Ch44 Pts w Renal Disorders
4. The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what? A) Wash hands carefully and frequently. B) Ensure immediate function of the donated kidney. C) Instruct the patient to wear a face mask. D) Restrict visitors.
Ans: A Chapter: 44 Page and Header: 1354, Kidney Transplantation Feedback: The nurse ensures that the patient is protected from exposure to infection by hospital staff, visitors, and other patients with active infections. Careful hand washing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the patient is receiving high doses of immunosuppressants. The nurse would not ensure immediate functioning of the donated kidney, instruct the patient to wear a face mask, or restrict visitors.
8. A patient admitted with nephrotic syndrome is being cared for on your unit. When writing this patient's care plan, based upon the major clinical manifestation of nephrotic syndrome, what nursing diagnosis would you include? A) Constipation related to immobility B) Risk for injury related to altered thought processes C) Hyperthermia related to the inflammatory process D) Excess fluid volume related to generalized edema
Ans: D Page and Header: 1317, Primary Glomerular Diseases Feedback: The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is "Excess fluid volume related to generalized edema." Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen. Options A, B, and C are incorrect nursing diagnoses for this patient.
36. A patient, status post resection of renal tumor, is being discharged home. You are planning discharge for this patient. What would you include in a teaching plan for this patient? A) Emotional support B) Need for dialysis C) Recurrence of cancer D) Continuing care
Ans: D Page and Header: 1320, Renal Cancer Feedback: Education and emotional support are provided related to the diagnosis, treatment, and continuing care because many patients are concerned about the loss of the other kidney, the possible need for dialysis, or the recurrence of cancer. You would not include in a teaching plan information about the need for dialysis or the recurrence of cancer. You would give emotional support, not teach about it.
3. The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with ESRD. The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. What is an important instruction that the nurse should give the patient about how to take the prescribed phosphorus-binding medication? A) Only when needed B) Daily at bedtime C) One hour prior to meals D) With each meal
Ans: D Page and Header: 1326, Chronic Renal Failure (End-Stage Renal Disease) Feedback: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be administered with food to be effective. Therefore options A, B, and C are incorrect.
38. The nurse is caring for a postoperative kidney surgery patient. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated the result can be hypovolemia and hemorrhagic shock in the patient. What assessment parameters are necessary to assess for bleeding in this postoperative patient? A) Skin condition B) Pain C) Level of consciousness D) Oral intake E) Urinary drainage system
Ans: C Page and Header: 1354, Kidney Transplantation Feedback: Bleeding is a major complication of kidney surgery. If undetected and untreated, this can result in hypovolemia and hemorrhagic shock. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Frequent monitoring of vital signs (initially monitored at least at hourly intervals) and urinary output is necessary for early detection of these complications. When assessing this patient for postoperative bleeding, you would not include assessing pain or oral intake.
27. What disease of the kidney is genetic in nature and leads to kidney failure? A) Nephritic syndrome B) Acute glomerulonephritis C) Nephrotic syndrome D) Polycystic kidney disease
Ans: D Page and Header: 1313, Chronic Kidney Disease Feedback: Polycystic kidney disease (PKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys. When cysts form in the kidneys, they are filled with fluid, destroying the nephrons. PKD cysts can profoundly enlarge the kidneys while replacing much of the normal structure, resulting in reduced kidney function and leading to kidney failure. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.
28. A patient is brought to the renal unit from the PACU status post resection of a renal tumor. What would be a priority nursing action in the care of this patient? A) Increase oral intake B) Management of postoperative pain C) Decrease urine output D) Increase mobility
Ans: B Page and Header: 1320, Renal Cancer Feedback: The patient requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increaseing oral intake, decreasing urine output, and increasing mobility are not priority nursing actions in the care of this patient.
