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1. 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.

Answer: C
Rationale: The patient's renal failure has been caused by the prerenal problem of hypovolemia. Prerenal oliguria is characterized by the ability of the kidneys to concentrate urine, resulting in a high urine specific gravity. The urinalysis in intrarenal failure would show proteins and tubular casts. Bacteriuria would be typical of a urinary tract infection (UTI), not renal failure.

Cognitive Level: Application Text Reference: pp. 1198-1199
Nursing Process: Assessment NCLEX: Physiological Integrity

2. 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.

Answer: B
Rationale: Patients with metabolic acidosis caused by ARF may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Tachycardia and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in ARF.

Cognitive Level: Application Text Reference: pp. 1200-1201
Nursing Process: Assessment NCLEX: Physiological Integrity

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: D
Rationale: The primary goal of treatment for ARF is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing ARF, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.

Cognitive Level: Application Text Reference: pp. 1201-1202
Nursing Process: Planning NCLEX: Physiological Integrity

4. 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.

Answer: B
Rationale: The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse will also review the other laboratory values, but abnormalities in these are not immediately life threatening.

Cognitive Level: Application Text Reference: p. 1200
Nursing Process: Assessment NCLEX: Physiological Integrity

5. 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.

Answer: D
Rationale: The specific gravity and presence of casts and debris in the urinalysis suggest intrarenal failure and acute tubular necrosis. The sudden onset indicates that the renal failure is acute, not chronic. In prerenal failure, there would not be casts or debris in the urine. The patient does not have risk factors for postrenal failure.

Cognitive Level: Application Text Reference: pp. 1198-1199
Nursing Process: Assessment NCLEX: Physiological Integrity

6. 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

Answer: C
Rationale: Usually fluid replacement should be based on the patient's measured output plus 600 ml/day for insensible losses.

Cognitive Level: Application Text Reference: pp. 1201-1202
Nursing Process: Implementation NCLEX: Physiological Integrity

7. 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.

Answer: C
Rationale: Changes in potassium will impact on the ECG and muscle strength, but the nurse should expect to recheck the serum potassium level during the infusion of glucose and insulin to determine the effectiveness of the therapy. The blood glucose level should be monitored during the infusion to assess for hypoglycemia or hyperglycemia. The BUN and creatinine levels will not change with administration of glucose and insulin.

Cognitive Level: Application Text Reference: pp. 1201-1202
Nursing Process: Evaluation NCLEX: Physiological Integrity

8. 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 μmol/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.

Answer: C
Rationale: During the diuretic phase of ARF, fluid and electrolyte losses may cause hypovolemia, hypotension, hyponatremia, and hypokalemia. Proteinuria, pulmonary edema, and hyperkalemia occur during the oliguric phase.

Cognitive Level: Application Text Reference: p. 1201
Nursing Process: Planning NCLEX: Physiological Integrity

9. 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.

Answer: B
Rationale: The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with ARF, but these would not directly affect the ECG. Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.

Cognitive Level: Application Text Reference: p. 1200
Nursing Process: Implementation NCLEX: Physiological Integrity

10. 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

Answer: A
Rationale: The contrast dye used in IVPs is nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure that adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure.

Cognitive Level: Application Text Reference: p. 1203
Nursing Process: Implementation NCLEX: Physiological Integrity

11. 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."

Answer: A
Rationale: Polyuria occurs early in chronic kidney disease (CKD) as a result of the inability of the kidneys to concentrate urine. The other symptoms would be expected later in the progression of CKD.

Cognitive Level: Application Text Reference: p. 1206
Nursing Process: Assessment NCLEX: Physiological Integrity

12. 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."

Answer: A
Rationale: The patient with CKD who is not receiving dialysis is generally taught to restrict fluids. The patient would need to measure urine output and then add 600 ml for insensible losses to calculate an appropriate oral intake. Erythropoietin is given to increase red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.

Cognitive Level: Application Text Reference: p. 1212
Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance

13. 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.

Answer: C
Rationale: Uremia is caused by the products of protein breakdown, and protein restriction is used to decrease uremia. Because the primary cause of the patient's disturbed sensory perception is the uremia, conveying a caring attitude and providing opportunities for the patient to discuss concerns will not be as helpful as protein restriction. Although safety is a concern for the patient, bed rest is likely to promote weakness. The patient should be supervised when out of bed.

Cognitive Level: Application Text Reference: p. 1211
Nursing Process: Implementation NCLEX: Physiological Integrity

14. 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.

Answer: C
Rationale: The patient's statements that there is nothing that is good to eat and that death is unavoidable indicate grieving about the losses being experienced as a result of the diabetes and chronic kidney disease (CKD). The patient data do not indicate knowledge deficit, anger, or the complexity of the therapeutic program as being issues for this patient.

Cognitive Level: Application Text Reference: p. 1215
Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

15. 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.

Answer: D
Rationale: Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency.

Cognitive Level: Application Text Reference: p. 1211
Nursing Process: Implementation NCLEX: Psychosocial Integrity

16. 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).

Answer: C
Rationale: Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not impact on the nurse's decision to give the medication.

Cognitive Level: Application Text Reference: pp. 1202, 1210
Nursing Process: Assessment NCLEX: Physiological Integrity

17. 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: A
Rationale: Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.

