A client with acute kidney injury states, "Why am I twitching and my fingers and toes tingling?" Which process should the nurse consider when formulating a response to this client?
1
Acidosis
2 Calcium depletion
3
...
A client with acute kidney injury states, "Why am I twitching and my fingers and toes tingling?" Which process should the nurse consider when formulating a response to this client?
1
Acidosis
2 Calcium depletion
3 Potassium retention
4
Sodium chloride depletion
30.
A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication?
1
Peritonitis
2
Hepatitis B
3
Renal calculi
4
Bladder infection
32.
A client with the diagnosis of chronic kidney disease develops hypocalcemia. Which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit? Select all that apply.
1
Acidosis
2
Lethargy
3
Fractures
4
Osteomalacia
5
Eye calcium deposits
42.
An older adult client is admitted to the hospital with a diagnosis of chronic kidney disease. The nurse reviews the client’s medical record. Which clinical finding is a priority to be communicated to the primary healthcare provider?
1
Sodium level
2
Potassium level
3
Creatinine results
4
Blood pressure results
43.
A client is admitted to the hospital with a diagnosis of severe chronic kidney disease. Which assessment findings should the nurse expect the client to exhibit? Select all that apply.
1
Polyuria
2
Paresthesias
3
Hypertension
4
Metabolic alkalosis
5
Widening pulse pressure
89.
What clinical indicators should the nurse expect a client with hyperkalemia to exhibit? Select all that apply.
1
Tetany
2
Seizures
3
Confusion
4
Weakness
5
Dysrhythmias
90.
A nurse on the Code Blue/Arrest team responds to a code that is called for a client with hyperkalemia who is experiencing cardiac standstill. What would an appropriate immediate treatment plan include?
1
Defibrillation
2
Furosemide
3
Sodium bicarbonate
4
Anticoagulation therapy
The nurse is caring for four different clients admitted with fluid overload. Which client should be considered a priority requiring immediate care?
1
Client A
2
Client B
3
Client C
4
Client D
102.
The laboratory reports of a client reveal that the serum creatinine value is 7 mg/dL (618.8 mmol/L) and the blood urea nitrogen (BUN) value is 240 mg/dL (85.68 mmol/L). Which integumentary manifestations can be noticed in this client? Select all that apply.
1
Pruritus
2
Clubbing
3
Cyanosis
4
Ecchymosis
5
Uremic frost
103.
The primary healthcare provider instructs the nurse to monitor serum creatinine and blood urea nitrogen in a client who is on therapy for burn wounds. Which medication most likely has been prescribed to the client?
1
Nitrofurantoin
2
Mafenide acetate
3
Silver sulfadiazine
4
Gentamicin sulfate
12.
A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed?
1
It equals the expected urinary output for the next 24 hours.
2
It will prevent the development of pneumonia and a high fever.
3
It will compensate for both insensible and expected output over the next 24 hours.
4
It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.
14.
A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action should the nurse take first?
1
Alert the cardiac arrest team.
2
Call the laboratory to repeat the test.
3
Take vital signs and notify the primary healthcare provider.
4
Obtain an electrocardiogram (ECG) strip and obtain an antiarrhythmic medication.
15.
A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed?
1
It equals the expected urinary output for the next 24 hours.
2
It will prevent the development of pneumonia and a high fever.
3
It will compensate for both insensible and expected output over the next 24 hours.
4
It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.
A client with acute kidney injury moves into the diuretic phase after 1 week of therapy. For which clinical indicators during this phase should the nurse assess the client? Select all that apply.
1
Skin rash
2
Dehydration
3
Hypovolemia
4
Hyperkalemia
5
Metabolic acidosis
17.
A nurse is caring for a client with acute kidney injury. Which findings should the nurse anticipate when reviewing the laboratory report of the client’s blood level of calcium, potassium, and creatinine? Select all that apply.
