Lippincott Renal Davis Renal

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 HOB, 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 cath.)

During peritoneal dialysis, the nurse observes that the flow of dialysate stops before all the solution 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 cath 4. have the client walk

1 (hyperkalemia!! can initiate cardiac instability)

The telemetry monitor tech notifies the nurse of the morning telemetry reading. Which client should the nurse assess first? 1 The client in normal sinus with a peaked T wave 2. The client dx with atrial fib and rate of 100 3. The client dx with MI and occasional PVC 4. The client with a first degree atrioventricular block and a rate of 92

b,d (The answers are B and D. Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient's phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.)

You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply: A. "This medication will help keep my calcium level normal." B. "I will take this medication with meals or immediately after." C. "It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication." D. "This medication will help prevent my phosphate level from increasing."

2 (fatigue, headache, and polyuria as well as loss of weight, anorexia, and excessive thirst are symptoms of chronic pyelonephritis, WRONG #1 those are signs of acute, #3 causes acute glomerulonephritis. #4 Viral pneumonia is a cause of acute glomerulonphritis)

d The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the dx 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 hemolytic strep infection last week 4. The client has an acute viral pneumonia infection

1,2,6 (F&E is regulated by the kidneys. Hematologic regulation is an interrelated concept because the client on hemodialysis does not have functioning kidney to produce erythropoietin to stimulate the bone marrow to produce RBCs. In addition removal of the entire circ blood 3x a week thru the dialysis machine stresses the RBCs and they do not last as long. Nutrition is also an issue because the client has a restricted diet to decrease toxic metabolites not being eliminated thru the kidneys. #3, #4, and #5 are wrong unless a comorbid condition exists and is not mentioned in this stem)

d The nurse is developing a care map for a client dx with CRF on hemodialysis. Which interrelated concepts should be included in the map? SATA 1. F&E 2. Hematologic regulation 3. Digestion 4. Metabolism 5. Mobility 6. Nutrition

3 (GFR is approx 120 mL/min If the GFR is decreased to 40 mL/min the kidneys are functioning about one-third filtration capacity. WRONG: #1 BUN is 8-20 wnl #2 creatinine 0.6-1.2 wnl #4 Norm creatinie clearance is 85-125 for males and 75-115 for females)

d The elderly client is dx with chronic glomerulonephritis. which lab value indicates to the nurse the condition has become worse? 1. The BUN is 15 2. the creatinine level is 1.2 3. The GFR is 40 mL/min 4. The 24 hr creatinine clearance is 100 mL/min

2 (Many in the AA culture believe the body must be kept intact after death, and organ donation is rare. as a culture)

d 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

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 a chilly sensation, but this is a secondary reason for warming the solution. The warmed solution does not force the K into cells or promote abd muscle relaxation)

The dialysis solution is warmed before use in peritoneal dialysis primarily to: 1 encourage the removal of serum urea 2. force K back into the cells 3. add extra warmth to the body 4. promote abdominal muscle relaxation

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. WRONG: #1 The client should NOT WAIT to call the HCP until the temp reaches 102, they should call at 100 or greater. #2 The client should apply DIRECT PRESSURE and notify the HCP not apply ice. #4 ENCOURAGE CLIENT INDEPENDENCE.)

d 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 the oral temp is 102 F 2. Apply ice to the access site if it starts bleeding at home 3. Keep the fingernails short and try not to scratch the skin 4. Encourage the significant other to make decisions for the client

4 (excess fluid volume is the priority because of the stress placed on the heart and vessels, which lead to heart failure, pulmonary edema and death. )

d The nurse is developing a nursing care plan for the client dx with CKD. Which nursing problem is priority for the client? 1. low self esteem 2. knowledge deficit 3. Activity intolerance 4. Excess fluid volume

3 (renal failure causes an imbalance of electrolytes, K, Na, Ca, Ph, therefore the desired client outcome is electrolytes wnl. WRONG: #1 this is an intervention, #2 this is a measurable client outcome, but ARF typically does not cause pain, #4 A Kayexalate resin enema may be administered to help decrease K levels, but this is an intervention, not an outcome)

d The nurse is developing a plan of care for a client dx with ARF. Which statement is an appropriate outcome for the client? 1. Monitor I&O every shift 2. Decrease the pain by 3 levels on a 1-10 scale 3. Electrolytes are wnl 4. Admin enemas to decrease hyperkalemia

3 (Carbs are increased to provide for the clients caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste and products. WRONG:#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. #4 The client must be on a therapeutic diet, but small feedings are not required.)

d he client dx with ARF is admitted to the ICU and placed on a therapeutic diet. Which diet is most appropriate for this client? 1. A high potassium and low calcium diet 2. A low fat and low cholesterol diet 3. A high carb and restricted protein diet 4. A reg diet with 6 small feedings a day

a (The answer is A. There are two types of drugs that can be used to treat hypertension and protect the kidneys in patients with CKD. These drugs include angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). The only drug listed here that is correct is Lisinopril. This drug is known as an ACE inhibitor. Metoprolol is a BETA BLOCKER. Amlodipine and Verapamil are calcium channel blockers.)

3. A 65 year old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys? A. Lisinopril B. Metoprolol C. Amlodipine D. Verapamil

b,d,e (The answers are B, D, and E. Patients with acute glomerulonephritis experience proteinuria and hematuria. In addition, they may experience mild edema (mainly in the face/eyes), hypertension, and in severe cases renal failure/oliguria. Therefore, it is very important the nurse monitors intake and output every hour, assesses color of urine, and weighs the patient every day on a standing scale. Option A is wrong because the patient should be consuming a LOW (not high) sodium diet. Option C is wrong because the patient should maintain bed rest until recovered due to experiencing hypertension. Option F is wrong because the patient will be on a fluid restriction...4 L is a lot of fluid to consume. It is generally 2 L or less of fluids per day.)

