Cirrhosis practice quiz
The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula? "The fistula can be used 5 to 7 days after the surgery for dialysis treatment." "A vein and an artery in your arm will be attached surgically." "The arm should be immobilized for 4 to 6 days." "One needle will be inserted into the fistula for each dialysis treatment."
"A vein and an artery in your arm will be attached surgically." Explanation: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need several weeks to "mature" before it can be used. The client is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.
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? "The doctor may decide to delay the use of immunosuppressant drugs." "Let's wait until after the surgery to discuss your treatment plan." "Immunosuppressive drugs guarantee organ success." "Even a perfect match does not guarantee organ success."
"Even a perfect match does not guarantee organ success." Explanation: Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.
A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis? "This will require you to have surgery and a catheter will need to be inserted into your abdomen." "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again." "Hemodialysis is a program that will require you to commit to daily treatment." "Hemodialysis is a treatment option that is usually required three times a week."
"Hemodialysis is a treatment option that is usually required three times a week." Explanation: Hemodialysis is the most commonly used method of dialysis. Clients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.
The nurse is caring for a client who underwent a kidney transplant. The client appears anxious and tearful and states, "My body is going to reject the new kidney; I know I'm going to die." What is the best response by the nurse? "Don't think like that; I'm certain you will be fine." "If your body rejects the kidney, you can go back on dialysis; you are not going to die." "I understand your concerns, let's talk about them." "You've waited years for this transplant, you need to think positively."
"I understand your concerns, let's talk about them." Explanation: The nurse must address the client's concerns and encourage the client to express any concerns. The rejection of a transplanted kidney is of great concern to the client, the family, and the health care team for many months. An important nursing function is the assessment of the client's stress and coping. The nurse uses each visit with the client to determine if the client and family are coping effectively and if the client is adhering to the prescribed medication regimen. If indicated or requested, the nurse refers the client for counseling. The other responses are non-therapeutic.
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? 1. "Be sure to eat meat at every meal." 2. "Eat plenty of bananas." 3. "Increase your carbohydrate intake." 4. "Drink plenty of fluids, and use a salt substitute."
"Increase your carbohydrate intake." Explanation: A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.
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? "When you shower, use really warm water and an antibacterial soap." "Keep your showers brief, patting your skin dry after showering." "Try washing clothes with a strong detergent to ensure that all impurities are gone." "Liberally apply alcohol to the areas of your skin where you itch the most."
"Keep your showers brief, patting your skin dry after showering." Explanation: The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash clothes and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue.
A 76-year-old client with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make? "The decision is certainly yours to make, but be sure not to make a mistake." "Have you talked this over with your family?" "Kidney transplants in patients your age are as successful as they are in younger patients." "I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare."
"Kidney transplants in patients your age are as successful as they are in younger patients." Explanation: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the elderly. However, the outcome is comparable to that of younger clients. The other listed options either belittle the client or give the client misinformation.
An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? "The risk of peritonitis is greater with this type of dialysis." "Peritoneal dialysis will require more work for you." "This type of dialysis will provide more independence." "Peritoneal dialysis does not work well for every client."
"This type of dialysis will provide more independence." Explanation: Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.
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? a. 250 mL b. 500 mL c. 750 mL d. 1,000 mL
1,000 mL Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg weight gain is equal to 1,000 mL of retained fluid.
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: a) 2,000 mL of fluid b) 1,000 mL of fluid c) 1,500 mL of fluid d) 500 mL of fluid
1,500 mL of fluid Explanation: A 1-kg weight gain is equal to 1,000 mL of retained fluid.
At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? 2 lb 1.0 lb 1.5 lb 0.5 lb
1.0 lb Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg (2-lb) weight loss is equal to 1,000 mL.
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?
6 The nurse will administer 2 tablets per dose (800 mg/400 mg per tablet). The client receives a total of 3 doses per day or 6 tablets (2 tablets per dose x 3 doses).
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.
