Nurs 107 PrepU Chap 48 Management of Patients with Kidney Disorders
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1. A patient has stage 3 chronic kidney failure. What A GFR of 30-59
would the nurse expect the patient's glomerular filtra- mL/min/1.73 m2
tion rate (GFR) to be?
A GFR of 85 mL/min/1.73 m2
A GFR of 90 mL/min/1.73 m2
A GFR of 30-59 mL/min/1.73 m2
A GFR of 120 mL/min/1.73 m2
2. The client with polycystic kidney disease asks the "As the disease
nurse, "Will my kidneys ever function normally progresses, you
again?" The best response by the nurse is: will most likely
"Genetic testing will determine the best treatment for require renal re-
your condition." placement thera-
"Draining of the cysts and antibiotic therapy will cure py."
your disease."
"As the disease progresses, you will most likely re-
quire renal replacement therapy."
"Dietary changes can reverse the damage that has
occurred in your kidneys."
3. What is a characteristic of the intrarenal category of Increased BUN
acute renal failure?
High specific gravity
Decreased creatinine
Decreased urine sodium
Increased BUN
4. A client is admitted with nausea, vomiting, and diar- Start IV fluids with
rhea. His blood pressure on admission is 74/30 mm a normal saline
Hg. The client is oliguric and his blood urea nitrogen solution bolus fol-
(BUN) and creatinine levels are elevated. The physi- lowed by a mainte-
cian will most likely write an order for which treat- nance dose.
ment?
Encourage oral fluids.
Administer furosemide (Lasix) 20 mg IV
Start hemodialysis after a temporary access is ob-
tained.
Start IV fluids with a normal saline solution bolus
followed by a maintenance dose.
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5. The nurse weighs a patient daily and measures uri- 1,500 mL of fluid
nary output every hour. The nurse notices a weight
gain of 1.5 kg in a 74-kg patient over 48 hours. The
nurse is aware that this weight gain is equivalent to
the retention of:
500 mL of fluid
1,500 mL of fluid
2,000 mL of fluid
1,000 mL of fluid
6. A nurse assesses a client shortly after living donor Urine output of 20
kidney transplant surgery. Which postoperative find- ml/hour
ing must the nurse report to the physician immediate-
ly?
Urine output of 20 ml/hour
Serum potassium level of 4.9 mEq/L
Serum sodium level of 135 mEq/L
Temperature of 99.2° F (37.3° C)
7. A client with chronic renal failure (CRF) is admitted Blood urea nitro-
to the urology unit. Which diagnostic test results are gen (BUN) 100
consistent with CRF? mg/dL and serum
Increased pH with decreased hydrogen ions creatinine 6.5
Uric acid analysis 3.5 mg/dL and phenolsulfonph- mg/dL
thalein (PSP) excretion 75%
Blood urea nitrogen (BUN) 100 mg/dL and serum cre-
atinine 6.5 mg/dL
Increased serum levels of potassium, magnesium,
and calcium
8. The nurse is reviewing the potassium level of a patient Administration of
with kidney disease. The results of the test are 6.5 sodium poly-
mEq/L, and the nurse observes peaked T waves on the styrene sulfonate
ECG. What priority intervention does the nurse antici- [Kayexalate])
pate the physician will order to reduce the potassium
level?
Administration of an insulin drip
Administration of a loop diuretic
Administration of sodium bicarbonate
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Nurs 107 PrepU Chap 48 Management of Patients with Kidney Disorders
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Administration of sodium polystyrene sulfonate
[Kayexalate])
9. A patient with chronic kidney failure experiences de- Anemia
creased levels of erythropoietin. What serious compli-
cation related to those levels should the nurse assess
for when caring for this client?
Anemia
Pericarditis
Acidosis
Hyperkalemia
10. The nurse is caring for a patient after kidney surgery. Hypovolemic
What major danger should the nurse closely monitor shock caused by
for? hemorrhage
Hypovolemic shock caused by hemorrhage
Paralytic ileus caused by manipulation of the colon
during surgery
Abdominal distention owing to reflex cessation of in-
testinal peristalsis
Pneumonia caused by shallow breathing because of
severe incisional pain
11. A client with renal failure is undergoing continuous Risk for infection
ambulatory peritoneal dialysis. Which nursing diagno-
sis is the most appropriate for this client?
