Acute/Chronic Renal Failure Practice Questions

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most significant for diagnosing ARF? 1. BUN and creatinine. 2. WBC and hemoglobin. 3. Potassium and sodium. 4. Bilirubin and ammonia level.

1 1. Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure. 2. WBCs (white blood cells) are monitored for infection, and hemoglobin is monitored for blood loss. 3. Potassium (intracellular) and sodium (interstitial) are electrolytes and are monitored for a variety of diseases or conditions not specific to renal function. Potassium levels will increase with renal failure, but the level is not a diagnostic indicator for renal failure. 4. Bilirubin and ammonia levels are laboratory values determining the function of the liver, not the kidneys. TEST-TAKING HINT: The nurse must know specific laboratory tests for specific organ functioning or conditions. This is memorizing, but it must be done

The client diagnosed with CKD has a new arteriovenous fistula in the left forearm. Which intervention should the nurse implement? 1. Teach the client to carry heavy objects with the right arm. 2. Perform all laboratory blood tests on the left arm. 3. Instruct the client to lie on the left arm during the night. 4. Discuss the importance of not performing any hand exercises.

1 1. Carrying heavy objects in the left arm could cause the fistula to clot by putting undue stress on the site, so the client should carry objects with the right arm. 2. The fistula should only be used for dialysis access, not for routine blood draws. 3. The client should not lie on the left arm because this may cause clotting by putting pressure on the site. 4. Hand exercises are recommended for new fistulas to help mature the fistula. TEST-TAKING HINT: The test taker must notice the adjectives, such as "left" and "right." Options "2" and "3" have the nurse doing something to the arm with the fistula.

The nurse is providing discharge teaching to the client diagnosed with polycystic kidney disease. Which statement made by the client indicates the teaching has been effective? 1. "I need to avoid any activity causing a risk for injury to my kidney." 2. "I should avoid taking medications for high blood pressure." 3. "When I urinate there may be blood streaks in my urine." 4. "I may have occasional burning when I urinate with this disease."

1 1. Polycystic kidney disease poses an increased risk for rupture of the kidney, and, therefore, sports activities or occupations with risks for trauma should be avoided. 2. Antihypertensive medications should be taken to protect the kidneys from further damage. 3. Blood should always be reported to the health-care provider, and hematuria is a sign of polycystic kidney disease. Further evaluation is needed. 4. Burning during urination should be treated to prevent further damage to the kidneys and renal system.

The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF? 1. Administer normal saline IV. 2. Take vital signs. 3. Place client on telemetry. 4. Assess abdominal dressing

1 1. Preventing and treating shock with blood and fluid replacement will prevent acute renal failure from hypoperfusion of the kidneys. Significant blood loss is expected in the client with a gunshot wound. 2. Taking and evaluating the client's vital signs is an appropriate action, but regardless of the results, this will not prevent ARF. 3. Placing the client on telemetry is an appropriate action, but telemetry is an assessment tool for the nurse and will not prevent ARF. 4. Assessment is often the first action, but assessing the abdominal dressing will not help prevent ARF. TEST-TAKING HINT: The test taker must read the stem carefully and understand what the question is asking. Options "2," "3," and "4" are all forms of assessment and do not help prevent ARF because they are not treatment.

The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first? 1. Place the client in the Trendelenburg position. 2. Turn off the dialysis machine immediately. 3. Bolus the client with 500 mL of normal saline. 4. Notify the health-care provider as soon as possible.

1 1. The nurse should place the client's chair with the head lower than the body, which will shunt blood to the brain; this is the Trendelenburg position. 2. The blood in the dialysis machine must be infused back into the client before the machine is turned off. 3. Normal saline infusion is a last resort because one of the purposes of dialysis is to remove excess fluid from the body. 4. Hypotension is an expected occurrence in clients receiving dialysis; therefore, the HCP does not need to be notified. TEST-TAKING HINT: The Trendelenburg position is often used as a distracter in questions, and the nurse needs to know it is only used in cases where blood needs to be shunted to the brain.

A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which of the following signs of peritoneal infection? 1.Cloudy dialysate fluid. 2.Swelling in the legs. 3.Poor drainage of the dialysate fluid. 4.Redness at the catheter insertion site.

1 Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may indicate heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.

During the first hemodialysis treatment, the client develops a headache, confusion, and nausea. The nurse should assess the client further for: 1.Disequilibrium syndrome. 2.Myocardial infarction. 3.Air embolism. 4.Peritonitis

1 Common symptoms of disequilibrium syndrome include headache, nausea and vomiting, confusion, and even seizures. Disequilibrium syndrome typically occurs near the end or after the completion of hemodialysis treatment. It is the result of rapid changes in solute composition and osmolality of the extracellular fluid. These symptoms are not related to cardiac function, air embolism, or peritonitis

The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which of the following snacks is most appropriate? 1.A gelatin dessert. 2.Yogurt. 3.An orange. 4.Peanuts.

1 Gelatin desserts contain little or no potassium and can be served to a client on a potassium-restricted diet. Foods high in potassium include bran and whole grains; most dried, raw, and frozen fruits and vegetables; most milk and milk products; chocolate, nuts, raisins, coconut, and strong brewed coffee

In the oliguric phase of acute renal failure, the nurse should assess the client for: 1.Pulmonary edema. 2.Metabolic alkalosis. 3.Hypotension. 4.Hypokalemia.

1 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 client is diagnosed with acute pyelonephritis. Which of the following instructions should the nurse provide to the client about managing the disease? 1."Urinate frequently because the bacteria that cause acute pyelonephritis reach the kidneys by means of an infection that progresses upward from lower in the urinary tract." 2."Taking frequent bubble baths will decrease the likelihood of further episodes of pyelonephritis." 3."You should take antibiotics for the rest of your life to prevent urinary tract infections." 4."By decreasing your fluid intake, you will decrease the need for frequent urination and the irritating effect of urine in your ureter.

