Question 1

The nurse is assessing a client who had a kidney transplant 8 years ago and is receiving the immunosuppressants tacrolimus, cyclosporin, and prednisone. Which of the following findings is of most concern to the nurse?

Accepted Answer

A)  The blood glucose is 7.9 mmol/L.
B)  The client's blood pressure is 150/92.
C)  There is a nontender lump in the axilla.
D)  The client has a round, moonlike face. C

Question 2

The nurse is caring for a client who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration. Which of the following findings is most important for the nurse to report to the health care provider?

Accepted Answer

A)  The blood urea nitrogen (BUN)  level is 23.1 mmol/L.
B)  The creatinine level is 186 mcmol/L.
C)  Urine output over an 8-hour period is 2 500 mL.
D)  The glomerular filtration rate is <30 mL/minute/1.73m2. C

Question 3

Which of the following assessments should the nurse complete before administering sodium polystyrene sulphonate to a client with hyperkalemia?

Accepted Answer

A)  Blood urea nitrogen (BUN)  and creatinine
B)  Blood glucose level
C)  Client's bowel sounds
D)  Level of consciousness (LO
C)   C

Question 4

Which of the following parameters is most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a client has had kidney transplantation?

Accepted Answer

A)  Heart rate
B)  Blood urea nitrogen (BUN)  level
C)  Urine output
D)  Creatinine clearance

Question 5

The nurse is preparing to administer calcium carbonate to a client with chronic kidney disease (CKD). Which of the following laboratory results should the nurse check prior to administration?

Accepted Answer

A)  Creatinine
B)  Potassium
C)  Total cholesterol
D)  Serum phosphate

Question 6

The nurse is caring for a client who requires vascular access for hemodialysis and asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. Which of the following information should the nurse explain is an advantage ofthefistula?

Accepted Answer

A)  Is much less likely to clot
B)  Increases client mobility
C)  Accommodates larger needles.
D)  Can be used sooner after surgery.

Question 7

The nurse is caring for a client receiving hemodialysis who has symptoms of nausea and dizziness. Which of the following actions should the nurse take first?

Accepted Answer

A)  Slow down the rate of dialysis.
B)  Obtain blood to check the blood urea nitrogen (BUN)  level.
C)  Check the client's blood pressure.
D)  Give prescribed PRN antiemetic drugs.

Question 8

The nurse is caring for a client with acute kidney injury (AKI) who has an arterial blood pH of 7.30. Which of the following assessment findings should the nurse anticipate?

Accepted Answer

A)  Vasodilation
B)  Poor skin turgor
C)  Bounding pulses
D)  Rapid respirations

Question 9

The nurse is caring for a client who has had an insertion of an arteriovenous graft (AVG) in the right forearm and has symptoms of pain and coldness of the right fingers. Which of the following actions should the nurse take?

Accepted Answer

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

Question 10

The nurse is caring for a client who has leg cramps during hemodialysis. Which of the following actions should the nurse implement first?

Accepted Answer

A)  Reposition the client
B)  Massage the client's legs
C)  Give acetaminophen
D)  Infuse a bolus of normal saline

Question 11

The nurse is caring for a client who has been admitted with a severe crushing injury after an industrial accident. Which of the following laboratory results is most important to report to the health care provider?

Accepted Answer

A)  Serum creatinine level 190 mcmol/L
B)  Serum potassium level 6.5 mmol/L
C)  White blood cell count 11.5 * 109/L
D)  Blood urea nitrogen (BUN)  18 mmol/L

Question 12

Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the client. Which information is most important to communicate to the health care provider?

Accepted Answer

A)  The urine output is 900-1 100 mL/hour.
B)  The blood urea nitrogen (BUN)  and creatinine levels are elevated.
C)  The client's central venous pressure (CVP)  is decreased.
D)  The client has level 8 (on a 10-point scale)  incisional pain.

Question 13

The nurse is caring for a client who had kidney transplantation several years ago. Which of the following findings may indicate that the client is experiencing adverse effects to the prescribed corticosteroid?

Accepted Answer

A)  Joint pain
B)  Tachycardia
C)  Postural hypotension
D)  Increase in creatinine level

Question 14

The nurse is teaching a client with stage 5 chronic kidney disease (CKD) about management of CKD. Which of the following client statements indicate that the teaching was 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."

Question 15

The nurse is caring for a client with acute kidney injury (AKI) who requires hemodialysis and a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which of the following interventions should be included in the plan ofcare?

Accepted Answer

A)  Place the client on bed rest.
B)  Start continuous pulse oximetry.
C)  Discontinue the retention catheter.
D)  Restrict the client's oral protein intake.

Question 16

The nurse is caring for a client with acute kidney injury who is dehydrated with symptoms of oliguria, anemia, and hyperkalemia. Which of the following prescribed actions should the nurse take first?

Accepted Answer

A)  Insert a urinary retention catheter.
B)  Place the client on a cardiac monitor.
C)  Administer an erythropoiesis-stimulating agent (ES
A)  .
D)  Give sodium polystyrene sulfonate.

Question 17

After noting lengthening QRS intervals in a client with acute kidney injury (AKI), which of the following actions should the nurse take first?

Accepted Answer

A)  Document the QRS interval.
B)  Notify the client's health care provider.
C)  Look at the client's current blood urea nitrogen (BUN)  and creatinine levels.
D)  Check the client's most recent blood potassium level.

Question 18

The nurse is caring for a client with acute glomerulonephritis, acute kidney injury (AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the following parameters should the nurse assess to evaluate the effectiveness of the medication?

Accepted Answer

A)  Urine output
B)  Calcium level
C)  Cardiac rhythm
D)  Neurological status

Question 19

The nurse is caring for a client with severe heart failure who develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet which of the following goals of treatment?

Accepted Answer

A)  Replace fluid volume
B)  Prevent hypertension
C)  Maintain cardiac output
D)  Dilute nephrotoxic substances

Question 20

The nurse is caring for a client with end-stage renal disease (ESRD). Which of the following findings indicate that the nurse should consult with the health care provider before giving the prescribed erythropoiesis-stimulating agent (ESA)?

Accepted Answer

A)  Creatinine 99 mcmol/L
B)  Oxygen saturation 89%
C)  Hemoglobin level 130 g/L
D)  Blood pressure 98/56 mm Hg

Exam 49: Nursing Management Acute Kidney Injury and Chronic Kidney Disease