4000 Explanation: A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded.
A 176-lb client with pyelonephritis has been instructed to drink at least 30 mL of water for each kilogram of body weight. The client prefers to drink bottled water and asks the nurse to calculate the number of 16-oz bottles needed to fulfill the daily intake required. Fill in the blank with the total number of 16-oz bottles of water that should be consumed each day.
5 Explanation: Step 1. 2.2 lb : 1 kg :: 176 lb: X kg 176 = 2.2 X 80 kg = X Step 2. Multiply 80 kg by 30 mL = 2400 mL/day Step 3. 30 mL : 1 oz :: 2400 mL : X oz 2400 = 30 X 80 oz = X Step 4.16 oz : 1 bottle :: 80 oz : X bottles 80 = 16 X 5 bottles = X
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 85 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2
A GFR of 30-59 mL/min/1.73 m2 Explanation: Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2
The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD? A client with a history of polycystic kidney disease A client with severe chronic obstructive pulmonary disease A client with diabetes mellitus and poorly controlled hypertension A client who is morbidly obese with a history of vascular disorders
A client with diabetes mellitus and poorly controlled hypertension Explanation: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A client with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the client with diabetes and hypertension is likely at highest risk for ESKD.
The client with liver failure related to cirrhosis may be expected to have
A decrease erythrocyte count. Low RBCs. Blood cells are not being adequately process due to liver degeneration
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 an insulin drip Administration of sodium polystyrene sulfonate [Kayexalate]) Administration of sodium bicarbonate Administration of a loop diuretic
Administration of sodium polystyrene sulfonate [Kayexalate]) Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? Pericarditis Acidosis Anemia Hyperkalemia
Anemia Explanation: Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.
A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. What outcome will the decrease in erythropoietin have? Increase in blood sugar levels due to alteration in insulin levels Anemia from the decrease in maturation of red blood cells Development of male sex characteristics Decrease in blood sugar levels due to alteration in insulin levels
Anemia from the decrease in maturation of red blood cells Explanation: The kidneys secrete erythropoietin, which is a substance that promotes the maturation of red blood cells
A client with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care? Assess for a thrill or bruit over the vascular access site each shift. Utilize the vascular access site for infusion of IV fluids. Ensure that the client moves the extremity with the vascular access site as little as possible. Change the dressing over the vascular access site at least every 12 hours.
Assess for a thrill or bruit over the vascular access site each shift. Explanation: The bruit, or "thrill," over the venous access site must be evaluated at least every shift. Frequent dressing changes are unnecessary and the client does not normally need to immobilize the site. The site must not be used for purposes other than dialysis.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? Assess the AV fistula for a bruit and thrill. Keep the AV fistula wrapped in gauze. Keep the AV fistula site dry. Take the client's blood pressure in the left arm.
Assess the AV fistula for a bruit and thrill. Explanation: The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.
The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? Assessment of the client's incision Assessment for flank or abdominal pain Assessment of the client's abdominal girth Assessment of the quantity of the client's urine output
Assessment of the quantity of the client's urine output Explanation: After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the client's abdomen or incision.
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Hematuria Azotemia Bacteremia Proteinuria
Azotemia Explanation: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Uses moisturizing creams Brief, hot daily showers Keeps nails trimmed short Pats skin dry after bathing
Brief, hot daily showers Explanation: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Increased pH with decreased hydrogen ions Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75% Increased serum levels of potassium, magnesium, and calcium
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Explanation: The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.
A nurse is caring for a client on bedrest with end-stage kidney disease. What major manifestation of uremia should the nurse expect to decrease with an exercise plan? Hyperparathyroidism A decreased serum phosphorus level Bone demineralization Increased secretion of parathormone
Bone demineralization Explanation: Uremic bone disease, often called renal osteodystrophy, develops from the complex changes in calcium, phosphate, and parathormone balance. Clients on bedrest with end-stage kidney disease will have increased bone demineralization. Bone disease will cause a retention of phosphorus, low serum calcium levels, abnormal vitamin D metabolism, and elevated aluminum levels. Hypoparathyroidism and decreased secretion of the parathormone will occur with the client on bedrest.
