GU/Renal + FE + Acid Base

Question 1

A nurse is caring for a client who is receiving intermittent peritoneal dialysis. The nurse observes that the peritoneal fluid is not adequately draining. Which of the following actions should the nurse take?

(a) Turn the client from side to side
(b) Elevate the height of the dialysate bag
(c) Lower the head of the client’s bed
(d) Advance the catheter approximately 2.5cm (1 in) further

Answer 1

(a) Turn the client from side to side

The nurse should assist the client in turning from side to side to facilitate the removal of peritoneal drainage. This action helps ensure there are no kinks in the tubing or an air lock in the peritoneal catheter. The nurse should raise the height of the dialysate bag to increase the rate of inflow; however, this action will not promote outflow of peritoneal fluid. The nurse should not push the peritoneal catheter further into the peritoneal cavity because this action introduces bacteria into the peritoneal cavity and increases the client’s risk of peritonitis.

Question 2

A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching?

(a) Hemodialysis restores kidney function.
(b) Hemodialysis replaces hormonal function of the renal system.
(c) Hemodialysis allows an unrestricted diet.
(d) Hemodialysis returns a balance to blood electrolytes.

Answer 2

(d) Hemodialysis returns a balance to blood electrolytes.

Question 3

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury. Which of the following actions should the nurse take? (Select all that apply)

(a) Review the medications the client currently takes.
(b) Assess the AV fistula for a bruit.
(c) Calculate the client’s hourly urine output.
(d) Measure the client’s weight.
(e) Check blood electrolytes.
(f) Use the access site area for venipuncture.

Answer 3

(a) Review the medications the client currently takes.
(b) Assess the AV fistula for a bruit.
(d) Measure the client’s weight.
(e) Check blood electrolytes.

Reviewing the medications the client currently takes can help determine which medications to withhold until after dialysis. Assessing the AV fistula for bruits determines the patency of the fistula for dialysis. The client’s hourly urine output can vary withe the remaining kidney function and does not determine the need for dialysis. Checking the blood electrolytes determines the need for dialysis. Never use the access site area for venipuncture because compression from the tourniquet can cause loss of vascular access.

Question 4

A nurse is planning post-procedure care for a client who received hemodialysis. Which fo the following interventions should the nurse include in the plan of care?
(Select all that apply)
(a) Check BUN and blood creatinine.
(b) Administer medications the nurse withheld prior to dialysis.
(c) Observe for findings of hypovolemia.
(d) Assess the access site for bleeding.
(e) Evaluate blood pressure on the arm with AV access.

Answer 4

(a) Check BUN and blood creatinine.
(b) Administer medications the nurse withheld prior to dialysis.
(c) Observe for findings of hypovolemia.
(d) Assess the access site for bleeding.

Question 5

A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take?

(a) Administer an opioid medication.
(b) Monitor for hypertension.
(c) Assess level of consciousness.
(d) Increase the dialysis exchange rate.

Answer 5

(c) Assess level of consciousness.

Question 6

A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? (Select all that apply)

(a) Anuria
(b) Marked azotemia
(c) Increased calcium level
(d) Crackles in the lungs
(e) Proteinuria

Answer 6

(a) Anuria
(b) Marked azotemia
(d) Crackles in the lungs
(e) Proteinuria

Question 7

A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include?

(a) “Decrease your intake of protein-rich foods.”
(b) “Take this medication with grapefruit juice.”
(c) “Monitor for and report a sore throat to your provider.”
(d) “Expect your skin to turn yellow.”

Answer 7

(c) “Monitor for and report a sore throat to your provider.”

Question 8

A nurse is planning care for a client who has Stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? (Select all that apply)

(a) Assess for jugular vein distention.
(b) Provider frequent mouth rinses.
(c) Auscultate for a pleural friction rub.
(d) Provide a high-sodium diet.
(e) Monitor for dysrhythmia.

Answer 8

(a) Assess for jugular vein distention.
(b) Provider frequent mouth rinses.
(c) Auscultate for a pleural friction rub.
(e) Monitor for dysrhythmia.

