Renal nclex review 11 and 12

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

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

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

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

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

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

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

80. 2, 4, 5. To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty, eat food before drinking fluids to alleviate dry mouth, encourage strict follow-up for blood work, dialysis, and health care provider visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.

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

80. 2,4,5. To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty and eat food before drinking fluids to alleviate dry mouth, and encourage strict follow-up for blood work, dialysis, and healthcare provider (HCP) visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.

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

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

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

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

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

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

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

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

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

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

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

87. 1, 2, 4, 5. Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. If peritonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Peritonitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.

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

87. 1,2,4,5. Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. If peritonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Peritonitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.

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

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

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

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

89. 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 Curling's stress ulcers 3. binding phosphate in the intestine 4. reversing metabolic acidosis

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

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

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

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

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

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

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

91. 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 client's understanding of the material frequently. 3. Conduct a one-on-one session with the client. 4. Use video clips to reinforce the material as needed.

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

93. 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 to accept that sexual activity will be decreased. 2. Suggest using alternative forms of sexual expression and intimacy. 3. Tell the client to plan rest periods after sexual activity. 4. Refer the client to a counselor.

93. 2. Altered sexual functioning commonly occurs in chronic renal failure and can stress marriages and relationships. Altered sexual functioning can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity. Unless the client provides additional information, it is not necessary to refer the client to counseling at this time.

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

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

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

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

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

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

79. A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula, the nurse should: 1. take the blood pressure in the arm with the fistula. 2. report the loss of a thrill or bruit on the arm with the fistula. 3. maintain a pressure dressing on the shunt. 4. start a second IV in the arm with the fistula.

79. 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 a thrill or bruit to the healthcare provider (HCP) as it indicates an occlusion. The client should not have a pressure dressing on the shunt and should avoid wearing tight clothing or carrying heavy items such as purse over the area of the shunt to avoid restricting blood flow in the shunt. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.

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

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

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

84. 2. Fluid return with peritoneal dialysis is accomplished by gravity flow. Actions that enhance gravity flow include turning the client from side to side, raising the head of the bed, and gently massaging the abdomen. The client is usually confined to a recumbent position during the dialysis. The nurse should not attempt to reposition the catheter.

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

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

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

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

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

84. 2. Fluid return with peritoneal dialysis is accomplished by gravity flow. Actions that enhance gravity flow include turning the client from side to side, raising the head of the bed, and gently massaging the abdomen. The client is usually confined to a recumbent position during the dialysis. The nurse should not attempt to reposition the catheter.

90. The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching? 1. "I will take it every 4 hours 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 snacks."

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

95. The client asks about diet changes when using continuous ambulatory peritoneal dialysis (CAPD). 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 than with standard peritoneal dialysis because dialysis is constant." 4. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly."

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

85.A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, the nurse should inquire whether the client has: 1.Diarrhea. 2.Vomiting. 3.Flatulence. 4.Constipation.

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

96. A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which sign of peritoneal infection? 1. cloudy dialysate fluid 2. swelling in the legs 3. poor drainage of the dialysate fluid 4. redness at the catheter insertion site

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

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

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

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

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

77. A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? Select all that apply. 1. Remind healthcare providers (HCPs) to draw blood from veins on the left side. 2. Avoid sleeping on the left arm. 3. Wear wristwatch on the right arm. 4. Assess fingers on the left arm for warmth. 5. Obtain BP from the left arm.

77. 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 circulation, such as warmth and color. When the client is hospitalized, the nurse posts a sign on the client's bed not to draw blood or obtain BP on the left side; the client is also instructed to be sure that none of the healthcare team members do so.

78. A client with end-stage chronic renal failure is admitted to the hospital with a serum potassium level of 7 mEq/L. In what order of priority from first to last does the nurse perform the prescriptions? All options must be used. 1. Administer calcium gluconate. 2. Start an IV access site. 3. Administer sodium polystyrene sulfonate. 4. Attach the client to a cardiac monitor.

78. 2,4,1,3. The nurse first assures an IV access site in case the client has respiratory or cardiac arrest. Next, the nurse monitors the client's heart rate and rhythm: Cardiovascular signs of elevated serum potassium levels are irregular, slow heart rate; decreased BP; narrow, peaked T waves; widened QRS complexes, prolonged PR intervals, and flattened D waves; frequent ectopy; ventricular fibrillation; and ventricular standstill. The nurse then administers calcium gluconate, which has an immediate action to antagonize the effect of hyperkalemia on cardiac muscle. Last, the nurse administers polystyrene sulfonate, which is a cation-exchange resin that removes potassium from the body by exchanging sodium ion for potassium; potassium-containing resin is then excreted; onset is in several hours to days.

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

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

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

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