A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage? Stage 4 Stage 1 Stage 3 Stage 2
Stage 3 Explanation: Stages of chronic kidney disease are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? Sodium Phosphorus Magnesium Calcium
Calcium Explanation: Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.
Patient education regarding a fistulae or graft includes which of the following? Select all that apply. No tight clothing. Cleanse site b.i.d. Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access.
Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing. Explanation: The nurse teaches the patient with fistulae or grafts to check daily for a thrill and bruit. Further teaching includes avoiding compression of the site; not permitting blood to be drawn, an IV to be inserted, or blood pressure to be taken on the extremity with the dialysis access; not to wear tight clothing, carry bags or pocketbooks on that side, and not lie on or sleep on the area. The site is not cleansed unless it is being accessed for hemodialysis.
The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? Cooked white rice Salad oils Citrus fruits Butter
Citrus fruits Explanation: Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.
A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient? Sex and size Need Compatible blood and tissue types Blood relationship
Compatible blood and tissue types Explanation: The donor and recipient must have compatible blood and tissue types. They should be fairly close in size and age, but these factors aren't as important as compatible blood and tissue types. When a living donor is considered, it's preferable to have a blood relative donate the organ. Need is important but it can't be the critical factor if a compatible donor isn't available.
A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include which of the following modifications? Select all that apply. Decreased sodium intake Vitamin D supplementation Increased potassium intake Decreased protein intake Fluid restriction
Decreased protein intake Decreased sodium intake Fluid restriction Explanation: Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation.
The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? Diminished erythropoietin production Azotemia Impaired immunologic response Electrolyte imbalances
Diminished erythropoietin production Explanation: Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic renal failure but not indicated with anemia.
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? Donors are selected from compatible living or deceased donors. The client is placed on a transplant list at the local hospital. Donors must be relatives. Donors with hypertension may qualify.
Donors are selected from compatible living or deceased donors. Explanation: Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. Each local hospital does not have its own transplant list, instead the client will be placed on a national computerized transplant waiting list.
Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply. Restrict fluid to daily urinary output plus 500 to 800 mL. Limit protein to 1.6 g/kg/day. Eat foods such as milk, fish, and eggs. Increase potassium to prevent cardiac problems. Restrict sodium to 2,000 to 3,000 mg daily.
Eat foods such as milk, fish, and eggs. Restrict sodium to 2,000 to 3,000 mg daily. Restrict fluid to daily urinary output plus 500 to 800 mL. Explanation: With hemodialysis, protein should be limited to 1.2 to 1.3 g/kg/24 hr. Potassium, along with sodium and phosphorus should be restricted.
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? Elevated white blood cells Hypocalcemia Hyperkalemia Elevated urea levels
Hyperkalemia Explanation: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Weight loss Diuresis Absence of pain Fever
Fever Explanation: Fever is an indicator of infection or transplant rejection.
Which of the following activities with the nurse most likely anticipate implementing for the client with end-stage liver failure with multi system effects?
Glucose monitoring per fingerstick AC & HS Hypoglycemia is a common finding due to interference with glycogenolysis with then the liver and concur and pancreatic dysfunction
Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply.
Hyperkalemia Anemia Hypocalcemia Explanation: Hyperkalemia is due to decreased potassium excretion and excessive potassium intake. Metabolic acidosis results from decreased acid secretion by the kidney. A damaged glomerular membrane causes excess protein loss.
A client is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, the client frequently suffers from breathing difficulty. Which measures should the nurse include in the care plan to relieve this distress? Select all that apply.
Help the client to breathe deeply and cough every 2 hours. Provide firm support for the incision when the client coughs. Auscultate lung sounds once per shift. Explanation: To monitor the client's respiratory status, the nurse would auscultate the lungs. The nurse also would provide assistance with deep breathing, coughing, and splinting. Antibiotic therapy administration would not relieve this acute distress.
A client diagnosed with chronic renal failure is receives continuous peritoneal dialysis (PD). The nurse instructs the client about which diet plan?