1
Calcium: 7.6 mg/dL (1.9 mmol/L)
2
Calcium: 10.5 mg/dL (2.6 mmol/L)
3
Potassium 6.0 mEq/L (6.0 mmol/L)
4
Potassium 3.5 mEq/L (3.5 mmol/L)
5
Creatinine: 3.2 mg/dL (194 mcmol/L)
6
Creatinine: 1.1 mg/dL (90 mcmol/L)
A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse’s best response?
1
“It prevents the development of serious heart problems.”
2
“It helps perform some of the work usually done by the kidneys.”
3
“It will keep your kidneys from getting worse and may ‘restart’ your kidneys to perform better than before.”
4
“It speeds recovery because the kidneys are not responding to regulating hormones.”
20.
A nurse is caring for a client with acute kidney injury who is receiving a protein-restricted diet. The client asks why this diet is necessary. Which information should the nurse include in a response to the client’s questions?
1
A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses.
2
Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis.
3
This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.
4
Urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amino acid synthesis must come from the dietary protein.
21.
The nurse is assessing a pediatric client diagnosed with chronic renal failure exhibiting alterations in growth patterns. When educating the client’s parents about the child’s growth, which statement is accurate?
1
"Your child’s poor growth is most likely caused by sustained alkalosis."
2
"The hypotension associated with your child’s diagnosis is causing poor growth."
3
"Your child’s poor growth is most likely caused by the carbohydrate restrictions."
4
"Resistance to growth hormone associated with your child’s diagnosis is causing poor growth."
22.
A client with chronic renal failure has been on hemodialysis for 2 years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client’s behavior is most likely for which reason?
1
An attempt to punish the nursing staff
2
A constructive method of accepting reality
3
A defense against underlying depression and fear
4
An effort to maintain life and to live it as fully as possible
A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet. What is the rationale for the nurse’s instruction?
1
A person’s body tends to retain fluid when a salt substitute is included in the diet.
2
Limiting salt substitutes in the diet prevents a buildup of waste products in the blood.
3
Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats.
4
A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca.
A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary?
1
"I realize it is important to take this medication because it will cure my anemia."
2
"I know many ways to protect myself from injury because I am at risk for seizures."
3
"I recognize that I may still need blood transfusions if my blood values are very low."
4
"I understand that I will still have to take supplemental iron therapy with this medication."
25.
A client with chronic renal failure stops responding to the treatment. On examination, the primary healthcare provider determines that the client is terminally ill. What is the best nursing intervention in this situation?
1
Suggest that the family members get a second opinion.
2
Suggest that the family members continue to try different treatments.
3
Encourage the family members to provide pallative care to the client.
4
Inform the family members that the disease is no longer curable and the client will die shortly.
26.
A nurse administers sodium polystyrene sulfonate to a client with chronic renal failure. Which finding provides evidence that the intervention is effective?
1
Frequent loose stools
2
Improved mental status
3
Sodium increases to 137 mEq/L (137 mmol/L)
4
Potassium decreases to 4.2 mEq/L (4.2 mmol/L)
27.
A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end-stage renal disease (ESRD)?
1
Fluid
2
Protein
3
Sodium
4
Potassium
28.
29.
When receiving hemodialysis, the client may develop hyponatremia. For which clinical findings associated with hyponatremia should the nurse assess the client? Select all that apply.
1
Diarrhea
2
Seizures
3
Chvostek sign
4
Cardiac dysrhythmias
5
Increased temperature
33.
A nurse is caring for a client with a diagnosis of chronic kidney failure who has just been told by the primary healthcare provider that hemodialysis is necessary. Which clinical manifestation indicates the need for hemodialysis?
1
Ascites
2
Acidosis
3
Hypertension
4
Hyperkalemia
34.
A client is to have hemodialysis. What must the nurse do before this treatment?
1
Obtain a urine specimen to evaluate kidney function.
2
Weigh the client to establish a baseline for later comparison.
3
Administer medications that are scheduled to be given within the next hour.
4
Explain that the peritoneum serves as a semipermeable membrane to remove wastes.
35.