Cognitive Level: Application Text Reference: pp. 1211-1212
Nursing Process: Evaluation NCLEX: Physiological Integrity

18. 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: A
Rationale: If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcitriol should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not impact whether calcitriol should be administered.

Cognitive Level: Application Text Reference: p. 1210
Nursing Process: Implementation NCLEX: Physiological Integrity

19. 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.

Answer: B
Rationale: Creatinine clearance testing, the most accurate way to assess GFR, requires a 24-hour urine collection. BUN levels may increase for other reasons, such as dehydration, and are not as accurate in determining glomerular filtration. Urine-specific gravity testing and monitoring residual urine would not be useful in determining the GFR.

Cognitive Level: Application Text Reference: p. 1206
Nursing Process: Planning NCLEX: Physiological Integrity

20. 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.

Answer: C
Rationale: AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not impact on needle size or patient mobility.

Cognitive Level: Application Text Reference: p. 1221
Nursing Process: Implementation NCLEX: Physiological Integrity

21. 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.

Answer: A
Rationale: The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.

Cognitive Level: Comprehension Text Reference: p. 1221
Nursing Process: Implementation NCLEX: Physiological Integrity

22. 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.

Answer: C
Rationale: Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is allowed. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

Cognitive Level: Application Text Reference: p. 1211
Nursing Process: Implementation NCLEX: Physiological Integrity

23. 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.

Answer: D
Rationale: The patient has symptoms of disequilibrium syndrome, which can be prevented by slowing the rate of dialysis so that fewer solutes are removed during the dialysis. Increasing the time of the dialysis to remove wastes more completely will increase the risk for disequilibrium syndrome. CRRT is a less efficient means of removing wastes and, because it is continuous, would not be used for a patient with CKD. Administration of medications to control the symptoms is not an appropriate action; rather, the disequilibrium syndrome should be avoided.

Cognitive Level: Application Text Reference: p. 1224
Nursing Process: Planning NCLEX: Physiological Integrity

24. 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.

Answer: A
Rationale: Patients with diabetes have better control of blood pressure, less hemodynamic instability, and fewer problems with retinal hemorrhages when using peritoneal dialysis than when using hemodialysis. CAPD is less expensive and has fewer dietary restrictions than hemodialysis. CAPD is not a contraindication for a kidney transplant.

Cognitive Level: Application Text Reference: p. 1220
Nursing Process: Implementation NCLEX: Physiological Integrity

25. 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).

Answer: B
Rationale: Abdominal pain and referred shoulder pain can be caused by a rapid infusion of dialysate; the nurse should slow the rate of the infusion. Massage and administration of acetaminophen (Tylenol) would not address the reason for the pain. There is no need to notify the health care provider.

Cognitive Level: Application Text Reference: p. 1219
Nursing Process: Implementation NCLEX: Physiological Integrity

26. 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.

Answer: B
Rationale: Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

Cognitive Level: Application Text Reference: p. 1219
Nursing Process: Assessment NCLEX: Physiological Integrity

27. 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.

Answer: A
Rationale: Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. Fluid infusion rate is titrated rather than being at a set rate. Blood pressure and urine appearance are not the major parameters considered when titrating fluid infusion.

Cognitive Level: Comprehension Text Reference: p. 1228
Nursing Process: Implementation NCLEX: Physiological Integrity

28. 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.

Answer: C
Rationale: Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Pain at the site, orthostatic dizziness, and changes in the urine appearance are not associated with corticosteroid use.

Cognitive Level: Comprehension Text Reference: p. 1230
Nursing Process: Implementation NCLEX: Physiological Integrity

29. 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.

Answer: C
Rationale: The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.

Cognitive Level: Application Text Reference: p. 1228
Nursing Process: Assessment NCLEX: Physiological Integrity

30. 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.

Answer: C
Rationale: A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The elevated glucose, moon face, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.

Cognitive Level: Application Text Reference: p. 1230
Nursing Process: Assessment NCLEX: Physiological Integrity

31. 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)

Answer: A
Rationale: Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.

Cognitive Level: Application Text Reference: p. 1207
Nursing Process: Assessment NCLEX: Physiological Integrity

32. 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.

Answer: D
Rationale: Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention; therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not impact whether the captopril was given or not.

Cognitive Level: Application Text Reference: p. 1210
Nursing Process: Assessment NCLEX: Physiological Integrity

33. 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.

Answer: C
Rationale: When a patient at risk for CKD receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin.

Cognitive Level: Application Text Reference: p. 1213
Nursing Process: Evaluation NCLEX: Physiological Integrity

34. 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.

Answer: B
Rationale: Outflow problems may occur because the peritoneal catheter is collapsed by a portion of the intestine, and repositioning the patient will move the catheter and allow outflow to occur. If less than the ordered 2 L of dialysate is infused, the dialysis will be less effective. Administration of a laxative may also help if the patient's colon is full, but this should be tried after repositioning the patient. If the problem with outflow persists after the patient is repositioned, the health care provider should be notified.

Cognitive Level: Application Text Reference: p. 1219
Nursing Process: Implementation NCLEX: Physiological Integrity

35. 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.

Answer: C
Rationale: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.

Cognitive Level: Application Text Reference: p. 1221
Nursing Process: Planning NCLEX: Physiological Integrity

36. 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.

Answer: B
Rationale: Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

Cognitive Level: Application Text Reference: p. 1223
Nursing Process: Implementation NCLEX: Physiological Integrity

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