1. A nursing instructor is talking with her clinical group about patients with acute glomerulonephritis. The instructor tells the students that the patient may exhibit which of the following clinical manifestations? A) Hematuria B) Decrease in serum creatinine levels C) Hypotension D) Glucosuria
Ans: A Page and Header: 1315, Primary Glomerular Diseases Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. The patient may be anemic primarily from fluid retention. Some degree of edema and hypertension is noted in 75% of patients
19. The nurse caring for a patient with acute glomerulonephritis would expect the patient's urine to what? A) Have a cola-color B) Have fibrinous threads C) Contain renal calculi D) Be copious in amount
Ans: A Page and Header: 1315, Primary Glomerular Diseases Feedback: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia, and proteinuria. The hematuria may be microscopic, macroscopic, or gross. The urine may appear cola-colored because of red blood cells and protein plugs or casts. Fibinous threads are commonly seen in peritoneal dialysis fluid drainage. Renal calculi are found in the urine after the patient passes the calculi. Copious amounts of urine are not noted with acute glomerulonephritis, as the patient retains fluid, develops edema, and may experience oliguria.
12. Renal failure can have prerenal, renal, or postrenal causes. A patient presents with acute renal failure and is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it? A) Heart failure B) Glomerulonephritis C) Ureterolithiasis D) Aminoglycoside toxicity
Ans: A Page and Header: 1321, Acute Renal Failure Feedback: By causing inadequate renal perfusion, heart failure can lead to prerenal failure. Glomerulonephritis (option B) and aminoglycoside toxicity (option D) are renal causes, and ureterolithiasis (option C) is a postrenal cause.
13. A 45-year-old man with diabetic nephropathy has end-stage renal failure and is starting dialysis. He asks for information about hemodialysis. What would the nurse include in the teaching for this patient? A) Hemodialysis is a treatment option that is required three times a week. B) Hemodialysis is a treatment option that is required daily. C) You will have surgery and a catheter will need to be inserted into the abdomen. D) Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again.
Ans: A Page and Header: 1333, Dialysis Feedback: Hemodialysis is the most commonly used method of dialysis. Patients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.
15. The nurse is planning patient teaching for a patient with end-stage renal disease who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula? A) A vein and an artery in your arm will be attached surgically. B) The arm should be immobilized for 4 to 6 weeks. C) One needle will be inserted into the fistula for each dialysis treatment. D) The fistula can be used immediately after the surgery for dialysis treatment.
Ans: A Page and Header: 1334, Dialysis Feedback: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need time, usually to 2 to 3 months, to "mature" before it can be used. The patient is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.
14. A patient is receiving patient education prior to beginning continuous ambulatory peritoneal dialysis. What would the nurse teach the patient that the most common complication associated with this procedure is? A) Peritonitis B) Blood loss C) Constipation D) Dehydration
Ans: A Page and Header: 1341, Dialysis Feedback: Peritonitis is the most common complication associated with peritoneal dialysis. Blood loss is a complication that may occur with hemodialysis. Constipation should be avoided by increasing fiber intake for a patient receiving peritoneal dialysis, but is not a complication of the procedure. Dehydration may occur in a patient receiving peritoneal dialysis if high concentration solutions are used and excess fluid is removed from the patient.
10. A patient waiting for a kidney transplant asks the nurse what signs and symptoms most likely indicate rejection. What would be the nurse's best response? A) "Oliguria is a sign of rejection." B) "Shortness of breath is a sign of rejection." C) "Decreasing blood pressure is a sign of rejection" D) "Weight loss is a sign of rejection."
Ans: A Page and Header: 1353, Kidney Transplantation Feedback: After kidney transplantation, the nurse assesses the patient for signs and symptoms of transplant rejection: oliguria, edema, fever, increasing blood pressure, weight gain, and swelling or tenderness over the transplanted kidney or graft. Patients receiving cyclosporine may not exhibit the usual signs and symptoms of acute rejection. In these patients, the only sign may be an asymptomatic rise in the serum creatinine level (more than a 20% rise is considered acute rejection). Therefore options B, C, and D are incorrect.
7. A college football player is brought to the emergency room by paramedics after a blunt trauma injury received during a game. There is a high suspicion that the patient has sustained an injury to his kidneys from being tackled from behind. The emergency room nurse caring for the patient reviews the initial orders written by the physician and notes that an order has been written to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important because: A) Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. B) Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this patient. C) A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. D) There is great concern about electrolyte imbalances and the laboratory will monitor the urine for sodium concentrations.
