Exam 4: Chronic Kidney Disease NCLEX Questions
b
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory PD program (CAPD). The nurse should explain that the major advantage of this approach is that it a. is relatively low in cost b. allows the client to be more independent c. is faster and more efficient than standard PD d. has fewer potential complications than does standard PD
a
A major advantage of peritoneal dialysis is a. the diet is less restricted and dialysis can be performed at home b. the dialysate is biocompatible and causes no long-term consequences c. high glucose concentrations of the dialysate causes a reduction in appetite, promoting weight loss d. no medications are required because of the enhances efficiency of the peritoneal membrane in removing toxins
a b d e
A nurse is planning care for a client who will undergo PD. Which of the following actions should the nurse take? Select all that apply a. monitor blood glucose levels b. report cloudy dialysate return c. warm the dialysate in a microwave oven d. assess for SOB e. check the access site dressing for wetness
d
A patient complains of leg cramps during hemodialysis. The nurse should first a. reposition the patient. b. massage the patients legs. c. give acetaminophen (Tylenol). d. infuse a bolus of normal saline.
b
After completion of PD, the nurse should assess the client for a. hematuria b. weight loss c. hypertension d. increased urine output
b
In replying to a patient's questions about the seriousness of her CKD, the nurse knows that the stage of CKD is based on what? a. total daily urine output b. GFR c. degree of altered mental status d. serum creatinine and urea levels
a
The advantage of continuous replacement therapy over hemodialysis is its ability to a. remove fluid without the use of a dialysate. b. remove fluid in less than 24 hours. c. allow the patient to receive the therapy at the work site. d. be administered through a peripheral line.
a
The dialysis solution is warmed before use in peritoneal dialysis primarily to a. encourage the removal of serum urea b. force potassium back into the cells c. add extra warmth to the body d. promote abdominal muscle relaxation
a
The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid? a. Joint pain b. Tachycardia c. Postural hypotension d. Increase in creatinine level
d
The nurse is preparing to administer a dose of PhosLo to a patient with chronic kidney disease. This medication should have a beneficial effect on which laboratory value? a. Sodium b. Potassium c. Magnesium d. Phosphorus
c e
The patient with CKD is considering whether to use PD or HD. What are advantages of PD when compared to HD? Select all that apply a. less protein loss b. rapid fluid removal c. less cardiovascular stress d. decreased hyperlipidemia e. requires fewer dietary restrictions
d
What is the most appropriate snack for the nurse to offer a patient with stage 4 CKD? a. raisins b. ice cream c. dill pickles d. hard candy
a
Which complication of CKD is treated with erythropoietin? a. anemia b. hypertension c. hyperkalemia d. mineral and bone disorder
b
Which should be included in the client's plan of care during dialysis therapy? a. limit the client's visitors b. monitor the client's blood pressure c. pad the side rails of the bed d. keep the client on NPO status
b
A 24-yr-old woman donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing significant pain and refuses to get up to walk. How should the nurse respond? a. Have the transplant psychologist convince her to walk. b. Encourage even a short walk to avoid complications of surgery. c. Tell the patient that no other patients have ever refused to walk. d. Tell the patient she is lucky she did not have an open nephrectomy.
a
A 78-yr-old patient has stage 3 CKD and is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? a. Apple, green beans, and a roast beef sandwich b. Granola made with dried fruits, nuts, and seeds c. Watermelon and ice cream with chocolate sauce d. Bran cereal with ½ banana and milk and orange juice
d
A HD client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? a. warmth, redness, and pain in the left hand b. ecchymosis and audible bruit over the fistula c. edema and reddish discoloration of the left arm d. pallor, diminished pulse, and pain in the left hand
a
A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which sign of peritoneal infection? a. cloudy dialysate fluid b. swelling in the legs c. poor drainage of the dialysate fluid d. redness at the catheter insertion site
b
A client is receiving peritoneal dialysis. While the dialysis solution is dwelling in the client's abdomen, the nurse should a. assess for urticaria b. observe respiratory status c. check capillary refill time d. monitor electrolyte status
d
A client undergoing long term PD at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, the nurse should inquire whether the client has a. diarrhea b. vomiting c. flatulence d. constipation
b
A client with CKD returns to the nursing unit following a HD treatment. On assessment, the nurse notes that the client's temperature is 101.2. Which nursing action is most appropriate? a. encourage fluid intake b. notify the HCP c. continue to monitor vital signs d. monitor the site of the shunt for infection
b
A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula, the nurse should a. take the BP in the arm with the fistula b. report the loss of a thrill or bruit on the arm with the fistula c. maintain a pressure dressing on the shunt d. start a second IV in the arm with the fistula
b d e
A client with chronic renal failure who receives hemodialysis 3 times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply a. drink fluids before eating solid foods b. have limited amounts of fluids only when thirsty c. limit activity d. keep all dialysis appointments e. eat smaller, more frequent meals
b c d
