Renal Failure (Acute & Chronic) By Rnpedia.Com

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Renal Failure (Acute & Chronic) By Rnpedia.Com - Quiz

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Questions and Answers
  • 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

    Correct Answer
    C. Limiting fluid intake
    Explanation
    During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn’t take precedence over fluid limitation. Controlling pain isn’t important because ARF rarely causes pain.

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  • 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.

    Correct Answer
    A. Confusion, headache, and seizures.
    Explanation
    Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

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  • 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

    Correct Answer
    A. Hyponatremia
    Explanation
    The normal serum sodium level is 135 – 145 mEq/L. The client’s serum sodium is below normal. Hyponatremia also manifests itself with abdominal cramps and nausea and vomiting

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  • 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.

    Correct Answer
    C. Hypovolemia, wide fluctuations in serum sodium and potassium levels.
    Explanation
    The second phase of ARF is the diuretic phase or high output phase. The diuresis can result in an output of up to 10L/day of dilute urine. Loss of fluids and electrolytes occur.

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  • 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.

    Correct Answer
    C. Hyperkalemia.
    Explanation
    Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

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  • 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

    Correct Answer
    A. Provide oral care every 3-4 hours
    Explanation
    Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.

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  • 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

    Correct Answer
    D. Serum potassium 6 mEq/L
    Explanation
    Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.

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  • 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

    Correct Answer
    D. Serum potassium 6 mEq/L
    Explanation
    Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.

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  • 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

    Correct Answer
    A. Hypovolemia
    Explanation
    In the diuretic phase fluid retained during the oliguric phase is excreted and may reach 3 to 5 liters daily, hypovolemia may occur and fluids should be replaced.

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  • 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

    Correct Answer
    A. Acute glomerulonephritis
    Explanation
    Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus.
    Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney.
    Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications.
    Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

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  • 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

    Correct Answer
    C. Infection
    Explanation
    Infection is responsible for one third of the traumatic or surgically induced death of clients with renal failure as well as medical induced acute renal failure (ARF)

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  • 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

    Correct Answer
    A. Hypovolemia
    Explanation
    During the diuretic phase of acute renal failure, the client experiences increased urine output. This can lead to a decrease in fluid volume in the body, resulting in hypovolemia. Hypovolemia is characterized by symptoms such as decreased blood pressure, increased heart rate, dry mucous membranes, and decreased urine output. It is important to carefully assess the client for these signs to prevent complications and provide appropriate interventions to restore fluid balance.

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  • 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

    Correct Answer
    A. Hourly urine output
    Explanation
    After nephrectomy, it is necessary to measure urine output hourly. This is done to assess the effectiveness of the remaining kidney also to detect renal failure early.

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  • 14. 

    Which of these drugs is nephrotoxic?

    • A.

      Diuretics

    • B.

      ACE inhibitors

    • C.

      NSAIDs

    • D.

      Sodium bicarbonate/ Potassium bicarbonate

    Correct Answer
    C. NSAIDs
    Explanation
    NSAIDs (Nonsteroidal anti-inflammatory drugs) are known to be nephrotoxic, meaning they can cause damage to the kidneys. These drugs inhibit the production of certain chemicals in the body that cause inflammation and pain, but they can also reduce blood flow to the kidneys and impair their function. Prolonged use or high doses of NSAIDs can lead to kidney damage, including acute kidney injury or chronic kidney disease. Therefore, NSAIDs are considered nephrotoxic drugs.

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  • 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

    Correct Answer
    B. Adequate calorie intake, high carbohydrate, limited protein
    Explanation
    A client with renal failure should be on a diet that includes adequate calorie intake to maintain their energy levels, high carbohydrate to provide fuel for the body, and limited protein to reduce the workload on the kidneys. This type of diet helps to manage the symptoms of renal failure and prevent further damage to the kidneys. High protein and low carbohydrate diets can put additional strain on the kidneys and are not recommended for individuals with renal failure. Low calorie diets may not provide enough energy for the body's needs.

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  • 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

    Correct Answer
    D. Continuous Renal Replacement Therapy
    Explanation
    Continuous Renal Replacement Therapy (CRRT) is a treatment for renal failure in which blood is continuously circulated and filtered. It involves the use of a machine that filters the blood, allowing excess water and solutes to be removed. This process helps to maintain fluid balance and remove waste products from the body. Unlike hemodialysis, which is typically done in shorter sessions, CRRT is a continuous process that can be performed over a longer period of time. It is often used for patients who are critically ill and unable to tolerate traditional hemodialysis.

