Ch 47 Acute Renal Failure and Chronic Renal Disease Flashcards

1
Q

The nurse preparing to administer a dose of calcium acetate (PhosLo) to a patient with chronic kidney disease (CKD) should know that this medication should have a beneficial effect on which laboratory value?

a. Sodium
b. Potassium
c. Magnesium
d. Phosphorus

A

D.
Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore administration of calcium should help to reduce a patient’s abnormally high phosphorus level, as seen with CKD. PhosLo will not have an effect on sodium, potassium, or magnesium levels.

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2
Q

When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention?

a. Weigh patient three times weekly.
b. Increase dietary sodium and potassium.
c. Provide a low-protein, high-carbohydrate diet.
d. Restrict fluids according to previous daily loss.

A

D.
Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention. Therefore they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 ml for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week.

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3
Q

Which statement by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure?

a. “It is essential that you maintain aseptic technique to prevent peritonitis.”
b. “You will be allowed a more liberal protein diet once you complete CAPD.”
c. “It is important for you to maintain a daily written record of blood pressure and weight.”
d. “You will need to continue regular medical and nursing follow-up visits while performing CAPD.”

A

A.
Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of preventing this from occurring. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality as does peritonitis, thus making that statement of highest priority.

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4
Q

A patient with a history of end-stage kidney disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessments should the nurse prioritize before, during, and after his treatment?

a. Level of consciousness
b. Blood pressure and fluid balance
c. Temperature, heart rate, and blood pressure
d. Assessment for signs and symptoms of infection

A

B.
Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of the procedure indicates a particular need to monitor the patient’s blood pressure and fluid balance.

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5
Q

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. What is an expected assessment finding for this patient during this early stage of recovery?

a. Hypokalemia
b. Hyponatremia
c. Large urine output
d. Leukocytosis with cloudy urine output

A

C.
Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

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6
Q

Which assessment finding is a consequence of the oliguric phase of AKI?

a. Hypovolemia
b. Hyperkalemia
c. Hypernatremia
d. Thrombocytopenia

A

B.
In AKI the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

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7
Q

The patient was diagnosed with prerenal AKI. The nurse should know that what is most likely the cause of the patient’s diagnosis?

a. IV tobramycin (Nebcin)
b. Incompatible blood transfusion
c. Poststreptococcal glomerulonephritis
d. Dissecting abdominal aortic aneurysm

A

D.
A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and poststretpcoccal glomerulonephritis are intrarenal causes of AKI.

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8
Q

The patient has a form of glomerular inflammation that is progressing rapidly. She is gaining weight, and the urine output is steadily declining. What is the priority nursing intervention?

a. Monitor the patient’s cardiac status.
b. Teach the patient about hand washing.
c. Obtain a serum specimen for electrolytes.
d. Increase direct observation of the patient.

A

A.
The nurse’s priority is to monitor the patient’s cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as ordered by the health care provider.

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9
Q

The nurse knows the patient with AKI has entered the diuretic phase when what assessments occur (select all that apply)?

a. Dehydration
b. Hypokalemia
c. Hypernatremia
d. BUN increases
e. Serum creatinine increases

A

A. and B.
Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Therefore the serum BUN and serum creatinine levels also begin to decrease.

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10
Q

The patient has had type 1 diabetes mellitus for 25 years and is now reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse finds that the patient has newly developed hypertension and difficulty with blood glucose control. The nurse should know that which diagnostic study will be most indicative of chronic kidney disease (CKD) in this patient?

a. Serum creatinine
b. Serum potassium
c. Microalbuminuria
d. Calculated glomerular filtration rate (GFR)

A

D.
The best study to determine kidney function or chronic kidney disease (CKD) that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient’s age, gender, race, and serum creatinine. It would need to be abnormal for 3 months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.

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11
Q

A 78-year-old patient has Stage 3 CKD and is being taught about a low potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat?

a. Apple, green beans, and a roast beef sandwich
b. Granola made with dried fruits, nuts, and seeds
c. Watermelon and ice cream with chocolate sauce
d. Bran cereal with ½ banana and milk and orange juice

A

A.
When the patient selects an apple, green beans, and a roast beef sandwich, the patient demonstrates understanding of the low potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have elevated levels of potassium, at or above 200 mg per 1/2 cup.