1 Pyelonephritis usually begins with colonization and infection of the lower urinary tract via the ascending urethral route, and the client should have an adequate intake of fluids to promote the flushing action of urination. Bubble baths and limiting fluid intake increase the risk of developing a urinary tract infection. Antibiotics should be used on a short-term basis because the risk of antibiotic resistance may lead to breakthrough infections with increasingly virulent pathogens

The client receives heparin while receiving hemodialysis. The nurse explains the rationale supporting anticoagulation by making which of the following statements? 1."Regional anticoagulation is achieved by putting heparin in the dialysis machine and protamine sulfate, which reverses the anticoagulation, in the client." 2."You will receive warfarin sodium (Coumadin) to maintain anticoagulation between treatments." 3."Heparin does not enter the body, so there is no risk of bleeding." 4."Clotting time is seriously prolonged for several hours after each treatment.

1 Regional anticoagulation can be achieved by infusing heparin in the dialyzer and protamine sulfate, its antagonist, in the client. Warfarin sodium (Coumadin) is not used in dialysis treatment. There is some risk of bleeding; however, clotting time is monitored carefully. The client's clotting time will not be seriously affected, although some rebound effect may occur

The client with acute renal failure is recovering and asks the nurse, "Will my kidneys ever function normally again?" The nurse's response is based on knowledge that the client's renal status will most likely: 1.Continue to improve over a period of weeks. 2.Result in the need for permanent hemodialysis. 3.Improve only if the client receives a renal transplant. 4.Result in end-stage renal failure.

1 The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. The client should be taught how to recognize the signs and symptoms of decreasing renal function and to notify the physician if such problems occur. In a client who is recovering from acute renal failure, there is no need for renal transplantation or permanent hemodialysis. Chronic renal failure develops before end-stage renal failure.

The dialysis solution is warmed before use in peritoneal dialysis primarily to: 1.Encourage the removal of serum urea. 2.Force potassium back into the cells. 3.Add extra warmth to the body. 4.Promote abdominal muscle relaxation.

1 The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.

The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which of the following nursing measures is appropriate for the care of this client? 1.Use the unaffected arm for blood pressure measurements. 2.Draw blood from the cannula for routine laboratory work. 3.Percuss the cannula for bruits each shift. 4.Inject heparin into the cannula each shift.

1 The unaffected arm should be used for blood pressure measurement. The external cannula must be handled carefully and protected from damage and disruption. In addition, a tourniquet or clamps should be kept at the bedside because dislodgment of the cannula would cause arterial hemorrhage. The arm with the cannula is not used for blood pressure measurement, IV therapy, or venipuncture. Patency is assessed by auscultating for bruits every shift. Heparin is not injected into the cannula to maintain patency. Because it is part of the general circulation, the cannula cannot be heparinized.

A client developed cardiogenic shock after a severe myocardial infarction and has now developed acute renal failure. The client's family asks the nurse why the client has developed acute renal failure. The nurse should base the response on the knowledge that there was: 1.A decrease in the blood flow through the kidneys. 2.An obstruction of urine flow from the kidneys. 3.A blood clot formed in the kidneys. 4.Structural damage to the kidney resulting in acute tubular necrosis.

1 There are three categories of acute renal failure: prerenal, intrarenal, and postrenal. Causes of prerenal failure occur outside the kidney and include poor perfusion and decreased circulating volume resulting from such factors as trauma, septic shock, impaired cardiac function, and dehydration. In this case of severe myocardial infarction, there was a decrease in perfusion of the kidneys caused by impaired cardiac function. An obstruction within the urinary tract, such as from kidney stones, tumors, or benign prostatic hypertrophy, is called postrenal failure. Structural damage to the kidney resulting from acute tubular necrosis is called intrarenal failure. It is caused by such conditions as hypersensitivity (allergic disorders), renal vessel obstruction, and nephrotoxic agents.

The client performs self peritoneal dialysis. What should the nurse teach the client about preventing peritonitis? Select all that apply. 1.Broad-spectrum antibiotics may be administered to prevent infection. 2.Antibiotics may be added to the dialysate to treat peritonitis. 3.Clean technique is permissible for prevention of peritonitis. 4.Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort. 5.Peritonitis is the most common and serious complication of peritoneal dialysis.

1, 2, 4, 5. Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. If peritonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Peritonitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. 1. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting. 4. Decreased urine-specific gravity. 5. Increased serum creatinine level

1,2,3 1. Renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity. 2. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit indicates the client is in the recovery period. 3. Nausea, vomiting, and diarrhea are common in the client with ARF; therefore, an absence of these indicates the client is in the recovery period. 4. The client in the recovery period has an increased urine-specific gravity. 5. The client in the recovery period has a decreased serum creatinine level. TEST-TAKING HINT: This is an alternate-type question in which the test taker may choose as many correct answers as warranted. The test taker should not immediately assume that the option mentioning urine is the correct answer. The nurse must realize renal failure affects every body system

A client has been admitted with acute renal failure. What should the nurse do? Select all that apply. 1.Elevate the head of the bed 30 to 45 degrees. 2.Take vital signs. 3.Establish an IV access site. 4.Call the admitting physician for prescriptions. 5.Contact the hemodialysis unit

1,2,3,4 Elevation of the head of the bed will 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 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 physician will need to be contacted for further prescriptions; there is no need to contact the hemodialysis unit.

The nurse is discussing kidney transplants with clients at a dialysis center. Which population is less likely to participate in organ donation? 1. Caucasian. 2. African American. 3. Asian. 4. Hispanic

2 1. Caucasians are composed of a multitude of cultures but for the most part organ donation is very likely, although individual preferences vary. 2. Many in the African American culture believe the body must be kept intact after death, and organ donation is rare among African Americans. This is also why a client of African American descent will be on a transplant waiting list longer than people of other races. This is because of tissue-typing compatibility. Remember, this does not apply to all African Americans; every client is an individual. 3. Asians as a culture participate in organ donation. 4. Hispanics as a culture participate in organ donation. TEST-TAKING HINT: The nurse must be aware of cultural differences in health care.

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? 1. Diabetes mellitus. 2. Hypotension. 3. Aminoglycosides. 4. Benign prostatic hypertrophy.

