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RENAL (under F&E PEarson) ARF and CRF

Terms in this set (58)

b
(Mr.​ Hill's rising serum creatinine indicates that he is developing renal dysfunction. The nurse should monitor his urine output and report a rate of less than 30​ mL/hr so that early interventions can be implemented to help restore renal function. Renal dysfunction alters the​ kidney's ability to excrete potassium and can result in hyperkalemia.​ However, a serum potassium levelof 4.0​ mEq/L is within normal limits.​ Therefore, Mr. Hill should not receive a potassium supplement. Gentamicin is a nephrotoxic drug and should not be administered to Mr. Hill given his compromised renal function. Mr.​ Hill's indwelling urinary catheter should remain in place so his urine output can be closely monitored.)
James Hill is an​ 80-year-old man who was admitted to the hospital with gastrointestinal bleeding and hemorrhagic shock. Despite blood product administration and cauterization of his duodenal​ ulcer, his serum creatinine has risen to 2.2 from 1.1​ mg/dL over the past 10 hours. His serum potassium level is 4.0​ mEq/L. Which intervention would the nurse include in the care plan for Mr.​ Hill?

a Removing the indwelling urinary catheter
b Reporting urine output of less than 30​ mL/hr
c Administering intravenous gentamicin as prescribed
d Administering potassium replacement
a
(Rationale:
The client's ability to state renal replacement therapies indicates understanding of treatment options and the ability to make informed decisions on treatment. Clients may be able to live independently, or with the assistance of a part-time caregiver. Home hemodialysis would require a helper for safety reasons to monitor the client's response. Hospice care is not needed for ESRD.)
An appropriate goal of nursing care for a client with end-stage renal disease is that the client will be able to:


a State the advantages and disadvantages of hemodialysis, peritoneal dialysis, and kidney transplant as renal replacement therapies.

b Demonstrate the ability to independently perform hemodialysis in the home.

c Identify a live-in caregiver.

d Relate the hospice philosophy and identify indicators of the need for hospice care.
d
(Rationale:
Cloudy urine could be a symptom of an infection. Prompt treatment is vital to preserve integrity of the transplanted organ in an immunosuppressed client. Recording the finding is insufficient; action must be taken. The nurse does not increase the intravenous flow rate without a physician's order. Irrigation of the urinary catheter would introduce possible contaminants into an immunosuppressed client.)
Following a kidney transplant, the nurse notes that the client's urine is cloudy. The most appropriate action by the nurse is to:


a Increase the intravenous flow rate.

b Record the finding.

c Irrigate the urinary catheter.

d Notify the physician.
a
(
Feedback
Rationale:
The client with little or no urine output is best assessed for fluid volume status by weight changes because retained fluid has weight. Lack of output would exclude intake and output as accurate data for assessment. The client's thirst does not indicate fluid status because the client on fluid restriction will be thirsty even with fluid volume excess. BUN and creatinine are used to assess kidney function; while BUN increases with dehydration, it is not the best indicator of fluid status.)
Which finding by the nurse would be an accurate indicator of fluid volume status in an oliguric or aneuric client?


a Weight changes

b Intake and output

c BUN and creatinine levels

d Level of thirst
a
(Rationale:
The client with renal failure with a potassium level above 6.5 mEq/L is treated with sodium polystyrene sulfonate (Kayexalate SPS suspension). Sodium polystyrene exchanges sodium ions for potassium in the intestines. Furosemide (Lasix) removes sodium and excess fluid. Aluminum hydroxide (Amphojel) is used to control hyperphosphatemia. Propranolol (Inderal) may control hypertension.)
A client with chronic renal failure has a serum potassium of 6.6 mEq/L. The nurse should anticipate an order for:


a sodium polystyrene sulfonate (Kayexalate).

b aluminum hydroxide (Amphojel).

c propranolol (Inderal).

d furosemide (Lasix).
d
(Rationale:
The client needs to be assessed for a functional arteriovenous fistula by palpating a thrill and auscultating a bruit. Clients may have edema, which is usually peripheral. A renal bruit indicates turbulent blood flow in the renal artery. A positive Homan's sign may indicate a deep vein thrombosis.)
A client with chronic renal failure has had an arteriovenous fistula created for hemodialysis. The nurse should assess this client for:


a periorbital edema.

b a renal bruit.

c homan's sign.

d a bruit and a thrill.
d
(Rationale:
Unless a kidney is received from an identical twin, the body will produce antibodies and will begin to reject the kidney. Immunosuppressants suppress the immune system and the inflammatory response. Bone marrow production is part of the suppressed immune system. The risk for infection is greater with this treatment because the immune system is suppressed.)
A client with end-stage renal disease has received a kidney transplant. The client asks, "Why do I need to take cyclosporine (Sandimmune)?" What is the best response by the nurse?


