CRRT: help for acute renal failure & ProProfs quiz maker

What is the most common early manifestation of kidney disease _____ and _____

loss of concentration and dilute urine loss of ability to concentrate and dilute urine

A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: A. Confusion, headache, and seizures. B. Acute bone pain and confusion. C. Weakness, tingling, and cardiac arrhythmias. D. Hypotension, tachycardia, and tachypnea.

A Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

How many ml/hr of urine output is the normal minimum?

30

A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client? A. Polyuria B. Polydypsia C. Oliguria D. Anuria

A

Which category of acute renal failure is most common? a. prerenal failure b. intrarenal failure c. postrenal failure

A

The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant? A. Provide oral care every 3-4 hours B. Monitor for indications of dehydration C. Administer 0.45% saline by IV line D. Assess daily weights for trends

A Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.

What is the # 1 renal function test? A. Renal Clearance/Creatinine Clearance B. Osmolarity C. Serum Creatinine D. BUN

A Renal Clearance/Creatinine Clearance

_________ is the most frequent complication during hemodialysis. A. Hypertension B. Bleeding C. Infection D. Dialysis dementia

A hypertension

A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that contraindications to kidney transplantation include A. Hepatitis C infection B. Extensive vascular disease C. Coronary artery disease D. Refractory hypertension

B

Acute renal failure is characterized by a. decreased serum creatinine and blood urea nitrogen (BUN) levels with polyuria b. increased serum creatinine and BUN levels with oliguria. c. urine output of less than 30 mL/hour with normal BUN and creatinine levels.

B

Signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include A. Tachycardia and headache B. Fever and painful transplant site C. Sever hypotension and weight loss D. Recurrent urinary tract infections and oral yeast infections

B

The kidneys perform which life-sustaining task? a. potassium metabolism b. regulating acid-base balance c. white blood cell production

B

Which statement about CRRT is correct? a. It causes rapid changes of volume, electrolytes, and solutes. b. It removes volume and solutes slowly c. It's a method of intermittent dialysis.

B

A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout this phase include observation for signs and symptoms of A. Hypervolemia, hypokalemia, and hypernatremia. B. Hypervolemia, hyperkalemia, and hypernatremia. C. Hypovolemia, wide fluctuations in serum sodium and potassium levels. D. Hypovolemia, no fluctuation in serum sodium and potassium levels.

C The second phase of ARF is the diuretic phase or high output phase. The diuresis can result in an output of up to 10L/day of dilute urine. Loss of fluids and electrolytes occur.

Anti-hypertensive therapy in patients with chronic renal disease is for? A. Renal protection B. Cardiovascular protection C. Both renal and cardiovascular protection D. None of the above

C

Chronic kidney disease is defined by Kidney Disease Outcomes Quality Initiative (K/DOQI) as evidence of structural or functional kidney abnormalities (abnormal urinalysis, imaging studies, or histology) that persists for at least ______________ months, with or without a decreased GFR. A. 1 B. 2 C. 3 D. 6 E. 12

C

Clients on continuous ambulatory peritoneal dialysis (CAPD) must empty their peritoneal cavity and replace the dialysate every __________ hours. A. 24 B. 6-8 C. 4-6 D. 48

C

ESRD occurs when the GFR is less than ___ per minute. A. 5 ml B. 10 ml C. 15 ml D. 25 ml

C

What does urine mostly consist of? A. Urea B. NaCl (salt) C. H2O (water) D. KCl

C

Which of these drugs is nephrotoxic? A. Diuretics B. ACE inhibitors C. NSAIDs D. Sodium bicarbonate/ Potassium bicarbonate

C

A client on peritoneal dialysis notices that the collecting bag of dialysate is cloudy, what is this an indication of? A. The client needs to change their dialysate B. The patient needs a kidney transplant C. Medication was added to the dialysate D. The patient is infected and experiencing peritonitis

D

Clients with chronic renal failure should notify the physician of any weight: A. Loss of 2 pounds over a 5 day period B. Gain of 2 pounds over a 2 day period C. Loss of 5 pounds over a 5 day period D. Gain of 5 pounds over a 2 day period

D

The leading cause of ESRD is the client with a history of A. Hypotension B. Anemia C. Prostate cancer D. Diabetes Mellitus

D

A client in acute renal failure is a candidate for continuous renal placement therapy (CRRT). The most common indication for use of CRRT is A. Azotemia B. Pericarditis C. Hyperkalemia D. Fluid overload

D

The nurse is caring for the client who has had a renal biopsy. Which of the following interventions would the nurse avoid in the care of the client after this procedure? A. Encourage fluids to at least 3L in the first 24 hours B. Administering narcotics as needed C. Testing serial samples iwth dipsticks for occult blood D. Ambulating the client in the room and hall for short distances

D

The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately? A. Blood urea nitrogen 50 mg/dl B. Hemoglobin of 10.3 mg/dl C. Venous blood pH 7.30 D. Serum potassium 6 mEq/L

D Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.

