Test 4 Quizlet

Which information will be included when the nurse is teaching self- management to a patient who is receiving peritoneal dialysis (select all that apply)? a. Avoid commercial salt substitutes. b. Drink 1500 mL to 2000 mL daily. c. Take phosphate binders with meals. d. Choose high protein for most meals. e. Have several servings of dairy products daily.

*a. Avoid commercial salt substitutes. *c. Take phosphate binders with meals. *d. Choose high protein for most meals.

A patient has an AV fistula created. Which of the following findings could indicate the presence of a problem post-operatively? a. Cool fingers b. Auscultation of a bruit c. Pain at the incision site d. Hyperemia of the hand

*a. Cool fingers

In the client experiencing acute kidney injury the nurse would evaluate which diagnostic tests to evaluate renal function? (Select all that apply) a. Glomerular filtration rate b. Electrolytes c. Blood urea nitrogen d. Creatinine e. Complete blood count

*a. Glomerular filtration rate *c. Blood urea nitrogen *d. Creatinine

Which of the following characterize acute kidney injury(AKI)? Select all that apply a. Primary cause of death is infection b. Almost always affects older people c. Disease course is potentially reversible d. Most common cause is diabetic nephropathy e. Caridovascular disease is the most common cause of death

*a. Primary cause of death is infection *c. Disease course is potentially reversible

A patient has just undergone a kidney transplant and is transferred to the ICU. Which of the following nursing diagnoses has the highest priority in the first 24 hours post-op? a. Risk for fluid and electrolyte balance. b. Risk for infection. c. Risk for constipation d. Risk for impaired mobility

*a. Risk for fluid and electrolyte balance.

A nurse caring for a patient in the diuretic phase of acute kidney injury (AKI) should assess for a. hypovolemia b. hyperkalemia c. hypertension d. metabolic acidosis

*a. hypovolemia

During assessment of a patient with chronic kidney disease (CKD), the nurse identifies a potential nephrotoxic agent when the patient reports the use of which of the following medications? (Select all that apply) a. metformin (Glucophage) b. metoprolol (Lopressor) c. ibuprofen (Advil) d. tobramycin (Nebcin) e. cardizem (Diltiazem)

*a. metformin (Glucophage) *c. ibuprofen (Advil) *d. tobramycin (Nebcin)

A 53-year- old patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? a. Instruct the patient to cough every hour. b. Monitor the patient for shortness of breath. c. Verify the position of the balloon every 4 hours. d. Deflate the gastric balloon if the patient reports nausea.

*b. Monitor the patient for shortness of breath.

A client is receiving peritoneal dialysis. Which assessment would be most appropriate for the nurse to make while the dialysis solution is dwelling within the abdomen? a. Assess abdominal tenderness b. Observe respiratory status c. Check neurological function d. Monitor electrolyte status

*b. Observe respiratory status

Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance

*b. Phosphate level

Which of the following is a possible etiology of post-renal acute kidney injury (AKI)? a. The patient who received a contrast dye agent. b. The patient who has malignant prostate cancer. c. The patient who experienced cardiogenic shock. d. The patient who has renal artery stenosis.

*b. The patient who has malignant prostate cancer.

A patient with end-stage cirrhosis is oozing blood from IV sites and exhibits diffuse bruising. What complication of cirrhosis is this client experiencing? a. Leukocytosis b. Thrombocytopenia c. Vitamin K toxicity d. Hypoalbuminemia

*b. Thrombocytopenia

Among laboratory studies used to monitor chronic kidney disease (CKD), the hemoglobin is important because a. thrombocytopenia may occur due to an increase in waste products. b. increased renin production may cause an increase in blood volume. c. erythropoietin manufacturing may be impaired due to the underlying disease. d. polycythemia may interfere with diffusion across the dialysis membrane.

*c. erythropoietin manufacturing may be impaired due to the underlying disease.