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  • 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

    Correct Answer
    D. The patient is infected and experiencing peritonitis
    Explanation
    Cloudy dialysate can be an indication of infection and peritonitis in a client on peritoneal dialysis. Peritonitis is an inflammation of the peritoneum, the lining of the abdominal cavity, and is a common complication of peritoneal dialysis. It can be caused by bacteria entering the peritoneal cavity during dialysis. Cloudy dialysate is often accompanied by other symptoms such as abdominal pain, fever, and an increase in white blood cell count. Prompt treatment with antibiotics is necessary to prevent further complications and to preserve the function of the peritoneal membrane.

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  • 18. 

    _________ is the most frequent complication during hemodialysis.

    • A.

      Hypertension

    • B.

      Bleeding

    • C.

      Infection

    • D.

      Dialysis dementia

    Correct Answer
    A. Hypertension
    Explanation
    Hypertension is the most frequent complication during hemodialysis because the process of removing excess fluid and waste products from the blood can cause changes in blood pressure. The rapid removal of fluid during dialysis can lead to hypotension, while the use of certain medications to control blood pressure can also cause hypertension. Additionally, the stress on the cardiovascular system during dialysis can contribute to the development or worsening of hypertension. Therefore, monitoring and managing blood pressure levels is crucial during hemodialysis to prevent complications.

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  • 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

    Correct Answer
    C. 4-6
    Explanation
    Clients on continuous ambulatory peritoneal dialysis (CAPD) need to empty their peritoneal cavity and replace the dialysate every 4-6 hours. This is necessary to ensure that waste products and excess fluid are effectively removed from the body. By regularly replacing the dialysate, the process of dialysis can continue uninterrupted, helping to maintain the client's overall health and well-being.

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  • 20. 

    Agents that damage the kidney tissue are called:

    • A.

      Nephrons

    • B.

      Nephrotoxins

    • C.

      Antibodies

    • D.

      Enterotoxins

    Correct Answer
    B. Nephrotoxins
    Explanation
    Nephrotoxins are agents that damage the kidney tissue. They can be substances such as drugs, chemicals, or toxins that have a toxic effect on the kidneys. These substances can impair the normal functioning of the kidneys and lead to kidney damage or dysfunction. Nephrotoxins can cause inflammation, cell death, or disruption of the kidney's filtration and reabsorption processes. It is important to identify and avoid exposure to nephrotoxins to prevent kidney damage and maintain proper kidney function.

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  • 21. 

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

    Correct Answer
    400
    Explanation
    Acute renal failure is typically diagnosed by oliguria, which is defined as a urine output of less than 400 mL per day. This means that if a person's urine output is consistently below 400 mL per day, it may indicate that their kidneys are not functioning properly and they are experiencing acute renal failure. Oliguria is a common symptom of this condition and is used as a diagnostic criterion.

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  • 22. 

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

    Correct Answer
    acute tubular necrosis, tubular necrosis
    Explanation
    Acute tubular necrosis is a condition where there is damage to the tubules in the kidneys, leading to kidney dysfunction. Ischemia refers to a lack of blood flow to the kidneys, which can further contribute to kidney damage. Exposure to a nephrotoxin, such as certain medications or chemicals, can also cause damage to the tubules. When ischemia and exposure to a nephrotoxin happen simultaneously, the risk for acute tubular necrosis and tubular necrosis is particularly high.

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  • 23. 

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

    Correct Answer
    acute
    Explanation
    Acute renal failure refers to a sudden and rapid decline in kidney function. This condition occurs abruptly and is characterized by a significant decrease in the kidney's ability to filter waste products and maintain electrolyte balance in the body. Acute renal failure can be caused by various factors such as dehydration, kidney infection, kidney stones, or drug toxicity. Prompt medical intervention is necessary to address the underlying cause and prevent further damage to the kidneys.

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  • 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

    Correct Answer
    A. Prerenal
    Explanation
    Prerenal failure refers to a condition where there is a decrease in blood flow to the kidneys, leading to impaired blood supply. This can be caused by factors such as dehydration, hemorrhage, heart failure, or shock. In this case, the impaired blood supply to the kidney is the cause of the failure, which aligns with the given correct answer "prerenal."

