Renal Failure (acute & Chronic) By Rnpedia.com

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 Renal Failure (acute & Chronic) By Rnpedia.com
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  • 1. 
    For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?  
    • A. 

      Encouraging coughing and deep breathing

    • B. 

      Promoting carbohydrate intake

    • C. 

      Limiting fluid intake

    • D. 

      Providing pain-relief measures


  • 2. 
    A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:  
    • A. 

      Confusion, headache, and seizures.

    • B. 

      Acute bone pain and confusion.

    • C. 

      Weakness, tingling, and cardiac arrhythmias.

    • D. 

      Hypotension, tachycardia, and tachypnea.


  • 3. 
    A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance?   
    • A. 

      Hyponatremia

    • B. 

      Hyperkalemia

    • C. 

      Hyperphosphatemia

    • D. 

      Hypercalcemia


  • 4. 
    A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout this phase include observation for signs and symptoms of   
    • A. 

      Hypervolemia, hypokalemia, and hypernatremia.

    • B. 

      Hypervolemia, hyperkalemia, and hypernatremia.

    • C. 

      Hypovolemia, wide fluctuations in serum sodium and potassium levels.

    • D. 

      Hypovolemia, no fluctuation in serum sodium and potassium levels.


  • 5. 
    Nurse Tristan is caring for a male client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:    
    • A. 

      Hypernatremia.

    • B. 

      Hypokalemia.

    • C. 

      Hyperkalemia.

    • D. 

      Hypercalcemia.


  • 6. 
    The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant?    
    • A. 

      Provide oral care every 3-4 hours

    • B. 

      Monitor for indications of dehydration

    • C. 

      Administer 0.45% saline by IV line

    • D. 

      Assess daily weights for trends


  • 7. 
     The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately?  
    • A. 

      Blood urea nitrogen 50 mg/dl

    • B. 

      Hemoglobin of 10.3 mg/dl

    • C. 

      Venous blood pH 7.30

    • D. 

      Serum potassium 6 mEq/L


  • 8. 
    The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported IMMEDIATELY?  
    • A. 

      Blood urea nitrogen 50 mg/dl

    • B. 

      Hemoglobin of 10.3 mg/dl

    • C. 

      Venous blood pH 7.30

    • D. 

      Serum potassium 6 mEq/L


  • 9. 
    Marina with acute renal failure moves into the diuretic phase after one week of therapy. During this phase the client must be assessed for signs of developing:  
    • A. 

      Hypovolemia

    • B. 

      Renal failure

    • C. 

      Metabolic acidosis

    • D. 

      Hyperkalemia


  • 10. 
    A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?
    • A. 

      Acute glomerulonephritis

    • B. 

      Acute renal failure

    • C. 

      Chronic renal failure

    • D. 

      Nephrotic syndrome


  • 11. 
    A client with acute renal failure is aware that the most serious complication of this condition is:
    • A. 

      Constipation

    • B. 

      Anemia

    • C. 

      Infection

    • D. 

      Platelet dysfunction


  • 12. 
    After 1 week a client with acute renal failure moves, into the diuretic phase. During this phase the client must be carefully assessed for signs of:
    • A. 

      Hypovolemia

    • B. 

      Hyperkalemia

    • C. 

      Metabolic acidosis

    • D. 

      Chronic renal failure


  • 13. 
    Nurse Liza is assigned to care for a client who has returned to the nursing unit after left nephrectomy. Nurse Liza’s highest priority would be…
    • A. 

      Hourly urine output

    • B. 

      Temperature

    • C. 

      Able to turn side to side

    • D. 

      Able to sips clear liquid


  • 14. 
    Which of these drugs is nephrotoxic?
    • A. 

      Diuretics

    • B. 

      ACE inhibitors

    • C. 

      NSAIDs

    • D. 

      Sodium bicarbonate/ Potassium bicarbonate


  • 15. 
    The client with renal failure should be on which type of diet?
    • A. 

      High protein, high carbohydrate, low calorie

    • B. 

      Adequate calorie intake, high carbohydrate, limited protein

    • C. 

      Limited protein, low carbohydrate, adequate calorie intake

    • D. 

      Low calorie, limited protein, low carbohydrate


  • 16. 
    ____________ is a treatment for renal failure in which blood id continuously circulated (artery to vein or vein to vein) and filtered, allowing excess water and solutes to empty into a collecting device. Fluid may be replaced with a balanced electrolyte solution as needed during treatment.
    • A. 

      Hemodialysis

    • B. 

      Continuous ambulatory peritoneal dialysis

    • C. 

      Continuous cyclic peritoneal dialysis

    • D. 

      Continuous Renal Replacement Therapy


  • 17. 
    A client on peritoneal dialysis notices that the collecting bag of dialysate is cloudy, what is this an indication of?
    • A. 

      The client needs to change their dialysate

    • B. 

      The patient needs a kidney transplant

    • C. 

      Medication was added to the dialysate

    • D. 

      The patient is infected and experiencing peritonitis


  • 18. 
    _________ is the most frequent complication during hemodialysis.
    • A. 

      Hypertension

    • B. 

