Test Acute Renal Failure
A client with acute renal failure is complaining of a metallic taste in the mouth and has no appetite. What should the nurse do to help this client's nutritional status? A) Provide mouth care before meals. B) Administer an antiemetic as prescribed. C) Restrict fluids. D) Encourage the intake of protein, salt, and potassium.
Answer: A Explanation: A metallic taste in the mouth is due to a build-up of uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic is prescribed for nausea. Restricting fluids will not reduce the metallic taste in the mouth. Encouraging the intake of protein, salt, and potassium will exacerbate the build-up of uremia which is causing the metallic taste in the mouth.
A client with renal failure will be discharged to home in the next few days. The nurse plans to reinforce dietary teaching for the client. The nurse teaches the client to choose proteins that are high in biological value. Which client statement indicates that teaching has been effective? A) "I will be sure to include eggs in my diet." B) "I should include vegetables at every meal." C) "Legumes should be included in my diet, as they are complete proteins." D) "I will eat nuts daily because they are high in protein."
Answer: A Explanation: Eggs are an excellent source of essential amino acids and are recommended as part of the diet for a client with renal failure who is on a protein-restricted diet. Legumes, nuts, and vegetables do contain protein, but they are incomplete proteins and are not as good protein sources as are eggs.
The nurse is planning care for the client with acute renal failure. The nurse selects Excess Fluid Volume as a nursing diagnosis based on what assessment finding? A) Pitting edema in the lower extremities B) Bowel sounds positive in 4 quadrants C) Wheezing in the lungs D) Generalized weakness
Answer: A Explanation: The client in acute renal failure will likely be edematous, as the kidneys are not producing urine. Wheezing in the lungs is an assessment consistent with asthma. Bowel sounds in 4 quadrants is a normal assessment finding. Generalized weakness may be due to whatever disease process precipitated the renal failure.
The nurse is caring for a client who has been diagnosed with acute renal failure. The nurse is reviewing the client's most recent laboratory data. Which lab result is an indicator to the nurse that a client with acute renal failure has met the expected outcomes? Select all that apply. A) Decreasing serum creatinine B) Decreasing blood urea nitrogen (BUN) levels C) Decreasing neutrophil count D) Decreasing lymphocyte count E) Decreasing erythrocyte count
Answer: A, B Explanation: Creatinine is the metabolic end product of creatine phosphate and is excreted via the kidneys in relatively constant amounts. BUN, a measurement of the nitrogen portion of urea, is also excreted in urine and is a good indicator of renal function. Neutrophils, lymphocytes, and erythrocytes are not used to monitor the return of renal function.
The nurse is concerned that an older client is at risk for developing acute renal failure. What client information caused the nurse to have this concern? Select all that apply. A) Diagnosed with hypotension B) Scheduled for aortic valve replacement surgery C) Prescribed high doses of intravenous antibiotics D) Previous total hip replacement surgery E) Taking medication for type 2 diabetes mellitus
Answer: A, B, C Explanation: Older adults develop acute renal failure more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for kidney failure. Hypotension, scheduled for aortic valve replacement surgery, and receiving high doses of intravenous antibiotics increase this client's risk for developing acute renal failure. A previous history of major surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute renal failure.
A client with frequent urinary tract infections in being seen in the urology clinic. The client asks the nurse if there is a chance of acute renal failure. The nurse explains that which risk factor can lead to acute renal failure? Select all that apply. A) Dehydration B) Renal calculi C) Ineffective would healing D) Low serum albumin E) Hypertension
Answer: A, B, E Explanation: Dehydration, renal calculi, and hypertension can all precipitate acute renal failure (ARF). Ineffective wound healing has not been shown to cause renal failure unless the infection becomes systemic. A low serum albumin does not cause ARF.
While visiting a family, the community nurse learns that the youngest child is home from school because of a sudden onset of nausea, vomiting, and lethargy. For which additional manifestations of acute renal failure should the nurse assess the child? Select all that apply. A) Elevated blood pressure B) Postural hypotension C) Wheezing D) Edema E) Hematuria
Answer: A, D, E Explanation: Pediatric manifestations of acute renal failure characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute renal failure in an older person. Wheezing is not a manifestation of acute renal failure.
The nurse is caring for a client admitted with a diagnosis of acute renal failure. The client asks the nurse, "Are my kidneys failing? Will I need a kidney transplant?" What is the appropriate nurse response? A) "No, don't think that. You're going to be fine." B) "Your condition can be reversed with prompt treatment and usually will not destroy the kidney." C) "Kidney transplantation is highly likely, and it would be a good idea to start talking to family members." D) "When the doctor comes to see you, we can talk about whether you will need a transplant."
