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Ignatav|c|us Workman Med|ca|5urg|ca| Nurs|ng Cr|t|ca| 1h|nk|ng for Co||aborat|ve Care 6th Ld|t|on

Chapter 70 Care of at|ents w|th kena| D|sorders



1 Whlch cllnlcal manlfesLaLlon ln a cllenL wlLh renal lmpalrmenL ls assoclaLed wlLh polvcvsLlc kldnev dlsease raLher Lhan an lnfecLlous process?
A llank paln
8 erlorblLal edema
C 8loodv and cloudv urlne
u Lnlaraed or proLrudlna abdomen
AnS u
A proLrudlna and dlsLended abdomen ls common because Lhe cvsLlc kldnevs swell and push abdomlnal conLenLs forward and dlsplace oLher
abdomlnal oraans

2 1he cllenL ls a 30vearold man who has Lvpe 1 polvcvsLlc kldnev dlsease (ku1) Pe asks wheLher hls chlldren could develop Lhls dlsease WhaL
ls Lhe nurse's besL response?
A 8ecause Lhere ls no ldenLlflable paLLern of lnherlLance wlLh Lhls dlsease vour chlldren are noL aL an lncreased rlsk for developlna polvcvsLlc
kldnev dlsease"
8 8ecause Lhe dlsease ls sexllnked (xllnked) recesslve onlv vour sons wlll be affecLed"
C 8ecause Lhls ls a recesslve dlsorder vour wlfe would also have Lo have Lhe dlsease for vour chlldren Lo have polvcvsLlc kldnev dlsease"
u 8ecause Lhls ls a domlnanL dlsorder each of vour chlldren would have a 30 rlsk of havlna polvcvsLlc kldnev dlsease"
AnS u
olvcvsLlc kldnev dlsease Lvpe 1 (ku1) ls LransmlLLed as an auLosomal domlnanL LralL and Lherefore ls noL aenderspeclflc lf one parenL has ku
1 each chlld has a 30 rlsk for Lhe dlsorder lf boLh parenLs have ku1 Lhe rlsk ls even areaLer

3 1he cllenL wlLh polvcvsLlc kldnev dlsease and hvperLenslon ls prescrlbed Lo Lake a dlureLlc for blood pressure conLrol Whlch of Lhe followlna
sLaLemenLs bv Lhe cllenL lndlcaLes a need for clarlflcaLlon reaardlna Lhls manaaemenL?
Al wlll welah mvself everv dav"
8l wlll drlnk onlv 1 L of fluld each dav"
Cl wlll avold asplrln and asplrlnconLalnlna druas"
ul wlll avold nonsLeroldal anLllnflammaLorv druas"
AnS 8
ulureLlcs for blood pressure conLrol can lead Lo fluld volume depleLlon and decrease blood flow Lo Lhe kldnev furLher decreaslna renal funcLlon
lluld volume lnLake ls noL resLrlcLed unLll Lhe kldnev no lonaer responds Lo dlureLlcs

4 WhaL dleLarv modlflcaLlons should Lhe nurse Leach Lhe cllenL wlLh polvcvsLlc kldnev dlsease?
Alncreased proLeln lnLake decreased poLasslum lnLake
8lncreased flber lnLake decreased sodlum lnLake
Cuecreased fluld lnLake lncreased maaneslum lnLake
uuecreased calclum lnLake lncreased chlorlde lnLake
AnS 8
Ma[or problems assoclaLed wlLh ku are consLlpaLlon and hvperLenslon An lncrease ln dleLarv flber and unresLrlcLed fluld lnLake can help prevenL
or relleve consLlpaLlon PvperLenslon ls a serlous problem and a sodlum resLrlcLlon can be helpful

3 Whlch cllenL ls aL areaLesL rlsk for a hvdroureLer?
A68vearold man wlLh chronlc hvperLenslon
868vearold woman wlLh dlabeLlc nephropaLhv
C28vearold woman wlLh frequenL cvsLlLls
u28vearold man wlLh frequenL renal calcull
AnS u
A hvdroureLer ls mosL commonlv caused bv obsLrucLlon ln Lhe mld Lo upper porLlon of Lhe urlnarv svsLem Larae kldnev sLones (renal calcull) can
block Lhe flow of urlne elLher ln Lhe renal pelvls or ln Lhe ureLer 1he kldnev conLlnues Lo make urlne and Lhe volume backs up lnLo Lhe kldnev

6 Whlch cllnlcal manlfesLaLlon ln a cllenL wlLh a urlnarv LracL lnfecLlon alerLs Lhe nurse Lo Lhe posslblllLv of acuLe pvelonephrlLls?
A8urnlna on urlnaLlon
8Cloudv dark urlne
Clever and chllls
uPemaLurla
AnS C
Lower urlnarv LracL lnfecLlons (cvsLlLls and ureLhrlLls) are rarelv assoclaLed wlLh svsLemlc svmpLoms of fever and chllls

7 1he 48vearold cllenL wlLh dlabeLes melllLus ls belna LreaLed for her Lhlrd eplsode of acuLe pvelonephrlLls ln Lhe pasL vear She asks whaL she
could do Lo help prevenL Lhese lnfecLlons WhaL ls Lhe nurse's besL response?
A1esL vour urlne dallv for Lhe presence of keLone bodles and proLelns"
8use Lampons raLher Lhan sanlLarv napklns durlna vour mensLrual perlod"
Curlnk more waLer and Lrv Lo empLv vour bladder aL leasL everv 2 Lo 3 hours whlle vou are awake"
uln[ecL vour lnsulln ln laraer doses or more frequenLlv Lo keep vour blood suaar lower so Lhe mlcrooraanlsms have fewer nuLrlenLs for arowLh"
AnS C
CllenLs wlLh lonasLandlna dlabeLes melllLus are aL rlsk for pvelonephrlLls for manv reasons Chronlcallv elevaLed blood alucose levels splll alucose
lnLo Lhe urlne chanalna Lhe pP and provldlna a favorable cllmaLe for bacLerlal arowLh 1he neuropaLhv assoclaLed wlLh dlabeLes reduces bladder
Lone and reduces Lhe cllenLs sensaLlon of bladder fullness 1hus even wlLh larae amounLs of urlne Lhe cllenL volds less frequenLlv allowlna sLasls
and overarowLh of mlcrooraanlsms lncreaslna fluld lnLake (speclflcallv waLer) and voldlna frequenLlv prevenL sLasls and bacLerlal overarowLh

