ch 54 renal

2. The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?

1,000mL

26. Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?

a. SpO2 at 90% with fine crackles in the lung bases

24. A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?

HTN

1. The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?

Administration of a sodium polystyrene sulfonate [kayexalate]

3. A client requires hemodialysis. Which type of drug should be withheld before this procedure?

Cardiac glycosides

restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?

Encourage use of incentive spirometer every 2 hours

36. The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?

a. The kidneys can improve over a period of months

30. The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:

a. "As the disease progresses, you will most likely require renal replacement therapy."

18. After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?

a. "It is appropriate to warm the dial sate in a microwave."

11. A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?

a. 'Even a perfect match does not guarantee organ rejection'

25. A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?

a. Urinary caliculi

32. A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing hintacute!hint renal failure (ARF)?

a. Urine output of 250 ml/24 hours

40. A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

a. Urine output of 250 ml/24 hours

14. A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following?

a. Weight

20. A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

a. Weight loss (because fluid loss?)

10. When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?

a. Check for thrill or bruit over the access site

8. The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium?

a. Citrus fruits

31. A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?

a. Decrease in the blood flow through the kidneys

29. The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?

a. Dehydration

28. An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?

a. Detects calculi, cysts, or tumors

5. The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?

a. Diminished erythropoietin production

9. Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?

a. Fever

38. Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?

a. Glomerulonephritis

23. Which of the following is the hallmark of the diagnosis of nephrotic syndrome?

a. Proteinuria

6. A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate?

a. 'Keep showers brief, patting your skin dry after showering'

37. Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

a. 6 tablets

33. The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?

a. Anemia

22. Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis?

a. Azotemia

19. Which of the following is an integumentary manifestation of chronic renal failure?

a. Gray-bronze color skin

41. The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

a. Hypovolemic shock caused by hemorrhage

13. A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?

a. Increase carbohydrates and limit protein intake

15. The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output?

a. Less than 400mL

39. When assessing the impact of medications on the etiology of ARF (acute renal failure), the nurse recognizes which of the following as the drug that is not nephrotoxic?

a. Penicillin

21. A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

a. Recent history of Streptococcal infection

17. The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function?

a. Serum creatinine of 1.5mg/dL

7. A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an hintarteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?

a. Access AV fistula for bruit and thrill

27. A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

a. Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.

16. Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia

a. Tall, peaked T waves

34. Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

a. Teach client to increase fluid intake up to 3 liters per day.

35. A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD?

a. The client has a history of diverticulitis

12. A nurse receives her client care assignment. Following the report, she should give priority asessment to the client:

a. Who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.