Saunders NCLEX-RN - Hypersensitivity Reactions and Allergy, Acute Kidney Injury, Chronic Kidney Disease

The nurse has provided instruction to a client with chronic kidney disease who has a prescription for epoetin alfa. Which statement by the client indicates that teaching was effective? 1. "I have to receive this medication subcutaneously." 2. "I will receive this medication through intramuscular injection." 3. "This medication has to be administered using the Z-track method." 4. "I will take this medication orally with the rest of my morning pills."

Answer: 1. "I have to receive this medication subcutaneously." Rationale: Epoetin alfa is administered parenterally by the intravenous or subcutaneous route. It cannot be given orally because it is a glycoprotein and would be degraded in the gastrointestinal tract. Test-Taking Strategy(ies): Note the strategic word, effective. Focus on the subject, epoetin alfa. Knowledge regarding the administration of this medication is required to answer this question. Eliminate options 3 and 4 first because they are comparable or alike. Z-track is an intramuscular injection. From the remaining options, remember that epoetin alfa (erythropoietin) is administered parenterally by either the intravenous or the subcutaneous route.

The nurse provides home care instructions to a client undergoing hemodialysis with regard to care of a newly created arteriovenous (AV) fistula. Which client statement indicates that teaching was effective? 1. "I should check the fistula every day by feeling it for a vibration." 2. "I am glad that the laboratory will be able to draw my blood from the fistula." 3. "I should wear a shirt with tight arms to provide some compression on the fistula." 4. "I should check my blood pressure in the arm where I have my fistula every week."

Answer: 1. "I should check the fistula every day by feeling it for a vibration." Rationale: An AV fistula provides access to the client's bloodstream for the dialysis procedure. The client is instructed to monitor fistula patency daily by palpating for a thrill (vibration feeling). The client is instructed to avoid compressing the fistula with tight clothing or when sleeping and that blood pressure measurements and blood draws should not be performed on the arm with the fistula. The client also is instructed to assess the fistula for signs and symptoms of infection, including pain, redness, swelling, and excessive warmth. Test-Taking Strategy(ies): Note the strategic word, effective. Focus on the subject, client understanding of the instructions about care of the fistula. Recalling that fistula patency and protecting the fistula from injury are the priorities will direct you to option 1.

A client has chronic kidney disease (CKD) that does not yet require dialysis. Which client statement indicates the need for further teaching? 1. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." 2. "The amount of fluid I can have every day depends on the amount of urine I put out." 3. "I will weigh myself on my bathroom scale every morning right after I have urinated." 4. "I should report a gain in weight, trouble with my breathing, or increased leg swelling."

Answer: 1. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." Rationale: CKD is a condition in which the kidneys have progressive problems in their ability to clear nitrogenous waste products and control fluid and electrolyte balance within the body. Conservative treatment of CKD slows progression of the disease and includes reducing the protein, sodium, potassium, and phosphorus in the diet, and controlling the blood pressure. It is important to reduce the sodium in the diet. Salt substitutes usually are potassium-based and should not be used by a client with CKD because of the risk of hyperkalemia. The client should alter the fluid intake in relation to urine output. Obtaining a daily weight is an important measurement that indicates fluid volume. The client should also monitor for signs and symptoms of fluid overload, which could include an increase in weight, edema, and fluid collection in the lungs. Test-Taking Strategy(ies): Focus on the subject, CKD. Also note the strategic words, need for further teaching. These words indicate a negative event query and the need to select the incorrect statement. Recall the pathophysiology associated with CKD and recognize that salt substitutes usually are potassium-based to assist you in answering correctly.

What actions should the nurse take when caring for a client with an anaphylactic reaction? Select all that apply. 1. Administer oxygen. 2. Maintain airway patency. 3. Start an intravenous (IV) line. 4. Administer medications as prescribed: 5. Contact the primary health care provider (PHCP). 6. Place the client supine with the legs in a dependent position over the side of the bed.

Answer: 1. Administer oxygen. 2. Maintain airway patency. 3. Start an intravenous (IV) line. 4. Administer medications as prescribed: 5. Contact the primary health care provider (PHCP). Rationale: If the client experiences an anaphylactic reaction, the immediate action would be to assess the respiratory status quickly and maintain a patent airway. The PHCP or Rapid Response Team is called. In the meantime, the nurse stays with the client and monitors the client's vital signs and also for signs of shock. An IV device is inserted if one is not already in place and normal saline is infused. The nurse then prepares for the administration of diphenhydramine and epinephrine and other medications as prescribed. The head of the bed is elevated if the client's blood pressure is normal. The client's feet and legs may be raised if the blood pressure is low. The nurse documents the event, actions taken, and the client's response. Test-Taking Strategy(ies): Focus on the subject, care to a client with an anaphylactic reaction. Think about the pathophysiology associated with anaphylaxis. Also, recalling that shock is a concern and thinking about the interventions for shock will assist in answering correctly.

What actions should the nurse take when caring for a client having an anaphylactic medication reaction? Select all that apply. 1. Assess vital signs. 2. Administer oxygen. 3. Ensure a patent airway. 4. Contact the primary health care provider (PHCP). 5. Continue the medication but monitor closely and note the reaction in the chart.

Answer: 1. Assess vital signs. 2. Administer oxygen. 3. Ensure a patent airway. 4. Contact the primary health care provider (PHCP). Rationale: If anaphylaxis occurs, the nurse immediately assesses the client's respiratory status. The medication is also immediately stopped. If the client's airway needs to be established or stabilized, the Rapid Response Team is called. In addition, the PHCP is contacted. The intravenous (IV) line is not removed because IV access is needed to administer emergency medications such as diphenhydramine or epinephrine. The client is positioned appropriately. The legs and feet are elevated. The head of the bed is elevated to improve ventilation; elevate the head of the bed 10 degrees if hypotension is present and 45 degrees or higher if the blood pressure is normal. The nurse stays with the client and monitors the client's status, including the vital signs. The nurse documents the event, actions taken, and the client's response. Test-Taking Strategy(ies): Note the subject, actions to take in an anaphylactic medication reaction. Think about the pathophysiology that occurs in an anaphylactic reaction and its cause. Since the cause is a medication, it must be stopped, making option 5 incorrect.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% (0.33) 2. Platelet count of 400,000 mm3 (400 × 10^9/L) 3. White blood cell count of 6000 mm3 (6.0 × 10^9/L) 4. Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

Answer: 1. Hematocrit of 33% (0.33) Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male: 42% to 52% (0.42 to 0.52); Female: 37% to 47% (0.37 to 0.47). Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 10^9/L). The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 10^9/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin. Test-Taking Strategy(ies): Focus on the subject, a therapeutic effect. Relate the name of the medication, epoetin alfa, to the potential action or effect of erythropoietin. The only laboratory test that would reflect the effect of this medication is a hematocrit of 33% (0.33), found in the correct option.

A client with chronic kidney disease has a medication prescription for epoetin alfa. The nurse should plan to administer this medication by which method? 1. Subcutaneously 2. Intramuscularly 3. With a full glass of water 4. Diluted in juice to enhance taste

Answer: 1. Subcutaneously Rationale: Epoetin alfa is erythropoietin that has been manufactured through the use of recombinant DNA technology. It is used to treat anemia in the client with chronic kidney disease. The medication may be administered subcutaneously or intravenously as prescribed. Test-Taking Strategy(ies): Focus on the subject, route of administration of epoetin alfa. Specific knowledge of epoetin alfa is necessary to answer this question. Remember that this medication is administered subcutaneously or intravenously; this will assist in answering questions similar to this one.

A client with chronic kidney disease (CKD) who is receiving an antihypertensive medication is experiencing frequent hypotensive episodes. The nurse reviews the client's medication record, knowing that which medication would have the greatest tendency to cause hypotension? 1. Methyldopa 2. Epoetin alfa 3. Levothyroxine 4. Calcium carbonate

Answer: 1. Methyldopa Rationale: Methyldopa is metabolized by the kidneys and requires careful dosage adjustment according to the client's renal function to prevent hypotension. Calcium carbonate is used in the treatment of calcium deficiency and does not cause hypotension when administered via the oral route. Parenteral administration of calcium may cause hypotension. Levothyroxine does not cause hypotension. Epoetin alfa is an erythropoietin and is more likely to cause hypertension than hypotension. Test-Taking Strategy(ies): Focus on the subject, hypotensive episodes. Eliminate options 2, 3, and 4 because they are not used to control blood pressure. Also, recalling that methyldopa is an antihypertensive medication will direct you to the correct option.

Aluminum hydroxide is prescribed for a client with chronic kidney disease (CKD). The nurse should instruct the client to take this medication at what time? 1. At bedtime 2. With meals 3. On an empty stomach 4. In the morning on arising

Answer: 2. With meals Rationale: The client who is receiving aluminum hydroxide should take the medication with meals. The phosphate-binding effect of this medication is most effective when it is taken with food. If tablets are used, they should be chewed well before swallowing. Test-Taking Strategy(ies): Focus on the subject, administration of aluminum hydroxide. Note that options 1, 3, and 4 are comparable or alike in that they all suggest administering the medication without a food item.

A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? 1. "Clear the nasal passages after use." 2. "Take the medication only as needed." 3. "The medication should start to work immediately." 4. "The medication works locally and decreases inflammation."

Answer: 4. "The medication works locally and decreases inflammation." Rationale: Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. The client should be instructed to clear the nasal passages before use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation. Test-Taking Strategy(ies): Focus on the subject, instructions on use of a nasal corticosteroid. To answer this question accurately, recall the functions of this medication. Also, eliminate option 1 because of the word after. Eliminate option 2 because of the closed-ended word "only." Eliminate option 3 because of the word immediately.

A client with a severe allergic reaction is prescribed intravenous corticosteroids. The nurse should expect that which desired effect will be achieved? 1. Pain relief 2. Enhanced immunity 3. Increased serum glucose 4. Decreased inflammation

Answer: 4. Decreased inflammation Rationale: A corticosteroid acts as an anti-inflammatory. Although reduction of inflammation may relieve pain, this is not the indication of the use of corticosteroids in the allergic response. Corticosteroids increase serum glucose, but this is not a therapeutic response. These medications decrease immunity. Test-Taking Strategy(ies): Focus on the subject, the desired effect for a client with a severe allergic reaction. Knowledge of corticosteroids is needed to answer this question. Remember that a corticosteroid acts as an anti-inflammatory.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? 1. Warmth, redness, and pain in the left hand 2. Ecchymosis and audible bruit over the fistula 3. Edema and reddish discoloration of the left arm 4. Pallor, diminished pulse, and pain in the left hand

Answer: 4. Pallor, diminished pulse, and pain in the left hand Rationale: Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth and redness probably would characterize a problem with infection. Ecchymosis and a bruit are normal findings for a fistula. Test-Taking Strategy(ies): Focus on the subject, arterial steal syndrome. Eliminate signs associated with infection or normal fistula findings. Recalling that steal syndrome results from vascular insufficiency after creation of a fistula will direct you to the correct option.

A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? 1. The client washes hands at least once per day. 2. The client's temperature remains lower than 101º F (38.3º C). 3. The client avoids blood pressure (BP) measurement in the left arm. 4. The client's white blood cell (WBC) count remains within normal limits.

Answer: 4. The client's white blood cell (WBC) count remains within normal limits. Rationale: General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand-washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the problem of risk for injury. Test-Taking Strategy(ies): Focus on the subject, risk for infection, and note the strategic word, best. Of the options provided, a normal WBC count is the best indicator that the client is infection free.

