Ch. 60 AKI and Chronic Kidney Disease

Question 1

While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action will the nurse implement?

A. Instruct the client to cough
B. Document the effluent as output
C. Turn the client to the opposite side
D. Reposition the catheter

Answer 1

C. Turn the client to the opposite side

Question 2

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends which food selection?

A. Eggs
B. Ham
C. Egg plant
D. Macaroni

Answer 2

A. Eggs

Question 3

The nurse is teaching a client with chronic kidney disease. Which teaching will the nurse include to help prevent renal osteodystrophy?

A. Consume a low-calcium diet
B. Avoid peas, nuts, and legumes
C. Drink cola beverages only once daily
D. Increase dairy products enriched with vitamin D

Answer 3

B. Avoid peas, nuts, and legumes

Question 4

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted?

A. Assess for crackles
B. Auscultate for pericardial friction rub
C. Monitor for decreased peripheral pulses
D. Determine if the client is able to ambulate

Answer 4

B. Auscultate for pericardial friction rub

Question 5

A client with end-stage kidney disease has been placed on fluid restrictions. Which assessment data indicates to the nurse that the fluid restriction has not been followed?

A. Dyspnea and anxiety at rest
B. Blood pressure of 118/78 mm Hg
C. Weight loss of 3 lb during hospitalization
D. Central venous pressure of 6 mm Hg

Answer 5

A. Dyspnea and anxiety at rest

Question 6

The nurse is caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter. Which assessment finding requires nursing action?

A. Anorexia
B. 1+ ankle edema
C. Temperature 100.8 F
D. Mild discomfort at the insertion site

Answer 6

C. Temperature 100.8 F

Question 7

The nurse is caring for a client who is receiving erythropoietin. Which assessment finding indicates a positive response to the medication?

A. Hematocrit of 26.7%
B. Potassium within normal range
C. Absence of spontaneous fractures
D. A decrease in fatigue

Answer 7

D. A decrease in fatigue

Question 8

The nurse is caring for a client who is receiving peritoneal dialysis. Which finding will the nurse report to the provider immediately?

A. Pulse oximetry reading of 95%
B. Sinus bradycardia, rate of 58 beats/min
C. Blood pressure of 148/90 mm Hg
D. Temperature of 101.2 F

Answer 8

D. Temperature of 101.2 F

Question 9

A client is scheduled to undergo kidney transplant surgery. Which teaching will the nurse include in the perioperative teaching?

A. “Your diseased kidney will be removed when the transplant is performed.”
B. “The new kidney will be placed directly below one of your old kidneys.”
C. “It is essential for you to wash your hands and avoid people who are ill.”
D. “You will receive dialysis the day before surgery and for about a week after.”

Answer 9

C. “It is essential for you to wash your hands and avoid people who are ill.”

Question 10

A client receiving immune-suppresive therapy after kidney transplantation. Which measure for infection control is important for the nurse to implement?

A. Adherence to therapy
B. Handwashing
C. Monitoring for low-grade fever
D. Strict clean technique

Answer 10

B. Handwashing

Question 11

To prevent prerenal acute kidney injury, which person will the nurse encourage to increase fluid consumption?

A. Construction worker
B. Office secretary
C. School teacher
D. Taxicab driver

Answer 11

A. Construction worker

Question 12

The nurse has provided discharge teaching for a client following kidney transplantation. Which client statement indicates understanding of the teaching?

A. “I can stop my medications when my kidney function returns to normal.”
B. “If my urine output is decreased, I should increase my fluids.”
C. “The antirejections medications will be taken for life.”
D. “I will drink 8 ounces of water with my medication.”

Answer 12

C. “The antirejections medications will be taken for life.”

Question 13

A client is being treated for kidney failure. Which nursing statement encourages client expression?

A. “All of this is new. What can’t you do?”
B. “Are you afraid of dying?”
C. “How are you doing this morning?”
D. “What concerns do you have about your kidney disease?”

Answer 13

D. “What concerns do you have about your kidney disease?”

Question 14

The nurse is caring for a client with kidney failure. Which assessment date indicates the need for increased fluids?

A. Pale-colored urine
B. Increased creatinine level
C. Increased blood urea nitrogen (BUN)
D. Decreased sodium level

Answer 14

C. Increased blood urea nitrogen (BUN)

Question 15

A client with new vascular access for hemodialysis is being discharged. Which teaching will the nurse include in the discharge instructions?

A. Details on proper nutrition
B. Steps to assess for bruit in the affected arm
C. Modifications to allow for complete rest of the affect arm
D. Avoid venipuncture and blood pressure measurements in the affected arm

Answer 15

D. Avoid venipuncture and blood pressure measurements in the affected arm

Question 16

A client admitted with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 L of normal saline infused over 2 hours. Which staff member would be assigned to care for the client?

A. RN who has floated from pediatrics for this shift
B. LPN/LVN with experience working on the medical unit
C. RN who usually works on the general surgical unit
D. New graduate RN who just finished a 6-week orientation

Answer 16

C. RN who usually works on the general surgical unit

Question 17

The RN has just received change-of-shift report. Which client will the nurse assess first?

A. Client with chronic kidney failure who was just admitted with shortness of breath
B. Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted
C. Client with azotemia whose blood urea nitrogen and creatinine are increasing
D. Client receiving peritoneal dialysis who needs help changing the dialysate bag

Answer 17

A. Client with chronic kidney failure who was just admitted with shortness of breath

Question 18

Which client will the nurse assess as at risk for acute kidney injury (AKI)? Select all that apply.

A. Football player in preseason practice
B. Client who underwent contrast dye radiology
C. Accident victim recovering from a severe hemorrhage
D. Accountant with poorly controlled diabetes mellitus
E. Client in the intensive care unit on high doses of antibiotics

Answer 18

A, B, C, E

Question 19

The nurse is teaching dietary modification to a client with acute kidney injury. What dietary teaching will the nurse include? Select all that apply

A. Restricted protein
B. Liberal sodium
C. Restricted fluids
D. Low potassium
E. Low fat

Answer 19

A, C, D

Question 20

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which nursing actions are required? Select all that apply.

A. Check brachial pulses daily
B. Auscultate for a bruit every 8 hours
C. Teach the client to palpate for a thrill over the site
D. Elevate the arm above heart level
E. Ensure that no blood pressure are taken in that arm

Answer 20

B, C, E

Question 21

While managing care for a client with chronic kidney disease, which action does the registered nurse plan to delegate to assistive personnel? Select all that apply

A. Obtain the client’s pre-hemodialysis weights.
B. Check the arteriovenous (AV) fistula for a thrill and bruit
C. Document the amount the client drinks throughout the shift
D. Auscultate the client’s lung sounds every 4 hours
E. Explain the components of a low-sodium diet

Answer 21

A, C

Question 22

The nurse is caring for a client following a kidney transplant. Which assessment data indicate to the nurse possible rejection of the kidney? Select all that apply.

A. Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL
B. Crackles in the lung fields
C. Temperature of 98.9 F
D. Blood pressure of 164/98 mm Hg
E. 3+ edema of the lower extremities

Answer 22

B, D, E