68 CHAPTER Care of Patients with Acute Kidney Injury and Chronic Kidney Disease (SG)
14. The nurse is caring for a postoperative patient and is evaluating the patient's intake and output as a measure to prevent AKI. The patient weighs 60 kilograms and has produced 180 mL of urine in the past 4 hours. What should the nurse do? a. Perform other assessments related to fluid status and record the output. b. Call the health care provider and obtain an order for a fluid bolus. c. Encourage the patient to drink more fluid, so that the output is increased. d. Compare the patient's weight to baseline to determine fluid retention.
a
16. According to the RIFLE classification (Risk, Injury, Failure, Loss, End-stage kidney failure). How would the nurse interpret the following data? Serum creatinine increased × 1.5 or glomerular filtration rate (GFR) decrease >25%; Urine output is <0.5 mL/kg/hr for ≥ 6 hours. a. Risk stage b. Injury stage c. Failure stage d. End-stage kidney disease (ESKD)
a
53. In order to assist a patient in the prevention of osteodystrophy, which intervention does the nurse perform? a. Administer phosphate binders with meals. b. Encourage high-quality protein foods. c. Administer iron supplements. d. Encourage extra milk at mealtimes.
a
12. The nurse is caring for several patients on a medical-surgical unit. None of the patients currently has any acute or chronic kidney problems. Which patient has the greatest risk to develop AKI? a. 73-year-old male who has hypertension and peripheral vascular disease b. 32-year-old female who is pregnant and has gestational diabetes c. 49-year-old male who is obese and has a history of skin cancer d. 23-year-old female who has been treated for a urinary tract infection
a
6. When shock or other problems cause an acute reduction in blood flow to the kidneys, how do the kidneys compensate? (Select all that apply.) a. Constrict blood vessels in the kidneys. b. Activate the renin-angiotensin-aldosterone pathway. c. Release beta blockers. d. Dilate blood vessels throughout the body. e. Release antidiuretic hormones.
a,b,e
96. What might the nurse notice if the patient is experiencing reduced perfusion and altered urinary elimination related to AKI? (Select all that apply.) a. Hemodynamic instability, especially persistent hypotension and tachycardia b. Urine output of less than 0.5 mL/kg/hour for 6 or more hours c. Serum creatinine below baseline or admission values d. Urine may be clear or have a pale yellow color e. Abnormal serum and urine potassium and sodium values
a,b,e
27. Which signs/symptoms does the nurse expect to see in the patient with AKI that has progressed in severity? (Select all that apply.) a. Oliguria b. Hypotension c. Shortness of breath d. Pulmonary crackles e. Weight loss
a,c,d
31. The nurse is caring for a patient in the intensive care unit who sustained blood loss during a traumatic accident. For early identification of signs and symptoms that would suggest the development of kidney dysfunction, what does the nurse observe for? (Select all that apply.) a. Hypotension b. Bradycardia c. Decreased urine output d. Decreased cardiac output e. Increased central venous pressure
a,c,d
69. Which patients with CKD are candidates for intermittent hemodialysis? (Select all that apply.) a. Patient with fluid overload who does not respond to diuretics b. Patient with injury stage according to the RIFLE classification c. Patient with symptomatic toxin ingestion d. Patient with uremic manifestations, such as decreased cognition e. Patient with symptomatic hyperkalemia and calciphylaxis
a,c,d,e
23. The nurse is taking a history of a patient at risk for kidney failure. What does the nurse ask the patient about during the interview? (Select all that apply.) a. Exposure to nephrotoxic chemicals b. Increased appetite c. History of diabetes mellitus, hypertension, systemic lupus erythematosus d. Recent surgery, trauma, or transfusions e. Leakage of urine when coughing or laughing f. Recent or prolonged use of antibiotics and NSAIDs
a,c,d,f
54. The home health nurse is reviewing the medication list of a patient with CKD. The nurse calls the health care provider as a reminder that the patient might need which nutritional supplements? (Select all that apply.) a. Iron b. Magnesium c. Phosphorus d. Calcium e. Vitamin D f. Water-soluble vitamins
a,d,e,f
82. Place the sequence of steps of continuous ambulatory peritoneal dialysis (CAPD) in the correct order using the numbers 1 through 4. _____ a. Fluid stays in the cavity for a specified time prescribed by the health care provider. _____ b. 1 to 2 L of dialysate is infused by gravity over a 10- to 20-minute period. _____ c. Fluid flows out of the body by gravity into a drainage bag. _____ d. Warm the dialysate bags before instillation by using a heating pad to wrap the bag.