High-protein diet Explanation: Because of protein loss with continuous PD, the client is instructed to eat a high-protein, nutritious diet. The client is also encouraged to increase daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity. A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for clients with acute renal failure.
The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? Check with the dialysis nurse about the medications. Hold the medications until after dialysis. Administer the medications as ordered. Ask if the client wants to take the medications.
Hold the medications until after dialysis. Explanation: Antihypertensive therapy, often part of the regimen of clients on dialysis, is one example when communication, education, and evaluation can make a difference in client outcomes. The client must know when—and when not—to take the medication. For example, if an antihypertensive agent is taken on a dialysis day, hypotension may occur during dialysis, causing dangerously low blood pressure. Many medications that are taken once daily can be held until after dialysis treatment.
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? Hydrating with saline intravenously before the test Performing the test without contrast Administering sodium bicarbonate after the procedure Administering Garamycin (gentamicin) prophylactically
Hydrating with saline intravenously before the test Explanation: Radiocontrast-induced nephropathy (CIN) is a major cause of hospital-acquired AKI. This is a potentially preventable condition. Baseline levels of creatinine greater than 2 mg/dL identify patients at high risk. Limiting the patient's exposure to contrast agents and nephrotoxic medications will reduce the risk of CIN (Murphy & Byrne, 2010; Rank, 2013). Administration of N-acetylcysteine and sodium bicarbonate before and during procedures reduces risk, but prehydration with saline is considered the most effective method to prevent CIN
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? Hypercalcemia Hypokalemia Hyperphosphatemia Metabolic alkalosis
Hyperphosphatemia Explanation: Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Hyperkalemia Elevated urea and nitrogen Hyperphosphatemia Elevated serum creatinine
Hyperphosphatemia Explanation: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? Decreased serum potassium level Increased red blood cell count Increased serum calcium level Increased serum creatinine level
Increased serum creatinine level Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.
A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? Inform the health care provider and assess the client for signs of infection. Flush the peritoneal catheter with normal saline. Remove the catheter promptly and have the catheter tip cultured. Administer a bolus of IV normal saline as prescribed.
Inform the health care provider and assess the client for signs of infection. Explanation: Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the physician would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.
Which of the following is not a function of the liver? Glycogenolysis Bile production hormone metabolism intoxication
Intoxication the actual term to describe liver function is detoxification
A client with decreased renal function is to receive a low-protein diet. The client asks the nurse why he needs this type of diet. The nurse would incorporate which reason into the response? Improve digestion Lessen workload on the kidneys Improve blood circulation Increase speed of treatment
Lessen workload on the kidneys Explanation: A low-protein diet lessens kidney workload and may be beneficial for a client with decreased kidney function. Although some protein is necessary for complete nutrition, clients with decreased renal function have difficulty excreting waste products from protein metabolism. A low-protein diet may not improve digestion, increase the speed of treatment, or improve blood circulation in a client with decreased renal function.
A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status?
Observing the client's urinary output. Explanation: Nephrotoxic drugs are not administered to a client with renal disease unless the client's life is in danger and no other therapeutic agent is of value. Since the client is given nephrotoxic drugs in normal doses, observing the client's urinary output can help the nurse determine a change in the renal status. Observing the client's fluid intake and noting the color of skin and nail beds do not help a nurse determine a change in the renal status. Checking for a thrill or a bruit daily is performed for a client with a vascular access device.
The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated? Obtaining a blood pressure reading from the right arm Palpating the fistula for a "thrill" Placing the client's watch on the left wrist Obtaining blood samples from the left arm
Obtaining a blood pressure reading from the right arm Explanation: The nurse assesses the vascular access for patency. The bruit, or "thrill," over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.