The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client indicates an accurate understanding of CAPD? 1. "No machinery is involved, and I can pursue my usual activities." 2. "A cycling machine is used, so the risk for infection is minimized." 3. "The drainage system can be used once during the day and a cycling machine for 3 cycles at night." 4. "A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."

Answer: 1. "No machinery is involved, and I can pursue my usual activities." Rationale: CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure. Test-Taking Strategy(ies): Read the options carefully, noting that options 2, 3, and 4 are comparable or alike and address the use of a cycling machine. The correct option is the one that is different and correctly describes the procedure for CAPD.

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option? 1. A client with severe heart failure 2. A client with a history of ruptured diverticula 3. A client with a history of herniated lumbar disk 4. A client with a history of 3 previous abdominal surgeries

Answer: 1. A client with severe heart failure Rationale: Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease. Severe cardiac disease can be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with hemodialysis. For the same reason, peritoneal dialysis may be indicated for the client with diabetes mellitus. Contraindications to peritoneal dialysis include diseases of the abdomen such as ruptured diverticula or malignancies; extensive abdominal surgeries; history of peritonitis; obesity; and a history of back problems, which could be aggravated by the fluid weight of the dialysate. Severe disease of the vascular system also may be a relative contraindication. Test-Taking Strategy(ies): Note the strategic word, best. Note the subject, the best candidate for peritoneal dialysis. Eliminate options 2 and 4 first because they are comparable or alike and describe clients with an abdominal condition. Regarding the remaining options, recall the concepts related to fluid shifts in the body and the rapid fluid shifts that occur with hemodialysis to direct you to the correct option.

A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing interventions are appropriate in working with this client? Select all that apply. 1. Acknowledge the client's feelings. 2. Assess the client and family's coping patterns. 3. Explore the meaning of the illness with the client. 4. Set limits on mood swings and expressions of hostility. 5. Give the client information when the client is ready to listen.

Answer: 1. Acknowledge the client's feelings. 2. Assess the client and family's coping patterns. 3. Explore the meaning of the illness with the client. 5. Give the client information when the client is ready to listen. Rationale: Clients with ESRD are likely to experience mood swings or express hostility, anger, and depression, among other responses. The nurse should acknowledge the client's feelings, allow the client to express those feelings, and be supportive. Options 1, 2, 3, and 5 are helpful and appropriate interventions for the client. Setting limits for this client is not client focused, does not allow the client to express concerns, and is nontherapeutic in this situation. Test-Taking Strategy(ies): Focus on the subject, interventions for the client with ineffective coping who has ESRD. Knowledge of basic communication strategies and psychosocial support will direct you to the correct option. Setting limits would not be helpful in this client situation.

A client with chronic kidney disease being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious, and the nurse suspects air embolism. What are the priority nursing actions? Select all that apply. 1. Administer oxygen to the client. 2. Continue dialysis at a slower rate after checking the lines for air. 3. Notify the primary health care provider (PHCP) and Rapid Response Team. 4. Stop dialysis, and turn the client on the left side with head lower than feet. 5. Bolus the client with 500 mL of normal saline to break up the air embolus.

Answer: 1. Administer oxygen to the client. 3. Notify the primary health care provider (PHCP) and Rapid Response Team. 4. Stop dialysis, and turn the client on the left side with head lower than feet. Rationale: If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, position the client so the air embolus is in the right side of the heart, notify the PHCP and Rapid Response Team, and administer oxygen as needed. Slowing the dialysis treatment or giving an intravenous bolus will not correct the air embolism or prevent complications. Test-Taking Strategy(ies): Note the strategic word, priority. Recall that air embolism is an emergency situation that affects the cardiopulmonary system suddenly and profoundly. Select the options that deal with the problem, supply oxygen, and get needed assistance.

A client develops an anaphylactic reaction after receiving morphine. The nurse should plan to institute which actions? Select all that apply. 1. Administer oxygen. 2. Quickly assess the client's respiratory status. 3. Document the event, interventions, and client's response. 4. Keep the client supine regardless of the blood pressure readings. 5. Leave the client briefly to contact a primary health care provider (PHCP). 6. Start an intravenous (IV) infusion of D5W and administer a 500-mL bolus.

Answer: 1. Administer oxygen. 2. Quickly assess the client's respiratory status. 3. Document the event, interventions, and client's response. Rationale: An anaphylactic reaction requires immediate action, starting with quickly assessing the client's respiratory status. Although the PHCP and the Rapid Response Team must be notified immediately, the nurse must stay with the client. Oxygen is administered and an IV of normal saline is started and infused per PHCP prescription. Documentation of the event, actions taken, and client outcomes need to be done. The head of the bed should be elevated if the client's blood pressure is normal. Test-Taking Strategy(ies): Focus on the subject, interventions the nurse takes for an anaphylactic reaction. Read each option carefully and remember that this is an emergency. Think about the pathophysiology that occurs in this reaction to answer correctly.

A client develops an anaphylactic reaction after receiving morphine. The nurse should plan to institute which actions? Select all that apply. 1. Administer oxygen. 2. Quickly assess the client's respiratory status. 3. Document the event, interventions, and client's response. 4. Keep the client supine regardless of the blood pressure readings. 5. Leave the client briefly to contact a primary health care provider (PHCP). 6. Start an intravenous (IV) infusion of D5W and administer a 500-mL bolus.

Answer: 1. Administer oxygen. 2. Quickly assess the client's respiratory status. 3. Document the event, interventions, and client's response. Rationale: An anaphylactic reaction requires immediate action, starting with quickly assessing the client's respiratory status. Although the PHCP and the Rapid Response Team must be notified immediately, the nurse must stay with the client. Oxygen is administered and an IV of normal saline is started and infused per PHCP prescription. Documentation of the event, actions taken, and client outcomes needs to be done. The head of the bed should be elevated if the client's blood pressure is normal. Test-Taking Strategy(ies): Focus on the subject, interventions the nurse takes for an anaphylactic reaction. Read each option carefully and remember that this is an emergency. Think about the pathophysiology that occurs in this reaction to answer correctly.

A client develops an anaphylactic reaction after receiving morphine. The nurse should plan to institute which actions? Select all that apply. 1. Administer oxygen. 2. Quickly assess the client's respiratory status. 3. Document the event, interventions, and client's response. 4. Leave the client briefly to contact a primary health care provider (PHCP). 5. Keep the client supine regardless of the blood pressure readings. 6. Start an intravenous (IV) infusion of D5W and administer a 500-mL bolus.

Answer: 1. Administer oxygen. 2. Quickly assess the client's respiratory status. 3. Document the event, interventions, and client's response. Rationale: An anaphylactic reaction requires immediate action, starting with quickly assessing the client's respiratory status. Although the PHCP and the Rapid Response Team must be notified immediately, the nurse must stay with the client. Oxygen is administered and an IV of normal saline is started and infused per PHCP prescription. Documentation of the event, actions taken, and client outcomes needs to be performed. The head of the bed should be elevated if the client's blood pressure is normal. Test-Taking Strategy(ies): Focus on the subject, interventions the nurse takes for an anaphylactic reaction. Read each option carefully and remember that this is an emergency. Think about the pathophysiology that occurs in this reaction to answer correctly.

A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply. 1. Agitation 2. Euphoria 3. Depression 4. Withdrawal 5. Labile emotions

Answer: 1. Agitation 3. Depression 4. Withdrawal 5. Labile emotions Rationale: The client with CKD often experiences a variety of psychosocial changes. These changes are related to uremia and to the stress associated with living with a chronic disease that is life threatening. Euphoria is not part of the clinical picture for the client in renal failure. Clients with CKD may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation which are used as coping mechanisms for a major life change. Delusions and psychosis also can occur. Test-Taking Strategy(ies): Focus on the subject, neurological and psychosocial manifestations of CKD. Think about the pathophysiology associated with this renal disorder to assist in answering correctly.

The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting which problem? 1. Anger 2. Projection 3. Depression 4. Withdrawal

Answer: 1. Anger Rationale: Psychosocial reactions to CKD and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems. The client in this question is exhibiting anger. The client's behavior is not indicative of projection; in addition, the client's statement does not reflect withdrawal or depression. Test-Taking Strategy(ies): Eliminate depression and withdrawal because they are comparable or alike. From the remaining choices, focus on the client's statement to direct you to the correct option.

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? 1. Blood pressure 2. Apical heart rate 3. Jugular vein distention 4. Level of consciousness

Answer: 1. Blood pressure Rationale: The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The heart rate affects the cardiac output but can be altered by factors unrelated to kidney function. Jugular vein distention and level of consciousness are unrelated items. Test-Taking Strategy(ies): Note the strategic word, best. Focusing on the subject of the question, the best indirect indicator of renal status, will assist in directing you to the correct option. Remember that the kidneys play a role in controlling the blood pressure.

A client in the later stages of chronic kidney disease (CKD) has hyperkalemia. With CKD, what other factors besides tissue breakdown can cause high potassium levels? Select all that apply. 1. Blood transfusions 2. Metabolic alkalosis 3. Bleeding or hemorrhage 4. Decreased sodium excretion 5. Ingestion of potassium in medications 6. Failure to restrict dietary potassium

Answer: 1. Blood transfusions 3. Bleeding or hemorrhage 5. Ingestion of potassium in medications 6. Failure to restrict dietary potassium Rationale: With CKD, factors other than tissue breakdown that can cause hyperkalemia include blood transfusions, bleeding or hemorrhage, ingestion of potassium in medications, and failure to restrict dietary potassium. Metabolic alkalosis and decreased sodium excretion are not contributing factors. Test-Taking Strategy(ies): Focus on the subject, hyperkalemia. Think about the causes of CKD and the factors other than tissue breakdown that can increase potassium levels in the body. With hyperkalemia, metabolic acidosis and not alkalosis is present, and the kidneys excrete more sodium and not less.

The client with chronic kidney disease has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. Which action should the nurse immediately take? 1. Change the dressing. 2. Reinforce the dressing. 3. Flush the peritoneal dialysis catheter. 4. Scrub the catheter with povidone-iodine.

Answer: 1. Change the dressing. Rationale: Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis. Test-Taking Strategy(ies): Note the strategic word, immediately. Also, note the subject, a wet dressing for an indwelling abdominal catheter for peritoneal dialysis. Recalling that this client is at risk for infection and knowing that it is better to change a wet dressing than to reinforce it will direct you to the correct option.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag. 2. Reposition the client to her or his side. 3. Place the client in good body alignment. 4. Check the peritoneal dialysis system for kinks. 5. Contact the primary health care provider (PHCP). 6. Increase the flow rate of the peritoneal dialysis solution.

Answer: 1. Check the level of the drainage bag. 2. Reposition the client to her or his side. 3. Place the client in good body alignment. 4. Check the peritoneal dialysis system for kinks. Rationale: If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting, and the clamps on the system are checked to ensure that they are open. There is no reason to contact the PHCP. Increasing the flow rate should not be done and also is not associated with the amount of outflow solution. Test-Taking Strategy(ies): Focus on the subject, outflow is less than inflow, and use the principles related to gravity flow and preventing obstruction to flow to answer this question. This will assist in determining the correct interventions.

