GU EAQ

Which patient is most likely to have renal compromise assessed by decreased urine production? 1. 10 year history of diabetes mellites 2. Recent history of stroke 3. White blood cell count of 12,000 4. Blood pressure of 82/40 for 12 hours

4

Which assessment finding does the nurse associate with the PTs AKI, postrenal type a. Elevated BUN b. Elevated creatinine c. Feeling of urgency d. Weight gain

c

Which food would the nurse encourage the client requiring hemodialysis to include in his or her dietary intake? 1 Rice 2 Potatoes 3 Canned salmon 4 Barbecued beef

1 (Foods high or moderately high in carbohydrates and low in protein, sodium, and potassium are encouraged for clients on hemodialysis. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.)

A client receiving hemodialysis undergoes surgery to create an arteriovenous fistula. Before discharge, the nurse discusses care at home with the client and his wife. Which statement by the client's wife indicates that further teaching is required? 1 "I must touch the shunt several times a day to feel for the bruit." 2 "I have to take his blood pressure every day in the arm with the fistula." 3 "He will have to be very careful at night not to lie on the arm with the fistula." 4 "We really should check the fistula every day for signs of redness and swelling."

2 (Taking the blood pressure in the affected arm may injure the fistula. The presence of a bruit indicates that the circulation is not obstructed by a thrombus. Hemorrhage can occur in a matter of minutes if the cannula is dislodged. It is correct that the patient should not lie on the arm with the fistula. Redness and swelling are signs of infection, which is a complication of cannulization.)

A child is admitted to the pediatric unit with a tentative diagnosis of acute glomerulonephritis (AGN). Which would the nurse expect the laboratory report to reveal? 1 Low sedimentation rate 2 Increased serum complement 3 Increased antistreptolysin O (ASO) titer 4 Decreased blood urea nitrogen level

3 (An increased ASO titer indicates the presence of a previous streptococcal infection; levels are highest with AGN, bacterial endocarditis, and scarlet fever. The sedimentation rate is increased in glomerulonephritis; it signifies an inflammatory process. A reduction in serum complement (C3) activity occurs early in the disease process of glomerulonephritis; activity increases as the child improves. The blood urea nitrogen level is increased, not decreased, with glomerulonephritis because of impaired glomerular function, with azotemia occurring as a result.)

A client receiving peritoneal dialysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate solution. Which action would the nurse take? 1 Increase the rate of infusion. 2 Auscultate the lungs for breath sounds. 3 Place the client in a supine position. 4 Drain the fluid from the peritoneal cavity.

4 (Pressure from the fluid may cause upward displacement of the diaphragm; draining the solution reduces intra-abdominal pressure, which allows the thoracic cavity to expand on inspiration. Additional fluid will aggravate the problem. Auscultation is important, but it does not alleviate the problem. The client should be placed in the semi-Fowler position for peritoneal dialysis; this allows inflow of fluid while not impinging on the thoracic cavity.)

A 75-year-old male who has a history of prostate cancer is admitted for a prostatectomy. The client's prostate specific antigen (PSA) levels have been increasing. Which intervention would the nurse to include in the client's plan of care? 1 Encourage the client to drink extra fluids. 2 Institute seizure precautions. 3 Monitor the plasma pH for acidosis. 4 Handle the client gently when turning.

4 (Increasingly elevated PSA levels may indicate a worsening of the client's condition with possible metastasis to the bone, increasing the risk of pathological fractures; therefore handling must be gentle. Additional fluids will not improve the PSA level. Seizure precautions are not necessary; a PSA elevation indicates bone, not brain, involvement. Elevated PSA levels do not significantly affect the plasma pH.)