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12
Q

Which patient should be taught preventive measures for CKD by the nurse because this patient is most likely to develop CKD?

a. A 50-year-old white female with hypertension
b. A 61-year-old Native American male with diabetes
c. A 40-year-old Hispanic female with cardiovascular disease
d. A 28-year-old African American female with a urinary tract infection

A

B.
It is especially important for the nurse to teach CKD prevention to the 61-year-old Native American with diabetes. This patient is at highest risk because diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD 6 times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. African Americans have the highest rate of CKD because hypertension is significantly increased in African Americans. A UTI will not cause CKD unless it is not treated or UTIs occur recurrently.

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13
Q

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse should know that ultrafiltration in peritoneal dialysis is achieved by which method?

a. Increasing the pressure gradient
b. Increasing osmolality of the dialysate
c. Decreasing the glucose in the dialysate
d. Decreasing the concentration of the dialysate

A

B.
Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream.

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14
Q

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do for the patient?

a. Administer hypertonic saline.
b. Administer a blood transfusion.
c. Decrease the rate of fluid removal. Correct
d. Administer antiemetic medications.

A

C.
The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.

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15
Q

A 24-year-old female donated a kidney via a laparoscopic donor nephrectomy to a non-related recipient. The patient is experiencing a lot of pain and refuses to get up to walk. How should the nurse handle this situation?

a. Have the transplant psychologist convince her to walk.
b. Encourage even a short walk to avoid complications of surgery.
c. Tell the patient that no other patients have ever refused to walk.
d. Tell the patient she is lucky she did not have an open nephrectomy.

A

B.
Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication. The transplant psychologist or social worker’s role is to determine if the patient is emotionally stable enough to handle donating a kidney, while postoperative care is the nurse’s role. Trying to shame the patient into walking by telling her that other patients have not refused and telling the patient she is lucky she did not have an open nephrectomy (implying how much more pain she would be having if it had been open) will not be beneficial to the patient or her postoperative recovery.

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16
Q

The nurse is caring for a 68-year-old man who had coronary artery bypass surgery 3 weeks ago. If the patient is now is in the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care?
Provide foods high in potassium.
Restrict fluids based on urine output.
Monitor output from peritoneal dialysis.
Offer high protein snacks between meals.

A

A.
Fluid intake is monitored during the oliguric phase. Fluid intake is determined by adding all losses for the previous 24 hours plus 600 mL. Potassium and protein intake may be limited in the oliguric phase to avoid hyperkalemia and elevated urea nitrogen. Hemodialysis, not peritoneal dialysis, is indicated in acute kidney injury if dialysis is needed.

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17
Q

A 52-year-old man with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which action should the nurse take?
Assess skin turgor to determine hydration status.
Insert a urinary catheter for the expected diuresis.
Evaluate the patient’s lower extremities for edema.
Check the patient’s urine for the presence of ketones.

A

A.
Preexisting kidney disease is the most important risk factor for the development of contrast-associated nephropathy and nephrotoxic injury. If contrast media must be administered to a high-risk patient, the patient needs to have optimal hydration. The nurse should assess the hydration status of the patient before the procedure is performed. Indwelling catheter use should be avoided whenever possible to decrease the risk of infection.

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18
Q
A 56-year-old woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. The nurse should assess the patient for
  fatigue.
  flank tenderness.
  cardiac dysrhythmias.
  elevated triglycerides.
A

C.
Hyperkalemia is the most serious electrolyte disorder associated with kidney disease. Fatal dysrhythmias can occur when the serum potassium level reaches 7 to 8 mEq/L. Fatigue and hypertriglyceridemia may be present but do not require urgent intervention. Tenderness or pain over the kidneys is not expected in CKD.

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19
Q
A frail 72-year-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid?
  Aspirin
  Acetaminophen (Tylenol)
  Diphenhydramine (Benadryl)
  Aluminum hydroxide (Amphogel)
A

D.
Antacids (that contain magnesium and aluminum) should be avoided because patients with kidney disease are unable to excrete these substances. Also, some antacids contain high levels of sodium that further increase blood pressure. Acetaminophen and aspirin (if taken for a short period of time) are usually safe for patients with kidney disease. Antihistamines may be used, but combination drugs that contain pseudoephedrine may increase blood pressure and should be avoided.

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20
Q

The home care nurse visits a 34-year-old woman receiving peritoneal dialysis. Which statement, if made by the patient, indicates a need for immediate follow-up by the nurse?
“Drain time is faster if I rub my abdomen.”
“The fluid draining from the catheter is cloudy.”
“The drainage is bloody when I have my period.”
“I wash around the catheter with soap and water.”

