Deck 36: Management of Clients with Renal Failure

Question 1

The nurse assesses the client for the electrolyte imbalance that tends to occur in the earlier stages of chronic renal failure, which is

A) hypercalcemia.
B) hypocalcemia.
C) hypokalemia.
D) hyponatremia.

Answer 1

hypokalemia.

Question 2

A client with ARF is allowed a specific amount of fluid by mouth during 24 hours in order to

A) compensate for insensible and measured fluid losses during the previous 24 hours.
B) equal the expected urine output for the next 24 hours.
C) prevent hyperkalemia, which could lead to serious cardiac dysrhythmia.
D) prevent the development of complicating hypostatic pneumonia.

Answer 2

compensate for insensible and measured fluid losses during the previous 24 hours.

Question 3

The nurse explains to a client's family that the most common overall manifestation of ARF is that

A) expected urine output is altered.
B) the client's breath develops a fruity odor.
C) urine specific gravity is greater than 1.040.
D) urine develops a "root beer" color.

Answer 3

expected urine output is altered.

Question 4

The nurse performing intermittent peritoneal dialysis notes that the medical record shows the client has not had a bowel movement for 3 days. The nurse would be careful to assess the client for

A) cloudy dialysate output.
B) fluid leakage.
C) increased thirst.
D) reduced catheter outflow.

Question 5

The nurse teaching a client about continuous ambulatory peritoneal dialysis (CAPD) would include the information that

A) a small, lightweight pump must be carried in a pocket or on a belt.
B) CAPD eliminates the need for strict aseptic technique when handling the catheter.
C) the procedure involves instilling 250 to 500 ml of fluid at a time.
D) there are four daily cycles with an 8-hour dwell for one cycle during the night.

Question 6

The nurse notes in the first few exchanges during peritoneal dialysis of a client that the effluent is tinged pink. The nurse's most appropriate action is to

A) continue the dialysis.
B) notify the physician.
C) send a specimen for culture.
D) stop the dialysis immediately.

Question 7

During peritoneal dialysis the client's dialysate white blood cell count is 150/mm³ and neutrophils are 60%. This would indicate that the client has developed

A) anemia.
B) bowel perforation.
C) peritonitis.
D) pyelonephritis.

Question 8

During a client's first dialysis treatment, the client complains of a severe headache and appears somewhat confused. The priority action by the nurse's is to

A) administer oxygen by nasal cannula.
B) encourage the client to drink fluids.
C) notify the physician immediately.
D) slow the rate of the dialysis.

Question 9

A client has been on dialysis for 6 weeks. The family is complaining that instead of feeling grateful at this second chance at life, the client has become irritable with them and seems depressed. The most helpful response by the nurse would be

A) "Depression is very common at this time; it is hard to adapt to the losses s/he feels."
B) "I am surprised that your loved one doesn't feel happier about being alive."
C) "This must be very hard on you for your loved one to be so unappreciative."
D) "We can arrange a psychiatric consultation if you think it will help."

Question 10

A client with oliguric ARF would exhibit

A) a BUN/creatinine ratio of 30:1.
B) hematuria.
C) proteinuria.
D) a urine specific gravity of 1.001.

Question 11

The nurse caring for a client in the diuretic phase of acute renal failure (ARF) should assess for manifestations of

A) dehydration.
B) hypertension.
C) hypokalemia.
D) metabolic acidosis.

Question 12

Three months after a kidney transplant, a client develops fever, graft tenderness, malaise, and elevated white blood cell count. The nurse conducts further assessments based on understanding that the likely cause of these manifestations is

A) graft rejection.
B) influenza.
C) pyelonephritis.
D) urinary tract infection.

Question 13

A client has been found to be an acceptable candidate for a kidney transplant. The nurse counsels the client and family that the client now faces the greatest impediment to renal transplantation, which is

A) high potential for rejection.
B) high risk for infection.
C) insufficient financial resources.
D) lack of sufficient donor organs.

Question 14

The nurse explains that a cation exchange resin such as Kayexalate will

A) decrease diastolic blood pressure.
B) stimulate diuresis by osmosis.
C) increase appetite by decreasing insulin degradation.
D) increase gastrointestinal potassium excretion.

Question 15

In caring for a chronic dialysis patient with an arteriovenous fistula, the nurse would

A) avoid getting the fistula site wet during the client's bath.
B) irrigate the fistula with heparin to prevent clotting.
C) not use the arm with the fistula when taking the client's BP.
D) perform dressing changes to prevent infection.