The nurse reviews the medical record of an older adult client admitted with chronic kidney disease. Which clinical finding is the priority requiring collaboration with the primary health care provider? 1 Sodium level: 135 2 Potassium level: 6 3 Creatinine results: 20 4 Blood pressure results: 150/100

2 (The client has an increased potassium level outside the expected range for an adult, placing the client at risk for a cardiac dysrhythmia; the higher priority is treatment for the increased potassium, because elevated levels can be lethal. The serum sodium of 135 mEq/L (135 mmol/L) is expected because of the electrolyte imbalance and the anemia related to the decreased production of erythropoietin by the kidney in the presence of chronic kidney failure. A creatinine clearance of 20 mL/min (0.33 mL/s) is low (normal range 95 mL/min in young women; 120 mL/min in young men); however, the client has chronic renal disease and this value reflects the disease process. The priority is the high potassium level. Clients with chronic kidney disease usually have hypertension, and notification is unnecessary.)

Which symptom is indicative of the need for dialysis in the child with chronic kidney disease? 1 Hypotension 2 Hypokalemia 3 Hypervolemia 4 Hypercalcemia

3 (Hypervolemia results when the kidneys have failed and are no longer able to maintain homeostasis, the blood pressure is high, and cardiac overload is imminent. Hypertension, not hypotension, is present when kidney failure occurs. Hyperkalemia, not hypokalemia, occurs with kidney failure. Hypocalcemia, not hypercalcemia, is present when kidney failure occurs.)

The primary health care provider for a client with chronic kidney disease prescribed immediate hemodialysis for the first time. Which clinical manifestation indicates the need for immediate hemodialysis in this client? 1 Ascites 2 Acidosis 3 Hypertension 4 Hyperkalemia

4 (Protein breakdown liberates cellular potassium ions, leading to hyperkalemia, which can cause a cardiac dysrhythmia and standstill. The failure of the kidneys to maintain a balance of potassium is one of the main indications for dialysis. Ascites occurs in liver disease and is not an indication for dialysis. Dialysis is not the usual treatment for acidosis; usually acidosis responds to administration of alkaline medications. Dialysis is not a treatment for hypertension. Treatment for hypertension includes antihypertensive medications and diet.)

Before a transurethral resection of the prostate (TURP), a client asks about what to expect postoperatively. Which response would the nurse provide? 1 "Your urine will be pink and free of clots." 2 "You will have an abdominal incision and a dressing." 3 "There will be an incision between your scrotum and rectum." 4 "There will be a urinary catheter and a continuous bladder irrigation."

4 (The presence of an indwelling urinary catheter and a continuous bladder irrigation are routine postoperative expectations after a TURP; they provide for hemostasis and urinary excretion. An abdominal incision and dressing are present with a suprapubic, not transurethral, prostatectomy. After a TURP, the client initially can expect hematuria and some blood clots; the continuous bladder irrigation keeps the bladder free of clots and the catheter patent. An incision between the scrotum and rectum is associated with a perineal prostatectomy, not a TURP.)

1. calorie malnutrition 2. lack of protein quality/quantity ("pot belly" sign) 3. combined energy and protein malnutrition

marasmus, kwashiorkor, marasmic-kwashiorkor

Which foods would the nurse encourage the client to eat to prevent constipation after a suprapubic prostatectomy? Select all that apply. One, some, or all responses may be correct. 1 Milk 2 Apples 3 Oatmeal 4 Green peas 5 Scrambled eggs

2, 3, 4 (Apples, oatmeal, and green peas are high in fiber, which helps prevent constipation. Milk and milk products can be constipating; they do not contain bulk. Scrambled eggs contain little dietary fiber and do not prevent constipation.)

