Exam 1-2 Med-Surg
A nurse provides home care instructions to a client undergoing hemodialysis with regard to care of a newly created arteriovenous (AV) fistula. Which client statement would indicate understanding of the instructions? 1. "I should check the fistula every day by feeling it for a vibration." 2. "I am glad that the laboratory will be able to draw my blood from the fistula." 3. "I should wear a shirt with tight arms to provide some compression on the fistula." 4. "I should check my blood pressure in the arm where I have my fistula every week."
1. "I should check the fistula every day by feeling it for a vibration."
The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option? 1. A client with severe heart failure 2. A client with a history of ruptured diverticula 3. A client with a history of herniated lumbar disk 4. A client with a history of three previous abdominal surgeries
1. A client with severe heart failure
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 3. Contact the health care provider (HCP). 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.
1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks.
Which findings noted in a client on continuous ambulatory peritoneal dialysis (CAPD) should be reported to the health care provider (HCP)? 1. Cloudy yellow dialysate output 2. Client refusal to take the stool softener 3. Previous evening's dwell time of 8 hours 4. Peritoneal catheter site is not red, and the skin has grown around the cuff
1. Cloudy yellow dialysate output
The nurse is reviewing a client's record and notes that the health care provider has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Decreased white blood cell count
1. Elevated creatinine level
The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation? 1. Fever 2. Fatigue 3. Clear dialysate output 4. Leaking around the catheter site
1. Fever
A nurse is performing an assessment on a client with acute kidney injury who is in the oliguric phase. During this phase, the nurse understands that which manifestations are associated findings? Select all that apply. 1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 4. Urine osmolarity of approximately 300 mOsm/L 5. A urine output of 600 to 800 mL in a 24-hour period
1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 4. Urine osmolarity of approximately 300 mOsm/L
A nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? 1. Maintain strict aseptic technique. 2. Add heparin to the dialysate solution. 3. Change the catheter site dressing daily. 4. Monitor the client's level of consciousness.
1. Maintain strict aseptic technique.
A client with chronic kidney disease (CKD) is being managed by continuous ambulatory peritoneal dialysis (CAPD). During outflow, the nurse notes that only half of the 2-L dialysate has returned and the flow has stopped. Which interventions should the nurse take to enhance the outflow? Select all that apply. 1. Reposition the client. 2. Encourage a low-fiber diet. 3. Make sure the peritoneal catheter is not kinked. 4. Slide the peritoneal catheter farther into the abdomen. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated.
1. Reposition the client. 3. Make sure the peritoneal catheter is not kinked. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated.
A client is about to begin hemodialysis. Which measure(s) should the nurse employ in the care of the client? Select all that apply. 1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron 5.Covering the connection site with a bath blanket to enhance extremity warmth
1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron
A client with a chronic kidney disease has completed a hemodialysis treatment. The nurse should use which standard indicators to evaluate the client's status after dialysis? 1. Vital signs and weight 2. Potassium level and weight 3. Vital signs and blood urea nitrogen level 4. Blood urea nitrogen and creatinine levels
1. Vital signs is priority and then weight
The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury? 1. Prerenal 2. Intrarenal 3. Postrenal 4. Extrarenal
2. Intrarenal
The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, would indicate an adequate understanding of the treatment plan for this client? 1. Prevent fluid overload. 2. Prevent loss of electrolytes. 3. Promote the excretion of wastes. 4. Reduce the urine specific gravity.
2. Prevent loss of electrolytes.
A nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further education about the diuretic phase of acute kidney injury? 1. "The increase in urine output indicates the return of some renal function." 2. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." 3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 4. "The blood urea nitrogen (BUN) and creatinine levels will continue to rise during the first few days of diuresis."
3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period."
A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 100.2° F. Which nursing action is most appropriate? 1. Encourage fluids. 2. Notify the health care provider. 3. Continue to monitor vital signs. 4. Monitor the site of the shunt for infection.
3. Continue to monitor vital signs.
In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate to note? 1. Glycosuria 2. Polyphagia 3. Crackles auscultated in lungs 4. Blood pressure 98/58 mm Hg
3. Crackles auscultated in lungs
A client undergoing hemodialysis begins to experience muscle cramping. What corrective action should the hemodialysis nurse caring for the client take? 1. Administer hypotonic saline. 2. Increase the ultrafiltration rate. 3. Decrease the ultrafiltration rate. 4. Administer magnesium sulfate.
3. Decrease the ultrafiltration rate.
A client is being discharged to home while recovering from acute kidney injury (AKI). A reduction in which substance indicates to the nurse that the client understands the dietary teaching? 1. Fats 2. Vitamins 3. Potassium 4. Carbohydrates
3. Potassium
A health care provider writes prescriptions for a client with chronic kidney disease (CKD). Which prescription should the nurse question? 1. Insert a saline lock. 2. Obtain a daily weight. 3. Provide a high-protein diet. 4. Administer a calcium supplement with each meal.
3. Provide a high-protein diet.
Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory study? 1. Urinalysis, hematocrit, hemoglobin 2. Culture and sensitivity testing, serum sodium 3. Urine specific gravity, intravenous pyelogram 4. Fasting blood glucose, serum potassium, serum calcium
4. Fasting blood glucose, serum potassium, serum calcium
The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching
4. Headache, deteriorating level of consciousness, and twitching. headache nausea vomiting increased blood pressure decreased mental abilities confusion about time, and then location and people as the pressure worsens double vision pupils that don't respond to changes in light shallow breathing seizures loss of consciousness coma
The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the most appropriate nursing action? 1. Monitor the client. 2. Elevate the head of the bed. 3. Medicate the client for nausea. 4. Notify the health care provider (HCP).