A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client do to? Select all that apply a. remind the HCPs to draw blood from veins on the left side b. avoid sleeping on the left arm c. wear wristwatch on the right arm d. assess fingers on the left arm for warmth e. obtain BP from the left arm
a
A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 weeks. What is the first action the nurse should take? a. assess temperature and initiate workup to rule out infection b. reassure the patient that this is common after transplantation c. provide warm cover for the patient and give 1 g acetaminophen orally d. notify the nephrologist that the patient has developed symptoms of acute rejection
a
A man with ESRD is scheduled for HD following healing of an arteriovenous fistula. What should the nurse explain to him that will occur during dialysis? a. he will be able to visit, read, sleep, or watch TV while reclining in a chair b. he will be placed on a cardiac monitor to detect any adverse effects that may occur c. the dialyzer will remove and hold part of his blood for 20-30 minutes to remove the waste products d. a large catheter with two lumens will be inserted into the fistula to send blood to and return it from the dialyzer
a b c e
A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? Select all that apply a. anuria b. marked azotemia c. crackles in the lungs d. increased calcium level e. proteinuria
c
A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? a. administer an opioid medication b. monitor for hypertension c. assess level of consiousness d. increase the dialysis exchange rate
a b c e
A nurse is planning postoperative care for a client following a kidney transplant. Which of the following actions should the nurse include? Select all that apply a. obtain daily weights b. assess dressings for bloody drainage c. replace hourly urine output with IV fluids d. expect oliguria in the first 4 hours e. monitor blood electrolytes
a b c d
A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? Select all that apply a. check BUN and blood creatinine b. administer medications the nurse withheld prior to dialysis c. observe for findings of hypovolemia d. assess the access site for bleeding e. evaluate BP on the arm with AV access
a b d e
A nurse is preparing to initiate hemodialysis for a client who has AKI. Which of the following actions should the nurse take? Select all that apply a. review the medications the client currently takes b. assess the AV fistula for a bruit c. calculate the client's hourly urine output d. measure the client's weight e. check blood electrolytes
d
A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching? a. hemodialysis restores kidney function b. hemodialysis replaces hormonal function of the renal system c. hemodialysis allows an unrestricted diet d. hemodialysis returns a balance to blood electrolytes
a c d
A nurse is teaching a client who is scheduled for a kidney transplant about organ rejection. Which of the following statements should the nurse include? Select all that apply a. "expect an immediate removal of the donor kidney for a hyperacute rejection" b. "you might need to begin dialysis to monitor your kidney function for a hyperacute reaction" c. "a fever is a manifestation of an acute rejection" d. "fluid retention is a manifestation of an acute rejection" e. "your provider will increase your immunosuppressive medications for a chronic rejection"
a
A patient is admitted to the hospital with CKD. The nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys b. a rapid decrease in urine output with an elevated BUN c. an increasing creatinine clearance with a decrease in urine output d. prostration, somnolence, and confusion with coma and imminent death
c
A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? a. Hypokalemia b. Hyponatremia c. Large urine output d. Leukocytosis with cloudy urine output
a
A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a. is much less likely to clot. b. increases patient mobility. c. can accommodate larger needles. d. can be used sooner after surgery.
d
A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that what is a contraindication to kidney transplantation? a. hepatitis C infection b. coronary artery disease c. refractory hypertension d. extensive vascular disease
a
A patient received a kidney transplant last month. Because of the effects of immunosuppressive drugs and CKD, what complication of transplantation should the nurse be assessing the patient for? a. infection b. rejection c. malignancy d. cardiovascular disease
d
A patient with a 25-year history of type 1 diabetes mellitus is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood sugars. Which diagnostic study is most indicative of chronic kidney disease (CKD)? a. Serum creatinine b. Serum potassium c. Microalbuminuria d. Calculated glomerular filtration rate (GFR)
b (This increases the magnesium level in the patient whom already has problems with hypermagnesemia)
A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required? a. Multivitamin with iron b. Milk of magnesia 30 mL c. Calcium phosphate (PhosLo) d. Acetaminophen (Tylenol) 650 mg
b
A patient with end-stage renal disease (ESRD) secondary to diabetes mellitus has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? a. Level of consciousness b. Blood pressure and fluid balance c. Temperature, heart rate, and blood pressure d. Assessment for signs and symptoms of infection
d
A week after kidney transplantation, a client develops a temperature of 101, the BP is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? a. antibiotic therapy b. peritoneal dialysis c. removal of the transplanted kidney d. increased immunosuppression therapy
b
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? a. Elevate the patients arm above the level of the heart. b. Report the patients symptoms to the health care provider. c. Remind the patient about the need to take a daily low-dose aspirin tablet. d. Educate the patient about the normal vascular response after AVG insertion.
