Urinary System Disorders | NCLEX Quiz 119

1. Which of the following nursing interventions should be included in the client's care plan during dialysis therapy?

Limit the client’s visitors

Monitor the client’s blood pressure

Pad the side rails of the bed

Keep the client NPO.

Because hypotension is a complication of peritoneal dialysis. the nurse records intake. and output. monitors VS. and observes the client’s behavior.Option A: The nurse also encourages visiting and other diversional activities.Options C and D: A client on PD does not need to be placed in bed with padded side rails or kept NPO.

Explanation

Because hypotension is a complication of peritoneal dialysis. the nurse records intake. and output. monitors VS. and observes the client’s behavior.Option A: The nurse also encourages visiting and other diversional activities.Options C and D: A client on PD does not need to be placed in bed with padded side rails or kept NPO.

2. The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure?

High carbohydrate. high protein

High calcium. high potassium. high protein

Low protein. low sodium. low potassium

Low protein. high potassium

Dietary management for clients with chronic renal failure is usually designed to restrict protein. sodium. and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. Reducing sodium in the diet helps to control high blood pressure. It also keeps one from being thirsty and prevents the body from holding onto extra fluid. Too much potassium can build up when the kidneys no longer function well. It can cause an irregular heartbeat or a heart attack.

Explanation

Dietary management for clients with chronic renal failure is usually designed to restrict protein. sodium. and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. Reducing sodium in the diet helps to control high blood pressure. It also keeps one from being thirsty and prevents the body from holding onto extra fluid. Too much potassium can build up when the kidneys no longer function well. It can cause an irregular heartbeat or a heart attack.

3. In planning teaching strategies for the client with chronic renal failure. the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate?

Providing all needed teaching in one extended session.

Validating frequently the client’s understanding of the material.

Conducting a one-on-one session with the client.

Using videotapes to reinforce the material as needed.

Uremia can cause decreased alertness. so the nurse needs to validate the client’s comprehension frequently.Option A: Because the client’s ability to concentrate is limited. short lesions are most effective.Option C: If family members are present at the sessions. they can reinforce the material.Option D: Written materials that the client can review are superior to videotapes. because the clients may not be able to maintain alertness during the viewing of the videotape.

Explanation

Uremia can cause decreased alertness. so the nurse needs to validate the client’s comprehension frequently.Option A: Because the client’s ability to concentrate is limited. short lesions are most effective.Option C: If family members are present at the sessions. they can reinforce the material.Option D: Written materials that the client can review are superior to videotapes. because the clients may not be able to maintain alertness during the viewing of the videotape.

4. The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:

MOM can cause magnesium toxicity

MOM is too harsh on the bowel

Metamucil is more palatable

MOM is high in sodium

Magnesium is normally excreted by the kidneys. When the kidneys fail. magnesium can accumulate and cause severe neurologic problems.Option B: MOM is harsher than Metamucil. but magnesium toxicity is a more serious problem.Option C: A client may find both MOM and Metamucil unpalatable.Option D: MOM is not high in sodium.

Explanation

Magnesium is normally excreted by the kidneys. When the kidneys fail. magnesium can accumulate and cause severe neurologic problems.Option B: MOM is harsher than Metamucil. but magnesium toxicity is a more serious problem.Option C: A client may find both MOM and Metamucil unpalatable.Option D: MOM is not high in sodium.

5. A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it:

Is relatively low in cost

Allows the client to be more independent

Is faster and more efficient than standard peritoneal dialysis

Has fewer potential complications than standard peritoneal dialysis

The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers. home health care personnel. and machines for life-sustaining treatment. The independence is a valuable outcome for some people.Option A: CAPD is costly and must be done daily.Option D: Side effects and complications are similar to those of standard peritoneal dialysis.

Explanation

The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers. home health care personnel. and machines for life-sustaining treatment. The independence is a valuable outcome for some people.Option A: CAPD is costly and must be done daily.Option D: Side effects and complications are similar to those of standard peritoneal dialysis.

6. During the client's dialysis. the nurse observes that the solution draining from the abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct?

Bleeding is expected with a permanent peritoneal catheter

Bleeding indicates abdominal blood vessel damage

Bleeding can indicate kidney damage.

Bleeding is caused by too-rapid infusion of the dialysate.

Because the client has a permanent catheter in place. blood tinged drainage should not occur. Persistent blood tinged drainage could indicate damage to the abdominal vessels. and the physician should be notified.Option C: The bleeding is originating in the peritoneal cavity. not the kidneys.Option D: Too rapid infusion of the dialysate can cause pain.

Explanation

Because the client has a permanent catheter in place. blood tinged drainage should not occur. Persistent blood tinged drainage could indicate damage to the abdominal vessels. and the physician should be notified.Option C: The bleeding is originating in the peritoneal cavity. not the kidneys.Option D: Too rapid infusion of the dialysate can cause pain.

7. What is the primary disadvantage of using peritoneal dialysis for long-term management of chronic renal failure?

The danger of hemorrhage is high.

It cannot correct severe imbalances.

It is a time consuming method of treatment.

The risk of contracting hepatitis is high.

The disadvantages of peritoneal dialysis in the long-term management of chronic renal failure is that requires large blocks of time.Options A and D: The risk of hemorrhage or hepatitis is not high with PD.Option B: PD is effective in maintaining a client’s fluid and electrolyte balance.

Explanation

The disadvantages of peritoneal dialysis in the long-term management of chronic renal failure is that requires large blocks of time.Options A and D: The risk of hemorrhage or hepatitis is not high with PD.Option B: PD is effective in maintaining a client’s fluid and electrolyte balance.

8. Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure?

To relieve the pain of gastric hyperacidity

To prevent Curling’s stress ulcers

To bind phosphorus in the intestine

To reverse metabolic acidosis.

A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body’s calcium stores. leading to renal osteodystrophy. To decrease this loss. aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion.Option A: Gastric hyperacidity is not necessarily a problem associated with chronic renal failure.Options B and D: Antacids will not prevent Curling’s stress ulcers and do not affect metabolic acidosis.

Explanation

A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body’s calcium stores. leading to renal osteodystrophy. To decrease this loss. aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion.Option A: Gastric hyperacidity is not necessarily a problem associated with chronic renal failure.Options B and D: Antacids will not prevent Curling’s stress ulcers and do not affect metabolic acidosis.

9. The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the following statements would indicate that the client understands the teaching?

“I’ll take it every four (4) hours around the clock.”

“I’ll take it between meals and at bedtime.”

“I’ll take it when I have a sour stomach.”

“I’ll take it with meals and bedtime snacks.”

Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks.Option A: There is no need for the client to take it on a 24-hour schedule.Options B and C: It is not administered to treat hyperacidity in clients with CRF and therefore is not prescribed between meals.

Explanation

Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks.Option A: There is no need for the client to take it on a 24-hour schedule.Options B and C: It is not administered to treat hyperacidity in clients with CRF and therefore is not prescribed between meals.

10. The dialysis solution is warmed before use in peritoneal dialysis primarily to:

Encourage the removal of serum urea.

Force potassium back into the cells.

Add extra warmth into the body.

Promote abdominal muscle relaxation.

The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels. which increases urea clearance.Options B and D: The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.Option C: Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations. but this is a secondary reason for warming the solution.

Explanation

The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels. which increases urea clearance.Options B and D: The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.Option C: Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations. but this is a secondary reason for warming the solution.