Risk for infection
Activity intolerance
Impaired urinary elimination
Toileting self-care deficit
12. A nurse identifies a nursing diagnosis of risk for in- Encourage use of
effective breathing pattern related to incisional pain incentive spirome-
and restricted positioning for a client who has had a ter every 2 hours.
nephrectomy. Which of the following would be most
appropriate for the nurse to include in the client's plan
of care?
Monitor temperature every 4 hours.
Administer isotonic fluid therapy as ordered.
Keep the drainage catheter below the level of inser-
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Nurs 107 PrepU Chap 48 Management of Patients with Kidney Disorders
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Encourage use of incentive spirometer every 2 hours.
13. A client admitted with a gunshot wound to the ab- Urine output of
domen is transferred to the intensive care unit after 250 ml/24 hours
an exploratory laparotomy. IV fluid is being infused at
150 mL/hour. Which assessment finding suggests that
the client is experiencing acute renal failure (ARF)?
Temperature of 100.2° F (37.8° C)
Serum creatinine level of 1.2 mg/dl
Blood urea nitrogen (BUN) level of 22 mg/dl
Urine output of 250 ml/24 hours
14. The nurse is providing supportive care to a client The kidneys can
receiving hemodialysis in the management of acute improve over a pe-
renal failure. Which statement from the nurse best riod of months.
reflects the ability of the kidneys to recover from acute
renal failure?
The kidneys can improve over a period of months.
Kidney function will improve with transplant.
Acute renal failure tends to turn to end-stage failure.
Once on dialysis, the need will be permanent.
15. Which nursing assessment finding indicates that the Fever
client who has undergone renal transplant has not
met expected outcomes?
Fever
Weight loss
Diuresis
Absence of pain
16. Following a nephrectomy, which assessment finding SpO2 at 90% with
is most important in determining nursing care for the fine crackles in the
client? lung bases
Pain of 3 out of 10, 1 hour after analgesic administra-
tion
Blood tinged drainage in Jackson-Pratt drainage tube
Urine output of 35 to 40 mL/hour
SpO2 at 90% with fine crackles in the lung bases
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17. Diet modifications are part of nutritional therapy for Citrus fruits
the management of ARF. Select the high-potassium
food that should be restricted.
Citrus fruits
Salad oils
Butter
White rice
18. A client is admitted for treatment of chronic renal water and sodi-
failure (CRF). The nurse knows that this disorder in- um retention sec-
creases the client's risk of: ondary to a se-
a decreased serum phosphate level secondary to kid- vere decrease in
ney failure. the glomerular fil-
metabolic alkalosis secondary to retention of hydro- tration rate.
gen ions.
water and sodium retention secondary to a severe
decrease in the glomerular filtration rate.
an increased serum calcium level secondary to kidney
failure.
19. A patient admitted with electrolyte imbalance has Calcium
carpopedal spasm, ECG changes, and a positive
Chvostek sign. What deficit does the nurse suspect
the patient has?
Phosphorus
Sodium
Magnesium
Calcium
20. A nurse is reviewing the history of a client who is Recent history of
suspected of having glomerulonephritis. Which of the streptococcal in-
following would the nurse consider significant? fection
History of hyperparathyroidism
Recent history of streptococcal infection
History of osteoporosis
Previous episode of acute pyelonephritis
21. A client has been diagnosed with acute glomeru- proteinuria.
lonephritis. This condition causes:
No option is correct.
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pyuria.
polyuria.
proteinuria.
22. Which of the following is a term used to describe Azotemia
excessive nitrogenous waste in the blood, as seen in
acute glomerulonephritis?
Azotemia
Bacteremia
Proteinuria
Hematuria
23. When assessing the impact of medications on the Penicillin
etiology of acute renal failure, the nurse recognizes
which of the following as the drug that is not nephro-
toxic?
Penicillin
Gentamicin
Tobramycin
Neomycin
24. A client has end-stage renal failure. Which of the fol- Increase carbohy-
lowing should the nurse include when teaching the drates and limit
client about nutrition to limit the effects of azotemia? protein intake.