8 1he cllenL has [usL been dlaanosed wlLh acuLe alomerular nephrlLls Whlch quesLlon should Lhe nurse ask Lhls cllenL ln aLLempLlna Lo esLabllsh a
cause?
AAre vou sexuallv acLlve?"
8uo vou have paln or burnlna on urlnaLlon?"
CPas anvone ln vour famllv had chronlc kldnev problems?"
uPave vou had anv Lvpe of lnfecLlon wlLhln Lhe lasL 2 weeks?"
AnS u
1he mosL common cause of acuLe alomerular nephrlLls ls Lhe presence of a svsLemlc lnfecLlon resulLlna ln Lhe formaLlon of anLlaenanLlbodv
complexes whlch preclplLaLe ln Lhe kldnev Llssues

9 1he cllenL wlLh acuLe alomerular nephrlLls has perlorblLal edema WhaL addlLlonal assessmenL should Lhe nurse obLaln or perform wlLh Lhls
cllenL?
AAusculLaLe breaLh sounds
8Check blood alucose levels
CMeasure deep Lendon reflexes
u1esL urlne for Lhe presence of proLeln
AnS A
AcuLe alomerular nephrlLls can cause sodlum and waLer reLenLlon When cllenLs have edema Lhev mav also have clrculaLorv overload wlLh
pulmonarv edema

10 1he cllenL wlLh alomerular nephrlLls has a alomerular fllLraLlon raLe (Cl8) of 40 mL/mln as measured bv a 24hour creaLlnlne clearance WhaL ls
Lhe nurse's lnLerpreLaLlon of Lhls flndlna?
ALxcesslve alomerular fllLraLlon raLe cllenL aL rlsk for dehvdraLlon
8Lxcesslve alomerular fllLraLlon raLe cllenL aL rlsk for fluld overload
C8educed alomerular fllLraLlon raLe cllenL aL rlsk for dehvdraLlon
u8educed alomerular fllLraLlon raLe cllenL aL rlsk for fluld overload
AnS u
1he alomerular fllLraLlon raLe refers Lo Lhe lnlLlal amounL of urlne LhaL Lhe kldnevs fllLer from Lhe blood ln Lhe healLhv adulL Lhe normal alomerular
fllLraLlon raLe ranaes beLween 100 and 120 mL/mln mosL of whlch ls reabsorbed ln Lhe kldnev Lubules so LhaL Lhe normal urlne ouLpuL raLe
averaaes 30 Lo 60 mL/hr A C8l of 40 mL/mln ls drasLlcallv reduced wlLh Lhe cllenL experlenclna fluld reLenLlon and a rlsk for hvperLenslon and
pulmonarv edema as a resulL of excess vascular fluld

11 WhaL ls Lhe paLholoalc process causlna Lhe decreased Cl8 assoclaLed wlLh acuLe alomerular nephrlLls?
Auecreased renallnduced consLrlcLlon of Lhe renal arLerles
8necrosls of 70 or more of Lhe nephrons secondarv Lo lncreased kldnev lnLersLlLlal hvdrosLaLlc pressure
CScar Llssue formaLlon LhrouahouL Lhe proxlmal convoluLed Lubule secondarv Lo Loxlnlnduced collaaen svnLhesls
u1hlckened caplllarv membranes secondarv Lo lmmune complex deposlLlon and cellular prollferaLlon
AnS u
MosL forms of alomerulonephrlLls are assoclaLed wlLh accumulaLlon of lmmune complexes ln Lhe alomerull and alomerular caplllarles Lhlckenlna
Lhe caplllarles and lmpedlna fllLraLlon 1he lmmune complexes acLlvaLe manv medlaLors lncludlna complemenL leukocvLes and coaaulaLlon
proLelns responslble for Lhe resulLanL renal Llssue ln[urv

12 WhaL cllnlcal manlfesLaLlon lndlcaLes Lo Lhe nurse LhaL Lhe cllenL wlLh alomerular nephrlLls belna LreaLed ln Lhe communlLv ls respondlna as
expecLed Lo Lhe prescrlbed LreaLmenL?
A1he cllenL has losL 11 pounds ln Lhe pasL 10 davs
81he cllenLs urlne speclflc aravlLv ls 1048
Cno blood ls observed ln Lhe cllenLs urlne
u1he cllenL ls LhlrsLv
AnS A
lluld reLenLlon ls a ma[or feaLure of alomerular nephrlLls 1hls welahL loss represenLs fluld loss lndlcaLlna LhaL Lhe alomerull are performlna Lhe
funcLlon of fllLraLlon

13 1he cllenL has nephroLlc svndrome wlLh a normal alomerular fllLraLlon raLe WhaL dleLarv modlflcaLlon should Lhe nurse Leach Lhls cllenL?
Auecreased lnLake of proLeln
8lncreased lnLake of proLeln
Cuecreased lnLake of carbohvdraLes
ulncreased lnLake of carbohvdraLes
AnS 8
ln nephroLlc svndrome Lhe renal loss of proLeln ls slanlflcanL leadlna Lo hvpoalbumlnemla and edema formaLlon lf alomerular fllLraLlon ls normal
or nearnormal Lhe lncreased proLeln loss should be maLched bv an lncreased lnLake of proLeln