A patient recently started on hemodialysis wants to know how the dialysis will take the place of his kidneys. The nurse's response is based on the knowledge that hemodialysis works by: a. Passing water through a dialyzing membrane b. Eliminating plasma proteins from the blood c. Lowering the pH by removing nonvolatile acids d. Filtering waste through a dialyzing membrane

*d. Filtering waste through a dialyzing membrane

A patient who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: a. During dialysis b. Just before dialysis c. The day after dialysis d. On return from dialysis

*d. On return from dialysis

When teaching a patient with chronic kidney disease(CKD) about management of the condition, the nurse should inform the patient that: a. the anemia of chronic kidney disease can be reversed by administration of iron supplements. b. phosphate supplements are necessary to maintain normal calcium levels in chronic kidney disease. c. NSAIDs are the safest OTC pain medications to use. d. antihypertensive drugs should always be used as directed to slow atherosclerotic changes that decrease renal function.

*d. antihypertensive drugs should always be used as directed to slow atherosclerotic changes that decrease renal function.

When lactulose (Cephulac) 30 ml QID is ordered for a patient with advanced cirrhosis, the patient complains that it causes diarrhea. The nurse explains to the patient that it is still important to take the medication because the lactulose will a. promote fluid loss b. prevent constipation c. prevent gastrointestinal (GI) bleeding d. decrease ammonia levels

*d. decrease ammonia levels

A patient with Acute Kidney Injury (AKI) has the following lab results. Which one is indicative of improvement in his condition? a. Hematocrit of 32% b. Sodium of 121 mEq/L c. Ammonia level 85 mcgN/dL d. creatinine of 1.2 mg/dL

d. creatinine of 1.2 mg/dL

The nurse instructs a patient with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the patient understands these dietary modifications if the patient selects which items from the dietary menu? a. Cream of wheat, blueberries, coffee b. Sausage and eggs, banana, orange juice c. Baked chicken, cantaloupe melon, tomato juice d. Cured pork, grits, strawberries, orange juice

*a. Cream of wheat, blueberries, coffee

The nurse is caring for a patient with cirrhosis who undergoes a liver biopsy. How should the patient be positioned after the procedure? a. On the right side b. On the left side c. Supine d. Prone

*a. On the right side

A patient undergoes hemodialysis, to effectively evaluate the outcome of this treatment the nurse should expect: a. Weight Loss b. International Normalized Ratio (INR) of 3.5 c. Decreases in pH d. Hyperactive bowel sounds

*a. Weight Loss

Which of the following is true regarding chronic organ rejection in transplant patients? a. It occurs days to months after transplantation b. It is irreversible c. Increasing amounts on immunosuppressive drugs will stop it d. It is associated with gradual occlusion of the renal collection system

*b. It is irreversible

In the oliguric phase of acute kidney injury (AKI) which changes in laboratory data are anticipated? a. Serum BUN and creatinine return to baseline b. Serum BUN, creatinine, and potassium levels increase. c. Serum BUN and creatinine fall and potassium levels rise. d. Serum BUN and creatinine rise and patient develops metabolic alkolosis

*b. Serum BUN, creatinine, and potassium levels increase.

The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider? a. Heart rate b. Urine output c. Creatinine clearance d. Blood, Urea, Nitrogen (BUN) levels

*b. Urine output

Which of the following are indications for the urgent implementation of dialysis for a renal failure patient? (Select all that apply) a. Hypokalemia b. Volume overload with pulmonary edema c. Metabolic alkalosis d. Hyperkalemia e. Decreased blood urea nitrogen (BUN) concentration

*b. Volume overload with pulmonary edema *d. Hyperkalemia

When assessing the neurological status of a patient with a diagnosis of hepatic encephalopathy, the nurse asks the patient to: a. stand on one foot b. ambulate with the eyes closed c. extend both arms d. perform Valsalva maneuver

*c. extend both arms

A patient is 48 hours post renal transplant. Which of the following should the nurse report to the physician? a. Urine output that is pink tinged b. Intake of 2500 mL and output of 2000 mL in the past 24 hours c. Blood pressure of 100/60 mmHg d. Weight gain of 2 kilograms in the past 24 hours

*d. Weight gain of 2 kilograms in the past 24 hours

Which of the following foods, if requested by the client with End Stage Renal Disease (ESRD), would indicate to the nurse that the client requires additional instruction? a. Acorn squash b. Turkey Sandwich c. Applesauce d. Broiled Cod

*a. Acorn squash

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? a. Increased serum albumin level b. Decreased indirect bilirubin level c. Improved alertness and orientation d. Fewer episodes of bleeding varices

*d. Fewer episodes of bleeding varices

A patient with advanced cirrhosis with ascites is short of breath and has an increased respiratory rate. The nurse should a. initiate oxygen therapy at 2 L/min to increase gas exchange. b. notify the health care provider so a paracentesis can be performed. c. ask patient to cough and deep breathe to clear respiratory secretions. d. place the patient in Fowler's position to relieve pressure on the diaphragm.