a=3,b=2,c=4,d=1
62. A patient with CKD is restless, anxious, and short of breath. The nurse hears crackles that begin at the base of the lungs. The pulse rate is increased and the patient has frothy, bloodtinged sputum. What does the nurse do first? a. Facilitate transfer to the ICU for aggressive treatment. b. Place the patient in a high-Fowler's position. c. Continue to monitor vital signs and assess breath sounds. d. Administer a loop diuretic such as furosemide (Lasix).
b
64. As a patient with ESKD experiences isosthenuria, what must the nurse be alert for? a. The diuretic stage b. Fluid volume overload c. Dehydration d. Alkalosis
b
67. As a result of kidney failure, excessive hydrogen ions cannot be excreted. With acid retention, the nurse is most likely to observe what type of respiratory compensation? a. Cheyne-Stokes respiratory pattern b. Increased depth of breathing c. Decreased respiratory rate and depth d. Increased arterial carbon dioxide levels
b
7. The nurse reads in the patient's chart that he has acute-on-chronic kidney disease. How does the nurse interpret this information? a. Kidney disease has progressed to the need for dialysis or transplant. b. Patient has chronic kidney disease and has sustained an acute kidney injury. c. Acute kidney injury requires aggressive management to prevent chronic disease. d. The condition could by acute or chronic; further diagnostic testing is needed.
b
88. A patient has recently started PD therapy and reports some mild pain when the dialysate is flowing in. What does the nurse do next? a. Immediately report the pain to the health care provider. b. Try warming the dialysate in the microwave oven. c. Reassure that pain should subside after the first week or two. d. Assess the connection tubing for kinking or twisting.
c
90. The nurse is monitoring a patient's PD treatment. The total outflow is slightly less than the inflow. What does the nurse do next? a. Instruct the patient to ambulate. b. Notify the health care provider. c. Record the difference as intake. d. Put the patient on fluid restriction.
c
94. The intensive care nurse is caring for the kidney transplant patient who was just transferred from the recovery unit. Which finding is the most serious within the first 12 hours after surgery and warrants immediate notification of the transplant surgeon? a. Diuresis with increased output b. Pink and bloody urine c. Abrupt decrease in urine d. Small clots in bladder irrigation fluid
c
57. A patient with CKD is taking digoxin (Lanoxin). Which signs of digoxin toxicity does the nurse vigilantly monitor for? (Select all that apply.) a. Nausea and vomiting b. Visual changes c. Respiratory depression d. Restlessness or confusion e. Headache or fatigue f. Tachycardia
a,b,d,e,f
58. The nurse is reviewing the medication list and appropriate dose adjustments made for a patient with CKD. The nurse would question the use and/or dosage adjustment of which type of medication? a. Antibiotics b. Magnesium antacids c. Oral antidiabetics d. Opioids
b
33. The nurse and the dietitian are planning dietary intake for a patient with AKI who is currently not on dialysis therapy. The dietitian informs the nurse that 0.6 g/kg of body weight of protein are needed. The patient weighs 130 pounds. How many grams of protein should the patient receive? (Round grams to the nearest whole number.) ___________ grams
35
48. The patient with CKD reports chronic fatigue and lethargy with weakness and mild shortness of breath with dizziness when rising to a standing position. In addition, the nurse notes pale mucous membranes. Based on the patient's illness and the presenting symptoms, which laboratory result does the nurse expect to see? a. Low hemoglobin and hematocrit b. Low white cell count c. Low blood glucose d. Low oxygen saturation
a
20. The nurse is caring for a patient with AKI and notes a trend of increasingly elevated BUN levels. How does the nurse interpret this information? a. Breakdown of muscle for protein which leads to an increase in azotemia b. Sign of urinary retention and decreased urinary output c. Expected trend that can be reversed by increasing dietary protein d. Ominous sign of impending irreversible kidney failure
a
22. A patient sustained extensive burns and depletion of vascular volume. The nurse expects which changes in vital signs and urinary function? a. Decreased urine output, hypotension, tachycardia b. Increased urine output, hypertension, tachycardia c. Bradycardia, hypotension, polyuria d. Dysrhythmias, hypertension, oliguria
a