A 5 year old male is admitted with acute glomerulonephritis. On assessment, you note mild edema predominately in the face and tea-colored urine. The patient's blood pressure is 165/110, heart rate 95, oxygen saturation 98% on room air, and temperature 98.9 'F. In your nursing care plan, what nursing interventions will you include in this patient's plan of care? SELECT-ALL-THAT-APPLY: A. Initiate and maintain a high sodium diet daily. B. Monitor intake and output hourly. C. Encourage patient to ambulate every 2 hours while awake. D. Assess color of urine after every void. E. Weigh patient every daily on a standing scale. F. Encourage the patient to consume 4 L of fluid per day.

1,2,3,4 (Elevation of the HOB will promote ease of breathing, REspiratory manifestations of ARF include SOB, orthopnea, crackles, and the potential for pulmonary edema. Therefore the priority is placed on facilitation of respiration. The nurse should assess VS because the pulse and RR will be elevated. Establishing an IV site for IV therapy will become important because fluids will be administered IV in addition to orally. The HCP will need to be contacted for further prescriptions, there is no need to contact the hemodialysis unit)

A client has been admitted with ARF. What should the nurse do? SATA 1. Elevate the HOB 30-45 degrees 2. Take VS 3 Establish IV site 4. Call the admitting HCP for prescriptions 5. Contact the hemodialysis unit

1 (Cloudy drainage indicates bacterial activity in the peritoneum. Other S/s of infection are fever, hyperactive bowel sounds, and abd pain. Swollen legs may indicate HF. Poor drainage or dialysate fluid is probably the result of a kinked cath. REdness at the insertion site indicates local infection. not peritonitis. However a local infection that is left untreated can progress to the peritoneum)

A client is receiving CAPD, The nurse should assess the client for which sign of peritoneal infection? 1. cloudly dialysate fluid 2. swelling in the legs 3. poor drainage of the dialysate fluids 4 redness at the catheter insertion site

1,2,3,4,6 (Before prescribing and administering packed RBCs the nurse should assess the IV site to make sure it has an 18-20 gauge infusion set. The nurse should also ensure that NS is used to prime the tubing to prevent RBCs from adhering to the tubing. The client must indicate informed consent for the procedure by signing the consent form. The clients blood type to determine ABo typing and RH compatibility, Cross matching is done to detect the presence of recipient antibodies to the donors minor antigens. VS provide a baseline reference for continuous monitoring throughout the transfusion. An ID band and red blood band are essential for client identification per facility policy. Two nurses must double check the clients ID with the client listed on the unit of RBCs. The transfusion should be started within 30 mins of the time that the RBC unit is checked out of the blood bank, thus no blood should be kept in the medication room before transfusing)

A client with ARF has anemia, tachycardia, hypotension, and sob. The HCP has prescribed 2 units of PRBCs. What should the nurse determine prior to initiating the blood transfusion? SATA 1. There is an IV access with the appropriate tubing and NS as the priming solution 2. There is a signed informed consent for transfusion therapy. 3. Blood typing and crossmatching are documented in the medical record. 4. The VS have been taken and documented in accordance with facility policy and procedure 5. There is the 2nd unit of blood in the medication room 6. The client has an identification bracelet

2,3,4 (The nurse instructs the client to protect the site of the fistula. The client should avoid pressure on the involved arm, such as sleeping on it, wearing tight jewelry, or obtaining BP. The client is also advised to assess the area distal to the fistula for adequate circ. such as warmth and color. When the client is hospitalized the nurse posts a sign on the clients bed not to draw blood or obtain BP on the left side, the client is also instructed to be sure that none of the team members do so)

A client with ESRD has an internal arteriovenous fistula in the L arm for vascular access during hemodialysis. What should the nurse instruct the client to do? SATA 1. Remind the HCPs to draw blood from the veins on the left side 2. Avoid sleeping on the L arm 3. wear a wristwatch on the R arm 4. Assess the fingers on the L arm for warmth 5. Obtain BP from the L arm

2 4 1 3 ( The nurse first assures IV access in case the client has a resp or cardiac arrest. Next the nurse monitors the clients HR and rhythm; Cardiovascular signs of elevated serum K levels are irreg slow HR, decreased BP, narrow peaked T waves, widened QRS complexes, prolonged PR intervals, and flattened D waves. Frequent ectopy, V fib, and ventricular standstill. The nurse then administers the Ca gluconate, which has an immed action to antagonize the effect of hyperK on cardiac muscle. Last the nurse administers the polystyrene sulfonate, which is a cation exchange resin that removes K from the body, exchanging sodium ions for K it is then excreted onset is several hours to days)

A client with ESRD is admitted to the hospital with K level of 7 In what order of priority from first to last does the nurse perform the prescriptions? 1. Admin calcium gluconate 2. start an IV access 3. Admin sodium polystyrene sulfonate 4. attach the client to a cardiac monitor

2 (The major benefit of CAPD is that is frees the client from daily dependence on dialysis centers, 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 are similar to those of standard peritoneal dialysis. Peritoneal dialysis usually takes less time but can not be done at home)

A client with chronic renal failure has asked to be evaluated for 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 does standard peritoneal dialysis

2,4,5 (to manage N, the nurse can advise the client to drink limited amounts of fluid only when thirsty and eat food before drinking to alleviate dry mouth, and encourage strict follow up for blood work, dialysis and HCP visits. Smaller more freq meals may help to reduce N and facilitate med 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 it removes wastes that contribute to N)

A client with chronic renal failure who receives hemodialysis 3 times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the N? SATA 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 freq meals

4 (High carb foods meet the bodys caloric needs during ARF. Protein is limited because its breakdown may result in accumulation of toxic waste products, The main goal of nutritional therapy in ARF is to decrease protein catabolism. Protein catabolism causes increased levels of urea, phophate and K. Carbs provide energy and decrease the need for protein breakdown. They do not have a diuretic effect. Some specific carbs influence urine PH but this is not the reason for encouraging a high carb low protein diet. There is no need to reduce demands on the liver through diet manipulation in ARF)

A high carb, low protein diet is prescribed for a client with ARF. 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

c (The answer is C. Patients will experience the most prominent swelling in the face in the morning when they awake. This is a common finding with kidney disorders. The skin of the eyes is fragile, folded, and pocketed which makes it easier for fluid to collect around the eyes. In addition, this is where the swelling looks more noticeable.)