2 1. Diabetes mellitus is a disease that may lead to chronic renal failure. 2. Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal failure (before the kidney). 3. Nephrotoxic medications are a cause of intrarenal failure (directly to kidney). ' 4. Benign prostatic hypertrophy (BPH) is a cause of postrenal failure (after the kidney). TEST-TAKING HINT: The test taker must be cautious of adjectives (words describing something); "prerenal" is the key to selecting the correct answer. The prefix pre- means "before."

The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis? 1. The client has fever, chills, flank pain, and dysuria. 2. The client complains of fatigue, headaches, and increased urination. 3. The client had a group B beta-hemolytic strep infection last week. 4. The client has an acute viral pneumonia infection.

2 1. Fever, chills, flank pain, and dysuria are symptoms of acute pyelonephritis, not chronic pyelonephritis. 2. Fatigue, headache, and polyuria as well as loss of weight, anorexia, and excessive thirst are symptoms of chronic pyelonephritis. 3. Group B beta-hemolytic streptococcus infections cause acute glomerulonephritis. 4. Acute viral pneumonia is a cause of acute glomerlonephritis. TEST-TAKING HINT: The key to this question is the adjective "chronic." The test taker must be aware disease processes may change over time do produce different effects.

The client diagnosed with ARF is placed on bedrest. The client asks the nurse, "Why do I have to stay in bed? I don't feel bad." Which scientific rationale supports the nurse's response? 1. Bedrest helps increase the blood return to the renal circulation. 2. Bedrest reduces the metabolic rate during the acute stage. 3. Bedrest decreases the workload of the left side of the heart. 4. Bedrest aids in reduction of peripheral and sacral edema.

2 1. Kidney function is improved about 40% when recumbent, but this is not the scientific rationale for bedrest in ARF. 2. Bedrest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine). 3. This is a scientific rationale for prescribing bedrest in clients with heart failure. 4. This is not the scientific rationale for prescribing bedrest. The foot of the bed may be elevated to help decrease peripheral edema, and bedrest causes an increase in sacral edema. TEST-TAKING HINT: The test taker should not jump to conclusions and select the only option with "renal" in the sentence. The nurse must know normal anatomy and physiology of the body and be aware keeping someone in bed will not restore kidney function when the kidneys have failed

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1. Have the assistant apply a moisture barrier cream to the skin. 2. Instruct the UAP to bathe the client in cool water. 3. Tell the UAP not to turn the client in this condition. 4. Explain this is normal and do not do anything for the client.

2 1. Moisture barrier cream will keep the crystals on the skin. 2. These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost. 3. The client should be turned every two (2) hours or more frequently to prevent skin breakdown. 4. This may occur with ARF, and it does require a nursing intervention. TEST-TAKING HINT: The nurse must know what is normal for specific disease processes, and something coming out of the skin requires some action even if the test taker is not familiar with the disease process. Option "4" could be eliminated based on this test-taking strategy. The test taker should eliminate option "3" because there are very few instances in which the client is not turned or moved; turning and movement are necessary to prevent the development of pressure ulcers.

The male client diagnosed with CKD secondary to diabetes has been receiving dialysis for 12 years. The client is notified he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis treatments. Which response by the nurse is most therapeutic? 1. "You cannot just quit your dialysis. This is not an option." 2. "You're angry at not being on the list, and you want to quit dialysis?" 3. "I will call your nephrologist right now so you can talk to the HCP." 4. "Make your funeral arrangements because you are going to die."

2 1. The client does have the right to quit dialysis if he or she wants to. 2. Reflecting the client's feelings and restating them are therapeutic responses the nurse should use when addressing the client's issues. 3. This is passing the buck; the nurse should address the client's issues. 4. This may be true, but it is not therapeutic in attempting to get the client to verbalize feelings. TEST-TAKING HINT: When asked to select a therapeutic response, the test taker should select an option with some type of "feeling" in the response, such as "angry" in option "2."

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%. 2. The client who does not have a palpable thrill or auscultated bruit. 3. The client who is complaining of being exhausted and is sleeping. 4. The client who did not take antihypertensive medication this morning.

2 1. These laboratory findings are low but do not require a blood transfusion and often are expected in a client who is anemic secondary to ESRD. 2. This client's dialysis access is compromised and he or she should be assessed first. 3. It is not uncommon for a client undergoing dialysis to be exhausted and sleep through the treatment. 4. Clients are instructed not to take their antihypertensive medications before dialysis to help prevent episodes of hypotension TEST-TAKING HINT: The test taker must determine which client's situation is not normal or expected for the disease process, which in this question is CKD because all clients are in the dialysis unit.

The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which one of the following strategies would be most useful? 1.Help the client to accept that sexual activity will be decreased. 2.Suggest using alternative forms of sexual expression and intimacy. 3.Tell the client to plan rest periods after sexual activity. 4.Suggest that the client avoid sexual activity to prevent embarrassment.

2 Altered sexual functioning commonly occurs in chronic renal failure and can stress marriages and relationships. Altered sexual functioning can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity.

Which of the following nursing interventions should be included in the client's plan of care during dialysis therapy? 1.Limit the client's visitors. 2.Monitor the client's blood pressure. 3.Pad the side rails of the bed. 4.Keep the client on nothing-by-mouth (NPO) status.

2 Because hypotension is a complication associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status

During the client's dialysis, the nurse observes that the solution draining from the abdomen is consistently blood-tinged. The client has a permanent peritoneal catheter in place. The nurse should interpret that the bleeding: 1.Is expected with a permanent peritoneal catheter. 2.Indicates abdominal blood vessel damage. 3.Can indicate kidney damage. 4.Is caused by too-rapid infusion of the dialysate.

2 Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood-tinged drainage.

The client with acute pyelonephritis wants to know the possibility of developing chronic pyelonephritis. The nurse's response is based on knowledge of which of the following disorders most commonly leads to chronic pyelonephritis? 1.Acute pyelonephritis. 2.Recurrent urinary tract infections. 3.Acute renal failure. 4.Glomerulonephritis.