A nurse is caring for a client with end-stage renal disease who has a mature arteriovenous (AV) fistula. Which nursing care should be included in the client’s plan of care? Select all that apply.
1
Auscultate for a bruit.
2
Palpate the site to identify a thrill.
3
Irrigate with saline to maintain patency.
4
Avoid drawing blood from the affected extremity.
5
Keep the fistula clamped until ready to perform dialysis.
37.
To prepare for hemodialysis, a client with end-stage kidney disease is scheduled for surgery, specifically for the creation of an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. When considering care for these sites, which difference will the nurse consider?
1
The graft is more subject to hemorrhage, clotting, and infection than the fistula is.
2
Blood pressure readings can be taken in the arm with the fistula but not in the one with the shunt.
3
Intravenous (IV) fluids can be administered in the arm with the shunt but not in the one with the fistula.
4
The fistula should be covered with a light dressing, and the shunt should be covered thoroughly with a heavy dressing.
To prepare for hemodialysis, a client with end-stage kidney disease is scheduled for surgery, specifically for the creation of an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. When considering care for these sites, which difference will the nurse consider?
1
The graft is more subject to hemorrhage, clotting, and infection than the fistula is.
2
Blood pressure readings can be taken in the arm with the fistula but not the one with the shunt.
3
Intravenous (IV) fluids can be administered in the arm with the shunt but not the one with the fistula.
4
The fistula should be covered with a light dressing, and the shunt should be covered thoroughly with a heavy dressing.
40.
A nurse is caring for a client with chronic kidney failure. Which clinical findings should the nurse expect when assessing this client? Select all that apply.
1
Polyuria
2
Lethargy
3
Hypotension
4
Muscle twitching
5
Respiratory acidosis
41.
A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information?
1
Prevention of uremic frost
2
Prevention of chronic fatigue
3
Prevention of tubular necrosis
4
Prevention of dependent edema
44.
A nurse evaluates that a client with chronic kidney disease understands an adequate source of high biologic-value (HBV) protein when the client selects which food from the menu?
1
Apple juice
2
Raw carrots
3
Cottage cheese
4
Whole wheat bread
45.
A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client’s spouse asks the nurse about the anticipated plan of care. Which is an appropriate nursing response?
1
"The staff will provide total care, because the infection causes severe fatigue."
2
"Mood elevators will be prescribed to improve depression and irritability."
3
"Vitamin B12 will be prescribed for the anemia, and the stools will be dark."
4
"The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."
46.
A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency?
1
Facial flushing
2
Edema and pruritus
3
Dribbling after voiding and dysuria
4
Diminished force and caliber of stream
47.
A nurse anticipates that dialysis will be necessary for a 12-year-old child with chronic kidney disease when the child begins to exhibit which symptom?
1
Hypotension
2
Hypokalemia
3
Hypervolemia
4
Hypercalcemia
48.
Which type of cytokine is used to treat anemia related to chronic kidney disease?
1
α-Interferon
2
Interleukin-2
3
Interleukin-11
4
Erythropoietin
A nurse is caring for a client with renal failure. The client wants to go back home but the family members want the client to undergo a kidney transplant. The nurse gives details about the possible threats and benefits of the surgery to the family and informs them that the client wants to stay home. What role does the nurse play here?
1
Educator
2
Manager
3
Caregiver
4
Advocate
50.
A nurse is caring for a client with end-stage kidney disease who is about to receive a transplant. When the client returns from the postanesthesia care unit after a kidney transplant, how often should the nurse measure the client’s urinary output?
1
1 hour
2
2 hours
3
15 minutes
4
30 minutes
52.
A client has end-stage kidney disease and is admitted for a kidney transplant. Which information should the nurse share when teaching about the donor?
1
Must have the same blood type
2
Must be a member of the same family
3
Must be approximately the same body size
4
Must have matching leukocyte antigen complexes
53.
A client with end-stage kidney disease says to the nurse, "I heard that it is inevitable that I will need a kidney transplant. If so, which one of my kidneys will be removed?" Which is the best response by the nurse?
