NCLEX Renal Function
Terms in this set (21)
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
a) a decreased serum phosphate level secondary to kidney failure.
b) an increased serum calcium level secondary to kidney failure.
c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
d) metabolic alkalosis secondary to retention of hydrogen ions.
C) water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
b) Administer furosemide (Lasix) 20 mg I.V.
c) Encourage oral fluids.
d) Start hemodialysis after a temporary access is obtained.
A) Start IV fluids with normal saline solution bolus followed by a maintenance dose.
Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?
a) Increased red blood cell count
b) Decreased serum potassium level
c) Increased serum calcium level
d) Increased serum creatinine level
D) Increased serum creatinine level
Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
a) Serum sodium level of 135 mEq/L
b) Serum potassium level of 4.9 mEq/L
c) Temperature of 99.2° F (37.3° C)
d) Urine output of 20 ml/hour
D) Urine output of 20 ml/hour
Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
a) "The effluent should be allowed to drain by gravity."
b) "It is important to use strict aseptic technique."
c) "The infusion clamp should be open during infusion."
d) "It is appropriate to warm the dialysate in a microwave."
D) It is appropriate to warm the dialysate in a microwave
Explanation: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
a) Impaired urinary elimination
b) Toileting self-care deficit
c) Risk for infection
d) Activity intolerance
C) Risk for infection
Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
a) Check for thrill or bruit over the access site.
b) Warm the solution to body temperature.
c) Inspect the catheter insertion site for infection.
d) Add the prescribed drug to the dialysate.
A) Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?
a) Therapeutic index
b) GI absorption rate
c) Liver function studies
d) Creatinine clearance
D) Creatinine clearance
The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
a) Urine output of 250 ml/24 hours
b) Temperature of 100.2° F (37.8° C)
c) Serum creatinine level of 1.2 mg/dl
d) Blood urea nitrogen (BUN) level of 22 mg/dl
A) Urine output of 250 ml/24 hours
ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find?
a) Decreased blood urea nitrogen (BUN)
b) Decreased potassium
c) Increased serum albumin
d) Increased serum creatinine
D) Increased serum creatinine
In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
Retention of which electrolyte is the most life-threatening effect of renal failure?
Retention of potassium is the most life-threatening effect of renal failure.
A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing?
Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.
Patients diagnosed with hypervolemia should avoid sweet or dry food because:
a) It obstructs water elimination.
b) It can cause dehydration.
c) It can lead to weight gain.
d) It increases the client's desire to consume fluid.
D) It increases the client's desire to consume fluid
The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed, and the client is advised to take limited amount of fluid when thirsty. Sweet or dry food can increase the client's desire to consume fluid. Sweet or dry food does not obstruct water elimination nor does it cause dehydration. Weight regulation is not part of hypervolemia management except to the extent that it is achieved on account of fluid reduction.
Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?
a) Give medications that promote fluid retention.
b) Limit sodium and water intake.
c) Teach client behaviors that decrease urination.
d) Assess for dehydration.
B) Limit sodium and water intake
Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?
a) Perform deep-breathing exercises vigorously.
b) Avoid carrying heavy items.
c) Auscultate the lungs frequently.
d) Wear a mask when performing exchanges.
D) Wear a mask when performing exchanges
The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
a) Weight loss
c) Absence of pain
Fever is an indicator of infection or transplant rejection.
A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse?
a) Renal circulation
b) Urine production
c) Kidney function
d) Kidney structure
A) Renal circulation
A renal angiogram (renal arteriogram) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.
The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program?
b) Diabetes mellitus
c) Neuromuscular disorders
Hypertension, not hypotension, is a risk factor for kidney disease.
A patient with an obstruction of the renal artery causing renal ischemia exhibits HTN. One factor that may contribute to HTN:
a) increase renin release
b) increased ADH secretion
c) decreased aldosterone secretion
d) increased synthesis and release of prostaglandins
A) Increase Renin Release
Renin is released in resonse to decreased B/P, renal ischemia, eosinophil chemotactic factor (ECF) depletion, and other factors affecting blood suppy to the kidney. It is they catalyst of the renin-angiotensin-aldosterone system, which raises B/P when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted within the renin-angiotensin II, and kidney prostaglandins lower B/P by causing vasodilation.
A clinical situation in which the increased release of erythropoietin would be expected is:
d) fluid overload
Erythropoietin is released when the oxygen tension of the renal blood supply is low and stimulates production of red blood cells in the bone marrow. Hypotension causes activation of the renin-angiotensin-aldosterone system, as well as release of ADH. Hyperkalemis stimulates release of aldosterone from the adrenal cortex, and fluid overload does not directly stimulate factors affecting the kidney.