2 Chronic pyelonephritis is most commonly the result of recurrent urinary tract infections. Chronic pyelonephritis can lead to chronic renal failure. Single cases of acute pyelonephritis rarely cause chronic pyelonephritis. Acute renal failure is not a cause of chronic pyelonephritis. Glomerulonephritis is an immunologic disorder, not an infectious disorder

Which of the following symptoms would most likely indicate that the client has pyelonephritis? 1.Ascites. 2.Costovertebral angle (CVA) tenderness. 3.Polyuria. 4.Nausea and vomiting.

2 Common symptoms of pyelonephritis include CVA tenderness, burning on urination, urinary urgency or frequency, chills, fever, and fatigue. Ascites, polyuria, and nausea and vomiting are not indicative of pyelonephritis.

Which of the following assessments would be most appropriate for the nurse to make while the dialysis solution is dwelling within the client's abdomen? 1.Assess for urticaria. 2.Observe respiratory status. 3.Check capillary refill time. 4.Monitor electrolyte status

2 During dwell time, the dialysis solution is allowed to remain in the peritoneal cavity for the time prescribed by the physician (usually 20 to 45 minutes). During this time, the nurse should monitor the client's respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress. The dialysis solution would not cause urticaria or affect circulation to the fingers. The client's laboratory values are obtained before beginning treatment and are monitored every 4 to 8 hours during the treatment, not just during the dwell time

During dialysis, the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should: 1.Have the client sit in a chair. 2.Turn the client from side to side. 3.Reposition the peritoneal catheter. 4.Have the client walk.

2 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. The nurse should not attempt to reposition the catheter.

During dialysis, the client has disequilibrium syndrome. The nurse should first: 1.Administer oxygen per nasal cannula. 2.Slow the rate of dialysis. 3.Reassure the client that the symptoms are normal. 4.Place the client in Trendelenburg's position.

2 If disequilibrium syndrome occurs during dialysis, the most appropriate intervention is to slow the rate of dialysis. The syndrome is believed to result from too-rapid removal of urea and excess electrolytes from the blood; this causes transient cerebral edema, which produces the symptoms. Administration of oxygen and position changes do not affect the symptoms. It would not be appropriate to reassure the client that the symptoms are normal

A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: 1.Is relatively low in cost. 2.Allows the client to be more independent. 3.Is faster and more efficient than standard peritoneal dialysis. 4.Has fewer potential complications than standard peritoneal dialysis.

2 The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, health care personnel, and machines for life-sustaining treatment. This independence is a valuable outcome for some people. CAPD is costly and must be done daily. Adverse effects and complications are similar to those of standard peritoneal dialysis. Peritoneal dialysis usually takes less time but cannot be done at home

The nurse is determining which teaching approaches for the client with chronic renal failure and uremia would be most appropriate. The nurse should: 1.Provide all needed teaching in one extended session. 2.Validate the client's understanding of the material frequently. 3.Conduct a one-on-one session with the client. 4.Use videotapes to reinforce the material as needed.

2 Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes because clients may not be able to maintain alertness during the viewing of the videotape

After completion of peritoneal dialysis, the nurse should assess the client for which of the following? 1.Hematuria. 2.Weight loss. 3.Hypertension. 4.Increased urine output.

2 Weight loss is expected because of the removal of fluid. The client's weight before and after dialysis is one measure of the effectiveness of treatment. Blood pressure usually decreases because of the removal of fluid. Hematuria would not occur after completion of peritoneal dialysis. Dialysis only minimally affects the damaged kidneys' ability to manufacture urine.

A client with chronic renal failure who receives hemodialysis three times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply. 1.Drink fluids before eating solid foods. 2.Have limited amounts of fluids only when thirsty. 3.Limit activity. 4.Keep all dialysis appointments. 5.Eat smaller, more frequent meals.

2,4,5 To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty, eat food before drinking fluids to alleviate dry mouth, encourage strict follow-up for blood work, dialysis, and health care provider visits. Smaller, more frequent meals may help to 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 preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal? 1. The client will have a blood pressure within normal limits. 2. The client will show no protein in the urine. 3. The client will maintain normal renal function. 4. The client will have clear lung sounds.

3 1. Blood pressure within normal limits is a short-term goal. 2. Lack of protein in the urine is a short-term goal. 3. A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment, and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal. 4. Clear lung sounds indicate the client has been able to process fluids and excrete them from the body. Preventing pulmonary edema is a short-term goal. TEST-TAKING HINT: Answer options "1," "2," and "4" all refer to body processes controlled or treated immediately after assessment of the problem. The stem is requesting a longterm goal.

The male client diagnosed with CKD has received the initial dose of erythropoietin, a biologic response modifier, one (1) week ago. Which complaint by the client indicates the need to notify the health-care provider? 1. The client complains of flu-like symptoms. 2. The client complains of being tired all the time. 3. The client reports an elevation in his blood pressure. 4. The client reports discomfort in his legs and back.

3 1. Flu-like symptoms are expected and tend to subside with repeated doses; the nurse should suggest Tylenol prior to the injections. 2. This medication takes up to two (2) to six (6) weeks to become effective in improving anemia and thereby reducing fatigue. 3. After the initial administration of erythropoietin, a client's antihypertensive medications may need to be adjusted. Therefore, this complaint requires notification of the HCP. Erythropoietin therapy is contraindicated in clients with uncontrolled hypertension. 4. Long bone and vertebral pain is an expected occurrence because the bone marrow is being stimulated to increase production of red blood cells. TEST-TAKING HINT: The test taker should select the potentially life-threatening option or a complaint requiring the medication to be adjusted or discontinued. The nurse should notify the HCP if the medication is causing an adverse effect, not an expected side effect.

The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? 1. The blood urea nitrogen is 15 mg/dL. 2. The creatinine level is 1.2 mg/dL. 3. The glomerular filtration rate is 40 mL/min. 4. The 24-hour creatinine clearance is 100 mL/min.