Which finding noted in the client on continuous ambulatory peritoneal dialysis (CAPD) should be reported to the primary health care provider (PHCP)? 1. Cloudy yellow dialysate output 2. Client refusal to take the stool softener 3. Previous evening's dwell time of 8 hours 4. Peritoneal catheter site is not red, and the skin has grown around the cuff

Answer: 1. Cloudy yellow dialysate output Rationale: CAPD is a form of peritoneal dialysis in which exchanges are completed 4 or 5 times daily. Peritonitis is a major complication of this type of dialysis. Peritonitis can be recognized by cloudy dialysate outflow, fever, abdominal guarding (board-like abdomen), abdominal pain, pain on inflow, malaise, nausea, and vomiting. The client has the right to refuse medications, but it also is important for the nurse to explain the importance of medications to the client. Typically the dwell time during the night is for the entire time that the client sleeps, which could be around 7 to 9 hours. The peritoneal site should have intact skin. The skin grows around the peritoneal catheter cuff, and this prevents tunnel (around catheter) infections. Test-Taking Strategy(ies): Focus on the subject, a client on CAPD and the finding that should be reported to the PHCP. Recalling the signs of infection and peritonitis will direct you to the correct option.

A client with chronic kidney disease (CKD) has been taking aluminum hydroxide gel. On the basis of this information, the nurse determines that the client is most at risk for which problem? 1. Constipation 2. Dehydration 3. Inability to tolerate activity 4. Impaired physical mobility

Answer: 1. Constipation Rationale: The client with CKD is almost certain to have a problem with constipation as a result of factors such as fluid restriction, fatigue that limits exercise, and dietary restrictions. In addition, phosphate-binding antacids such as aluminum hydroxide gel cause constipation as a side effect. The other problems listed are unrelated to the information in the question. Test-Taking Strategy(ies): Note the strategic word, most. Note that inability to tolerate activity and impaired physical mobility are comparable or alike and thus can be eliminated. Also, focus on the subject, side effects of aluminum hydroxide gel, and on the information in the question, and recall that this medication causes constipation.

A home care nurse is assigned to visit a client who has returned home from the emergency department following treatment for a sprained ankle. The nurse notes that the client was sent home with crutches that have rubber axillary pads and needs instruction regarding crutch walking. On admission assessment, the nurse discovered that the client has an allergy to latex. Before providing instructions regarding crutch walking, what action should the nurse take? 1. Cover the crutch pads with cloth. 2. Contact the primary health care provider (PHCP). 3. Call the local medical supply store and ask that a cane be delivered. 4. Tell the client that the crutches must be removed from the house immediately.

Answer: 1. Cover the crutch pads with cloth. Rationale: Latex allergy is a type I hypersensitivity reaction in which a specific allergen is a processed natural latex rubber protein. The rubber pads used on crutches may contain latex. If the client requires crutches, the nurse can cover the pads with a cloth to prevent cutaneous contact. No reason exists to contact the PHCP at this time. The nurse cannot prescribe a cane for a client. In addition, this type of assistive device may not be appropriate, considering this client's injury. Telling the client that the crutches must be removed from the house is inappropriate and may alarm the client. Test-Taking Strategy(ies): Focus on the subject, a client with a latex allergy. Recall specific knowledge of alternative resources for a client with a latex allergy. No data in the question support the need to contact the PHCP. The nurse should not prescribe assistive devices for the client. Telling the client that the crutches must be removed from the house immediately is not a therapeutic action.

The nurse instructs a client with chronic kidney disease who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu? 1. Cream of wheat, blueberries, coffee 2. Sausage and eggs, banana, orange juice 3. Bacon, cantaloupe melon, tomato juice 4. Cured pork, grits, strawberries, orange juice

Answer: 1. Cream of wheat, blueberries, coffee Rationale: The diet for a client with chronic kidney disease who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids, which is indicated in the correct option. The food items in the remaining options are high in sodium, phosphorus, or potassium. Test-Taking Strategy(ies): Focus on the subject, dietary modification for a client with chronic kidney disease. Think about the pathophysiology of this disorder to recall that sodium needs to be limited. Noting the items sausage, bacon, and cured pork will assist in eliminating these options.

The nurse is reviewing a client's record and notes that the primary health care provider has documented that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Increased number of white blood cells in the urine

Answer: 1. Elevated creatinine level Rationale: The creatinine level is the most specific laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count are associated with anemia or blood loss and not specifically with decreased renal function. Increased white blood cells in the urine are noted with urinary tract infection. Test-Taking Strategy(ies): Note the strategic words, most likely. Note that options 2 and 3 are comparable or alike and are both part of hematology studies and therefore can be eliminated. Recalling the relationship between the creatinine level and renal function will direct you to the correct option.

The nurse is reviewing a client's record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Increased number of white blood cells in the urine

Answer: 1. Elevated creatinine level Rationale: The creatinine level is the most specific laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count are associated with anemia or blood loss and not specifically with decreased renal function. Increased white blood cells in the urine are noted with urinary tract infection. Test-Taking Strategy(ies): Note the strategic words, most likely. Recalling the relationship between the creatinine level and renal function will direct you to the correct option.

The community health nurse is conducting a research study and is identifying clients in the community at risk for latex allergy. Which client population is most at risk for developing this type of allergy? 1. Hairdressers 2. The homeless 3. Children in day care centers 4. Individuals living in a group home

Answer: 1. Hairdressers Rationale: Individuals most at risk for developing a latex allergy include health care workers; individuals who work in the rubber industry; or those who have had multiple surgeries, have spina bifida, wear gloves frequently (such as food handlers, hairdressers, and auto mechanics), or are allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, or water chestnuts. Test-Taking Strategy(ies): Focus on the subject, a latex allergy, and note the strategic word, most. Recalling the sources of latex and of the allergic reaction will direct you easily to the correct option.

The community health nurse is conducting a research study and is identifying clients in the community at risk for latex allergy. Which client population is most at risk for developing this type of allergy? 1. Hairdressers 2. The homeless 3. Children in day care centers 4. Individuals living in a group home

Answer: 1. Hairdressers Rationale: Individuals most at risk for developing a latex allergy include health care workers; individuals who work in the rubber industry; those who have had multiple surgeries, have spina bifida, or wear gloves frequently (i.e., food handlers, hairdressers, and auto mechanics); or people who are allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, or water chestnuts. Test-Taking Strategy(ies): Focus on the subject, a latex allergy, and note the strategic word, most. Recalling the sources of latex and of the allergic reaction will direct you easily to the correct option.

The nurse is caring for a client with chronic kidney disease. The nurse plans care knowing that besides maintaining urinary elimination, the kidneys also are involved in what body processes? Select all that apply. 1. Help regulate blood pressure. 2. Encourage immunosuppression. 3. Stimulate liver to secrete enzymes. 4. Assist to regulate acid-base balance. 5. Convert vitamin D to an active form. 6. Produce erythropoietin for red blood cell synthesis.

Answer: 1. Help regulate blood pressure. 4. Assist to regulate acid-base balance. 5. Convert vitamin D to an active form. 6. Produce erythropoietin for red blood cell synthesis. Rationale: Besides maintaining urinary elimination, the kidneys are also involved with helping to regulate blood pressure, assisting in regulating acid-base balance, converting vitamin D to an active form, and producing erythropoietin for red blood cell synthesis. The kidneys do not encourage immunosuppression and do not stimulate the liver to secrete enzymes. Test-Taking Strategy(ies): Focus on the subject, functions of the kidneys. Think about what body processes are dependent on kidney activity. Eliminate options 2 and 3 because the kidneys are not involved with immunosuppression or have any action directed to the liver. The remaining options are the correct options.

A client with chronic kidney disease has completed a hemodialysis treatment. The nurse should use which standard indicators to evaluate the client's status after dialysis? 1. Vital signs and weight 2. Potassium level and weight 3. Vital signs and blood urea nitrogen level 4. Blood urea nitrogen and creatinine levels

Answer: 1. Vital signs and weight Rationale: Following dialysis the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended. Test-Taking Strategy(ies): Note the subject, measures to determine the client's status after dialysis. Recalling the purpose of hemodialysis will direct you to the correct option.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% (0.33) 2. Platelet count of 400,000 mm3 (400 × 10^9/L) 3. White blood cell count of 6000 mm3 (6.0 × 10^9/L) 4. Blood urea nitrogen level of 15 mg/dL (5.4 mmol/L)

Answer: 1. Hematocrit of 33% (0.33) Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is 42% to 52% (0.42 to 0.52) for males and 37% to 47% (0.37 to 0.47) for females. Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (5 to 10 × 10^9/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin. Test-Taking Strategy(ies): Focus on the subject, a therapeutic effect. Relate the name of the medication, epoetin alfa, to the potential action or effect of erythropoietin. The only laboratory test that would reflect the effect of this medication is a hematocrit of 33% (0.33), found in the correct option.

A client recently diagnosed with chronic kidney disease requiring hemodialysis has an arteriovenous fistula for access. The client asks the nurse what complications can occur with the access site. What complications should the nurse inform the client about? Select all that apply. 1. Hepatitis 2. Infection 3. Hypertension 4. Muscle cramping 5. Post-treatment blood clots

Answer: 1. Hepatitis 2. Infection Rationale: Complications directly related to the access site for hemodialysis include hepatitis or infection as a result of poor infection control practices, as well as post-treatment blood loss from certain dialysis procedure practices and the removal of needles following the procedure. In addition, heparin is often given to prevent clotting of the access site; this can potentiate postdialysis bleeding. Hypotension from rapid removal of vascular volume can occur, as can muscle cramps from fluid shifting; however, these complications are not directly related to the access site. Test-Taking Strategy(ies): Focus on the subject, the complications of the access site used for hemodialysis. To answer this question, think about the procedure and what it involves. Recall that there is a potential for infection because of direct access to vasculature.

The nurse is performing assessment on a client with acute kidney injury who is in the oliguric phase. Which should the nurse expect to note? Select all that apply. 1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 4. A urine output of 600 to 800 mL in a 24-hour period 5. Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)

Answer: 1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 5. Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg) Rationale: During the oliguric phase of acute kidney injury, serum creatinine levels increase by approximately 1 mg/dL (88 mcmol/L) per day, and the BUN level increases by approximately 20 mg/dL (7.1 mmol/L) per day. The specific gravity of the urine is low and fixed, and the urine osmolarity approaches that of the client's serum level, or about 300 mOsm/kg (300 mmol/kg). Urine output is less than 100 mL in a 24-hour period. Test-Taking Strategy(ies): Focus on the subject, the oliguric phase of acute kidney injury. Think about the pathophysiology associated with acute kidney injury, and note the word oliguric. Recalling the definition of the word oliguric will assist in eliminating the incorrect option.

The nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? 1. Maintain strict aseptic technique. 2. Add heparin to the dialysate solution. 3. Change the catheter site dressing daily. 4. Monitor the client's level of consciousness.

Answer: 1. Maintain strict aseptic technique. Rationale: The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although changing the catheter site dressing daily may assist in preventing infection, this option relates to an external site. Adding heparin to the dialysate solution and monitoring the client's level of consciousness are unrelated to the major complication of peritoneal dialysis. Test-Taking Strategy(ies): Focus on the subject, the major complication associated with peritoneal dialysis. Visualize the peritoneal dialysis procedure to assist in recalling that the major concern is peritonitis. This will direct you to the correct option.

