Question 1

The nurse assesses the client for the electrolyte imbalance that tends to occur in the earlier stages of chronic renal failure, which is
A) hypercalcemia.
B) hypocalcemia.
C) hypokalemia.
D) hyponatremia.

Accepted Answer

The tubular salt-wasting properties of some failing kidneys, in addition to vomiting and diarrhea, may cause hyponatremia. Late in the disease the problem becomes hypernatremia.

Question 2

A client with ARF is allowed a specific amount of fluid by mouth during 24 hours in order to
A) compensate for insensible and measured fluid losses during the previous 24 hours.
B) equal the expected urine output for the next 24 hours.
C) prevent hyperkalemia, which could lead to serious cardiac dysrhythmia.
D) prevent the development of complicating hypostatic pneumonia.

Accepted Answer

Fluid replacement volumes are usually calculated on the basis of some fraction of the previous day's urine output plus an amount (e.g., 400 ml) to account for the usual insensible loss that occurs during a 24-hour period.

Question 3

The nurse explains to a client's family that the most common overall manifestation of ARF is that
A) expected urine output is altered.
B) the client's breath develops a fruity odor.
C) urine specific gravity is greater than 1.040.
D) urine develops a "root beer" color.

Accepted Answer

The most common overall manifestation of ARF is alteration in the expected urine output. Usually this is oliguria or anuria, although polyuric ARF accounts for 30% of cases.

Question 4

The nurse performing intermittent peritoneal dialysis notes that the medical record shows the client has not had a bowel movement for 3 days. The nurse would be careful to assess the client for
A) cloudy dialysate output.
B) fluid leakage.
C) increased thirst.
D) reduced catheter outflow.

Accepted Answer

Constipation can reduce catheter flow, possibly because peristalsis facilitates outflow.

Question 5

The nurse teaching a client about continuous ambulatory peritoneal dialysis (CAPD) would include the information that
A) a small, lightweight pump must be carried in a pocket or on a belt.
B) CAPD eliminates the need for strict aseptic technique when handling the catheter.
C) the procedure involves instilling 250 to 500 ml of fluid at a time.
D) there are four daily cycles with an 8-hour dwell for one cycle during the night.

Accepted Answer

CAPD usually uses four dialysis cycles every 24 hours, including an 8-hour dwell overnight. There is still the need for asepsis.

Question 6

The nurse notes in the first few exchanges during peritoneal dialysis of a client that the effluent is tinged pink. The nurse's most appropriate action is to
A) continue the dialysis.
B) notify the physician.
C) send a specimen for culture.
D) stop the dialysis immediately.

Accepted Answer

Bloody effluent is usually insignificant and disappears spontaneously.

Question 7

During peritoneal dialysis the client's dialysate white blood cell count is 150/mm³ and neutrophils are 60%. This would indicate that the client has developed
A) anemia.
B) bowel perforation.
C) peritonitis.
D) pyelonephritis.

Accepted Answer

Peritonitis is diagnosed when the dialysate white blood cell count is greater than 100/mm³ and neutrophils are greater than 50%.

Question 8

During a client's first dialysis treatment, the client complains of a severe headache and appears somewhat confused. The priority action by the nurse's is to
A) administer oxygen by nasal cannula.
B) encourage the client to drink fluids.
C) notify the physician immediately.
D) slow the rate of the dialysis.

Accepted Answer

Dialysis equilibrium syndrome can occur after dialysis, particularly during the client's first few dialysis episodes. The syndrome is characterized by mental confusion, deterioration in level of consciousness, headache, and seizures and may last for several days. The frequency or strength of the dialysate may need to be altered. The priority action by the nurse is to notify the physician; the nurse should not independently slow the dialysis rate or encourage the client to drink fluids as fluids may be restricted. Oxygen will not help the situation.

Question 9

A client has been on dialysis for 6 weeks. The family is complaining that instead of feeling grateful at this second chance at life, the client has become irritable with them and seems depressed. The most helpful response by the nurse would be
A) "Depression is very common at this time; it is hard to adapt to the losses s/he feels."
B) "I am surprised that your loved one doesn't feel happier about being alive."
C) "This must be very hard on you for your loved one to be so unappreciative."
D) "We can arrange a psychiatric consultation if you think it will help."