A patient is postoperative day 3 following the successful transplantation of a kidney. The nurse is aware of the importance of assessing the patient for signs and symptoms of rejection. Consequently, the nurse is constantly monitoring the patient for: Oliguria and edema Pain and hematuria Weight loss and lethargy Decreased level of consciousness and pruritus
Oliguria and edema Explanation: After kidney transplantation, the nurse assesses the patient for signs and symptoms of transplant rejection: oliguria, edema, fever, increasing blood pressure, weight gain, and swelling or tenderness over the transplanted kidney or graft. The other given assessment findings are not directly suggestive or organ rejection.
Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? Inspect the catheter site for leakage of dialysate. Observe for evidence of bleeding. Measure fluid drainage to estimate incomplete recovery of fluid. Palpate the abdominal wall for rebound tenderness.
Palpate the abdominal wall for rebound tenderness. Explanation: Peritonitis is the most serious complication of peritoneal dialysis. To detect rebound tenderness, the nurse presses one hand firmly into the abdominal wall and quickly withdraws the hand. Rebound tenderness exists when pain occurs upon removal; this pain is associated with inflammation of the peritoneal cavity.
Cirrhosis is characterized by
Repeated and ongoing self-destruction, fatty infiltration and scar replacement
Which of the following is the most sensitive indicator of renal function? Blood urea nitrogen (BUN) Serum creatinine Potassium Creatinine clearance
Serum creatinine Explanation: Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body.
A client is experiencing a decreasing glomerular filtration. What laboratory values should the nurse expect to follow the change? Select all that apply. Blood urea nitrogen (BUN) increases Hypophosphatemia Hypokalemia Creatinine clearance decreases Serum creatinine increases
Serum creatinine increases Blood urea nitrogen (BUN) increases Creatinine clearance decreases Explanation: As glomerular filtration decreases, the serum creatinine and BUN levels increase; the creatinine clearance decreases. Potassium and phosphate levels should not be affected by decreased glomerular filtration.
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? BUN of 20 mg/dLb Serum creatinine of 1.5 mg/dL Urinary protein level of 150 mg/24h. Creatinine clearance of 90 mL/min
Serum creatinine of 1.5 mg/dL Explanation: As glomerular filtration decreases, the serum creatinine and BUN levels increase and the creatinine clearance decreases. Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body. The BUN is affected not only by renal disease but also by protein intake in the diet, tissue catabolism, fluid intake, parenteral nutrition, and medications such as corticosteroids.
The nurse treats a client with end-stage kidney disease (ESKD). The nurse is concerned that the client is developing renal osteodystrophy. Upon review of the client's laboratory values, it is noted the client has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which medication? Mylanta Calcium carbonate Sevelamer hydrochloride Calcium acetate
Sevelamer hydrochloride Explanation: Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the gastrointestinal tract. Binders such as calcium carbonate or calcium acetate are prescribed, but there is a risk of hypercalcemia. If calcium is high or the calcium-phosphorus product exceeds 55 mg/dL, a polymeric phosphate binder such as sevelamer hydrochloride may be prescribed. This medication binds dietary phosphorus in the intestinal tract; one to four tablets should be administered with food to be effective. Magnesium-based antacids are avoided to prevent magnesium toxicity.
What is used to decrease potassium level seen in acute renal failure? IV dextrose 50% Sodium polystyrene sulfonate Calcium supplements Sorbitol
Sodium polystyrene sulfonate Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this client? The client feels best immediately after the dialysis treatment. The client should not feel pain during initiation of dialysis. Using a stethoscope for auscultating the fistula is contraindicated. Taking a BP reading on the affected arm can damage the fistula.
Taking a BP reading on the affected arm can damage the fistula. Explanation: When blood flow is reduced through the access for any reason (hypotension, application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, clients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful.
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? Hypotension Tenderness over transplant site Weight loss Polyuria
Tenderness over transplant site Explanation: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.
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? The client has a history of diverticulitis. The client is blind in his right eye. The client has a history of severe anemia during hemodialysis. The client is on the kidney transplant waiting list.
The client has a history of diverticulitis. Explanation: A history of diverticulitis contraindicates CAPD because CAPD has been associated with the rupture of diverticulum. A history of severe anemia while on hemodialysis or being on the transplant waiting list doesn't contraindicate CAPD. The client who's blind or partially blind can still learn to perform CAPD.
