Acute and Chronic Renal Failure and dialysis

37. A client is to receive peritoneal dialysis. To prepare for the procedure, the nurse should:

1. Assess the dialysis access for a bruit and thrill.

2. Insert an indwelling urinary catheter and drain all urine from the bladder.

3. Ask the client to turn toward the left side.

4. Warm the solution in the warmer.

4.

38. A client has been admitted with acute renal failure. What should the nurse do? Select all that apply.

1. Elevate the head of the bed 30 to 45 degrees.

2. Take vital signs.

3. Establish an IV access site.

4. Call the admitting physician for prescriptions.

5. Contact the hemodialysis unit.

1, 2, 3, 4.

39. Which of the following is the most common initial manifestation of acute renal failure?

1. Dysuria.

2. Anuria.

3. Hematuria.

4. Oliguria.

4

40. A client developed cardiogenic shock after a severe myocardial infarction and has now developed acute renal failure. The

client's family asks the nurse why the client has developed acute renal failure. The nurse should base the response on the knowledge that

there was:

1. A decrease in the blood flow through the kidneys.

2. An obstruction of urine flow from the kidneys.

3. A blood clot formed in the kidneys.

4. Structural damage to the kidney resulting in acute tubular necrosis

1.

41. The client who is in acute renal failure has an elevated blood urea nitrogen (BUN). What is the likely cause of this finding?

1. Fluid retention.

2. Hemolysis of red blood cells.

3. Below-normal metabolic rate.

4. Reduced renal blood flow.

4

42. The client's serum potassium level is elevated in acute renal failure, and the nurse administers sodium polystyrene sulfonate

(Kayexalate). This drug acts to:

1. Increase potassium excretion from the colon.

2. Release hydrogen ions for sodium ions.

3. Increase calcium absorption in the colon.

4. Exchange sodium for potassium ions in the colon.

4

43. A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for:

1. Cardiac arrest.

2. Pulmonary edema.

3. Circulatory collapse.

4. Hemorrhage.

1

44. A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The intended outcome of this diet is to:

1. Act as a diuretic.

2. Reduce demands on the liver.

3. Help maintain urine acidity.

4. Prevent the development of ketosis.

4

45. The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which of the

following snacks is most appropriate?

1. A gelatin dessert.

2. Yogurt.

3. An orange.

4. Peanuts.

1

46. In the oliguric phase of acute renal failure, the nurse should assess the client for:

1. Pulmonary edema.

2. Metabolic alkalosis.

3. Hypotension.

4. Hypokalemia.

1

47. The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which of the following nursing

measures is appropriate for the care of this client?

1. Use the unaffected arm for blood pressure measurements.

2. Draw blood from the cannula for routine laboratory work.

3. Percuss the cannula for bruits each shift.

4. Inject heparin into the cannula each shift.

1

48. During the first hemodialysis treatment, the client develops a headache, confusion, and nausea. The nurse should assess the

client further for:

1. Disequilibrium syndrome.

2. Myocardial infarction.

3. Air embolism.

4. Peritonitis.

1

49. During dialysis, the client has disequilibrium syndrome. The nurse should first:

1. Administer oxygen per nasal cannula.

2. Slow the rate of dialysis.

3. Reassure the client that the symptoms are normal.

4. Place the client in Trendelenburg's position.

2

50. The client receives heparin while receiving hemodialysis. The nurse explains the rationale supporting anticoagulation by making

which of the following statements?

1. "Regional anticoagulation is achieved by putting heparin in the dialysis machine and protamine sulfate, which reverses the

anticoagulation, in the client."

2. "You will receive warfarin sodium (Coumadin) to maintain anticoagulation between treatments."

3. "Heparin does not enter the body, so there is no risk of bleeding."

4. "Clotting time is seriously prolonged for several hours after each treatment."

1

51. Which of the following abnormal blood values would not be improved by dialysis treatment?

1. Elevated serum creatinine level.

2. Hyperkalemia.

3. Decreased hemoglobin concentration.

4. Hypernatremia.

3

52. The nurse teaches the client how to recognize infection in the shunt by telling the client to assess the shunt each day for:

1. Absence of a bruit.

2. Sluggish capillary refill time.

3. Coolness of the involved extremity.

4. Swelling at the shunt site.

4

53. The client with acute renal failure is recovering and asks the nurse, "Will my kidneys ever function normally again?" The nurse's

response is based on knowledge that the client's renal status will most likely:

1. Continue to improve over a period of weeks.

2. Result in the need for permanent hemodialysis.

3. Improve only if the client receives a renal transplant.

4. Result in end-stage renal failure.

1

79. A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula the nurse should:

1. Take the blood pressure in the arm with the fistula.

2. Report the loss of a thrill or bruit on the arm with the fistula.

3. Auscultate for a thrill and palpate for a bruit on the arm with the fistula.

4. Start a second IV in the arm with the fistula.

3

80. A client with chronic renal failure who receives hemodialysis three times a week is experiencing severe nausea. What should the

nurse advise the client to do to manage the nausea? Select all that apply.