Ans: A Page and Header: 1355, Renal Trauma Feedback: Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium concentrations.
37. You are caring for a patient who has just returned to his room following renal surgery. The patient has tubes that were inserted during surgery for drainage. What would your assessment parameters be for urine output and drainage from the tubes inserted during surgery? (Mark all that apply.) A) Amount B) Color C) Type D) Odor E) Casts
Ans: A, B, C Page and Header: 1350, Management of Patients Undergoing Kidney Surgery Feedback: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. You would not assess the odor or the inclusion of casts in the urine and/or drainage.
30. The nurse is caring for a patient status post MVA. The patient has developed ARF. What is the nurse's role in caring for this patient? (Mark all that apply.) A) Provides emotional support for the family B) Monitors for complications C) Participates in emergency treatment of fluid and electrolyte imbalances D) Provides nursing care for primary disorder E) Directs nutritional status
Ans: A, B, C, D Page and Header: 1324, Acute Renal Failure Feedback: The nurse has an important role in caring for the patient with ARF. The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances, assesses the patient's progress and response to treatment, and provides physical and emotional support. Additionally, the nurse keeps family members informed about the patient's condition, helps them understand the treatments, and provides psychological support. Although the development of ARF may be the most serious problem, the nurse continues to provide nursing care indicated for the primary disorder (eg, burns, shock, trauma, obstruction of the urinary tract). The nurse does not direct the patient's nutritional status; the dietician and the physician collaborate with the nurse on directing the patient's nutritional status.
39. A nurse on the renal unit is caring for a patient who gets peritoneal dialysis. The family of the patient asks the nurse to explain about the peritoneal dialysis catheter that has been placed in the patient's peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? (Mark all that apply.) A) The cuffs are made of Dacron polyester. B) The cuffs stabilize the catheter. C) The cuffs prevent the dialysate from leaking. D) The cuffs provide a barrier against microorganisms. E) The cuffs keep the catheter from being accidentally pulled out.
Ans: A, B, C, D Page and Header: 1340, Dialysis Feedback: Most of these catheters have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms.
33. The patient you are caring for has just returned to the unit after having kidney surgery. How would you assess this patient's circulatory status? (Mark all that apply.) A) Monitor arterial or central venous pressure B) Increase extent of support system C) Monitor drainage from incision and drainage tubes D) Assess skin color and urine output E) Decrease perception of pain and discomfort
Ans: A, C, D Page and Header: 1347, Management of Patients Undergoing Kidney Surgery Feedback: The patient's vital signs and arterial or central venous pressure are monitored. Skin color and temperature and urine output provide information about circulatory status. The surgical incision and drainage tubes are observed frequently to help detect unexpected blood loss and hemorrhage. You would not increase the extent of the patient's support system. Immediately postoperative you would not decrease the patient's perception of pain and discomfort.
40. A critical care nurse is caring for a trauma patient who has gone into acute renal failure. The critical care nurse knows that he can set up, initiate, maintain, and terminate what system of dialysis for this patient? A) Continuous ambulatory peritoneal dialysis B) Continuous venovenous hemofiltration C) Continuous venovenous hemodialysis D) Peritoneal dialysis (PD)
Ans: B Page and Header: 1339, Dialysis Feedback: Continuous venovenous hemofiltration (CVVH) is used to manage acute renal failure. Blood from a double-lumen venous catheter is pumped (using a small blood pump) through a hemofilter and then returned to the patient through the same catheter. CVVH provides continuous slow fluid removal (ultrafiltration); therefore, hemodynamic effects are mild and better tolerated by patients with unstable conditions. CVVH does not require arterial access, and critical care nurses can set up, initiate, maintain, and terminate the system. The nurse cannot set up, initiate, maintain, or terminate the system for peritoneal dialysis.