Question 9

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the client’s dialysate output is less than the input and that his abdomen is distended. Which of the following actions should the nurse take?

(a) Insert an indwelling urinary catheter
(b) Administer pain medication to the client
(c) Change the client’s position
(d) Place the drainage bag above the client’s abdomen

Answer 9

(c) Change the client’s position

The client is retaining the dialysate solution after the dwell time. The nurse should ensure that the clamp is open and the tubing is not kinked and should reposition the client to facilitate the drainage of the solution from the peritoneal cavity.

Question 10

A nurse is assessing a client who is receiving peritoneal dialysis. Which of the following findings should the nurse report to the provider immediately?

(a) Difficulty draining the effluent
(b) Redness at the access site
(c) Fluid flowing from the catheter site
(d) Cloudy effluent

Answer 10

(d) Cloudy effluent

A cloudy or opaque effluent indicates the client is at high risk for peritonitis, a bacterial infection of the peritoneum. Therefore, this is the priority finding for the nurse to report to the provider.

Question 11

A nurse is assessing a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider?

(a) WBC 6000/mm3
(b) Potassium 3.0mEq/L
(c) Clear, pale yellow drainage
(d) Report of abdominal fullness

Answer 11

(b) Potassium 3.0mEq/L

A potassium level of 3.0mEq/L is below the expected reference range and can cause dysrhythmias. Dialysis removes fluid, waste products, and electrolytes from the blood and can cause hypokalemia. Abdominal fullness is an expected finding during the dwell period, when dialysate stays in the peritoneal cavity. A supine low-Fowler’s position can reduce abdominal pressure.

Question 12

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following adverse effects?

(a) Diarrhea
(b) Increased serum albumin
(c) Hypoglycemia
(d) Peritonitis

Answer 12

(d) Peritonitis

Peritonitis is an adverse effect of peritoneal dialysis. Prevention requires using sterile technique and frequently assessing the catheter exit site. The nurse should obtain cultures of the dialysate outflow (effluent) if peritonitis is suspected.

Question 13

A nurse is assessing a client who is receiving hemodialysis for the first time. Which of the following findings indicates that the client is developing dialysis disequilibrium syndrome (DDS)?

(a) Elevated BUN
(b) Bradycardia
(c) Headache
(d) Temperature 39.2C (102.5F)

Answer 13

(c) Headache

DDS is a CNS disorder that can develop in clients who are new to dialysis due to the rapid removal of solutes and changes in the blood pH. Clients beginning hemodialysis are at greatest risk, particularly if their BUN is above 175. DDS causes headaches, nausea, vomiting, a decreased level of consciousness, seizures, and restlessness. When the condition is severe, clients progress to confusion, seizures, coma, and death.

Question 14

A nurse is caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take?

(a) Warm the dialysate solution prior to administration
(b) Cleanse the catheter site using a back and forth motion, beginning at the end of the catheter and moving inward
(c) Place the drainage bag at the level of the client’s chest
(d) Apply clean gloves and cleanse the client’s catheter site with cold water

Answer 14

(a) Warm the dialysate solution prior to administration

The nurse should warm the dialysate solution prior to administration to prevent pain and abdominal cramping.

Question 15

A nurse is reviewing the laboratory report of a client who has chronic kidney disease (CKD). The nurse finds the following laboratory test results: potassium 6.8mEq/L, calcium 7.4mg/dL, hemoglobin 10.2g/dL, and phosphate 4.8mg/dL. Which finding is the priority for the nurse to report to the provider?

(a) Hypocalcemia
(b) Hyperkalemia
(c) Anemia
(d) Hypoalbuminemia

Answer 15

(b) Hyperkalemia

Question 16

A nurse is checking the laboratory values of a client who has chronic kidney disease. The nurse should expect elevations in which of the following values?

(a) Potassium and magnesium
(b) Calcium and bicarbonate
(c) Hemoglobin and hematocrit
(d) Arterial pH and PaCO2

Answer 16

(a) Potassium and magnesium

Clients who have CKD have hyperkalemia, hyperphosphatemia, and hypermagnesia as well as elevations in serum creatinine and blood urea nitrogen.