A

B.
The primary clinical manifestation of peritonitis is a cloudy peritoneal effluent. Blood may be present in the effluent of women who are menstruating, and no intervention is indicated. Daily catheter care may include washing around the catheter with soap and water. Drain time may be facilitated by gently massaging the abdomen.

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21
Q

A 25-year-old male patient has been admitted with a severe crushing injury after an industrial accident.
Which laboratory result will be most important to report to the health care provider?
a. Serum creatinine level 2.1 mg/dL
b. Serum potassium level 6.5 mEq/L
c. White blood cell count 11,500/μL
d. Blood urea nitrogen (BUN) 56 mg/dL

A

ANS: B
The hyperkalemia associated with crushing injuries may cause
cardiac arrest and should be treated immediately. The nurse
also will report the other laboratory values, but abnormalities
in these are not immediately life threatening

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22
Q

A 37-year-old female patient is hospitalized with acute kidney injury (AKI). Which
information will be most useful to the nurse in evaluating improvement in kidney function?
a. Urine volume
b. Creatinine level
c. Glomerular filtration rate (GFR)
d. Blood urea nitrogen (BUN) level

A

ANS: C
GFR is the preferred method for evaluating kidney function. BUN levels can
fluctuate based on factors such as fluid volume status and protein intake. Urine
output can be normal or high in patients with AKI and does not accurately
reflect kidney function. Creatinine alone is not an accurate reflection of renal
function

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23
Q

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.

A

ANS: B
A nontender lump suggests a malignancy such as a lymphoma, which could
occur as a result of chronic immunosuppressive therapy. The elevated glucose,
skin change, and hypertension are possible side effects of the prednisone and
should be addressed, but they are not as great a concern as the possibility of a
malignancy

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24
Q

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

A

ANS: B
Because hyperkalemia can cause fatal cardiac dysrhythmias, the initial action
should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time
to correct the hyperkalemia and anemia. The catheter allows monitoring of the
urine output but does not correct the cause of the renal failure

25
Q

A 48-year-old patient with stage 2 chronic kidney disease (CKD) is scheduled for an
intravenous pyelogram (IVP). Which order for the patient will the nurse question?
a. NPO for 6 hours before procedure
b. Ibuprofen (Advil) 400 mg PO PRN for pain
c. Dulcolax suppository 4 hours before procedure
d. Normal saline 500 mL IV infused before procedure

A

ANS: B
The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other
nephrotoxic medications such as the nonsteroidal anti-inflammatory drugs (NSAIDs)
should be avoided. The suppository and NPO status are necessary to ensure adequate
visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps
reduce the risk for contrast-induced renal failure

26
Q

A 55-year-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of
epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving
the medication?
a. Creatinine 1.6 mg/dL
b. Oxygen saturation 89%
c. Hemoglobin level 13 g/dL
d. Blood pressure 98/56 mm Hg

A

ANS: C
High hemoglobin levels are associated with a higher rate of thromboembolic events and
increased risk of death from serious cardiovascular events (heart attack, heart failure,
stroke) when erythropoietin (EPO) is administered to a target hemoglobin of >12 g/dL.
Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose.
The other information also will be reported to the health care provider but will not affect
whether the medication is administered

27
Q

A 62-year-old female patient has been hospitalized for 8 days with acute kidney injury (AKI) caused by
dehydration. Which information will be most important for the nurse to report to the health care
provider?
a. The creatinine level is 3.0 mg/dL.
b. Urine output over an 8-hour period is 2500 mL.
c. The blood urea nitrogen (BUN) level is 67 mg/dL.
d. The glomerular filtration rate is <30 mL/min/1.73m2.

A

ANS: B
The high urine output indicates a need to increase fluid
intake to prevent hypovolemia. The other information is
typical of AKI and will not require a change in therapy

28
Q

A 64-year-old male patient who has had progressive chronic kidney disease (CKD) for several years has
just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?
a. Increased calories are needed because glucose is lost during hemodialysis.
b. Unlimited fluids are allowed because retained fluid is removed during dialysis.
c. More protein is allowed because urea and creatinine are removed by dialysis.
d. Dietary potassium is not restricted because the level is normalized by dialysis.

A

ANS: C
Once the patient is started on dialysis and nitrogenous wastes are removed, more protein
in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and
complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium
and potassium intake continues to be restricted to avoid the complications associated with
high levels of these electrolytes

29
Q

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 at 50 mL/hour.