9. The nurse coming on shift is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing end-stage renal disease (ESRD)? A) History of polycystic kidney disease B) Diabetes mellitus with poorly controlled hypertension C) History of vascular disorders D) History of respiratory infections
Ans: B Page and Header: 1313, Chronic Kidney Disease Feedback: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESRD. A patient with more than one of these risk factors is at the greatest risk for developing ESRD. Therefore options A, C, and D are incorrect.
23. A specific disease process is a major cause of CKD and ESRD. It is a disease that develops usually after prolonged hypertension and diabetes. What disease process is this? A) Azotemia B) Nephrosclerosis C) Glomerulonephritis D) Nephritic syndrome
Ans: B Page and Header: 1314, Nephrosclerosis Feedback: Nephrosclerosis (hardening of the renal arteries) is most often due to prolonged hypertension and diabetes. Nephrosclerosis is a major cause of CKD and ESRD secondary to many disorders. There are two forms of nephrosclerosis: malignant (accelerated) and benign. Malignant nephrosclerosis is often associated with significant hypertension (diastolic blood pressure higher than 130 mm Hg). It usually occurs in young adults and twice as often in men compared to women. Azotemia is an abnormal concentration of nitrogenous wastes in the blood. Glomerulonephritis is an inflammation of the glomerular capillaries that can occur in acute and chronic forms. Acute nephritic syndrome is the clinical manifestation of glomerular inflammation.
25. A patient presents at the walk-in clinic complaining of edema around the eyes and flank tenderness bilaterally. Acute glomerular inflammation is suspected. What tests would the nurse expect to be ordered to confirm the diagnosis? A) CBC B) Urinalysis C) BUN D) Creatinine
Ans: B Page and Header: 1315, Primary Glomerular Diseases Feedback: Some degree of edema and hypertension is present in most patients. Marked proteinuria due to the increased permeability of the glomerular membrane may also occur, with associated pitting edema, hypoalbuminemia, hyperlipidemia, and fatty casts in the urine. Blood urea nitrogen (BUN) and serum creatinine levels may increase as urine output decreases. In addition, anemia may be present. A CBC would not be ordered for diagnostic purposes.
18. A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders? A) Monitor the patient's electrolyte values every hour before the procedure B) Preprocedure hydration and administration of acetylcysteine C) Hemodialysis immediately prior to the CT scan D) Obtain a creatinine clearance by collecting a 24-hour urine specimen
Ans: B Page and Header: 1323, Acute Renal Failure Feedback: Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute renal failure. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The nurse would not monitor the patient's electrolytes every hour preprocedure. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.
31. A 71-year-old patient has ESRD and has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make? A) "The decision is certainly yours to make, just don't make the wrong one." B) "Kidney transplants in patients your age are as successful as they are in younger patients." C) "I understand your hesitancy to commit to a transplant surgery. It is not as successful as it is in younger people." D) "Have you talked this over with your family?"
Ans: B Page and Header: 1328, Chronic Renal Failure (End-Stage Renal Disease) Feedback: Although there is no specific age limitation for renal transplantation, concomitant disorders (eg, coronary artery disease, peripheral vascular disease) have made it a less common treatment for the elderly. However, the outcome is comparable to that of younger patients. Options A, C, and D are incorrect as they belittle the patient or give the patient misinformation.
17. A living organ donor is 1 hour postoperative after donating a kidney. The critical care nurse caring for the patient notes that the patient is clammy and pale. The nurse knows the patient is exhibiting symptoms of what? A) Urinary retention B) Shock C) Increased blood pressure D) Normal symptoms of anesthetic administration
Ans: B Page and Header: 1347, Management of Patients Undergoing Kidney Surgery Feedback: Because the kidney is a highly vascular organ, hemorrhage and shock are the chief complications of renal surgery. Fluid and blood component replacement is frequently necessary in the immediate postoperative period to treat intraoperative blood loss. Urinary retention, increased blood pressure, and normal symptoms of anesthetic administration are not normal postoperative symptoms.
