Renal Failure (Acute & Chronic) By Rnpedia.Com

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:  

• Confusion, headache, and seizures.

• Acute bone pain and confusion.

• Weakness, tingling, and cardiac arrhythmias.

• Hypotension, tachycardia, and tachypnea.

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?   

• Hyponatremia

• Hyperkalemia

• Hyperphosphatemia

• Hypercalcemia

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   

• Hypervolemia, hypokalemia, and hypernatremia.

• Hypervolemia, hyperkalemia, and hypernatremia.

• Hypovolemia, wide fluctuations in serum sodium and potassium levels.

• Hypovolemia, no fluctuation in serum sodium and potassium levels.

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:    

• Hypernatremia.

• Hypokalemia.

• Hyperkalemia.

• Hypercalcemia.

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?    

• Provide oral care every 3-4 hours

• Monitor for indications of dehydration

• Administer 0.45% saline by IV line

• Assess daily weights for trends

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

• Blood urea nitrogen 50 mg/dl

• Hemoglobin of 10.3 mg/dl

• Venous blood pH 7.30

• Serum potassium 6 mEq/L

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

• Blood urea nitrogen 50 mg/dl

• Hemoglobin of 10.3 mg/dl

• Venous blood pH 7.30

• Serum potassium 6 mEq/L

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:  

• Hypovolemia

• Renal failure

• Metabolic acidosis

• Hyperkalemia

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

• Acute glomerulonephritis

• Acute renal failure

• Chronic renal failure

• Nephrotic syndrome

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

• Constipation

• Anemia

• Infection

• Platelet dysfunction

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:

• Hypovolemia

• Hyperkalemia

• Metabolic acidosis

• Chronic renal failure

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…

• Hourly urine output

• Temperature

• Able to turn side to side

• Able to sips clear liquid

Which of these drugs is nephrotoxic?

• Diuretics

• ACE inhibitors

• NSAIDs

• Sodium bicarbonate/ Potassium bicarbonate

The client with renal failure should be on which type of diet?

• High protein, high carbohydrate, low calorie

• Adequate calorie intake, high carbohydrate, limited protein

• Limited protein, low carbohydrate, adequate calorie intake

• Low calorie, limited protein, low carbohydrate

____________ 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.

• Hemodialysis

• Continuous ambulatory peritoneal dialysis

• Continuous cyclic peritoneal dialysis

• Continuous Renal Replacement Therapy

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

• The client needs to change their dialysate

• The patient needs a kidney transplant

• Medication was added to the dialysate

• The patient is infected and experiencing peritonitis

_________ is the most frequent complication during hemodialysis.

• Hypertension

• Bleeding

• Infection

• Dialysis dementia

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

• 24

• 6-8

• 4-6

• 48

Agents that damage the kidney tissue are called:

• Nephrons

• Nephrotoxins

• Antibodies

• Enterotoxins

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

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

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

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

• Prerenal

• Intrarenal

• Postrenal

• Perirenal

Whici is a normal value of Blood Urea Nitrogen (BUN)?

• 0.5-1.1 mg/dL

• 5-20 mg/dL

• 40-70 mg/dL

• 250-500 mg/dL

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

• Hematuria

• Oliguria

• Uremia

• Nephrotoxins

Clients with chronic renal failure should notify the physician of any weight:

• Loss of 2 pounds over a 5 day period

• Gain of 2 pounds over a 2 day period

• Loss of 5 pounds over a 5 day period

• Gain of 5 pounds over a 2 day period

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 ________.

• Encouraged

• Limited

• Restricted

"urine in the blood"

Which diagnostic test would be monitored to evaluate glomerulat filtration rateand renal function?

• Sreum creatinine and BUN

• Urinalysis

• Kidney biopsy

• Creatinine cleatance

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.

• End-stage renal disease (ESRD)

• Renal insufficiency

• Acute tubular necrosis

• Dialysis

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?

• Initiation phase

• Maintenance phase

• Recovery fase

• Intrarenal phase

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

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

• Prerenal

• Intrarenal

• Postrenal

• Perirenal

________ 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)

• Prerenal

• Intrarenal

• Postrenal

• Perirenal

________ 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.

Anti-hypertensive therapy in patients with chronic renal disease is for?

• Renal protection

• Cardiovascular protection

• Both renal and cardiovascular protection

• Non of the above

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

• Ibuprofen

• Cimetidine

• Trimethoprim

• Cefoxitin

• Flucytosine

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

• 45

• 30

• 15

• 10

• 5

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.

• 1

• 2

• 3

• 6

• 12

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

• Azotemia

• Pericarditis

• Hyperkalemia

• Fluid overload

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

• Hepatitis C infection

• Extensive vascular disease

• Coronary artery disease

• Refractory hypertension

The most serious electrolyte disorder associated with kidney disease is

• Hypermagnesemia

• Hyponatremia

• Hyperkalemia

• Metabolic acidosis

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

• Tachycardia and headache

• Fever and painful transplant site

• Sever hypotension and weight loss

• Recurrent urinary tract infections and oral yeast infections

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?

• Notify the physician

• Monitor the client

• Elevate the head of the bed

• Medicate the client for nausea

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?

• Polyuria

• Polydypsia

• Oliguria

• Anuria

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

• 5 ml

• 10 ml

• 15 ml

• 25 ml

The leading cause of ESRD is the client with a history of

• Hypotension

• Anemia

• Prostate cancer

• Diabetes Mellitus

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

• Self-esteem disturbance related to dependence on dialysis

• Anxiety related to perceived threat to health status and role functioning

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

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