24. Which disorder could be a complication from AKI? a. Heart failure b. Diabetes mellitus c. Kidney cancer d. Compartment syndrome
a
26. The nurse is caring for a patient with AKI who does not have signs or symptoms of fluid overload. A fluid challenge is performed to promote kidney perfusion by doing what? a. Administering normal saline 500 to 1000 mL infused over 1 hour b. Administering drugs to suppress aldosterone release c. Instilling warm, sterile normal saline into the bladder d. Having the patient drink several large glasses of water
a
29. A patient with AKI has a high rate of catabolism. What is this related to? a. Increased levels of catecholamines, cortisol, and glucagon b. Inability to excrete excess electrolytes c. Conversion of body fat into glucose d. Presence of retained nitrogenous wastes
a
40. A patient with CKD has a potassium level of 8 mEq/L. The nurse notifies the health care provider after assessing for which sign/symptom? a. Cardiac dysrhythmias b. Respiratory depression c. Tremors or seizures d. Decreased urine output
a
43. A patient with CKD develops severe chest pain, an increased pulse, low-grade fever, and a pericardial friction rub with a cardiac dysrhythmia and muffled heart tones. The nurse immediately alerts the health care provider and prepares for which emergency procedure? a. Pericardiocentesis b. CVVH c. Kidney dialysis d. Endotracheal intubation
a
45. The nurse is reviewing urinalysis results for a patient who is in the early stages of CKD, What results might the nurse expect to see? a. Excessive protein, glucose, red blood cells, and white blood cells b. Increased specific gravity with a dark amber discoloration c. Dramatically increased urine osmolarity d. Pink-tinged urine with obvious small blood clots
a
56. The nurse monitors a CKD patient's daily weights because of the risk for fluid retention. What instructions does the nurse give to the UAP? a. Weigh the patient daily at the same time each day, same scale, with the same amount of clothing. b. Weigh the patient daily and add 1 kilogram of weight for the intake of each liter of fluid. c. Weigh the patient in the morning before breakfast and weigh the patient at night just before bedtime. d. Ask the patient what his or her normal weight is and then weigh the patient before and after each voiding.
a
59. The nurse is evaluating a patient's treatment response to erythropoietin (Epogen). Which hemoglobin reading indicates that the goal is being met? a. Around 10 g/dL b. Greater than 20 g/dL c. Upward trend d. At baseline for gender
a
60. A patient has been receiving erythropoietin (Epogen). Which statement by the patient indicates that the therapy is producing the desired effect? a. "I can do my housework with less fatigue." b. "I have been passing more urine than I was before." c. "I have less pain and discomfort now." d. "I can swallow and eat much better than before."
a
70. The home health nurse is evaluating the home setting for a patient who wishes to have inhome hemodialysis. What is important to have in the home setting to support this therapy? a. Specialized water treatment system to provide a safe, purified water supply b. Large dust-free space to accommodate and store the dialysis equipment c. Modified electrical system to provide high voltage to power the equipment d. Specialized cooling system to maintain strict temperature control
a
73. A patient is undergoing a dialysis treatment and exhibits a progression of symptoms which include headache, nausea, and vomiting; and fatigue. How does the nurse interpret these symptoms? a. Mild dialysis disequilibrium syndrome b. Expected manifestations in ESKD c. Transient symptoms in a new dialysis patient d. Adverse reaction to the dialysate
a
76. The nurse is providing postdialysis care for a patient. In comparing vital signs and weight measurements to the predialysis data, what does the nurse expect to find? a. Blood pressure and weight are reduced. b. Blood pressure is increased and weight is reduced. c. Blood pressure and weight are slightly increased. d. Blood pressure is low and weight is the same.
a
79. A patient has returned to the medical-surgical unit after having a dialysis treatment. The nurse notes that the patient is also scheduled for an invasive procedure on the same day. What is the primary rationale for delaying the procedure for 4 to 6 hours? a. The patient was heparinized during dialysis. b. The patient will have cardiac dysrhythmias after dialysis. c. The patient will be incoherent and unable to give consent. d. The patient needs routine medications that were delayed.
