Question 1

A client with acute renal failure has jugular vein distention,lower extremity edema,and elevated blood pressure.Based on this data,which nursing diagnosis is the most appropriate?
A) Ineffective Renal Tissue Perfusion
B) Excess Fluid Volume
C) Risk for Altered Cardiac Perfusion
D) Risk for Infection

Accepted Answer

A) Jugular vein distention, edema, and elevated blood pressure are indications of excessive fluid. The diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Altered Cardiac Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.
B) Jugular vein distention, edema, and elevated blood pressure are indications of excessive fluid. The diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Altered Cardiac Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.
C) Jugular vein distention, edema, and elevated blood pressure are indications of excessive fluid. The diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Altered Cardiac Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.
D) Jugular vein distention, edema, and elevated blood pressure are indications of excessive fluid. The diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Altered Cardiac Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.

Question 2

The nurse is concerned that an older adult client is at risk for developing acute renal failure.Which information in the client's history support the nurse's concern? Select all that apply.
A) Diagnosed with hypotension
B) Recent aortic valve replacement surgery
C) Prescribed high doses of intravenous antibiotics
D) Total hip replacement surgery 5 years ago
E) Taking medication for type 2 diabetes mellitus

Accepted Answer

A) Older adults develop acute renal failure more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for kidney failure. Hypotension, scheduled for aortic valve replacement surgery, and receiving high doses of intravenous antibiotics increase this client's risk for developing acute renal failure. A previous history of major surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute renal failure.
B) Older adults develop acute renal failure more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for kidney failure. Hypotension, scheduled for aortic valve replacement surgery, and receiving high doses of intravenous antibiotics increase this client's risk for developing acute renal failure. A previous history of major surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute renal failure.
C) Older adults develop acute renal failure more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for kidney failure. Hypotension, scheduled for aortic valve replacement surgery, and receiving high doses of intravenous antibiotics increase this client's risk for developing acute renal failure. A previous history of major surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute renal failure.
D) Older adults develop acute renal failure more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for kidney failure. Hypotension, scheduled for aortic valve replacement surgery, and receiving high doses of intravenous antibiotics increase this client's risk for developing acute renal failure. A previous history of major surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute renal failure.
E) Older adults develop acute renal failure more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for kidney failure. Hypotension, scheduled for aortic valve replacement surgery, and receiving high doses of intravenous antibiotics increase this client's risk for developing acute renal failure. A previous history of major surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute renal failure.

Question 3

A client with a history of hypertension,is diagnosed with chronic renal disease.When the client asks the nurse how this occurred,which response by the nurse is the most appropriate?
A) "Thickening of the kidney structures and gradual death of nephrons has caused this diagnosis."
B) "Cysts compress renal tissue that destroys the kidneys causing this diagnosis."
C) "High blood pressure reduces renal blood flow and harms the kidney tissue causing this diagnosis."
D) "Immune complexes form in the kidney tissue that causes inflammation causing this diagnosis."

Accepted Answer

A) Longstanding hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. Diabetic nephropathy causes renal failure by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes renal failure by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Systemic lupus erythematosus causes renal failure by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.
B) Longstanding hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. Diabetic nephropathy causes renal failure by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes renal failure by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Systemic lupus erythematosus causes renal failure by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.
C) Longstanding hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. Diabetic nephropathy causes renal failure by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes renal failure by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Systemic lupus erythematosus causes renal failure by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.
D) Longstanding hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. Diabetic nephropathy causes renal failure by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes renal failure by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Systemic lupus erythematosus causes renal failure by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.

Question 4

A client with acute renal failure is complaining of a metallic taste in the mouth and has no appetite.Based on this data,which intervention by the nurse is the most appropriate?
A) Provide mouth care before meals.
B) Administer an antiemetic as prescribed.
C) Restrict fluids.
D) Encourage the intake of protein, salt, and potassium.