The nurse is caring for a client with chronic kidney disease on continuous replacement renal therapy (CRRT) without the use of a hemodialysis machine. The nurse determines that which parameter is most important in ensuring success of this treatment? 1. Mean arterial pressure (MAP) 2. Systolic blood pressure (SBP) 3. Diastolic blood pressure (DBP) 4. Central venous pressure (CVP)

Answer: 1. Mean arterial pressure (MAP) Rationale: Continuous renal replacement therapy (CRRT) provides continuous ultrafiltration of extracellular fluid and clearance of urinary toxins over a period of 8 to 24 hours; it is used primarily for clients with acute kidney injury (AKI) or critically ill clients with chronic kidney disease (CKD) who cannot tolerate hemodialysis. Water, electrolytes, and other solutes are removed as the client's blood passes through a hemofilter. If CRRT does not require a hemodialysis machine, the client's MAP needs to be maintained above 60 mm Hg, and arterial and venous access sites are necessary. The SBP, DBP, and CVP may be monitored but each of these measures a component of the cardiovascular status rather than the complete cardiac cycle. Test-Taking Strategy(ies): Note the strategic words, most important. Recall that the mean arterial pressure is a measure that takes into account the complete cardiac cycle and is therefore the umbrella option that encompasses all other options.

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first? 1. "Have you had any diarrhea?" 2. "Have you been constipated recently?" 3. "Have you had any abdominal discomfort?" 4. "Have you had an increased amount of flatulence?"

Answer: 2. "Have you been constipated recently?" Rationale: Reduced outflow from the dialysis catheter may be caused by the catheter position, infection, or constipation. Constipation may contribute to a reduced outflow because peristalsis seems to aid in drainage. Options 1, 3, and 4 are unrelated to the causes of reduced outflow from the dialysis catheter. Test-Taking Strategy(ies): Note the strategic word, first. Focus on the subject, decreased dialysate output. Consider how each of the options may contribute to this problem to direct you to the correct option.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula. 2. Presence of a radial pulse in the left wrist. 3. Visualization of enlarged blood vessels at the fistula site. 4. Capillary refill less than 3 seconds in the nailbeds of the fingers on the left hand.

Answer: 1. Palpation of a thrill over the fistula. Rationale: The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula patency. Although the presence of a radial pulse in the left wrist and capillary refill less than 3 seconds in the nailbeds of the fingers on the left hand indicate adequate circulation to the hand, they do not assess fistula patency. Test-Taking Strategy(ies): Eliminate options 2 and 4 first because they are comparable or alike, and assess for adequate circulation in the distal portion of the extremity (not the fistula). Enlarged blood vessels occur when the fistula is created. Select option 1, because a thrill indicates blood flow and patency of the fistula.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. apply. 1. Place the client on a cardiac monitor. 2. Notify the primary health care provider (PHCP). 3. Put the client on NPO (nothing by mouth) status except for ice chips. 4. Review the client's medications to determine whether any contain or retain potassium. 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

Answer: 1. Place the client on a cardiac monitor. 2. Notify the primary health care provider (PHCP). 4. Review the client's medications to determine whether any contain or retain potassium. Rationale: The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A potassium level of 7.0 is elevated. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the PHCP and also review medications to determine whether any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Test-Taking Strategy(ies): Note the strategic word, priority. First, note that the potassium level is significantly elevated to select options 1 and 4. Also, use the ABCs—airway, breathing, and circulation—to select option 2.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1. Place the client on a cardiac monitor. 2. Notify the primary health care provider (PHCP). 3. Put the client on NPO (nothing by mouth) status except for ice chips. 4. Review the client's medications to determine if any contain or retain potassium. 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

Answer: 1. Place the client on a cardiac monitor. 2. Notify the primary health care provider (PHCP). 4. Review the client's medications to determine if any contain or retain potassium. Rationale: The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A potassium level of 7.0 is elevated. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the PHCP and also review medications to determine if any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Test-Taking Strategy(ies): Note the strategic word, priority. First, note that the potassium level is significantly elevated to select options 2 and 4. Also, use the ABCs-airway, breathing, and circulation-to select option 1.

The nurse is conducting allergy skin testing on a client. Which postprocedure interventions are most appropriate? Select all that apply. 1. Record site, date, and time of the test. 2. Give the client a list of potential allergens if identified. 3. Estimate the size of the wheal and document the finding. 4. Tell the client to return to have the site inspected only if there is a reaction. 5. Have the client wait in the waiting room for at least 1 to 2 hours after injection.

Answer: 1. Record site, date, and time of the test. 2. Give the client a list of potential allergens if identified. Rationale: Skin testing involves administration of an allergen to the surface of the skin or into the dermis. Site, date, and time of the test must be recorded, and the client must return at a specific date and time for a follow-up site evaluation, even if no reaction is suspected. A list of potential allergens is identified and reviewed and given to the client. For the follow-up evaluation, the size of the site has to be measured and not estimated. After injection, clients only need to be monitored for about 30 minutes to assess for any adverse effects. Test-Taking Strategy(ies): Note the strategic words, most appropriate. Eliminate option 3, because any results must be accurately measured and not estimated. Eliminate option 4 because of the closed-ended word "only." Eliminate option 5, because it is unreasonable to have the client wait 1 to 2 hours.

The nurse is conducting allergy skin testing on a client. Which postprocedure interventions are most appropriate? Select all that apply. 1. Record site, date, and time of the test. 2. Give the client a list of potential allergens if identified. 3. Estimate the size of the wheal and document the finding. 4. Tell the client to return to have the site inspected only if there is a reaction. 5. Have the client wait in the waiting room for at least 1 to 2 hours after injection.

Answer: 1. Record site, date, and time of the test. 2. Give the client a list of potential allergens if identified. Rationale: Skin testing involves administration of an allergen to the surface of the skin or into the dermis. Site, date, and time of the test must be recorded, and the client must return at a specific date and time for a follow-up site evaluation, even if no reaction is suspected; a list of potential allergens is identified. For the follow-up evaluation, the size of the site has to be measured and not estimated. After injection, clients only need to be monitored for about 30 minutes to assess for any adverse effects. Test-Taking Strategy(ies): Note the strategic words, most appropriate. Eliminate option 3 because any results must be accurately measured and not estimated. Eliminate option 4 because of the closed-ended word "only." Eliminate option 5 because it is unreasonable to have the client wait 1 to 2 hours.

The nurse is caring for a client who has been diagnosed as having an acute kidney injury (AKI) due to intrarenal causes. What diagnostic test is most effective in confirming this diagnosis? 1. Renal biopsy 2. Ultrasonography 3. Computed tomography scan 4. Magnetic resonance imaging

Answer: 1. Renal biopsy Rationale: A renal biopsy is considered the best method for confirming intrarenal causes of acute kidney injury (AKI). Magnetic resonance imaging (MRI) and computed tomography (CT) scans contain contrast mediums that can be harmful to clients with this condition. An ultrasound study is not definitive and may not provide enough information. Test-Taking Strategy(ies): Focus on the subject, diagnostic test for AKI, and the strategic words, most effective. Know that an MRI study with the contrast media gadolinium is not advised in clients with kidney failure unless there is a significant reason to do these tests or unless the ultrasound or CT will not provide the information needed. Administration of gadolinium in clients with kidney failure has been associated with the development of a potentially fatal condition called nephrogenic systemic fibrosis. An ultrasound discriminates only between a fluid-filled cyst and a solid mass and does not identify what the actual tissue mass contains.

A client with chronic kidney disease (CKD) is being managed by continuous ambulatory peritoneal dialysis (CAPD). During outflow, the nurse notes that only half of the 2-L dialysate has returned, and the flow has stopped. Which interventions should the nurse take to enhance the outflow? Select all that apply. 1. Reposition the client. 2. Encourage a low-fiber diet. 3. Make sure the peritoneal catheter is not kinked. 4. Slide the peritoneal catheter farther into the abdomen. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated.

Answer: 1. Reposition the client. 3. Make sure the peritoneal catheter is not kinked. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated. Rationale: CAPD is a method of peritoneal dialysis in which the client infuses dialysate into the abdomen through a special peritoneal catheter and then lets it dwell for a period of hours. After a specified time, the client drains the dialysate out of the abdomen by gravity and then instills another 1.5 to 3 L of dialysate into the peritoneal cavity. During the dwell time, substances are exchanged across the peritoneal membrane through the process of diffusion. It is important for the nurse to make sure that all of the dialysate in each treatment is removed to ensure proper waste and fluid removal. The distal end of the peritoneal catheter hangs loosely within the abdomen cavity, so if the nurse encourages the client to change position, placement of the catheter also could be changed, potentially increasing outflow. Because the peritoneal catheter and the tubing to the drainage bag are long and flexible, either could get kinked. Correcting this is an easy solution to the outflow problem. The peritoneal catheter is surgically placed in the abdomen, and the skin grows around the cuff. With peritoneal dialysis, gravity is the process whereby dialysate is removed from the peritoneal cavity. Keeping the bag lower than the abdomen enhances gravity. Constipation is 1 of the primary causes of poor outflow. Assessing and intervening for constipation and encouraging a high-fiber diet are important actions to include in the care of a client on peritoneal dialysis. The catheter cannot be physically manipulated. In addition, this is not an action that would be within the focus of a nursing responsibility. Test-Taking Strategy(ies): Focus on the subject, insufficient outflow with a client who is being managed with CAPD. Eliminate option 4 first because this is not a nursing role. Thinking about the causes of this problem will assist in eliminating option 2.

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory studies? 1. Serum potassium, serum calcium 2. Urinalysis, hematocrit, hemoglobin 3. Culture and sensitivity testing, serum sodium 4. Urine specific gravity, intravenous pyelogram

Answer: 1. Serum potassium, serum calcium Rationale: Because of the potentially life-threatening outcomes associated with hyperkalemia and hypocalcemia, they are the most relevant to nursing management of the client with CKD. The diagnostic tests in the remaining options may be helpful in diagnosing CKD or in monitoring treatment but are not the most relevant. Additionally, decreased hematocrit and hemoglobin occur in CKD because of the decreased level of erythropoietin. However, a decrease in hematocrit and hemoglobin may be reflective of various health alterations. Test-Taking Strategy(ies): Note the strategic word, most. Focusing on the words providing care and late stages will direct you to the correct option. Also, recall the potentially life-threatening outcomes associated with hyperkalemia and hypocalcemia.

The nurse is reviewing laboratory results for a client with chronic kidney disease before a hemodialysis treatment. The serum electrolyte levels are sodium 142 mEq/L (142 mmol/L), chloride 103 mEq/L (103 mmol/L), potassium 5.2 mEq/L (5.2 mmol/L), and bicarbonate 23 mEq/L (23 mmol/L). What action should the nurse take? 1. Take no action. 2. Order a stat hemodialysis treatment. 3. Recheck the labs because these values are all abnormal. 4. Page the primary health care provider (PHCP) with the results.

Answer: 1. Take no action. Rationale: No action is needed because all of the blood levels are normal for a hemodialysis client before a treatment. The normal adult ranges of serum electrolyte levels are sodium 135 to 145 mEq/L (135 to 145 mmol/L), chloride 98 to 106 mEq/L (98 to 106 mmol/L), bicarbonate (venous) 21 to 28 mEq/L (21 to 28 mmol/L), and potassium 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Although the potassium level is elevated, the normal range for potassium for a client with chronic kidney disease receiving hemodialysis is 4 to 6.5 mEq/L (4 to 6.5 mmol/L). Test-Taking Strategy(ies): Focus on the subject, the action the nurse should take, and focus on the data in the question. Noting that the client has chronic kidney disease will assist in answering correctly.