a "It will help prevent infection."

b It will increase your immune system to prevent rejection."

c "It increases bone marrow cell production to assist in preventing rejection."

d "It will help prevent rejection of the kidney by suppressing your immune system."
d
(Rationale:
Dialysis can cause disequilibrium syndrome if fluid is withdrawn too quickly. The nurse should assess for headache, nausea, vomiting, change in level of consciousness, and hypertension. Congestive heart failure is fluid overload. The client is more likely to experience hypokalemia. Peripheral edema is a sign of fluid overload.)
A client has just returned from hemodialysis. For which should the nurse assess this client?


a Hyperkalemia.

b Peripheral edema and headache.

c Congestive heart failure.

d Signs of disequilibrium syndrome.
d
(Rationale:
Respiratory distress due to increased pressure from the dialysate may occur unless the client remains in semi-Fowler's or Fowler's position. Lateral, supine, or dorsal recumbent positions may increase the risk of respiratory distress)
The nurse instructs a client who is on peritoneal dialysis to remain in which of the position?


a Dorsal recumbent

bSupine

c Lateral Sims's

d Semi-Fowler's
a
(Rationale:
Ringer's solution is an isotonic, balanced electrolyte solution that can expand plasma volume and help restore electrolyte balance. Hypertonic solutions such as 10% dextrose and 3% sodium chloride pull interstitial and intracellular fluid into the vascular system, leading to cellular dehydration. A hypotonic solution such as 0.45% sodium chloride may be used to treat cellular dehydration.)
A client is admitted to the emergency department with hypovolemia. Which intravenous solution would the nurse anticipate administering?


a Ringer's solution

b 10% dextrose in water

c 0.45% sodium chloride

d 3% sodium chloride
d
(Rationale:
In fluid volume deficit, there is less volume in the vascular system, which decreases venous return and cardiac output, leading to manifestations of dizziness, orthostatic hypotension, and flat neck veins. The heart rate increases and the blood pressure falls. Dyspnea and crackles usually are associated with excess fluid volume. Headache and muscle cramps are often due to electrolyte imbalance, not fluid loss.)
When assessing a client with fluid volume deficit, the nurse would assess for which of the following s/sx?


a Headache and muscle cramps.

b Increased pulse rate and blood pressure.

c Dyspnea and respiratory crackles.

d Orthostatic hypotension and flat neck veins.
a,c,e
(Rationale:
Frequent neurological checks are necessary as hypernatremia draws water out of brain cells, causing them to shrink. As the brain shrinks, tension is placed on cerebral vessels, which may cause them to tear and bleed. Hypernatremia affects mental status and brain function (including orientation to time, place, and person), as can rapid correction of hypernatremia. Fluid replacement is the primary treatment for hypernatremia. Maintaining intravenous access is necessary for administration of fluids and possible emergency medications. There is no reason to limit visit length.)
The nurse caring for a client with acute hypernatremia would include which of the following in the plan of care? (Select all that apply.)


a Conduct frequent neurologic checks.

b Restrict fluids to 1500 mL per day.

c Orient to time, place, and person frequently.

d Limit length of visits.

e Maintain intravenous access.
a
(Rationale:
Hypokalemia affects nerve impulse transmission, including the transmission of cardiac impulses. The client may develop ECG changes and atrial or ventricular dysrhythmias. Although hypokalemia can lead to muscle weakness and activity intolerance, bed rest generally is unnecessary. Starting oxygen would be appropriate only if the client is in respiratory distress. The client is more likely to experience cardiac arrest, not seizures; in any case, the priority is cardiac monitoring. The client is not hypoxic, so oxygen is not needed.)
Laboratory results for a client show a serum potassium level of 2.2 mEq/L. Which of the following actions would the nurse do first?


a Initiate cardiac monitoring.

b Start oxygen at 2 L/min.

c Initiate seizure precautions.

d Keep the client on bed rest.
d
(Rationale:
Calcium should be taken with a full glass of water to allow maximum absorption. It is more effectively absorbed when it is taken on an empty stomach and the prescribed doses are spaced throughout the day. Taking calcium is not an immediate fix for problems; it is a long-term replacement therapy.)
The nurse is teaching a client about calcium supplement therapy. Which statement made by the client indicates understanding?


a "I will take my calcium tablets with meals."

b "I will take my calcium tablets as needed for tremulousness."

c "I will take my calcium tablets all at one time in the morning."