A

ANS: A
The patient’s elevation in BUN is most likely associated with hydronephrosis
caused by the acute urinary retention, so the insertion of a retention catheter is
the first action to prevent ongoing postrenal failure for this patient. The other
actions also are appropriate, but should be implemented after the retention
catheter

30
Q

A 74-year-old who is progressing to stage 5 chronic kidney disease 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.”

A

ANS: B
The nurse should initially clarify the patient’s concerns and questions about
dialysis. The patient is the one responsible for the decision and many people
using dialysis do have good quality of life, but these responses block further
assessment of the patient’s concerns. Referring to which type of dialysis the
patient might use only indirectly responds to the patient’s question

31
Q

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

A

ANS: D
The patient who is tachycardic after hemodialysis may be bleeding or
excessively hypovolemic and should be assessed immediately for
these complications. The other patients also need assessments or
interventions but are not at risk for life-threatening complications

32
Q

After the insertion of an arteriovenous graft (AVG) in the right forearm, a 54-year-old patient complains
of pain and coldness of the right fingers. Which action should the nurse take?
a. Teach the patient about normal AVG function.
b. Remind the patient to take a daily low-dose aspirin tablet.
c. Report the patient’s symptoms to the health care provider.
d. Elevate the patient’s arm on pillows to above the heart level

A

ANS: C
The patient’s complaints suggest the development of distal ischemia (steal
syndrome) and may require revision of the AVG. Elevation of the arm above the
heart will further decrease perfusion. Pain and coolness are not normal after
AVG insertion. Aspirin therapy is not used to maintain grafts

33
Q

Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney
disease (CKD), the nurse should check laboratory results for
a. potassium level.
b. total cholesterol.
c. serum phosphate.
d. serum creatinine.

A

ANS: C
If serum phosphate is elevated, the calcium and phosphate can cause soft
tissue calcification. The calcium carbonate should not be given until the
phosphate level is lowered. Total cholesterol, creatinine, and potassium values
do not affect whether calcium carbonate should be administered

34
Q

Before administration of captopril (Capoten) to a patient with stage 2 chronic kidney
disease (CKD), the nurse will check the patient’s
a. glucose.
b. potassium.
c. creatinine.
d. phosphate.

A

ANS: B
Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD
because they delay the progression of the CKD, but they cause potassium retention.
Therefore careful monitoring of potassium levels is needed in patients who are at risk for
hyperkalemia. The other laboratory values would also be monitored in patients with CKD
but would not affect whether the captopril was given or not.

35
Q

During routine hemodialysis, the 68-year-old patient complains of nausea and dizziness.
Which action should the nurse take first?
a. Slow down the rate of dialysis.
b. Check patient’s blood pressure (BP).
c. Review the hematocrit (Hct) level.
d. Give prescribed PRN antiemetic drugs

A

ANS: B
The patient’s complaints of nausea and dizziness suggest
hypotension, so the initial action should be to check the BP. The
other actions may also be appropriate based on the blood
pressure obtained

36
Q

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2 L inflows. Which
information should the nurse report immediately to the health care provider?
a. The patient has an outflow volume of 1800 mL.
b. The patient’s peritoneal effluent appears cloudy.
c. The patient has abdominal pain during the inflow phase.
d. The patient’s abdomen appears bloated after the inflow

A

ANS: B
Cloudy appearing peritoneal effluent is a sign of peritonitis and
should be reported immediately so that treatment with antibiotics can
be started. The other problems can be addressed through nursing
interventions such as slowing the inflow and repositioning the patient

37
Q

A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2
chronic kidney disease. Which observation by the RN requires an intervention?
a. The LPN/LVN administers the erythropoietin subcutaneously.
b. The LPN/LVN assists the patient to ambulate out in the hallway.
c. The LPN/LVN administers the iron supplement and phosphate binder with lunch.
d. The LPN/LVN carries a tray containing low-protein foods into the patient’s room.

A

ANS: C
Oral phosphate binders should not be given at the same time as iron because
they prevent the iron from being absorbed. The phosphate binder should be
given with a meal and the iron given at a different time. The other actions by
the LPN/LVN are appropriate for a patient with renal insufficiency.

38
Q

The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease
(CKD). Which medication reported by the patient indicates that patient teaching is required?
a. Multivitamin with iron
b. Magnesium hydroxide
c. Acetaminophen (Tylenol)
d. Calcium phosphate (PhosLo)

A

ANS: B
Magnesium is excreted by the kidneys, and patients with CKD
should not use over-the-counter products containing
magnesium. The other medications are appropriate for a
patient with CKD.