What is the #1 cause of death when kidneys fail?

Hyperkalemia

During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids.

Maintenance

_________ renal Failure is a rapid decline in renal function with an abrupt onset

acute

The risk for __________________ is particularly high when ischemia and exposure to a nephrotoxin occur at the same time.

acute tubular necrosis, tubular necrosis

What could a decrease in BUN/Creatinine ratio indicate?

fluid volume excess malnutrition fluid volume excess or malnutrition

Acute renal failure is generally identified by oliguria (urine output <_____ mL/day).

400

After 1 week a client with acute renal failure moves, into the diuretic phase. During this phase the client must be carefully assessed for signs of: A. Hypovolemia B. Hyperkalemia C. Metabolic acidosis D. Chronic renal failure

A

Nurse Liza is assigned to care for a client who has returned to the nursing unit after left nephrectomy. Nurse Liza's highest priority would be... A. Hourly urine output B. Temperature C. Able to turn side to side D. Able to sips clear liquid

A After nephrectomy, it is necessary to measure urine output hourly. This is done to assess the effectiveness of the remaining kidney also to detect renal failure early.

What tests and results prove the presence of dilute urine? A. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l) B. GFR (100 ml/min), and/or Specific Gravity (1.030) C. Serum Creatinine (1.5 mg/dl)

A Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)

Which phase of Acute Renal Failure results in FVE and edema due to salt and water retention, hypertension, Azotemia, hyperkalemia, muscle weakness, nausea, diarrhea, and high serum creatinine and BUN levels? A. Initiation phase B. Maintenance phase C. Recovery fase D. Intrarenal phase

B

Whici is a normal value of Blood Urea Nitrogen (BUN)? A. 0.5-1.1 mg/dL B. 5-20 mg/dL C. 40-70 mg/dL D. 250-500 mg/dL

B

True or false? Creatinine, phosphate, sulfates, and uric acid should not be present in urine because they signify renal failure. A. True B. False

B Creatinine, phosphate, sulfates, and uric acid should be found in urine.

________ failure is caused by Acute damage to renal tissue and nephrons or acute tubular necrosis: abrupt decline in tubular and glomerular function due to either prolonged ischemia and/or exposure to nephrotoxins. (Acute glomerulonephritis, malignant hypertension, ischemia; nephrotoxic drugs or substances; red blood cell destruction; muscle tissur breakdown due to trauma, heatstroke) A. Prerenal B. Intrarenal C. Postrenal D. Perirenal

B Intrarenal

Agents that damage the kidney tissue are called: A. Nephrons B. Nephrotoxins C. Antibodies D. Enterotoxins

B Nephrotoxins

The client with ESRD tells the nurse that she hates the thought of being tied to the machine, but is also glad to start dialysis because she will be able to eat and drink what she wants. Based on this information, the nuse identifies the nursing diagnosis of A. Self-esteem disturbance related to dependence on dialysis B. Anxiety related to perceived threat to health status and role functioning C. Ineffective management of therapeutic regimen related to lack of knowledge of treatment plan D. Risk for imbalanced nutrition: more than body requirements, related to increased dietary intake

C

Which statement about the maintenance phase of acute renal failure is correct a. It marks the beginning of renal tissue repair. b. It's the time from onset to when tubular injury occurs. c. Urine output is at its lowest in this phase.

C

Which statement about the normal kidney is correct? a. Renal veins bring blood to the kidney for filtering. b. The medulla of the kidney filters blood to form urine. c. There are 1 million nephrons in each kidney

C

How much water do normal kidneys excrete each day? A. 3-4 liters B. 5-6 liters C. 1-2 liters D. 7-8 liters

C 1-2 liters

For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? A. Encouraging coughing and deep breathing B. Promoting carbohydrate intake C. Limiting fluid intake D. Providing pain-relief measures

C During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

The most serious electrolyte disorder associated with kidney disease is A. Hypermagnesemia B. Hyponatremia C. Hyperkalemia D. Metabolic acidosis

C Hyperkalemia

How do kidneys control Na+ levels and K+ levels? A. The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+ B. Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin. Angiotensin controls the levels of Na+ and K+ C. The kidneys release renin which controls K+. The kidneys release angiotensin which causes Na+ realease.