14 WhaL ls Lhe prlorlLv nurslna dlaanosls for Lhe cllenL wlLh nephrosclerosls?
A8lsk for lmpalred Skln lnLearlLv
88lsk for lnfecLlon
CulsLurbed 8odv lmaae
uueflclenL knowledae
AnS u
1he ma[or cause of nephrosclerosls ls poorlv conLrolled hvperLenslon as a resulL of aLherosclerosls and/or dlabeLes ConLrol of Lhe hvperLenslon ls
essenLlal Lo preserve renal funcLlon and avold Lhe need for renal replacemenL Lherapv 1eachlna Lhe cllenL Lhe need for and how Lo manaae drua
Lherapv for Lhls condlLlon ls kev Lo prevenLlna compllcaLlons

13 ln order Lo plan approprlaLe care for whlch elecLrolvLe lmbalance should Lhe nurse monlLor Lhe cllenL wlLh renal cell carclnoma?
APvponaLremla
8PvpernaLremla
CPvpocalcemla
uPvpercalcemla
AnS u
8enal cell carclnoma Llssues frequenLlv produce ecLoplc hormones lncludlna paraLhvrold hormone 1he lncreased producLlon of paraLhvrold
hormone leads Lo decreased renal excreLlon of calclum and an lncrease ln Lhe serum calclum concenLraLlon

16 ln assesslna Lhe cllenL who had a radlcal nephrecLomv for a renal cell carclnoma 6 hours aao a nurse noLes LhaL Lhe cllenLs blood pressure has
decreased from 134/90 Lo 100/36 and Lhe urlne ouLpuL ls 20 mL for Lhls pasL hour WhaL ls Lhe nurse's besL flrsL acLlon?
AoslLlon Lhe cllenL so LhaL Lhe remalnlna kldnev ls noL dependenL
8Measure Lhe speclflc aravlLv of Lhe urlne
CuocumenL Lhe flndlnas as Lhe onlv acLlon
unoLlfv Lhe phvslclan
AnS u
1he radlcal naLure of Lhe suraerv and proxlmlLv of Lhe suraerv Lo Lhe adrenal aland puL Lhe cllenL aL rlsk for hemorrhaae and adrenal lnsufflclencv
PvpoLenslon ls a cllnlcal manlfesLaLlon assoclaLed wlLh boLh hemorrhaae and adrenal lnsufflclencv 1he hvpoLenslon ls parLlcularlv danaerous Lo
Lhe remalnlna kldnev whlch musL recelve adequaLe perfuslon Lo funcLlon effecLlvelv

17 WhaL should Lhe nurse emphaslze when provldlna homeaolna lnsLrucLlons Lo Lhe cllenL who has underaone a nephrecLomv?
A8e sure Lo llmlL vour lnLake of fluld Lo no more Lhan 2000 mL/dav"
81esL vour urlne dallv for keLone bodles and blood"
C?ou should never parLlclpaLe ln conLacL sporLs"
uAvold all alcohollc beveraaes"
AnS C
1he remalnlna kldnev musL perform Lhe excreLlna and meLabollc funcLlons of Lwo kldnevs 1he kldnevs are locaLed ln an ln[urvprone area posLerlor
Lo Lhe perlLoneal cavlLv and are poorlv proLecLed aaalnsL Lrauma CllenLs wlLh one kldnev should noL parLlclpaLe ln conLacL sporLs

1 1he nurse ls lnLervlewlna a cllenL wlLh a famllv hlsLorv of polvcvsLlc kldnev dlsease (Cku) Whlch of Lhe followlna manlfesLaLlons are Lvplcal of
Cku? (SelecL all LhaL applv)
A nocLurla
8 llank paln
C ularrhea
u PvpoLenslon
L uvsurla
l 8loodv urlne
C lncreased abdomlnal alrLh
AnS 8 l C
8aLlonale llank paln and abdomlnal alrLh slze are relaLed Lo Lhe dlsLenLlon and bloodv urlne ls seen wlLh Llssue damaae secondarv Lo Lhe Cku
1he cllenL mav also have consLlpaLlon and hvperLenslon


2 1he nurse ls carlna for a cllenL wlLh nephroLlc svndrome Whlch of Lhe followlna manlfesLaLlons are Lvplcal? (SelecL all LhaL applv)
A roLelnurla less Lhan 3 a/24 hr
8 Pvpoalbumlnemla
C lluld volume deflclL
u Llpldurla
L uvsurla
l lrequencv
C CvA Lenderness
P PvpoLenslon
AnS 8 u
8aLlonale nephroLlc svndrome ls due Lo alomerular damaae and ls characLerlzed bv proLelnurla hlaher Lhan 33 a/24 hr hvpoalbumlnemla edema
and llpldurla 1he cllenL mav also have hvperLenslon from Lhe fluld volume excess CvA Lenderness ls presenL wlLh lnflammaLorv chanaes ln Lhe
kldnev dvsurla and frequencv are presenL wlLh cvsLlLls
Ignatav|c|us Workman Med|ca|5urg|ca| Nurs|ng Cr|t|ca| 1h|nk|ng for Co||aborat|ve Care 6th Ld|t|on
Chapter 71 Care of at|ents w|th Acute kena| Ia||ure and Chron|c k|dney D|sease

1 Whlch sLaLemenL reaardlna Lhe paLhophvsloloalc process of acuLe renal fallure ls Lrue?
AAcuLe renal fallure can resulL from condlLlons LhaL cause lnadequaLe kldnev perfuslon
8AcuLe renal fallure bealns wlLh a aradual process of decreased renal funcLlon
CAcuLe renal fallure resulLs ln damaae Lo 90 Lo 93 of nephrons
uAcuLe renal fallure ls lrreverslble
AnS A
1here are manv causes of acuLe renal fallure CondlLlons LhaL cause lnadequaLe perfuslon of Lhe kldnev lnlLlaLe auLoreaulaLorv responses LhaL
acLuallv decrease urlne ouLpuL

