Med/Surg Exam 4

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for

fatigue and weakness.

acute kidney injury (AKI)

rapid loss of renal function due to damage to the kidneys; formerly called acute renal failure

The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching

"I should drink as much as possible to keep my kidneys working."

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of?

1,500 mL of fluid

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?

Cola-colored urine

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be

A GFR of 30-59 mL/min/1.73 m2

A client with chronic kidney disease (CKD) has been receiving erythropoietin injections as prescribed. Which outcome would indicate to the nurse that this medication has been effective

Absence of pallor

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client

Hemodialysis

A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value

Hyperkalemia

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess

Hypertension

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

Hypovolemic shock caused by hemorrhage

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output

Less than 400 mL

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated

Obtaining a blood pressure reading from the right arm

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase

Oliguria

Which of the following occurs late in chronic glomerulonephritis

Peripheral neuropathy

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant

Recent history of streptococcal infection

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client

Risk for infection

What is used to decrease potassium level seen in acute renal failure

Sodium polystyrene sulfonate

The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client

SpO2 at 90% with fine crackles in the lung bases

The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client?

SpO2 at 90% with fine crackles in the lung bases

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD

The client has a history of diverticulitis.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 250 ml/24 hours

nephrotoxic

any substance, medication, or action that is toxic to kidney tissue

nephrosclerosis

hardening of the renal arteries

The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for

hypertension.

diuresis

increased urine volume

dysuria

painful or difficult urination

nephrons

structural and functional units of the kidney responsible for urine formation

The most accurate indicator of fluid loss or gain in an acutely ill client is

weight.

pyuria

white blood cells in the urine

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."

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis

Azotemia

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has

Calcium

A client requires hemodialysis. Which type of drug should be withheld before this procedure

Cardiac glycosides

A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient

Compatible blood and tissue types

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate

Donors are selected from compatible living or deceased donors.

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care

Encourage use of incentive spirometer every 2 hours.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure

Gray-bronze skin color

Acute dialysis is indicated during which situation

Impending pulmonary edema

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia

Increase carbohydrates and limit protein intake.

What is a characteristic of the intrarenal category of acute kidney injury (AKI)

Increased BUN

What is a characteristic of the intrarenal category of acute renal failure?

Increased BUN

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client

Keep the dialysis supplies in a clean area, away from children and pets

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important

Limiting fluid intake

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

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI

Oliguria

Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys

Oliguria

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia?

Tall, peaked T waves

A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead the nurse to suspect that the client is experiencing rejection

Tenderness over transplant site

The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse

Turn the client from side to side.

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client

Use an aseptic technique during the procedure.

renal clearance

ability of the kidneys to clear solutes from the plasma

glomerular filtration rate (GFR)

amount of plasma filtered through the glomeruli per unit of time

uremia

an excess of urea and other nitrogenous wastes in the blood

creatinine

endogenous waste product of muscle energy metabolism

glycosuria

excretion of glucose in the urine

specific gravity

expression of the degree of concentration of the urine

erythropoietin

glycoprotein produced by kidney; stimulates bone marrow to produce red blood cells

The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed

hyperacute rejection.

continuous ambulatory peritoneal dialysis (CAPD)

method of peritoneal dialysis whereby a patient manually performs a prescribed number of exchanges or cycles throughout the day

diffusion

movement of solutes (waste products) from an area of higher concentration to an area of lower concentration

proteinuria

protein in the urine

urinary casts

proteins secreted by damaged kidney tubules

A client has been diagnosed with acute glomerulonephritis. This condition causes

proteinuria.

hematuria

red blood cells in the urine

dialysate

the electrolyte solution that circulates through the dialyzer in hemodialysis and through the peritoneal membrane in peritoneal dialysis

nephrotic syndrome

type of kidney disease with increased glomerular permeability and massive proteinuria

arteriovenous graft

type of surgically created vascular access for dialysis by which a piece of biologic, semibiologic, or synthetic graft material connects the patient's artery to a vein

arteriovenous fistula

type of vascular access for dialysis which is created by surgically connecting an artery to a vein

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education

Brief, hot daily showers

SATA Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included?

*Eat foods such as milk, fish and eggs. *Restrict sodium to 2,000 to 3,000 mg daily. *Restrict fluid to daily urinary output plus 500-800 mL.

SATA A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would the nurse expect to find?

*Hypertension *Pain from retroperitoneal bleeding *Polyuria

SATA The nurse is caring for a postoperative client who reports difficulty urinating. The client does not have a urinary catheter in place. Which nursing action(s) are most appropriate at this time?

*Run water to assist in the let down reflex *Assist to the bathroom. *Assist the client to stand *Measure urinary output

SATA A client is experiencing a decreasing glomerular filtration. What laboratory values should the nurse expect to follow the change?