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  • 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

    Correct Answer
    B. 5-20 mg/dL
    Explanation
    A normal value of Blood Urea Nitrogen (BUN) is typically in the range of 5-20 mg/dL. BUN is a measure of the amount of nitrogen in the blood that comes from the waste product urea, which is produced by the liver during the breakdown of proteins. Higher levels of BUN may indicate kidney dysfunction or dehydration, while lower levels may suggest liver disease or malnutrition. Therefore, a range of 5-20 mg/dL is considered normal for BUN levels.

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  • 26. 

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

    • A.

      Hematuria

    • B.

      Oliguria

    • C.

      Uremia

    • D.

      Nephrotoxins

    Correct Answer
    C. Uremia
    Explanation
    Uremia is a condition characterized by the buildup of waste products in the blood due to impaired kidney function. This can lead to various metabolic disturbances such as hyperkalemia (high potassium levels), acidosis (excess acid in the blood), hyperlipidemia (elevated levels of fats in the blood), hyperuricemia (high levels of uric acid in the blood), and malnutrition. These effects occur as the kidneys are responsible for filtering waste products from the blood, and when they are not functioning properly, these waste products accumulate and disrupt normal metabolic processes.

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  • 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

    Correct Answer
    D. Gain of 5 pounds over a 2 day period
    Explanation
    Clients with chronic renal failure should notify the physician of a gain of 5 pounds over a 2 day period. This sudden and significant weight gain could indicate fluid retention, which is a common symptom of renal failure. It may be a sign that the kidneys are not functioning properly and are unable to remove excess fluid from the body. Prompt medical attention is necessary in order to prevent further complications and manage the condition effectively.

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  • 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

    Correct Answer
    B. Limited
    Explanation
    When the kidneys are unable to effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, it is necessary to limit the intake of fluid and sodium. This is because excessive intake of these substances can further burden the kidneys and worsen the imbalance. By limiting the intake, the kidneys are given a chance to better manage the fluid and electrolyte levels in the body and prevent the accumulation of waste products.

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  • 29. 

    "urine in the blood"

    Correct Answer
    uremia
    Explanation
    Uremia is a medical condition characterized by the presence of urine in the blood. It occurs when the kidneys are unable to effectively filter waste products and toxins from the bloodstream, leading to a buildup of urea and other waste products in the blood. This can result in various symptoms such as fatigue, nausea, loss of appetite, and changes in urine output. If left untreated, uremia can lead to serious complications and organ damage.

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  • 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

    Correct Answer
    D. Creatinine cleatance
    Explanation
    Creatinine clearance is the most appropriate diagnostic test to monitor glomerular filtration rate and renal function. Creatinine is a waste product that is filtered by the kidneys, and its clearance rate provides an accurate measure of the kidneys' ability to remove waste from the blood. By measuring the amount of creatinine in both the blood and urine over a specific period of time, creatinine clearance can be calculated. This test is commonly used to assess kidney function and detect any abnormalities or impairments in the glomerular filtration rate.

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  • 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

    Correct Answer
    A. End-stage renal disease (ESRD)
    Explanation
    When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, the client is said to have end-stage renal disease (ESRD). This is the final stage of Chronic Renal Failure where the kidneys are no longer able to function properly. In ESRD, the kidneys have lost almost all of their ability to function, and the patient may require dialysis or a kidney transplant to survive. Renal insufficiency refers to a lesser degree of kidney dysfunction, while acute tubular necrosis is a specific type of kidney injury. Dialysis is a treatment option for ESRD but not a term used to describe the condition itself.

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  • 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

    Correct Answer
    B. Maintenance phase
    Explanation
    The maintenance phase of Acute Renal Failure results in fluid volume excess (FVE) and edema due to salt and water retention. It also leads to hypertension, azotemia, hyperkalemia, muscle weakness, nausea, diarrhea, and high serum creatinine and BUN levels. During this phase, the kidneys are unable to properly filter and eliminate waste products and excess fluid from the body, leading to these symptoms and imbalances.

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  • 33. 

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

    Correct Answer
    maintenance
    Explanation
    During the maintenance phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids. This phase is characterized by a significant decrease in urine output, usually less than 400 ml per day. The kidneys are unable to regulate fluid and electrolyte balance properly, leading to the buildup of waste products and imbalances in the body. Treatment during this phase focuses on managing fluid and electrolyte levels and addressing the underlying cause of the renal failure.

