Question 1

Based on her knowledge of the primary cause of ESRD, the nurse knows to assess the most important indicator. What is that indicator? a) pH and HCO3 b) Blood pressure c) Serum glucose d) Urine protein

Accepted Answer

c) Serum glucose The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.

Question 2

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a) Recent history of streptococcal infection b) History of osteoporosis c) Previous episode of acute pyelonephritis d) History of hyperparathyroidism

Accepted Answer

a) Recent history of streptococcal infection Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

Question 3

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? a) Assess the AV fistula for a bruit and thrill. b) Keep the AV fistula site dry. c) Take the client's blood pressure in the left arm. d) Keep the AV fistula wrapped in gauze.

Accepted Answer

a) Assess the AV fistula for a bruit and thrill. The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

Question 4

The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed which of the following? a) Acute rejection b) Chronic rejection c) Simple rejection d) Hyperacute rejection

Accepted Answer

d) Hyperacute rejection After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term simple is not used in the categorization of types of rejection of kidney transplants.

Question 5

The client with polycystic kidney disease asks the nurse, Will my kidneys ever function normally again? The best response by the nurse is: a) As the disease progresses, you will most likely require renal replacement therapy. b) Draining of the cysts and antibiotic therapy will cure your disease. c) Dietary changes can reverse the damage that has occurred in your kidneys. d) Genetic testing will determine the best treatment for your condition.

Accepted Answer

a) As the disease progresses, you will most likely require renal replacement therapy.There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

Question 6

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Risk for infection b) Impaired urinary elimination c) Toileting self-care deficit d) Activity intolerance

Accepted Answer

a) Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

Question 7

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? a) Let's wait until after the surgery to discuss your treatment plan. b) The doctor may decide to delay the use of immunosuppressant drugs. c) Immunosuppressive drugs guarantee organ success. d) Even a perfect match does not guarantee organ rejection.

Accepted Answer

d) Even a perfect match does not guarantee organ rejection. Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.

Question 8

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a) Hypovolemic shock caused by hemorrhage b) Abdominal distention owing to reflex cessation of intestinal peristalsis c) Paralytic ileus caused by manipulation of the colon during surgery d) Pneumonia caused by shallow breathing because of severe incisional pain

Accepted Answer

a) Hypovolemic shock caused by hemorrhageIf bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.

Question 9

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Weight loss b) Absence of pain c) Diuresis d) Fever

Accepted Answer

d) FeverFever is an indicator of infection or transplant rejection.

Question 10

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD? a) The client is blind in his right eye. b) The client has a history of diverticulitis. c) The client has a history of severe anemia during hemodialysis. d) The client is on the kidney transplant waiting list.

Accepted Answer

b) The client has a history of diverticulitis. A history of diverticulitis contraindicates CAPD because CAPD has been associated with the rupture of diverticulum. A history of severe anemia while on hemodialysis or being on the transplant waiting list doesn't contraindicate CAPD. The client who's blind or partially blind can still learn to perform CAPD.

Question 11

The nurse is caring for a patient with end-stage kidney disease in the hospital and smells a fetid odor from the patient's breath. What major manifestation of uremia will be present? a) A decreased serum phosphorus level b) Hypocalcemia with bone changes c) Increased secretion of parathormone d) Hyperparathyroidism

Accepted Answer

b) Hypocalcemia with bone changes Uremic bone disease, often called renal osteodystrophy, develops from the complex changes in calcium, phosphate, and parathormone balance. Bone disease and metastatic and vascular calcifications occur due to retention of phosphorus, low serum calcium levels, abnormal vitamin D metabolism, and elevated aluminum levels.

Question 12

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? a) Liberally apply alcohol to the areas of your skin where you itch the most. b) When you shower, use really warm water and an antibacterial soap. c) Try washing clothes with a strong detergent to ensure that all impurities are gone. d) Keep your showers brief, patting your skin dry after showering.

Accepted Answer

d) Keep your showers brief, patting your skin dry after showering.  The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash close and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue.

Question 13

The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium? a) Cooked white rice b) Salad oils c) Citrus fruits d) Butter

Accepted Answer

c) Citrus fruits Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.