Accepted Answer

A) A metallic taste in the mouth is due to a build-up of uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic is prescribed for nausea. Restricting fluids will not reduce the metallic taste in the mouth. Encouraging the intake of protein, salt, and potassium will exacerbate the build-up of uremia which is causing the metallic taste in the mouth.
B) A metallic taste in the mouth is due to a build-up of uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic is prescribed for nausea. Restricting fluids will not reduce the metallic taste in the mouth. Encouraging the intake of protein, salt, and potassium will exacerbate the build-up of uremia which is causing the metallic taste in the mouth.
C) A metallic taste in the mouth is due to a build-up of uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic is prescribed for nausea. Restricting fluids will not reduce the metallic taste in the mouth. Encouraging the intake of protein, salt, and potassium will exacerbate the build-up of uremia which is causing the metallic taste in the mouth.
D) A metallic taste in the mouth is due to a build-up of uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic is prescribed for nausea. Restricting fluids will not reduce the metallic taste in the mouth. Encouraging the intake of protein, salt, and potassium will exacerbate the build-up of uremia which is causing the metallic taste in the mouth.

Question 5

The nurse is providing care for a child diagnosed with renal failure who is experiencing hyperkalemia.When planning meals for this child,which choice would be most appropriate for this client?
A) Hamburger on a bun, banana
B) Cold cuts with bun with fresh pears
C) Spaghetti and meat sauce, breadsticks
D) Carrots and green, leafy vegetables

Accepted Answer

A) Carrots; green, leafy vegetables; pears; and bananas are high in potassium. Spaghetti and meat sauce with breadsticks would be the most appropriate meal from the choices provided.
B) Carrots; green, leafy vegetables; pears; and bananas are high in potassium. Spaghetti and meat sauce with breadsticks would be the most appropriate meal from the choices provided.
C) Carrots; green, leafy vegetables; pears; and bananas are high in potassium. Spaghetti and meat sauce with breadsticks would be the most appropriate meal from the choices provided.
D) Carrots; green, leafy vegetables; pears; and bananas are high in potassium. Spaghetti and meat sauce with breadsticks would be the most appropriate meal from the choices provided.

Question 6

While caring for a client with end-stage renal disease,the nurse tracks the client's serum albumin level.For which nursing diagnosis is the action most indicated?
A) Excess Fluid Volume
B) Imbalanced Nutrition: Less Than Body Requirements
C) Risk for Ineffective Perfusion
D) Risk for Infection

Accepted Answer

A) Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less Than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.
B) Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less Than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.
C) Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less Than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.
D) Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less Than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.

Question 7

A nurse evaluating the therapeutic effect of the drug sodium polystyrene sulfonate (Kayexalate)for a client diagnosed with chronic renal failure.Which therapeutic effect from the medication does the nurse anticipate?
A) Increased serum sodium
B) Increased stool excretion
C) Decreased urine specific gravity
D) Decreased serum potassium

Accepted Answer

A) The client with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the sodium level or the specific gravity.
B) The client with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the sodium level or the specific gravity.
C) The client with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the sodium level or the specific gravity.
D) The client with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the sodium level or the specific gravity.

Question 8

The nurse is preparing to administer a hemodialysis treatment for a client with chronic kidney disease.Which laboratory values does the nurse anticipate prior to the client's treatment? Select all that apply.
A) Increased blood urea nitrogen (BUN)
B) Decreased potassium
C) Decreased phosphorus
D) Increased urine osmolality
E) Increased creatinine

Accepted Answer

A) The damaged kidney is unable to excrete waste products, including creatinine, so it will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.
B) The damaged kidney is unable to excrete waste products, including creatinine, so it will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.
C) The damaged kidney is unable to excrete waste products, including creatinine, so it will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.
D) The damaged kidney is unable to excrete waste products, including creatinine, so it will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.
E) The damaged kidney is unable to excrete waste products, including creatinine, so it will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.

Question 9

The nurse is caring for a client from another country who was admitted with hypertension and chronic renal failure.The client is receiving hemodialysis three times a week.The nurse is assessing the client's diet and the client reports the use of salt substitutes.When teaching the client to avoid salt substitute,which rationale supports this teaching point?
A) They will increase the risk of AV fistula infection.
B) They will cause the client to retain fluid.
C) They will interact with the client's antihypertensive medications.
D) They can potentiate hyperkalemia.