a
An ESRD patient receiving HD is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that a. successful transplantation usually provides a better quality of life than that offered by dialysis b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available c. HD replaces the normal function of the kidneys, and patients do not have to live with the continual fear of rejection d. the immunosuppressive therapy following transplantation makes the person ineligible to receive other forms of treatment if the kidney fails
c
Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the a. blood urea nitrogen (BUN) and creatinine. b. blood glucose level. c. patients bowel sounds. d. level of consciousness (LOC).
b
During PD, the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should a. have the client sit in a chair b. turn the client from side to side c. reposition the peritoneal catheter d. have the client walk
c
During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Obtain blood to check the blood urea nitrogen (BUN) level. c. Check the patients blood pressure. d. Give prescribed PRN antiemetic drugs.
c
During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? a. Administer hypertonic saline. b. Administer a blood transfusion. c. Decrease the rate of fluid removal. d. Administer antiemetic medications.
b
During the PD, the nurse observes that the solution draining from the client's abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. The nurse should recognize that the bleeding a. is expected with a permanent peritoneal catheter b. indicates abdominal blood vessel damage c. can indicate kidney damage d. is caused by too-rapid infusion of the dialysate
a
During the immediate postoperative care of a recipient of a kidney transplant, what is a priority for the nurse to do? a. regulate fluid intake hourly based on urine output b. monitor urine-tinged drainage on abdominal dressing c. medicate the patient frequently for incisional flank pain d. remove the urinary catheter to evaluate the ureteral implant
c
Measures indicated in the conservative therapy of CKD include a. decreased fluid intake, carbohydrate intake, and protein intake. b. increased fluid intake; decreased carbohydrate intake and protein intake. c. decreased fluid intake and protein intake; increased carbohydrate intake. d. decreased fluid intake and carbohydrate intake; increased protein intake.
a b d
Patients with CKD experience an increase incidence of cardiovascular disease related to Select all that apply a. hypertension b. vascular calcifications c. a genetic predisposition d. hyperinsulinemia causing dyslipidemia e. increased high-density lipoprotein levels
d
The client newly diagnosed with CKD recently has begun HD. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? a. hypertension, tachycardia, and fever b. hypotension, bradycardia, and hypothermia c. restlessness, irritability, and generalized weakness d. headache, deteriorating LOC, and twitching
a b d e
The client performs self PD. What should the nurse teach the client about preventing peritonitis? Select all that apply a. broad-spectrum antibiotics may be administered to prevent infection b. antibiotics may be added to the dialysate to treat peritonitis c. clean technique is permissible for prevention of peritonitis d. peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort e. peritonitis is the most common and serious complication of peritoneal dialysis
b
The home care nurse visits a 34-yr-old woman receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? a. "Drain time is faster if I rub my abdomen." b. "The fluid draining from the catheter is cloudy." c. "The drainage is bloody when I have my period." d. "I wash around the catheter with soap and water."
a
The nurse has instructed a patient who is receiving hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful? a. Scrambled eggs, English muffin, and apple juice b. Oatmeal with cream, half a banana, and herbal tea c. Split-pea soup, whole-wheat toast, and nonfat milk d. Cheese sandwich, tomato soup, and cranberry juice
b
The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which information should be reported immediately to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patients peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient complains of feeling bloated after the inflow.
a
The nurse is assessing the patency of a client's left arm AV fistula prior to initiating HD. Which findings indicate that the fistula is patent? a. palpation of a thrill over the fistula b. presence of a radial pulse in the left wrist c. visualization of enlarged blood vessels at the fistula site d. capillary refill <3 seconds in the nail beds of the fingers on the left hand
c
The nurse is caring for a patient with chronic kidney disease after hemodialysis. Which patient care action should the nurse delegate to the experienced unlicensed assistive personnel (UAP)? a. Assess the patient's access site for a thrill and bruit. b. Monitor for signs and symptoms of postdialysis bleeding. c. Check the patient's postdialysis blood pressure and weight. d. Instruct the patient to report signs of dialysis disequilibrium syndrome immediately.