      Bleeding

    • C. 

      Infection

    • D. 

      Dialysis dementia


  • 19. 
    Clients on continuous ambulatory peritoneal dialysis (CAPD) must empty their peritoneal cavity and replace the dialysate every __________ hours.
    • A. 

      24

    • B. 

      6-8

    • C. 

      4-6

    • D. 

      48


  • 20. 
    Agents that damage the kidney tissue are called:
    • A. 

      Nephrons

    • B. 

      Nephrotoxins

    • C. 

      Antibodies

    • D. 

      Enterotoxins


  • 21. 
    Acute renal failure is generally identified by oliguria (urine output <_____ mL/day).

  • 22. 
    The risk for __________________ is particularly high when ischemia and exposure to a nephrotoxin occur at the same time.

  • 23. 
    _________ renal Failure is a rapid decline in renal function with an abrupt onset

  • 24. 
    The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock)
    • A. 

      Prerenal

    • B. 

      Intrarenal

    • C. 

      Postrenal

    • D. 

      Perirenal


  • 25. 
    Whici is a normal value of Blood Urea Nitrogen (BUN)?
    • A. 

      0.5-1.1 mg/dL

    • B. 

      5-20 mg/dL

    • C. 

      40-70 mg/dL

    • D. 

      250-500 mg/dL


  • 26. 
    Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________.
    • A. 

      Hematuria

    • B. 

      Oliguria

    • C. 

      Uremia

    • D. 

      Nephrotoxins


  • 27. 
    Clients with chronic renal failure should notify the physician of any weight:
    • A. 

      Loss of 2 pounds over a 5 day period

    • B. 

      Gain of 2 pounds over a 2 day period

    • C. 

      Loss of 5 pounds over a 5 day period

    • D. 

      Gain of 5 pounds over a 2 day period


  • 28. 
    When the kidneys cannot effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, intake of these substances must be regulated. Fluid and Sodium intahe are ________.
    • A. 

      Encouraged

    • B. 

      Limited

    • C. 

      Restricted


  • 29. 
    "urine in the blood"

  • 30. 
    Which diagnostic test would be monitored to evaluate glomerulat filtration rateand renal function?
    • A. 

      Sreum creatinine and BUN

    • B. 

      Urinalysis

    • C. 

      Kidney biopsy

    • D. 

      Creatinine cleatance


  • 31. 
    When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, the client is said to have ____________, the final stage of Chronic Renal Failure.
    • A. 

      End-stage renal disease (ESRD)

    • B. 

      Renal insufficiency

    • C. 

      Acute tubular necrosis

    • D. 

      Dialysis


  • 32. 
    Which phase of Acute Renal Failure results in FVE and edema due to salt and water retention, hypertension, Azotemia, hyperkalemia, muscle weakness, nausea, diarrhea, and high serum creatinine and BUN levels?
    • A. 

      Initiation phase

    • B. 

      Maintenance phase

    • C. 

      Recovery fase

    • D. 

      Intrarenal phase


  • 33. 
    During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids.

  • 34. 
    __________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction by calculi)
    • A. 

      Prerenal

    • B. 

      Intrarenal

    • C. 

      Postrenal

    • D. 

      Perirenal


  • 35. 
    ________ failure is caused by Acute damage to renal tissue and nephrons or acute tubular necrosis: abrupt decline in tubular and glomerular function due to either prolonged ischemia and/or exposure to nephrotoxins. (Acute glomerulonephritis, malignant hypertension, ischemia; nephrotoxic drugs or substances; red blood cell destruction; muscle tissur breakdown due to trauma, heatstroke)
    • A. 

      Prerenal

    • B. 

      Intrarenal

    • C. 

      Postrenal

    • D. 

      Perirenal


  • 36. 
    ________ renal failure is a slow, insidious process of kidney destruction. It may go unrecognized for years as nephrons are destroyed and renal mass is reduced.

  • 37. 
    Anti-hypertensive therapy in patients with chronic renal disease is for?
    • A. 

      Renal protection

    • B. 

      Cardiovascular protection

    • C. 

      Both renal and cardiovascular protection

    • D. 

      Non of the above


  • 38. 
    Which of the following medications does not interfere with either creatinine secretion or the assay used to measure the serum creatinine?
    • A. 

      Ibuprofen

    • B. 

      Cimetidine

    • C. 

      Trimethoprim

    • D. 

      Cefoxitin

    • E. 

      Flucytosine


  • 39. 
    End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2.
    • A. 

      45

    • B. 

      30

    • C. 

      15

    • D. 

      10

    • E. 

      5


  • 40. 
    Chronic kidney disease is defined by Kidney Disease Outcomes Quality Initiative (K/DOQI) as evidence of structural or functional kidney abnormalities (abnormal urinalysis, imaging studies, or histology) that persists for at least ______________ months, with or without a decreased GFR.
    • A. 

      1

    • B. 

      2

    • C. 

      3

    • D. 

      6

    • E. 

      12


  • 41. 
    A client in acute renal failure is a candidate for continuous renal placement therapy (CRRT). The most common indication for use of CRRT is
    • A. 

      Azotemia

    • B. 