A patient who is experiencing poststreptococcal glomerulonephritis has edema mainly in the face and around the eyes. As the nurse, you know to expect the edema to be more prominent during the? A. Evening B. Afternoon C. Morning D. Bedtime

a (The answer is A. The patient should follow this type of diet because protein breaks down into urea (remember patients will have increased urea levels), low sodium to prevent fluid retention, low potassium to prevent hyperkalemia (remember glomerulus isn't filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia.)

A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a: A. Low protein, low sodium, low potassium, low phosphate diet B. High protein, low sodium, low potassium, high phosphate diet C. Low protein, high sodium, high potassium, high phosphate diet D. Low protein, low sodium, low potassium, high phosphate diet

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

Aluminum hydroxide gel 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 Curlings stress ulcers 3. Binding phosphate in the intestine 4. Reversing metabolic acidosis

2 (If disequilibrium syndrome occurs, 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, Admin of O2 and position changes do not affect the symptoms. It would not be appropriate to reassure the client the symptoms are normal)

During dialysis the client has disequilibrium syndrome. The nurse should first: 1. admin O2 via NC 2. Slow the rate of the dialysis 3. reassure the client the symptoms are normal 4. place the client in trendelenburgs

f (The answer is FALSE: Poststreptococcal glomerulonephritis is a type of NEPHRITIC (not nephrOtic) SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate. In Nephrotic Syndrome, there is only leakage of PROTEIN (not red blood cells) into the filtrate.)

TRUE or FALSE: Poststreptococcal glomerulonephritis is a type of NEPHROTIC SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate. True False

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 dialysis are effective)

The client asks about diet changes when using continuous ambulatory peritoneal dialysis. Which response by the nurse would be best? 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 because dialysis is constant 4. Diet restrictions with CAPD are fewer because CAPD works more quickly

1,2,3 (The HCP may order certain foods and meds when obtaining a 24 hr urine collection to evaluate for calcium oxalate or uric acid When the collection begins, the client should completely empty the bladder and discard the urine. The test is started after the bladder is empty. All urine for 24 hrs should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instruction will result in a inaccurate test result. WRONG: The client is not catheterized unless incont, the nurse can delegate the UAP to place the urine in the appropriate collection container.)

The client dx with RENAL CALCULI is scheduled for a 24 hr urine specimen collection. Which interventions should the nurse implement? SATA 1. Check for the ordered diet and medication modifications 2. Instruct the client to urinate and discard this urine when starting collection 3. Collect the urine during 24 hours and place in appropriate specimen container 4. Insert an indwelling cath in client after having the client empty the bladder 5. Instruct the UAP to notify the nurse when the client urinates

1,2,4,5 (Broad spectrum antibiotics may be administered to prevent infection when a peritoneal cath 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 is characterized by cloudy dialysate drainage, diffuse abdominal pain and rebound tenderness.)

The client performs self peritoneal dialysis. What should the nurse teach the client about preventing peritonitis? SATA 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

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

The clients serum K level is elevated in ARF, and the nurse administers sodium polystyrene sulfonate. The mechanism of action for this drug is to: 1 increase K excretion from the colon 2. release hydrogen ions for sodium ions 3. increase Calcium absorption in th colon 4. exchange sodium for potassium ions in the colon

1,3,4,5,6,7 (The client is hyponatremic, the nurse will closely monitor VS, restrict fluids, accurately record intake and output with the aid of a Foley cath, prescribe labs for morning, and ensure client safety with use of a bed alarm. Encouraging fluids and restricting dietary sodium to 2g further exacerbate the hyponatremia. The nurse will also monitor for neurological changes and inform the hCP immediately of any change or if the client becomes unable to take food or fluids by mouth)

The elderly client admitted with new onset confusion, headache, poor skin turgor, bounding pulse and urinary incontinence has been drinking copious amounts of water. Upon reviewing the lab results, the nurse discovers a sodium level of 122. A report to the hcP should include what recommendations? SATA 1. fluid restriction 2. encourage fluids 3. VS q4 instead of q8 4. bed alarm 5. Foley cath 6. strick I&O 7 repeat electrolytes, urine for Na and sp gravity in the morning 8. 2 g sodium diet

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

The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates the client understands the teaching? 1. I will take it every 4 hrs around the clock 2. I will take it between meals and at bedtime 3. I will take it when I have an upset stomach 4. I will take it with meals and bedtime snack

3 (Dialysis has no effect on hemoglobin levels because some RBCs are injured during the procedure, dialysis aggravates a low hgb concentration and may contribute to anemia. Dialysis will clear metabolic waste products from the body and correct electrolyte imbalances such as creatinine, K and Na levels)

Which abnormal blood value would not be improved by dialysis treatment? 1. elevated serum creatinine level 2. hyperkalemia 3. decreased hemoglobin concentration 4. hypernatremia