A PT with a history of CKD is admitted with acute shoulder pain. What order should you question 1. Metoprolol 50mg PO bid 2. Digoxin 0.125mg daily 3. Ibuprofen 800mg q4hr for pain 4. Pan cultures for a temperature >38.5 C

3

First priority for a PT with history of vomiting and diarrhea, BP pf 85/60 and HR of 105 a. Finding source of infection b. Replacing fluid loss c. Preventing nutritional deficit d. Releif of nausea

b

Which is a result of stimulation of erythropoietin production in the kidney tissue a. Increased blood flow to the kidney b. Increased bone marrow production of RBCs c. Inhibition of the transport of Na, leading to hyponatremia d. Inhibition of vitamin D and loss of bone density

b

The pathologic process for post-infectious glomerulonephritis is believed to be: a. Infarction of renal vessels b. Bacterial endotoxin deposition and destruction of glomeruli c. Immune complex formation and glomerular deposition d. Glomeruli blocked by bacteria from endocardial vegetation

c

Which is most important for the nurse to implement a PT after renal transplant surgery a. Flushing peritoneal dialysis catheter once per shift b. Monitoring magnesium levels daily c. Removing indwelling catheter as soon as possible d. Placing the client on contact isolation

c

Which history statement would be expected when admitting a child with acute glomerulonephritis to the inpatient unit? 1 The child had a sore throat a few weeks ago. 2 The child has just recovered from the measles. 3 The child's father has a family history of urinary tract infections. 4 The child's immunizations were administered at the start of school.

1 (Acute poststreptococcal glomerulonephritis (APSGN) is associated with a history of streptococcal infection of the throat. The measles virus is not associated with the development of APSGN. APSGN is not an inherited disease. No immunizations can cause glomerulonephritis.)

A client who is receiving peritoneal dialysis reports severe respiratory difficulty. Which immediate action would the nurse implement? 1 Auscultate the lungs. 2 Obtain arterial blood gases. 3 Notify the health care provider. 4 Apply pressure to the abdomen.

1 (Always assess the client first to determine if the lung sounds are indicative of fluid overload. When respiratory distress occurs, possibly from pressure of the dialysate on the diaphragm, respiratory status and vital signs should be assessed. The health care provider should be notified and arterial blood gases should be obtained after immediate action is taken. Never apply pressure to the abdomen, as that could worsen the respiratory status.)

Where is the blood pressure cuff placed on a client with a dialysis access fistula in the right arm? 1 On the left arm 2 Over the fistula 3 Below the fistula 4 Above the fistula

1 (If the fistula is located in the right arm, then the left arm should be used for blood pressure cuff placement. Blood pressure cuffs or any other restrictive devices should not be placed on the arm with a dialysis access fistula including above, below, or over the fistula site.Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.)

A child who has a history of a 5-lb (2.3 kg) weight gain in 1 week and periorbital edema is admitted with a diagnosis of acute glomerulonephritis. How can the nurse obtain the most accurate information on the status of the child's edema? 1 Weighing daily 2 Observing body changes 3 Measuring intake and output 4 Monitoring electrolyte values

1 (Weight monitoring is the most useful means of assessing fluid balance and changes in the edematous state; 1 L of fluid weighs about 2.2 lb (1 kg). Visual inspection is subjective and generally inaccurate. Measuring intake and output is not as accurate as daily weights; fluid may be trapped in the third compartment. Monitoring of electrolyte values is unreliable; they may or may not be altered with fluid shifts.)

A school-age child is admitted with hypertensive acute glomerulonephritis. Which medication would the nurse anticipate being prescribed initially in addition to hydralazine? 1 Digoxin 2 Alprazolam 3 Phenytoin 4 Furosemide

4 (Furosemide is a loop diuretic that is recommended for the treatment of acute glomerulonephritis; it promotes the excretion of fluid and thus limits fluid retention. Digoxin is not used because there is no cardiac involvement. An anxiolytic is unnecessary. Phenytoin may be used only if hypertensive encephalopathy causes seizures.)

Which action would the nurse take before a client's scheduled hemodialysis treatment? 1 Obtain the client's urine specimen to evaluate kidney function. 2 Weigh the client to establish a baseline for later comparison. 3 Administer medications that are scheduled to be given within the next hour. 4 Explain that the peritoneum serves as a semipermeable membrane to remove wastes.

2 (A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.)