2 A cllenL ls brouahL Lo Lhe hosplLal wlLh prerenal azoLemla from hvpovolemla WhaL lnLervenLlon should be lnlLlaLed lf prerenal azoLemla ls Lo be
reversed?
AAdmlnlsLraLlon of amlnoalvcoslde anLlbloLlcs
8PvdraLlon wlLh lnLravenous flulds
ClnlLlaLlon perlLoneal dlalvsls
u8esLrlcLlon of C flulds
AnS 8
Pvpoperfuslon of Lhe kldnev LhaL resulLs ln prerenal azoLemla can be reversed wlLh lncreaslna lnLravascular volume lncreaslna cardlac ouLpuL and
lncreaslna blood pressure lv flulds are alven Lo resLore lnLravascular volume

3 A cllenL wlLh renal fallure conLlnues Lo puL ouL adequaLe urlne WhaL form of acuLe renal fallure ls Lhe cllenL experlenclna?
Arerenal
8lnLrarenal
Cnonollaurlc
uosLrenal
AnS C
Some cllenLs have a nonollaurlc form of A8l ln whlch urlne ouLpuL remalns near normal

4 Whlch laboraLorv daLa would reflecL earlv slans of renal Lubular damaae?
Auecreased hemoalobln level
8lncreased serum sodlum level
Clncreased serum calclum level
uuecreased urlne speclflc aravlLv
AnS u
A decrease ln urlne speclflc aravlLv lndlcaLes a loss of urlneconcenLraLlna ablllLv and ls Lhe earllesL slan of renal Lubular damaae

3 Whlch laboraLorv daLa alLeraLlon would Lhe nurse expecL Lo see manlfesLed ln a cllenL wlLh renal fallure?
APvpokalemla and meLabollc acldosls
8Pvperkalemla and meLabollc alkalosls
CPvperphosphaLemla and hvpocalcemla
uPvpophosphaLemla and hvpercalcemla
AnS C
normallv a reclprocal relaLlonshlp exlsLs beLween calclum and phosphaLe whlch ls medlaLed bv vlLamln u ln renal fallure hvperphosphaLemla and
hvpocalcemla resulL from a deflclencv of acLlvaLed vlLamln u and decreased Lubular excreLlon of phosphaLe A decrease ln Lhe Cl8 (alomerular
fllLraLlon raLe) lncreases Lhe plasma phosphaLe level leadlna Lo hvperphosphaLemla As phosphaLe levels lncrease phosphaLe blnds Lo calclum
resulLlna ln a decrease ln Lhe serum calclum levels ln Lhe presence of less acLlvaLed vlLamln u less calclum can be absorbed Lhrouah Lhe lnLesLlnal
mucosa

6 Whlch medlcaLlon Laken bv a cllenL dlaanosed wlLh acuLe renal fallure mav be a poLenLlal cause of Lhe dlsorder?
AAceLamlnophen
8lurosemlde
Clbuprofen
uLanoxln
AnS C
AcuLe renal fallure can be caused bv cerLaln medlcaLlons consldered Lo have a nephroLoxlc effecL such as nSAlus ACL lnhlblLors and
amlnoalvcoslde anLlbloLlcs

7 Whlch lnLervenLlon wlll prevenL severe blood volume depleLlon LhaL can lead Lo renal fallure?
AMeasurlna urlne speclflc aravlLv
8Lncouraalna cllenLs' adequaLe lnLake of flulds
CSLrlcL lnLake and ouLpuL measuremenLs
uuallv bodv welahlna uslna Lhe same scale
AnS 8
Lncouraalna cllenLs Lo malnLaln adequaLe fluld lnLake helps avold dehvdraLlon whlch can lead Lo volume depleLlon and renal fallure

8 Whlch of Lhe followlna cllenLs ls mosL aL rlsk of developlna posLrenal azoLemla?
A43vearold female cllenL dlaanosed wlLh renal calcull
873vearold male cllenL wlLh conaesLlve hearL fallure
C33vearold male cllenL Laklna nSAlus for arLhrlLls paln
u32vearold female cllenL recoverlna from alomerulonephrlLls
AnS A Causes of posLrenal azoLemla lnclude dlsorders LhaL obsLrucL Lhe flow of urlne such as renal calcull

9 A cllenL has been admlLLed Lo Lhe hosplLal wlLh ollaurlc acuLe renal fallure ln Lhe ollaurlc phase whaL chanaes ln laboraLorv daLa would Lhe
nurse anLlclpaLe ln Lhls cllenL?
A8enal funcLlon lndlces reLurn Lo basellne levels
8Serum 8un creaLlnlne and poLasslum levels and meLabollc acldosls lncrease
CA LranslenL rlse ln 8un creaLlnlne and poLasslum levels ls followed bv meLabollc alkalosls
u1he 8un level sLarLs Lo fall and conLlnues Lo fall as creaLlne and poLasslum levels rlse
AnS 8
1he ollaurlc phase of acuLe renal fallure ls characLerlzed bv Lhe accumulaLlon of nlLroaenous wasLes resulLlna ln lncreaslna levels of serum 8un
creaLlnlne and poLasslum and a blcarbonaLe deflclL (meLabollc acldosls)

10 A 43vearold man ls brouahL Lo Lhe emeraencv deparLmenL wlLh a rlahL renal calcull causlna obsLrucLlon WhaL flndlnas would Lhe nurse expecL
Lo see vlsuallzed on an xrav sLudv of Lhe rlahL kldnev?
Anormalslzed kldnevs bllaLerallv
8An enlaraed rlahL kldnev resulLlna from hvdronephrosls
CA shrunken aLrophled rlahL kldnev secondarv Lo urlnarv obsLrucLlon
uullaLlon of Lhe lefL kldnev ln response Lo obsLrucLlon on Lhe rlahL slde
AnS 8
An obsLrucLlon caused bv renal calcull ofLen causes hvdronephrosls Cn xrav fllm Lhe affecLed kldnev appears enlaraed as compared wlLh Lhe
unaffecLed kldnev