Question 14

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? a) Blood tinged drainage in Jackson-Pratt drainage tube b) Urine output of 35 to 40 mL/hour c) SpO2 at 90% with fine crackles in the lung bases d) Pain of 3 out of 10, 1 hour after analgesic administration

Accepted Answer

c) SpO2 at 90% with fine crackles in the lung bases The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.

Question 15

The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? (Select all that apply.) a) Red blood cells in the urine b) Proteinuria c) Polyuria d) Hemoglobin of 12.8 g/dL e) White cell casts in the urine

Accepted Answer

a) Red blood cells in the urineb) Proteinuriae) White cell casts in the urineThe primary presenting features of an acute glomerular inflammation are hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria (excess protein in the urine) (Porth & Matfin, 2009). The urine may appear cola colored because of red blood cells (RBCs) and protein plugs or casts; RBC casts indicate glomerular injury.

Question 16

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2&deg; F (37.8&deg; C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl

Accepted Answer

a) Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2&deg; F (37.8&deg; C) wouldn't result from this disorder.

Question 17

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? a) Increase your carbohydrate intake. b) Eat plenty of bananas. c) Drink plenty of fluids, and use a salt substitute. d) Be sure to eat meat at every meal.

Accepted Answer

a) Increase your carbohydrate intake.A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.

Question 18

Which of the following nursing actions is most important in caring for the client following lithotripsy? a) Administer allopurinol (Zyloprim). b) Notify the physician of hematuria. c) Monitor the continuous bladder irrigation. d) Strain the urine carefully for stone fragments.

Accepted Answer

d) Strain the urine carefully for stone fragments.The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.

Question 19

Which of the following is a characteristic of the intrarenal category of acute renal failure? a) Decreased creatinine b) High specific gravity c) Increased BUN d) Decreased urine sodium

Accepted Answer

c) Increased BUN The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

Question 20

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? a) Avoid carrying heavy items. b) Auscultate the lungs frequently. c) Perform deep-breathing exercises vigorously. d) Wear a mask when performing exchanges.

Accepted Answer

d) Wear a mask when performing exchanges. The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

Question 21

The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication? a) 2 hours before meals b) 2 hours after meals c) At bedtime with 8 ounces of fluid d) With food

Accepted Answer

d) With food Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.

Question 22

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find? a) Absent proteinuria b) Pyuria c) Slightly acidic pH d) High specific gravity

Accepted Answer

b) Pyuria The chief abnormality noted with the urinalysis is pyuria (combination of bacteria and leukocytes). Specific gravity would be low, pH would be slightly alkaline, and proteinuria would be minimal to mild.

Question 23

Mr. Jarvis's renal failure has become chronic. You are seeing him in clinic and he discusses the various signs and symptoms he is experiencing. Select all of the following which you know to be associated with chronic renal failure. a) Muscle cramps b) Enhanced cognition c) Bleeding of the oral mucous membranes d) Lethargy

Accepted Answer

a) Muscle crampsc) Bleeding of the oral mucous membranesd) Lethargy Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.

Question 24

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? a) Oliguria b) Acute tubular necrosis c) Diuresis d) Restored glomerular function

Accepted Answer

a) OliguriaDuring the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.

Question 25

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as: a) oliguria. b) hematuria. c) polyuria. d) anuria.

Accepted Answer

d) anuria Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.

Question 26

The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following? a) Metabolic alkalosis b) Hypophosphatemia c) Hypokalemia d) Anemia

Accepted Answer

d) AnemiaAnemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.

Question 27

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a) Low blood pressure b) Tea-colored urine c) Left upper quadrant pain d) Pyuria

Accepted Answer

b) Tea-colored urine Tea-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.

Question 28

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? a) Providing pain-relief measures b) Limiting fluid intake c) Encouraging coughing and deep breathing d) Promoting carbohydrate intake

Accepted Answer

b) Limiting fluid intake During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

Question 29

A client has undergone a renal transplant and returns to the healthcare agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? a) Polyuria b) Hypotension c) Weight loss d) Abdominal pain

Accepted Answer

d) Abdominal pain Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.

Question 30

Which clinical finding should a nurse look for in a client with chronic renal failure? a) Uremia b) Polycythemia c) Hypotension d) Metabolic alkalosis

Accepted Answer

a) Uremia Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

Question 31

The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase? a) It is accompanied by reduced blood flow to the nephrons. b) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. c) Normal glomerular filtration and tubular function are restored. d) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications.