2 (The severe flank pain assoc with a stone in the ureter often causes a sympathetic response with associated N/V pallor and cool clammy skin. Dull flank pain and microscopic hematuria are manifestations of a RENAL stone in the kidney Gross hematuria and suprapubic pain when voiding are S/s of bladder stone)

Which clinical manifestations should the nurse expect to assess for the client dx with an ureteral RENAL STONE? 1. dull aching flank pain and microscopic hematuria 2. N/V pallor, cool clammy skin 3. Gross hematuria, and dull suprapubic pain with voiding 4. The client will be asymptomatic

a,b,d (The answers are A, B, D. The patient with AGN may experience HYPERtension (not hypotension), DECREASED glomerular filtration rate (NOT increased), MILD (not massive) proteinuria. Massive proteinuria is a classic sign and symptom in Nephrotic Syndrome which doesn't present with hematuria. Options C, E, and F can be present in AGN.)

Which of the following are NOT a sign and symptom of acute glomerulonephritis (poststreptococcal)? SELECT-ALL-THAT-APPLY: A. Hypotension B. Increased Glomerular filtration rate C. Cola-colored urine D. Massive proteinuria E. Elevated BUN and creatinine F. Mild swelling in the face or eyes

a (The answer is A. An ASO (antistreptolysin) titer is a test used to diagnose strep infections. Remember strep infections increase, especially in the pediatric population, the risk of developing AGN. Patients in options B, C, and D are not at risk for this.)

Which patient below is at MOST RISK for developing acute glomerulonephritis? A. A 3 year old male who has a positive ASO titer. B. A 5 year old male who is recovering from an appendectomy. C. An 18 year old male who is diagnosed with HIV. D. A 6 year old female newly diagnosed with measles.

b (The answer is B. This patient is experiencing OLIGURIA (low urinary output). The patient weighs 30 lbs. which is 13.6 kg (30/2.2= 13.6). Remember a normal urinary output for a pediatric patient should be 1 mL/kg/hr. Based on the patient's weight, their urinary output is 10 mL/hr...it should be 13.6 mL/hr. Therefore, the patient is at high risk for retaining POTASSIUM due to decreased renal function. The nurse should limit foods high in potassium.)

While providing care to a pediatric patient with acute glomerulonephritis, you note the urine output to be 10 mL/hr. The patient weighs 30 lbs. As the nurse, you will want to limit what type of foods from the patient's diet? A. Calcium-rich foods B. Potassium-rich foods C. Purine -rich foods D. None of the above because the patient's urinary output is normal based on the patient's weight.

d (The answer is D. This is the only correct statement. Option A is wrong because this condition tends to present 10-14 days (not 6 months) after a strep infection of the throat or skin. Option B is wrong because the patient is at risk for HYPERkalemia (not HYPOkalemia) especially if low urinary output is present. Option C if wrong because patients with this conditon will experience hematuria which is a hallmark of this condition.)

Within the past month, the admission rate of patients with poststreptococcal glomerulonephritis has doubled on your unit. You are proving an in-service to your colleagues about this condition. Which statement is CORRECT about this condition? A. "This condition tends to present 6 months after a strep infection of the throat or skin." B. "It is important the patient consumes a diet rich in potassium based foods due to the risk of hypokalemia." C. "Patients are less likely to experience hematuria with this condition." D. "This condition is not caused by the streptococcal bacteria attacking the glomerulus, but by the immune system's response to the bacteria by creating an antigen-antibody complex which inflames the glomerulus."

3 (This is usually the length of time clients need to wait prior to having sexual intercourse, this is the info the client wants to know)

bph d: The client who is post op TURP asks the nurse "When will I know if I will be able to have sex after my TURP? Which response is most appropriate by the nurse? 1. You seem anxious about your surgery 2. Tell me about your fears of impotency 3. Potency can return in 6-8 weeks 4. Did you ask your dr about your concern?

4 (The nurse should always assess any complaint before dismissing it as a commonly occurring problem)

bph d: The client with a TURP who has a continuous irrigation cath complains of the need to urinate. Which intervention should the nurse implement first? 1. Call the surgeon to inform the HCP of the clients complaint 2. Admin the clients narcotic med for pain 3. Explain to the client that this sensation happens frequently 4. Assess the continuous irrigation catheter fro patency

2 (elevating scrotum on a towel for support is a task that can be delegated to the UAP)

bph: d The client is one day postop TURP Which task should the nurse delegate to the UAP? 1. Increase the irrigation fluid to clear clots from the tubing 2. Elevate the scrotum on a towel roll for support 3. Change the dressing on the first postop day 4. Teach the client how to care for the continuous irrigation catheter

2 (increasing the irrigation fluid will flush out the clots and blood)

bph: d The nurse observes red urine and several large clots in the tubing of NS continuous irrigation catheter for the client who is on 1 day post op TURP. Which intervention should the nurse implement? 1. Remove the indwelling cath 2. Titrate the NS to run faster 3. Admin protamine sulfate IVP 4. Admin the Vit K slowly

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. WRONG: #! peritoneal dialysis administered through a cath inserted into the peritoneal cavity, a fistula would be for hemodialysis. The other answers #2 and #3 are wnl)

d The client dx 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 clients abd is soft nontender and has bowel sounds 3. The dialysate being removed from the clients abd is clear 4 The dialysate instilled was 1500 mL and removed was 1500 mL

1

d The client dx with CRF is prescribed a 60 gm protein, a 2000 mg Na diet. Which food choices indicate the client understanding of the restrictions? 1. a 4 oz grilled chicken breast, broccoli, and small glass unsweet tea 2. Baked potato with chopped ham and sour cream, 12 oz steak and beer 3. Double cheeseburger, FF, and saccharin sweet Kool aid 4. Roast beef sandwich, potato chips, and a soft drink

