Question 1

A patient who has been on continuous ambulatory peritoneal dialysis (CAPD) is hospitalized and is receiving CAPD with four exchanges a day. During the dialysate inflow, the patient complains of having abdominal pain and pain in the right shoulder. The nurse should

Accepted Answer

A)  massage the patient's abdomen and back. 
B)  decrease the rate of dialysate infusion. 
C)  stop the infusion and notify the health care provider. 
D)  administer the PRN acetaminophen (Tylenol).

Question 2

When reviewing the laboratory values for a patient admitted with a severe crushing injury after an industrial accident, the nurse will be most concerned about levels of

Accepted Answer

A)  creatinine. 
B)  potassium. 
C)  white blood cells (WBCs). 
D)  BUN.

Question 3

A patient with diabetes who has chronic kidney disease (CKD) is considering using continuous ambulatory peritoneal dialysis (CAPD). In discussing this treatment option with the patient, the nurse informs the patient that

Accepted Answer

A)  patients with diabetes who use CAPD have fewer dialysis-related complications than those on hemodialysis. 
B)  home CAPD requires more extensive equipment than does home hemodialysis. 
C)  CAPD is contraindicated for patients who might eventually want a kidney transplant. 
D)  dietary restrictions are stricter for patients using CAPD than for those having hemodialysis.

Question 4

A patient in ARF has a gradual increase in urinary output to 3400 ml a day with a BUN of 92 mg/dl (33 mmol/L) and a serum creatinine of 4.2 mg (371 mmol/L). The nurse should plan to

Accepted Answer

A)  use a urine dipstick to monitor for proteinuria. 
B)  auscultate the lungs to assess for pulmonary edema. 
C)  take the blood pressure to check for hypotension. 
D)  draw blood to monitor for hyperkalemia.

Question 5

A patient with chronic kidney disease (CKD) is started on hemodialysis, and after the first treatment, the patient complains of nausea and a headache. The nurse notes mild jerking and twitching of the patient's extremities. The nurse will anticipate the need to

Accepted Answer

A)  increase the time for the next dialysis to remove wastes more completely. 
B)  switch to continuous renal replacement therapy (CRRT) to improve dialysis efficiency. 
C)  administer medications to control these symptoms before the next dialysis. 
D)  slow the rate for the next dialysis to decrease the speed of solute removal.

Question 6

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it

Accepted Answer

A)  can accommodate larger needles. 
B)  increases patient mobility. 
C)  is much less likely to clot. 
D)  can be used sooner after surgery.

Question 7

In preparation for hemodialysis, a patient has an AV native fistula created in the left forearm. When caring for the fistula postoperatively, the nurse should

Accepted Answer

A)  check the fistula site for a bruit and thrill. 
B)  assess the rate and quality of the left radial pulse. 
C)  compare blood pressures in the left and right arms. 
D)  irrigate the fistula site daily with low-dose heparin.

Question 8

The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful?

Accepted Answer

A)  Scrambled eggs, English muffin, and apple juice 
B)  Cheese sandwich, tomato soup, and cranberry juice 
C)  Split-pea soup, whole-wheat toast, and nonfat milk 
D)  Oatmeal with cream, half a banana, and herbal tea

Question 9

A patient with acute renal failure (ARF) requires hemodialysis and temporary vascular access is obtained by placing a catheter in the left femoral vein. The nurse will plan to

Accepted Answer

A)  restrict the patient's oral protein intake. 
B)  discontinue the retention catheter. 
C)  place the patient on bed rest. 
D)  start continuous pulse oximetry.

Question 10

A patient with CKD has a nursing diagnosis of disturbed sensory perception related to central nervous system changes induced by uremic toxins. An appropriate nursing intervention for this problem is to

Accepted Answer

A)  convey a caring attitude and foster the nurse-patient relationship. 
B)  keep the patient on bed rest to avoid possible falls or other injuries. 
C)  ensure restricted protein intake to prevent nitrogenous product accumulation. 
D)  provide an opportunity for the patient to discuss concerns about the condition.

Question 11

A patient receiving peritoneal dialysis using 2 L of dialysate per exchange has an outflow of 1200 ml. Which action should the nurse take first?

Accepted Answer

A)  Infuse 1200 ml of dialysate during the inflow. 
B)  Assist the patient in changing position. 
C)  Administer a laxative to the patient. 
D)  Notify the health care provider about the outflow problem.

Question 12

In the immediate postoperative period, the nurse caring for a patient who is a recipient of a kidney transplant would expect that fluid therapy would involve administration of IV fluids

Accepted Answer

A)  to be determined hourly, based on every milliliter of urine output. 
B)  at a minimum rate of 100 ml/hr to perfuse the kidney. 
C)  titrated to keep blood pressure within a normal range. 
D)  at a rate to keep urine clear and without blood clots.

Question 13

Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess

Accepted Answer

A)  the BUN and creatinine. 
B)  the blood glucose level. 
C)  the patient's bowel sounds. 
D)  the level of consciousness (LO
C) .

Question 14

The nurse is assessing a patient who is receiving peritoneal dialysis with 2-L inflows. Which information should be reported immediately to the health care provider?

Accepted Answer

A)  The patient complains of feeling bloated after the inflow. 
B)  The patient's peritoneal effluent appears cloudy. 
C)  The patient has abdominal pain during the inflow phase. 
D)  The patient has an outflow volume of 1600 ml.

Question 15

A diabetic patient is admitted for evaluation of renal function because of recent fatigue, weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing history, the nurse identifies an early symptom of renal insufficiency when the patient states,

Accepted Answer

A)  "I get up several times every night to urinate." 
B)  "I wake up in the night feeling short of breath." 
C)  "My memory is not as good as it used to be." 
D)  "My mouth and throat are always dry and sore."

Question 16

A patient in the oliguric phase of acute renal failure has a 24-hour fluid output of 150 ml emesis and 250 ml urine. The nurse plans a fluid replacement for the following day of ___ ml.

Accepted Answer

A)  400 
B)  800 
C)  1000 
D)  1400

Exam 47: Nursing Management: Acute Renal Failure and Chronic Kidney Disease