Which interventions apply in the care of a client at high risk for an allergic response to a latex allergy? Select all that apply. 1. Use nonlatex gloves. 2. Use medications from glass ampules. 3. Place the client in a private room only. 4. Keep a latex-safe supply cart available in the client's area. 5. Avoid the use of medication vials that have rubber stoppers. 6. Use a blood pressure cuff from an electronic device only to measure the blood pressure.

Answer: 1. Use nonlatex gloves. 2. Use medications from glass ampules. 4. Keep a latex-safe supply cart available in the client's area. 5. Avoid the use of medication vials that have rubber stoppers. Rationale: If a client is allergic to latex and is at high risk for an allergic response, the nurse would use nonlatex gloves and latex-safe supplies, and would keep a latex-safe supply cart available in the client's area. Any supplies or materials that contain latex would be avoided. These include blood pressure cuffs and medication vials with rubber stoppers that require puncture with a needle. It is not necessary to place the client in a private room. Test-Taking Strategy(ies): Focus on the subject, the client at high risk for an allergic response to latex. Recalling that items that contain rubber are likely to contain latex will direct you to the correct interventions. Also, noting the closed-ended word "only" in options 3 and 6 will assist in eliminating these options.

A client is about to begin hemodialysis. Which measures should the nurse employ in the care of the client? Select all that apply. 1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron 5. Covering the connection site with a bath blanket to enhance extremity warmth

Answer: 1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron Rationale: Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the application of a face mask for both nurse and client are extremely important. It also is imperative that standard precautions be followed, which includes the use of goggles, mask, gloves, and apron. The connection site should not be covered; it should be visible so that the nurse can assess for bleeding, ischemia, and infection at the site during the hemodialysis procedure. Test-Taking Strategy(ies): Focus on the subject, care of the client receiving hemodialysis. Think about what this procedure involves and its complications. Recalling the importance of both strict asepsis and standard precautions will direct you to the correct options.

A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? 1. Hypovolemia 2. Acute kidney injury 3. Glomerulonephritis 4. Urinary tract infection

Answer: 2. Acute kidney injury Rationale: The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal injury is signaled by decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels. Normal reference levels are BUN, 10 to 20 mg/dL (3.6 to 7.1 mmol/L), and creatinine, male, 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and female 0.5 to 1.1 mg/dL (44 to 97 mcmol/L). The client may need medications to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data in the question indicate the presence of hypovolemia, glomerulonephritis, or urinary tract infection. Test-Taking Strategy(ies): Eliminate glomerulonephritis and urinary tract infection first because they are comparable or alike in that there are no data indicating infection or inflammation. Noting that the creatinine level is elevated will assist you in eliminating hypovolemia.

A client calls the nurse in the emergency department and states that he was just stung by a bumblebee while gardening. The client is afraid of a severe reaction because the client's neighbor experienced such a reaction just 1 week ago. Which action should the nurse take? 1. Advise the client to soak the site in hydrogen peroxide. 2. Ask the client if he ever sustained a bee sting in the past. 3. Tell the client to call an ambulance for transport to the emergency department. 4. Tell the client not to worry about the sting unless difficulty with breathing occurs.

Answer: 2. Ask the client if he ever sustained a bee sting in the past. Rationale: In some types of allergies, a reaction occurs only on second and subsequent contacts with the allergen. The appropriate action, therefore, would be to ask the client if he ever experienced a bee sting in the past. Option 1 is not appropriate advice. Option 3 is unnecessary. The client should not be told "not to worry." Test-Taking Strategy(ies): Use the steps of the nursing process to answer the question. The correct option is the only one that addresses assessment.

A client with a history of asthma comes to the emergency department complaining of itchy skin and shortness of breath after starting a new antibiotic. What is the first action the nurse should take? 1. Place the client on 100% oxygen and prepare for intubation. 2. Assess for anaphylaxis and prepare for emergency treatment. 3. Teach the client about the relationship between asthma and allergies. 4. Obtain an arterial blood gas and immunoglobulin E (IgE) blood level.

Answer: 2. Assess for anaphylaxis and prepare for emergency treatment. Rationale: Hypersensitivity or allergy is excessive inflammation occurring in response to the presence of an antigen to which the person usually has been previously exposed. If a client is experiencing an allergic or hypersensitivity response, the nurse's initial action is to assess for anaphylaxis. Promptly notifying the health care provider and preparing emergency equipment, including medication such as epinephrine and possible corticosteroids, is essential in preventing progression of anaphylaxis. Laboratory work is not a priority in this situation. The nurse would expect the IgE level to be elevated; the client may be hypoxic. The nurse would give the client supplemental oxygen; however, 100% is not given unless prescribed, and based on the information in the question, intubation is not the first thing the nurse would prepare this client for. Teaching the client is important; however, this is not the right time. When the client is stabilized, the nurse should teach or reinforce that allergies, including some medications, are common triggers for asthma attacks and that people with asthma are predisposed to more allergies than people without asthma. Test-Taking Strategy(ies): Note the strategic word, first, and the words starting a new antibiotic. Read each option carefully and use the steps of the nursing process to direct you to option 2. The nurse needs to assess the client first.

The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous (IV) infusion at a rate of 150 mL/hour, unchanged for the last 10 hours. The client's urine output for the last 3 hours has been 90, 50, and 28 mL (28 mL is most recent). The client's blood urea nitrogen level is 35 mg/dL (12.6 mmol/L), and the serum creatinine level is 1.8 mg/dL (159 mcmol/L), measured this morning. Which nursing action is the priority? 1. Check the urine specific gravity. 2. Call the primary health care provider (PHCP). 3. Put the IV line on a pump so that the infusion rate is sure to stay stable. 4. Check to see if the client had a blood sample for a serum albumin level drawn.

Answer: 2. Call the primary health care provider (PHCP). Rationale: Following abdominal aortic aneurysm resection or repair, the nurse monitors the client for signs of acute kidney injury. Acute kidney injury can occur because often much blood is lost during the surgery and, depending on the aneurysm location, the renal arteries may be hypoperfused for a short period during surgery. Normal reference levels are BUN, 10 to 20 mg/dL (3.6 to 7.1 mmol/L), and creatinine, male, 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and female, 0.5 to 1.1 mg/dL (44 to 97 mcmol/L). Options 1 and 4 are not associated with the data in the question. The IV should have already been on a pump. Urine output lower than 30 mL/hour is reported to the PHCP. Test-Taking Strategy(ies): Note the strategic word, priority. Focus on the data in the question and the abnormal assessment data. This question indicates elevations in blood urea nitrogen and creatinine levels and a significant drop in hourly urine output. These assessment findings should direct you to the correct option.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. Peritonitis 2. Hyperglycemia 3. Hyperphosphatemia 4. Disequilibrium syndrome

Answer: 2. Hyperglycemia Rationale: An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Peritonitis is a risk associated with breaks in aseptic technique. Hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction. Disequilibrium syndrome is a complication associated with hemodialysis. Test-Taking Strategy(ies): Focus on the subject, a complication associated with an extended dwell time. Noting the client's diagnosis and recalling that the dialysate solution contains glucose will direct you to the correct option.

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse should expect to note which abnormal finding documented on the client's medical record? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4. Decreased central venous pressure

Answer: 2. Hypertension Rationale: AKI caused by glomerulonephritis is classified as an intrinsic or intrarenal cause of renal failure. It is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from a prerenal cause is characterized by decreased blood pressure, tachycardia, decreased cardiac output, and decreased central venous pressure. Bradycardia is not part of the clinical picture for any form of kidney failure. Test-Taking Strategy(ies): Focus on the subject, manifestation associated with glomerulonephritis and AKI. Begin to answer this question by recalling that kidney failure is accompanied by fluid overload. This would guide you to eliminate option 4 first. Because fluid overload increases the workload of the heart as a pump (tachycardia), option 1 can be eliminated next. Choose correctly between the remaining options after recalling that hypertension accompanies AKI because of intrarenal causes, whereas decreased cardiac output accompanies AKI because of prerenal causes.

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4. Decreased central venous pressure

Answer: 2. Hypertension Rationale: AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure. Test-Taking Strategy(ies): Focus on the subject, manifestations of AKI. Recalling that renal failure is accompanied by fluid overload will assist in eliminating decreased central venous pressure. Fluid overload is accompanied by tachycardia (because the heart works harder to pump the volume), so bradycardia can be eliminated. Regarding the remaining choices, knowing that hypertension accompanies AKI from intrarenal causes, whereas decreased cardiac output accompanies AKI attributable to prerenal causes, will direct you to the correct option.

The nurse is caring for a client with acute kidney injury (AKI). The nurse should test the client's urine for proteinuria to determine which type of AKI? 1. Prerenal 2. Intrinsic 3. Atypical 4. Postrenal

Answer: 2. Intrinsic Rationale: In intrinsic failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In prerenal failure, the specific gravity is high, and there is very little or no proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. There is no disorder known as atypical renal failure. Test-Taking Strategy(ies): Note the subject, types of AKI. Begin to answer this question by eliminating option 3 because there is no known disorder with this name. Regarding the remaining choices, knowing that proteinuria occurs because of leakage at the basement membrane of the glomerulus helps you choose the correct option.

The nurse is caring for a client with acute kidney injury (AKI) experiencing metabolic acidosis. When performing an assessment, the nurse should expect to note which breathing pattern? 1. Apnea 2. Kussmaul respirations 3. Decreased respirations 4. Cheyne-Stokes respirations

Answer: 2. Kussmaul respirations Rationale: Clinical manifestations associated with AKI occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not characteristic of AKI. Test-Taking Strategy(ies): Focus on the subject, breathing patterns in AKI. Recalling that the client with AKI experiences metabolic acidosis will direct you to the correct option.

A client begins experiencing wheezing, anxiety, swelling, and hives after eating shellfish and is brought to the emergency department. Which immediate action should the nurse implement? 1. Administer epinephrine. 2. Maintain a patent airway. 3. Administer a corticosteroid. 4. Apply a MedicAlert bracelet.

Answer: 2. Maintain a patent airway. Rationale: Swelling, hives, lowered blood pressure, anxiety, and wheezing are indicative of anaphylaxis. If the client experiences an anaphylactic reaction, the immediate action would be to maintain a patent airway. The client then would receive epinephrine. Corticosteroids may also be prescribed. The client will need to be instructed about obtaining and wearing a MedicAlert bracelet, but this is not the immediate action. Test-Taking Strategy(ies): Focus on the strategic word, immediate, which tells you that you need to prioritize your nursing actions. Use the ABCs-airway, breathing, and circulation-to answer the question. The airway is always the priority.

The nurse is caring for a client with chronic kidney disease. Arterial blood gas results indicate a pH of 7.30 (7.30), a Paco2 of 32 mm Hg (32 mm Hg), and a bicarbonate concentration of 20 mEq/L (20 mmol/L). Which laboratory value should the nurse expect to note? 1. Sodium level of 145 mEq/L (145 mmol/L) 2. Potassium level of 5.2 mEq/L (5.2 mmol/L) 3. Phosphorus level of 3.0 mg/dL (0.97 mmol/L) 4. Magnesium level of 1.3 mg/dL (0.53 mmol/L)

Answer: 2. Potassium level of 5.2 mEq/L (5.2 mmol/L) Rationale: Interpretation of the arterial blood gas (ABG) indicates metabolic acidosis with partial compensation by the respiratory system. Clinical manifestations of metabolic acidosis include hyperpnea with Kussmaul's respirations; headache; nausea, vomiting, and diarrhea; fruity-smelling breath resulting from improper fat metabolism; central nervous system depression, including mental dullness, drowsiness, stupor, and coma; twitching; and convulsions. Hyperkalemia will occur. Test-Taking Strategy(ies): Note the subject, interpretation of ABG and laboratory values. Use knowledge of the clinical manifestations of metabolic acidosis and normal laboratory values to answer the question. The only abnormal laboratory value is the potassium level, the correct option.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client? 1. Prevent fluid overload. 2. Prevent loss of electrolytes. 3. Promote the excretion of wastes. 4. Reduce the urine specific gravity.