3 1. Normal blood urea nitrogen levels are 7 to 18 mg/dL or 8 to 20 mg/dL for clients older than age 60 years. 2. Normal creatinine levels are 0.6 to 1.2 mg/dL. 3. Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity. 4. Normal creatinine clearance is 85 to 125 mL/min for males and 75 to 115 mL/min for females. TEST-TAKING HINT: The nurse must memorize common laboratory values. BUN and creatinine levels are common laboratory values used to determine status in a number of diseases. Options "1" and "2" are normal values and could be eliminated. Then, the test taker could choose from only two (2) options.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task is most appropriate for the nurse to delegate? 1. Collect a clean voided midstream urine specimen. 2. Evaluate the client's eight (8)-hour intake and output. 3. Assist in checking a unit of blood prior to hanging. 4. Administer a cation-exchange resin enema.

3 1. The UAP can collect specimens. Collecting a midstream urine specimen requires the client to clean the perineal area, to urinate a little, and then collect the rest of the urine output in a sterile container. 2. The UAP can obtain the client's intake and output, but the nurse must evaluate the data to determine if interventions are needed or if interventions are effective. 3. Two registered nurses must check the unit of blood at the bedside prior to administering it. 4. This is a medication enema and UAPs cannot administer medications. Also, for this to be ordered, the client must be unstable with an excessively high serum potassium level. TEST-TAKING HINT: Nursing tasks not delegated to a UAP include any task requiring nursing judgment, medication administration, teaching, evaluating, or assessing

The client receiving hemodialysis is being discharged home from the dialysis center. Which instruction should the nurse teach the client? 1. Notify the HCP if oral temperature is 102°F or greater. 2. Apply ice to the access site if it starts bleeding at home. 3. Keep fingernails short and try not to scratch the skin. 4. Encourage the significant other to make decisions for the client.

3 1. The client should not wait until the temperature is 102°F to call the HCP; the client should call when the temperature is 100°F or greater. 2. The client should apply direct pressure and notify the HCP if the access site starts to bleed, not apply ice to the site. 3. Uremic frost, which results when the skin attempts to take over the function of the kidneys, causes itching, which can lead to scratching, possibly resulting in a break in the skin. 4. The nurse should encourage the client's independence, not foster dependence by encouraging the significant other to make the client's decision. TEST-TAKING HINT: The test taker must read the question carefully. A temperature of 102°F is usually not acceptable in any client. Fostering dependence in any chronic illness is not encouraged by the nurse and so the test taker could eliminate option "4."

The client diagnosed with ARF is admitted to the intensive care department and placed on a therapeutic diet. Which diet is most appropriate for the client? 1. A high-potassium and low-calcium diet. 2. A low-fat and low-cholesterol diet. 3. A high-carbohydrate and restricted-protein diet. 4. A regular diet with six (6) small feedings a day.

3 1. The diet is low potassium, and calcium is not restricted in ARF. 2. This is a diet recommended for clients with cardiac disease and atherosclerosis. 3. Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products. 4. The client must be on a therapeutic diet, and small feedings are not required TEST-TAKING HINT: The test taker must notice adjectives. A "therapeutic" diet should cause the test taker to eliminate option "4" because it is a regular diet

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client? 1. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH. 2. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis. 3. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate. 4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

3 1. There is a decrease in the excretion of phosphates and organic acids, not an increase. 2. The red blood cell destruction does not affect the arterial blood pH. 3. This is the correct scientific rationale for metabolic acidosis occurring in the client with CKD. 4. This compensatory mechanism occurs to maintain an arterial blood pH between 7.35 and 7.45, but it does not occur as a result of CKD. TEST-TAKING HINT: In option "1," the test taker should note "increased excretion"; CKD does not have any type of increase in excretion, so the test taker could eliminate option "1." Option "4" does not even mention the renal system and a loss of hydrochloric acid results in a metabolic alkalosis, not acidosis, so the test taker can eliminate this option

The client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are effectively treating my infection?" The nurse's most appropriate response would be which of the following? 1."After you take the antibiotics for 2 weeks, you'll not have any infection." 2."Your health care provider can tell by the color and odor of your urine." 3."Your health care provider will take a urine culture." 4."When your symptoms disappear, you'll know that your infection is gone.

3 Antibiotics are usually prescribed for a 2- to 4-week period. A urine culture is needed to evaluate the effectiveness of antibiotic therapy. Urine must be examined microscopically to adequately determine the presence of bacteria; looking at the color of the urine or checking the odor is not sufficient. Symptoms usually disappear 48 to 72 hours after antibiotic therapy is started, but antibiotics may need to continue for up to 4 weeks.

Which of the following abnormal blood values would not be improved by dialysis treatment? 1.Elevated serum creatinine level. 2.Hyperkalemia. 3.Decreased hemoglobin concentration. 4.Hypernatremia.

3 Dialysis has no effect on anemia. Because some red blood cells are injured during the procedure, dialysis aggravates a low hemoglobin concentration. Dialysis will clear metabolic waste products from the body and correct electrolyte imbalances.

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which of the following diets would be most appropriate? 1.High-carbohydrate, high-protein. 2.High-calcium, high-potassium, high-protein. 3.Low-protein, low-sodium, low-potassium. 4.Low-protein, high-potassium.

3 Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.

The client asks about diet changes when using continuous ambulatory peritoneal dialysis (CAPD). Which of the following would be the nurse's best response? 1."Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique." 2."Diet restrictions are the same for both CAPD and standard peritoneal dialysis." 3."Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant." 4."Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly.

3 Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective

A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula the nurse should: 1.Take the blood pressure in the arm with the fistula. 2.Report the loss of a thrill or bruit on the arm with the fistula. 3.Auscultate for a thrill and palpate for a bruit on the arm with the fistula. 4.Start a second IV in the arm with the fistula.