*d. place the patient in Fowler's position to relieve pressure on the diaphragm.

The nurse is caring for a patient with acute kidney injury (AKI). Which of the following conditions indicates that the nurse should anticipate beginning hemodialysis? a. Low urine output, third spacing fluid volume, and fever 102. b. Elevated potassium level with peaked T waves. c. Glucose level remains above 400 in spite of utilizing a sliding scale. d. The client began to complain of muscle weakness and leg cramps.

*b. Elevated potassium level with peaked T waves.

A patient with cirrhosis develops hepatic encephalopathy and is extremely confused and agitated. The nurse places priority on administering which ordered medication? a. Lactulose b. Serax c. Protonix d. Vitamin K

*a. Lactulose

The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? a. Maintain strict aseptic technique. b. Add heparin to the dialysate solution. c. Change the catheter site dressing daily. d. Monitor the client's level of consciousness.

*a. Maintain strict aseptic technique.

When assessing a patient in early stages of cirrhosis of the liver, what sign would be anticipated? a. Jaundice b. Peripheral edema c. Ascites d. Anorexia

*d. Anorexia

Which of the following interventions is the highest priority for a patient with acute kidney injury (AKI)? a. Administering an NSAID for the patient's discomfort b. Administering erythropoetin to correct anemia c. Monitoring for fluid and electrolyte imbalances d. Restricting fluid and sodium intake in all phases of acute kidney injury (AKI)

c. Monitoring for fluid and electrolyte imbalances

In preparation for hemodialysis, a patient has an arteriovenous fistula created in the left forearm. To assess the patency of the fistula, the nurse should a. auscultate the fistula site for a bruit. b. assess the rate and quality of the radial pulse. c. assess the blood pressure of the affected arm. d. irrigate the fistula site daily.

*a. auscultate the fistula site for a bruit.

One of the major disadvantages of peritoneal dialysis is that: a. hypotension is a constant problem because of continuous fluid removal. b. blood loss can be extensive because of the use of heparin to keep the catheter patent. c. solutes are removed more rapidly from the blood than from the CNS. d. high glucose concentrations of the dialysate causes carbohydrate and lipid abnormalities.

*d. high glucose concentrations of the dialysate causes carbohydrate and lipid abnormalities.

In the client with acute renal failure, calcium channel blockers are used to: a. prevent build up of calcium stones in the kidneys b. prevent build up of vitamin D in the kidneys c. limit renal perfusion and flow d. improve GFR (glomerulofiltration rate)

*d. improve GFR (glomerulofiltration rate)

You are providing nursing care for a patient with acute kidney injury for whom a nursing diagnosis of Excess Fluid Volume related to compromised regulatory mechanisms has been identified. Which actions should you delegate to an experienced nursing assistant? (Select all that apply.) a. Measure and record vital signs every 4 hours b. Weigh the patient every morning with standing scale c. Administer Lasix (furosemide) 40mg orally twice daily d. Remind patient to save all urine intake and output for measurement e. Assess breath sounds every 4 hours

*a. Measure and record vital signs every 4 hours *b. Weigh the patient every morning with standing scale *d. Remind patient to save all urine intake and output for measurement

The goal of care for a client with liver failure is to lower the blood ammonia level. Which actions would prevent increased ammonia? SELECT ALL THAT APPLY a. Prevent gastrointestinal bleeding. b. Reduce dietary protein intake. c. Avoid diarrhea and vomiting. d. Decrease bacterial flora in the intestines

*a. Prevent gastrointestinal bleeding. *b. Reduce dietary protein intake. *d. Decrease bacterial flora in the intestines

The client is admitted with renal failure and hyperkalemia and has medication ordered for the hyperkalemia. Which are used to decrease the dangers of hyperkalemia? Mark all that apply a. Sodium bicarbonate b. Calcium gluconate c. digoxin d. Lactulose (Cephulac) e. Regular insulin