Question 16

The nurse explains to a client with chronic renal failure that the rationale for receiving calcium carbonate is that it

A) binds with phosphorus to eliminate it from the body.
B) binds with potassium to eliminate it from the body.
C) helps prevent constipation.
D) helps prevent ulcer formation.

Question 17

A client with renal failure has an order to infuse dopamine (Intropin) to activate the dopamine receptors in the kidney. The nurse would set the infusion rate for

A) 21 to 25 mg/kg/minute.
B) 11 to 20 mg/kg/minute.
C) 6 to 10 mg/kg/minute.
D) 1 to 5 mg/kg/minute.

Question 18

While caring for a client in the oliguric phase of ARF, the nurse's plan of care should include

A) encouraging fluid intake to prevent dehydration.
B) increasing the client's protein intake to prevent muscle wasting.
C) maintaining reverse isolation to prevent infection.
D) meticulous skin care to prevent skin breakdown.

Question 19

The client with chronic renal failure who would not be a candidate for peritoneal dialysis is a client

A) who has diabetes mellitus.
B) who is a 10-year-old child.
C) with severe cardiovascular disease.
D) with severe respiratory disease.

Question 20

For the nurse trying to assist a client with renal failure to stay within the prescribed fluid restriction, the least helpful strategy would be to

A) give medication at mealtime.
B) provide frequent oral hygiene.
C) put allotted water into a spray bottle.
D) use ice chips liberally instead of fluids.

Question 21

The nurse is conducting peritoneal dialysis for a client with renal failure and finds the drainage tubing has no outflow. The priority action that the nurse would take is to

A) apply a 5-pound sandbag to the abdomen.
B) check the tubing for kinks or obstruction.
C) notify the physician about the problem.
D) try a more concentrated dialysate solution.

Question 22

A nurse is planning care for a client who has chronic kidney disease. Which of the following interventions would help the client meet a priority outcome?

A) Delegate monitoring vital signs during dialysis to the nurses' aide.
B) Instruct the client not to get out of bed without assistance.
C) Place a sign on the door outlining the fluid allotment for each shift.
D) Plan to weigh the client each morning on the same scale.

Question 23

A client is complaining about the decrease in quality of life experienced since the client started dialysis. Using recent research to guide suggestions, the nurse counsels the client to

A) become more active in care planning.
B) engage in regular exercise.
C) start attending church if not already going.
D) try to stay active in the community.

Question 24

The nurse monitoring a client load for risks of acute renal failure (ARF) understands that older clients are more susceptible to ARF because (Select all that apply)

A) cardiac contractile function and kidney perfusion diminish with age.
B) medication use is generally lower in this age group.
C) of a higher probability of pre-existing renal damage.
D) older adults have more difficulty with fluid balance in general.
E) the ability to retain sodium declines with age.

Question 25

A client had a kidney transplant and is doing well, except for being concerned that the spouse does not seem happy about it. The assessment by the nurse that would yield the most helpful information is to ask the

A) client what hobbies and activities they enjoy together.
B) client why he/she thinks the spouse is acting that way.
C) spouse how he/she feels about the client's progress.
D) spouse what his/her role was while the client was ill.

Question 26

A client is at a follow-up appointment and confesses that s/he does not take medications as prescribed. When planning a teaching strategy to address this problem, the nurse understands that clients often do not adhere to self-care guidelines because (Select all that apply)

A) a good understanding of the consequences leads them to skip meds.
B) clients may believe they no longer need the medications.
C) side effects may be disruptive and unpleasant.
D) the economic costs are too high for them to absorb.

Question 27

To assess the effect of epoetin alfa on a client with chronic renal failure, the nurse would monitor

A) blood urea nitrogen level.
B) hematocrit level.
C) leukocyte count.
D) serum creatinine level.

Question 28

A client had an episode of acute renal failure after heart surgery but seems to have recovered now. What is an important health promotion strategy the nurse could teach the client? The nurse should teach the client to

A) avoid aminoglycosides and IVP dye in the future.
B) drink lots of fluids on an ongoing basis.
C) have a BUN and creatinine drawn every 6 months.
D) monitor his/her temperature daily.

Question 29

To help the peritoneal dialysis client who is complaining of low back pain associated with increased weight in the abdomen, the nurse would suggest

A) lying down as much as possible.
B) performing specified exercises.
C) reducing voluntary fluid intake.
D) walking on surfaces with gradual inclines.

Question 30

For a client with chronic renal failure who is experiencing insomnia, the least helpful strategy would be

A) establishing a pre-sleep quiet time.
B) planning on a standard time to go to bed.
C) setting up a bedtime routine.
D) taking an over-the-counter sedative drug.