You have a patient with pre-renal AKI. Which condition would you expect to find in the patients history 1. Pyelonephritis 2. Myocardial infarction 3. Bladder cancer 4. Kidney stones

3

HCT: F, m HGB: F, m BUN: Creatinine: Albumin: Potassium: Phosphorus:

Hct: F: 12-15, M: 13.5-17.5 Hgb: F: 35-45%, M: 38.8-50% BUN: 10-20 Creatinine: 0.5-1.1 Albumin 3.5-5 Potassium: 3.5-5 Phosphorus: 2.4-4.1

Drugs to stimulate appetite

Periactin (antihistamine), Megace, multivitamins

Which element would the nurse teach the client with chronic kidney disease to limit as an intervention to control uremia associated with end-stage renal disease? 1 Fluid 2 Protein 3 Sodium 4 Potassium

2 (The waste products of protein metabolism are the main cause of uremia. The severity of the chronic kidney disease determines the degree of protein restriction. Fluid restriction may be necessary to prevent edema, heart failure, or hypertension; fluid intake does not directly influence uremia. Sodium restrictions control fluid retention, not uremia. Potassium restrictions prevent hyperkalemia, not uremia.)

Which clinical manifestation would the nurse expect to find when assessing a client who has acute glomerulonephritis? 1 Nocturia 2 Periorbital edema 3 Increased appetite 4 Recent weight loss

2 (Periorbital edema occurs because of the retention of fluid. The client will experience oliguria, not nocturia. The client will develop anorexia related to elevated toxic substances in the blood. The client will have a weight gain because of the retention of fluid.)

A child who has nephrotic syndrome is prescribed steroid therapy. Which explanation would the nurse give the parents regarding the goal of this treatment? 1 Prevents infection 2 Stimulates diuresis 3 Provides hemopoiesis 4 Reduces blood pressure

2 (Although the exact mechanism is unknown, steroids produce diuresis in most children with nephrotic syndrome. Steroids will not prevent infection and will mask the signs and symptoms of infection. Steroids have no effect on the production of red blood cells. Steroids do not reduce hypertension, and hypertension is not a common finding in children with nephrotic syndrome.)

Which action would the nurse plan for a client during the early postoperative period after a prostatectomy? 1 Have the client stand to void. 2 Discourage straining for a bowel movement. 3 Use a bulb syringe to aspirate urine from the retention catheter. 4 Notify the primary health care provider if the client does not void by bedtime.

2 (Straining applies pressure to the operative site, which can precipitate bleeding and should be avoided. A retention catheter is routinely put into place, so standing to void and not voiding by bedtime are not applicable. To prevent trauma, negative pressure should not be exerted on the bladder by using a bulb syringe to aspirate.)

A client with cancer of the prostate requests the urinal frequently but either does not void or voids in very small amounts. Which factor is the likely cause? 1 Edema 2 Dysuria 3 Retention 4 Suppression

3 (An enlarged prostate constricts the urethra, interfering with urine flow and causing retention. When the bladder fills and approaches capacity, small amounts can be voided, but the bladder never empties completely. Edema does not cause the client to void frequently in small amounts. Dysuria is painful or difficult urination, which is not part of the client's responses. The urge to void is caused by stimulation of the stretch receptors as the bladder fills with urine; in suppression, little or no urine is produced.)

Which medication may be useful in managing hypertension in a child with acute glomerulonephritis? 1 Digoxin 2 Diazepam 3 Captopril 4 Phenytoin

3 (Captopril, an angiotensin-converting enzyme inhibitor antihypertensive, blocks the conversion of angiotensin I to the constrictor angiotensin II. Digoxin is not an antihypertensive; it increases the contractility and output of the heart. Diazepam is not an antihypertensive; it relaxes skeletal muscle. Phenytoin is not an antihypertensive; it is an anticonvulsant.)

The nurse is notified that the latest potassium level for a client who has acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action would the nurse take? 1 Alert the cardiac arrest team. 2 Call the laboratory to repeat the test. 3 Notify the primary health care provider. 4 Obtain an antiarrhythmic medication.