*a. Sodium bicarbonate *b. Calcium gluconate *e. Regular insulin

The nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse should be alert for which of the following? Select all that apply. a. Trousseau's sign b. Cardiac arrhythmias c. Constipation d. Decreased clotting time e. Drowsiness and lethargy f. Fractures

*a. Trousseau's sign *b. Cardiac arrhythmias *f. Fractures

A patient with advanced liver disease has marked ascites and signs of hepatic encephalopathy. Following instruction about his diet, the nurse determines that teaching has been effective when the patient's choice of foods from the daily menu includes which items? A. cheese omelet, mushrooms, and milk B. baked beans with ham, cornbread and sweet potatoes C. Baked chicken, french fries and soda D. pancakes with honey and butter and Orange juice E. Grilled cheese sandwich with canned tomato soup F. Steak and tomato/cucumber salad

D. pancakes with honey and butter and Orange juice

While providing care to a patient with a diagnosis of acute kidney injury (AKI), the nurse notes a newly irregular apical pulse. Which action by the nurse would be the most appropriate? a. Review the client's laboratory results b. Encourage the client to decrease their fluid intake c. Immediately weigh the client to determine fluid balance status d. Continue to monitor as this is a common finding in clients with acute kidney injury (AKI)

a. Review the client's laboratory results

A client needing vascular access for hemodialysis asked the nurse what the differences are between an arteriovenous fistula and a graft. The nurse explains that one advantage of the fistula is that it a. Increases client mobility. b. is much less likely to clot. c. can accommodate larger needles. d. can be used sooner after the surgery.

b. is much less likely to clot.

In preparation for discharging the client newly started on hemodialysis, the nurse determines that discharge teaching was effective if the client states which of the following? a. "I will go for dialysis treatment 3 times per week" b. "I will weigh myself once a week" c. "I will call the doctor if I feel a buzzing in my arm" d. "I will eat a diet high in dairy products"

*a. "I will go for dialysis treatment 3 times per week"

The nurse is caring for a patient with End Stage Renal Disease (ESRD). The patient was hemodialyzed two days ago and is scheduled to be dialyzed today. The patient is experiencing weight gain, hypertension, and jugular neck vein distention. Which best explains the patient's symptoms? a. Uremia b. Hypervolemia c. Decreased serum potassium levels d. Increased serum sodium levels

*b. Hypervolemia

A patient is admitted with complications of cirrhosis. Which of the following lab results are consistent with advanced cirrhosis? (select all that apply) a. A Platelet count of 95,000/microliter b. An international normalized ratio (INR) of 2.1 c. A serum albumin of 2.4g/dL d. A hemoglobin of 15g/dL e. A serum potassium of 4.8 mEq/L

*a. A Platelet count of 95,000/microliter *b. An international normalized ratio (INR) of 2.1 *c. A serum albumin of 2.4g/dL

A week after kidney transplantation, the client develops a temperature of 101 degrees Fahrenheit, the blood pressure is elevated, and the kidney is tender. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following complications? a. Acute rejection b. Kidney infection c. Chronic rejection d. Kidney obstruction

*a. Acute rejection

A patient with cirrhosis of the liver has severe ascites that is causing shortness of breath and difficulty breathing. The physician plans a paracentesis to relieve the fluid pressure on the diaphragm. To prepare the patient for the procedure, the nurse should do which of the following? (Select all that apply) a. Asks the patient to empty the bladder. b. Positions the patient flat on the right side. c. Confirms informed consent for the procedure. d. Have the patient lie flat with a small pillow under the small of the back. e. Question the patient about an allergy to contrast dye.

*a. Asks the patient to empty the bladder. *c. Confirms informed consent for the procedure.

Which of the following foods, if requested by the client with End Stage Renal Disease (ESRD), would indicate to the nurse that the client requires additional instruction? a. Avocado b. Turkey Sandwich c. Applesauce d. Broiled Cod

*a. Avocado

The occurence of which of the following adverse effects would be a reason for the nurse to hold erythropoietin (EPO)? a. Hypertension b. Ototoxicity c. Chovstek's Sign d. Rhabdomyolysis

*a. Hypertension

The nurse is providing discharge teaching for a patient with hepatic encephalopathy. Which of the following statements indicate the need for additional teaching? a. I will stop the Lactulose if I have loose stools b. I will limit my intake of sodium c. The Lactulose will lower my ammonia d. I should avoid sedatives

*a. I will stop the Lactulose if I have loose stools

In evaluating the effects of lactulose (Cephalac) in a cirrhosis patient, the nurse should expect the client to exhibit which of the following? a. Increased alertness b. Decreased bleeding c. Decreased jaundice d. Increased urine output

*a. Increased alertness

A 72-year- old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? a. Insert urethral catheter. b. Obtain renal ultrasound c. Draw a complete blood count d. Infuse normal saline 0.9% @ 50 mL / hr

*a. Insert urethral catheter.