*Serum creatinine increases *Blood urea nitrogen (BUN) increases *Creatinine clearance decreases

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse

"Even a perfect match does not guarantee organ success."

A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened

The patient is experiencing a cerebral fluid shift.

A client develops acute renal failure (ARF) after receiving IV 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.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

Urine output of 20 ml/hour

As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur

Hyperphosphatemia

continuous renal replacement therapy (CRRT)

method used to replace normal kidney function in patients who are hemodynamically unstable by circulating the patient's blood through a hemofilter and returning it to the patient

osmosis

movement of water through a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder

pH 7.20, PaCO2 36, HCO3 14-

micturition

urination or voiding

During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication

Dehydration

Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for

removal of the transplanted kidney.

urinary frequency

voiding more frequently than every 3 hours

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?

" The best response by the nurse is? "As the disease progresses, you will most likely require renal replacement therapy."

A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching

"As long as I have one normal kidney, I should be fine."

dialyzer

artificial kidney; contains a semipermeable membrane through which particles of a certain size can pass

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse

"This type of dialysis will provide more independence."

Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective

"Ultrafiltration methods take much longer than hemodialysis."

SATA A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug?

*Gentamycin *Tobramycin *Neomycin

SATA A client is receiving hemodialysis for acute kidney failure. Which assessment finding(s) indicates to the nurse that the client is experiencing dialysis disequilibrium?

*Nausea *Vomiting *Headache *Confusion

A client with chronic kidney disease weighs 209 lbs (95 kg) and is prescribed 1.2 grams of protein per kg per day. Which amount of protein will the client ingest per day

114

nocturia

awakening at night to urinate

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level

Administration of sodium polystyrene sulfonate [Kayexalate])

The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal?

Enter your response as a whole number? 4000

Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure

Fluid volume excess

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure

Glomerulonephritis

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures

Hyperphosphatemia

A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate

Lasix 80 mg IVP

A client recovering from hepatitis B develops acute nephrotic syndrome. Which treatment will the nurse anticipate being prescribed for this client?

Methylprednisolone

A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause

Renal calculi

Which of the following would a nurse classify as a prerenal cause of acute renal failure

Septic shock

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment

Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

azotemia

abnormal concentration of nitrogenous waste products in the blood

Which clinical finding should a nurse look for in a client with chronic renal failure

Uremia

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis

Wear a mask when performing exchanges.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem

White blood cell (WBC) count of 20,000/mm3

A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is

anaphylaxis

The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of

anemia.

bacteriuria

bacteria in the urine

anuria

decreased urine output of less than 50 mL in 24 hours

exchange

denotes a complete cycle including fill, dwell, and drain phases of peritoneal dialysis

urea nitrogen

end product of protein metabolism (synonym: blood urea nitrogen [BUN])

polyuria

excessive urine production

end-stage kidney disease (ESKD)

final stage of chronic kidney disease that results in retention of uremic waste products and the need for renal replacement therapies; formerly called end-stage renal disease (ESRD)

antidiuretic hormone (ADH)

hormone secreted by the posterior pituitary gland; causes the kidneys to reabsorb more water (synonym: vasopressin)

aldosterone

hormone synthesized and released by the adrenal cortex; causes the kidneys to reabsorb sodium

glomerulonephritis

inflammation of the glomerular capillaries

peritonitis

inflammation of the peritoneal membrane

interstitial nephritis

inflammation within the renal tissue

chronic kidney disease (CKD)

kidney damage or a decrease in the glomerular filtration rate lasting for 3 or more months

continuous cyclic peritoneal dialysis (CCPD)

method of peritoneal dialysis in which a peritoneal dialysis machine (cycler) automatically performs exchanges, usually while the patient sleeps

hemodialysis (HD)

procedure during which a patient's blood is circulated through a dialyzer to remove waste products and excess fluid

peritoneal dialysis (PD)

procedure that uses the lining of the patient's peritoneal cavity, the peritoneal membrane, as the semipermeable membrane for exchange of fluid and solutes

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.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure

Dehydration

effluent

term used to describe the drained fluid from a peritoneal dialysis exchange

glomerulus

tuft of capillaries forming part of the nephron through which filtration occurs

acute tubular necrosis (ATN)

type of acute kidney injury in which there is damage to the kidney tubules

acute nephritic syndrome

type of kidney disease with glomerular inflammation

oliguria

urine output less than 400 mL in 24 hours or less than 0.5 mL/kg/h over 6 hours

ultrafiltration

process whereby water is removed from the blood by means of a pressure gradient between the patient's blood and the dialysate

A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering

sodium polystyrene sulfonate (Kayexalate)

The nurse is caring for a client who underwent a kidney transplant. The client appears anxious and tearful and states, "My body is going to reject the new kidney; I know I'm going to die." What is the best response by the nurse

"I understand your concerns, let's talk about them."

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take

Hold the medications until after dialysis.

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition

Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.