4 (This is septic shock and not fluid volume shock, but the circ system is still compromised. Increasing the fluid volume will support the clients BP until the IVPB is infused.)

d The client dx with UTI has a BP of 83/56 and a pulse of 122. What should the nurse do first? 1. notify the HCP 2. Hang the IVPB antibiotic at prescribed rate 3. Check the lab work to determine if the urine culture is completed 4. Increase the NS IV from keep open rate to 150 mL.hr

4 (maintaining the clients BP to greater than 100/60 ensures perfusion to the kidneys. ARF occurs when the kidneys have not been adequately perfused. Vasopressor drips are used to maintain the BP.)

d The client in the ICU after a MVA in which the client lost an estimated 3 units of blood. Which action by the nurse could prevent the client from developing acute renal failure? 1. Take and document the VS every hr 2. Assess the clients dressing every 2 hrs 3. Check the Urinary output every shift 4. Maintain the BP greater than 100/60

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 to the client with a gunshot wound. The other actions are appropriate but not aimed at preventing ARF)

d The client is admitted to the ED after a gunshot wound to the abdomen, Which nursing intervention should the nurse implement first to prevent ARF? 1. Administer NS IV 2. Take VS 3. Place client on telemetry 4. Assess the abdominal dressing

4 (Maintaining the clients BP to greater than 100/60 ensures perfusion of the kidneys. ARF occurs when the kidneys have not been adequately perfused. Vasopressor drips are used to maintain the BP)

d The client is in the ICU after a MVA in which the client had 3 units blood. Which action by the nurse could prevent the client from developing ARF? 1. Take and document the VS every hour 2. Assess the clients dressing every 2 hrs 3. Check the clients urinary output every shift 4. Maintain the clients BP greater than 100/60

1,2,4 (These are called the pre and post weights, the pre weight determines the amount of fluid to be removed during the tx and the post weight is used to determine if the goal met. Clients experiencing renal failure are not processing fluids in their body, restrictions are prescribed to allow for some fluid so the client does not become dehydrated but limited so the heart is not overtaxed causing HF. The clients entire blood supply is being removed from the body and being returned after being filtered, the client could bleed out in minutes if the access becomes dislodged. WRONG: Low salt options only! and #5 most like to rest during)

d The client with CRF is prescribed hemodialysis on M, W, and F. Which interventions should the dialysis nurse implement?SATA 1. Weigh the client before each treatment 2. discuss the recommended fluid restriction 3. Provide the potato chips and pretzels as a snack 4. Monitor the hemodialysis access site continuously 5. Keep up the lively conversation during the treatments

3 (after the initial admin of erythropoietin a clients antihypertensive med may need to be adjusted. Therefore this complaint requires notification of the HCP Erythropoietin therapy is contraindicated in pts with uncontrolled HTN. WRONG#1 flu like symptoms are expected and tend to subside with repeated doses. the nurse should suggest Tylenol prior to the injections. #2 This med takes up to 2-6 weeks to become effective in improving anemia and thereby reducing fatigue. #4 Long bone and vertebral pain is an expected occurrence because the bone marrow is being stimulated to increase production of RBCs)

d The male client dx with CKD has received the initial dose of erythropoietin, a biologic response modifier, 1 week ago. Which complaint by the client indicates the need to notify the HCP? 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 BP 4. The client reports discomfort in the legs and back

4 (Noncompliance is a choice the client has a right to make. but the nurse should determine the reason for it and then take appropriate action based on the clients rationale. For example the client may have financial difficulty, the nurse may suggest how the client can afford the proper foods along with medications or refer to a social worker. The other options do not address the clients choice of noncompliance)

d The nurse caring for a client dx 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 dietician 3. Explain the importance of eating proper foods 4. Determine the reason for the client not adhering to the diet

2 (hypotension which causes a decreased blood supply to the kidney is one of the most common causes of prerenal failure which means before the kidney. WRONG: #1 Diabetes may lead to CRF, #2 Nephrotoxic meds are a cause of INTRArenal failure, which means directly to the kidney. #4 BPH is a cause of POST renal failure or after the kidney)

d The nurse caring for a client dx with rule out ARF. Which condition predisposes the client to developing prerenal failure? 1. Diabetes mellitus 2. hypotension 3. aminoglycosides 4. BPH

3 (This is the correct scientific rationale for metabolic acidosis occurring in the client with CKD. WRONG: #1 There is a DECREASE in the excretion of phosphate and organic acids, not an increase. #2 The RBC destruction does not affect PH #4 The compensatory mechanism occurs to maintain the arterial blood PH between 7.35 and 7.45, but does not occur as a result of CKD)

d The nurse caring for the client dx with CKD who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in the 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 RBCs 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 N/V causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately

1 (The 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 lab value most significant in diagnosing renal failure. WRONg: #2 WBC for infection, hgb for blood loss #3 K intracellular, and Na interstitial are electrolytes monitored for a variety of diseases or conditions not specific to renal function. K will increase with renal failure, but the level is not diagnostic indicator for renal failure.)

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

c (The answer is C. This is known as Stage 4 of CKD because the GFR (glomerular filtration rate) for this stage is 15-29 mL/min (patient's GFR is 25 mL/min). The other stage's criteria are as follows: Stage 1: Kidney damage with normal renal function GFR >90 ml/min but with proteinuria (3 months or more); Stage 2: Kidney damage with mild loss of renal function GFR 60-89 ml/min with proteinuria (3 months or more); Stage 3: Mild-to-severe loss of renal function GFR 30-59 mL/min; Stage 4: Severe loss renal function GFR 15-29 mL/min; Stage 5: End stage renal disease GRF less 15 mL/min)

1. A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as? A. Stage 1 B. Stage 3 C. Stage 4 D. Stage 5

c (Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis.)