A patient arrives in the emergency department with a history of cirrhosis. Upon assessment you observed the patient' abdomen is distended, what do you expect the doctor to order? SELECT ALL THAT APPLY a. Limit sodium intake 2 grams per day b. Administration of Lasix c. Administration of NSAIDS d. Monitor for hyperkalemia

*a. Limit sodium intake 2 grams per day *b. Administration of Lasix

Problems associated with long-term use of corticosteroids in renal transplant patients are numerous and include: Select ALL that apply a. Peptic ulcer b. Hyperglycemia c. Nephrotoxicity d. Avascular necrosis e. Osteoporosis

*a. Peptic ulcer *b. Hyperglycemia *d. Avascular necrosis *e. Osteoporosis

The nurse who is caring for an end stage renal disease (ESRD) patient emphasizes all of the following when teaching the patient (MARK ALL THAT APPLY) a. kidney disease can affect every organ system in your body. b. a strong support system will help you deal with your disease. c. this disease is treated with both medications and dietary modifications. d. after about a year of hemodialysis, your glomerular filtration rate (GFR) will return to normal. e. You should use salt substitutes instead of table salt

*a. kidney disease can affect every organ system in your body. *b. a strong support system will help you deal with your disease. *c. this disease is treated with both medications and dietary modifications.

A 74-year- old who is progressing to end stage renal disease (ESRD) asks the nurse, "Do you think I should go on dialysis?" Which initial response by the nurse is best? a. "It depends on which type of dialysis you are considering." b. "Tell me more about what you are thinking regarding dialysis." c. "You are the only one who can make the decision about dialysis." d. "Many people your age use dialysis and have a good quality of life."

*b. "Tell me more about what you are thinking regarding dialysis."

Continuous renal replacement therapy (CRRT) would most likely be used on which patients? a. 65-year- old patient recovering from an acute myocardial infarction (MI) with a Blood Pressure of 146/90 and heart rate of 75. b. 40-year- old septic patient with a blood pressure of 75/35 and a heart rate of 110. c. 24-year- old patient diagnosed with acute kidney injury (AKI) related to urinary obstruction with a blood pressure of 150/96 and a heart rate of 90. d. 70-year- old trauma patient with a blood pressure of 110/60 and a heart rate of 110.

*b. 40-year- old septic patient with a blood pressure of 75/35 and a heart rate of 110.

A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician? a. Teach the patient about fluid restrictions. b. Check blood pressure before beginning dialysis. c. Assess for causes of an increase in predialysis weight. d. Determine the ultrafiltration rate for the hemodialysis.

*b. Check blood pressure before beginning dialysis.

When caring for a client with acute kidney injury the nurse would plan which one of the following treatment goals for the client? a. Prevent infection by administering Neomycin b. Compensate for renal impairment by restoring fluid balance c. Increase fluids to prevent nephrolithiasis d. Maintain adequate nutrition by encouraging a high protein and calorie diet

*b. Compensate for renal impairment by restoring fluid balance

Which conditions cause intra-renal failure? (Select all that apply) a. Heart Failure b. Hemolytic Blood Transfusion Reaction c. Ureteral Calculi d. Renal Artery Thrombosis e. Glomerulonephritis

*b. Hemolytic Blood Transfusion Reaction *e. Glomerulonephritis

The hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse assesses this client for which of the following manifestations? a. A positive bruit and thrill at the fistula site. b. Pallor, diminished pulse, and pain in the left hand. c. Edema and reddish discoloration of the left arm. d. Aching pain, pallor, and edema of the left shoulder.

*b. Pallor, diminished pulse, and pain in the left hand.

A 42-year- old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa ( Epogen, Procrit) d. Give sodium polystyrene sulfonate (Kayexalate)

*b. Place the patient on a cardiac monitor.

