chapter 49

Question 1

The nurse is caring for a client who has had an insertion of an arteriovenous graft (AVG) in the right forearm and has symptoms of pain and coldness of the right fingers. Which of the following actions should the nurse take?
a. Elevate the client’s arm above the level of the heart.
b. Report the client’s symptoms to the health care provider.
c. Remind the client about the need to take a daily low-dose Aspirin tablet.
d. Educate the client about the normal vascular response after AVG insertion.

Answer 1

b. Report the client’s symptoms to the health care provider.

Question 2

The nurse is caring for a client with acute kidney injury (AKI) who has an arterial blood pH of 7.30. Which of the following assessment findings should the nurse anticipate?
a. Vasodilation
b. Poor skin turgor
c. Bounding pulses
d. Rapid respirations

Answer 2

d. Rapid respirations

Question 3

The nurse is caring for a client with severe heart failure who develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet which of the following goals of treatment?
a. Replace fluid volume
b. Prevent hypertension
c. Maintain cardiac output
d. Dilute nephrotoxic substances

Answer 3

c. Maintain cardiac output

Question 4

The nurse is caring for a client with acute glomerulonephritis, acute kidney injury (AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the following parameters should the nurse assess to evaluate the effectiveness of the medication?
a. Urine output
b. Calcium level
c. Cardiac rhythm
d. Neurological status

Answer 4

c. Cardiac rhythm

Question 5

The nurse is caring for a client with stage 2 chronic kidney disease (CKD) who is scheduled for an intravenous pyelogram (IVP). Which of the following prescriptions for the client should the nurse question?
a. NPO for 6 hours before IVP procedure
b. Normal saline 500 mL IV before procedure
c. Ibuprofen 400 mg PO PRN for pain
d. Dulcolax suppository 4 hours before IVP procedure

Answer 5

c. Ibuprofen 400 mg PO PRN for pain

Question 6

The nurse is teaching a client with stage 5 chronic kidney disease (CKD) about management of CKD. Which of the following client statements indicate that the teaching was effective?
a. “I need to try to get more protein from dairy products.”
b. “I will try to increase my intake of fruits and vegetables.”
c. “I will measure my urinary output each day to help calculate the amount I can drink.”
d. “I need to take the erythropoietin to boost my immune system and help prevent infection.”

Answer 6

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

Question 7

The nurse is caring for a client with chronic kidney disease (CKD) who is prescribed calcium carbonate. Which of the following parameters should the nurse assess in order to determine the effectiveness of the treatment?
a. Blood pressure
b. Phosphate level
c. Neurological status
d. Creatinine clearance

Answer 7

b. Phosphate level

Question 8

Which of the following assessments should the nurse complete before administering sodium polystyrene sulphonate to a client with hyperkalemia?
a. Blood urea nitrogen (BUN) and creatinine
b. Blood glucose level
c. Client’s bowel sounds
d. Level of consciousness (LOC)

Answer 8

c. Client’s bowel sounds

Question 9

The nurse is teaching a client who is receiving hemodialysis about appropriate dietary choices. Which of the following menu choices by the client indicates that the teaching has been effective?
a. Scrambled eggs, English muffin, and apple juice
b. Oatmeal with cream, half a banana, and herbal tea
c. Split-pea soup, whole-wheat toast, and nonfat milk
d. Cheese sandwich, tomato soup, and cranberry juice

Answer 9

a. Scrambled eggs, English muffin, and apple juice

Question 10

The nurse is preparing to administer calcium carbonate to a client with chronic kidney disease (CKD). Which of the following laboratory results should the nurse check prior to administration?
a. Creatinine
b. Potassium
c. Total cholesterol
d. Serum phosphate

Answer 10

d. Serum phosphate

Question 11

Which of the following information is most useful to the nurse in evaluating improvement in kidney function for a client who is hospitalized with acute kidney injury (AKI)?
a. Blood urea nitrogen (BUN) level
b. Urine output
c. Creatinine level
d. Calculated glomerular filtration rate (GFR)

Answer 11

d. Calculated glomerular filtration rate (GFR)

Question 12

The nurse is caring for a client who requires vascular access for hemodialysis and asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. Which of the following information should the nurse explain is an advantage of the fistula?
a. Is much less likely to clot
b. Increases client mobility
c. Accommodates larger needles.
d. Can be used sooner after surgery.

Answer 12

a. Is much less likely to clot

Question 13

The nurse is caring for a client with a left arm arteriovenous fistula. Which of the following actions should the nurse include in the plan of care to maintain the patency of the fistula?
a. Check the fistula site for a bruit and thrill.
b. Assess the rate and quality of the left radial pulse.
c. Compare blood pressures in the left and right arms.
d. Irrigate the fistula site with saline every 8–12 hours.