Clinical manifestations of acute glomerulonephritis include which of the following? a Chills and flank pain b Oliguria and generalized edema c Hematuria and proteinuria d Dysuria and hypotension

2 (because the client has a perm cath in place, blood tinged drainage should not occur. Persistent blood tinged drainage could indicate damage to the abdominal vessels and the HCP should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too rapid infusion of the dialysate can cause pain, but not blood tinged drainage)

During the peritoneal dialysis, the nurse observes the solution draining from the clients abdomen is consistently blood tinged. The client has a permanent peritoneal cath in place. The nurse should recognize that the bleeding: 1. is expected with a permanent peritoneal cath 2. Indicates abd blood vessel damage 3. can indicate kidney damage 4. is caused by too rapid infusion of the dialysate

c (In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium.)

Polystyrene sulfonate (Kayexalate) is used in renal failure to: a Correct acidosis b Reduce serum phosphate levels c Exchange potassium for sodium d Prevent constipation from sorbitol use

4 (SEVERE PAIN is priority... the pain can be so severe a sympathetic response may occur causing N/V pallor and cool clammy skin)

The client dx with an acute episode of URETERAL CALCULI . Which client problem is priority when caring for this client? 1. Fluid vol loss 2. Knowledge deficit 3. Impaired urinary elimination 4. Alteration in comfort

3 (dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium and K intake. Protein intake is reduced because kidneys can no longer excrete the by products of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high carb diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1000-2000 mg/day)

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? 1. high carb, high protein 2. high calcium, high K, high protein 3. low protein, low sodium, low K 4. low protein, high K

4 (S/s of an external access shunt infection include redness, tenderness, swelling and drainage from around the shunt site. The absence of a bruit would indicate closing of the shunt. Sluggish cap refill and coolness of the extremity would indicate decrease blood flow to the extremity)

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 cap refill time 3. coolness of the involved extremity 4. swelling of the shunt site

d (The answer is D. The patient's potassium level is extremely elevated. A normal potassium level is 3.5-5.1 mEq/L. This patient is experiencing hyperkalemia, which can cause tall peak T-waves. Remember in CKD (especially prior to dialysis), the patient will experience electrolyte imbalances, especially hyperkalemia.)

Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality? A. Phosphate 3.2 mg/dL B. Calcium 9.3 mg/dL C. Magnesium 2.2 mg/dL D. Potassium 7.1 mEq/L

1,3,4 (The nurse SHOULD assess the drain postoperatively. The HOB SHOULD be lowered and the foot elevated to shunt blood to the central circulating system. The surgeon NEEDS to be notified at the change in condition. WRONG #2 The client is HEMORRHAGING, so the nurse should INCREASE the irrigation fluid to clear red urine, not decrease the rate. #5 Those values assess kidney function, not the circ system so this is not an appropriate intervention)

bph d: The client returned from surgery after having a TURP and has a P 110, RR 24, BP 90/40and cool clammy skin. Which interventions should the nurse implement? SATA 1. Assess the urine in the continuous irrigation drainage bag 2. Decrease the irrigation fluid in the continuous irrigation catheter 3. Lower the HOB while raising the foot of bed 4. Contact the surgeon to give an update on the clients condition 5. Check the clients post op creatinine and BUN

2 (These crystals are uremic frost resulting from irritating toxins deposited in the clients tissues. Bathing in cool water will remove the crystals, promote client comfort and decrease the itching resulting from uremic frost. WRONG: #1 a moisture barrier would keep the crystals on the skin, #3 the client should be turned q2 to prevent skin breakdown. #4 this may occur with ARF and DOES require nursing intervention)

d The UAP tells the nurse that the client with ARF has a white crystal like layer on top of the skin. Which intervention would 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

1,2,3 (renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures, in recovery period, the client is alert and has no seizure activity. In renal failure levels of erythropoietin are decreased, leading to anemia. An increase in hbg and hct indicates the client is in recovery. N/V and D are common in the client with ARF; therefore an absence of these indicates the client is in recovery. WRONG: #4/#5 The client in the recovery period has an INCREASED specific gravity, and has a DECREASED creatinine level)

d The client diagnosed with ARF. Which S/S indicate to the nurse the client is in the recovery period? SATA 1. Increased alertness and no seizure activity 2. Increase in hgb and hct 3. Denial of N/V 4 Decreased urine specific gravity 5. Increased serum creatinine level

3 (regular insulin along with glucose, will drive K into the cells, thereby lowering serum K levels temporarily. #1 stimulates RBC production, not affect K, #2 does help protect the heart from the effect of high K. #4 a LOOP diuretic may be ordered to decrease K level)

d The client dx with ARF is experiencing hyperkalemia Which medications should the nurse prepare to administer to help decrease the K level? 1. erythropoietin 2. calcium gluconate 3. regular insulin 4. osmotic diuretic

3 (Dehydration results in concentrated serum, causing lab values to increase because the blood has normal constituents but not enough volume to dilute the values to wnl or lower. WRONG: #4 In renal failure the kidneys cannot excrete urine and this results in TOO MUCH fluid in the body. #1 Clients who are OVERhydrated or have FVE, experience DILUTED values of Na and RBCs. The levels are lower not higher)

f/e The client admitted to a nursing unit from a LTC with a hct of 56% and Na 152. Which condition is a cause for these findings? 1. OVerhydration 2. Anemia 3. dehydration 4. renal failure

2 (FVE refers to an isotonic expansion of the extracellular fluid by an abnormal expansion of water and NA. Therefore Na is restricted to allow the body to excrete the water. WRONG: #4 If the FVE is the reslut of renal failure then hemodialysis may be ordered. but this info is NOT PROVIDED in this stem. #3 High blood glucose result in viscous blood and cause the kidneys to try to fix the problem by excreting glucose through INCREASING urine outputs, which would result in FVD. #1 Nursing plans of care do not change HCP orders)

f/e The nurse writes the client problem of FVE. Which intervention should be included in the plan of care? 1. change the IV fluid from NS to D5W 2. Restrict the Na in the clients diet 3. Monitor the blood glucose levels 4. Prepare for hemodialysis

d (The answer is D. The adrenal glands are responsible for maintaining cortisol production not the kidneys.)