For a patient with cirrhosis, which of the following nursing actions can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient for jaundice b. Providing oral hygiene after a meal c. Palpating the abdomen for distention d. Assisting the patient to choose the diet

*b. Providing oral hygiene after a meal

A 38-year- old patient who had a kidney transplant 8 years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone). Which assessment data will be of most concern to the nurse? a. The blood glucose is 144 mg/dL. b. There is a nontender axillary lump. c. The patient's skin is thin and fragile. d. The patient's blood pressure is 150/92.

*b. There is a nontender axillary lump.

A patient with cirrhosis has 4+ pitting edema of the feet and legs and massive ascites. The data indicate that it is most important for the nurse to monitor which of the following lab results? a. AST level. b. albumin level. c. hemoglobin level. d. creatinine level.

*b. albumin level.

Your patient has developed ascites and will be needing a paracentesis. Your patient needs further education when he states: a. "I sit upright in bed during the procedure, so I can breathe better." b. "I may feel some dizziness or weakness after the procedure." c. "I can use the bathroom after the procedure." d. "I am to notify the nurse if I notice my dressing is wet."

*c. "I can use the bathroom after the procedu

(MISSING DIAGRAM) For your patient undergoing peritoneal dialysis, which statement made by the patient indicates that he requires further education? a. "I should call the doctor if the fluid in A is clear and straw colored" b. "I should call the doctor if the fluid in B is clear and straw colored" c. "I should call the doctor if I see any signs of infection at this insertion site C" d. "This process that is occurring at D places more stress on the cardiovascular system"

*c. "I should call the doctor if I see any signs of infection at this insertion site C"

Which statement by a 62-year- old patient with end stage renal disease (ESRD) indicates that the nurse's teaching about management of CKD has been effective? a. "I need to get most of my protein from low-fat dairy products." b. "I will increase my intake of fruits and vegetables to 5 per day." c. "I will measure my urinary output each day to help calculate the amount I can drink." d. "I need to take erythropoietin to boost my immune system and help prevent infection.";

*c. "I will measure my urinary output each day to help calculate the amount I can drink."

You are caring for a patient on the medical-surgical floor who has end-stage liver disease. You would expect the patient's laboratory data to demonstrate: a. Decreased albumin and globulin, with an elevated bilirubin b. Decreased AST and SGOT, with an elevated ammonia c. Decreased total protein and serum albumin, with an elevated bilirubin d. Decreased bilirubin and ALT, with an elevated globulin

*c. Decreased total protein and serum albumin, with an elevated bilirubin

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. Hemoglobin level 13 g/dL

The nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response on knowing that the glucose: a. Decreases the risk of peritonitis b. Prevents disequilibrium syndrome c. Increases osmotic pressure to produce ultrafiltration d. Prevents excess glucose from being removed from the client

*c. Increases osmotic pressure to produce ultrafiltration

The patient with end-stage renal disease tells the nurse that she hates the thought of being tied to the machine but is glad to start dialysis because she will be able to eat and drink what she wants. Based on this information, the nurse identifies the nursing diagnosis of: a. Nutrition: Readiness for Enhanced b. Self-Care Deficit c. Knowledge Deficit d. Spiritual Distress

*c. Knowledge Deficit

An end stage renal disease (ESRD) patient with invasive breast cancer and vascular access problems would be an ideal candidate for which of the following treatments? a. Hemodialysis b. Continuous renal replacement therapy c. Peritoneal dialysis d. Kidney transplant

*c. Peritoneal dialysis

Which action by a 70-year- old patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while taking a bath each day. d. The patient slows the inflow rate when experiencing abdominal pain.

*c. The patient cleans the catheter while taking a bath each day.

The nurse is caring for a patient with cirrhosis and an upper GI bleed. Which of the following would be the highest priority to the nurse? a. The patient's blood pressure is 100/68 b. The patient's hemoglobin is 10 g/dl c. The patient's urine output is 200 mL for the past 12 hours d. The patient's heart rate is 90

*c. The patient's urine output is 200 mL for the past 12 hours

During assessment of a patient with chronic kidney disease (CKD), the nurse identifies a potential nephrotoxic agent when the patient reports the use of which of the following medications? a. acetaminophen b. metoprolol c. ibuprofen d. amlodipine

*c. ibuprofen

The nurse identifies a nursing diagnosis of risk for injury: fracture related to alterations in calcium and phosphorus metabolism for a patient with end stage renal disease (ESRD). The pathologic process directly related to the risk for fractures is a. loss of sodium through the impaired kidneys. b. deposition of magnesium caltrate in soft tissues of the body. c. impaired activation of vitamin D. d. decreased release of parathyroid hormone.