      Pericarditis

    • C. 

      Hyperkalemia

    • D. 

      Fluid overload


  • 42. 
    A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that contraindications to kidney transplantation include
    • A. 

      Hepatitis C infection

    • B. 

      Extensive vascular disease

    • C. 

      Coronary artery disease

    • D. 

      Refractory hypertension


  • 43. 
    The most serious electrolyte disorder associated with kidney disease is
    • A. 

      Hypermagnesemia

    • B. 

      Hyponatremia

    • C. 

      Hyperkalemia

    • D. 

      Metabolic acidosis


  • 44. 
    Signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include
    • A. 

      Tachycardia and headache

    • B. 

      Fever and painful transplant site

    • C. 

      Sever hypotension and weight loss

    • D. 

      Recurrent urinary tract infections and oral yeast infections


  • 45. 
    The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action?
    • A. 

      Notify the physician

    • B. 

      Monitor the client

    • C. 

      Elevate the head of the bed

    • D. 

      Medicate the client for nausea


  • 46. 
    A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client?
    • A. 

      Polyuria

    • B. 

      Polydypsia

    • C. 

      Oliguria

    • D. 

      Anuria


  • 47. 
    ESRD occurs when the GFR is less than ___ per minute.
    • A. 

      5 ml

    • B. 

      10 ml

    • C. 

      15 ml

    • D. 

      25 ml


  • 48. 
    The leading cause of ESRD is the client with a history of
    • A. 

      Hypotension

    • B. 

      Anemia

    • C. 

      Prostate cancer

    • D. 

      Diabetes Mellitus


  • 49. 
    The client with ESRD tells the nurse that she hates the thought of being tied to the machine, but is also glad to start dialysis because she will be able to eat and drink what she wants. Based on this information, the nuse identifies the nursing diagnosis of
    • A. 

      Self-esteem disturbance related to dependence on dialysis

    • B. 

      Anxiety related to perceived threat to health status and role functioning

    • C. 

      Ineffective management of therapeutic regimen related to lack of knowledge of treatment plan

    • D. 

      Risk for imbalanced nutrition: more than body requirements, related to increased dietary intake


  • 50. 
    The nurse is caring for the client who has had a renal biopsy. Which of the following interventions would the nurse avoid in the care of the client after this procedure?
    • A. 

      Encourage fluids to at least 3L in the first 24 hours

    • B. 

      Administering narcotics as needed

    • C. 

      Testing serial samples iwth dipsticks for occult blood

    • D. 

      Ambulating the client in the room and hall for short distances


  • 51. 
    How much water do normal kidneys excrete each day?
    • A. 

      3-4 liters

    • B. 

      5-6 liters

    • C. 

      1-2 liters

    • D. 

      7-8 liters


  • 52. 
    How much salt do normal kidneys excrete each day?
    • A. 

      1-2 mg

    • B. 

      5 g

    • C. 

      3-4 g

    • D. 

      6-8 g


  • 53. 
    How much KCL do normal kidneys excrete each day?
    • A. 

      6-8 g

    • B. 

      1 g

    • C. 

      6-8 mg

    • D. 

      3 mg


  • 54. 
    What does urine mostly consist of?
    • A. 

      H2O (Water)

    • B. 

      NaCl (Salt)

    • C. 

      Urea

    • D. 

      KCl


  • 55. 
    What electrolytes are in urine?
    • A. 

      Na

    • B. 

      K

    • C. 

      Cl

    • D. 

      HCO3-

    • E. 

      All of the above


  • 56. 
    True or false? Creatinine, phosphate, sulfates, and uric acid should not be present in urine because they signify renal failure.
    • A. 

      True

    • B. 

      False


  • 57. 
    How acidic is urine compared to blood?
    • A. 

      100 times more acidic

    • B. 

      200 times less acidic

    • C. 

      1000 times more acidic

    • D. 

      2000 times more acidic


  • 58. 
    How do kidneys control Na+ levels and K+ levels?
    • A. 

      The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+

    • B. 

      Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin. Angiotensin controls the levels of Na+ and K+

    • C. 

      The kidneys release renin which controls K+. The kidneys release angiotensin which causes Na+ realease.


  • 59. 
    How many ml/hr of urine output is the normal minimum?

  • 60. 
    What controls the amount of water reabsorbtion?

  • 61. 
    What is the most common early manifestation of kidney disease _____ and _____

  • 62. 
    What tests and results prove the presence of dilute urine?
    • A. 

      Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)

    • B. 

      GFR (100 ml/min), and/or Specific Gravity (1.030)

    • C. 

      Serum Creatinine (1.5 mg/dl)


  • 63. 
    What is the # 1 renal function test?
    • A. 

      Renal Clearance/Creatinine Clearance

    • B. 

      Osmolarity

    • C. 

      Serum Creatinine

    • D. 

      BUN


  • 64. 
    What is the #1 cause of death when kidneys fail?

  • 65. 
    Which of the following are abnormal to be found in the urine?
    • A. 

      K

    • B. 

      Amino acids

    • C. 

      Glucose

    • D. 

      All of the above

    • E. 

      Amino acids and Glucose


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