3 The nurse must always palpate for a thrill and auscultate for a bruit in the arm with the fistula and promptly report the absence of either/or a thrill or bruit to the health care provider as it indicates an occlusion. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1. Administer a phosphate binder. 2. Type and crossmatch for whole blood. 3. Assess the client for leg cramps. 4. Prepare the client for dialysis

4 1. Phosphate binders are used to treat elevated phosphorus levels, not elevated potassium levels. 2. Anemia is not the result of an elevated potassium level. 3. Assessment is an independent nursing action, which is appropriate for the elevated potassium level, but the question asks for a collaborative treatment. 4. Normal potassium level is 3.5 to 5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-care provider order, so it is a collaborative intervention. TEST-TAKING HINT: Adjectives must be noted when reading the stem of the question and the answer options

The nurse caring for a client diagnosed with CKD writes a client problem of "noncompliance with dietary restrictions." Which intervention should be included in the plan of care? 1. Teach the client the proper diet to eat while undergoing dialysis. 2. Refer the client and significant other to the dietitian. 3. Explain the importance of eating the proper foods. 4. Determine the reason for the client not adhering to the diet.

4 1. Teaching is an intervention for knowledge deficit, not noncompliance. 2. Referring the client does not address the issue of noncompliance. 3. Noncompliance is a client's choice, and explaining interventions will not necessarily make the client choose differently. 4. Noncompliance is a choice the client has a right to make, but the nurse should determine the reason for the noncompliance and then take appropriate actions based on the client's rationale. For example, if the client has financial difficulties, the nurse may suggest how the client can afford the proper foods along with medications, or the nurse may be able to refer the client to a social worker. TEST-TAKING HINT: The test taker must always clarify and understand exactly what the question is asking the nurse to do. Answer options "1," "2," and "3" have the nurse doing the talking; only option "4" is allowing the client to explain the lack of compliance.

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview? 1. "Have you recently traveled outside the United States?" 2. "Did you recently begin a vigorous exercise program?" 3. "Is there a chance you have been exposed to a virus?" 4. "What over-the-counter medications do you take regularly?"

4 1. Usually there are no diseases or conditions warranting this question when discussing ARF. 2. Vigorous exercise will not impede blood flow to the kidneys, leading to ARF. 3. Usually viruses do not cause ARF. 4. Medications such as nonsteroidal antiinflammatory drugs (NSAIDs) and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate. TEST-TAKING HINT: Asking about medications, especially over-the-counter and herbal remedies, during the admission interview is an important intervention because many medications are nephrotoxic and hepatotoxic.

The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel (Amphojel). Which of the following statements would indicate that the client understands the teaching? 1."I'll take it every 4 hours around the clock." 2."I'll take it between meals and at bedtime." 3."I'll take it when I have an upset stomach." 4."I'll take it with meals and bedtime snacks.

4 Aluminum hydroxide gel (Amphojel) is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat an upset stomach caused by hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.

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, the nurse should inquire whether the client has: 1.Diarrhea. 2.Vomiting. 3.Flatulence. 4.Constipation.

4 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.

A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The intended outcome of this diet is to: 1.Act as a diuretic. 2.Reduce demands on the liver. 3.Help maintain urine acidity. 4.Prevent the development of ketosis.

4 High-carbohydrate foods meet the body's caloric needs during acute renal failure. Protein is limited because its breakdown may result in 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

The client's serum potassium level is elevated in acute renal failure, and the nurse administers sodium polystyrene sulfonate (Kayexalate). This drug acts to: 1.Increase potassium excretion from the colon. 2.Release hydrogen ions for sodium ions. 3.Increase calcium absorption in the colon. 4.Exchange potassium for sodium ions in the colon.

4 Polystyrene sulfonate, a cation-exchange resin, causes the body to excrete potassium through the gastrointestinal tract. In the intestines, particularly the colon, the sodium of the resin is partially replaced by potassium. The potassium is then eliminated when the resin is eliminated with feces. Although the result is to increase potassium excretion, the specific method of action is the exchange of sodium ions for potassium ions. Polystyrene sulfonate does not release hydrogen ions or increase calcium absorption.

A client is to receive peritoneal dialysis. To prepare for the procedure, the nurse should: 1.Assess the dialysis access for a bruit and thrill. 2.Insert an indwelling urinary catheter and drain all urine from the bladder. 3.Ask the client to turn toward the left side. 4.Warm the solution in the warmer.

4 Solution for peritoneal dialysis 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's position.

A client is diagnosed with pyelonephritis. Which of the following is a priority for care now? 1.Monitor hemoglobin levels. 2.Insert a urinary catheter. 3.Stress importance of use of long-term antibiotics. 4.Ensure sufficient hydration.

4 The nurse should ensure the client has adequate hydration. A urinary catheter is discouraged because of the risk of urinary tract infection. Monitoring of the hemoglobin level is not necessary for clients with pyelonephritis. Although antibiotics may be prescribed for long-term management and for chronic pyelonephritis, at this time the nurse should focus on helping the client maintain hydration

The client who is in acute renal failure has an elevated blood urea nitrogen (BUN). What is the likely cause of this finding? 1.Fluid retention. 2.Hemolysis of red blood cells. 3.Below-normal metabolic rate. 4.Reduced renal blood flow

4. Urea, an end product of protein metabolism, is excreted by the kidneys. Impairment in renal function caused by reduced renal blood flow results in an increase in the plasma urea level. Fluid retention, hemolysis of red blood cells, and lowered metabolic rate do not cause an elevated BUN value.

Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the a. bowel sounds. b. blood glucose. c. blood urea nitrogen (BUN). d. level of consciousness (LOC).

ANS: A Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication.

A 72-year-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? a. Insert urethral catheter b. Obtain renal ultrasound c. Draw a complete blood count. d. Infuse normal saline at 50 mL/hour.

ANS: A The patient's elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate, but should be implemented after the retention catheter.

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)? a. Avoid commercial salt substitutes. b. Drink 1500 to 2000 mL of fluids daily. c. Take phosphate-binders with each meal. d. Choose high-protein foods for most meals. e. Have several servings of dairy products daily.

