Renal Prep U - Exam #4 (312)
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?
Acute glomerulonephritis
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?
Administration of sodium polystyrene sulfonate [Kayexalate])
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client?
Anemia
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
Assess the AV fistula for a bruit and thrill
Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply.
Eat foods such as milk, fish, and eggs. Restrict sodium to 2,000 to 3,000 mg daily. Restrict fluid to daily urinary output plus 500 to 800 mL.
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching?
"As long as I have one normal kidney, I should be fine."
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
"As the disease progresses, you will most likely require renal replacement therapy."
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?
"Even a perfect match does not guarantee organ success."
Patient education regarding a fistulae or graft includes which of the following? Select all that apply.
- Check daily for thrill and bruit. - Avoid compression of the site. - No IV or blood pressure taken on extremity with dialysis access. - No tight clothing.
A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would be expected? Select all that apply.
- hypertension - pain from retroperitoneal bleeding
The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?
1,000 mL
At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to?
1.0 lb
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values?
Hyperkalemia
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?
Hypovolemic shock caused by hemorrhage
The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?
Less than 400 mL
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?
Oliguria
When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic?
Penicillin
What is a hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
Recent history of streptococcal infection
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause?
Renal calculi
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
Risk for infection
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
Urine output of 20 ml/hour
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
Urine output of 250 ml/24 hours
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?
Wear a mask when performing exchanges
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
White blood cell (WBC) count of 20,000/mm3
he nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication?
With food
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
fatigue and weakness
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder?
pH 7.20, PaCO2 36, HCO3 14-
A client has been diagnosed with acute glomerulonephritis. This condition causes:
proteinuria
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include:
restricting sources of potassium usually found in fresh fruits and vegetables
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:
sodium polystyrene sulfonate (Kayexalate)
A nurse receives her client care assignment. Following the report, she should give priority assessment to the client:
who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?
Decrease in the blood flow through the kidneys
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
Dehydration
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate?
Donors are selected from compatible living donors
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
Fever
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?
Glomerulonephritis
A client diagnosed with chronic renal failure is receives continuous peritoneal dialysis (PD). The nurse instructs the client about which diet plan?
High-protein diet
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
Tall, peaked T waves
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
Tea-colored urine
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
"It is appropriate to warm the dialysate in a microwave."
A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate?
"Keep your showers brief, patting your skin dry after showering."
An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?
"This type of dialysis will provide more independence."
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective?
"Ultrafiltration methods take much longer than hemodialysis."
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
Increase carbohydrates and limit protein intake
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
Increased BUN
What is used to decrease potassium level seen in acute renal failure?
Sodium polystyrene sulfonate
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?
SpO2 at 90% with fine crackles in the lung bases
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?
Brief, hot daily showers
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?
Hydrating with saline intravenously before the test
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of:
1,500 mL of fluid
Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?
6
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
A GFR of 30-59 mL/min/1.73 m2
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?
Azotemia
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL
An expected outcome for the hemodialysis client is:
The client explains how to assess the venous access site.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?
The kidneys can improve over a period of months
Which of the following is the most accurate indicator of fluid loss or gain?
Weight
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
Check for thrill or bruit over the access site
Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.
Citrus fruits
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?
Cola-colored urine
A client who is blind is admitted for treatment of gastroenteritis. Which nursing diagnosis takes highest priority for this client?
Deficient fluid volume
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure?
Gray-bronze skin color