome. Pain in the flank region is not associated with dialysis.

The nurse is preparing to irrigate a urinary drainage system. Which supplies will the nurse need to gather for the procedure? Select all that apply.

sterile gloves sterile saline syringe Explanation: The nurse would use sterile irrigating solution and not tap water in the syringe in order to prevent infection in a closed system with this procedure. The nurse should also wear sterile, not clean, gloves to prevent introducing microorganisms during the procedure. A syringe would be required for the irrigation procedure.

The nurse determines that the parent understands the diet restrictions for a child with chronic renal failure who is receiving peritoneal dialysis when the parent reports providing a diet involving which components?

protein and phosphorous restrictions Explanation: Regulation of the diet is the most effective means, besides dialysis, for reducing renal excretion. Dietary phosphorus is restricted, which reduces the protein load on the kidneys. Clients are also given substances to bind phosphorus in the intestines to prevent absorption. Limited protein in the diet should include foods high in essential amino acids. Foods high in fat and carbohydrate are used to increase caloric intake. Sodium and water may not be restricted because of the continual loss of sodium and water through the dialysate. Iron-rich foods are commonly high in protein.

The nurse is assessing a client's data with primary glomerular disease. Which assessment data will the nurse expect to verify progression to nephrotic syndrome? Select all that apply.

proteinuria diffuse edema hypoalbuminemia Explanation: The nurse will see proteinuria, diffuse edema, and hypoalbuminemia with nephrotic syndrome. Hypertension and elevated serum cholesterol are associated with nephrotic syndrome.

A client is in the oliguric phase of acute kidney injury. For which risk should the nurse assess the client?

pulmonary edema Explanation: Pulmonary edema can develop during the oliguric phase of acute renal failure because of decreased urine output and fluid retention. Metabolic acidosis develops because the kidneys cannot excrete hydrogen ions, and bicarbonate is used to buffer the hydrogen. Hypertension may develop as a result of fluid retention. Hyperkalemia develops as the kidneys lose the ability to excrete potassium.

A graduate nurse is asking for information about chronic renal failure. Which statement by the nurse would be most accurate when providing teaching?

"It is characterized by azotemia, fluid volume excess, and hyperkalemia." Explanation: When chronic renal failure occurs, the body is unable to eliminate the wastes, resulting in azotemia. In addition, the kidneys are not able to eliminate the body fluids, resulting in fluid volume overload. There is also a rise in potassium levels resulting in hyperkalemia. The most common cause of chronic renal failure is diabetes. There is a depression of erythropoietin with chronic renal failure. The liver converts wastes to creatinine and blood urea nitrogen, not the kidneys.

A client has a temperature of 98.6° F (37° C) prior to dialysis and 100° F (37.7° C) post dialysis. What is the appropriate nursing action?

Document the finding as the only action. Explanation: A slight temperature elevation after dialysis is an expected finding, and the healthcare provider does not need to be notified. Fluids should not be increased in a client receiving dialysis unless specifically ordered. There are no other manifestations to indicate that a culture of the fistula site is necessary.

A client with chronic renal failure who receives hemodialysis twice a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply

Have limited amounts of fluids only when thirsty. Keep all dialysis appointments. Eat smaller, more frequent meals. Explanation: To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty and eat food before drinking fluids to alleviate dry mouth, and encourage strict follow-up for blood work, dialysis, and health care provider visits. Smaller, more frequent meals may help reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.

The nurse is caring for a client who had a closed renal biopsy. Which should the nurse include in the care plan after the biopsy?

Maintain the client on strict bed rest in a supine position for 6 hours. Explanation: After a renal biopsy, the client is maintained on strict bed rest in a supine position for at least 6 hours to prevent bleeding. If no bleeding occurs, the client typically resumes general activity after 24 hours. Urine output is monitored, but an indwelling catheter is not typically inserted. A pressure dressing is applied over the site, but a sandbag is not necessary. Opioids to control pain would not be anticipated; local discomfort at the biopsy site can be controlled with nonopioid analgesics.

A client develops acute renal failure (ARF) after receiving I.V. 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:

cardiac arrhythmia. Explanation: As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.

A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are: pH 7.30 PaO2 97 PaCO2 37 HCO3 18

clammy skin, blood pressure 86/46 mm Hg, headache Explanation: Metabolic acidosis, a common clinical disturbance, is characterized by decreased pH and plasma bicarbonate concentration. Common causes of metabolic acidosis include diarrhea, chronic renal failure, use of diuretics, intestinal fistulas, and ureterostomies. The client will experience the following signs and symptoms: headache, confusion, increased respiratory rate, nausea, vomiting, cold and clammy skin, and decreased blood pressure.

A client receiving peritoneal dialysis in the home is suspected of having peritonitis. Which finding should the nurse expect to assess in this client? Select all that apply.

hypotension abdominal pain rebound tenderness Explanation: A client receiving peritoneal dialysis is at risk for developing peritonitis. Manifestations of peritonitis include diffuse abdominal pain and rebound tenderness. Hypotension can occur if the infection continues. Weight loss and extreme thirst are not signs of peritonitis.

A client with chronic renal failure (CRF) has a hemoglobin of 10.2 g/dl and hematocrit of 40%. Which choice would be a primary assessment?

presence of fatigue and weakness Explanation: A hemoglobin of 10.2 is low; however the hematocrit is normal. RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Although chronic renal failure can cause fluid volume overload, the normal hematocrit level does not indicate fluid volume overload. Dyspnea and cyanosis is associated with fluid excess, not anemia. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, are not signs of anemia.

A client is scheduled for a creatinine clearance test. The client needs further instruction about preparing for the test after making which statement?

I will be sure to fast from midnight until the test begins at 8:00 am the following day." Explanation: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. High levels of protein in the diet, especially prior to the test can lead to false abnormal test results. Similarly, staying hydrated is important, as fluid deficit or overload can also skew test results. A client may engage in normal activity the days before the test but should not engage in overly vigorous exercise, as this may cause muscle stress and alter the test results.

The nurse teaches a client about care of an arteriovenous (AV) access site. Which statement should the nurse include? Select all that apply.

The incision should be kept dry until it is healed and the sutures are removed. Dressings should be kept on access site for several hours after dialysis. Notify the healthcare provider of any redness, swelling, or drainage at AV access site. Explanation: The nurse should teach the client to keep the incision dry until it is healed and the sutures are removed. Scabs should not be loosened as this can lead to infection. Dressings should be kept on the access site for several hours after dialysis and the healthcare provider should be notified of any redness, swelling, or drainage at the AV access site. The arm with the AV access does not need to be kept elevated after dialysis.

The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder?

pH 7.20 PaCO2 36 HCO3 14 Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.