Question 1

Which statement by a patient with stage 5 chronic kidney disease ( CKD ) indicates that the nurse's teaching about management of CKD has been effective?

Accepted Answer

A)   "I need to try to get more protein from dairy products."
B)   "I will try to increase my intake of fruits and vegetables."
C)   "I will measure my urinary output each day to help calculate the amount I can drink."
D)   "I need to take the erythropoietin to boost my immune system and help prevent infection." C

Question 2

Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate ( Caltrate ) for a patient with chronic kidney disease ( CKD )?

Accepted Answer

A)   Blood pressure
B)   Phosphate level
C)   Neurologic status
D)   Creatinine clearance B

Question 3

When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation?

Accepted Answer

A)   The patient has metastatic lung cancer.
B)   The patient has poorly controlled type 1 diabetes.
C)   The patient has a history of chronic hepatitis C infection.
D)   The patient is infected with the human immunodeficiency virus. A

Question 4

The nurse has instructed a patient who is receiving hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful?

Accepted Answer

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

Question 5

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for

Accepted Answer

A)   vasodilation.
B)   poor skin turgor.
C)   bounding pulses.
D)   rapid respirations.

Question 6

A patient with hypertension and stage 2 chronic kidney disease ( CKD ) is receiving captopril ( Capoten ). Before administration of the medication, the nurse will check the patient's

Accepted Answer

A)   glucose.
B)   potassium.
C)   creatinine.
D)   phosphate.

Question 7

A patient with chronic kidney disease ( CKD ) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required?

Accepted Answer

A)   Multivitamin with iron
B)   Milk of magnesia 30 mL
C)   Calcium phosphate ( PhosLo ) 
D)   Acetaminophen ( Tylenol )  650 mg

Question 8

Which of the following information obtained by the nurse who is caring for a patient with end-stage renal disease ( ESRD ) indicates the nurse should consult with the health care provider before giving the prescribed epoetin alfa ( Procrit )?

Accepted Answer

A)   Creatinine 1.2 mg/dL
B)   Oxygen saturation 89%
C)   Hemoglobin level 13 g/dL
D)   Blood pressure 98/56 mm Hg

Question 9

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

Question 10

Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse?

Accepted Answer

A)   The blood glucose is 144 mg/dL.
B)   The patient's blood pressure is 150/92.
C)   There is a nontender lump in the axilla.
D)   The patient has a round, moonlike face.

Question 11

The RN observes an LPN/LVN carrying out all of the following actions while caring for a patient with stage 2 chronic kidney disease. Which action requires the RN to intervene?

Accepted Answer

A)   The LPN/LVN administers erythropoietin subcutaneously.
B)   The LPN/LVN assists the patient to ambulate in the hallway.
C)   The LPN/LVN gives the iron supplement and phosphate binder with lunch.
D)   The LPN/LVN carries a tray containing low-protein foods into the patient's room.

Question 12

After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take?

Accepted Answer

A)   Elevate the patient's arm above the level of the heart.
B)   Report the patient's symptoms to the health care provider.
C)   Remind the patient about the need to take a daily low-dose aspirin tablet.
D)   Educate the patient about the normal vascular response after AVG insertion.

Question 13

Which action by a patient who is using peritoneal dialysis ( PD ) indicates that the nurse should provide more teaching about PD?

Accepted Answer

A)   The patient slows the inflow rate when experiencing pain.
B)   The patient leaves the catheter exit site without a dressing.
C)   The patient plans 30 to 60 minutes for a dialysate exchange.
D)   The patient cleans the catheter while taking a bath every day.

Question 14

Which information about a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration will be most important for the nurse to report to the health care provider?

Accepted Answer

A)   The blood urea nitrogen (BUN)  level is 67 mg/dL.
B)   The creatinine level is 3.0 mg/dL.
C)   Urine output over an 8-hour period is 2500 mL.
D)   The glomerular filtration rate is 2.

Question 15

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 has an outflow volume of 1800 mL.
B)   The patient's peritoneal effluent appears cloudy.
C)   The patient has abdominal pain during the inflow phase.
D)   The patient complains of feeling bloated after the inflow.

Question 16

A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patient's

Accepted Answer

A)   urine osmolality.
B)   serum potassium.
C)   blood glucose level.
D)   blood urea nitrogen (BUN)  and creatinine.

Question 17

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

Question 18

A patient complains of leg cramps during hemodialysis. The nurse should first

Accepted Answer

A)   reposition the patient.
B)   massage the patient's legs.
C)   give acetaminophen (Tylenol) .
D)   infuse a bolus of normal saline.

Question 19

When a patient who has had progressive chronic kidney disease ( CKD ) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching?

Accepted Answer

A)   Increased calories are needed because glucose is lost during hemodialysis.
B)   Unlimited fluids are allowed since retained fluid is removed during dialysis.
C)   More protein will be allowed because of the removal of urea and creatinine by dialysis.
D)   Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.

Question 20

Before administration of calcium carbonate ( Caltrate ) to a patient with chronic kidney disease ( CKD ), the nurse should check the laboratory value for

Accepted Answer

A)   creatinine.
B)   potassium.
C)   total cholesterol.
D)   serum phosphate.

Exam 47: Nursing Management: Acute Kidney Injury and Chronic Kidney Disease