Accepted Answer

A) Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitute is to be avoided. The control of hypertension is essential in the management of a client with kidney disease, but salt substitute is not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection could be caused by constricting clothing, venipunctures, and other items.
B) Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitute is to be avoided. The control of hypertension is essential in the management of a client with kidney disease, but salt substitute is not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection could be caused by constricting clothing, venipunctures, and other items.
C) Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitute is to be avoided. The control of hypertension is essential in the management of a client with kidney disease, but salt substitute is not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection could be caused by constricting clothing, venipunctures, and other items.
D) Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitute is to be avoided. The control of hypertension is essential in the management of a client with kidney disease, but salt substitute is not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection could be caused by constricting clothing, venipunctures, and other items.

Question 10

The nurse is caring for a client with chronic renal disease who is pale and experiencing fatigue.The nurse attributes these symptoms to anemia secondary to chronic renal disease.The client's spouse asks why the client is anemic.Which response by the nurse is the most appropriate?
A) "Your spouse has a genetic tendency for the development of anemia."
B) "The increased metabolic waste products in the body depress the bone marrow and cause anemia."
C) "There is a decreased production by the kidneys of the hormone erythropoietin which is the cause of anemia."
D) "The client is not eating enough iron-rich foods which is causing anemia."

Accepted Answer

A) Anemia is common in clients with renal disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not suppress the bone marrow. Diet and heredity do not factor into the production of erythropoietin.
B) Anemia is common in clients with renal disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not suppress the bone marrow. Diet and heredity do not factor into the production of erythropoietin.
C) Anemia is common in clients with renal disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not suppress the bone marrow. Diet and heredity do not factor into the production of erythropoietin.
D) Anemia is common in clients with renal disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not suppress the bone marrow. Diet and heredity do not factor into the production of erythropoietin.

Question 11

The nurse is planning care for a client with chronic kidney disease and osteoporosis.After reviewing the client's medical record,which is the priority nursing diagnosis for this client?
A) Anxiety
B) Disturbed Body Image
C) Risk for Injury
D) Risk for Bleeding

Accepted Answer

A) The client with chronic kidney disease with osteoporosis is at high risk for fractures; therefore, preventing injury is the priority nursing diagnosis. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, it is specified that the client has significant osteoporosis. Anxiety is not related to osteoporosis.
B) The client with chronic kidney disease with significant osteodystrophy (osteoporosis, or calcium loss from the bones) is at high risk for fractures; therefore, preventing injury is the most appropriate outcome. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, it is specified that the client has significant osteoporosis. Anxiety is not related to osteoporosis.
C) The client with chronic kidney disease with significant osteodystrophy (osteoporosis, or calcium loss from the bones) is at high risk for fractures; therefore, preventing injury is the most appropriate outcome. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, it is specified that the client has significant osteoporosis. Anxiety is not related to osteoporosis.
D) The client with chronic kidney disease with significant osteodystrophy (osteoporosis, or calcium loss from the bones) is at high risk for fractures; therefore, preventing injury is the most appropriate outcome. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, it is specified that the client has significant osteoporosis. Anxiety is not related to osteoporosis.

Question 12

A client with chronic renal disease is experiencing manifestations of anemia.Based on this data,which treatment does the nurse anticipate for this client?
A) Begin a fluid restriction.
B) Administer intravenous glucose and insulin.
C) Begin a low-sodium diet.
D) Epoetin injections

Accepted Answer

A) Epoetin injections are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In chronic kidney disease, this hormone production will be reduced. A fluid restriction would be indicated for uremia caused by chronic kidney disease. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by chronic kidney disease. A low-sodium diet is used to help reduce fluid volume excess that is caused by chronic kidney disease.
B) Epoetin injections are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In chronic kidney disease, this hormone production will be reduced. A fluid restriction would be indicated for uremia caused by chronic kidney disease. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by chronic kidney disease. A low-sodium diet is used to help reduce fluid volume excess that is caused by chronic kidney disease.
C) Epoetin injections are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In chronic kidney disease, this hormone production will be reduced. A fluid restriction would be indicated for uremia caused by chronic kidney disease. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by chronic kidney disease. A low-sodium diet is used to help reduce fluid volume excess that is caused by chronic kidney disease.
D) Epoetin injections are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In chronic kidney disease, this hormone production will be reduced. A fluid restriction would be indicated for uremia caused by chronic kidney disease. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by chronic kidney disease. A low-sodium diet is used to help reduce fluid volume excess that is caused by chronic kidney disease.