39
Q

The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most
important to communicate to the health care provider?
a. The urine output is 900 to 1100 mL/hr.
b. The patient’s central venous pressure (CVP) is decreased.
c. The patient has a level 7 (0 to 10 point scale) incisional pain.
d. The blood urea nitrogen (BUN) and creatinine levels are elevated.

A

ANS: B
The decrease in CVP suggests hypovolemia, which must be
rapidly corrected to prevent renal hypoperfusion and acute
tubular necrosis. The other information is not unusual in a
patient after a transplant

40
Q

The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea
nitrogen (BUN) and creatinine levels. The primary collaborative treatment goal in the plan will be
a. augmenting fluid volume.
b. maintaining cardiac output.
c. diluting nephrotoxic substances.
d. preventing systemic hypertension.

A

ANS: B
The primary goal of treatment for acute kidney injury (AKI) is to eliminate the
cause and provide supportive care while the kidneys recover. Because this
patient’s heart failure is causing AKI, the care will be directed toward treatment
of the heart failure. For renal failure caused by hypertension, hypovolemia, or
nephrotoxins, the other responses would be correct

41
Q

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) level

A

ANS: B
Fluid volume is replaced based on urine output after transplant
because the urine output can be as high as a liter an hour. The
other data will be monitored but are not the most important
determinants of fluid infusion rate

42
Q

A patient complains of leg cramps during hemodialysis. The nurse should first

a. massage the patient’s legs.
b. reposition the patient supine.
c. give acetaminophen (Tylenol).
d. infuse a bolus of normal saline

A

ANS: D
Muscle cramps during dialysis are caused by rapid removal of
sodium and water. Treatment includes infusion of normal saline.
The other actions do not address the reason for the cramps.

43
Q

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 starting dialysis.
c. Assess for causes of an increase in predialysis weight.
d. Determine the ultrafiltration rate for the hemodialysis

A

ANS: B
Dialysis technicians are educated in monitoring for blood
pressure. Assessment, adjustment of the appropriate
ultrafiltration rate, and patient teaching require the education
and scope of practice of an RN.

44
Q

A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the
nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?
a. Urine volume
b. Calcium level
c. Cardiac rhythm
d. Neurologic status

A

ANS: C
The calcium gluconate helps prevent dysrhythmias that might
be caused by the hyperkalemia. The nurse will monitor the
other data as well, but these will not be helpful in determining
the effectiveness of the calcium gluconate

45
Q

A patient will need vascular access for hemodialysis. Which statement by the nurse
accurately describes an advantage of a fistula over a graft?
a. A fistula is much less likely to clot.
b. A fistula increases patient mobility.
c. A fistula can accommodate larger needles.
d. A fistula can be used sooner after surgery.

A

ANS: A
Arteriovenous (AV) fistulas are much less likely to clot than grafts,
although it takes longer for them to mature to the point where they
can be used for dialysis. The choice of an AV fistula or a graft does
not have an impact on needle size or patient mobility

46
Q

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram
(ECG) than were noted on the previous shift. Which action should the nurse take first?
a. Notify the patient’s health care provider.
b. Document the QRS interval measurement.
c. Check the medical record for most recent potassium level.
d. Check the chart for the patient’s current creatinine level.

A

ANS: C
The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the
most recent potassium and then notify the patient’s health care provider. The BUN and
creatinine will be elevated in a patient with AKI, but they would not directly affect the
electrocardiogram (ECG). Documentation of the QRS interval is also appropriate, but
interventions to decrease the potassium level are needed to prevent life-threatening
dysrhythmias

47
Q

A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin (Garamycin) 60
mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient’s
a. blood glucose.
b. urine osmolality.
c. serum creatinine.
d. serum potassium.

A

ANS: C
When a patient at risk for chronic kidney disease (CKD) receives a potentially
nephrotoxic medication, it is important to monitor renal function with BUN and
creatinine levels. The other laboratory values would not be useful in assessing
for the adverse effects of the gentamicin

48
Q

Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia.
Before administering the medication, the nurse should assess the
a. bowel sounds.
b. blood glucose.
c. blood urea nitrogen (BUN).
d. level of consciousness (LOC).