Accepted Answer

Clients are often happy and grateful as they start dialysis and begin to feel well for the first time in a long time. But as the time goes by and the implication of the permanent change to their lives becomes apparent, it is common for them to have psychosocial difficulties, including depression. In fact, the suicide rate for dialysis clients is estimated to be 100 times that of the general public. The other three options not only do not give helpful information about what is happening but also are poor examples of therapeutic communication.

Question 10

A client with oliguric ARF would exhibit
A) a BUN/creatinine ratio of 30:1.
B) hematuria.
C) proteinuria.
D) a urine specific gravity of 1.001.

Accepted Answer

In oliguric ARF, urine production usually falls below 400 ml/day. The BUN/creatinine ratio is significantly elevated, reaching levels of 10:1 to 40:1.

Question 11

The nurse caring for a client in the diuretic phase of acute renal failure (ARF) should assess for manifestations of
A) dehydration.
B) hypertension.
C) hypokalemia.
D) metabolic acidosis.

Accepted Answer

A gradual or abrupt return to glomerular filtration and leveling of blood urea nitrogen (BUN) level signal the diuretic phase. Urine output may be 1000 ml/day, which may lead to dehydration.

Question 12

Three months after a kidney transplant, a client develops fever, graft tenderness, malaise, and elevated white blood cell count. The nurse conducts further assessments based on understanding that the likely cause of these manifestations is
A) graft rejection.
B) influenza.
C) pyelonephritis.
D) urinary tract infection.

Accepted Answer

Clinical manifestations of renal transplant rejection include fever, graft tenderness, anemia, and malaise.

Question 13

A client has been found to be an acceptable candidate for a kidney transplant. The nurse counsels the client and family that the client now faces the greatest impediment to renal transplantation, which is
A) high potential for rejection.
B) high risk for infection.
C) insufficient financial resources.
D) lack of sufficient donor organs.

Accepted Answer

The primary factor limiting the number of transplants done is the availability of kidneys.

Question 14

The nurse explains that a cation exchange resin such as Kayexalate will
A) decrease diastolic blood pressure.
B) stimulate diuresis by osmosis.
C) increase appetite by decreasing insulin degradation.
D) increase gastrointestinal potassium excretion.

Accepted Answer

Hyperkalemia is probably the most dangerous imbalance because of its contribution to cardiac dysrhythmias and arrest. Cation exchange resins such as sodium polystyrene sulfonate (Kayexalate) may be administered orally or rectally to facilitate excretion of potassium from the gastrointestinal (GI) tract.

Question 15

In caring for a chronic dialysis patient with an arteriovenous fistula, the nurse would
A) avoid getting the fistula site wet during the client's bath.
B) irrigate the fistula with heparin to prevent clotting.
C) not use the arm with the fistula when taking the client's BP.
D) perform dressing changes to prevent infection.

Accepted Answer

Blood pressure should not be measured on or blood drawn from the limb containing the access. Between dialysis periods the skin over the fistula or graft requires only routine care with soap and water. The graft does not need heparin injections.

Question 16

The nurse explains to a client with chronic renal failure that the rationale for receiving calcium carbonate is that it
A) binds with phosphorus to eliminate it from the body.
B) binds with potassium to eliminate it from the body.
C) helps prevent constipation.
D) helps prevent ulcer formation.

Accepted Answer

To improve excretion of phosphorus, the client with chronic renal failure is given calcium-based phosphate binders, such as calcium acetate or calcium carbonate.

Question 17

A client with renal failure has an order to infuse dopamine (Intropin) to activate the dopamine receptors in the kidney. The nurse would set the infusion rate for
A) 21 to 25 mg/kg/minute.
B) 11 to 20 mg/kg/minute.
C) 6 to 10 mg/kg/minute.
D) 1 to 5 mg/kg/minute.