c
The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? a. high-carbohydrate, high-protein b. high-calcium, high-potassium, high-protein c. low-protein, low-sodium, low-potassium d. low-protein, high-potassium
d
The nurse is performing an assessment on a client who has returned from the dialysis unit following HD. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? a. monitor the client b. elevate the HOB c. assess the fistula site and dressing d. notify the HCP
a
The nurse is reviewing a client's record and notes that the HCP has documented that the client has CKD. On review of the laboratory results, the nurse most likely would expect to note which finding? a. elevated creatinine level b. decreased hemoglobin level c. decreased RBC d. increased number of WBC in the urine
a b d e
The nurse monitoring the client receiving PD notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply a. check the level of the drainage bag b. reposition the client to their side c. contact the HCP d. place the client in good body alignment e. check the PD system for kinks
d
The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? a. Sodium b. Potassium c. Magnesium d. Phosphorus
c
The patient with CKD is brought to the ED with Kussmaul respirations. What does the nurse know about CKD that could cause this patient's Kussmaul respirations? a. uremic pleuritis is occurring b. there is decreased pulmonary macrophage activity c. they are caused by respiratory compensation for metabolic acidosis d. pulmonary edema from HF and fluid overload is occurring
a b d
The patient with CKD is receiving dialysis, and the nurse observes excoriations on the patient's skin. What pathophysiologic changes in CKD most likely occur that can contribute to this finding? Select all that apply a. dry skin b. sensory neuropathy c. vascular calcifications d. calcium-phosphate skin deposits e. uremic crystallization from high BUN
c d e
To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should Select all that apply a. monitor the BP in the affected arm b. irrigate the graft daily with low-dose heparin c. palpate the area of the graft to feel a normal thrill d. listen with a stethoscope over the graft to detect a bruit e. frequently monitor the pulses and neurovascular status distal to the graft
b
To prevent the most common serious complication of PD, what is most important for the nurse to do? a. infuse the dialysate slowly b. use strict aseptic technique in the dialysis procedures c. have the patient empty the bowel before the inflow phase d. reposition the patient frequently and promote deep breathing
c
Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider? a. The urine output is 900 to 1100 mL/hr. b. The blood urea nitrogen (BUN) and creatinine levels are elevated. c. The patients central venous pressure (CVP) is decreased. d. The patient has level 8 (on a 10-point scale) incisional pain.
c
What causes the GI manifestation of stomatitis in the patient with CKD? a. high serum sodium levels b. irritation of the GI tract from creatinine c. increased ammonia from bacterial breakdown of urea d. iron salts, calcium-containing phosphate binders, and limited fluid intake
b
What is the most serious electrolyte disorder associated with kidney disease? a. hypocalcemia b. hyperkalemia c. hyponatremia d. hypermagnesemia
c
When a patient who has had progressive chronic kidney disease (CKD) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. Unlimited fluids are allowed since retained fluid is removed during dialysis. c. More protein will be allowed because of the removal of urea and creatinine by dialysis. d. Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.
a
When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? a. Check the fistula site for a bruit and thrill. b. Assess the rate and quality of the left radial pulse. c. Compare blood pressures in the left and right arms. d. Irrigate the fistula site with saline every 8 to 12 hours.
a
When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation? a. The patient has metastatic lung cancer. b. The patient has poorly controlled type 1 diabetes. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with the human immunodeficiency virus.
d
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient slows the inflow rate when experiencing pain. b. The patient leaves the catheter exit site without a dressing. c. The patient plans 30 to 60 minutes for a dialysate exchange. d. The patient cleans the catheter while taking a bath every day.
c
Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse? a. The blood glucose is 144 mg/dL. b. The patients blood pressure is 150/92. c. There is a nontender lump in the axilla. d. The patient has a round, moonlike face.
a c e
Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD)? Select all that apply a. Anemia b. Dehydration c. Hypertension d. Hypercalcemia e. Increased risk for fractures
b
Which nursing action for a patient who has arrived for a scheduled hemodialysis session is most appropriate for the RN to delegate to a dialysis technician? a. Educate patient about fluid restrictions. b. Check blood pressure before starting dialysis. c. Assess for reasons for increase in predialysis weight. d. Determine the ultrafiltration rate for the hemodialysis.
c
Which of the following information obtained by the nurse who is caring for a patient with end-stage renal disease (ESRD) indicates the nurse should consult with the health care provider before giving the prescribed epoetin alfa (Procrit)? a. Creatinine 1.2 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg
c
Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation? a. Heart rate b. Blood urea nitrogen (BUN) level c. Urine output d. Creatinine clearance
b
Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance
d
Which serum laboratory value indicates to the nurse that the patient's CKD is getting worse? a. decreased BUN b. decreased sodium c. decreased creatinine d. decreased calculated GFR
c
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurses teaching about management of CKD has been effective? a. I need to try to get more protein from dairy products. b. I will try to increase my intake of fruits and vegetables. c. I will measure my urinary output each day to help calculate the amount I can drink. d. I need to take the erythropoietin to boost my immune system and help prevent infection.
b
Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? a. "Maintain a daily written record of blood pressure and weight." b. "It is essential that you maintain aseptic technique to prevent peritonitis." c. "You will be allowed a more liberal protein diet once you complete CAPD." d. "Continue regular medical and nursing follow-up visits while performing CAPD."