34. The critical care nurse is monitoring her patient's urine output and drainage from tubes inserted intraoperatively. What would the nurse promptly report to the physician? A) Increased pain on movement B) Absent drainage C) Increased urine output D) Blood-tinged serosanguineous drainage
Ans: B Page and Header: 1350, Management of Patients Undergoing Kidney Surgery Feedback: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported to the physician because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario prescribed. Increased urine output is expected so you wouldn't report it to the physician in a prompt fashion. Serosanguineous drainage is to be expected.
21. What physiologic abnormalities indicate the development of chronic renal disease ? (Mark all that apply.) A) Hypophosphatemia B) Anemia C) Metabolic acidosis D) Respiratory alkalosis E) Hypercalcemia
Ans: B, C, E Page and Header: 1313, Chronic Kidney Disease Feedback: Anemia due to decreased erythropoietin production by the kidney, metabolic acidosis, and abnormalities in calcium and phosphorus herald the development of CKD.
6. A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based upon this GFR, the nurse interprets that the patient's chronic kidney disease is at what stage? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4
Ans: C Page and Header: 1313, Chronic Kidney Disease Feedback: Stages of chronic renal failure are based on the glomerular filtration rate (GFR). Stage 3 is defined by a GFR in the range of 30-59 mL/min/1.73 m2. This is considered a moderate decrease in GFR. Stage 1 is defined by a GFR 90 mL/min/1.73 m2. Stage 2 is defined by a GFR of 60-89 mL/min/1.73 m2. Stage 4 is a GFR in the range of 15-29 mL/min/1.73 m2. Stage 5 is a GFR > 15 mL/min/1.73 m2. Therefore options A, B, and D are incorrect.
26. The nurse is caring for a patient with chronic glomerulonephritis. What can cause chronic glomerulonephritis? A) Epstein-Barr virus B) Atherosclerosis C) Repeated episodes of acute nephritic syndrome D) Hypertensive encephalopathy
Ans: C Page and Header: 1316, Primary Glomerular Diseases Feedback: Chronic glomerulonephritis may be due to repeated episodes of acute nephritic syndrome, hypertensive nephrosclerosis, hyperlipidemia, chronic tubulointerstitial injury, or hemodynamically mediated glomerular sclerosis. Secondary glomerular diseases that can have systemic effects include lupus erythematosus, Goodpasture's syndrome (caused by antibodies to the glomerular basement membrane), diabetic glomerulosclerosis, and amyloidosis.
2. You are caring for a patient with acute renal failure. What is the most common clinical manifestation of acute renal failure? A) Decrease in BUN B) Anuria C) Oliguria D) Decrease in serum creatinine
Ans: C Page and Header: 1320, Acute Renal Failure Feedback: Acute renal failure manifests as oliguria, anuria, or normal urine volume. Oliguria (less than 500 mL/d of urine) is the most common clinical situation seen in acute renal failure; anuria (less than 50 mL/d of urine) and normal urine output are not as common. Regardless of the volume of urine excreted, the patient with acute renal failure experiences rising serum creatinine and BUN levels and retention of other metabolic waste products (azotemia) normally excreted by the kidneys.
35. You are writing a teaching plan for a patient you are caring for status post resection of a renal tumor. What would you include in that teaching plan? A) Postsurgical hygiene B) Signs and symptoms of rejection C) To inspect and care for the incision D) Post surgical urine retention
Ans: C Page and Header: 1320, Renal Cancer Feedback: The nurse teaches the patient to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving, and pain management. The nurse would not include postsurgical hygiene or postsurgical urine retention in the teaching plan for this patient. There would be no need to teach the signs or symptoms of rejection as there has been no transplant.
11. The nurse is caring for a patient in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: A) Hypernatremia. B) Hypokalemia. C) Hyperkalemia. D) Hypercalcemia.
Ans: C Page and Header: 1321, Acute Renal Failure Feedback: Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.
29. A nurse is caring for a renal patient in the dieresis period of ARF. What must the patient be observed closely for during this phase? A) Hyperkalemia B) Hypocalcimia C) Dehydration D) Hypervolemia
Ans: C Page and Header: 1321, Acute Renal Failure Feedback: The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. Laboratory values stabilize and eventually decrease. Although the volume of urinary output may reach normal or elevated levels, renal function may still be markedly abnormal. Because uremic symptoms may still be present, the need for expert medical and nursing management continues. The patient must be observed closely for dehydration during this phase; if dehydration occurs, the uremic symptoms are likely to increase.