Answer: 2. Prevent loss of electrolytes. Rationale: In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of AKI. Test-Taking Strategy(ies): Focus on the subject, the diuretic phase of AKI. Also note the strategic word, primary. Knowing that during this phase the client experiences a high urine output will direct you to the correct option.

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply. 1. "Sterile dialysate must be used." 2. "Dialysate contains metabolic waste products." 3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion."

Answer: 3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion." Rationale: Heparin sodium is used during dialysis, and it inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis. The dialysate is warmed to approximately 100º F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore, the dialysate does not need to be sterile. Test-Taking Strategy(ies): Focus on the subject, an understanding of the dialysis procedure. Think about the purpose of dialysis and the procedure to eliminate options 1 and 2.

The nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury? 1. "The increase in urine output indicates the return of some renal function." 2. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." 3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 4. "The blood urea nitrogen and creatinine levels will continue to rise during the first few days of diuresis."

Answer: 3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." Rationale: The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than 1000 mL in a 24-hour period. This increase in urine output indicates the return of some renal function; however, blood urea nitrogen and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days. Test-Taking Strategy(ies): Note the strategic words, need for further teaching. This phrasing indicates a negative event query and asks you to select an option that is an incorrect statement. Focusing on the subject, diuretic phase, will direct you to option 3 because in this phase a urine output of more than 1000 mL in a 24-hour period is expected.

The nurse is planning a teaching session with a client who has chronic kidney disease (CKD) about managing the condition between dialysis treatments. The nurse should plan to include the instruction that weight gain between dialysis treatments should be ideally what value? 1. 11 to 13 lb (5 to 6 kg) 2. 4.5 to 9 lb (2 to 4 kg) 3. 2 to 3 lb (1 to 1.5 kg) 4. 1 to 2 lb (0.5 to 1.0 kg)

Answer: 3. 2 to 3 lb (1 to 1.5 kg) Rationale: Limiting weight gain to 2 to 3 lb (1 to 1.5 kg) between dialysis treatments helps prevent the hypotension that occurs with the removal of large volumes of fluid during dialysis. The nurse instructs the client in how to manage daily fluid allotment to assist the client in staying within a low fluid intake range to prevent excess weight gain. Options 1, 2, and 4 are incorrect. Test-Taking Strategy(ies): Focus on the subject, weight monitoring of the client on dialysis. It may be helpful in answering this question to recall that 1 L of fluid weighs approximately 1 kg. Recalling that there is approximately 6 L of blood circulating in the body will help you eliminate options 1 and 2 as both are too large of a weight gain. Similarly, option 4 is eliminated because it is too small, representing only 500 to 1000 mL of fluid.

The nurse is preparing to perform a discharge teaching with a client who is started on hemodialysis. Which information should the nurse provide regarding the hemodialysis schedule? 1. 5 hours of treatment, 2 days per week 2. 2 hours of treatment, 6 days per week 3. 3 to 4 hours of treatment, 3 days per week 4. 2 to 3 hours of treatment, 5 days per week

Answer: 3. 3 to 4 hours of treatment, 3 days per week Rationale: The typical schedule for hemodialysis is 3 to 4 hours of treatment, 3 days per week. Individual adjustments are made according to variables such as the size of the client, type of dialyzer, rate of blood flow, personal client preferences, and other factors. Test-Taking Strategy(ies): Note the subject, hemodialysis schedule. Knowledge regarding the typical schedule for hemodialysis is required to answer this question. Remember that the typical schedule is 3 to 4 hours of treatment, 3 days per week.

A client with chronic kidney disease is receiving epoetin alfa for the past 2 months. What should the nurse determine is an indicator that this therapy is effective? 1. A decrease in blood pressure 2. An increase in white blood cells 3. An increase in serum hematocrit 4. A decrease in serum creatinine level

Answer: 3. An increase in serum hematocrit Rationale: Epoetin alfa stimulates red blood cell production. Initial effects should be seen within 1 to 2 weeks, and the hematocrit reaches normal levels in 2 to 3 months. Test-Taking Strategy(ies): Note the strategic word, effective. Focus on the subject, expected findings associated with this medication, and focus on the effects of epoetin alfa. Eliminate option 1 because as the hematocrit rises, blood pressure also may rise transiently. Eliminate option 4 because the medication does not have a direct effect on serum creatinine levels. Eliminate option 2 because epoetin alfa does not have an effect on white blood cells. An elevated white blood cell count could indicate that the client has an infection.

A client who is undergoing peritoneal dialysis calls the nurse at the renal unit and reports the presence of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis returns are brown-tinged in color. Which would the nurse suspect? 1. Infection 2. An intact catheter 3. Bowel perforation 4. Bladder perforation

Answer: 3. Bowel perforation Rationale: Complications of a peritoneal catheter include infection, perforation of the bowel or bladder, and bleeding. Brown-tinged returns suggest bowel perforation, which usually is accompanied by severe abdominal pain and diarrhea. Cloudy or opaque returns suggest possible infection. Urine-colored returns suggest possible bladder perforation. An intact catheter is unrelated to the information provided in the question. Test-Taking Strategy(ies): Note the subject, brown-tinged output. Focusing on the information provided in the question will assist in eliminating options 1 and 2. Regarding the remaining choices, noting the words brown-tinged in color will direct you to the correct option.

In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate? 1. Glycosuria 2. Polyphagia 3. Crackles auscultated in the lungs 4. Blood pressure of 98/58 mm Hg

Answer: 3. Crackles auscultated in the lungs Rationale: CKD is a condition in which the kidneys have progressive problems in clearing nitrogenous waste products and controlling fluid and electrolyte balance within the body. Cardiovascular symptoms of heart failure and hypertension are caused by the fluid volume overload resulting from the kidneys' inability to excrete water. Signs and symptoms of heart failure include jugular venous distention, S3 heart sound, pedal edema, increased weight, shortness of breath, and crackles auscultated in the lungs. The typical signs and symptoms of CKD include proteinuria or hematuria, not glycosuria. The nurse would observe anorexia and nausea in this client, not polyphagia. Test-Taking Strategy(ies): Focus on the subject, CKD. Recall that the kidneys' function is to maintain the body's fluid and electrolyte balance and that when the kidneys are unable to function, the client will experience fluid volume overload and electrolyte imbalances. This will direct you to the correct option.

The nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse should base the response on knowing that which is the action of the glucose in the solution? 1. Decreases the risk of peritonitis 2. Prevents disequilibrium syndrome 3. Increases osmotic pressure to produce ultrafiltration 4. Prevents excess glucose from being removed from the client

Answer: 3. Increases osmotic pressure to produce ultrafiltration Rationale: Increasing the glucose concentration makes the solution more hypertonic. The more hypertonic the solution, the higher the osmotic pressure for ultrafiltration and thus the greater the amount of fluid removed from the client during an exchange. The remaining options do not identify the purpose of the glucose. Test-Taking Strategy(ies): Focus on the subject, the purpose of the glucose contained in the peritoneal dialysis solution. Think about the pathophysiology associated with peritoneal dialysis, and use specific knowledge regarding the principles related to ultrafiltration to direct you to the correct option.

The nurse has completed teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse should determine that education was effective if the client states to record which parameters daily? 1. Pulse and respiratory rate 2. Amount of activity and sleep 3. Intake and output (I&O) and weight 4. Blood urea nitrogen (BUN) and creatinine levels

Answer: 3. Intake and output (I&O) and weight Rationale: The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording I&O and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight per day. It is not necessary to record the pulse and respiratory rate or the amount of activity and sleep; these parameters are not specifically related to hemodialysis. BUN and creatinine levels are not measured on a daily basis. Test-Taking Strategy(ies): Note the strategic word, effective. Focus on the subject, client self-monitoring between hemodialysis treatments. Recalling the pathophysiology of chronic kidney disease and the effect on the client's bodily functions will assist in answering the question. Also, note that the correct option relates to monitoring of fluid retention.

The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury? 1. Prerenal 2. Postrenal 3. Intrarenal 4. Extrarenal

Answer: 3. Intrarenal Rationale: Serum myoglobin levels increase in crush injuries when large amounts of myoglobin and hemoglobin are released from damaged muscle and blood cells. The accumulation may cause acute tubular necrosis, an intrarenal cause of renal failure. Prerenal causes are conditions that interfere with the perfusion of blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the kidney. The cause and the type of renal failure may determine the interventions used in treatment. Test-Taking Strategy(ies): Note the subject, acute kidney injury. Use knowledge of the categories of acute kidney injury to answer this question. Eliminate option 4 first because it is not a category of acute kidney injury. Next, focus on the nature of the injury (crush injury) and its effect on the kidney to direct you to the correct option.

The nurse is creating a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care? 1. Increase the amount of protein in the diet. 2. Increase the amount of potassium in the daily diet. 3. Maintain a diet high in calories with frequent snacks. 4. Encourage the client to eat a large breakfast and smaller meals later in the day.

Answer: 3. Maintain a diet high in calories with frequent snacks. Rationale: Uremia usually is accompanied by nausea, anorexia, and an unpleasant taste in the mouth. Most clients experience more nausea and vomiting in the morning. Therefore, to maintain optimal nutrition, it is best for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the morning and larger meals later in the day. Dietary management usually is aimed at restricting protein, sodium, and potassium. Test-Taking Strategy(ies): Focus on the subject, diet for the client with chronic kidney disease. Noting that the client has chronic kidney disease will assist in eliminating options 1 and 2. Remembering that most clients with uremia experience more nausea and vomiting in the morning will assist in directing you to the correct option from the remaining choices.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5° C (101.2° F). Which nursing action is most appropriate? 1. Encourage fluid intake. 2. Continue to monitor vital signs. 3. Notify the primary health care provider. 4. Monitor the site of the shunt for infection.

Answer: 3. Notify the primary health care provider. Rationale: A temperature of 101.2° F (38.5° C) is significantly elevated and may indicate infection. The nurse should notify the primary health care provider (PHCP). Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should be monitored, but the PHCP should be notified first. Test-Taking Strategy(ies): Note the strategic words, most appropriate. Focus on the data in the question. Note the temperature elevation. This warrants notification of the PHCP, who may prescribe diagnostic tests or medications.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5º C (101.2º F). Which nursing action is most appropriate? 1. Encourage fluid intake. 2. Continue to monitor vital signs. 3. Notify the primary health care provider. 4. Monitor the site of the shunt for infection.

Answer: 3. Notify the primary health care provider. Rationale: A temperature of 101.2º F (38.5º C) is significantly elevated and may indicate infection. The nurse should notify the primary health care provider (PHCP). Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should be monitored, but the PHCP should be notified first. Test-Taking Strategy(ies): Note the strategic words, most appropriate. Focus on the data in the question. Note the temperature elevation. This warrants notification of the PHCP, who may prescribe diagnostic tests or medications.