1
"Neither of your kidneys will be removed unless they are infected."
2
"The kidney that is the most diseased is removed and replaced with a new one."
3
"It is up to the primary healthcare provider as to which kidney is replaced with a new one."
4
"Your right kidney will be removed, because it has a longer renal vein, making transplantation easier."
54.
56.
The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. What does the nurse identify as the purpose of these drugs?
1
Stimulate leukocytosis
2
Provide passive immunity
3
Prevent iatrogenic infection
4
Reduce antibody production
57.
59.
A nurse is caring for a client with end-stage kidney disease after a kidney transplant. Which finding indicates the transplant is successful?
1
Increased specific gravity
2
ion of hypotension
3
Elevated serum potassium
4
Decreasing serum creatinine
A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy?
1
"It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration."
2
"It exchanges and cleanses blood by ion of electrolytes and excretion of creatinine."
3
"It decreases the need for immobility because it clears toxins in short and intermittent periods."
4
"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."
69.
A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy?
1
"It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration."
2
"It exchanges and cleanses blood by ion of electrolytes and excretion of creatinine."
3
"It decreases the need for immobility, because it clears toxins in short and intermittent periods."
4
"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."
70.
A nurse is caring for a client with a diagnosis of benign prostatic hyperplasia (BPH). Which information about this condition is important for the nurse to consider when caring for this client?
1
It is a congenital abnormality.
2
A malignancy usually results.
3
It predisposes to hydronephrosis.
4
Prostate-specific antigen decreases.
72.
A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result will the nurse check to confirm the diagnosis?
1
Rectal examination
2
Serum phosphatase level
3
Biopsy of prostatic tissue
4
Massage of prostatic fluid
73.
The healthcare provider prescribes finasteride for a client with benign prostatic hyperplasia. What information does the nurse provide to the client?
1
Male pattern baldness can occur.
2
Results can be expected in 4 to 6 weeks.
3
The medication relaxes the muscles in the bladder neck, making it easier to urinate.
4
Protection should be worn during intercourse with a pregnant female.
74.
When admitting a client with benign prostatic hyperplasia, which assessment made by the nurse is most relevant?
1
Perineal edema
2
Urethral discharge
3
Flank pain radiating to the groin
4
Distention of the lower abdomen
75.
A client is admitted to the hospital with a tentative diagnosis of urinary retention related to benign prostatic hyperplasia. The primary healthcare provider notes a secondary diagnosis of delirium related to urosepsis and prescribes the insertion of an indwelling urinary retention catheter. Which nursing action is most important at this time?
1
Secure a prescription for wrist restraints.
2
Orient the client to time, place, and person.
3
Involve family members in the client’s care.
4
Determine whether any unsafe behavior patterns exist.
76.
77.
If a client on peritoneal dialysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate solution, what should the nurse do?
1
Increase the rate of infusion.
2
Auscultate the lungs for breath sounds.
3
Place the client in a low-Fowler position.
4 Drain the fluid from the peritoneal cavity.
78.
A nurse is evaluating a client’s understanding of peritoneal dialysis. Which information in the client’s response indicates an understanding of the purpose of the procedure?
1
Reestablishing kidney function
2
Cleaning the peritoneal membrane
3
Providing fluid for intracellular spaces
4
Removing toxins in addition to other metabolic wastes
79.
80.
The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled into the peritoneal cavity. Which information will the nurse share with the client?
1
Because it forces potassium back into the cells, thereby decreasing serum levels
2
Because it adds extra warmth to the body because metabolic processes are disturbed
3
Because it helps prevent cardiac dysrhythmias by speeding up removal of excess potassium
4
Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels
82.
A client in end-stage kidney disease is receiving peritoneal dialysis. What should the nurse do when caring for this client?
1
Maintain the client in the supine position during the entire procedure.
2
Position the client from side to side if fluid is not draining adequately.