Eliminate fat intake and increase protein intake.
Increase carbohydrates and limit protein intake.
Increase protein, carbohydrates, and fat intake.
Increase fat intake and limit carbohydrates.
25. A client has undergone a renal transplant and returns Tenderness over
to the health care agency for a follow-up evaluation. transplant site
Which finding would lead to the suspicion that the
client is experiencing rejection?
Tenderness over transplant site
Weight loss
Hypotension
Polyuria
26. What is a characteristic of the intrarenal category of Increased BUN
acute renal failure?
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Increased BUN
Decreased urine sodium
Decreased creatinine
High specific gravity
27. One of the roles of the nurse in caring for clients with restricting sources
chronic renal failure is to help them learn to minimize of potassium.
and manage potential complications. This would in-
clude:
limiting iron and folic acid intake.
restricting sources of potassium.
eating protein liberally.
allowing liberal use of sodium.
28. The nurse cares for a client who underwent a kidney hyperacute rejec-
transplant. The nurse understands that rejection of a tion.
transplanted kidney within 24 hours after transplant
is termed:
hyperacute rejection.
simple rejection.
acute rejection.
chronic rejection.
29. A client with end-stage renal disease is scheduled to "Even a perfect
undergo a kidney transplant using a sibling donated match does not
kidney. The client asks if immunosuppressive drugs guarantee organ
can be avoided. Which is the best response by the success."
nurse?
"Let's wait until after the surgery to discuss your
treatment plan."
"Immunosuppressive drugs guarantee organ suc-
cess."
"The doctor may decide to delay the use of immuno-
suppressant drugs."
"Even a perfect match does not guarantee organ suc-
cess."
30. The client is admitted to the hospital with a diagnosis Cola-colored urine
of acute glomerulonephritis. Which clinical manifesta-
tion would the nurse expect to find?
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Cola-colored urine
Hypotension
Hyperalbuminemia
Peripheral neuropathy
31. After teaching a group of students about how to per- "It is appropriate to
form peritoneal dialysis, which statement would indi- warm the dialysate
cate to the instructor that the students need additional in a microwave."
teaching?
"It is important to use strict aseptic technique."
"The infusion clamp should be open during infusion."
"The effluent should be allowed to drain by gravity."
"It is appropriate to warm the dialysate in a mi-
crowave."
32. When caring for the patient with acute glomeru- Cola-colored urine
lonephritis, which of the following assessment find-
ings should the nurse anticipate?
Pyuria
Cola-colored urine
Low blood pressure
Left upper quadrant pain
33. A group of students are reviewing the phases of acute Oliguria
renal failure. The students demonstrate understand-
ing of the material when they identify which of the
following as occurring during the second phase?
Acute tubular necrosis
Restored glomerular function
Oliguria
Diuresis
34. A male client has doubts about performing peritoneal Wear a mask
dialysis at home. He informs the nurse about his exist- when performing
ing upper respiratory infection. Which of the following exchanges.
suggestions can the nurse offer to the client while
performing an at-home peritoneal dialysis?
Auscultate the lungs frequently.
Avoid carrying heavy items.
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Perform deep-breathing exercises vigorously.
Wear a mask when performing exchanges.
35. A client recovering from hepatitis B develops acute Methylpred-
nephrotic syndrome. Which treatment will the nurse nisolone
anticipate being prescribed for this client?
Vancomycin
Methylprednisolone
Increase in sodium intake
Low-carbohydrate diet
36. A client with chronic renal failure complains of gener- Hyperphos-
alized bone pain and tenderness. Which assessment phatemia
finding would alert the nurse to an increased potential
for the development of spontaneous bone fractures?
Elevated urea and nitrogen
Hyperphosphatemia
Elevated serum creatinine
Hyperkalemia
37. The client with chronic renal failure complains of in- Brief, hot daily
tense itching. Which assessment finding would indi- showers
cate the need for further nursing education?
Brief, hot daily showers
Pats skin dry after bathing
Uses moisturizing creams
Keeps nails trimmed short
38. An investment banker with chronic renal failure in- "This type of
forms the nurse of the choice for continuous cyclic dialysis will pro-
peritoneal dialysis. Which is the best response by the vide more inde-
nurse? pendence."