A

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action? A. Notify the physician B. Monitor the client C. Elevate the head of the bed D. Medicate the client for nausea

A

When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, the client is said to have ____________, the final stage of Chronic Renal Failure. A. End-stage renal disease (ESRD) B. Renal insufficiency C. Acute tubular necrosis D. Dialysis

A

Which of the following medications does not interfere with either creatinine secretion or the assay used to measure the serum creatinine? A. Ibuprofen B. Cimetidine C. Trimethoprim D. Cefoxitin E. Flucytosine

A

Which patient is a candidate for CRRT? a. Mr. A, who's 54 and has a life-threatening electrolyte imbalance b. Ms. P, who's hemodynamically stable c. Mrs. S, who's 46 and has no vascular access available

A

Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________. A. Hematuria B. Oliguria C. Uremia D. Nephrotoxins

C Uremia

Which of the following are abnormal to be found in the urine? A. K B. Amino acids C. Glucose D. All of the above E. Amino acids and Glucose

E amino acids (proteins) found in the urine indicate trauma to the glomeruli. Glucose found in the urine indicate BS levels to be above the renal threshold.

The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock) A. Prerenal B. Intrarenal C. Postrenal D. Perirenal

A Prerenal

The client with renal failure should be on which type of diet? A. High protein, high carbohydrate, low calorie B. Adequate calorie intake, high carbohydrate, limited protein C. Limited protein, low carbohydrate, adequate calorie intake D. Low calorie, limited protein, low carbohydrate

B

"urine in the blood"

uremia

Marina with acute renal failure moves into the diuretic phase after one week of therapy. During this phase the client must be assessed for signs of developing: A. Hypovolemia B. Renal failure C. Metabolic acidosis D. Hyperkalemia

A In the diuretic phase fluid retained during the oliguric phase is excreted and may reach 3 to 5 liters daily, hypovolemia may occur and fluids should be replaced.

A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance? A. Hyponatremia B. Hyperkalemia C. Hyperphosphatemia D. Hypercalcemia

A The normal serum sodium level is 135 - 145 mEq/L. The client's serum sodium is below normal. Hyponatremia also manifests itself with abdominal cramps and nausea and vomiting

When the kidneys cannot effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, intake of these substances must be regulated. Fluid and Sodium intake are ________. A. Encouraged B. Limited C. Restricted

B

Nurse Tristan is caring for a male client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: A. Hypernatremia. B. Hypokalemia. C. Hyperkalemia. D. Hypercalcemia.

C Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

A client with acute renal failure is aware that the most serious complication of this condition is: A. Constipation B. Anemia C. Infection D. Platelet dysfunction

C Infection is responsible for one third of the traumatic or surgically induced death of clients with renal failure as well as medical induced acute renal failure (ARF)

Which diagnostic test would be monitored to evaluate glomerulat filtration rate and renal function? A. Serum creatinine and BUN B. Urinalysis C. Kidney biopsy D. Creatinine clearance

D Creatinine clearance

____________ is a treatment for renal failure in which blood is continuously circulated (artery to vein or vein to vein) and filtered, allowing excess water and solutes to empty into a collecting device. Fluid may be replaced with a balanced electrolyte solution as needed during treatment. A. Hemodialysis B. Continuous ambulatory peritoneal dialysis C. Continuous cyclic peritoneal dialysis D. Continuous Renal Replacement Therapy

D Continuous Renal Replacement Therapy

What controls the amount of water reabsorbtion?

antidiuretic hormone, vasopressin and ADH, ADH and Vasopressin

During the recovery phase of acute renal failure a. increases in serum potassium and magnesium levels occur. b. retained fluid may cause edema and pulmonary congestion. c. urine output gradually increases as diuresis occurs.

C

End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2. A. 45 B. 30 C. 15 D. 10 E. 5

C

__________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction by calculi) A. Prerenal B. Intrarenal C. Postrenal D. Perirenal

C Postrenal