ANS: A, C, D Patients who are receiving peritoneal dialysis should have a high-protein diet. Phosphate binders are taken with meals to help control serum phosphate and calcium levels. Commercial salt substitutes are high in potassium and should be avoided. Fluid intake is limited in patients requiring dialysis. Dairy products are high in phosphate and usually are limited.

Before administration of captopril (Capoten) to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's a. glucose. b. potassium. c. creatinine. d. phosphate.

ANS: B Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the captopril was given or not.

A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).

ANS: B Because hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure

Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance

ANS: B Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2 L inflows. Which information should the nurse report immediately to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient's abdomen appears bloated after the inflow.

ANS: B Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician? a. Teach the patient about fluid restrictions. b. Check blood pressure before starting dialysis. c. Assess for causes of an increase in predialysis weight. d. Determine the ultrafiltration rate for the hemodialysis.

ANS: B Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.

The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? a. Multivitamin with iron b. Magnesium hydroxide c. Acetaminophen (Tylenol) d. Calcium phosphate (PhosLo)

ANS: B Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.

When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of a. persistent skin tenting b. rapid, deep respirations. c. bounding peripheral pulses. d. hot, flushed face and neck.

ANS: B Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.

A 62-year-old female patient has been hospitalized for 8 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider? a. The creatinine level is 3.0 mg/dL. b. Urine output over an 8-hour period is 2500 mL. c. The blood urea nitrogen (BUN) level is 67 mg/dL. d. The glomerular filtration rate is <30 mL/min/1.73m2.

ANS: B The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.

Which intervention will be included in the plan of care for a male patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? a. Start continuous pulse oximetry. b. Restrict physical activity to bed rest. c. Restrict the patient's oral protein intake. d. Discontinue the urethral retention catheter.

ANS: B The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.

During routine hemodialysis, the 68-year-old patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Check patient's blood pressure (BP). c. Review the hematocrit (Hct) level. d. Give prescribed PRN antiemetic drugs.

ANS: B The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions may also be appropriate based on the blood pressure obtained.

The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary collaborative treatment goal in the plan will be a. augmenting fluid volume. b. maintaining cardiac output. c. diluting nephrotoxic substances. d. preventing systemic hypertension.

ANS: B The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.

A 37-year-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function? a. Urine volume b. Creatinine level c. Glomerular filtration rate (GFR) d. Blood urea nitrogen (BUN) level

ANS: C GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status and protein intake. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.

A 55-year-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? a. Creatinine 1.6 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg

ANS: C High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when erythropoietin (EPO) is administered to a target hemoglobin of >12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider but will not affect whether the medication is administered.

Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for a. potassium level. b. total cholesterol. c. serum phosphate. d. serum creatinine.

ANS: C If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.

A 64-year-old male patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular 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 because retained fluid is removed during dialysis. c. More protein is allowed because urea and creatinine are removed by dialysis. d. Dietary potassium is not restricted because the level is normalized by dialysis.

ANS: C Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine volume b. Calcium level c. Cardiac rhythm d. Neurologic status

ANS: C The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.

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.

ANS: D Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? A. Check for kinks in the outflow tubing B. Raise the drainage bag above the level of the abdomen C. Place the patient in a reverse Trendelenburg position D. Ask the patient to cough

A Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement.

A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can accommodate larger needles. d. A fistula can be used sooner after surgery.

ANS: A Arteriovenous (AV) fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? a. Notify the patient's health care provider. b. Document the QRS interval measurement. c. Check the medical record for most recent potassium level. d. Check the chart for the patient's current creatinine level.

ANS: C The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening dysrhythmias.

Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? A. Rub the skin vigorously with a towel B. Take frequent baths C. Apply alcohol-based emollients to the skin D. Keep fingernails short and clean

D Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the risk of infection.

The nurse is caring for a pregnant client diagnosed with acute pyelonephritis. Which scientific rationale supports the client being hospitalized for this condition? 1. The client must be treated aggressively to prevent maternal/fetal complications. 2. The nurse can force the client to drink fluids and avoid nausea and vomiting. 3. The client will be dehydrated and there won't be sufficient blood flow to the baby. 4. Pregnant clients historically are afraid to take the antibiotics as ordered.

1 1. A pregnant client diagnosed with a UTI will be admitted for aggressive IV antibiotic therapy. After symptoms subside, the client will be sent home to complete the course of treatment with oral medications. 2. The nurse cannot "force" a client to drink, and forcing fluids could result in nausea and vomiting, not prevent it. 3. The client may or may not be dehydrated. 4. Pregnant clients have a right to be concerned about taking medications, but most are comfortable taking medications prescribed by the obstetrician. TEST-TAKING HINT: In option "2" the nurse is "forcing" a client to do something, which should be eliminated as a possible correct answer. Option "4" is a broad generalization about "all" pregnant clients and should be discarded as a possible correct answer.

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1. Erythropoietin. 2. Calcium gluconate. 3. Regular insulin. 4. Osmotic diuretic.

3 1. Erythropoietin is a chemical catalyst produced by the kidneys to stimulate red blood cell production; it does not affect potassium level. 2. Calcium gluconate helps protect the heart from the effects of high potassium levels. 3. Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily. 4. A loop diuretic, not an osmotic diuretic, may be ordered to help decrease the potassium level. TEST-TAKING HINT: The test taker must be familiar with medical terms such as "hyperkalemia" and know the rationale for administering medications

Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of giving this drug? 1.Relieving the pain of gastric hyperacidity. 2.Preventing Curling's stress ulcers. 3.Binding phosphate in the intestine. 4.Reversing metabolic acidosis.

3 A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.

The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is priority for the client? 1. Low self-esteem. 2. Knowledge deficit. 3. Activity intolerance. 4. Excess fluid volume.

4 1. Low self-esteem, related to dependency, role changes, and changes in body image, is a pertinent client problem, but psychosocial problems are not priority over physiological problems. 2. Teaching is always an important part of the care plan, but it is not priority over a physiological problem. 3. Activity intolerance related to fatigue, anemia, and retention of waste products is a physiological problem, but it is not a life-threatening problem. 4. Excess fluid volume is priority because of the stress placed on the heart and vessels, which could lead to heart failure, pulmonary edema, and death. TEST-TAKING HINT: The test taker must read the stem of the question and understand what the question is asking. This is a priority question. This means all the options are pertinent problems for CKD, but only one is priority. Applying Maslow's hierarchy of needs is one way to determine priorities: physiological problems are priority over psychosocial problems, and life-threatening conditions take first priority.