A client with advanced cirrhosis exhibiting signs and symptoms of fluid overload over here as a physician use the term portal hypertension when reviewing the chart. The client asked the nurse about this. The nurse explains that
The liver is congested and fluid "backs up" within blood vessels of the liver, resulting in general swelling all over
A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened? The patient is having an allergic reaction to the dialysate. Too much fluid was pulled off during dialysis. The dialysis was performed too rapidly. The patient is experiencing a cerebral fluid shift.
The patient is experiencing a cerebral fluid shift. Explanation: Dialysis disequilibrium results from cerebral fluid shifts. Signs and symptoms include headache, nausea and vomiting, restlessness, decreased level of consciousness, and seizures. It is rare and more likely to occur in AKI or when BUN levels are very high (exceeding 150 mg/dL).
Which clinical finding should a nurse look for in a client with chronic renal failure? Hypotension Metabolic alkalosis Polycythemia Uremia
Uremia Explanation: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? Urine output of 20 ml/hour Serum sodium level of 135 mEq/L Serum potassium level of 4.9 mEq/L Temperature of 99.2° F (37.3° C)
Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? Use an aseptic technique during the procedure. Wear a mask while handling any dialysate solutions. Clean the catheter insertion site daily with soap. Keep the catheter stabilized to the abdomen, below the belt line.
Use an aseptic technique during the procedure. Explanation: The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to do what? Wash hands carefully and frequently. Ensure immediate function of the donated kidney. Instruct the client to wear a face mask. Bar visitors from the client's room.
Wash hands carefully and frequently. Explanation: The nurse ensures that the client is protected from exposure to infection by hospital staff, visitors, and other clients with active infections. Careful handwashing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the client is receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred outright. Ensuring kidney function is vital, but does not prevent infection.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
White blood cell (WBC) count of 20,000/mm3 Explanation: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.
The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time?
With each meal Explanation: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be given with food to be effective.
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? 2 hours after meals With food 2 hours before meals At bedtime with 8 ounces of fluid
With food Explanation: Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.
The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder? a) pH 7.47, PaCO2 45, HCO3 33- b) pH 7.31, PaCO2 48, HCO3 24- c) pH 7.20, PaCO2 36, HCO3 14- d) pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Explanation: Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: fatigue and weakness. dyspnea and cyanosis. thrush and circumoral pallor. nausea and vomiting.
fatigue and weakness. Explanation: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.
The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for muscle cramping. air embolism. hypertension. dysrhythmias.
hypertension. Explanation: The nurse should monitor for hypotension, not hypertension, during the treatment related to the removal of fluid. Muscle cramping may occur late in dialysis as fluid and electrolytes rapidly leave the extracellular space. Dysrhythmias may result from electrolyte and pH changes or removal of antiarrhythmic medications. Air embolism is rare, but could occur if air enters the vascular system.
A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply. lethargy enhanced cognition muscle cramps bleeding of the oral mucous membranes
lethargy muscle cramps bleeding of the oral mucous membranes Explanation: Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: restricting sources of potassium usually found in fresh fruits and vegetables. allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally.
restricting sources of potassium usually found in fresh fruits and vegetables. Explanation: Restrict sources of potassium usually found in fresh fruits and vegetables; hyperkalemia can cause life-threatening changes. Restrict sodium intake as ordered; doing so prevents excess sodium and fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken. Iron and folic acid supplements are needed for RBC production. Epogen stimulates bone marrow to produce RBCs. Restrict protein intake to foods that are complete proteins within prescribed limits. Complete proteins provide positive nitrogen balance for healing and growth.
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: increased urine output. hematuria. increased blood pressure. weight loss.
weight loss. Explanation: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.
The most accurate indicator of fluid loss or gain in an acutely ill client is: blood pressure. weight. edema. pulse rate.
weight. Explanation: The most accurate indicator of fluid loss or gain in an acutely ill client is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.