A

ANS: A
Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient
with a paralytic ileus (as indicated by absent bowel sounds) because bowel
necrosis can occur. The BUN and creatinine, blood glucose, and LOC would
not affect the nurse’s decision to give the medication

49
Q
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse
will expect an assessment finding of
a. persistent skin tenting
b. rapid, deep respirations.
c. bounding peripheral pulses.
d. hot, flushed face and neck.
A

ANS: B
Patients with metabolic acidosis caused by AKI may have Kussmaul respirations
as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation
are not associated with metabolic acidosis. Because the patient is likely to have
fluid retention, poor skin turgor would not be a finding in AKI

50
Q

When caring for a patient with a left arm arteriovenous fistula, which action will the nurse
include in the plan of care to maintain the patency of the fistula?
a. Auscultate for a bruit at the fistula site.
b. Assess the quality of the left radial pulse.
c. Compare blood pressures in the left and right arms.
d. Irrigate the fistula site with saline every 8 to 12 hours.

A

ANS: A
The presence of a thrill and bruit indicates adequate blood flow through the
fistula. Pulse rate and quality are not good indicators of fistula patency. Blood
pressures should never be obtained on the arm with a fistula. Irrigation of the
fistula might damage the fistula, and typically only dialysis staff would access
the fistula

51
Q

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

A

ANS: C
Patients are encouraged to take showers rather than baths to
avoid infections at the catheter insertion side. The other patient
actions indicate good understanding of peritoneal dialysis

52
Q

Which assessment finding may indicate that a patient is experiencing adverse effects to a
corticosteroid prescribed after kidney transplantation?
a. Postural hypotension
b. Recurrent tachycardia
c. Knee and hip joint pain
d. Increased serum creatinine

A

ANS: C
Aseptic necrosis of the weight-bearing joints can occur when
patients take corticosteroids over a prolonged period.
Increased creatinine level, orthostatic dizziness, and
tachycardia are not caused by corticosteroid use.

53
Q

Which information in a patient’s history indicates to the nurse that the patient is not an
appropriate candidate for kidney transplantation?
a. The patient has type 1 diabetes.
b. The patient has metastatic lung cancer.
c. The patient has a history of chronic hepatitis C infection.
d. The patient is infected with the human immunodeficiency virus.

A

ANS: B
Disseminated malignancies are a contraindication to
transplantation. The conditions of the other patients
are not contraindications for kidney transplant

54
Q

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 to 2000 mL of fluids daily.
c. Take phosphate-binders with each meal.
d. Choose high-protein foods for most meals.
e. Have several servings of dairy products daily

A

ANS: A, C, D
Patients who are receiving peritoneal dialysis should have a high-protein diet.
Phosphate binders are taken with meals to help control serum phosphate and
calcium levels. Commercial salt substitutes are high in potassium and should be
avoided. Fluid intake is limited in patients requiring dialysis. Dairy products are
high in phosphate and usually are limited

55
Q

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

A

ANS: B
Calcium carbonate is prescribed to bind phosphorus and
prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate

56
Q

Which intervention will be included in the plan of care for a male patient with acute kidney
injury (AKI) who has a temporary vascular access catheter in the left femoral vein?
a. Start continuous pulse oximetry.
b. Restrict physical activity to bed rest.
c. Restrict the patient’s oral protein intake.
d. Discontinue the urethral retention catheter

A

ANS: B
The patient with a femoral vein catheter must be on bed rest to prevent trauma
to the vein. Protein intake is likely to be increased when the patient is receiving
dialysis. The retention catheter is likely to remain in place because accurate
measurement of output will be needed. There is no indication that the patient
needs continuous pulse oximetry

57
Q

Which menu choice by the patient who is receiving hemodialysis indicates that the nurse’s
teaching has been successful?
a. Split-pea soup, English muffin, and nonfat milk
b. Oatmeal with cream, half a banana, and herbal tea
c. Poached eggs, whole-wheat toast, and apple juice
d. Cheese sandwich, tomato soup, and cranberry juice

A

ANS: C
Poached eggs would provide high-quality protein, and apple juice is low in
potassium. Cheese is high in salt and phosphate, and tomato soup would be
high in potassium. Split-pea soup is high in potassium, and dairy products are
high in phosphate. Bananas are high in potassium, and the cream would be high
in phosphate

58
Q

Which statement by a 62-year-old patient with stage 5 chronic kidney disease (CKD)
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.”

A

ANS: C
The patient with end-stage kidney disease is taught to measure urine output as a means of
determining an appropriate oral fluid intake. Erythropoietin is given to increase the red
blood cell count and will not offer any benefit for immune function. Dairy products are
restricted because of the high phosphate level. Many fruits and vegetables are high in
potassium and should be restricted in the patient with CKD