The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate intervention by the nurse? 1. Inability to auscultate a bruit over the fistula. 2. The client's abdomen is soft, is nontender, and has bowel sounds. 3. The dialysate being removed from the client's abdomen is clear. 4. The dialysate instilled was 1,500 mL and removed was 1,500 mL.

4 1. Peritoneal dialysis is administered through a catheter inserted into the peritoneal cavity; a fistula is used for hemodialysis. 2. Peritonitis, inflammation of the peritoneum, is a serious complication resulting in a hard, rigid abdomen. Therefore, a soft abdomen does not warrant immediate intervention. 3. The dialysate return is normally colorless or straw-colored, but it should never be cloudy, which indicates an infection. 4. Because the client is in ESRD, fluid must be removed from the body, so the output should be more than the amount instilled. These assessment data require intervention by the nurse. TEST-TAKING HINT: The words "warrant immediate intervention" should clue the test taker into selecting an option with abnormal or unexpected data for the client.

Which of the following factors would put the client at increased risk for pyelonephritis? 1.History of hypertension. 2.Intake of large quantities of cranberry juice. 3.Fluid intake of 2,000 mL/day. 4.History of diabetes mellitus

4 A client with a history of diabetes mellitus, urinary tract infections, or renal calculi is at increased risk for pyelonephritis. Others at high risk include pregnant women and people with structural alterations of the urinary tract. A history of hypertension may put the client at risk for kidney damage, but not kidney infection. Intake of large quantities of cranberry juice and a fluid intake of 2,000 mL/day are not risk factors for pyelonephritis

To assess the client's rental status, the nurse should monitor which of the following laboratory tests? Select all that apply. 1.Serum sodium 2.Potassium levels. 3.Arterial blood gases. 4.Hemoglobin. 5.Serum blood urea nitrogen (BUN) 6.Creatinine levels. 7.Urinalysis.

5, 6. Serum BUN and creatinine are the tests most commonly used to assess renal function, with creatinine being the most reliable indicator. Nonrenal factors may affect BUN levels as well as serum sodium and potassium levels. Arterial blood gases and hemoglobin are not used to assess renal status. Urinalysis is a general screening test.

After receiving change-of-shift report, which patient should the nurse assess first? a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L d. Patient who has just returned from having hemodialysis and has a heart rate of 124/min

ANS: D The patient who is tachycardic after hemodialysis may be bleeding or excessively hypovolemic and should be assessed immediately for these complications. The other patients also need assessments or interventions but are not at risk for life-threatening complications.

Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium). A. If the urine turns orange-red, call the doctor. B. Take phenazopyridine just before urination to relieve pain. C. Once painful urination is relieved, discontinue prescribed antibiotics. D. After painful urination is relieved, stop taking phenazopyridine

D Pyridium is taken to relieve dysuria because is provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. The urine may temporarily turn red or orange due to the dye in the drug. The drug isn't taken before voiding, and is usually taken 3 times a day for 2 days.

A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for: 1.Cardiac arrest. 2.Pulmonary edema. 3.Circulatory collapse. 4.Hemorrhage.

1 Hyperkalemia places the client at risk for serious cardiac arrhythmias and cardiac arrest. Therefore, the nurse should carefully monitor the client for cardiac arrhythmias and be prepared to treat cardiac arrest when caring for a client with hyperkalemia. Increased potassium levels do not result in pulmonary edema, circulatory collapse, or hemorrhage.

The client with chronic renal failure takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because: 1.Milk of magnesia can cause magnesium intoxication. 2.Milk of magnesia is too harsh on the bowel. 3.Metamucil is more palatable. 4.Milk of magnesia is high in sodium

1 Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. Milk of magnesia is harsher than Metamucil, but magnesium toxicity is a more serious problem. A client may find both milk of magnesia and Metamucil unpalatable. Milk of magnesia is not high in sodium

Which of the following is the most common initial manifestation of acute renal failure? 1.Dysuria. 2.Anuria. 3.Hematuria. 4.Oliguria

4 Oliguria is the most common initial symptom of acute renal failure. Anuria is rarely the initial symptom. Dysuria and hematuria are not associated with acute renal failure.

You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: A. 200ml B. 400ml C. 800ml D. 1000ml

B Oliguria is defined as urine output of less than 400ml/24hours.

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client? 1. Monitor intake and output every shift. 2. Decrease of pain by three (3) levels on a 1-to-10 scale. 3. Electrolytes are within normal limits. 4. Administer enemas to decrease hyperkalemia

3 1. This is a nursing intervention, not a client outcome. 2. This is a measurable client outcome, but acute renal failure does not cause pain. 3. Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits. 4. A Kayexalate resin enema may be administered to help decrease the potassium level, but this is an intervention, not a client outcome. TEST-TAKING HINT: The nurse must be knowledgeable of the nursing process. Client outcomes are used to evaluate the planning part of the nursing process. The outcomes must be measurable, client focused, and realistic

The nurse teaches the client how to recognize infection in the shunt by telling the client to assess the shunt each day for: 1.Absence of a bruit. 2.Sluggish capillary refill time. 3.Coolness of the involved extremity. 4.Swelling at the shunt site.

4 Signs and symptoms of an external access shunt infection include redness, tenderness, swelling, and drainage from around the shunt site. The absence of a bruit indicates closing of the shunt. Sluggish capillary refill time and coolness of the extremity indicate decreased blood flow to the extremity.

Which action by a 70-year-old patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while taking a bath each day. d. The patient slows the inflow rate when experiencing abdominal pain.

ANS: C Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.

Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? A. Increase the rate of dialysis B. Infuse normal saline solution C. Administer a 5% dextrose solution D. Encourage active ROM exercises

B Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.