11 A cllenL has been dlaanosed wlLh prerenal azoLemla WhaL cllnlcal manlfesLaLlons can Lhe nurse expecL Lhls cllenL Lo exhlblL?
A1achvcardla decreased urlnarv ouLpuL and hvpoLenslon
88radvcardla decreased urlnarv ouLpuL and hvpoLenslon
C8radvcardla scanLv urlne ouLpuL and rlslna serum elecLrolvLe levels
u1achvcardla larae quanLlLles of dlluLe urlne and normal serum elecLrolvLe levels
AnS A 1he slans and svmpLoms of prerenal azoLemla are Lachvcardla decreased urlnarv ouLpuL hvpoLenslon decreased Cv and leLharav

12 A cllenL admlLLed wlLh acuLe renal fallure proaresses from Lhe ollaurlc Lo Lhe dlureLlc phase of Lhe dlsorder WhaL prlmarv problems mlahL Lhe
nurse expecL Lhls cllenL Lo exhlblL?
APvpervolemla wlLh dlluLe urlne
8Pvpovolemla and elecLrolvLe loss
CPvpervolemla and elecLrolvLe excess
uPvpovolemla wlLh concenLraLed urlne
AnS 8
When Lhe cllenL moves from Lhe ollaurlc Lo Lhe dlureLlc phase hvpovolemla and elecLrolvLe losses are Lhe prlmarv problems ln Lhe ollaurlc phase
fluld and elecLrolvLes are reLalned

13 A cllenL wlLh acuLe renal fallure develops hvperkalemla WhaL drua should Lhe nurse be prepared Lo admlnlsLer?
AkavexalaLe
8lurosemlde
Cuopamlne
uMannlLol
AnS A
kavexalaLe (sodlum polvsLvrene) ls a caLlon exchanae resln LhaL exchanaes sodlum for poLasslum 1hls drua can be alven orallv or as a reLenLlon
enema

14 A cllenL wlLh acuLe renal fallure has been prescrlbed a fluld resLrlcLlon 1he cllenL asks how much fluld wlll be permlLLed each dav WhaL ls Lhe
nurse's besL response?
ALach healLh care provlder decldes Lhls lndlvlduallv based on Lhe amounL of permanenL damaae Lo vour kldnevs"
8?ou wlll be permlLLed Lo drlnk an amounL equal Lo Lhe urlne vou excreLe plus 300 mL"
C1he amounL of fluld vou can drlnk ls dependenL on how much proLeln vou eaL each dav"
u?ou wlll be permlLLed Lo drlnk approxlmaLelv 2 L of fluld each dav"
AnS 8 lluld lnLake ls aenerallv calculaLed Lo equal Lhe amounL of urlne excreLed plus 300 mL

13 A nurse ls carlna for a cllenL wlLh acuLe renal fallure who has had a femoral veln cannulaLlon for hemodlalvsls access lor whaL compllcaLlon of
Lhls procedure should Lhe nurse remaln alerL?
AAsclLes
8PemaLoma
CSkln necrosls
u8enal arLerv occluslon
AnS 8
1he puncLure slLe of Lhe femoral veln ls prone Lo hemaLoma formaLlon because poslLlonlna Lhe exLremlLv can cause movemenL of Lhe cannula and
subsequenL bleedlna aL Lhe slLe

16 A cllenL wlLh acuLe renal fallure has beaun LreaLmenL wlLh conLlnuous arLerlovenous hemofllLraLlon (CAvP) lor whaL compllcaLlon of Lhls
LreaLmenL should Lhe nurse monlLor Lhls cllenL?
A8leedlna
81hrombosls
CPvperLenslon
ulluld overload
AnS A
1he areaLesL rlsk for cllenLs underaolna CAvP ls bleedlna resulLlna from Lhe anLlcoaaulanLs used Lo prevenL membrane cloLLlna

17 A cllenL wlLh suspecLed dlmlnlshed renal funcLlonlna has come Lo Lhe ouLpaLlenL cllnlc for an appolnLmenL WhaL laboraLorv LesL would be mosL
accuraLe ln assesslna Lhls cllenL's renal reserve?
A24hour urlne for creaLlnlne clearance
8Serum blood urea nlLroaen level
Curlne speclflc aravlLv
uSerum sodlum level
AnS A
A 24hour creaLlnlne clearance LesL ls necessarv Lo deLecL chanaes ln renal reserve CreaLlnlne clearance ls a measure of Lhe alomerular fllLraLlon
raLe 1he ablllLv of Lhe alomerull Lo acL as a fllLer ls decreased ln renal dlsease

18 WhaL sLaLemenL reaardlna renal lnsufflclencv (sLaae ll) ls Lrue?
A8enal funcLlon ls reduced buL Lhere ls no accumulaLlon of meLabollc wasLes
81he healLhler kldnev compensaLes for Lhe dlseased kldnev
C1here ls decreased responslveness Lo dlureLlcs
u1he kldnevs are unable Lo malnLaln homeosLasls
AnS C
SLaae ll renal lnsufflclencv ls characLerlzed bv a decreased responslveness Lo dlureLlcs Lhe bealnnlna accumulaLlon of meLabollc wasLes and
decreaslna Cl8


19 Whlch of Lhe followlna manlfesLaLlons would alerL Lhe nurse Lo a poLenLlallv danaerous compllcaLlon ln Lhe cllenL wlLh chronlc renal fallure?
Anausea and vomlLlna
8SofL less audlble hearL sounds
CaresLheslas of Lhe hands and feeL
uAnemla accompanled bv follc acld deflclencles
AnS 8
SofL less audlble hearL sounds can slanal Lhe accumulaLlon of fluld wlLhln Lhe perlcardlal sac lluld accumulaLlon resulLs from Lhe accumulaLlon of
uremlc Loxlns causlna lnflammaLlon of Lhe perlcardlum and subsequenL fluld bulldup Lxcesslve amounLs of fluld wlLhln Lhe perlcardlal sac can
resulL ln cardlac Lamponade a medlcalsuralcal emeraencv