d "I will take my calcium tablets with a full glass of water."
b
(
Feedback
Rationale:
A positive Chvostek's sign indicates increased neuromuscular excitability, commonly associated with both hypomagnesemia and hypocalcemia, often seen in people who abuse alcohol and who are nutritionally depleted. Additional manifestations of hypomagnesemia include confusion, hallucinations, and possible psychoses. Administration of magnesium sulfate helps restore magnesium balance and neuromuscular function. The symptoms presented are not those of potassium depletion, the need for glucose and insulin, or sodium depletion.)
A client with a history of alcohol abuse presents with confusion, hallucinations, and a positive Chvostek's sign. Which medication(s) should the nurse anticipate administering?


a Sodium bicarbonate

b Magnesium sulfate

c Insulin and glucose

d Potassium chloride
b
(
Feedback
Rationale:
Losing heat through their heads will have minimal effect on fluid loss in infants. All the other answers are appropriate responses)
The neonatal nurse explains to new parents that infants are at greater risk for fluid and electrolyte imbalance than are older children. Which of the following parent comments would indicate that further education is needed?


a "Infants have a higher metabolic rate than older children do."

b "Infants maintain their temperature by losing heat through their heads."

c "An infant has little body water for reserve, as compared with an adult."

d "Infants lose water through their skin, and they have a larger proportion of skin surface area than older children do."
a,b,c,d
(Rationale:
All of the choices represent assessment measures that measure the effectiveness of therapy except abdominal girth, which does not provide information regarding hydration status.

Nursing Process:Assessment
Client Need:Physiological Integrity
Cognitive Level:Evaluating)
A 6-month-old infant is admitted with severe dehydration. Which of the following assessment measures by the nurse would indicate effective therapy? (Select all that apply.)


a Level of consciousness

b Intake and output

c Mucous membrane assessment for moisture

d Daily weights

e Abdominal girth
a,b,e
(Rationale
Nursing care for clients with fluid volume overload caused by acute renal failure includes maintaining intake and output measurements and daily weighing to assist in tracking fluid balance. The​ semi-Fowler position helps improve respiratory excursion of the client with fluid overload. Clients with acute renal failure have hyperkalemia and should not be given potassium supplements. Liberal fluid intake is contraindicated in clients with acute renal failure because of their inability to excrete excess fluid.)
Which nursing intervention would be implemented for a client with fluid volume overload due to acute renal​ failure?
​(Select all that​ apply.)

a Weighing daily
b Placing in​ semi-Fowler position
c Administering potassium replacements
d Encouraging liberal fluid intake
e Maintaining intake and output records
b
(Rationale
A renal biopsy is done to differentiate between acute and chronic renal​ failure, so the nurse should provide education for this diagnostic test. A renal ultrasonogram identifies obstructive causes of renal failure and does not differentiate between acute and chronic renal failure.​ Therefore, the nurse should not provide education for this diagnostic test. A CT scan or an MRI evaluates kidney size and identifies possible​ obstructions, but it does not differentiate between acute and chronic renal​ failure; therefore, the nurse should not provide education for these diagnostic tests.)
A client with renal failure will be undergoing a diagnostic test that will differentiate between acute and chronic renal failure. For which diagnostic test should the nurse provide​ education?

a CT scan
b Renal biopsy
c Renal ultrasonography
d MRI
b
(​Rationale:
A client in the maintenance phase of acute renal failure will experience​ azotemia, which is more severe in a client with oliguria. Muscle​ weakness, anemia, and dehydration typically are not more severe when experiencing oliguria.)
The nurse is caring for a client in the maintenance phase of acute renal failure. Which manifestation typically is more severe if the client is experiencing​ oliguria?
a Muscle weakness
b Azotemia
c Anemia
d Dehydration
a
(Rationale
Impaired potassium excretion leads to​ hyperkalemia, which causes electrocardiographic changes.​ Hypotension, constipation, and weight gain are not manifestations of hyperkalemia.)
The nurse identifies that a client in acute renal failure is experiencing hyperkalemia. For which manifestation should the nurse monitor the​ client?

a Electrocardiographic changes
b Constipation
c Weight gain
d Hypotension
d
(Rationale
Sepsis causes prerenal acute renal failure because it causes altered vascular resistance. Fluid retention is not a cause of prerenal acute renal failure. Renal calculi are not a cause of prerenal acute renal failure but are the cause of postrenal acute renal failure. Glomerulonephritis is not the cause of prerenal acute renal failure but is the cause of intrarenal acute renal failure.)
The nurse is caring for a client diagnosed with acute renal failure. Which condition most likely caused prerenal acute renal failure in this​ client?

