Deck 47: Nursing Management: Acute Renal Failure and Chronic Kidney Disease

Question 1

The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful?

A) Scrambled eggs, English muffin, and apple juice
B) Cheese sandwich, tomato soup, and cranberry juice
C) Split-pea soup, whole-wheat toast, and nonfat milk
D) Oatmeal with cream, half a banana, and herbal tea

Answer 1

Scrambled eggs, English muffin, and apple juice

Question 2

Before administration of calcitriol (Rocaltrol) to a patient with CKD, the nurse should check the laboratory value for

A) serum phosphate.
B) total cholesterol.
C) creatinine.
D) potassium.

Answer 2

serum phosphate.

Question 3

A patient with severe heart failure develops elevated BUN and creatinine levels. The nurse plans care for the patient based on the knowledge that collaborative care of the patient will be directed toward the goal of

A) preventing hypertension.
B) replacing fluid volume.
C) diluting nephrotoxic substances.
D) maintaining cardiac output.

Answer 3

maintaining cardiac output.

Question 4

A patient with CKD has a nursing diagnosis of disturbed sensory perception related to central nervous system changes induced by uremic toxins. An appropriate nursing intervention for this problem is to

A) convey a caring attitude and foster the nurse-patient relationship.
B) keep the patient on bed rest to avoid possible falls or other injuries.
C) ensure restricted protein intake to prevent nitrogenous product accumulation.
D) provide an opportunity for the patient to discuss concerns about the condition.

Question 5

The RN observes an LPN/LVN carrying out all these actions while caring for a patient with renal insufficiency. Which action requires the RN to intervene?

A) The LPN/LVN carries a tray containing low-protein foods into the patient's room.
B) The LPN/LVN assists the patient to ambulate in the hallway.
C) The LPN/LVN administers erythropoietin subcutaneously.
D) The LPN/LVN gives the iron supplement and phosphate binder with lunch.

Question 6

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it

A) can accommodate larger needles.
B) increases patient mobility.
C) is much less likely to clot.
D) can be used sooner after surgery.

Question 7

A patient with renal insufficiency is scheduled for an intravenous pyelogram (IVP). Which of the following orders for the patient will the nurse question?

A) Ibuprofen (Advil) 400 mg PO PRN for pain
B) Dulcolax suppository 4 hours before IVP procedure
C) Normal saline 500 ml IV before procedure
D) NPO for 6 hours before IVP procedure

Question 8

A patient with acute renal failure (ARF) has an arterial blood pH of 7.30. The nurse will assess the patient for

A) tachycardia.
B) rapid respirations.
C) poor skin turgor.
D) vasodilation.

Question 9

As the nurse reviews a diet plan with a patient with diabetes and renal insufficiency, the patient states that with diabetes and kidney failure there is nothing that is good to eat. The patient says, "I am going to eat what I want; I'm going to die anyway!" The best nursing diagnosis for this patient is

A) imbalanced nutrition: more than required related to knowledge deficit about appropriate diet.
B) risk for noncompliance related to feelings of anger.
C) grieving related to actual and perceived losses.
D) risk for ineffective health maintenance related to complexity of therapeutic regimen.

Question 10

Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess

A) the BUN and creatinine.
B) the blood glucose level.
C) the patient's bowel sounds.
D) the level of consciousness (LOC).

Question 11

A patient admitted with severe dehydration has a urine output of 380 ml over the next 24 hours and elevated blood urea nitrogen (BUN) and creatinine levels. A finding that the nurse would expect when reviewing the patient's urinalysis is

A) proteinuria.
B) bacteriuria.
C) high specific gravity.
D) tubular casts.

Question 12

A patient in the oliguric phase of acute renal failure has a 24-hour fluid output of 150 ml emesis and 250 ml urine. The nurse plans a fluid replacement for the following day of ___ ml.

A) 400
B) 800
C) 1000
D) 1400

Question 13

The health care provider orders IV glucose and insulin to be given to a patient in ARF whose serum potassium level is 6.3 mEq/L. To best evaluate the effectiveness of the medications, the nurse will

A) monitor the patient's electrocardiograph (ECG).
B) check the blood glucose level.
C) obtain serum potassium levels.
D) assess BUN and creatinine levels.

Question 14

A patient is diagnosed with stage 3 CKD. The patient is treated with conservative management, including erythropoietin injections. After teaching the patient about management of CKD, the nurse determines teaching has been effective when the patient states,

A) "I will measure my urinary output each day to help calculate the amount I can drink."
B) "I need to take the erythropoietin to boost my immune system and help prevent infection."
C) "I need to try to get more protein from dairy products."
D) "I will try to increase my intake of fruits and vegetables."

Question 15

A patient in ARF has a gradual increase in urinary output to 3400 ml a day with a BUN of 92 mg/dl (33 mmol/L) and a serum creatinine of 4.2 mg (371 mmol/L). The nurse should plan to

A) use a urine dipstick to monitor for proteinuria.
B) auscultate the lungs to assess for pulmonary edema.
C) take the blood pressure to check for hypotension.
D) draw blood to monitor for hyperkalemia.

Question 16

A diabetic patient is admitted for evaluation of renal function because of recent fatigue, weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing history, the nurse identifies an early symptom of renal insufficiency when the patient states,

A) "I get up several times every night to urinate."
B) "I wake up in the night feeling short of breath."
C) "My memory is not as good as it used to be."
D) "My mouth and throat are always dry and sore."

Question 17

After noting increasing QRS intervals in a patient with ARF, which action should the nurse take first?

A) Notify the patient's health care provider.
B) Check the chart for the most recent blood potassium level.
C) Look at the patient's current BUN and creatinine levels.
D) Document the QRS interval.