3 (The primary health care provider must treat this hyperkalemia to prevent cardiac dysrhythmias. The cardiac arrest team responds to a cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time and probably reaffirm the original results; the client needs medical attention. Obtaining an antiarrhythmic is premature, there is no evidence of dysrhythmia.)

The parents of a 7-year-old child who has acute glomerulonephritis (AGN) are fearful that their other child may contract the illness. Which would the nurse explain to them about the disorder? 1 The cause of AGN is unknown, so it is difficult to know how to prevent it. 2 AGN is inherited as a sex-linked recessive trait that usually occurs only in males. 3 The cause of AGN is the formation of a clot in the renal tubules resulting from a systemic infection. 4 AGN is caused by an antigen-antibody response that is usually associated with Streptococcus infection.

4 (AGN is usually the sequela of a beta-hemolytic streptococcal infection; it is not contagious. The cause is known; prevention depends on treating individuals who contract a streptococcal infection with antibiotics to eliminate the organism. AGN is an acquired, not an inherited, disorder, although incidence in males outnumbers that in females 2:1. The precipitating streptococcal infection is usually a localized pharyngitis, and clots do not form in the small renal tubules.)

Which instruction would the nurse provide to a client receiving brachytherapy for prostate cancer to prevent injury? 1 "Use bleach when doing laundry." 2 "Wear a mask when around others." 3 "Flush the toilet several times after use." 4 "Refrain from close contact with others."

4 (Brachytherapy involves the implantation of radioactive isotopes near the tumor to destroy cancer cells. Clients are radioactive while receiving treatment, making them potentially hazardous to others. Therefore, the nurse will instruct clients to refrain from close contact with others. Using bleach with the laundry and flushing the toilet several times are instructions for clients receiving chemotherapy. Clients who are immunosuppressed will be instructed to wear a face mask to help prevent infections.)

Which type of cytokine is used to treat anemia secondary to chronic kidney disease? 1 α-Interferon 2 Interleukin-2 3 Interleukin-11 4 Erythropoietin

4 (Cytokines are signaling cells. Erythropoietin is used to treat anemia related to chronic kidney disease. The failing kidneys are not able to produce erythropoietin to signal the bone marrow to produce red blood cells, resulting in anemia. α-Interferon is used to treat hairy cell leukemia or malignant melanoma. Interleukin-2 is used to treat metastatic renal carcinoma. Interleukin-11 is used to prevent thrombocytopenia after chemotherapy.)

Which parameter will you monitor in a PT with CKD to determine fluid and NA retention status a. Capillary refill b. Weight and blood pressure c. Intake and output d. Muscle growth

b

Which patient statement about nutrition and nephrotic syndrome which normal GFR is correct a. I must decrease my intake of fat b. I will increased my intake of protein c. A decreased intake of carbohydrates will be required d. An increased intake of vitamin C in necessary

b

A client with acute kidney injury states, "Why am I experiencing twitching and tingling of my fingers and toes?" Which process would the nurse consider when formulating a response to this client? 1 Acidosis 2 Calcium depletion 3 Potassium retention 4 Sodium chloride depletion

2 (In kidney failure, as the glomerular filtration rate decreases, phosphorus is retained. As hyperphosphatemia occurs, calcium is excreted. Calcium depletion hypocalcemia causes tetany, which causes twitching and tingling of the extremities, among other symptoms. Acidosis, potassium retention, and sodium chloride depletion are not characterized by twitching and tingling of the extremities.)