Accepted Answer

a) It is accompanied by reduced blood flow to the nephrons. The initiation phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.

Question 32

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? a) BUN of 18 mg/dL. b) Glomerular filtration rate (GFR) of 100 mL/min. c) Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. d) Serum creatinine of 1.2 mg/dL.

Accepted Answer

c) Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.

Question 33

A nurse assesses a patient diagnosed in the prerenal stage of ARF. The nurse expects to find the following signs and symptoms. Select all that apply. a) BUN value of <10 mg/dL b) Urine specific gravity of 1.029 c) Creatinine level of 1.3 mg/dL d) Urine sodium <20 mEq/L e) Increase in urinary sediment f) Urine osmolality of 350 mOsm/Kg

Accepted Answer

b) Urine specific gravity of 1.029c) Creatinine level of 1.3 mg/dLd) Urine sodium <20 mEq/L The BUN reading is within normal range, the urine osmolality would be greater than 500 mOsm/kg, and there would be few hyaline casts. Refer to Table 27-2 in the text.

Question 34

The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient? a) Keep the catheter stabilized to the abdomen, below the belt line b) Wear a mask while handling any dialysate solutions c) Keep the dialysis supplies in a clean area, away from children and pets d) Clean the catheter insertion site daily with soap

Accepted Answer

c) Keep the dialysis supplies in a clean area, away from children and petsIt is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

Question 35

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? a) Cola-colored urine b) Hyperalbuminemia c) Peripheral neuropathy d) Hypotension

Accepted Answer

a) Cola-colored urine Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

Question 36

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a) increased urine output. b) weight loss. c) increased blood pressure. d) hematuria.

Accepted Answer

b) weight loss.Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

Question 37

Mr. Billings is being seen as a client in the urology practice. He has a family history of polycystic kidney disease. Of the following assessment findings, which would you expect to find as you gather information and complete an assessment related to a polycystic kidney diagnosis? Select all that apply. a) No renal stones b) Normal urinalysis c) Pain from retroperitoneal bleeding d) Hypertension

Accepted Answer

c) Pain from retroperitoneal bleedingd) Hypertension Hypertension is present in approximately 75% of affected clients at the time of diagnosis. Pain from retroperitoneal bleeding is caused by the size and effects of the cysts. Urinalysis shows mild proteinuria, hematuria, and pyuria. Renal stones are common.

Question 38

A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief? a) Encourage frequent ambulation. b) Encourage deep-breathing exercises. c) Encourage the client to void every 2 to 3 hours. d) Restrict the client's sodium intake.

Accepted Answer

a) Encourage frequent ambulation.When a client with urinary calculi complains of excruciating pain, the client should be encouraged to ambulate. This is because the supine position increases colic, while ambulation relieves it. Also, adequate fluid intake should be suggested to promote the passage of stones and to prevent urinary stasis, or the formation of new stones. The client should be encouraged to void when there is a risk of infection related to urinary stasis. The suggestion for restricting sodium intake is offered to a client with chronic glomerulonephritis, not urinary calculi. The nurse should promote deep-breathing exercises to provide relief to a client recovering from surgery who has an ineffective breathing pattern.

Question 39

The nurse notes that the client's urine is blood-tinged following cystoscopy. Which of the following nursing actions should the nurse do next? a) Instruct the client to increase fluid intake. b) Inspect the client's urinary meatus. c) Notify the physician of the finding. d) Document the finding in the health record.

Accepted Answer

d) Document the finding in the health record. The physician does not need to be contacted as blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. The nurse should document the finding and continue to monitor the client. The client should be encouraged to increase fluid intake to help flush the urinary tract of microorganisms. The urinary meatus does not need to be inspected.

Question 40

The nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include? a) Dressings and tape b) Antihypertensive agents c) Suction equipment d) Padded tongue blades

Accepted Answer

c) Suction equipment The contrast agent injected into the client for an intravenous pyelogram is allergenic and nephrotoxic. Emergency supplies and equipment should be readily available in case the client experiences an anaphylactic reaction, including airway and suction equipment, oxygen, epinephrine, corticosteroids, and vasopressors.