a Glomerulonephritis
b Renal calculi
c Fluid retention
d Sepsis
a,b,c,e
(Rationale:
Specific data that the nurse needs to collect during a physical examination of a client in acute renal failure include​ weight, peripheral​ pulses, edema, and bowel sounds. Altered mental status is not a factor in the physical examination of a client in acute renal failure.)
The nurse is completing a physical examination of a client with acute renal failure. Which piece of data should the nurse collect during the physical​ examination? (Select all that​ apply.)
a Bowel sounds
b Weight
c Edema
d Mental status
e Peripheral pulses
d
(An older adult client may experience orthostatic hypotension with acute renal failure.​ Nausea, uremia, and gross hematuria are symptoms typically experienced by children with acute renal failure.)
Which symptom may indicate acute renal failure in an older adult​ client?
a Nausea
b Uremia
c Gross hematuria
d Orthostatic hypotension
b,c,d,e
(Major​ trauma, heart​ failure, and hemorrhage are risk factors for acute renal failure because they can reduce blood flow to the kidneys. Radiologic contrast media can be nephrotoxic and cause acute renal failure. Cerebrovascular disease is not a risk factor for acute renal failure because it does not reduce blood flow to the kidneys and it does not cause nephrotoxicity.)
Which critical illness is a risk factor for acute renal​ failure?
​(Select all that ​apply.)

a Cerebrovascular disease
b Severe heart failure
c Hemorrhage
d Radiologic contrast media
e Major trauma
d
(A diagnostic test used to assess kidney function is serum creatinine levels. Hemoglobin and hematocrit are used to assess hemoconcentration in the blood. Serum osmolality helps to differentiate isotonic fluid loss from water loss.)
Which diagnostic test assesses kidney​ function?

a Serum osmolality
b Hemoglobin
c Hematocrit
d Serum creatinine
d
(Calcium gluconate is used to treat hyperkalemia. Hypernatremia is treated with fluid replacement. Hypochloremia is treated with increasing dietary salt and adding chloride to the IV fluid. Hyponatremia is treated by increasing dietary sodium and administering sodium containing IV fluids.)
Which electrolyte imbalance is treated with calcium​ gluconate?

a Hypernatremia
b Hyponatremia
c Hypochloremia
d Hyperkalemia
b
How much urine output is considered normal for a client experiencing acute renal​ failure?

a 25​ mL/hr
b 30​ mL/hr
c 15​ mL/hr
d 20​ mL/hr
c,d,e
(When completing a physical examination on a client experiencing renal​ failure, the nurse needs to note the client​'s ​weight, skin​ color, and lung sounds. Reports of edema and having a history of diabetes mellitus is information collected when obtaining a client​'s health history.)
Which pieces of data should the nurse collect when completing a physical examination on a client in acute renal​ failure?
​(Select all that​ apply.)

a Reports of edema
b History of diabetes mellitus
c Lung sounds
d Skin color
e Weight
c
(Children are at greatest risk for developing acute renal failure from acute gastrointestinal illnesses.​ Therefore, the nurse needs to further question​ Rosa's parents about recent acute gastrointestinal illnesses. Major​ surgery, infections, and certain medications that are nephrotoxic can increase the risk for acute renal failure in older adult clients.)
Rosa Serrano is a​ 6-year-old child admitted to a medical unit. You notice that Rosa is lethargic and has generalized edema. When reviewing the laboratory​ results, the nurse finds that Rosa is experiencing gross hematuria. Which further information would the nurse obtain from the parents to assist with the diagnosis of acute renal​ failure?
a Current medications
b Past infections
c Recent acute gastrointestinal illness
d Previous major surgery
d
(Fluid intake for clients with renal failure is usually restricted because the kidneys cannot eliminate fluids normally. Fluid intake is calculated for these clients by adding the amount of output for the previous 24 hours to 500 mL to allow for insensible losses. Mr.​ Sanger's output for the past 24 hours was 250​ mL; added to 500​ mL, the fluid volume calculation equals 750 mL. A fluid intake of​ 1,250, 2,750, or​ 3,000 mL would be too much fluid for Mr. Sanger and put him at risk for fluid overload.)
Benjamin Sanger is a​ 63-year-old man admitted to the hospital with postrenal failure because of a kidney stone. During the past 24​ hours, he has voided 250 mL of urine. He has not had any other type of output. How much fluid should Mr. Sanger receive over the next 24​ hours?
a ​1,250 mL
​b 3,000 mL
​c 2,750 mL
d 750 mL
d
(Rationale
Urethral obstruction resulting from cancer is the cause of postrenal acute renal failure and is not the cause of​ prerenal, intrarenal, or intrinsic acute renal failure.)
The nurse is caring for a client in acute renal failure resulting from an obstruction due to cancer. Which type of acute renal failure is the client​ experiencing?

a Intrinsic
b Prerenal
c Intrarenal
d Postrenal
a,b,d,e
(Rationale
The nurse should anticipate that calcium​ chloride, sodium​ bicarbonate, insulin, and glucose would be prescribed to treat the client​'s hyperkalemia. An ACE inhibitor is used to treat​ hypertension, not hyperkalemia. Add to this: Ace inhibitors can cause retention of potassium!)
A client diagnosed with acute renal failure is experiencing hyperkalemia. Which medication should the nurse anticipate being prescribed to this​ client?
​(Select all that​ apply.)