a
80. The nurse is talking to a patient with ESKD. The patient frequently displays weight gain and increased blood pressure beyond the baseline measurements. Which question is the nurse most likely to ask to determine if the patient is doing something that is contributing to these assessment findings? a. "Are you controlling your salt intake?" b. "Are you following the protein restrictions?" c. "Have you been eating a lot of sweets?" d. "Have you been exercising regularly?"
a
84. What is the best description of CAPD? a. Daily infusion of four 2 L exchanges of dialysate every 4 to 6 hours while awake. b. Is a form of automated dialysis that uses an automated cycling machine. c. Functions of the cycling machine are programmed to the patient's needs. d. This form decreases the risk of peritonitis and poor dialysate flow.
a
85. The home health nurse is visiting a patient who independently performs PD. Which question does the nurse ask the patient to assess for the major complication associated with PD? a. "Have you noticed any signs or symptoms of infection?" b. "Are you having any pain during the dialysis treatments?" c. "Is the dialysate fluid slow or sluggish?" d. "Have you noticed any leakage around the catheter?"
a
89. The nurse is caring for a patient requiring PD. In order to monitor the patient's weight, what does the nurse do? a. Check the weight after a drain and before the next fill to monitor the patient's "dry weight." b. Calculate the "dry weight" by weighing the patient every day and comparing the measurements to baseline. c. Determine "dry weight" by comparing the patient's weight to a standard weight chart based on height and age. d. Weigh the patient each day and count fluid intake and dialysate volume to determine the patient's "dry weight."
a
9. The nurse is caring for a patient who had hypovolemic shock secondary to trauma in the emergency department (ED) 2 days ago. Based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess at least every hour? a. Urinary output b. Presence of edema c. Urine color d. Presence of pain
a
15. The nurse is caring for a patient receiving gentamicin. Because this drug has potential for nephrotoxicity, which laboratory results does the nurse monitor? (Select all that apply.) a. Blood urea nitrogen (BUN) b. Creatinine c. Drug peak and trough levels d. Prothrombin time (PT) e. Platelet count f. Hemoglobin and hematocrit
a,b,c
66. Which are the most accurate ways to monitor kidney function in the patient with CKD? (Select all that apply.) a. Monitoring intake and output b. Checking urine specific gravity c. Reviewing BUN and serum creatinine levels d. Reviewing x-ray reports e. Consulting the dietitian's notes
a,b,c
68. The nurse is assessing a patient with uremia. Which gastrointestinal changes does the nurse expect to find? (Select all that apply.) a. Halitosis b. Hiccups c. Anorexia d. Nausea e. Vomiting f. Salivation
a,b,c,d,e
1. Which problems occur with acute kidney injury (AKI)? (Select all that apply.) a. Decreased peristalsis b. Anemia c. Metabolic acidosis d. Hypokalemia e. Peripheral edema
a,b,c,e
51. In collaboration with the registered dietitian, the nurse teaches the patient about which diet recommendations for management of CKD? (Select all that apply.) a. Controlling protein intake b. Limiting fluid intake c. Restricting potassium d. Increasing sodium e. Restricting phosphorus f. Reducing calories
a,b,c,e
4. A patient can develop intrarenal kidney injury from which causes? (Select all that apply.) a. Vasculitis b. Pyelonephritis c. Strenuous exercise d. Exposure to nephrotoxins e. Bladder cancer
a,b,d
35. Which characteristics are associated with ESKD? (Select all that apply.) a. Severe fluid overload b. Renal osteodystrophy c. Nephrons compensate d. Dialysis or transplant needed to maintain homeostasis e. Excessive waste products
a,b,d,e
10. The nurse is talking to an older adult male patient who is reasonably healthy for his age, but has benign prostatic hyperplasia (BPH). Which condition does the BPH potentially place him at risk for? a. Prerenal acute kidney injury b. Postrenal acute kidney injury c. Polycystic kidney disease d. Acute glomerulonephritis
b
18. A patient is in the diuretic phase of AKI. During this phase, what is the nurse mainly concerned about? a. Assessing for hypertension and fluid overload b. Monitoring for hypovolemia and electrolyte loss c. Adjusting the dosage of diuretic medications d. Balancing diuretic therapy with intake
b
19. A patient with prerenal azotemia is administered a fluid challenge. In evaluating response to the therapy, which outcome indicates that the goal was met? a. Patient reports feeling better and indicates an eagerness to go home. b. Patient produces urine soon after the initial bolus. c. The therapy is completed without adverse effects. d. The health care provider orders a diuretic when the challenge is completed.