Question 41

A group of students is reviewing the process of urine elimination. The students demonstrate understanding of the process when they identify which amount of urine as triggering the reflex? a) 150 mL b) 50 mL c) 250 mL d) 350 mL

Accepted Answer

a) 150 mL The desire to urinate comes from the feeling of bladder fullness. A nerve reflex is triggered when approximately 150 to 200 mL of urine accumulates.

Question 42

Common tests of renal function include which of the following? Select all that apply. a) Serum creatinine b) Arterial blood gas analysis c) Blood urea nitrogen (BUN) d) Creatinine clearance e) Renal concentration test

Accepted Answer

a) Serum creatininec) Blood urea nitrogen (BUN)d) Creatinine clearancee) Renal concentration test Common tests of renal function include BUN, serum creatinine, creatinine clearance, and renal concentration tests. Arterial blood gas analysis is a test of respiratory function.

Question 43

A 32 year old female client has come to your clinic with a complaint of hematuria, or the presence of red blood cells in the urine. Of the following, which is not a cause of hematuria? a) Renal stones b) Lithium toxicity c) Extreme exercise d) Acute glomerulonephritis

Accepted Answer

b) Lithium toxicity Hematuria may be caused by cancer of the genitourinary tract, acute glomerulonephritis, renal stones, renal tuberculosis, blood dyscrasias, trauma, extreme exercise, rheumatic fever, hemophilia, leukemia, or sickle cell trait or disease.

Question 44

In which of the following renal disorders would one suspect a decreased urine specific gravity? Select all that apply a) Glomerulonephritis b) Diabetes c) Severe renal damage d) Fluid deficits e) Diabetes insipidus

Accepted Answer

a) Glomerulonephritisc) Severe renal damagee) Diabetes insipidus  Disorders or conditions that cause decreased urine specific gravity (ie, dilute urine) include diabetes insipidus, glomerulonephritis, and severe renal damage that may cause a fixed specific gravity of 1.010. Etiologies associated with increased urine specific gravity include diabetes mellitus, patients who have recently received high density radiopaque dyes, and fluid deficit.

Question 45

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. a) Phosphate 5.0 mg/dL; tachycardia and nausea and emesis b) Calcium 7.5 mg/dL; hypotension and irritability c) Chloride 90 mEq/L; irritability and seizures d) Potassium 6.4 mEq/L; dysrhythmias and abdominal distention e) Magnesium 1.5 mg/dL; mood changes and insomnia

Accepted Answer

a) Phosphate 5.0 mg/dL; tachycardia and nausea and emesisb) Calcium 7.5 mg/dL; hypotension and irritabilityd) Potassium 6.4 mEq/L; dysrhythmias and abdominal distentionDecreased calcium, increased potassium, and increased phosphate levels are associated with ESKD, along with the signs and symptoms associated with these serum values. Decreased magnesium and chloride levels are not associated with ESKD.

Question 46

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? a) Hyperkalemia b) Elevated white blood cells c) Hypocalcemia d) Elevated urea levels

Accepted Answer

a) Hyperkalemia Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

Question 47

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? a) Very few symptoms are associated with renal cancer. b) You should have sought treatment earlier. c) Squamous cell carcinomas do not present with detectable symptoms. d) Painless gross hematuria is the first symptom in renal cancer.

Accepted Answer

a) Very few symptoms are associated with renal cancer.Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%),whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.

Question 48

The nurse is passing out medications on a medical-surgical unit. A male patient is preparing for hemodialysis. The patient is ordered to receive numerous medications including antihypertensives. Which of the following is the best action for the nurse to take? a) Administer the medications as ordered. b) Ask the patient if he wants to take his medications. c) Check with the dialysis nurse about the medications. d) Hold the medications until after dialysis.

Accepted Answer

d) Hold the medications until after dialysis.

Question 49

Patient education regarding a fistulae or graft includes which of the following? Select all that apply. a) Check daily for thrill and bruit. b) No IV or blood pressure taken on extremity with dialysis access. c) Cleanse site b.i.d. d) Avoid compression of the site. e) No tight clothing.

Accepted Answer

a) Check daily for thrill and bruit.b) No IV or blood pressure taken on extremity with dialysis access.d) Avoid compression of the site.e) No tight clothing. The nurse teaches the patient with fistulae or grafts to check daily for a thrill and bruit. Further teaching includes avoiding compression of the site; not permitting blood to be drawn, an IV to be inserted, or blood pressure to be taken on the extremity with the dialysis access; not to wear tight clothing, carry bags or pocketbooks on that side, and not lie on or sleep on the area. The site is not cleansed unless it is being accessed for hemodialysis.