Question 17

A nurse is providing dietary teaching to a client who has late-stage chronic kidney disease (CKD). Which of the following nutrients should the nurse instruct the client to increase in her diet?

(a) Calcium
(b) Phosphorous
(c) Potassium
(d) Sodium

Answer 17

(a) Calcium

A client who has CKD can develop hypocalcemia due to the reduced production of active vitamin D, which is needed for calcium absorption. The client should supplement dietary calcium.

Question 18

A nurse is reviewing the laboratory findings of a client who has chronic kidney disease. The client reports significant persistent nausea and muscle weakness. Which of the following findings should the nurse expect?

(a) Hypernatremia
(b) Hypomagnesemia
(c) Hypercalcemia
(d) Hyperkalemia

Answer 18

(d) Hyperkalemia

Question 19

A nurse is teaching a client who has CKD. Which of the following instructions should the nurse include?

(a) Limit fluid intake
(b) Limit caloric intake
(c) Eat a diet high in phosphorus
(d) Eat a diet high in protein

Answer 19

(a) Limit fluid intake

A client who has CKD should limit fluid intake to prevent hypervolemia (excessive fluid overload). A client who has CKD should increase caloric intake so that the body can use protein for protein synthesis instead of energy consumption. Using protein for energy can lead to a negative nitrogen balance and malnutrition. A client who has CKD should limit phosphorus intake because the kidneys are unable to excrete it. A client who has CKD should not eat excessive protein to prevent the build-up of protein waste products and uremia.

Question 20

A nurse is caring for a client who is scheduled for a thoracentesis. Prior to the procedure, which of the following actions should the nurse take?

(a) Position the client in an upright position, leaning over the bedside table.
(b) Explain the procedure.
(c) Obtain ABGs.
(d) Administer benzocaine spray.

Answer 20

(a) Positioning the client in an upright position, leaning over the bedside table.

This widens the intercostal space for the provider to access the pleural fluid. It is the responsibility of the provider, not the nurse, to explain the procedure. It is not indicated that the client needs ABGs drawn. Benzocaine spray is administered for a bronchoscopy, not a thoracentesis.

Question 21

A nurse is assessing a client following a bronchoscopy. Which of the following findings should the nurse report to the provider?

(a) Blood-tinged sputum
(b) Dry, nonproductive cough
(c) Sore throat
(d) Bronchospasms

Answer 21

(d) Bronchospasms

Question 22

A nurse is caring for a client following a thoracentesis. Which of the following manifestations should the nurse recognize as risks for complications? (SATA)

(a) Dyspnea
(b) Localized bloody drainage on the dressing
(c) Fever
(d) Hypotension
(e) Report of pain at the puncture site

Answer 22

(a) Dyspnea
(c) Fever
(d) Hypotension

Question 23

A nurse in the ED is assessing a client who has deep, rapid respirations. Arterial blood gas analysis includes the following values: pH 7.25, PaCO2 40, and HCO3- 18. Which of the following acid-base imbalances should the nurse identify and report to the provider?

(a) Respiratory alkalosis
(b) Metabolic alkalosis
(c) Respiratory acidosis
(d) Metabolic acidosis

Answer 23

(d) Metabolic acidosis

A pH of 7.25 indicates acidosis. If the cause is respiratory, pH and PaCo2 values will deviate in opposite directions. Since PaCO2 is within the expected reference range, despite the low pH, the cause must be metabolic. Therefore, the nurse should report to the provider that the client has metabolic acidosis.

Question 24

A nurse is preparing a client for a bronchoscopy. Which of the following actions should the nurse take? (SATA)

(a) Explain that the client will receive sedation and will not remember the procedure.
(b) Verify that the client understands the purpose and nature of the procedure.
(c) Offer the client sips of clear liquids until 1hr before the test.
(d) Obtain a pre-procedural sputum specimen.
(e) Instruct the client to keep his neck in a neutral position.

Answer 24

(a) Explain that the client will receive sedation and will not remember the procedure.
(b) Verify that the client understands the purpose and nature of the procedure.