The kidneys are responsible for performing all the following functions EXCEPT? A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production

1 (There are 3 categories of ARF. Prerenal, intrarenal, and postrenal. Cause 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 MI, there was a decrease in the perfusion of the kidneys caused by impaired cardiac function. An obstruction within the urinary tract, such as from kidney stones, tumors, or BPH is called post renal 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)

A client developed cardiogenic shock after a severe MI and has now developed ARF. The clients family asks the nurse why the client has developed ARF 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

2 (during dwell time the dialysis solution is allowed to remain in the peritoneal cavity for the time prescribed by the HCP, usually 20-45 mins) During this time, the nurse should monitor the clients respiratory status because the pressure of the dialysis solution on the diaphragm can creat respiratory distress. The dialysis solution would not cause urticaria or affect the circ to the fingers. The clients lab values are obtained before beginning treatment and are monitored every 4-8 hrs during the treatment not just during the dwell time)

A client is receiving peritoneal dialysis. While the dialysis solution is dwelling in the clients abdomen, the nurse should: 1. assess for urticaria 2. observe respiratory status 3. check capillary refill time 4. monitor the electrolyte status

4 (Solution for peritoneal dialysis should be warmed to body temp 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 cath is not required. The nurse should position the client in a supine or low fowlers position.)

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 cath 3. ask the client to turn towards the left side 4. warm the dialysate in the warmer

4 (Constipation may contribute to a 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, D, V and flatulence typically do not cause decreased outflow in a peritoneal dialysis cath)

A client undergoing long term peritoneal dialysis at home is currently experiencing a reduced outflow from the cath. To determine if the cath is obstructed, the nurse should inquire whether the client has: 1. diarrhea 2. vomiting 3. flatulence 4. constipation

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 RBCs and lowered metabolic rate do not elevate BUN)

A client who is in ARF has an elevated BUN. What is the likely cause of this finding? 1. fluid retention 2, hemolysis of RBCs 3. below normal metabolic rate 4. reduced renal blood flow

1 (Hyperkalemia places the client at risk for serious cardiac arrhythmias and cardiac arrest. )

A client with ARF has an increase in the serum K level. The nurse should monitor the client for : 1. cardiac arrest 2. pulmonary edema 3. circulatory collapse 4. hemorrhage

2 (The nurse must always auscultate for a bruit and palpate for a thrill in the arm with the fistula and promptly report the absence of either to the HCP. as it indicates occlusion. The client SHOULD NOT have a pressure dressing or wear tight clothing, or carry heavy items on that side, no procedures such as IV access BP or blood draws are done on that arm)

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 BP in the arm with the fistula 2. report the loss of a thrill or bruit on the arm with the fistula 3. maintain a pressure dressing on the shunt 4 start a second IV in the arm with the fistula

b (The answer is B. This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this as well.)

A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood? A. Calcium B. Urea C. Phosphate D. Erythropoietin

b (he patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used without a doctor's order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed)

A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? a Low-protein diet with unlimited amounts of water b Low-protein diet with a prescribed amount of water c No protein in the diet and use of a salt substitute d No restrictions

2 (weight loss is expected because of the removal of fluid. The clients weight before and after dialysis is one measure of the effectiveness of treatment. BP 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)

After completion of peritoneal dialysis, the nurse should assess the client for: 1. hematuria 2. weight loss 3. hypertension 4. increased urine output

1 (pulmonary edema can develop during the oliguric phase of ARF. because of decreased urine output and fluid retention. Metabolic ACIDOSIS develops because the kidneys cannot excrete hydrogen ions, and bicarb is used to buffer hydrogen. HTN may develop as a result of fluid retention. Hyper K develops as kidneys lose the ability to excrete K)

In the oliguric phase of ARF the nurse should assess the client for: 1. pulmonary edema 2 metabolic alkalosis 3. hypotension 4. hypokalemia

4 (Clients with Na level LESS THAN 120 are at risk for seizure. The lower the Na level the greater the risk. WRONG#1 The client will be placed on fluid restriction, #3 the ADH would cause fluid retention which would increase the problem as it is a vasopressin #2 Hypertonic solutions are 3-5% NOT 10. They may be used @ 3-5% cautiously because if Na levels increase too rapidly a massive fluid shift can occur in the body resulting in neuro damage and HF)

The client admitted with a serum sodium of 110. Which nursing intervention should be implemented? 1 Encourage oral fluids 2. Admin 10% saline solution IVPB 3. Admin ADH intranasally 4. Place on seizure precautions

2 (Bedrest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of K and accumulation of endogenous waste products, such as urea and creatinine. WRONG:#1 Kidney function is improved about 40% when recumbent, but this is not the scientific rationale for bedrest for ARF. #3 That would be the rationale for HF #4 This is not the rationale, it can increase sacral edema, elevating the foot of the bed may reduce peripheral edema)

The client dx with ARF is placed on bedrest. The client asks the nurse, :Why do I have to stay in bed? I dont feel bad" Which scientific rationale supports the nurses response? 1. Bedrest helps increase the blood return to the renal circulation 2. Bedrest reduces the metabolic rate during the acute stage 3. Bed rest decreases the workload of the L side of the heart 4. Bed rest aids in reduction of peripheral and sacral edema