3
Remove the cannula at the end of the procedure, applying a dry, sterile dressing.
4
Notify the primary healthcare provider if there is a deficit of 100 mL in the drainage return.
83.
A client with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The nurse should monitor the client for which peritoneal dialysis complications? Select all that apply.
1
Pruritus
2
Oliguria
3
Tachycardia
4
Cloudy outflow
5
Abdominal pain
85.
During the infusion of dialysate during peritoneal dialysis, the client exhibits symptoms of severe respiratory difficulty. What should the nurse do?
1 Slow the rate of the client's infusion
2 Place the client in a low-Fowler position
3 Auscultate the client's lungs for breath sounds
4 Drain the fluid from the client's peritoneal cavity
86.
A client who is receiving peritoneal dialysis reports severe respiratory difficulty. What immediate action should the nurse implement?
1 Auscultate the lungs.
2 Obtain arterial blood gases.
3 Notify the healthcare provider.
4 Apply pressure to the abdomen.
87.
The nurse reviews a medical record and is concerned that the client may develop hyperkalemia. Which disease increases the risk of hyperkalemia?
1
Crohn disease
2
Cushing disease
3
End-stage renal disease
4
Gastroesophageal reflux disease
91.
Which medication requires the nurse to monitor the client for signs of hyperkalemia?
1
Furosemide
2
Metolazone
3
Spironolactone
4
Hydrochlorothiazide
92.
A client’s laboratory report indicates hyperkalemia. Which responses should the nurse expect the client to exhibit? Select all that apply.
1
Anorexia
2
Vomiting
3
Constipation
4
Muscle weakness
5
Irregular heart rate
94.
What clinical finding does a nurse anticipate when admitting a client with an extracellular fluid volume excess?
1
Rapid, thready pulse
2
Distended jugular veins
3
Elevated hematocrit level
4
Increased serum sodium level
Which nursing intervention should the nurse consider to be a priority for clients with fluid overload?
1 Ensuring client safety
2 Providing drug therapy
3 Providing nutritional therapy
4 Preventing future fluid overload
97.
The nurse is caring for a client admitted with fluid overload. Which tasks are mostappropriate to be delegated to the patient care associate? Select all that apply.
1
Documenting vital signs
2
Documenting urine output
3
Assessing the laboratory findings
4
Administering diuretic intravenously
5
Repositioning the client every one or two hours
98.
A client who experienced extensive burns is receiving intravenous fluids to replace fluid loss. The nurse should monitor for which initial sign of fluid overload?
1
Crackles in the lungs
2
Decreased heart rate
3
Decreased blood pressure
4
Cyanosis
99.
Which complications does the nurse expect in the client with a renal disorder who has a blood urea nitrogen (BUN)/creatinine ratio of 28? Select all that apply.
1
Malnutrition
2
Hepatic damage
3
Kidney impairment
4
Fluid volume deficit
5
Obstructive uropathy
100.
Which part of the nephron secretes creatinine required for elimination?
1
Glomerulus
2
Loop of Henle
3
Collecting duct
4
Proximal tubule
104.
While performing diagnostic tests on a client with a urinary tract infection, the nurse documents the urine creatinine value as 0.9 mg/dL and serum creatinine level as 1.0 mg/dL. The volume of urine collected is 100 mL/min. What is the creatinine clearance of the client? Record your answer using a whole number. _____
Error! Filename not specified.
105.
A nurse is caring for a 6-year-old child with a diagnosis of glomerulonephritis. The child's urine output decreases to less than 100 mL/24 hr, the creatinine clearance is 60 mL/min, and there is an irregular apical pulse. A diagnosis of acute renal failure is made. Blood is drawn for testing. Which serum level requires immediate intervention?
1
Sodium 126 mEq/L (126 mmol/L)
2
Bilirubin 0.3 mg/dL (5.1 mcmol/L)
3
Creatinine 1.3 mg/dL (114.4 mcmol/L)
4
Potassium 6.1 mEq/L (6.1 mmol/L)
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