Answer 13

a. Check the fistula site for a bruit and thrill.

Question 14

The nurse is caring for a client who has had progressive chronic kidney disease (CKD) for several years and is starting hemodialysis. Which of the following information about diet should the nurse include in client teaching?
a. Increased calories are needed because glucose is lost during hemodialysis.
b. Unlimited fluids are allowed since retained fluid is removed during dialysis.
c. More protein will be allowed because of the removal of urea and creatinine by dialysis.
d. Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.

Answer 14

c. More protein will be allowed because of the removal of urea and creatinine by dialysis.

Question 15

Which of the following actions by a client who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
a. The client slows the inflow rate when experiencing pain.
b. The client leaves the catheter exit site without a dressing.
c. The client plans 30–60 minutes for a dialysate exchange.
d. The client cleans the catheter while taking a bath every day.

Answer 15

d. The client cleans the catheter while taking a bath every day.

Question 16

The nurse is taking a history for a client who is a possible candidate for a kidney transplant. Which of the following information indicates that the client is not an appropriate candidate for transplantation?
a. The client has metastatic lung cancer.
b. The client has poorly controlled type 1 diabetes.
c. The client has a history of chronic hepatitis C infection.
d. The client is infected with the human immunodeficiency virus.

Answer 16

a. The client has metastatic lung cancer.

Question 17

The nurse is caring for a client who had kidney transplantation several years ago. Which of the following findings may indicate that the client is experiencing adverse effects to the prescribed corticosteroid?
a. Joint pain
b. Tachycardia
c. Postural hypotension
d. Increase in creatinine level

Answer 17

a. Joint pain

Question 18

The nurse is assessing a client who had a kidney transplant 8 years ago and is receiving the
immunosuppressants tacrolimus, cyclosporin, and prednisone. Which of the following findings is of most concern to the nurse?
a. The blood glucose is 7.9 mmol/L.
b. The client’s blood pressure is 150/92.
c. There is a nontender lump in the axilla.
d. The client has a round, moonlike face.

Answer 18

c. There is a nontender lump in the axilla

Question 19

The nurse is interviewing a client with chronic kidney disease (CKD) who brings all home medications to the clinic to be reviewed by the nurse. Which of the following medications being used by the client indicates that client teaching is required?
a. Multivitamin with iron
b. Milk of magnesia 30 mL
c. Calcium acetate
d. Acetaminophen 650 mg

Answer 19

b. Milk of magnesia 30 mL

Question 20

The nurse is caring for a client with hypertension and stage 2 chronic kidney disease (CKD) who is prescribed ramapril. Which of the following laboratory tests should the nurse assess before administration of the medication?
a. Glucose
b. Potassium
c. Creatinine
d. Phosphate

Answer 20

b. Potassium

Question 21

The nurse is caring for a client with diabetes who has been admitted with pneumonia and is prescribed gentamicin 60 mg IV. Which of the following parameters should the nurse monitor to evaluate the client for adverse effects of the medication?
a. Urine osmolality
b. Serum potassium
c. Blood glucose level
d. Blood urea nitrogen (BUN) and creatinine

Answer 21

d. Blood urea nitrogen (BUN) and creatinine

Question 22

The nurse is caring for a client with end-stage renal disease (ESRD). Which of the following findings indicate that the nurse should consult with the health care provider before giving the prescribed erythropoiesis-stimulating agent (ESA)?
a. Creatinine 99 mcmol/L
b. Oxygen saturation 89%
c. Hemoglobin level 130 g/L
d. Blood pressure 98/56 mm Hg

Answer 22

c. Hemoglobin level 130 g/L

Question 23

The nurse is caring for a client with acute kidney injury (AKI) who requires hemodialysis and a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which of the following interventions should be included in the plan of care?
a. Place the client on bed rest.
b. Start continuous pulse oximetry.
c. Discontinue the retention catheter.
d. Restrict the client’s oral protein intake.

Answer 23

a. Place the client on bed rest.

Question 24

The nurse is caring for a client who has been admitted with a severe crushing injury after an industrial accident. Which of the following laboratory results is most important to report to the health care provider?
a. Serum creatinine level 190 mcmol/L
b. Serum potassium level 6.5 mmol/L
c. White blood cell count 11.5 ́ 109/L
d. Blood urea nitrogen (BUN) 18 mmol/L

Answer 24

b. Serum potassium level 6.5 mmol/L

Question 25

The nurse is caring for a client with a history of benign prostatic hyperplasia (BPH) with acute urinary retention and an elevated blood urea nitrogen (BUN) and creatinine. Which of the following prescribed therapies should the nurse implement first?
a. Obtain renal ultrasound.
b. Insert retention catheter.
c. Infuse normal saline at 50 mL/hour.
d. Draw blood for complete blood count.