Which of the following clients is most likely at risk for developing postrenal renal failure a. Client diagnosed with renal calculi b. Client taking drugs (NSAIDs) for arthritis pain c. Client with congestive heart failure d. Client recovering from glomerulonephritis

a

You observe tall, peaked T waves on the ECG of a client with ESKD. What is the best action a. Checking potassium level b. Nothing. This is a normal finding c. Preparing to give sodium bicarb to correct acidosis d. Repeating ECG

a

What is the priority info for the nurse to provide the PT with a hip fracture and CKD prior to discharge a. Increased intake of foods with protein b. Monitor daily intake and output c. Take your aluminum hydroxide (Nephrox) with meals d. Maintain bedrest until the fracture is healed

c

You have a PT with chronic hypertension. What indicates that the PTs BP is not under control a. HR 55 b. irregular heart sounds c. Elevated creatinine d. Blood glucose of 128

c

Following hemodialysis, a PT begins bleeding profusely from his IV site and nose. Why? a. Liver disease b. Low albumin c. He received heparin during hemodialysis d. Elevated platelets

c (*** antidote: protamine sulfate)

A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed to address which purpose? 1 To correct hyperkalemia 2 To increase urinary output 3 To prevent respiratory acidosis 4 To increase serum calcium levels

1 (The 50% glucose and regular insulin infusion treats the hyperkalemia associated with kidney failure; it moves potassium from the intravascular compartment into the intracellular compartment. Insulin will not increase urinary output. Insulin is not a treatment for respiratory acidosis. Insulin and glucose do not increase serum calcium levels.)

Which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia? 1 Uremic frost 2 Chronic fatigue 3 Tubular necrosis 4 Dependent edema

2 (Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small, superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathological condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.)

A client's clinical manifestations include dysuria, hesitancy, urinary urgency, and urinary leakage. The client's serum prostate-specific antigen (PSA) level is 5 ng/mL, and the client has an elevated prostatic acid phosphatase (PAP) level. Which disorder would the nurse suspect? 1 Orchitis 2 Hydrocele 3 Prostatitis 4 Prostate cancer

4 (Symptoms of prostate cancer include dysuria, hesitancy, urinary urgency, and leaking or dribbling. PSA is a blood test used to confirm prostate cancer. An elevated level of prostatic isoenzyme of serum acid phosphatase (PAP) is another indicator of prostate cancer. The normal range of a PSA level is 0 to 4 ng/mL. The client has an elevated PSA level. Acute inflammation of the testis indicates orchitis, characterized by a painful, tender, and swollen testis. A hydrocele is nontender, scrotal swelling caused by an accumulation of serous fluid in the scrotum. PSA levels are not elevated with a hydrocele. Prostatitis is a condition involving inflammation of the prostate gland and characterized by fever, chills, back pain, and perineal pain, along with acute urinary symptoms such as dysuria, urinary frequency, urgency, and cloudy urine. Increased PSA levels also indicate prostatitis, but the symptoms such as hesitancy and dribbling and elevated levels of PAP are not associated with prostatitis.)

A school-aged child with acute glomerulonephritis has fluid intake restricted to the previous day's output plus 40 mL. The child's output over the past 24 hours was 140 mL. From 3:00 PM to 11:00 PM the child is to receive one-third of the total daily fluid permitted. How much fluid would the nurse provide for the evening intake? 1 60 mL 2 70 mL 3 80 mL 4 90 mL

1 (The child should receive 60 mL from 3:00 PM to 11:00 PM. 40 mL + 140 mL = 180 mL per day. There are three 8-hour segments in a day; 180 divided by 3 equals 60 mL for the 8-hour segment from 3:00 PM to 11:00 PM. The amounts of 70, 80, and 90 mL are all more than the amount of fluid the child may safely receive.)

Sildenafil is prescribed for a man with erectile dysfunction. Which side effects of this medication would the nurse mention in teaching? Select all that apply. One, some, or all responses may be correct. 1 Flushing 2 Headache 3 Dyspepsia 4 Constipation 5 Hypertension

1, 2, 3 (Flushing is a common central nervous system response to sildenafil. Headache is a common central nervous system response to sildenafil. Dyspepsia is a common gastrointestinal response to sildenafil. Diarrhea, not constipation, is a common gastrointestinal response to sildenafil. Hypotension, not hypertension, is a cardiovascular response to sildenafil. It should not be taken with anti-hypertensives and nitrates because medication interactions can precipitate cardiovascular collapse.)