Question 13

The nurse is planning a seminar to instruct community members on ways to reduce the development of chronic kidney disease.Which topics should the nurse include in the seminar? Select all that apply.
A) Avoid eating red meat.
B) Control blood glucose levels in diabetes mellitus.
C) Adhere to medication regimen to control hypertension.
D) Participate in regular exercise.
E) Avoid smoking.

Accepted Answer

A) Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of end-stage renal disease.
B) Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of end-stage renal disease.
C) Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of end-stage renal disease.
D) Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of end-stage renal disease.
E) Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of end-stage renal disease.

Question 14

A client agrees to receive long-term hemodialysis to treat acute renal failure.For which surgical procedure should the nurse instruct this client?
A) Insertion of a double-lumen catheter into the subclavian artery
B) Placement of a peritoneal catheter
C) Insertion of a subarachnoid-peritoneal shunt
D) Placement of an arteriovenous fistula

Accepted Answer

A) For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis and not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebral spinal fluid and not for hemodialysis.
B) For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis and not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebral spinal fluid and not for hemodialysis.
C) For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis and not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebral spinal fluid and not for hemodialysis.
D) For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis and not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebral spinal fluid and not for hemodialysis.

Question 15

The nurse is caring for an older adult client diagnosed with chronic kidney disease.The client reports no bowel movement in the past 2 days.Based on this data,which condition is the client at an increased risk for developing?
A) Metabolic acidosis
B) Hypercalcemia
C) Increased serum creatinine levels
D) Hyperkalemia

Accepted Answer

A) Constipation exacerbates hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium. Hypokalemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.
B) Constipation exacerbates hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium. Hypokalemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.
C) Constipation exacerbates hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium. Hypokalemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.
D) Constipation exacerbates hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium. Hypokalemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.

Question 16

The nurse is preparing to discharge a client with chronic kidney disease.The nurse is teaching the client and family about administering calcium acetate tablets by mouth with each meal at home.Which explanation about this medication is the most appropriate?
A) "The calcium acetate will lower your serum phosphate levels."
B) "The calcium acetate helps to neutralize your gastric acids."
C) "The calcium acetate will help to stimulate your appetite."
D) "The calcium acetate will decrease your serum creatinine levels."

Accepted Answer

A) The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease. This medication has no effect on appetite stimulation.
B) The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease. This medication has no effect on appetite stimulation.
C) The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease. This medication has no effect on appetite stimulation.
D) The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease. This medication has no effect on appetite stimulation.

Question 17

During a home visit,the nurse is concerned that an older adult client is developing renal failure.The client has no history of cardiovascular disease.Which data in the client's assessment caused the nurse to have this concern? Select all that apply.
A) Progressive edema
B) Complaints of hip joint pain
C) New onset of hypertension
D) Recent increase in hunger and thirst
E) Warm moist skin

Accepted Answer

A) The manifestations of renal failure often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of renal failure in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not renal failure in the older client. A client with renal failure will have pale dry skin with poor turgor.
B) The manifestations of renal failure often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of renal failure in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not renal failure in the older client. A client with renal failure will have pale dry skin with poor turgor.
C) The manifestations of renal failure often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of renal failure in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not renal failure in the older client. A client with renal failure will have pale dry skin with poor turgor.
D) The manifestations of renal failure often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of renal failure in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not renal failure in the older client. A client with renal failure will have pale dry skin with poor turgor.
E) The manifestations of renal failure often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of renal failure in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not renal failure in the older client. A client with renal failure will have pale dry skin with poor turgor.

Question 18

The community nurse visits the home of a young child who is home from school because of sudden onset of nausea,vomiting,and lethargy.The nurse suspects acute renal failure.Which clinical manifestations support the nurse's suspicions? Select all that apply.
A) Elevated blood pressure
B) Postural hypotension
C) Wheezing
D) Edema
E) Hematuria

Accepted Answer

A) Pediatric manifestations of acute renal failure characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute renal failure in an older person. Wheezing is not a manifestation of acute renal failure.
B) Pediatric manifestations of acute renal failure characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute renal failure in an older person. Wheezing is not a manifestation of acute renal failure.
C) Pediatric manifestations of acute renal failure characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute renal failure in an older person. Wheezing is not a manifestation of acute renal failure.
D) Pediatric manifestations of acute renal failure characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute renal failure in an older person. Wheezing is not a manifestation of acute renal failure.
E) Pediatric manifestations of acute renal failure characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute renal failure in an older person. Wheezing is not a manifestation of acute renal failure.

Question 19

The nurse instructs a client with chronic renal disease on the prescribed medication furosemide (Lasix).Which client statement indicates that teaching has been effective?
A) "I will take this medication to keep my calcium balance normal."
B) "This medication will make sure I have enough red blood cells in my body."
C) "I will take this pill to keep my protein level in my body stable."
D) "This pill will reduce the swelling in my body and get rid of the extra potassium."

Accepted Answer

A) Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with chronic kidney disease that is used to stabilize protein levels in the body.
B) Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with chronic kidney disease that is used to stabilize protein levels in the body.
C) Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with chronic kidney disease that is used to stabilize protein levels in the body.
D) Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with chronic kidney disease that is used to stabilize protein levels in the body.

Quiz 6: Fluids and Electrolytes

A client with acute renal failure has jugular vein distention,lower extremity edema,and elevated blood pressure.Based on this data,which nursing diagnosis is the most appropriate?

The nurse is concerned that an older adult client is at risk for developing acute renal failure.Which information in the client's history support the nurse's concern? Select all that apply.

A client with a history of hypertension,is diagnosed with chronic renal disease.When the client asks the nurse how this occurred,which response by the nurse is the most appropriate?

A client with acute renal failure is complaining of a metallic taste in the mouth and has no appetite.Based on this data,which intervention by the nurse is the most appropriate?

The nurse is providing care for a child diagnosed with renal failure who is experiencing hyperkalemia.When planning meals for this child,which choice would be most appropriate for this client?

While caring for a client with end-stage renal disease,the nurse tracks the client's serum albumin level.For which nursing diagnosis is the action most indicated?

A nurse evaluating the therapeutic effect of the drug sodium polystyrene sulfonate (Kayexalate) for a client diagnosed with chronic renal failure.Which therapeutic effect from the medication does the nurse anticipate?

The nurse is preparing to administer a hemodialysis treatment for a client with chronic kidney disease.Which laboratory values does the nurse anticipate prior to the client's treatment? Select all that apply.

The nurse is caring for a client with chronic renal disease who is pale and experiencing fatigue.The nurse attributes these symptoms to anemia secondary to chronic renal disease.The client's spouse asks why the client is anemic.Which response by the nurse is the most appropriate?

The nurse is planning care for a client with chronic kidney disease and osteoporosis.After reviewing the client's medical record,which is the priority nursing diagnosis for this client?

A client with chronic renal disease is experiencing manifestations of anemia.Based on this data,which treatment does the nurse anticipate for this client?

The nurse is planning a seminar to instruct community members on ways to reduce the development of chronic kidney disease.Which topics should the nurse include in the seminar? Select all that apply.

A client agrees to receive long-term hemodialysis to treat acute renal failure.For which surgical procedure should the nurse instruct this client?

The nurse is caring for an older adult client diagnosed with chronic kidney disease.The client reports no bowel movement in the past 2 days.Based on this data,which condition is the client at an increased risk for developing?

The nurse is preparing to discharge a client with chronic kidney disease.The nurse is teaching the client and family about administering calcium acetate tablets by mouth with each meal at home.Which explanation about this medication is the most appropriate?

During a home visit,the nurse is concerned that an older adult client is developing renal failure.The client has no history of cardiovascular disease.Which data in the client's assessment caused the nurse to have this concern? Select all that apply.

The community nurse visits the home of a young child who is home from school because of sudden onset of nausea,vomiting,and lethargy.The nurse suspects acute renal failure.Which clinical manifestations support the nurse's suspicions? Select all that apply.

The nurse instructs a client with chronic renal disease on the prescribed medication furosemide (Lasix) .Which client statement indicates that teaching has been effective?