Answer 25

b. Insert retention catheter.

Question 26

The nurse is caring for a client who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration. Which of the following findings is most important for the nurse to report to the health care provider?
a. The blood urea nitrogen (BUN) level is 23.1 mmol/L.
b. The creatinine level is 186 mcmol/L.
c. Urine output over an 8-hour period is 2 500 mL.
d. The glomerular filtration rate is <30 mL/minute/1.73m2.

Answer 26

c. Urine output over an 8-hour period is 2 500 mL.

Question 27

After noting lengthening QRS intervals in a client with acute kidney injury (AKI), which of the following actions should the nurse take first?
a. Document the QRS interval.
b. Notify the client’s health care provider.
c. Look at the client’s current blood urea nitrogen (BUN) and creatinine levels.
d. Check the client’s most recent blood potassium level.

Answer 27

d. Check the client’s most recent blood potassium level.

Question 28

The nurse is caring for a client with acute kidney injury who is dehydrated with symptoms of oliguria, anemia, and hyperkalemia. Which of the following prescribed actions should the nurse take first?
a. Insert a urinary retention catheter.
b. Place the client on a cardiac monitor.
c. Administer an erythropoiesis-stimulating agent (ESA).
d. Give sodium polystyrene sulfonate.

Answer 28

b. Place the client on a cardiac monitor.

Question 29

The nurse is caring for a client who is receiving hemodialysis and has symptoms of nausea, vomiting, and a headache. Which of the following actions is priority?
a. Infuse a hypotonic solution
b. Increase the rate of the dialysis
c. Administer an antiemetic medication
d. Stop the dialysis solution

Answer 29

d. Stop the dialysis solution

Question 30

The RN observes a nursing student carrying out all of these actions while caring for a client with stage 2 chronic kidney disease. Which of the following actions require the RN to intervene?
a. The student administers erythropoietin subcutaneously.
b. The student assists the client to ambulate in the hallway.
c. The student gives the iron supplement and phosphate binder with lunch.
d. The student carries a tray containing low-protein foods into the client’s room.

Answer 30

c. The student gives the iron supplement and phosphate binder with lunch.

Question 31

The nurse is assessing a client who is receiving peritoneal dialysis with 2 L inflows. Which of the following information should be reported immediately to the health care provider?
a. The client has an outflow volume of 1 800 mL.
b. The client’s peritoneal effluent appears cloudy.
c. The client has abdominal pain during the inflow phase.
d. The client complains of feeling bloated after the inflow.

Answer 31

b. The client’s peritoneal effluent appears cloudy.

Question 32

Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the client. Which information is most important to communicate to the health care provider?
a. The urine output is 900–1 100 mL/hour.
b. The blood urea nitrogen (BUN) and creatinine levels are elevated.
c. The client’s central venous pressure (CVP) is decreased.
d. The client has level 8 (on a 10-point scale) incisional pain.

Answer 32

c. The client’s central venous pressure (CVP) is decreased.

Question 33

The nurse is caring for a client in the oliguric phase of acute renal failure who has a 24-hour fluid output of 150 mL emesis and 250 mL urine. Which of the following amounts in mL should the nurse plan a fluid replacement for the following day?
a. 400
b. 800
c. 1 000
d. 1 400

Answer 33

c. 1 000

Question 34

The nurse is caring for a client receiving hemodialysis who has symptoms of nausea and dizziness. Which of the following actions should the nurse take first?
a. Slow down the rate of dialysis.
b. Obtain blood to check the blood urea nitrogen (BUN) level.
c. Check the client’s blood pressure.
d. Give prescribed PRN antiemetic drugs.

Answer 34

c. Check the client’s blood pressure.

Question 35

Which of the following parameters is most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a client has had kidney
transplantation?
a. Heart rate
b. Blood urea nitrogen (BUN) level
c. Urine output
d. Creatinine clearance

Answer 35

c. Urine output

Question 36

The nurse is caring for a client who has leg cramps during hemodialysis. Which of the following actions should the nurse implement first?
a. Reposition the client
b. Massage the client’s legs
c. Give acetaminophen
d. Infuse a bolus of normal saline

Answer 36

d. Infuse a bolus of normal saline