A client is being discharged to home while recovering from acute kidney injury (AKI). Reduced dietary intake of which substance indicates to the nurse that the client understands the dietary teaching? 1. Fats 2. Vitamins 3. Potassium 4. Carbohydrates

Answer: 3. Potassium Rationale: The excretion of potassium and maintenance of potassium balance are normal functions of the kidneys. In the client with AKI or chronic kidney disease, potassium intake must be restricted as much as possible (60 to 70 mEq/day). The primary mechanism of potassium removal during AKI is dialysis. Vitamins, carbohydrates, and fats are not normally restricted in the client with AKI unless a secondary health problem warrants the need to do so. The amount of fluid permitted is generally calculated to be equal to the urine volume plus the insensible loss volume of 500 mL. Test-Taking Strategy(ies): Focus on the subject, dietary restrictions in a client with AKI. Noting the diagnosis of the client will assist in answering the question. Recalling that potassium balance and excretion are controlled by the kidneys will direct you to the correct option.

The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process? 1. Anxiety 2. Memory deficits 3. Presence of family 4. Short attention span

Answer: 3. Presence of family Rationale: The client with CKD may have several barriers to learning. The presence of family members is helpful because they need to understand the disease and treatment and may help reinforce information with the client after the formal teaching session is over. Anxiety about the disease and its ramifications frequently interferes with learning. Physiological effects of the disease process also impair the client's mental functioning. Specifically, the client may exhibit a short attention span and have memory deficits. Mental functioning usually improves once hemodialysis has begun. Test-Taking Strategy(ies): Focus on the subject, the factor that will enhance the educational process. Eliminate anxiety, knowing that it commonly interferes with learning. Memory deficit and short attention span are comparable or alike in that they reflect neurological impairment and are eliminated next. Recall that the presence of family members does not necessarily interfere with learning; in fact, they may be quite helpful.

The primary health care provider writes prescriptions for a client with chronic kidney disease (CKD). Which prescription should the nurse question? 1. Insert a saline lock. 2. Obtain a daily weight. 3. Provide a high-protein diet. 4. Administer a calcium supplement with each meal.

Answer: 3. Provide a high-protein diet. Rationale: When a client experiences CKD, the blood urea nitrogen (BUN) and serum creatinine levels rise. The client also experiences increased potassium, increased phosphates, and decreased calcium. BUN and creatinine are the byproducts of protein metabolism, so monitoring protein intake is important, with care taken to include proteins of high biological value. Clients with CKD will have protein restricted early in the disease to preserve kidney function. In end-stage disease, protein is restricted according to the client's weight, the type of dialysis, and protein loss. With CKD, the nurse is concerned about fluid volume overload and accumulation of waste products. Because of the kidneys' inability to excrete fluid, it is important for the nurse to prevent, as well as assess for early signs of, fluid volume excess. Infusing an intravenous (IV) solution into a client with CKD significantly increases the risk for overload. If an IV access is needed, it usually involves only a saline lock. Obtaining the client's daily weight is 1 of the most important assessment tools for evaluating changes in fluid volume. The kidneys also are responsible for removing waste products. The client also receives phosphate binders, calcium supplements, and vitamin D to prevent bone demineralization (osteodystrophy) from chronically elevated phosphate levels. Test-Taking Strategy(ies): Focus on the subject, the prescription that the nurse should question for a client with CKD. Recall the pathophysiology associated with CKD and that protein is restricted to assist you in answering correctly.

A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and complains of itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is the priority? 1. Administer oxygen and protamine sulfate. 2. Cut the infusion rate in half and sit the client up in bed. 3. Stop the infusion and call for the Rapid Response Team (RRT). 4. Administer diphenhydramine and epinephrine and continue the infusion.

Answer: 3. Stop the infusion and call for the Rapid Response Team (RRT). Rationale: The client is experiencing an anaphylactic reaction. Therefore, the priority action is to stop the infusion and notify the RRT. The primary health care provider should be contacted once the client has been stabilized. The client may be treated with epinephrine, antihistamines, and corticosteroids as prescribed, but the infusion should not be continued. Test-Taking Strategy(ies): Note the strategic word, priority. Recall that an allergic reaction and possible anaphylaxis are risks associated with alteplase therapy. Also, focusing on the signs and symptoms in the question will assist in answering correctly. When a severe allergic reaction occurs, the offending substance should be stopped, and lifesaving treatment should begin.

The nurse reviews the electrolyte results of a client with chronic kidney disease and notes that the potassium level is 5.7 mEq/L (5.7 mmol/L). Which patterns would the nurse watch for on the cardiac monitor as a result of the laboratory value? Select all that apply. 1. ST depression 2. Prominent U wave 3. Tall peaked T waves 4. Prolonged ST segment 5. Widened QRS complexes

Answer: 3. Tall peaked T waves 5. Widened QRS complexes Rationale: The client with chronic kidney disease is at risk for hyperkalemia. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level greater than 5.0 mEq/L (5.0 mmol/L) indicates hyperkalemia. Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves. ST depression and a prominent U wave occurs in hypokalemia. A prolonged ST segment occurs in hypocalcemia. Test-Taking Strategy(ies): Focus on the subject, a client with chronic kidney disease and the electrocardiographic changes that occur in a potassium imbalance. From the data in the question you need to determine that this condition is a hyperkalemic one. From this point, you must know the electrocardiographic changes that are expected when hyperkalemia exists. Remember that tall peaked T waves, flat P waves, widened QRS complexes, and prolonged PR interval are associated with hyperkalemia.

A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement? 1. The client has an accurate understanding of the procedure and aftercare. 2. The client does not realize how painful removal of the dialysis catheter will be. 3. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. 4. The client is not aware that the alternative access site is left in place prophylactically for 2 months.

Answer: 3. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. Rationale: An AV fistula is the internal creation of an arterial-to-venous anastomosis. This causes engorgement of the vein, allowing both the artery and the vein to be easily cannulated for hemodialysis. Fistulas take 1 to 2 weeks to mature (engorgement) or develop before they can be used for dialysis, so the current method of access must remain in place to be used during that period. Options 1, 2, and 4 are incorrect interpretations of the client's statement. Test-Taking Strategy(ies): Focus on the subject, maturation of an AV fistula. To answer this question correctly, it is necessary to understand concepts related to the creation and use of internal AV fistulas. Remember that an AV fistula needs 1 to 2 weeks to mature after it is created before it can be used.

The clinic nurse is providing home care instructions to a client who has been diagnosed with a latex allergy. The nurse most appropriately instructs the client to avoid which activity? 1. Sunlight 2. Going to parties 3. The use of latex condoms 4. Outdoor activities as much as possible

Answer: 3. The use of latex condoms Rationale: Latex allergy is a type I hypersensitivity reaction in which a specific allergen is a processed natural latex rubber protein. Mucosal exposure to latex can occur on contact with latex condoms. The nurse most appropriately would provide instructions to the client about the need to avoid the use of condoms unless they are latex-free. No reason exists for the client to avoid outdoor activities or sunlight or to avoid parties; however, the client should be informed that certain forms of balloons are made of latex. Test-Taking Strategy(ies): Note the strategic words, most appropriately. Eliminate options 1 and 4 first because they are comparable or alike. Regarding the remaining options, focusing on the subject (contraindications for the client with a latex allergy) will direct you to the correct option.

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include? 1. "It is acceptable to eat whatever you want on the day before hemodialysis." 2. "It is acceptable to exceed the fluid restriction on the day before hemodialysis." 3. "Medications should be double-dosed on the morning of hemodialysis because of potential loss." 4. "Several types of medications should be withheld on the day of dialysis until after the procedure."

Answer: 4. "Several types of medications should be withheld on the day of dialysis until after the procedure." Rationale: Many medications are dialyzable, which means that they are extracted from the bloodstream during dialysis. Therefore, many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be double-dosed because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions. Test-Taking Strategy(ies): Note the strategic words, most appropriate. Knowing that clients are not taught to disregard dietary or fluid restriction will help you eliminate options 1 and 2, which are comparable or alike options. Regarding the remaining options, recall that hemodialysis decreases serum medication levels and that some medications are not generally given before dialysis.

A client with chronic kidney disease (CKD) has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these assessment data are compatible with which condition? 1. Advancing uremia 2. Phosphate overdose 3. Folic acid deficiency 4. Aluminum intoxication

Answer: 4. Aluminum intoxication Rationale: Aluminum hydroxide may be prescribed as a phosphate-binding agent. Aluminum intoxication can occur when there is an accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. It can be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum. The data in the question are not specifically associated with the other conditions noted in the options. Test-Taking Strategy(ies): Focus on the subject, an adverse effect of aluminum hydroxide. Note the relationship between the name of the medication in the question and the correct option.

The nurse is developing a plan of care for a preoperative client who has a latex allergy. Which intervention should be included in the plan? 1. Avoid using medications from glass ampules. 2. Use medications that are from ampules with rubber stoppers. 3. Avoid using intravenous tubing that is made of polyvinyl chloride. 4. Apply a cloth barrier to the client's arm under a blood pressure cuff when taking the blood pressure.

Answer: 4. Apply a cloth barrier to the client's arm under a blood pressure cuff when taking the blood pressure. Rationale: If a client has a latex allergy, a cloth barrier should be applied to his or her arm under a blood pressure cuff to prevent skin contact with the cuff. Medications from glass ampules are safe to use, and medications from ampules with rubber stoppers are unsafe to use. Latex-safe intravenous tubing made of polyvinyl chloride should be used for a client with a latex allergy. Additionally, agency procedures should be followed for a client with a latex allergy; usually, a latex allergy cart containing latex-free supplies is kept in the client's room. Test-Taking Strategy(ies): Focus on the subject, latex allergy. Recalling the causes of a latex allergy and the items that contain latex will direct you to the correct option.

The nurse is performing an assessment on a client who has been diagnosed with an allergy to latex. In determining the client's risk factors, the nurse should question the client about an allergy to which food item? 1. Eggs 2. Milk 3. Yogurt 4. Bananas

Answer: 4. Bananas Rationale: Individuals who are allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, or water chestnuts are at risk for developing a latex allergy. This is thought to be the result of a possible cross-reaction between the food and the latex allergen. Options 1, 2, and 3 are unrelated to latex allergy. Test-Taking Strategy(ies): Recall knowledge regarding the food items related to a latex allergy. Eliminate options 1, 2, and 3 because they are comparable or alike and relate to dairy products.

The nurse has administered a dose of salmeterol to a client. The client develops a generalized rash and urticaria, and the eyelids begin to swell. Which action should the nurse take? 1. Apply a lanolin-based cream to the rash. 2. Encourage the client to drink fluids quickly. 3. Assess the client's vision with a Snellen chart. 4. Call the primary health care provider (PHCP) immediately.

Answer: 4. Call the primary health care provider (PHCP) immediately. Rationale: Hypersensitivity reaction can occur in clients taking salmeterol. Signs include rash; urticaria; and swelling of the face, lips, or eyelids. The nurse should call the PHCP immediately if any of these occur. The other options are incorrect. Test-Taking Strategy(ies): Focus on the subject, salmeterol. Recognizing that the signs listed in the question are typical of a hypersensitivity reaction allows you to eliminate options 1 and 3 first. From the remaining choices, recall that the client needs treatment with an antihistamine or epinephrine, not oral fluids.