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  • 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

    Correct Answer
    C. Postrenal
    Explanation
    Postrenal failure is caused by obstruction of urine flow, such as in cases of urethral obstruction by an enlarged prostate or tumor, or ureteral or kidney pelvis obstruction by calculi. This obstruction prevents the normal flow of urine from the kidneys to the bladder, leading to a build-up of pressure in the urinary system. This can result in kidney damage and ultimately kidney failure.

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  • 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

    Correct Answer
    B. Intrarenal
    Explanation
    Intrarenal failure is the correct answer because it refers to damage that occurs within the kidneys themselves. This damage can be caused by acute damage to renal tissue and nephrons, such as acute tubular necrosis. This type of failure is characterized by a sudden decline in tubular and glomerular function, often due to prolonged ischemia or exposure to nephrotoxins. Other causes of intrarenal failure include conditions like acute glomerulonephritis, malignant hypertension, ischemia, nephrotoxic drugs or substances, red blood cell destruction, and muscle tissue breakdown due to trauma or heatstroke.

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  • 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.

    Correct Answer
    chronic
    Explanation
    Chronic renal failure refers to a gradual and progressive deterioration of kidney function over time. This condition is characterized by the slow destruction of nephrons (the functional units of the kidneys) and a decrease in renal mass. It can often go unnoticed for an extended period, as the symptoms may be mild or absent in the early stages. The term "chronic" indicates that the condition is ongoing and long-term, in contrast to acute renal failure, which is sudden and typically reversible.

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  • 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

    Correct Answer
    C. Both renal and cardiovascular protection
    Explanation
    Anti-hypertensive therapy in patients with chronic renal disease is necessary for both renal and cardiovascular protection. Chronic renal disease often leads to high blood pressure, which can further damage the kidneys and increase the risk of cardiovascular events such as heart attacks and strokes. By controlling blood pressure, anti-hypertensive therapy helps to protect the kidneys from further damage and reduces the risk of cardiovascular complications. Therefore, both renal and cardiovascular protection are important goals of anti-hypertensive therapy in patients with chronic renal disease.

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  • 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

    Correct Answer
    A. Ibuprofen
    Explanation
    Ibuprofen does not interfere with either creatinine secretion or the assay used to measure serum creatinine. This means that taking ibuprofen medication will not affect the levels of creatinine in the body or alter the accuracy of creatinine measurement in blood tests.

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  • 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

    Correct Answer
    C. 15
    Explanation
    End-stage renal disease is defined as a Glomerular Filtration Rate (GFR) less than 15 ml/min per 1.73m2. GFR is a measure of kidney function and indicates how well the kidneys are able to filter waste products from the blood. A GFR of less than 15 ml/min per 1.73m2 indicates severe kidney damage and signifies the need for kidney replacement therapy, such as dialysis or kidney transplantation.

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  • 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

    Correct Answer
    C. 3
    Explanation
    Chronic kidney disease is defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI) as evidence of structural or functional kidney abnormalities that persist for at least 3 months, with or without a decreased GFR. This means that in order for a diagnosis of chronic kidney disease to be made, there must be evidence of kidney abnormalities that have been present for at least 3 months. This can be determined through abnormal urinalysis, imaging studies, or histology. It is important to note that a decreased glomerular filtration rate (GFR) may or may not be present in chronic kidney disease.

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  • 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

    Correct Answer
    D. Fluid overload
    Explanation
    The correct answer is fluid overload because continuous renal replacement therapy (CRRT) is commonly used in patients with acute renal failure who have fluid overload. CRRT helps remove excess fluid from the body by continuously filtering the blood and removing waste products. This treatment is particularly beneficial in cases where diuretics are not effective or when there is a risk of fluid overload leading to complications such as pulmonary edema or heart failure.

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  • 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

    Correct Answer
    B. Extensive vascular disease
    Explanation
    Contraindications to kidney transplantation include extensive vascular disease. This means that if a patient has significant damage or blockage in their blood vessels, it may not be safe or feasible to perform a kidney transplant. Extensive vascular disease can affect the blood flow to the transplanted kidney, leading to complications and potential failure of the transplant. Therefore, it is important to assess the patient's vascular health before considering them as a candidate for kidney transplantation.

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  • 43. 

    The most serious electrolyte disorder associated with kidney disease is

    • A.

      Hypermagnesemia

    • B.

      Hyponatremia

    • C.

      Hyperkalemia

    • D.