"This type of dialysis will provide more indepen-
dence."
"Peritoneal dialysis will require more work for you."
"The risk of peritonitis is greater with this type of
dialysis."
"Peritoneal dialysis does not work well for every
client."
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39. The nurse expects which of the following assessment Dehydration
findings in the client in the diuretic phase of acute
renal failure?
Dehydration
Hypertension
Crackles
Hyperkalemia
40. Which of the following causes should the nurse sus- Glomerulonephri-
pect in a client diagnosed with intrarenal failure? tis
Ureteral calculus
Hypovolemia
Glomerulonephritis
Dysrhythmia
41. A client with chronic renal failure (CRF) has devel- fatigue and weak-
oped faulty red blood cell (RBC) production. The nurse ness.
should monitor this client for:
thrush and circumoral pallor.
nausea and vomiting.
fatigue and weakness.
dyspnea and cyanosis.
42. The nurse is caring for a patient in the oliguric phase Less than 400 mL
of acute kidney injury (AKI). What does the nurse know
would be the daily urine output?
Less than 50 mL
Less than 400 mL
1.5 L
1.0 L
43. What is a hallmark of the diagnosis of nephrotic syn- Proteinuria
drome?
Hyperalbuminemia
Hypokalemia
Hyponatremia
Proteinuria
44. A client is diagnosed with polycystic kidney disease
and requires teaching on the management of the dis-
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Nurs 107 PrepU Chap 48 Management of Patients with Kidney Disorders
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order. Which statement made by the client indicates a "As long as I have
need for further teaching? one normal kidney,
"As long as I have one normal kidney, I should be I should be fine."
fine."
"If renal failure develops, I may need to consider dial-
ysis."
"I inherited this disorder from one of my parents."
"The cysts can get quite large in size."
45. A client with decreased urine output refractory to fluid
challenges is evaluated for renal failure. Which condi-
tion may cause the intrinsic (intrarenal) form of acute
renal failure?
Obstruction of the urinary collecting system
Nephrotoxic injury secondary to use of contrast me-
dia
Damage to cells in the adrenal cortex
Poor perfusion to the kidneys
46. The presence of prerenal azotemia is a probable in-
dicator for hospitalization for CAP. Which of the fol-
lowing is an initial laboratory result that would alert a
nurse to this condition?
BUN of 18 mg/dL.
Glomerular filtration rate (GFR) of 100 mL/min.
Serum creatinine of 1.2 mg/dL.
Blood urea nitrogen (BUN)-to-creatinine ratio
(BUN:Cr) >20.
47. The nurse treats a client with end-stage kidney dis- Sevelamer hy-
ease (ESKD). The nurse is concerned that the client is drochloride
developing renal osteodystrophy. Upon review of the
client's laboratory values, it is noted the client has had
a calcium level of 11 mg/dL for the past 3 days and the
phosphate level is 5.5 mg/dL. The nurse anticipates
the administration of which medication?
Sevelamer hydrochloride
Mylanta
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Calcium carbonate
Calcium acetate
48. A client in chronic renal failure becomes confused Hyperkalemia
and complains of abdominal cramping, racing heart
rate, and numbness of the extremities. The nurse re-
lates these symptoms to which of the following lab
values?
Hypocalcemia
Hyperkalemia
Elevated urea levels
Elevated white blood cells
49. A nurse is caring for a client who's ordered contin- The client has a
uous ambulatory peritoneal dialysis (CAPD). Which history of divertic-
finding should lead the nurse to question the client's ulitis.
suitability for CAPD?
The client has a history of diverticulitis.
The client is blind in his right eye.
The client has a history of severe anemia during he-
modialysis.
The client is on the kidney transplant waiting list.
50. Because of difficulties with hemodialysis, peritoneal White blood cell
dialysis is initiated to treat a client's uremia. Which (WBC) count of
finding during this procedure signals a significant 20,000/mm3
problem?
Blood glucose level of 200 mg/dl
Potassium level of 3.5 mEq/L
Hematocrit (HCT) of 35%
White blood cell (WBC) count of 20,000/mm3
51. The nurse is administering calcium acetate (PhosLo) With food
to a patient with end-stage renal disease. When is the
best time for the nurse to administer this medication?