Answer: B Explanation: Acute renal failure is often resolved without the need for transplant if treatment is initiated quickly. There is no need to start lining up donors or wait for the provider to arrive to explore options. Telling the client that everything will be fine is condescending, provides no information, and is not within the nurse's ability to know.
A client with acute renal failure has jugular vein distention, lower extremity edema, and elevated blood pressure. Which nursing diagnosis should the nurse use to plan care for these findings? A) Ineffective Renal Tissue Perfusion B) Excess Fluid Volume C) Risk for Altered Cardiac Perfusion D) Risk for Infection
Answer: B Explanation: Jugular vein distention, edema, and elevated blood pressure are indications of excessive fluid. The diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Altered Cardiac Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.
A client with renal failure is being treated with peritoneal dialysis. The nurse is explaining the process to the client. Which statement would the nurse include in a discussion with the client and family? A) "The peritoneum is more permeable because of the presence of excess metabolites." B) "The metabolites will diffuse from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration." C) "The peritoneum acts as a semi-permeable membrane through which wastes move by diffusion and osmosis." D) "The solutes in the dialysate will enter the bloodstream through the peritoneum."
Answer: C Explanation: The peritoneum acts as a semipermeable membrane, allowing substances to move from an area of high concentration (the blood) to an area of lower concentration (the dialysate). Metabolic waste products and excess water can be eliminated through osmosis and diffusion utilizing the peritoneum as the semipermeable membrane.
The nurse is administering peritoneal dialysis on a client with acute renal failure. The nurse notes the presence of a cloudy dialysate return. Which action does the nurse initiate after notifying the physician? A) Measure abdominal girth. B) Document the cloudy dialysate. C) Culture the dialysate return. D) Increase dialysate instillation.
Answer: C Explanation: The return should be clear. The presence of cloudy drainage might indicate peritonitis, and the nurse should culture the return in order to help identify the presence and type of organism that could be causing the infection. Documenting the cloudy dialysate and nursing actions taken would be necessary, but is not the next-priority action. Measurement of abdominal girth is performed prior to the dialysis procedure, and although increased girth could indicate peritonitis, culturing the return is more important. The instillation part of the procedure is completed prior to the collection of the dialysate return, and the rate of the instillation has no relationship to the development of an infection.
A 5-year-old child is in the hospital with acute renal failure following a streptococcus infection. The parents are Spanish-speaking and speak little English. The parents, through an interpreter, ask the nurse what mistake they made that caused the child to be so sick. What is the most appropriate response by the nurse? A) "Your child does not have enough dietary protein." B) "Your child has a congenital defect that led to renal failure." C) "Your child's renal failure has been caused by a low calcium level." D) "Your child's recent infection precipitated the renal failure."
Answer: D Explanation: Clients with streptococcus are at risk for kidney and cardiac sequelae. In this case, the child has no evidence of a congenital defect leading to acute renal failure (ARF). A low-protein or low-calcium diet will not lead to ARF.
A client agrees to receive long-term hemodialysis to treat acute renal failure. For which surgical procedure should the nurse instruct this client? A) Insertion of a double-lumen catheter into the subclavian artery B) Placement of a peritoneal catheter C) Insertion of a subarachnoid-peritoneal shunt D) Placement of an arteriovenous fistula
Answer: D Explanation: For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis and not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebral spinal fluid and not for hemodialysis.
The nurse is planning care for a client admitted with heart failure. For which type of kidney failure should the nurse select interventions to prevent the development in this client? A) Prerenal hypovolemia B) Intrarenal glomerular injury C) Intrarenal acute tubular necrosis D) Prerenal low cardiac output
Answer: D Explanation: One cause of prerenal kidney failure due to low cardiac output is heart failure. Causes of prerenal kidney failure due to hypovolemia include hemorrhage, dehydration, excess fluid loss from the gastrointestinal tract, burns, and wounds. Causes of intrarenal kidney failure due to glomerular injury include glomerulonephritis, disseminated intravascular coagulation, vasculitis, hypertension, toxemia of pregnancy, and hemolytic uremic syndrome. Causes of intrarenal kidney failure due to acute tubular necrosis include ischemia resulting from conditions associated with prerenal failure, toxins, hemolysis, and rhabdomyolysis.