Which instruction would the nurse include when teaching the client how to perform peritoneal dialysis and the importance of preventing peritonitis? Select all that apply. One, some, or all responses may be correct. 1 Wear a mask during the procedure. 2 Clean the catheter exit site every day. 3 Maintain meticulous aseptic technique. 4 Wash your hands before the exchange. 5 Store supplies in a clean and dry location.

1, 2, 3, 4, 5 (The location of the peritoneal dialysis catheter makes it a direct portal to the peritoneum, which increases the client's risk for peritonitis. The nurse would ensure that the client understands the importance of preventing peritonitis when providing instructions on performing peritoneal dialysis. The client would be instructed to wear a mask during the procedure, especially when changing connector sets. The nurse would show the client how to properly clean the area around the catheter exit site and instruct that this be done every day to remove secretions. The client must be aware that meticulous aseptic technique throughout all phases of the exchange is essential. Proper hand-washing technique would be demonstrated and the client instructed on the importance of hand washing before the exchange. Supplies would be stored in a clean and dry place.)

normal BMI range

18.5-24.9

A client with an acute kidney injury has peritoneal dialysis (PD) prescribed and asks why the procedure is necessary. Which response statement would the nurse use? 1 "PD prevents the development of serious heart problems by removing the damaged tissues." 2 "PD helps perform some of the work usually performed by your kidneys." 3 "PD stabilizes the kidney damage and may 'restart' your kidneys to perform better than before." 4 "PD speeds recovery because the kidneys are not responding to regulating hormones."

2 (PD removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Telling the patient that PD may 'restart' your kidneys so that they perform better than before is misleading. PD helps maintain fluid and electrolytes; in acute kidney injury, damage occurs in the nephrons, so the PD may or may not speed recovery.)

A client with a history of chronic kidney disease is hospitalized. Which assessment findings would alert the nurse to suspect kidney insufficiency? 1 Facial flushing 2 Edema and pruritus 3 Dribbling after voiding 4 Diminished force of urination

2 (The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.)

Which sign and symptom is an associated complication of chronic kidney disease while undergoing peritoneal dialysis? 1 Petechiae 2 Abdominal bruit 3 Cloudy return dialysate 4 Increased blood glucose level

3 (The returned dialysate should be clear; cloudy return dialysate solution is indicative of infection. Petechiae do not occur during dialysis treatments. There is no danger of developing an abdominal bruit during dialysis. Dialysis does not affect the blood glucose level.)

A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client reports feeling depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. Which response would the nurse provide? 1 "The staff will provide total care, because the infection causes severe fatigue." 2 "Mood elevators will be prescribed to improve the depression and irritability." 3 "Vitamin B12 will be prescribed for the anemia, and the stools will be dark." 4 "Protein foods will be restricted so the kidneys can clear the waste products."

4

The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled. Which information would the nurse share with the client? 1 It forces potassium back into the cells, thereby decreasing serum levels. 2 It adds extra warmth to the body because metabolic processes are disturbed. 3 It helps prevent cardiac dysrhythmias by speeding up removal of excess potassium. 4 It encourages removal of urea by preventing constriction of peritoneal blood vessels.

4 (A warm temperature encourages the removal of serum urea by preventing constriction of peritoneal blood vessels so that urea, a large-molecular substance, is shifted from the body into the dialyzing solution. Heat does not affect the shift of potassium into the cells. The removal of metabolic wastes is affected in kidney failure, not the metabolic processes. Heating dialysis solution does not affect cardiac dysrhythmias.)

A client with chronic kidney disease selects treatment using continuous ambulatory peritoneal dialysis (CAPD). Which statement indicates the client understands the purpose of this therapy? 1 "The treatment provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." 2 "The treatment exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." 3 "The treatment decreases the need for immobility, because the fluids clear the toxins in short and intermittent periods." 4 "The treatment uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."

4 (Diffusion moves particles from an area of greater concentration to an area of lesser concentration. Osmosis moves fluid from an area of lesser concentration to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane for indirect cleansing of the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.)