2 hours after meals
2 hours before meals
With food
At bedtime with 8 ounces of fluid
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52. The nurse cares for a client with end-stage kidney pH 7.20, PaCO2
disease (ESKD). Which acid-base imbalance is asso- 36, HCO3 14-
ciated with this disorder?
pH 7.50, PaCO2 29, HCO3 22-
pH 7.31, PaCO2 48, HCO3 24-
pH 7.20, PaCO2 36, HCO3 14-
pH 7.47, PaCO2 45, HCO3 33-
53. The nurse helps a client to correctly perform peri- Keep the dialysis
toneal dialysis at home. The nurse must educate the supplies in a clean
client about the procedure. Which educational infor- area, away from
mation should the nurse provide to the client? children and pets
Clean the catheter insertion site daily with soap
Keep the dialysis supplies in a clean area, away from
children and pets
Keep the catheter stabilized to the abdomen, below
the belt line
Wear a mask while handling any dialysate solutions
54. Which of the following would a nurse classify as a Septic shock
prerenal cause of acute renal failure?
Prostatic hypertrophy
Polycystic disease
Ureteral stricture
Septic shock
55. The nurse cares for a client after extensive abdom- Hemodialysis
inal surgery. The client develops an infection that is
treated with IV gentamicin. After 4 days of treatment,
the client develops oliguria, and laboratory results
indicate azotemia. The client is diagnosed with acute
tubular necrosis and transferred to the ICU. The client
is hemodynamically stable. Which dialysis method
would be most appropriate for the client?
Peritoneal dialysis
Continuous arteriovenous hemofiltration (CAVH)
Hemodialysis
Continuous venovenous hemofiltration (CVVH)
56.
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A client with newly diagnosed renal cancer is ques- "Very few symp-
tioning why detection was delayed. Which is the best toms are associat-
response by the nurse? ed with renal can-
"Very few symptoms are associated with renal can- cer."
cer."
"Squamous cell carcinomas do not present with de-
tectable symptoms."
"Painless gross hematuria is the first symptom in
renal cancer."
"You should have sought treatment earlier."
57. Which of the following occurs late in chronic glomeru- Peripheral neu-
lonephritis? ropathy
Peripheral neuropathy
Seizure
Stroke
Nosebleed
58. Compliance to a renal diet is a difficult lifestyle Restrict fluid to
change for a patient on hemodialysis. The nurse daily urinary out-
should reinforce nutritional information. Which of the put plus 500 to 800
following teaching points should be included? Select mL.
all that apply. Eat foods such
Limit protein to 1.6 g/kg/day. as milk, fish, and
Restrict fluid to daily urinary output plus 500 to 800 eggs.
mL. Restrict sodium to
Eat foods such as milk, fish, and eggs. 2,000 to 3,000 mg
Increase potassium to prevent cardiac problems. daily.
Restrict sodium to 2,000 to 3,000 mg daily.
59. For a client in the oliguric phase of acute renal failure Limiting fluid in-
(ARF), which nursing intervention is the most impor- take
tant?
Encouraging coughing and deep breathing
Providing pain-relief measures
Limiting fluid intake
Promoting carbohydrate intake
60. A client with chronic kidney disease (CKD) has been Absence of pallor
receiving erythropoietin injections as prescribed.
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Which outcome would indicate to the nurse that this
medication has been effective?
Bowel movements solid and formed
Blood pressure within normal limits
Absence of pallor
Absence of a paradoxical pulse
61. A nurse is caring for a client on bedrest with end-stage Bone demineral-
kidney disease. What major manifestation of uremia ization
should the nurse expect to decrease with an exercise
plan?
Bone demineralization
A decreased serum phosphorus level
Hyperparathyroidism
Increased secretion of parathormone
62. The nurse passes out medications while a client pre- Hold the medica-
pares for hemodialysis. The client is ordered to re- tions until after
ceive numerous medications including antihyperten- dialysis.
sives. What is the best action for the nurse to take?
Check with the dialysis nurse about the medications.
Administer the medications as ordered.
Hold the medications until after dialysis.
Ask if the client wants to take the medications.
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