a Sodium bicarbonate
b Insulin
​c Angiotensin-convertingdashenzyme ​(ACE) d inhibitors
d Glucose
e Calcium chloride
a,c,d,e
(Rationale
The client will need to continue dietary​ restrictions, monitoring blood​ pressure, and monitoring symptoms of possible relapse after​ discharge, so these statements indicate client understanding of the education. The client will need to avoid life​ stressors, which can slow​ healing, after​ discharge, so this statement indicates client understanding of the education. The client needs to avoid nephrotoxic drugs for up to 1 year after an episode of acute renal​ failure, so this statement does not indicate understanding of the education.)
The nurse is preparing client education to address the problem of readiness for enhanced knowledge. Which client statement indicates understanding of how to manage acute renal failure after​ discharge?
​(Select all that​ apply.)

​a "I will monitor my blood​ pressure."
​b "I need to avoid nephrotoxic drugs for 1​ month."
​c "I need to continue with dietary​ restrictions."
​d "I will avoid life​ stressors."
e ​"I must monitor for symptoms of possible​ relapse."
b,c,d,e
(​Rationale:
When completing a health history on a client with acute renal​ failure, the nurse needs to collect information on recent exposure to nephrotoxic​ medications; previous transfusion​ reactions; chronic diseases such as diabetes​ mellitus, heart​ failure, and kidney​ disease; and reports of anorexia. The nurse needs to collect information on reports of weight​ gain, not weight loss.)
The nurse is completing a health history on a client admitted in acute renal failure. Which information should the nurse​ collect? (Select all that​ apply.)
a Reports of weight loss
b Chronic diseases
c Reports of anorexia
d Previous transfusion reactions
e Recent exposure to nephrotoxic medications
d
(Rationale:
Carbohydrates are increased for a client with acute renal failure in order to maintain adequate caloric intake. For a client with acute renal​ failure, protein is limited in the diet to reduce the risk of azotemia. Decreasing dietary fiber and dairy intake is not essential for a client with acute renal failure.)
The nurse is preparing to educate a client diagnosed with acute renal failure about dietary needs. Which information should the nurse​ include?
a Increase protein
b Decrease dairy
c Decrease fiber
d Increase carbohydrates
b,c,d,e
(Rationale
​Hypertension, hemolysis,​ glomerulonephritis, and vasculitis cause acute damage to the renal parenchyma and​ nephrons, leading to intrarenal acute renal failure. Dehydration causes prerenal acute renal failure and does not cause damage to the renal parenchyma and nephrons.)
The nurse is providing education to a new nurse about renal failure. Which condition causes damage to the renal parenchyma and​ nephrons?
​(Select all that​ apply.)

a Dehydration
b Vasculitis
c Hemolysis
d Glomerulonephritis
e Hypertension
d
(Rationale
The client with chronic renal failure would require a​ sodium-restricted diet of no more than 2​ g/day. Fluid​ restrictions, daily​ weighing, and dairy restrictions are appropriate prescriptions for the client with chronic renal failure.)
The nurse is providing care to a client with chronic renal failure. Which order would the nurse question for this​ client?

a Dairy restrictions
b Daily weighing
c Fluid restriction of 1-2 L per day
d 4g sodium diet
c
(Rationale
In diabetic​ nephropathy, thickening and sclerosis of the glomerular basement membrane and glomerulus lead to gradual nephron destruction and a fall in the glomerular filtration rate​ (GFR). Polycystic kidney disease results in multiple bilateral cysts compressing renal​ tissue, impairing renal perfusion and causing​ ischemia; release of inflammatory mediators damages and destroys normal kidney tissue. In a client with systemic lupus​ erythematosus, immune complexes in the capillary basement membrane lead to inflammation and sclerosis with​ focal, local, or diffuse glomerulonephritis. Hypertension affects the glomerulus in that it leads to sclerosis and narrowing of renal​ arterioles, reducing blood flow and causing​ ischemia, glomerular​ destruction, and tubular atrophy.)
The nurse is discussing the pathophysiology of diabetic nephropathy with a nursing student. The nurse asks the student to describe this pathophysiologic process. Which response indicates to the nurse that the student understands diabetic​ nephropathy?

