Urinary System Disorders | NCLEX Quiz 117

1. The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?

Monitor the client’s level of consciousness

Maintain strict aseptic technique

Add heparin to the dialysate solution

Change the catheter site dressing daily

The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option D may assist in preventing infection. this option relates to an external site.

Explanation

The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option D may assist in preventing infection. this option relates to an external site.

2. The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations?

Warmth. redness. and pain in the left hand.

Pallor. diminished pulse. and pain in the left hand.

Edema and reddish discoloration of the left arm

Aching pain. pallor. and edema in the left arm.

Steal syndrome results from vascular insufficiency after the creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula. which is due to tissue ischemia.Option A: Warmth. redness. and pain more likely would characterize a problem with infection.

Explanation

Steal syndrome results from vascular insufficiency after the creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula. which is due to tissue ischemia.Option A: Warmth. redness. and pain more likely would characterize a problem with infection.

3. 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

Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbiturates may be necessary to prevent a life-threatening situation. The physician must be notified.

Explanation

Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbiturates may be necessary to prevent a life-threatening situation. The physician must be notified.

4. The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome. the nurse assesses the client during dialysis for:

Hypertension. tachycardia. and fever

Hypotension. bradycardia. and hypothermia

Restlessness. irritability. and generalized weakness

Headache. deteriorating level of consciousness. and twitching.

Disequilibrium syndrome is characterized by headache. mental confusion. decreasing level of consciousness. nausea. and vomiting. twitching. and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time. the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result. water goes into cerebral cells because of the osmotic gradient. causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

Explanation

Disequilibrium syndrome is characterized by headache. mental confusion. decreasing level of consciousness. nausea. and vomiting. twitching. and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time. the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result. water goes into cerebral cells because of the osmotic gradient. causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

5. A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client's status after dialysis?

Potassium level and weight

BUN and creatinine levels

VS and BUN

VS and weight.

Following dialysis. the client’s vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client’s predialysis weight to determine the effectiveness of fluid extraction.Options A. B. and C: Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.

Explanation

Following dialysis. the client’s vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client’s predialysis weight to determine the effectiveness of fluid extraction.Options A. B. and C: Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.

6. The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items. if selected by the client. would indicate an understanding of this dietary restriction?

Cantaloupe

Spinach

Lima beans

Strawberries

Lima beans (1/3 c) averages three (3) mEq per serving.Option A: Cantaloupe (1/4 small).Option B: Spinach (1/2 cooked).Option D: Strawberries (1 ¼ cups) are high potassium foods and average 7 mEq per serving.

Explanation

Lima beans (1/3 c) averages three (3) mEq per serving.Option A: Cantaloupe (1/4 small).Option B: Spinach (1/2 cooked).Option D: Strawberries (1 ¼ cups) are high potassium foods and average 7 mEq per serving.

7. The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client's temperature is 100.2. Which of the following is the most appropriate nursing action?

Encourage fluids

Notify the physician

Monitor the site of the shunt for infection

Continue to monitor vital signs

The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated. sepsis would be suspected. and a blood sample would be obtained as prescribed for culture and sensitivity purposes.

Explanation

The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated. sepsis would be suspected. and a blood sample would be obtained as prescribed for culture and sensitivity purposes.

8. A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate?

Slow the infusion

Decrease the amount to be infused

Explain that the pain will subside after the first few exchanges

Stop the dialysis

Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however. the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased. and the infusion should not be slowed or stopped.

Explanation

Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however. the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased. and the infusion should not be slowed or stopped.

9. 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

Polydipsia

Oliguria

Anuria

Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria. and the client loses all normal functions of the kidney.Options B. C. and D: Oliguria and anuria are not early signs. and polydipsia is unrelated to chronic renal failure.

Explanation

Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria. and the client loses all normal functions of the kidney.Options B. C. and D: Oliguria and anuria are not early signs. and polydipsia is unrelated to chronic renal failure.

10. If a client's prostate enlargement is caused by a malignancy. which of the following blood examinations should the nurse anticipate to assess whether metastasis has occurred?

Serum creatinine level

Serum acid phosphatase level

Total nonprotein nitrogen level

Endogenous creatinine clearance time

Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution. the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.

Explanation

Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution. the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.