20. A patient is admitted to the intensive care unit after a motor vehicle accident. On the second day of the hospital admission, the patient develops acute renal failure. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patient's hypervolemia and hyperkalemia. Which of the following therapies will the patient's hemodynamic status best tolerate? A) Hemodialysis B) Peritoneal dialysis C) Continuous venovenous hemodialysis (CVVHD) D) Plasmapheresis
Ans: C Page and Header: 1339, Dialysis Feedback: CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable patient. Peritoneal dialysis is not the best choice, as the patient may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.
32. Peritonitis is a common and dangerous complication of peritoneal dialysis. What is a nursing action that helps these patients fight peritonitis? A) Green's stain is used to identify the invading organism. B) Drainage fluid is cultured to erradicate the organism. C) Aminoglycosides are added to the dialysate for subsequent exchanges. D) Cephalosporins are given intravenously.
Ans: C Page and Header: 1341, Dialysis Feedback: Drainage fluid is examined for cell count; and Gram's stain and culture are used to identify the organism and guide treatment. Antibiotic agents (aminoglycosides or cephalosporins) are usually added to subsequent exchanges until Gram stain or culture results are available for appropriate antibiotic determination. Options A, B, and D are incorrect.
5. The nurse is caring for a patient receiving hemodialysis treatments. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient? A) Using a stethoscope for auscultating the fistula is contraindicated. B) The patient feels best immediately after the dialysis treatment. C) Taking a blood pressure reading on the affected arm can cause clotting of the fistula. D) The patient shouldn't feel pain during initiation of dialysis.
Ans: C Page and Header: 1345, Dialysis Feedback: When blood flow is reduced through the access for any reason (hypotension, application of blood pressure cuff or tourniquet), the access can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, the needle stick is still painful.
22. An 84-year-old female diagnosed with cancer is admitted to your unit for surgical treatment. The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patient contribute to acute renal failure? (Mark all that apply.) A) Anxiety B) Minimal social support C) Normal aging D) Chronic systemic disease E) Chemotheraputic agents
Ans: C, D Page and Header: 1314, Chronic Kidney Disease Feedback: Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney dysfunction and renal failure. In addition, the incidence of systemic diseases, such as atherosclerosis, hypertension, heart failure, diabetes, and cancer, increases with advancing age, predisposing older adults to renal disease associated with these disorders. Anxiety and minimal social support would need to be addressed in this patient, but they are not precipitating factors for acute renal disease.
24. A 16-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. What is a cause of postinfectious glomerular disease? A) Viral tonsillitis that precedes the onset of glomerulonephritis by 4 to 6 weeks B) Staphylococcal infection of the sinuses that precedes the onset of glomerulonephritis by 3 to 4 weeks C) Group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 5 to 6 weeks D) Group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks
Ans: D Page and Header: 1314, Primary Glomerular Diseases Feedback: Postinfectious causes are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Therefore options A, B, and C are incorrect.
16. A patient with ESRD is scheduled for his first hemodialysis treatment. The patient asks the nurse what common complications may occur from the treatment. What would be the nurse's best reply? A) "High blood sugar levels and low protein levels may occur." B) "Excessive bleeding and double vision may occur." C) "Confusion and diarrhea may occur." D) "Hypotension and cramping may occur."
Ans: D Page and Header: 1335, Dialysis Feedback: The most common side effects associated with hemodialysis are hypotension and cramping. Confusion is an uncommon complication related to dialysis disequilibrium syndrome, and this condition is not frequently observed with advancing hemodialysis technology. Diarrhea is not a complication related to hemodialysis. High blood sugar levels and low protein levels are complications associated with peritoneal dialysis. Blood loss is a complication related to hemodialysis, but excessive bleeding is not a common complication related to advanced technology and equipment monitors. Double vision is not associated with hemodialysis, but blurry vision may be a manifestation of hypotension.