a "Excess pressure in the glomerulus causes the damage in diabetic​ nephropathy."
b "Cysts in the kidney press on the functional​ tissue."
​c "The capillary walls in the nephron become​ thickened."
​d "Antibody and antigen complexes get stuck in the​ nephron."
d
(Rationale
The first stage of renal​ failure, decreased renal​ reserve, is characterized by a slight decrease in the glomerular filtration rate​ (GFR), but the client is asymptomatic. A longstanding history of poorly controlled hypertension along with diabetes predisposes the client to the development of renal​ disease, and the client should be closely monitored. In stage 1 of chronic renal​ failure, the BUN and creatinine levels are within normal limits. Renal insufficiency is characterized by a further decrease in the​ GFR, and the BUN and creatinine levels will begin to increase. Renal failure is characterized by​ azotemia, oliguria, and a sharp increase in the BUN and creatinine levels.)
The nurse is caring for a client with a​ 20-year history of poorly controlled hypertension and type 2 diabetes mellitus. The morning​'s laboratory work shows a blood urea nitrogen​ (BUN) level of 18​ mg/dL and a creatinine level of 0.9​ mg/dL, and the client had a urine output of 400 mL over the past 8 hours. What is the​ nurse's correct assumption about this​ client's renal​ status?

a The client has normal renal function.
b The client is experiencing renal insufficiency.
c The client is experiencing renal failure.
d The client will need to be monitored for advancing renal disease.
c
(Rationale
The kidneys produce​ erythropoietin, which stimulates red blood cell production in the bone marrow. Erythropoietin production decreases in renal failure. Low serum calcium levels in chronic renal failure lead to renal​ osteodystrophy, or bone breakdown. In chronic renal​ failure, some red blood cells may be found in the urine but not enough to cause anemia. Fluid overload is common in renal failure but it will not change the red blood cell count.)
A client with chronic renal failure asks the nurse why he is anemic. What is the nurse​'s best​ response?

​a "You are retaining more​ fluid, so your blood is​ diluted."
b Your bone marrow is depressed because of low calcium​ levels."
​c "Your kidneys are not producing a hormone that tells your body to make more blood​ cells."
​d "Your kidneys are excreting more blood​ cells."
a,c,d,e
(Rationale
Sodium polystyrene sulfonate​ (Kayexalate) is a​ potassium-ion exchange resin that removes potassium by exchanging sodium ions for potassium in the small bowel. A combination of regular​ insulin, bicarbonate, and glucose​ (dextrose) facilitates the movement of potassium ions into the cells to decrease serum potassium levels. A serum potassium level of 6.6​ mEq/L is​ hyperkalemic, so potassium replacement is not appropriate.)
A nurse caring for a client with chronic renal failure notes that the client​'s potassium level is 6.5​ mEq/dL.The nurse anticipates which orders for this​ client?
​(Select all that​ apply.)
a Sodium bicarbonate
b Potassium 30 mEq in 100 mL IV over 2 hours.
c IV regular insulin
d Sodium polystyrene sulfonate​ (Kayexalate)
e IV​ 50% dextrose solution
a
(Rationale
The cardiovascular assessment finding that supports the diagnosis of chronic renal failure is systemic hypertension. Anemia is a hematologic symptom of chronic renal failure. A decreased white blood cell count is a manifestation of chronic renal failure that affects the immune system. Hyperkalemia occurs as the result of the effects of chronic renal failure on fluids and electrolytes.)
The nurse is providing care to a client with chronic renal failure. Which cardiovascular assessment finding supports this​ diagnosis?

a Systemic hypertension
b Anemia
c Decreased white blood cell count
d Hyperkalemia
d
(Chronic hypertension can lead to chronic renal failure because of sclerotic changes in the renal arterioles that reduce blood flow and cause ischemia and glomerular destruction.​ Cystitis, or bladder​ infection, will not lead to chronic renal failure because the infection is distal to the kidneys. COPD and CAD do not affect renal function.)
Which chronic health conditions can lead to progressive renal​ failure?

a Cystitis
b Chronic obstructive pulmonary disease​ (COPD)
c Coronary artery disease​ (CAD)
d Hypertension
b
(A client with mildly decreased GFR is diagnosed with stage 2 chronic kidney disease. GFR in stage 1 is increased. GFR in stage 3 is moderately decreased. GFR in stage 4 is severely decreased.)
Which stage of chronic kidney disease does a client have when the glomerular filtration rate​ (GFR) is mildly​ decreased?
a Stage 4
b Stage 2
c Stage 1
d Stage 3
c
(An increasing serum potassium level is an indication for hemodialysis because of its arrhythmogenic effects. Although anemia​ (decreased red blood​ cells) and low serum sodium are associated with acute renal​ failure, they can be managed with therapies other than hemodialysis. Cell casts in the urine are a sign of acute tubular necrosis and cannot be reversed with hemodialysis.)
Which laboratory value is an indication for​ hemodialysis?
a Decreased red blood cells
b Low serum sodium
c Increasing serum potassium level
d Cell casts in urine
a,c,d,e
(Major​ trauma, heart​ failure, and hemorrhage are risk factors for acute renal failure because they can reduce blood flow to the kidneys. Radiologic contrast media can be nephrotoxic and cause acute renal failure. Cerebrovascular disease is not a risk factor for acute renal failure because it does not reduce blood flow to the kidneys and it does not cause nephrotoxicity.)
Which critical illness is a risk factor for acute renal​ failure?
​(Select all that ​apply.)

