Renal practice Flashcards
A pt is admitted to the hospital with CKD. The nurse understands that this condition is characterized by?
a) progressive irreversible destruction of kidneys
b) a rapid decrease in urine output with an elevated BUN
c) an increasing creatinine clearance with a decrease in urine output
d) prostration, somnolence, and confusion with coma and imminent death
a
Nurses can screen pt at risk for developing CKD. Those considered to be at increased risk include? SATA
a) older black pt
b) pt more than 60 years old
c) those with a history of pancreatitis
d) those with a history of hypertension
e) those with a history of type 2 DM
a,b,d,e
Pt with CKD have an increased incidence of cardiovascular disease related to? SATA
a) hypertension
b) vascular calcificcation
c) a genetic predisposition
d) hyperinsulinemia causing dyslipidemia
a,b,d
Nutritional support and management are essential across the entire continuum of CKD. Which statements are true and related to nutritional therapy? SATA
a) Sodium and salt may be restricted in some with advocated CKD
b) Fluid is not usually restricted for patients receiving prtoyoneal dialysis
c) Decreased fluid intake and a low-potassium diet are part of the diet for a pt receiving hemodialysis
d) Decreased fluid intake and a low-potassium diet are part of the diet for a pt receiving peritoneal dialysis
e) Decreased fluid intake and a diet of protein-rich foods are part of a diet for a pt receiving hemodialysis
a,b,c
An ESRD pt receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In helping the pt decide about treatment, the nurse informs the pt that?
a) successful transplantation usually provides better quality of life than that offered by dialysis
b) if the rejection of the transplanted kidney occurs, no further treatment for the renal failure is available
c) hemodialysis replaces the normal functions of the kidneys, and pt do not have to live with the continua fear of rejection
d) the immunosuppressive therapy after transplantation makes the person ineligible to receive other treatments if the kidney fails
a
To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should? SATA
a) monitor the BP in the affected arm
b) irrigate the graft daily with low-dose heparin
c) palpate the area of the graft to feel a normal thrill
d) listen with a stethoscope over the graft to detect a bruit
e) assess the pulses and neurovascular status distal to the graft
c,d,e
A kidney transplant recipient had fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take?
a) assess temp and initiate workup to rule out infection
b) reassure the pt that this is common after transplantation
c) provide warm covers to the pt and give 1g oral acetaminophen
d) notify the nephrologist that the pt has manifestation of acute rejection
a
A client diagnosed with end-stage renal disease comes to the dialysis clinic for treatment. Which actions should the nurse take to prepare the client for hemodialysis? Select all that apply.
A) Administer subcutaneous heparin to decrease clotting during dialysis
B) Administer the client’s morning doses of carvedilol and lisinopril
C) Check the client’s medical records to determine the last post-dialysis weight
D) Obtain a set of client vital signs and the client’s current weight
E) Palpate the fistula in the client’s arm for a thrill and auscultate for a bruit
C,D,E
A 65 year old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia?
A) Intravenous calcium gluconate
B) Intravenous regular insulin with dextrose
C) Oral sodium polystyrene sulfonate
D) Transport to hemodialysis unit
A
Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the myocardium by raising the threshold for dysrhythmia occurrence
The nurse assesses a client diagnosed with chronic kidney disease who had an internal arteriovenous fistula performed on the left arm yesterday. Which assessment finding would require immediate follow-up?
A) A bruit cannot be auscultated over the fistula site
B) Capillary refill of 2 seconds is assessed on the left hand
C) Client reports squeezing a rubber ball with the left hand several times a day
D) Incision is dry with no redness and has sterile skin closures in place
a
absence of the thrill or bruit can indicate potential clot formation in the fistula.
The nurse is caring for a 68 year old male client following a laparoscopic cholecystectomy 8 hours ago. The client has not urinated since surgery. Which would be the most appropriate initial intervention?
A) Conduct a bladder scan
B) Help the client out of bed
C) Insert an indwelling catheter using sterile technique
D) Obtain a prescription for intermittent catheterization
b
Urinary retention occurs frequently after surgery due to administration of opioids and anesthesia, The nurse should first try noninvasive methods to help the client urinate in a normal position
The charge nurse is making rounds and should immediately intervene when making which observation?
A) A new nurse is using gentle pressure to flush a kidney pelvis catheter with 5 mL of fluid
B) A nursing assistant is hanging a urinary drainage bag on the back of a wheelchair when transporting a client
C) Indwelling urinary catheter is taped to a male client’s inner thigh
D) Total oral fluid intake in 24 hours for a client with a urinary diversion device is 2,800 mL
B
The flow of urine is dependent on gravity. In order to maintain gravity flow, the drainage bag should be hung below the level of the bladder.
The nurse assesses a client receiving peritoneal dialysis. Which assessment findings are most important for the nurse to report to the health care provider? Select all that apply.
A) Cloudy outflow
B) Low-grade fever
C) Oliguria
D) Pruritus
E) Tachycardia
A,B,E
Cloudy outflow (effluent), tachycardia, and low-grade fever are signs of peritonitis, an infection of the peritoneal cavity and a major concern with PD. Bloody fluid can indicate intestinal perforation or that the client may be menstruating. Brown effluent can indicate fecal contamination from perforation. All these findings need to be reported to the HCP.
A client returns to the unit after receiving hemodialysis for the first time. The client vomits once, reports headache, and appears restless and disoriented. What is the priority intervention?
A) Administer antihypertensives that were held prior to dialysis
B) Administer PRN ondansetron to relieve nausea
C) Contact the health care provider
D) Place the client in Trendelenburg position
C
Dialysis disequilibrium syndrome (DDS) is a rare but potentially life-threatening complication that can occur in clients during the initial stages of hemodialysis; it can be prevented by slowing the rate of dialysis.
A client with chronic kidney disease has a subcutaneous arteriovenous fistula (AVF) placed in the nondominant left wrist for hemodialysis. Which of the following statements indicate the client understands how to care for the fistula properly? Select all that apply.
A) “I don’t need to call my health care provider if I have numbness or tingling in my left arm.”
B) “I will make sure I always have my blood pressure taken in my nondominant (left) arm.”
C) “I will squeeze a small sponge with my left hand several times a day.”
D) “I will touch the site and feel for a vibration several times a day.”
E) “I will try not to sleep on my left arm.”
C,D,E
A-Report numbness or tingling of the extremity to the HCP to prevent neuromuscular damage