      Metabolic acidosis

    Correct Answer
    C. Hyperkalemia
    Explanation
    Hyperkalemia is the most serious electrolyte disorder associated with kidney disease. Kidneys play a crucial role in maintaining the balance of electrolytes in the body, including potassium. In kidney disease, the kidneys are unable to effectively remove excess potassium from the body, leading to a buildup of potassium in the bloodstream. This can result in various complications, including irregular heart rhythms and potentially life-threatening cardiac arrhythmias. Therefore, hyperkalemia is considered the most serious electrolyte disorder in kidney disease.

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  • 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

    Correct Answer
    B. Fever and painful transplant site
    Explanation
    The signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include fever and painful transplant site. This is because fever is a common symptom of infection or inflammation, which can indicate rejection of the transplanted kidney. Additionally, a painful transplant site can suggest the presence of rejection, as the body's immune system may be attacking the new organ. Monitoring these symptoms is important for early detection and prompt medical intervention to prevent further complications.

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  • 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

    Correct Answer
    A. Notify the physician
    Explanation
    The client has just returned from dialysis and is experiencing symptoms such as headache, nausea, and restlessness. These symptoms could indicate a potential complication or adverse reaction to the dialysis treatment. Therefore, it is important to notify the physician so that they can evaluate the client's condition and provide appropriate medical intervention if necessary. Monitoring the client is important, but notifying the physician takes precedence in this situation. Elevating the head of the bed may provide some relief for the client, but it does not address the underlying cause of their symptoms. Medicating the client for nausea may provide temporary relief, but it is important to determine the cause of the symptoms before administering any medication.

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  • 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

    Correct Answer
    A. Polyuria
    Explanation
    In early stage chronic renal failure, the kidneys are still able to produce urine, although their function is impaired. Polyuria, the excessive production of urine, is a common symptom in this stage. This occurs because the kidneys are unable to properly concentrate urine, leading to increased urine output. Polydypsia, the excessive thirst, may also be present as the body tries to compensate for the increased urine output. Oliguria, decreased urine output, and anuria, absence of urine production, are not expected findings in early stage chronic renal failure.

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  • 47. 

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

    • A.

      5 ml

    • B.

      10 ml

    • C.

      15 ml

    • D.

      25 ml

    Correct Answer
    C. 15 ml
    Explanation
    ESRD stands for End-Stage Renal Disease, which is the final stage of chronic kidney disease. The GFR (glomerular filtration rate) is a measure of how well the kidneys are functioning. A GFR of less than 15 ml per minute indicates that the kidneys are severely impaired and are not able to effectively filter waste products from the blood. This is a critical threshold at which patients usually require dialysis or a kidney transplant to survive.

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  • 48. 

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

    • A.

      Hypotension

    • B.

      Anemia

    • C.

      Prostate cancer

    • D.

      Diabetes Mellitus

    Correct Answer
    D. Diabetes Mellitus
    Explanation
    Diabetes Mellitus is the leading cause of end-stage renal disease (ESRD) because it can damage the small blood vessels in the kidneys over time. This damage can lead to decreased kidney function and eventually ESRD. Hypotension, anemia, and prostate cancer may contribute to kidney problems, but they are not the primary cause of ESRD.

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  • 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

    Correct Answer
    C. Ineffective management of therapeutic regimen related to lack of knowledge of treatment plan
    Explanation
    Based on the client's statement, it can be inferred that she is glad to start dialysis because it will allow her to eat and drink what she wants. This suggests that she may not have a clear understanding of the treatment plan and how it relates to her dietary restrictions. Therefore, the nursing diagnosis of ineffective management of therapeutic regimen related to lack of knowledge of treatment plan is the most appropriate choice.

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  • 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

    Correct Answer
    D. Ambulating the client in the room and hall for short distances
    Explanation
    After a renal biopsy, the nurse would avoid ambulating the client in the room and hall for short distances. This is because after the procedure, the client may experience pain, discomfort, and potential bleeding. Ambulation may increase the risk of bleeding and can exacerbate the client's pain. Therefore, it is important to avoid unnecessary movement and allow the client to rest and recover. Encouraging fluids, administering narcotics as needed, and testing serial samples with dipsticks for occult blood are all appropriate interventions for the care of the client after a renal biopsy.

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Quiz Review Timeline +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 22, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jan 19, 2013
    Quiz Created by
    RNpedia.com
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