Question 50

A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include: a) moderate to severe hypotension. b) green-tinged urine. c) periorbital edema. d) polyuria.

Accepted Answer

c) periorbital edema.Periorbital edema is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.

Question 51

As an inflammatory response in the glomerular capillary membrane, the renal filtration system is disrupted. Although diagnostic urinalysis can reveal glomerulonephritis, many of those suffering with glomerulonephritis exhibit what symptoms? a) Fever b) No symptoms c) Polyuria d) Headache

Accepted Answer

b) No symptoms Many clients with glomerulonephritis have no symptoms. Early symptoms may be so slight that the client does not seek medical attention.

Question 52

Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective? a) A family member can help me perform hemodialysis in my home. b) A special access is created in my vein for peritoneal dialysis. c) Ultrafiltration methods take much longer than hemodialysis. d) There are few complications with renal replacement therapies.

Accepted Answer

c) Ultrafiltration methods take much longer than hemodialysis. Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects.

Question 53

A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for: a) dehydration. b) paresthesia. c) cardiac arrhythmia. d) pruritus.

Accepted Answer

c) cardiac arrhythmia. As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.

Question 54

An expected outcome for the hemodialysis client is: a) The client identifies signs and symptoms of rejection. b) The client demonstrates how to administer the dialysate by gravity. c) The client explains how to assess the venous access site. d) The client verbalizes the dwell time for the dialysate.

Accepted Answer

c) The client explains how to assess the venous access site. Hemodialysis requires the creation of an arterio-venous access site. The absence of a palpable thrill suggests the AV site is blocked or clotted.

Question 55

Which phase of acute renal failure signals that glomerular filtration has started to recover? a) Diuretic b) Recovery c) Initiation d) Oliguric

Accepted Answer

a) Diuretic The oliguric period is accompanied by an increase in the serum concentration of wastes such as urea, creatinine, organic acids, and the electrolytes potassium, phosphorous, and magnesium. The initiation period begins with the initial insult and ends when cellular injury and oliguria develops. The diuretic phase is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The recovery period signals the improvement of renal function and energy level and may take 6 to 12 months.

Question 56

The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? a) Serum creatinine of 1.5 mg/dL b) Creatinine clearance of 90 mL/min c) Urinary protein level of 150 mg/24h. d) BUN of 20 mg/dLb

Accepted Answer

a) Serum creatinine of 1.5 mg/dLAs glomerular filtration decreases, the serum creatinine and BUN levels increase and the creatinine clearance decreases. Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body. The BUN is affected not only by renal disease but also by protein intake in the diet, tissue catabolism, fluid intake, parenteral nutrition, and medications such as corticosteroids.

Question 57

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: a) acute bone pain and confusion. b) confusion, headache, and seizures. c) weakness, tingling, and cardiac arrhythmias. d) hypotension, tachycardia, and tachypnea.

Accepted Answer

b) confusion, headache, and seizures.Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiological functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

Question 58

A nurse is teaching a client about peritoneal dialysis. The nurse should tell the client the dwell time is:`

Accepted Answer

20 minutesThe average dwell time is about 20 minutes. The fluid infuses within 10 minutes, dwells for 20 minutes, and then drains in about 20 minutes. The diffusion on the small particles into the dialysate peaks in the first 10 minutes.

Question 59

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?You Selected:

Accepted Answer

White blood cell (WBC) count of 20,000/mm3An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

Question 60

Which of the following is the hallmark of the diagnosis of nephrotic syndrome?

Accepted Answer

ProteinuriaProteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

Question 61

A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, I can even feel the pain at the tip of my penis. Which of the following would the nurse suspect?

Accepted Answer

Urinary calculiSymptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

Question 62

The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output?

Accepted Answer

Less than 400 mLThe oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.

Question 63

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?

Accepted Answer

A GFR of 30-59 mL/min/1.73 m2Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2

Question 64

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

Accepted Answer

Hypovolemic shock caused by hemorrhageIf bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.The nurse weighs a patient daily and measures urinary output every hour.

Chapter 54: Management of Patients With Kidney Disorders

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