For a bronchoscopy, clients typically receive premedication with a benzodiazepine or an opioid to ensure sedation and amnesia. The client will have signed a consent form, so the nurse should verify that the provider explained the procedure and that the client understands it. The client should remain NPO for 4-8hrs prior to the procedure to minimize aspiration risk. The provider can obtain any necessary sputum specimens during the procedure. The client’s neck will be hyperextended to bring the pharynx into alignment with the trachea and allow insertion of the scope without trauma.

Question 25

A nurse is preparing a client for discharge following a bronchoscopy. Which of the following assessments is the nurse’s monitoring priority?

(a) Measuring heart rate
(b) Palpating peripheral pulses
(c) Observing sputum for blood
(d) Confirming the gag reflex

Answer 25

(d) Confirming the gag reflex

The greatest risk to the client’s safety is aspiration resulting from a depressed gag reflex. The nurse’s priority is to make sure the client’s gag reflex has returned before discharge so that the client can maintain hydration and nutrition

Question 26

A nurse is providing teaching to a client who has a chronic cough and is scheduled for a bronchoscopy. Which of the following client statements indicates an understanding of the teaching?

(a) “I can keep my dentures in during the procedure.”
(b) “I am allowed only clear liquids prior to the procedure.”
(c) “A tissue sample might be obtained during the procedure.”
(d) “A signed consent form is not required for this procedure.”

Answer 26

(c) “A tissue sample might be obtained during the procedure.”

Question 27

A nurse is assisting a provider with performing a paracentesis on a client. Which of the following actions should the nurse take?

(a) Ask the client to empty his bladder before the procedure
(b) Place the client leaning forward over the bedside table for the procedure
(c) Inform the client he will be sedated during the procedure
(d) Instruct the client to fast for 6hrs prior to the procedure

Answer 27

(a) Ask the client to empty his bladder before the procedure

The nurse should ask the client to empty his bladder before the procedure to prevent injury to the bladder. The client should lean forward over the bedside table for the thoracentesis to be performed. This gives the provider complete access to the client’s chest and back and expands the spaces between the client’s ribs where the pleural fluid as accumulated. The client is fully awake during the procedure; sedation is not required. The client can eat or drink until the procedure; fasting is not required.

Question 28

A nurse is preparing a client for thoracentesis. In which of the following positions should the nurse place the client?

(a) Lying flat on the affected side
(b) Prone with the arms raised over the head
(c) Supine with the head of the bed elevated
(d) Sitting while leaning forward over the bedside table

Answer 28

(d) Sitting while leaning forward over the bedside table

When preparing a client for thoracentesis, the nurse should have the client sit on the edge of the bed and lean forward over the bedside table. This position maximizes the space between the client’s ribs and allows aspiration of accumulated fluid and air.

Question 29

A nurse is caring for a client who is experiencing respiratory distress. Which of the following early manifestations of hypoxemia should the nurse recognize? (SATA)

(a) Confusion
(b) Pale skin
(c) Bradycardia
(d) Hypotension
(e) Elevated blood pressure

Answer 29

(b) Pale skin
(e) Elevated blood pressure
Confusion, bradycardia, and hypotension are late manifestations of hypoxemia.

Question 30

A nurse in the ED is caring for a client who is experiencing an acute asthma attack. Which of the following assessments indicates that the respiratory status is declining? (SATA)

(a) SaO2 95%
(b) Wheezing
(c) Retraction of sternal muscles
(d) Pink mucous membranes
(e) Tachycardia

Answer 30

(b) Wheezing
(c) Retraction of sternal muscles
(e) Tachycardia

Question 31

A nurse is caring for an older adult client who has COPD with pneumonia. The nurse should monitor the client for which of the following acid-base imbalances?

(a) Respiratory alkalosis
(b) Respiratory acidosis
(c) Metabolic alkalosis
(d) Metabolic acidosis

Answer 31

(b) Respiratory acidosis

This complication occurs because clients who have COPD are unable to exhale carbon dioxide due to a loss of elastic recoil in the lungs.