b
21. The nurse is caring for a patient with AKI that developed after a severe anaphylactic reaction. What is a primary treatment goal of the initial phase that will help to prevent permanent kidney damage for this patient? a. Correct fluid volume by administering IV normal saline. b. Maintain a mean arterial pressure (MAP) of 65 mm Hg. c. Prevent kidney infections by administering antibiotics. d. Give antihistamines to prevent allergic response.
b
30. The nurse requests a dietary consult to address the patient's high rate of catabolism. Which nutritional element is directly related to this metabolic process? a. Carbohydrates b. Proteins c. Liquids d. Fats
b
39. The nurse is reviewing a patient's laboratory results. In the early phase of CKD, the patient is at risk for which electrolyte abnormality? a. Hyperkalemia b. Hyponatremia c. Hypercalcemia d. Hypokalemia
b
46. The night shift nurse sees a patient with kidney failure sitting up in bed. The patient states, "I feel a little short of breath at night or when I get up to walk to the bathroom." What assessment does the nurse do? a. Check for orthostatic hypotension because of potential volume depletion. b. Auscultate the lungs for crackles, which indicate fluid overload. c. Check the pulse and blood pressure for possible decreased cardiac output. d. Assess for normal sleep pattern and need for a prn sedative.
b
52. A patient receives dialysis therapy and the health care provider has ordered sodium restriction to 3 g daily. What does the nurse teach the patient? a. Add smaller amounts of salt at the table or during cooking. b. Identify foods that are high in sodium (e.g., bacon, potato chips, fast foods). c. Avoid foods that have a metallic, salty, or bitter taste. d. Eat larger amounts of bland foods with very minimal amounts of spicing.
b
55. The nurse is caring for a patient with ESKD and dialysis has been initiated. Which drug order does the nurse question? a. Erythropoietin b. Diuretic c. ACE inhibitor d. Calcium channel blocker
b
72. A patient and family are trying to plan a schedule that coordinates with the patient's dialysis regimen. The patient asks, "How often will I have to go and how long does it take?" What is the nurse's best response? a. "If you are compliant with the diet and fluid restrictions, you spend less time in dialysis; about 12 hours a week." b. "Most patients require about 12 hours per week; this is usually divided into three 4-hour treatments." c. "It varies from patient to patient. You will have to call your health care provider for specific instructions." d. "If you gain a large amount of fluid weight, a longer treatment time may be needed to prevent severe side effects."
b
75. The nurse is assessing a patient's extremity with an arteriovenous graft. The nurse notes a thrill and a bruit, and the patient reports numbness and a cool feeling in the fingers. How does the nurse interpret this information in regard to the graft? a. The graft is functional and these symptoms are expected. b. The patient has "steal syndrome" and may need surgical intervention. c. The graft is patent, but the blood is flowing in the wrong direction. d. The patient needs to increase active use of hands and fingers.
b
86. The nurse is teaching a patient about performing PD at home. In order to identify the earliest manifestation of peritonitis, what does the nurse instruct the patient to do? a. Monitor temperature before starting PD. b. Check the effluent for cloudiness. c. Be aware of feelings of malaise. d. Monitor for abdominal pain.
b
95. The nurse is caring for the kidney transplant patient who is 3 days postsurgery. The nurse notes a sudden and abrupt decrease in urine. The nurse alerts the health care provider because this is a sign of which anomaly? a. Rejection b. Thrombosis c. Stenosis d. Infection
b
91. Which patients are likely to be excluded from receiving a transplant? (Select all that apply.) a. Patient who had breast cancer 6 years ago b. Patient with advanced and uncorrectable heart disease c. Patient with a chemical dependency d. Patient who is 70 years old and has a living related donor e. Patient with diabetes mellitus
b,c
3. What are common causes of prerenal kidney injury? (Select all that apply.) a. Urethral cancer b. Hypovolemic shock c. Enlarged prostate gland d. Sepsis e. Severe burns
b,c,d
34. What are the characteristics of continuous venovenous hemofiltration (CVVH)? (Select all that apply.) a. Requires placement of arterial and venous access b. Uses a pump to drive blood from the patient catheter into the dialyzer c. Risk of air embolus d. More commonly used for patients who are critically ill e. Most convenient method for home care patients
b,c,d
87. During PD, the nurse notes slowed dialysate outflow. What does the nurse do to troubleshoot the system? (Select all that apply.) a. Ensure that the drainage bag is elevated. b. Inspect the tubing for kinking or twisting. c. Ensure that clamps are open. d. Turn the patient to the other side. e. Make sure the patient is in good body alignment. f. Instruct the patient to stand or cough.