3 (The UAP can take the client to the car. Post procedure VS should not be delegated due to high risk, Assessment and teaching are done by the RN)

The client dx with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP? 1. Monitor the amount color and consistency of the urine 2. Teach the client about care of the indwelling cath 3. assist the client to the car when being discharged home 4. Take the clients postprocedural VS

1 (duh if you dont know this already... just quit)

The client in ARF has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client? 1. use the unaffected arm for BP 2,. draw blood work from the cannula for routine labs 3. percuss the cannula for bruits each shift 4. inject heparin into the cannula each shift

1 (The nurse should place the clients chair with the head lower than the body, which will shunt the blood to the brain. this is the Trendelenburg position. WRONG: #2 The blood in the dialysis machine must be infused back into the client before being turned off. #3 NS 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 need not be notified)

The client receiving dialysis is complaining of being dizzy and light headed. Which action should the nurse implement first? 1. Place the client in Trendelenberg position 2. Turn off the clients dialysis machine immed 3. Bolus the client with 500 mL NS 4. Notify the HCP asap

1 (Foods high in K include: bran, whole grains, most dried, raw and frozen fruits and veges, most milk and milk products, chocolate, nuts, raisens, coconut and strong brewed coffee)

The client with ARF asks the nurse for a snack. Because the clients K is elevated, which snack is most appropriate? 1. A gelatin dessert 2. yogurt 3. an orange 4. peanuts

1 (The kidneys have a remarkable recovery ability from serious insult. The client should be taught how to recognize the signs and symptoms of decreasing renal function and to notify the HCP if they occur. Recovery may take 3-12 months. Chronic renal failure develops BEFORE ESRF)

The client with ARF is recovering and asks the nurse "Will my kidneys ever function normally again?" The nurses response is based on knowledge that the clients renal status 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

2 (reflect and restate are therapeutic responses the nurse should use)

The male client with CKD is dx with CKD seconary to diabetes and 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 anymore dialysis treatments. Which response by the nurse is most appropriate? 1. You cannot just quit your dialysis, This is not an option 2. Your 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

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.)

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

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. Unless the client provides additional information, it is not necessary to refer the client to counseling at this time)

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

4 (oliguria is the most common initial symptom of ARF. Anuria is rarely the initial symptom. Dysuria and hematuria are not assoc with ARF)

Which initial manifestation of ARF is most common? 1. dysuria 2 anuria 3. hematuria 4. oliguria

2 (Uremia can cause decreased alertness, so the nurse needs to validate the clients comprehension frequently. Because the clients 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 videos because the client may not be able to maintain alertness during the viewing of the videotape)

Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate? 1. Provide all needed teaching in one extended session 2, validate the clients understanding of the material freq 3. conduct one on one session with the client 4 use video clips to reinforce the material as needed

b (The answer is B. A normal phosphate level is 2.7-4.5 mg/dL. This patient is experiencing HYPERphosphatemia. When hyperphosphatemia presents the calcium level DECREASES because phosphate and calcium bind to each. When there is too much phosphate in the blood it takes too much calcium with it and it decreases the calcium in the blood. Therefore, the nurse would expect to find the calcium level decreased.)

While assessing morning labs on your patient with CKD. You note the patient's phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be? A. Elevated B. Low C. Normal D. Same as the phosphate level

b (oliguria is less than 400 mL in 24 hrs)

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

4 (Normal K level is 3.5-5.5 mEq/L A level of 6.8 is life- threatening. and could lead to cardiac dysrhythmias. Therefore the client may be dialyzed to decrease the potassium level quickly. This requires a HCP order, so it is a collaborative intervention. WRONG: #1 phosphate binders are used to treat elevated phosphorous levels, not K. #2 Anemia is not the result of elevated K. #3 assessment is a independent action)

d The client dx 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

1 (Carrying heavy objects in the LA could cause the fistula to clot by putting undue stress on the site. so the client should carry objects with the R arm. The fistula should ONLY be used for dialysis, do not lie on the affected side, and hand exercise IS recommended for new fistulas to help mature the fistula)

d The client dx with CKD has a new arteriovenous fistula in the LFA. Which intervention should the nurse implement? 1. Teach the client to carry heavy objects with the right arm 2. Perform all lab test on L arm 3. Instruct the client to lay on the L arm during the night 4. Discuss the importance of not performing any hand excercises

2 (The clients dialysis access is compromised. and should be assessed first. WRONG: #1 These labs are low but do not require a blood transfusion, and are often expected in ESRD #3 It is not uncommon for a client undergoing dialysis to be exhausted and sleep thru treatment. #4 Clients are instructed not to take the antihypertensive meds before dialysis to prevent episodes of hypotension)

d The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1 The client who has a hgb of 9.8 and hct 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

4 (Medications such as NSAIDS and some herbal remedies are nephrotoxic; and some herbal remedies are nephrotoxic, therefore asking about meds is appropriate. )

d The nurse is admitting a client dx with ARF Which question is most important for the nurse to ask during the admission interview? 1. Have you recently traveled outside the US? 2. Did you recently begin a rigorous exercise program? 3. IS there a chance you have been exposed to a virus? 4. What OTC meds do you take regulary?

2 (Hypotension is a possible complication of peritoneal dialysis, the nurse records I&O's. VS. and observes the clients behavior. The nurse also encourages visiting and other diversional activities. A client on dialysis does not need to be kept NPO or have padded side rails)

Which should be included in the clients plan of care during dialysis therapy? 1. Limit the clients visitors 2. Monitor the clients BP 3. Pad the side rails of the bed 4. Keep the client NPO