20 1he renal fallure cllenL's resplraLlon raLe ls rapld and lncreased ln depLh WhaL does Lhls lndlcaLe abouL Lhe cllenL's renal fallure?
A1he cllenL's blood oxvaen level ls low
81he cllenL's blood carbon dloxlde ls low
C1he cllenL's renal fallure ls worsenlna
u1he cllenL's blood pP ls Loo hlah
AnS C
As renal fallure advances acld reLenLlon lncreases and pP decreases 1he resplraLorv svsLem compensaLes bv lncreaslna Lhe raLe and depLh of
resplraLlons Lo excreLe carbon dloxlde from Lhe lunas

21 A cllenL wlLh chronlc renal fallure has developed uremlc perlcardlLls ln assesslna Lhe cardlovascular svsLem of Lhls cllenL whaL sounds would
Lhe nurse expecL Lo hear?
AA harsh blowlna murmur aL Lhe lefL sLernal border
8An lrreaular hearLbeaL accompanled bv a precordlal llfL
CA perlcardlal frlcLlon rub presenL ln svsLole and dlasLole
uSofL dlsLanL hearL sounds accompanled bv an S3
AnS C
1he classlc slan of acuLe perlcardlLls ls Lhe scraLchv sound assoclaLed wlLh a perlcardlal frlcLlon rub 1hls sound can be heard ln boLh svsLole and
dlasLole SofL dlsLanL hearL sounds can be presenL lf Lhe perlcardlLls ls accompanled bv an effuslon

22 A cllenL wlLh mlldlv dlmlnlshed renal reserve asks how Lo prevenL furLher damaae Lo Lhe kldnevs WhaL ls Lhe nurse's besL response?
AunforLunaLelv furLher kldnev damaae ls lnevlLable wlLh Llme"
8?ou wlll need Lo follow a hlahproLeln dleL Lo preserve kldnev funcLlon"
CAsk lf anv newlv prescrlbed medlcaLlons foods or dlaanosLlc LesLs pose a rlsk Lo vour kldnev funcLlon"
u1he dlureLlcs vou are Laklna wlll prevenL furLher damaae bv lnlLlaLlna enouah urlne Lo remove wasLes"
AnS C
CllenLs wlLh even mlld kldnev lmpalrmenL should Lrv Lo avold nephroLoxlc subsLances LhaL could poLenLlallv harm Lhe kldnevs

23 A nurse ls carlna for a cllenL wlLh chronlc renal fallure who has developed severe meLabollc acldosls WhaL assessmenL flndlna would be
expecLed ln Lhls cllenL?
APvpervenLllaLlon
88radvcardla
CPvpoLenslon
uSelzures
AnS A
WlLh severe meLabollc acldosls Lhe cllenL wlll develop hvpervenLllaLlon or kussmaul resplraLlon

24 A nurse ls provldlna dleLarv Leachlna Lo a cllenL who ls on hemodlalvsls WhaL lnsLrucLlon should Lhe nurse provlde Lo Lhls cllenL reaardlna
proLeln lnLake?
A?our proLeln needs wlll noL chanae buL vou mav Lake more flulds"
8?ou wlll need more proLeln now because some proLeln ls losL bv dlalvsls"
C?ou wlll need less proLeln because dlalvsls makes more amlno aclds avallable for use"
uulalvsls removes wasLes from Lhe bodv so lL does noL maLLer how much proLeln vou eaL"
AnS 8
When renal dlsease has proaressed and requlres LreaLmenL wlLh dlalvsls lncreased proLeln ls requlred ln Lhe dleL Lo compensaLe for proLeln losses
Lhrouah dlalvsls

23 Whlch assessmenL parameLer should Lhe nurse monlLor ln a cllenL wlLh chronlc renal fallure Lo deLermlne fluld and sodlum reLenLlon sLaLus?
AWelahL and blood pressure
8lnLake and ouLpuL
CMuscle sLrenaLh
uCaplllarv reflll
AnS A
WelahL and blood pressure are helpful ln esLlmaLlna fluld and sodlum reLenLlon WelahL and blood pressure rlse wlLh excess fluld and sodlum

26 A cllenL wlLh chronlc renal fallure ls on a sodlum and poLasslumresLrlcLed dleL 1he cllenL asks lf a salL subsLlLuLe can be used WhaL ls Lhe
nurse's besL response?
ASalL subsLlLuLes conLaln some sodlum and should be used ln moderaLlon"
8SalL subsLlLuLes conLaln poLasslum and Lherefore should noL be used"
CSalL subsLlLuLes mav be used once dlalvsls ls beaun"
u?ou mav use a salL subsLlLuLe anv Llme vou llke"
AnS 8
1he cllenL ls LauahL Lo avold salL subsLlLuLes because mosL conLaln poLasslum ln chronlc renal fallure hvperkalemla ls a danaer because lL can lead
Lo cardlac dvsrhvLhmlas

27 A nurse observes Lall peaked 1 waves on Lhe LCC of a cllenL wlLh LS8u WhaL would be Lhe nurse's besL acLlon?
Arepare an ampule of sodlum blcarbonaLe Lo counLeracL meLabollc acldosls
8noLhlna Lhls ls a normal flndlna for lndlvlduals wlLh LS8u
CCheck Lhe serum poLasslum level
u8epeaL Lhe LCC
AnS C
1all peaked 1 waves are a manlfesLaLlon of hvperkalemla Lhus Lhe nurse should check Lhe poLasslum level

28 A cllenL wlLh chronlc renal fallure savs LhaL he wlll be aolna Lo Lhe denLlsL for a planned LooLh exLracLlon WhaL would be Lhe nurse's besL
response?
A?ou mav Lake anv medlcaLlon for paln LhaL Lhe denLlsL prescrlbes"
8?ou should recelve prophvlacLlc anLlbloLlcs before anv denLal procedure"
C?ou should rlnse vour mouLh wlLh an anLlsepLlc soluLlon once Lhe LooLh ls removed"
uPave vour denLlsL check all of vour LeeLh because kldnev problems can cause LooLh decav"
AnS 8
1o prevenL sepsls from oral cavlLv bacLerla Lhe cllenL should be alven prophvlacLlc anLlbloLlcs before anv denLal procedure