A client with chronic kidney disease is receiving ferrous sulfate. The nurse instructs the client that which finding is a common side/adverse effect associated with this medication? 1. Fatigue 2. Headache 3. Weakness 4. Constipation

Answer: 4. Constipation Rationale: Ferrous sulfate is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners often are prescribed to prevent constipation. Options 1, 2, and 3 are not side or adverse effects associated with this medication. Test-Taking Strategy(ies): Focus on the subject, side/adverse effects of ferrous sulfate and on the name of the medication, and recall that it is an iron supplement. Recalling that oral iron can cause constipation will direct you to the correct option.

A home care nurse is prescribing dressing supplies for a client who has an allergy to latex. Which item should the nurse ask the medical supply personnel to deliver? 1. Elastic bandages 2. Adhesive bandages 3. Brown ACE bandages 4. Cotton pads and silk tape

Answer: 4. Cotton pads and silk tape Rationale: Latex allergy is a type I hypersensitivity reaction in which a specific allergen is a processed natural latex rubber protein. Cotton pads and plastic or silk tape are latex-free products. The items identified in the other options contain latex. Test-Taking Strategy(ies): Focus on the subject, a client with a latex allergy. Recall specific knowledge of products that contain latex to answer this question. Eliminate options 1 and 3 regarding elastic and brown ACE bandages first because they are comparable or alike. Noting the words cotton and silk in the correct option will assist you in choosing this over option 2, adhesive bandages.

The nurse is caring for a client with suspected kidney failure. A 24-hour urine specimen is prescribed. What value measures overall kidney function? 1. Sodium levels 2. Protein levels 3. Blood uric acid levels 4. Creatinine clearance levels

Answer: 4. Creatinine clearance levels Rationale: Creatinine clearance is a calculated measure of glomerular filtration rate and is the best indication of overall kidney function. The amount of creatinine cleared from the blood (e.g., filtered into the urine) is measured in the total volume of urine excreted in a defined period. The analysis compares the urine creatinine level with the blood creatinine level, and therefore, a blood specimen for creatinine must also be collected. Sodium levels are decreased in prerenal acute kidney injury. Increased levels of protein indicate glomerular disease, nephrotic syndrome, diabetic neuropathy, and urinary tract malignancies and irritations. Uric acid levels are increased in conditions such as gout or uric acid calculi. Test-Taking Strategy(ies): Focus on the subject, kidney failure. Think about the various levels that are measured in a 24-hour urine test. Remember that creatinine is the most effective level indicating overall kidney failure. Sodium, protein, and uric acid may also be measured in a 24-hour urine test, but their levels are not as significant in diagnosing renal failure.

A client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. Which is the priority nursing intervention? 1. Check the shunt for the presence of bruit and thrill. 2. Observe the site once during the shift as time permits. 3. Check the results of the prothrombin time as they are determined. 4. Ensure that small clamps are attached to the arteriovenous shunt dressing.

Answer: 4. Ensure that small clamps are attached to the arteriovenous shunt dressing. Rationale: An external arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because 2 ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours. Checking the shunt for the presence of bruit and thrill relates to patency of the shunt. Although checking the results of the prothrombin time is important, it is not the priority nursing action. Test-Taking Strategy(ies): Note the strategic word, priority. Focus on the subject, preventing bleeding in a client with an external arteriovenous shunt in place for hemodialysis. Visualize this type of access device. Recalling that disconnection can occur will direct you to the correct option.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching

Answer: 4. Headache, deteriorating level of consciousness, and twitching Rationale: Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates. Tachycardia and fever are associated with infection. Generalized weakness is associated with low blood pressure and anemia. Restlessness and irritability are not associated with disequilibrium syndrome. Test-Taking Strategy(ies): Focus on the subject, disequilibrium syndrome. Think about the pathophysiology and that brain cells are responsive to changes in osmolarity. This will assist you to choose the correct option describing neurological symptoms.

The client in chronic kidney disease is receiving epoetin alfa. The nurse should monitor this client for which side/adverse effect of this medication? 1. Fever 2. Depression 3. Bradycardia 4. Hypertension

Answer: 4. Hypertension Rationale: Epoetin alfa is generally well tolerated, although hypertension can occur and is the most significant adverse effect. Occasionally, tachycardia may also occur. It may also cause an improved sense of well-being. Fever, depression, and bradycardia are not adverse effects of this medication. Test-Taking Strategy(ies): Focus on the subject, side/adverse effects of epoetin alfa. This knowledge is required to answer this question. Remember that hypertension can occur.

A client with chronic kidney disease (CKD) is prescribed aluminum hydroxide. Which information should the nurse include while instructing the client regarding the action of this medication? 1. It prevents ulcers. 2. It prevents constipation. 3. It promotes the elimination of potassium from the body. 4. It combines with phosphorus and helps eliminate phosphates from the body.

Answer: 4. It combines with phosphorus and helps eliminate phosphates from the body. Rationale: Aluminum hydroxide may be prescribed for a client with CKD. It binds with phosphate in the intestines for excretion in the feces, thus lowering phosphorus levels. It can cause constipation, and it does not promote the elimination of potassium. It may be used in the treatment of hyperacidity associated with gastric ulcers, but this is not the purpose of its use in the client with renal failure. Test-Taking Strategy(ies): Focus on the subject, the action of aluminum hydroxide. Noting the client's diagnosis and the pathophysiology associated with it and recalling the purpose of this medication in CKD will direct you to the correct option.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1. Monitor the client. 2. Elevate the head of the bed. 3. Assess the fistula site and dressing. 4. Notify the primary health care provider (PHCP).

Answer: 4. Notify the primary health care provider (PHCP). Rationale: Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome, and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The PHCP must be notified. Monitoring the client, elevating the head of the bed, and assessing the fistula site are correct actions, but the priority action is to notify the PHCP. Test-Taking Strategy(ies): Note the strategic word, priority, and focus on the client's signs and symptoms. Determine if an abnormality exists. Recalling the serious complications associated with hemodialysis such as disequilibrium syndrome will direct you to the correct option.

A client with chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril. When should the nurse plan to administer this medication? 1. During dialysis 2. Just before dialysis 3. The day after dialysis 4. On return from dialysis

Answer: 4. On return from dialysis Rationale: Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure. Test-Taking Strategy(ies): Focus on the subject, administration of prescribed medication for the client receiving hemodialysis. Begin to answer this question by thinking about the effects of an antihypertensive medication on the blood pressure when fluid is being removed from the body. Because hypotension is much more likely to occur in this circumstance, eliminate options 1 and 2, during and just before dialysis. Eliminate option 3, the day after dialysis, because this action would lead to ineffective blood pressure control.

The nurse is admitting a client who has an arteriovenous (AV) fistula in the right arm for hemodialysis. Which nursing intervention is the best way to prevent injury to the AV site? 1. Putting a large note about the access site on the front of the medical record 2. Applying an allergy bracelet to the right arm, indicating the presence of the fistula 3. Telling the client to inform all caregivers who enter the room about the presence of the access site 4. Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm"

Answer: 4. Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm" Rationale: No venipunctures or blood pressure measurements should be performed in a limb with a hemodialysis access device. This commonly is communicated to all caregivers by placing a sign at the client's bedside. Placing a note on the front of the medical record does not ensure that everyone caring for the client is aware of the access device. An allergy bracelet is placed on the client with an allergy. The client should not be assigned the responsibility for informing caregivers. Some agencies use special bracelets for clients with an AV fistula to alert primary health care providers. Agency guidelines should always be followed in the care of the client. Test-Taking Strategy(ies): Note the strategic word, best. Eliminate option 2 because an allergy bracelet is used for a client with an allergy. Eliminate option 3 next because this responsibility should not be placed on the client. Regarding the remaining options, note that the correct option best informs those caring for the client of the presence of the fistula.

The nurse is analyzing the posthemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? 1. Potassium 2. Creatinine 3. Phosphorus 4. Red blood cell (RBC) count

Answer: 4. Red blood cell (RBC) count Rationale: Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia because RBCs are lost during dialysis from blood sampling and anticoagulation and from residual blood left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process. Test-Taking Strategy(ies): Focus on the subject, an expected but nontherapeutic effect. Knowing that decreased laboratory values are expected will guide you to focus on which result is nontherapeutic.

The nurse has a prescription to give a first dose of hydrochlorothiazide to an assigned client. The nurse would question the prescription if the client has a history of allergy to which item? 1. Iodine 2. Shellfish 3. Penicillin 4. Sulfa medications

Answer: 4. Sulfa medications Rationale: Thiazide diuretics, such as hydrochlorothiazide, are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. A sulfa allergy must be communicated to the pharmacist, primary health care providers (PHCPs), and nurse. The other options are not contraindications for administering the medication. Test-Taking Strategy(ies): Focus on the subject, a contraindication for administering hydrochlorothiazide. Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate iodine and shellfish. To select from the remaining options, recall that the chemical composition of thiazide diuretics contains a sulfa ring. This will easily direct you to the correct option.

A client experiencing end-stage kidney disease has an arteriovenous (AV) fistula placed surgically for hemodialysis. Which action is most appropriate for the nurse to document in the plan for care of the AV fistula? 1. Palpate the bruit of the AV fistula weekly to assess for thrombosis. 2. Use the AV fistula site for blood draws to prevent increased pain of multiple blood draws. 3. Take the blood pressure readings in the extremity with the AV fistula to get a more accurate reading. 4. Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis.

Answer: 4. Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis. Rationale: An AV fistula is a vascular access system that is required for hemodialysis. It is a device established for clients who need long-term hemodialysis. It is created by connecting an artery to a vein inside the body to create a vessel that can handle the amount of blood flow necessary for effective dialysis. Bleeding, clotting, and infection are risks with all vascular devices. It also is very important to avoid any activity that would promote the status of blood or increase the risk for infection. Taking the blood pressure in the affected arm, carrying heavy objects in the arm, and lying on the arm at night could increase the risk for clotting in the fistula. To check circulation of the fistula, the nurse should palpate or feel for the thrill or auscultate (listen with a stethoscope) for the bruit. It is important to do this at least daily to ascertain the patency of the fistula. To avoid infection, that extremity is never used for peripheral intravenous access (placement of an intravenous line) or for blood draws. Strict aseptic technique is used in accessing the fistula for dialysis. Test-Taking Strategy(ies): Focus on the subject, the care of an AV fistula, and note the strategic words, most appropriate. Recall the purpose and use of the AV fistula and the need to protect the fistula from injury and actions that could cause bleeding. This will direct you to the correct option.

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse should formulate a response using what fact about the kidneys? 1. The kidneys get fatigued from having to filter too much fluid. 2. The kidneys can react adversely to moderate doses of furosemide. 3. The kidneys will shut down easily if serum levels of digoxin are high. 4. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

Answer: 4. The kidneys generally require and receive about 20% to 25% of the resting cardiac output. Rationale: Heart failure is referred to as a prerenal cause of acute kidney injury because heart failure results in decreased blood flow to the kidneys. The kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly. With a significant or prolonged decrease in blood supply, the kidneys can fail. Options 1 and 3 are incorrect. As for option 2, large doses of furosemide resulting in severe dehydration may lead to decreased kidney perfusion, but moderate doses of furosemide do not cause prerenal acute kidney injury, and furosemide may be used to treat acute kidney injury. Test-Taking Strategy(ies): Focus on the subject, how heart failure affects the kidneys. To answer this question accurately, you must have an understanding of renal physiology and knowledge of the impact of inadequate renal circulation on kidney function. Recall that the kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly.