Question 1

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

Accepted Answer

If fluid does not drain properly during peritoneal dialysis, the nurse should check the system for kinks or other obstructions. If there is no obvious problem, then the nurse should notify the physician. The other two options are not related.

Question 2

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?

Accepted Answer

Almost 90% of clients with chronic kidney disease have renal osteodystrophy. This demineralization of the bones leaves them vulnerable to fracture with slight trauma. The client should have assistance when getting out of bed to avoid injury. Client safety is a TJC priority. Option a does not meet a client outcome; option c is a good idea, except then the client cannot see how fluids are divided over the day; option d is a good intervention to monitor fluid status, but does not address a safety need.

Question 3

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

Accepted Answer

While all suggestions might help improve quality of life for the client undergoing dialysis, a recent research study with 226 participants identified exercise activity as the most important predictor of quality of life approximately 60 days after starting dialysis.

Question 4

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)

Accepted Answer

There are several reasons why older clients are at increased risk of ARF, including options a, c, d, and e. Older clients also have more difficulty concentrating urine. Elderly clients in general take more medications that do clients in other age groups.

Question 5

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

Accepted Answer

After a kidney transplant, the client must incorporate the new kidney and better functional status into his or her self-image. Family members must also adapt. For both client and family, role changes occur that require adaptation. Family members may no longer feel needed if they took care of the client. Asking the spouse what his/her role was during the client's illness will give the nurse information about the spouse's role and the nurse can then start a discussion of role adaptation.

Question 6

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)

Accepted Answer

There are many reasons for noncompliance, including options b, c, and d. Failure to follow prescribed guidelines is a major problem and the nurse's challenge is to collaborate on a plan to take medications as directed while fitting this activity into the client's lifestyle.

Question 7

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

Accepted Answer

Anemia in clients with chronic renal failure is treated primarily with erythropoietin, a hormone produced in the kidney that stimulates red blood cell production.

Question 8

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

Accepted Answer

An important health promotion strategy to help prevent renal failure is to avoid nephrotoxic agents, including aminoglycosides and IVP dye.

Question 9

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

Accepted Answer

Low back pain may develop with continuous dialysis procedures because the abdominal weight affects posture. Appropriate exercises may help relieve this problem.

Question 10

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

Accepted Answer

Hypnotics and sedatives must be used cautiously because these drugs may alter mentation and may not be adequately cleared by the failing kidneys.

Quiz 36: Management of Clients with Renal Failure