Accepted Answer

Low doses (1 to 5 mg/kg/minute) of dopamine hydrochloride (Intropin) may be given to activate dopamine receptors in the kidney.

Question 18

While caring for a client in the oliguric phase of ARF, the nurse's plan of care should include
A) encouraging fluid intake to prevent dehydration.
B) increasing the client's protein intake to prevent muscle wasting.
C) maintaining reverse isolation to prevent infection.
D) meticulous skin care to prevent skin breakdown.

Accepted Answer

The poor systemic nutrition and edema accompanying renal failure may cause skin breakdown. Meticulous skin care, frequent turning, and special mattresses are very important. Clients may well be on fluid restrictions. They do not need reverse isolation. Protein is often restricted as well.

Question 19

The client with chronic renal failure who would not be a candidate for peritoneal dialysis is a client
A) who has diabetes mellitus.
B) who is a 10-year-old child.
C) with severe cardiovascular disease.
D) with severe respiratory disease.

Accepted Answer

Relative contraindications to peritoneal dialysis include obesity, history of ruptured diverticuli, abdominal disease, respiratory disease, recurrent episodes of peritonitis, abdominal malignancies, severe vascular disease, and extensive abdominal surgery with drains or tubes, which may increase risk of infection.

Question 20

For the nurse trying to assist a client with renal failure to stay within the prescribed fluid restriction, the least helpful strategy would be to
A) give medication at mealtime.
B) provide frequent oral hygiene.
C) put allotted water into a spray bottle.
D) use ice chips liberally instead of fluids.

Accepted Answer

The nurse helps the client stay within the prescribed fluid restriction with careful oral hygiene and judicious use of ice chips, lip ointments, and appropriate diversionary activities. Placing the allotted water in a spray bottle may help to spread out the amount taken. To conserve fluids for the client with renal failure, medications are administered with meals, if possible.

Quiz 36: Management of Clients with Renal Failure

The nurse assesses the client for the electrolyte imbalance that tends to occur in the earlier stages of chronic renal failure, which is

A client with ARF is allowed a specific amount of fluid by mouth during 24 hours in order to

The nurse explains to a client's family that the most common overall manifestation of ARF is that

The nurse performing intermittent peritoneal dialysis notes that the medical record shows the client has not had a bowel movement for 3 days. The nurse would be careful to assess the client for

The nurse teaching a client about continuous ambulatory peritoneal dialysis (CAPD) would include the information that

The nurse notes in the first few exchanges during peritoneal dialysis of a client that the effluent is tinged pink. The nurse's most appropriate action is to

During peritoneal dialysis the client's dialysate white blood cell count is 150/mm³ and neutrophils are 60%. This would indicate that the client has developed

During a client's first dialysis treatment, the client complains of a severe headache and appears somewhat confused. The priority action by the nurse's is to

A client has been on dialysis for 6 weeks. The family is complaining that instead of feeling grateful at this second chance at life, the client has become irritable with them and seems depressed. The most helpful response by the nurse would be

A client with oliguric ARF would exhibit

The nurse caring for a client in the diuretic phase of acute renal failure (ARF) should assess for manifestations of

Three months after a kidney transplant, a client develops fever, graft tenderness, malaise, and elevated white blood cell count. The nurse conducts further assessments based on understanding that the likely cause of these manifestations is

A client has been found to be an acceptable candidate for a kidney transplant. The nurse counsels the client and family that the client now faces the greatest impediment to renal transplantation, which is

The nurse explains that a cation exchange resin such as Kayexalate will

In caring for a chronic dialysis patient with an arteriovenous fistula, the nurse would

The nurse explains to a client with chronic renal failure that the rationale for receiving calcium carbonate is that it

A client with renal failure has an order to infuse dopamine (Intropin) to activate the dopamine receptors in the kidney. The nurse would set the infusion rate for

While caring for a client in the oliguric phase of ARF, the nurse's plan of care should include

The client with chronic renal failure who would not be a candidate for peritoneal dialysis is a client

For the nurse trying to assist a client with renal failure to stay within the prescribed fluid restriction, the least helpful strategy would be to