a Severe heart failure
b Cerebrovascular disease
c Radiologic contrast media
d Hemorrhage
e Major trauma
d
(Because a client with chronic renal failure is at risk of​ infection, health care workers should use standard precautions to provide care. The other types of precautions are not appropriate for a client with chronic renal failure.)
Which infection control measure is appropriate for a client with chronic renal​ failure?
a Contact precautions
b Airborne precautions
c Droplet precautions
d Standard precautions
a,d,e
(When completing a physical examination on a client experiencing renal​ failure, the nurse needs to note the client​'s ​weight, skin​ color, and lung sounds. Reports of edema and having a history of diabetes mellitus is information collected when obtaining a client​'s health history.)
Which pieces of data should the nurse collect when completing a physical examination on a client in acute renal​ failure?
​(Select all that​ apply.)

a Skin color
b History of diabetes mellitus
c Reports of edema
d Lung sounds
e Weight
c
(Chronic​ hypertension, with its resulting sclerosis and reduced blood​ flow, can result in chronic renal failure because of the​ long-term effects of hypertension on the blood vessels of the kidney. Elevated lipid​ levels, social​ drinking, and obesity are not risk factors for developing chronic renal failure.)
Mr. Cain is a​ 70-year-old African American male who recently developed chronic renal​ failure, which was initially identified by elevated serum blood urea nitrogen​ (BUN) and creatinine levels. Which item in the​ client's health history may be a factor in the development of chronic renal​ failure?
​
a Hypertriglycerides
b Obesity
c Hypertension
d Social drinking for 20 years
d
(The client is taking glucocorticoids to prevent rejection of the new kidney. Glucocorticoids do not prevent​ infection, boost immunologic​ function, or control hypertension.)
Mrs. Taylor is a​ 42-year-old woman who has been receiving hemodialysis for 8 years. A kidney match became available​ recently, and Mrs. Taylor underwent a kidney transplant. She began taking an immunosuppressant medication and glucocorticoids postoperatively. When the nurse discusses and administers her​ medications, which statement by Mrs. Taylor indicates that she understands the action of the​ glucocorticoids?
​
​a "I am taking the glucocorticoid to prevent infection after​ surgery."
​b "The glucocorticoid will boost my immune​ system."
​c "I am taking the glucocorticoid to help control my elevated blood​ pressure."
​d "The glucocorticoid will prevent my body from rejecting the new​ kidney."
c
(An appropriate intervention for a client with disturbed body image is to encourage the expression of feelings related to the disease process and the treatments. While support groups are​ encouraged, the nurse would not recommend that the client speak to an adolescent client with chronic renal failure. While offering written information regarding treatment is​ important, this intervention is not appropriate for a client with disturbed body image. Telling the client to increase her physical activity to avoid gaining weight is not therapeutic.)
Ms. Simpson is a​ 26-year-old woman who was diagnosed with polycystic kidney disease at birth and has developed chronic renal failure. She began receiving peritoneal dialysis a few weeks ago. While the nurse is teaching Ms. Simpson about how to care for her peritoneal​ catheter, she​ says, "I look so fat doing this​ dialysis!" Which nursing action would help Ms. Simpson cope with her disturbed body​ image?

a Recommend that Ms. Simpson increase her physical activity to be sure that she does not gain weight.
b Offer Ms. Simpson some written information regarding the technical aspects of her dialysis procedure.
c Encourage expression of feelings related to her disease and​ treatment, and their impact on her life.
d Recommend that Ms. Simpson speak with adolescents who also have developed chronic renal failure.
a
(Rationale:
Administering an​ angiotensin-converting enzyme inhibitor like enalapril will reduce systemic hypertension and preserve renal function. Assessing the arteriovenous fistula is an important nursing intervention to preserve the patency of the fistula and reduce the risk of​ infection, not preserve renal perfusion. The kidney with chronic disease is unable to excrete protein​ by-products, causing the multisystemic effects of uremia. Monitoring the​ client's protein intake will address these effects but does not directly preserve renal perfusion. An increase in white blood cells can indicate infection but does not directly affect renal perfusion.)
The nurse knows that preserving renal perfusion is important in the care of a client with chronic renal disease. Which intervention supports this​ principle?
a Administering an​ angiotensin-converting enzyme inhibitor per orders
b Monitoring the​ client's protein intake
c Assessing the arteriovenous fistula on every shift
d Monitoring the white blood cell count
a
(Rationale
The client with ESRD will often experience a disturbance in body image. The client should be encouraged to express feelings in an accepting environment. Referral for mental health counseling may be indicated for a client with chronic renal disease.​ However, the nurse should make​ open-ended statements to allow the client to express feelings. The client should be supported in an environment without criticism. The nurse should not support denial. The client should be encouraged to participate in​ self-care.)
A client with​ end-stage renal disease​ (ESRD) tells the​ nurse, "I feel like half a person. How can I go out in public looking like​ this?" What is the nurse​'s best​ response?