Which assessment is necessary for the nurse to complete in a client with chronic kidney disease receiving loop diuretics? 1 Hemoglobin levels 2 Occurrence of nausea 3 Presence of constipation 4 Intake and output measurement

4 (Diuretics are administered to increase urine output, so the measure of intake and output are very important to diuretic use. Hemoglobin levels are important to monitor in the use of erythropoietin in the chronic kidney disease client. Nausea and constipation are important to monitor with the administration of iron-containing vitamins and mineral supplements.)

The nurse is evaluating a client's understanding of peritoneal dialysis. Which information in the client's response indicates understanding the purpose of the procedure? 1 Reestablishing normal kidney function 2 Cleaning the peritoneal membrane 3 Providing fluid for intracellular spaces 4 Removing toxins and metabolic wastes

4 (Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution. Peritoneal dialysis acts as a substitute for kidney function; it does not reestablish kidney function. The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity. Fluid in the abdominal cavity does not enter the intracellular compartment.)

Monitoring vital signs, particularly the blood pressure and the pulse rate and quality, is essential in detecting physiological adaptations in a preschool child with nephrotic syndrome. Which clinical manifestation would the nurse be able to detect from these vital signs? 1 Heart failure 2 Hypovolemia 3 Pulmonary embolus 4 Increased serum potassium

2 (The shift of fluid from the intravascular to the interstitial compartment predisposes the child to hypovolemia; a weak, thready pulse and hypotension are signs of impending shock. Heart failure is usually not a complication of nephrotic syndrome; however, it is a major complication of glomerulonephritis. The development of a pulmonary embolus is not a complication of nephrotic syndrome. Chest pain and dyspnea are signs of a pulmonary embolus. Hypokalemia, not hyperkalemia, occurs. Tubular reabsorption of sodium is increased to replenish the vascular volume; therefore, potassium is excreted.)

A client with end-stage renal failure begins hemodialysis for the first time. Which prescribed hemodialysis protocol would the nurse implement when the client reports nausea and a headache, and then appears to become confused? 1 Administer an analgesic for the headache. 2 Administer an antiemetic for the nausea. 3 Decrease the rate of the hemodialysis exchange. 4 Discontinue the procedure immediately.

3 (Headache, nausea, and confusion are signs and symptoms of disequilibrium syndrome, which results from rapid changes in composition of the extracellular fluid; therefore the nurse would decrease the rate of hemodialysis exchange. Although an analgesic may relieve the headache, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Although administering an antiemetic may relieve the nausea, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Discontinuing the procedure is unnecessary; reducing the rate of exchange should reduce the adaptations of disequilibrium syndrome.)

The nurse teaches a client with chronic kidney disease to avoid all salt substitutes in his or her diet. Which rationale supports the nurse's instruction? 1 A person's body tends to retain fluid when a salt substitute is included in the diet. 2 Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. 3 Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. 4 The salt substitute substances interfere with capillary membrane transfer, resulting in anasarca.

3 (Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Chronic kidney disease already places the client at a higher risk for hyperkalemia because of poor elimination of fluids and electrolytes. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen and creatinine levels; these are the result of protein metabolism. There is not a substance in the salt substitute that interferes with capillary membrane transfer. Anasarca is extensive fluid in the tissues throughout the body and more extensive than typical edema.)

Which information would the nurse include in response to a client's questioning a protein-restricted dietary change required for his or her acute kidney injury? 1 "A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses." 2 "Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis." 3 "This diet supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys." 4 "Currently, your body is unable to synthesize amino acids, so the nitrogen for amino acid synthesis must come from the dietary protein."

3 (The amount of protein permitted in the diet depends on the extent of kidney function; excess protein causes an increase in urea concentration, excess metabolic waste, and added stress on the kidneys. The restricted protein diet prevents overburdening the client's kidneys at this time. When experiencing acute kidney injury, the kidneys are unable to eliminate the waste products of a high-protein diet. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.)