*c. impaired activation of vitamin D.

A patient with heart failure develops acute kidney injury (AKI).Collaborative care of the renal failure will be directed toward the goal of: a. preventing hypokalemia. b. replacing fluid volume. c. maintaining cardiac output. d. diluting nephrotoxic substances.

*c. maintaining cardiac output.

A physician orders sodium polystyrene sulfonate (Kayexalate) to be given to a patient in acute renal failure whose serum potassium level is 6.9 mEq/L. The nurse recognizes that the expected effect of the Kayexalate is a. increasing the release of insulin, which promotes movement of potassium into body cells. b. promoting loss of body potassium by promoting the excretion of potassium in alkaline urine. c. promotion of the exchange of potassium ions for sodium ions in the GI system, increasing potassium elimination. d. an increase in blood pH, resulting in movement of potassium from the extracellular fluid into the cells in exchange for hydrogen ions.

*c. promotion of the exchange of potassium ions for sodium ions in the GI system, increasing potassium elimination.

The nurse knows the patient on peritoneal dialysis (PD) understands the treatment when the patient states, a. "I must increase my carbohydrate intake daily." b. "I must maintain a positive nitrogen balance by decreasing proteins." c. "I must take prophylactic antibiotics to prevent infection" d. "I must be aware of the signs and symptoms of peritonitis."

*d. "I must be aware of the signs and symptoms of peritonitis."

A patient in the oliguric phase of acute kidney injury (AKI) has a 24-hour fluid output of 400 ml of urine and 100 ml of emesis. The nurse plans a fluid replacement for the following day of a. 500 ml. b. 800 ml. c. 1000 ml. d. 1100 ml.

*d. 1100 ml.

What health teaching should be included for a client being discharged home from the medical-surgical floor with cirrhosis? a. Instruct the patient that they may take acetaminophen for a fever of 101.0. b. Instruct the patient to be active and continue with their daily activities. c. Cirrhosis is an acute disease that can be controlled only with medications. d. Avoid activities that place the patient at risk for contracting viral hepatitis.

*d. Avoid activities that place the patient at risk for contracting viral hepatitis.

The nurse identifies the nursing diagnosis of fluid volume excess for a cirrhosis patient with ascites. Which of the following is an appropriate short term expected outcome for this patient? a. The patient will have a normal serum albumin level within 24 hours b. The patient will gain no more than 2 pounds within 24 hours c. The nurse will provide teaching on a low sodium diet within 24 hours d. The patient's abdominal girth will decreases by 1 cm within 24 hours

*d. The patient's abdominal girth will decreases by 1 cm within 24 hours

In the immediate postoperative period, the nurse caring for a patient who is the recipient of a kidney transplant would expect that fluid therapy would involve the administration of IV fluids: a. At a minimum rate of 100ml/hr to perfuse the kidney. b. Titrated to keep heart rate within normal range. c. At a rate to keep urine clear and without blood clots. d. To be determined hourly, based on every milliliter of urine output.

*d. To be determined hourly, based on every milliliter of urine output.

Three weeks after a kidney transplant a patient develops leukopenia. The nurse should be aware that this is most likely caused by a. bacterial infection. b. high creatinine levels. c. rejection of the transplanted kidney. d. anti-rejection medications.

*d. anti-rejection medications.

A patient with Acute Kidney Injury (AKI) has the following lab results. Which one is indicative of improvement in his condition? a. Hematocrit of 32% b. Sodium of 121 mEq/L c. Ammonia level 85 mcgN/dL d. creatinine of 1.2 mg/dL

*d. creatinine of 1.2 mg/dL

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for a. vasodilation b. poor skin turgor c. bounding pulses d. rapid respirations

*d. rapid respirations

After receiving change-of- shift report, which patient should the nurse assess first? a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L d. A patient who has just returned from having hemodialysis and has a heart rate of 124/min

d. A patient who has just returned from having hemodialysis and has a heart rate of 124/min