29 A nurse ls admlnlsLerlna dlaoxln Lo a cllenL wlLh renal dlsease who has a hlsLorv of conaesLlve hearL fallure lor whaL musL Lhe nurse monlLor
Lhls cllenL?
ASlans of concurrenL damaae Lo Lhe llver caused bv Lhe meLabollsm of dlaoxln
8Slans of muscle LeLanv caused bv Lhe blndlna of dlaoxln wlLh calclum
CSlans of dlaoxln LoxlclLv because dlaoxln ls excreLed bv Lhe kldnevs
uSkln erupLlons and ervLhema caused bv dlaoxln
AnS C
ulaoxln ls excreLed bv Lhe kldnevs ln Lhe presence of renal fallure drua levels are more llkelv Lo accumulaLe leadlna Lo dlaoxln LoxlclLv

30 A cllenL hosplLallzed for worsenlna renal fallure suddenlv becomes resLless and aalLaLed 1he assessmenL reveals Lachvcardla and crackles
bllaLerallv aL Lhe bases of Lhe lunas WhaL concluslon can Lhe nurse draw from Lhls lnformaLlon?
A1he cllenL requlres an anLlanxleLv aaenL
81he cllenL ls developlna pulmonarv edema
C1he cllenL has noL Laken Lhe prescrlbed medlcaLlons
u1he cllenL ls upseL abouL Lhe decllne ln kldnev funcLlon
AnS 8
8esLlessness anxleLv Lachvcardla dvspnea and crackles aL Lhe bases of Lhe lunas are earlv manlfesLaLlons of pulmonarv edema

31 A cllenL has hvperLenslon chronlc renal lnsufflclencv Whlch of Lhe followlna are Lhe mosL effecLlve druas for conLrolllna hvperLenslon and
preservlna renal funcLlon?
AAnaloLenslonconverLlna enzvme lnhlblLors
88eLaadreneralc blockers
CCalclum channel blockers
uAlphaadreneralc blockers
AnS A 8esearch lndlcaLes LhaL ACL lnhlblLors appear Lo be Lhe mosL effecLlve druas Lo slow Lhe proaresslon of renal fallure

32 Whlch measure would be approprlaLe for Lhe nurse Lo Lake ln carlna for a cllenL wlLh chronlc renal fallure recelvlna dlalvsls vla a rlahL arm
flsLula?
A1ake Lhe cllenL's blood pressure ln boLh arms
81ake Lhe cllenL's blood pressure ln Lhe lefL arm onlv
Clace Lhe rlahL arm ln a sllna Lo proLecL lL from ln[urv
uPave Lhe cllenL perform acLlve 8CM arm exerclses Lo ald blood flow Lo Lhe flsLula
AnS 8 1he blood pressure should be Laken ln Lhe lefL arm onlv Lo prevenL occluslon of Lhe dlalvsls flsLula

33 WhaL assessmenL would help Lhe nurse deLermlne Lhe paLencv of a cllenL's Av flsLula for dlalvsls?
A1he presence of a sLrona pulsaLlon aL Lhe slLe of Lhe venousarLerlal anasLomosls
8LqulvalenL blood pressure measuremenLs ln each arm
C1he presence of a Lhrlll buL no brulL
u1he presence of a Lhrlll and brulL
AnS u 1he presence of a Lhrlll and brulL are slans LhaL Lhe flsLula ls paLenL wlLhouL Lhrombosls

34 1o reduce Lhe occurrence of Av flsLula Lhrombus whlch acLlon bv Lhe nurse would be mosL approprlaLe?
AlnsLrucL Lhe cllenL Lo resLrlcL use of Lhe arm wlLh Lhe flsLula for 1 hour afLer dlalvsls
88un lv flulds as ordered dlrecLlv lnLo Lhe flsLula afLer dlalvsls Lo prevenL cloLLlna
C8oLaLe needle lnserLlon slLes wlLh each dlalvsls LreaLmenL
uApplv pressure Lo Lhe puncLure slLe
AnS C 8oLaLlon of needle lnserLlon slLes wlLh each LreaLmenL reduces Lhe rlsk of Lhrombus formaLlon aL Lhe puncLure slLe

33 ln assesslna a cllenL afLer dlalvsls a nurse flnds a sllahL elevaLlon ln bodv LemperaLure as compared wlLh predlalvsls measures WhaL ls Lhe
nurse's besL acLlon?
AuocumenL Lhe flndlna as Lhe onlv acLlon
8repare Lo culLure Lhe flsLula slLe
CLncouraae Lhe cllenL Lo drlnk aL leasL 1 L of fluld
unoLlfv Lhe phvslclan because Lhls slanals lmpendlna sepsls
AnS A
1he cllenL's LemperaLure mav be elevaLed because Lhe dlalvsls machlne warms Lhe blood sllahLlv An excesslve LemperaLure elevaLlon from
basellne can slanal sepsls and ln Lhls case Lhe nurse should lnform Lhe phvslclan and obLaln blood culLures

36 1he phvslclan has prescrlbed llslnoprll for a cllenL wlLh chronlc renal fallure and hvperLenslon Whlch lnLervenLlon ls approprlaLe for Lhe
admlnlsLraLlon of Lhls drua?
AAdmlnlsLer Lhe drua aL 9 AM everv mornlna
8AdmlnlsLer Lhe drua before hemodlalvsls
CAdmlnlsLer Lhe drua durlna hemodlalvsls
uAdmlnlsLer Lhe drua afLer hemodlalvsls
AnS u vasoacLlve druas can cause hvpoLenslon durlna hemodlalvsls and should be held unLll afLer hemodlalvsls