b,c,d,e
92. A daughter is considering donating a kidney to her mother for organ transplant. What information does the nurse give to the daughter about the criteria for donation? (Select all that apply.) a. Age limit is at least 21 years old. b. Systemic disease and infection must be absent. c. There must be no history of cancer. d. Hypertension or kidney disease must be absent. e. There must be adequate kidney function as determined by diagnostic studies. f. The donor must understand the surgery and be willing to give up the organ.
b,c,d,e,f
78. The nurse is caring for a patient with an arteriovenous fistula. What is included in the nursing care for this patient? (Select all that apply.) a. Keep small clamps handy by the bedside. b. Encourage routine range-of-motion exercises. c. Avoid venipuncture or IV administration on the arm with the access device. d. Instruct the patient to carry heavy objects to build muscular strength. e. Assess for manifestations of infection of the fistula. f. Instruct the patient to sleep on the side with the affected arm in the dependent position.
b,c,e
5. Postrenal kidney injury can result from which conditions? (Select all that apply.) a. Septic shock b. Cervical cancer c. Nephrolithiasis or ureterolithiasis d. Heart failure e. Neurogenic bladder f. Prostate cancer
b,c,e,f
83. The health care provider has ordered intraperitoneal heparin for a patient with a new PD catheter to prevent clotting of the catheter by blood and fibrin formation. How does the nurse advise the patient? a. Watch for bruising or bleeding from the gums. b. Make a follow-up appointment for coagulation studies. c. Intraperitoneal heparin does not affect clotting times. d. Heparin will be given with a small subcutaneous needle.
c
11. Which combination of drugs is the most nephrotoxic? a. Angiotensin-converting enzyme (ACE) inhibitors and aspirin b. Angiotensin II receptor blockers and antacids c. Aminoglycoside antibiotics and nonsteroidal antiinflammatory drugs (NSAIDs) d. Calcium channel blockers and antihistamines
c
13. For a patient with AKI, the nurse would consider questioning the order for which diagnostic test? a. Kidney biopsy b. Ultrasonography c. Computed tomography with contrast dye d. Kidney, ureter, bladder (KUB) x-ray
c
38. A patient's laboratory results show an elevated creatinine level. The patient's history reveals no risk factors for kidney disease. Which question does the nurse ask the patient to shed further light on the laboratory result? a. "How many hours of sleep did you get the night before the test?" b. "How much fluid did you drink before the test?" c. "Did you take any type of antibiotics before taking the test?" d. "When and how much did you last urinate before having the test?"
c
41. The nurse is assessing a patient with kidney injury and notes a marked increase in the rate and depth of breathing. The nurse recognizes this as Kussmaul respiration, which is the body's attempt to compensate for which condition? a. Hypoxia b. Alkalosis c. Acidosis d. Hypoxemia
c
42. A patient is diagnosed with renal osteodystrophy. What does the nurse instruct the unlicensed assistive personnel (UAP) to do in relation to this patient's diagnosis? a. Assist the patient with toileting every 2 hours. b. Gently wash the patient's skin with a mild soap and rinse well. c. Handle the patient gently because of risk for fractures. d. Assist the patient with eating because of loss of coordination.