Question 18

To determine glomerular filtration rate (GFR) for a patient with chronic kidney disease, the nurse will plan to

A) schedule frequent blood urea nitrogen (BUN) tests.
B) initiate a 24-hour collection of the patient's urine.
C) check the specific gravity on serial urine specimens.
D) use a bladder scanner to check for residual urine.

Question 19

A patient admitted with sepsis has had several episodes of severe hypotension. Laboratory results indicate a BUN 50 mg/dl (10.7 mmol/L), serum creatinine 2.0 mg/dl (177 µmol/L), urine sodium 70 mEq/L (70 mmol/L), urine specific gravity 1.010, and cellular casts and debris in the urine. The nurse knows these findings are consistent with

A) chronic renal insufficiency.
B) prerenal failure.
C) postrenal failure.
D) acute tubular necrosis.

Question 20

When reviewing the laboratory values for a patient admitted with a severe crushing injury after an industrial accident, the nurse will be most concerned about levels of

A) creatinine.
B) potassium.
C) white blood cells (WBCs).
D) BUN.

Question 21

Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse?

A) The blood glucose is 144 mg/dl.
B) The patient has a round, moonlike face.
C) There is a nontender lump in the axilla.
D) The patient's blood pressure is 150/92.

Question 22

A patient with chronic kidney disease (CKD) is started on hemodialysis, and after the first treatment, the patient complains of nausea and a headache. The nurse notes mild jerking and twitching of the patient's extremities. The nurse will anticipate the need to

A) increase the time for the next dialysis to remove wastes more completely.
B) switch to continuous renal replacement therapy (CRRT) to improve dialysis efficiency.
C) administer medications to control these symptoms before the next dialysis.
D) slow the rate for the next dialysis to decrease the speed of solute removal.

Question 23

A patient with hypertension and stage 2 chronic kidney disease is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patient's

A) creatinine.
B) glucose.
C) phosphate.
D) potassium.

Question 24

A patient receiving peritoneal dialysis using 2 L of dialysate per exchange has an outflow of 1200 ml. Which action should the nurse take first?

A) Infuse 1200 ml of dialysate during the inflow.
B) Assist the patient in changing position.
C) Administer a laxative to the patient.
D) Notify the health care provider about the outflow problem.

Question 25

A patient with diabetes who has chronic kidney disease (CKD) is considering using continuous ambulatory peritoneal dialysis (CAPD). In discussing this treatment option with the patient, the nurse informs the patient that

A) patients with diabetes who use CAPD have fewer dialysis-related complications than those on hemodialysis.
B) home CAPD requires more extensive equipment than does home hemodialysis.
C) CAPD is contraindicated for patients who might eventually want a kidney transplant.
D) dietary restrictions are stricter for patients using CAPD than for those having hemodialysis.

Question 26

Two hours after a kidney transplant, the nurse obtains all these data when assessing the patient. Which information is most important to communicate to the health care provider?

A) The BUN and creatinine levels are elevated.
B) The urine output is 900 to 1100 ml/hr.
C) The patient's central venous pressure (CVP) is decreased.
D) The patient has level 8 (on a 10-point scale) incision pain when coughing.

Question 27

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

A) give acetaminophen (Tylenol).
B) infuse a bolus of normal saline.
C) massage the patient's legs.
D) reposition the patient.

Question 28

A patient begins hemodialysis after having had conservative management of chronic kidney disease. The nurse explains that one dietary regulation that will be changed when hemodialysis is started is that

A) unlimited fluids are allowed since retained fluid is removed during dialysis.
B) increased calories are needed because glucose is lost during hemodialysis.
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.

Question 29

A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patient's

A) blood glucose.
B) serum potassium.
C) BUN and creatinine.
D) urine osmolality.

Question 30

To monitor for corticosteroid-related complications after a kidney transplant, the nurse teaches the patient to report

A) pain at the donor kidney site.
B) dizziness with position change.
C) pain in the hips, knees, and other joints.
D) changes in the character of the urine.

Question 31

In the immediate postoperative period, the nurse caring for a patient who is a recipient of a kidney transplant would expect that fluid therapy would involve administration of IV fluids

A) to be determined hourly, based on every milliliter of urine output.
B) at a minimum rate of 100 ml/hr to perfuse the kidney.
C) titrated to keep blood pressure within a normal range.
D) at a rate to keep urine clear and without blood clots.

Question 32

A patient with acute renal failure (ARF) requires hemodialysis and temporary vascular access is obtained by placing a catheter in the left femoral vein. The nurse will plan to

A) restrict the patient's oral protein intake.
B) discontinue the retention catheter.
C) place the patient on bed rest.
D) start continuous pulse oximetry.

Question 33

In preparation for hemodialysis, a patient has an AV native fistula created in the left forearm. When caring for the fistula postoperatively, the nurse should

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 daily with low-dose heparin.

Question 34

The nurse is assessing a patient who is receiving peritoneal dialysis with 2-L inflows. Which information should be reported immediately to the health care provider?

A) The patient complains of feeling bloated after the inflow.
B) The patient's peritoneal effluent appears cloudy.
C) The patient has abdominal pain during the inflow phase.
D) The patient has an outflow volume of 1600 ml.

Question 35

A patient with CKD brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required?

A) Milk of magnesia 30 ml administered orally
B) Oral acetaminophen (Tylenol) 650 mg
C) Multivitamin with iron
D) Calcium phosphate (PhosLo)

Question 36

A patient who has been on continuous ambulatory peritoneal dialysis (CAPD) is hospitalized and is receiving CAPD with four exchanges a day. During the dialysate inflow, the patient complains of having abdominal pain and pain in the right shoulder. The nurse should

A) massage the patient's abdomen and back.
B) decrease the rate of dialysate infusion.
C) stop the infusion and notify the health care provider.
D) administer the PRN acetaminophen (Tylenol).