​a "You seem to be upset about the changes that have occurred in your body as a result of your​ disease."
b ​"Would you like to speak with the hospital​ chaplain?"
​c "You do not look all that bad. Would you like me to help you wash your​ hair?"
​d "You should be happy that you are​ alive."
a
(Rationale
Jehovah​'s Witness clients typically have strong beliefs regarding blood transfusions. Jehovah​'s Witness clients are not known to refuse medications prior to surgery. The client may or may not request counsel from their elder​ (pastor), but will not request counsel from a spiritual leader of another faith.)
The nurse is providing care to a client with chronic renal failure. The nurse reads in the medical record that the client is a Jehovah​'s Witness. The client is scheduled to receive a kidney transplant in several weeks. Which action does the nurse expect from this​ client?

a To adhere to the beliefs of Jehovah​'s Witnesses regarding blood transfusions
b To sign a consent for donor transfusion during the surgery
c To refuse all medications prior to surgery
d To request counsel from the hospital chaplain
b,e
(​Rationale:
High levels of urea mixing with sweat can result in uremic​ frost, crystallized deposits of urea on the skin. The condition will cause pruritus. Bruising is a common manifestation of chronic renal​ failure, but this manifestation is caused by impaired platelet function. Clients with ESRD may develop a yellowish tinge to the skin because of retained pigmented​ metabolites, but a yellowed sclera is significant of other disease processes. Dry skin with poor turgor is a common dermatological assessment in clients with ESRD.)
The nurse is providing care to a client diagnosed with chronic renal failure. Which assessment findings are consistent with​ uremia?
​(Select all that​ apply.)
a Yellow color noted on the​ client's sclera
b Crystals noted on the​ client's skin
c Bruising noted on upper extremities
d Moist skin noted on palpation
e Client complaints of pruritus
a,b
(Rationale
​Long-term renal complications of diabetes involve thickening and sclerosis of the glomerular basement membrane and the gradual destruction of the nephron unit. Diabetes and hypertension are the leading cause of​ end-stage renal disease. It is important to have good control over both blood pressure and blood sugar as a preventive measure against chronic renal failure. Frequent​ follow-up of laboratory work is important for a client with diabetes and hypertension. Daily monitoring of blood pressure and blood sugar will assist the client in maintaining good control over the disease processes.)
The nurse is teaching a client about the​ long-term complications of diabetes and hypertension. The nurse knows that additional teaching is required when the client makes which​ statements? (Select all that​ apply.)

​a "My doctor told me the only thing I need to worry about with my high blood pressure is a heart attack or​ stroke."
​b "I don​'t need to worry about my kidneys because diabetes is about sugar in the​ blood."
c It is important that I get my laboratory work drawn like the doctor​ orders."
​d "I will try to have good control over my blood​ pressure."
​e "I will check my blood sugar and blood pressure every​ day."
b
(​Rationale:
Peritoneal dialysis uses the peritoneal membrane as the dialyzing surface. Metabolic wastes and excess electrolytes diffuse into the dialysate in the​ abdomen, and an osmotic gradient pulls excess fluid from the blood. Hemodialysis is the process in which the blood volume is filtered through an external filter to remove toxins and excess fluid from the blood. The dialysate fluid does not diffuse into the bloodstream. It remains in the peritoneal space. Fluid is not exchanged in peritoneal dialysis. The same fluid that infuses into the abdomen is what is drained several hours later.)
A client receiving peritoneal dialysis asks the nurse how it works. What is the​ nurse's best​ response?
a ​"Your blood is filtered through an external filter that will pull excess fluid and toxins out of your​ blood."
​b "The fluid that infuses into your abdomen will pull fluid and toxins from the​ bloodstream, and then the waste products will drain from your​ abdomen."
​c "Your body exchanges the fluid in the bloodstream with the clean fluid in the​ abdomen, and then the fluid with the toxins drains​ out."
​d "The fluid that infuses into your abdomen diffuses into the blood and dilutes the​ toxins."
THIS SET IS OFTEN IN FOLDERS WITH...