1. Drink fluids before eating solid foods.

2. Have limited amounts of fluids only when thirsty.

3. Limit activity.

4. Keep all dialysis appointments.

5. Eat smaller, more frequent meals.

2, 4, 5.

81. The dialysis solution is warmed before use in peritoneal dialysis primarily to:

1. Encourage the removal of serum urea.

2. Force potassium back into the cells.

3. Add extra warmth to the body.

4. Promote abdominal muscle relaxation.

1

82. Which of the following assessments would be most appropriate for the nurse to make while the dialysis solution is dwelling

within the client's abdomen?

1. Assess for urticaria.

2. Observe respiratory status.

3. Check capillary refill time.

4. Monitor electrolyte status.

2

83. During the client's dialysis, the nurse observes that the solution draining from the abdomen is consistently blood-tinged. The client

has a permanent peritoneal catheter in place. The nurse should interpret that the bleeding:

1. Is expected with a permanent peritoneal catheter.

2. Indicates abdominal blood vessel damage.

3. Can indicate kidney damage.

4. Is caused by too-rapid infusion of the dialysate.

2

84. During dialysis, the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should:

1. Have the client sit in a chair.

2. Turn the client from side to side.

3. Reposition the peritoneal catheter.

4. Have the client walk.

2

85. A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter.

To determine if the catheter is obstructed, the nurse should inquire whether the client has:

1. Diarrhea.

2. Vomiting.

3. Flatulence.

4. Constipation.

4

86. Which of the following nursing interventions should be included in the client's plan of care during dialysis therapy?

1. Limit the client's visitors.

2. Monitor the client's blood pressure.

3. Pad the side rails of the bed.

4. Keep the client on nothing-by-mouth (NPO) status.

2

87. The client performs self peritoneal dialysis. What should the nurse teach the client about preventing peritonitis? Select all that

apply.

1. Broad-spectrum antibiotics may be administered to prevent infection.

2. Antibiotics may be added to the dialysate to treat peritonitis.

3. Clean technique is permissible for prevention of peritonitis.

4. Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort.

5. Peritonitis is the most common and serious complication of peritoneal dialysis.

1, 2, 4, 5.

88. After completion of peritoneal dialysis, the nurse should assess the client for which of the following?

1. Hematuria.

2. Weight loss.

3. Hypertension.

4. Increased urine output.

2

89. Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the expected

outcome of giving this drug?

1. Relieving the pain of gastric hyperacidity.

2. Preventing Curling's stress ulcers.

3. Binding phosphate in the intestine.

4. Reversing metabolic acidosis.

3

90. The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel (Amphojel). Which of the following

statements would indicate that the client understands the teaching?

1. "I'll take it every 4 hours around the clock."

2. "I'll take it between meals and at bedtime."

3. "I'll take it when I have an upset stomach."

4. "I'll take it with meals and bedtime snacks."

4

91. The client with chronic renal failure takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests

that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:

1. Milk of magnesia can cause magnesium intoxication.

2. Milk of magnesia is too harsh on the bowel.

3. Metamucil is more palatable.

4. Milk of magnesia is high in sodium.

1

92. The nurse is determining which teaching approaches for the client with chronic renal failure and uremia would be most

appropriate. The nurse should:

1. Provide all needed teaching in one extended session.

2. Validate the client's understanding of the material frequently.

3. Conduct a one-on-one session with the client.

4. Use videotapes to reinforce the material as needed.

2

93. The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which of the following diets

would be most appropriate?

1. High-carbohydrate, high-protein.

2. High-calcium, high-potassium, high-protein.

3. Low-protein, low-sodium, low-potassium.

4. Low-protein, high-potassium.

3

94. The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which one of the following

strategies would be most useful?

1. Help the client to accept that sexual activity will be decreased.

2. Suggest using alternative forms of sexual expression and intimacy.

3. Tell the client to plan rest periods after sexual activity.

4. Suggest that the client avoid sexual activity to prevent embarrassment.

2

95. A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD)

program. The nurse should explain that the major advantage of this approach is that it:

1. Is relatively low in cost.

2. Allows the client to be more independent.

3. Is faster and more efficient than standard peritoneal dialysis.

4. Has fewer potential complications than standard peritoneal dialysis.

2

96. The client asks about diet changes when using continuous ambulatory peritoneal dialysis (CAPD). Which of the following would

be the nurse's best response?

1. "Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique."

2. "Diet restrictions are the same for both CAPD and standard peritoneal dialysis."

3. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant."

4. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly."

3

97. A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which of the

following signs of peritoneal infection?

1. Cloudy dialysate fluid.

2. Swelling in the legs.

3. Poor drainage of the dialysate fluid.

4. Redness at the catheter insertion site.

1.