4. Notify the health care provider (HCP).
The nurse is admitting a client to the nursing unit who has an arteriovenous (AV) fistula in the right arm for hemodialysis. Which nursing intervention is the best way to prevent injury to the AV site? 1. Putting a large note about the access site on the front of the medical record 2. Applying an allergy bracelet to the right arm, indicating the presence of the fistula 3. Telling the client to inform all caregivers who enter the room about the presence of the access site 4. Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm"
4. Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm"
The nurse is analyzing the post-hemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? 1. Potassium 2. Creatinine 3. Phosphorus 4. Red blood cell (RBC) count
4. Red blood cell (RBC) count
A nurse is caring for an older client. When evaluating the client's renal function, the nurse recalls that which change takes place as part of the normal aging process? 1. Tubular reabsorption increases 2. Urine-concentrating ability increases 3. Medications are metabolized in larger amounts 4. The glomerular filtration rate (GFR) diminishes
4. The glomerular filtration rate (GFR) diminishes
IN collaboration w/ the nutritionist, the nurse teaches the pt about which diet recommendations for management of CRF? (Select all that pply)
A-controlling protein intake, B-Limiting fluid intake, C-restricting potassium, E-restricting phosphorus, F-eating enough calories to meet metabolic need
The nurse is caring for the pt w/ prerenal azotemia. What are the primary treatment goalsin the initial phase tha tprevent permanent kidney damage for this patient? (select all that apply)
A-correct blood volume, B-Increase Blood pressure, C-Improve cardiac output
The nurse is caring for the pt in the ICU who sustained blood loss during a traumatic accident. In order to assess for prerenal azotemia, which s/s does the nurse observe for? (select all that apply)
A-hypotension, C-decreased urine output, D-decreased cardia output, F-Lethargy
Which are the most accurate ways to monitor kidney funtion in the pt w/ CRF? (select all that apply)
A-monitoring intake & output, B-checking urine specific gravity, C-Reviewing BUN & serum creatinine levels
Which chronic renal pts are candidates for hemodialysis (select all that apply?)
A-pt w/ fluid overload who does not respond to diuretics, C-Pts w/ severe neurologic problems, D-Pt w/ decreased attention span & decreased cognition, E-pt w/ worsening anemia & puritus
The intensive care nurse is caring for the renal transplant pt who was just transferred fr. the recovery unit. Which finding is the most serious w/in the 1st 12 hours after surgery & warrents immediate notification of the transplant surgeon?
Abrupt decrease in urine
Which pt is taking a combination of drugs that are the most nephrotoxic?
Aminoglycoside antibiotics & NSAIDs
The nurse is providing postdialysis care for the pt. In comparing vital signs & weight measurements to the predialysis data, what does the nurse expect to find?
BP & weight are reduced
The nurse is assessing the pt who just returned fr. Hemodialysis. What is unexpected finding that warrants notification of the health care provider?
Bleeding @ the access site
The nurse is reviewing the medication record of a client diagnosed with chronic kidney disease (CKD). The nurse notes that the client is receiving aluminum hydroxide (ALternaGEL). The nurse plans care, knowing that which is the purpose of this medication? 1. Prevents ulcers. 2. Prevents constipation. 3. Promotes the elimination of potassium from the body. 4. Combines with phosphorus and helps eliminate phosphates from the body.
Combines with phosphorus and helps eliminate phosphates from the body.
The pt is undergoing a dialysis treatment & exhibits a progression of symptoms which included headache, N & V, decreased LOC, & seizure activity. How does the nurse interpret these symptoms?
Dialysis desequilibrium syndrome
The pt w/ CRF reports chronic fatigue & lethargy w weakness & mild SOB w/ dizziness when rising to a standing position. In addition, the nurse nortes pale mucous membranes. Based on the pt's illness & presenting symptoms, which lab restult does the nurse expect to see?
Low hemoglobin & hematocrit
The nurse is review the pt's lab results. In the early phase of CRF, what does the nurse expect to see?
Lower than normal sodium
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula 2. Presence of a radial pulse in the left wrist 3. Absence of a bruit on auscultation of the fistula 4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand
Palpation of a thrill over the fistula
The nurse is talking to the older adult male patient who is resonably healthy for his age, but has benign porstatic hypertrophy. Which condition does the BPH potentially place him @ risk for?
Postrenal azotemia
The nurse is assessing the pt w/ ARF. The nurse notes bladder distention & the pt reports "feeling the urge to urinate" Urine sodium level is 40 mEq, specific gravity of 1.010. How does the nurse interpret these findings?
Postrenal failure
Which renal pt is the best candidate for peritoneal dialysis?
Pt w/ hx of difficulty w/ anticoagulants
The pt has returned to the medical surgical unit after having a dialysis treatment. The nurse notes that the pt is also scheduled for an invasion procedure on the same day. What is the primary rationale for delaying the procedure for 4-6 hours?
The pt was heparinized during dialysis
The pt w/ CRF has a potassium level of 8 mEq. The nurse notifies the health care provider after assessing for which s/s?
cardiac dysrhythmias
the nurse has obtained a urine specimen fr. the pt & has used a dipstick to test the urine. Which abnormal finding is the earliest sign of renal tubular damage?
decreased urine specific gravity