c
47. What type of breath odor is most likely to be noted in a patient with CKD? a. Fruity smell b. Fecal smell c. Smells like urine d. Smells like blood
c
50. The nurse notes an abnormal laboratory test finding for a patient with CKD and alerts the health care provider. The nurse also consults with the registered dietitian because an excessive dietary protein intake is directly related to which factor? a. Elevated serum creatinine level b. Protein presence in the urine c. Elevated BUN level d. Elevated serum potassium level
c
61. Which behavior is the strongest indicator that a patient with ESKD is not coping well with the illness and may need a referral for psychological counseling? a. Displays irritability when the meal tray arrives b. Refuses to take one of the drugs because it causes nausea c. Repeatedly misses dialysis appointments d. Seems distracted when the health care provider talks about the prognosis
c
63. Which patient is the most likely candidate for CVVH? a. Patient with fluid volume overload b. Patient who needs long-term management c. Patient who is critically ill d. Patient who is ready for discharge to home
c
65. The nurse is caring for a patient with CKD. The family asks about when renal replacement therapy will begin. What is the nurse's best response? a. "As early as possible to prevent further damage in stage I." b. "When there is reduced kidney function and metabolic wastes accumulate." c. "When the kidneys are unable to maintain a balance in body functions." d. "It will be started with diuretic therapy to enhance the remaining function."
c
8. The nurse is talking to a group of healthy young college students about maintaining good kidney health and preventing AKI. Which health promotion point is the nurse most likely to emphasize with this group? a. "Have your blood pressure checked regularly." b. "Find out if you have a family history of diabetes." c. "Avoid dehydration by drinking at least 2 to 3 L of water daily." d. "Have annual testing for microalbuminuria and urine protein."
c
17. A patient has been diagnosed with AKI, but the cause is uncertain. The nurse prepares patient educational material about which diagnostic test? a. Flat plate of the abdomen b. Renal ultrasonography c. Computed tomography d. Kidney biopsy
d
25. A patient with AKI is ill and has a poor appetite. What would the health care team try first? a. IV normal saline to prevent dehydration b. Familiar foods brought by the family c. Nasogastric tube for enteral feedings d. Oral supplements designed for kidney patients
d
28. A patient has AKI related to nephrotoxins. In order to maintain cell integrity, improve GFR, and improve blood flow to the kidneys, which type of medication does the nurse anticipate the health care provider will prescribe? a. Loop diuretics b. Alpha-adrenergic blockers c. Beta blockers d. Calcium channel blockers
d
36. The nurse is taking a history on a patient with diabetes and hypertension. Because of the patient's high risk for developing kidney problems, which early sign of chronic kidney disease (CKD) does the nurse assess for? a. Decreased output with subjective thirst b. Urinary frequency of very small amounts c. Pink or blood-tinged urine d. Increased output of very dilute urine
d
37. Increased BUN and creatinine, hyperkalemia, and hypernatremia are all characteristics of which stage of kidney disease? a. Stage 1 CKD b. Mild CKD c. Moderate CKD d. ESKD
d
44. All patients with hypertension or diabetes should have yearly screenings for which factor? a. Creatinine b. BUN c. Glycosuria d. Microalbuminuria
d
49. The nurse is assessing the skin of a patient with ESKD. Which clinical manifestation is considered a sign of very late, premorbid, advanced uremic syndrome? a. Ecchymoses b. Sallowness c. Pallor d. Uremic frost
d
71. The nursing student is explaining principles of hemodialysis to the nursing instructor. Which statement by the student indicates a need for additional study and research on the topic? a. "Dialysis works as molecules from an area of higher concentration move to an area of lower concentration." b. "Blood and dialyzing solution flow in opposite directions across an enclosed semipermeable membrane." c. "Excess water, waste products, and excess electrolytes are removed from the blood." d. "Bacteria and other organisms can also pass through the membrane, so the dialysate must be kept sterile."
d
74. The nurse is caring for a patient with an arteriovenous fistula. What instructions are given to the UAP regarding the care of this patient? a. Palpate for thrills and auscultate for bruits every 4 hours. b. Check for bleeding at needle insertion sites. c. Assess the patient's distal pulses and circulation. d. Do not take blood pressure readings in the arm with the fistula.
d
77. The nurse is assessing a patient who has just returned from hemodialysis. Which assessment finding is cause for greatest concern? a. Feeling of malaise b. Headache c. Muscle cramps in the legs d. Bleeding at the access site
d
81. Which patient with kidney problems is the best candidate for peritoneal dialysis (PD)? a. Patient with peritoneal adhesions b. Patient with a history of extensive abdominal surgery c. Patient with peritoneal membrane fibrosis d. Patient with a history of difficulty with anticoagulants
d
93. The nurse is caring for the kidney transplant patient in the immediate postoperative period. During this initial period, the nurse will assess the urine output at least every hour for how many hours? a. First 8 hours b. First 12 hours c. First 24 hours d. First 48 hours
d