37 uurlna hemodlalvsls a cllenL wlLh chronlc renal fallure develops headache nausea and vomlLlna and resLlessness Whlch lnlLlal acLlon bv Lhe
nurse would be mosL approprlaLe?
AnoLlfv Lhe phvslclan lmmedlaLelv
8ulsconLlnue Lhe hemodlalvsls lmmedlaLelv
CCrder a blood urea nlLroaen level S1A1
uAdmlnlsLer an lnLravenous bolus of dexLrose soluLlon
AnS A
Peadache nausea vomlLlna and resLlessness mav be slans of dlalvsls dlsequlllbrlum svndrome 8apld decreases ln fluld and Lhe 8un level can
cause cerebral edema and lncreased lC Larlv recoanlLlon and LreaLmenL of Lhls svndrome are essenLlal ln prevenLlna a llfeLhreaLenlna slLuaLlon

38 Whlch response bv Lhe cllenL lndlcaLes an undersLandlna of measures Lo faclllLaLe Lhe flow of perlLoneal dlalvsaLe fluld?
Al wlll Lake mv sLool sofLeners everv dav"
8l wlll mllk Lhe dlalvsls Lublna wlLh everv exchanae"
Cl wlll keep Lhe dralnaae baa aL Lhe level of mv abdomen"
ul wlll sLand Lo decrease Lhe pressure lnslde Lhe abdomen durlna Lhe ouLflow"
AnS A
ConsLlpaLlon ls Lhe prlmarv cause of lnflow and ouLflow problems 1o prevenL consLlpaLlon cllenLs are placed on a bowel realmen before Lhe
placemenL of a perlLoneal caLheLer

39 A nurse ls carlna for a cllenL who ls underaolna perlLoneal dlalvsls 1he nurse noLes Lhe color of Lhe effluenL Lo appear cloudv WhaL ls Lhe
nurse's besL acLlon?
AlrrlaaLe Lhe perlLoneal caLheLer
8noLlfv Lhe healLh care provlder
CuocumenL Lhe flndlna as Lhe onlv acLlon
uChanae Lhe dlalvsaLe
AnS 8
Cloudv or opaque effluenL ls Lhe earllesL slan of perlLonlLls 1he healLh care provlder should be noLlfled and a sample of Lhe ouLflow should be senL
for culLure and senslLlvlLv

40 ln assesslna a cllenL on CAu who has had repeaLed eplsodes of perlLonlLls Lhe home care nurse noLes a decllne ln Lhe amounL of ouLflow
WhaL phvsloloalc explanaLlon can accounL for Lhls decllne?
A1he anLlbloLlcs prescrlbed for perlLonlLls can lead Lo scarrlna of Lhe perlLoneal membrane and decreased ouLflow
81he perlLoneal caLheLer has caused a chronlc lnflammaLorv process and Lherefore musL be chanaed
C8esldue from Lhe dlalvsaLe fluld has collecLed alona Lhe lumen of Lhe caLheLer lmpedlna Lhe flow of effluenL
u8epeaLed eplsodes of perlLonlLls have caused a decllne ln Lhe ulLrafllLraLlon capablllLv
AnS u
8epeaLed eplsodes of perlLonlLls can damaae Lhe perlLoneal membrane resulLlna ln dlmlnlshed ulLrafllLraLlon capablllLv whlch mav necesslLaLe
Lransfer Lo hemodlalvsls

41 A cllenL wlLh a recenLlv placed perlLoneal dlalvsls caLheLer has decreased dlalvsaLe flow Whlch of Lhe followlna lnLervenLlons wlll lmprove flow?
AMllk Lhe Lublna
8verlfv Lube placemenL bv xrav
C8alse and Lhen lower Lhe dralnaae baa
uulsconnecL and flush Lhe Lublna
AnS A
llbrln cloL formaLlon can occur afLer u caLheLer placemenL Mllklna Lhe Lublna mav dlslodae Lhe flbrln cloL and lmprove dlalvsaLe flow

42 A cllenL who underwenL kldnev LransplanLaLlon 7 davs aao has developed ollaurla an lncreased LemperaLure leLharav and elevaLlons ln Lhe
serum creaLlnlne 8un and poLasslum levels Whlch lnLervenLlon should Lhe nurse anLlclpaLe for Lhls cllenL?
AConservaLlve manaaemenL of svmpLoms unLll dlalvsls ls requlred as a resulL of chronlc re[ecLlon
8lncrease ln Lhe doses of lmmunosuppresslve druas Lo combaL acuLe re[ecLlon
ClmmedlaLe removal of Lhe LransplanLed kldnev because of hvperacuLe re[ecLlon
ulnsLlLuLlon of perlLoneal dlalvsls Lo ald Lhe LransplanLed kldnev
AnS 8
Cllaurla leLharav elevaLed LemperaLure and lncreases ln serum elecLrolvLe levels 1 week Lo 2 vears posLLransplanLaLlon are hallmarks of acuLe
re[ecLlon whlch can be reverslble wlLh lncreased lmmunosuppresslve Lherapv

43 A nurse ls assesslna a renal LransplanL reclplenL for malnLenance of prescrlbed drua Lherapv Whlch sLaLemenL bv Lhe cllenL lndlcaLes a need for
more Leachlna?
Al wlll need Lo conLlnue Lo Lake lnsulln for mv dlabeLes"
8l wlll have Lo Lake Lhe lmmunosuppressanLs for Lhe resL of mv llfe"
Cl wlll Lake Lhe anLlbloLlcs Lhree Llmes dallv unLll Lhe medlcaLlon ls flnlshed"
uMv new kldnev ls worklna flne l do noL need Lo Lake medlcaLlons anv lonaer"
AnS u
A cruclal role of Lhe nurse ln Lhe lonaLerm followup of Lhe renal LransplanL cllenL ls ln Lhe malnLenance of prescrlbed drua Lherapv Such cllenLs
wlll need Lo Lake lmmunosuppressanLs for Lhe resL of Lhelr llves Lo prevenL re[ecLlon of Lhe kldnev

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