MSN Exam for Acute Renal Failure

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1) The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock)

  1. prerenal
  2. Intrarenal
  3. Postrenal
  4. perirenal

2) What electrolytes are in urine?

  1. Na
  2. K
  3. Cl
  4. HCO3-
  5. All of the above

3) Which diagnostic test would be monitored to evaluate glomerulat filtration rateand renal function?

  1. Sreum creatinine and BUN
  2. Urinalysis
  3. Kidney biopsy
  4. creatinine clearance

4) Marina with acute renal failure moves into the diuretic phase after one week of therapy. During this phase the client must be assessed for signs of developing:

  1. Hypovolemia
  2. renal failure
  3. metabolic acidosis
  4. hyperkalemia

5) true or false? Creatinine, phosphate, sulfates, and uric acid should not be present in urine because they signify renal failure.

  1. True
  2. False

6) The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately?

  1. Blood urea nitrogen 50 mg/dl
  2. Hemoglobin of 10.3 mg/dl
  3. Venous blood pH 7.30
  4. Serum potassium 6 mEq/L

7)Nurse Liza is assigned to care for a client who has returned to the nursing unit after left nephrectomy. Nurse Liza’s highest priority would be…

  1. Hourly urine output
  2. Temperature
  3. Able to turn side to side
  4. Able to sips clear liquidQ.
8) The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant?
  1. Provide oral care every 3-4 hours
  2. Monitor for indications of dehydration
  3. Administer 0.45% saline by IV line
  4. Assess daily weights for trends

9) __________ in BUN/Creatinine ratio indicate fluid volume excess,malnutrition and fluid volume excess or malnutrition ?

  1. Increase
  2. Decrease

10) The most serious electrolyte disorder associated with kidney disease is

  1. hypermagnesemia
  2. hyponatremia
  3. hyperkalemia
  4. metabolic acidosis

11) A client in acute renal failure is a candidate for continuous renal placement therapy (CRRT). The most common indication for use of CRRT is

  1. azotemia
  2. pericarditis
  3. hyperkalemia
  4. fluid overload

12) A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?

  1. Acute glomerulonephritis
  2. Acute renal failure
  3. Chronic renal failure
  4. Nephrotic syndrome

13) The leading cause of ESRD is the client with a history of

  1. hypotension
  2. anemia
  3. prostate cancer
  4. diabetes Mellitus

14) The risk for __________________ is particularly high when ischemia and exposure to a nephrotoxin occur at the same time.

  1. acute tubular necrosis or tubular necrosis
  2. acute glomerulonephritis
  3. chronic renal failure
  4. UTI

15) What controls the amount of water absorption?

  1. antidiuretic hormone (Vasopressin)
  2. melanin
  3. thyroxine
  4. prolactin

16) What does urine mostly consist of?

  1. H2O (Water)
  2. NaCl (Salt)
  3. Urea
  4. KCl

17) How much water do normal kidneys excrete each day?

  1. 3-4 liters
  2. 5-6 liters
  3. 1-2 liters
  4. 7-8 liters

18) Chronic kidney disease is defined by Kidney Disease Outcomes Quality Initiative (K/DOQI) as evidence of structural or functional kidney abnormalities (abnormal urinalysis, imaging studies, or histology) that persists for at least ______________ months, with or without a decreased GFR.

  1. 1
  2. 2
  3. 3
  4. 6
  5. 12

19) What is the # 1 renal function test?

  1. Renal Clearance/Creatinine Clearance
  2. Osmolarity
  3. Serum Creatinine
  4. BUN

20) For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?

  1. Encouraging coughing and deep breathing
  2. Promoting carbohydrate intake
  3. Limiting fluid intake
  4. Providing pain-relief measures

21) How much salt do normal kidneys excrete each day?

  1. 1-2 mg
  2. 5 g
  3. 3-4 g
  4. 6-8 g

22) Which is a normal value of Blood Urea Nitrogen (BUN)?

  1. 0.5-1.1 mg/dL
  2. 5-20 mg/dL
  3. 40-70 mg/dL
  4. 250-500 mg/dL

23) When the kidneys cannot effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, intake of these substances must be regulated. Fluid and Sodium intake are ________.

  1. encouraged
  2. limited
  3. restricted

24) The nurse is caring for the client who has had a renal biopsy. Which of the following interventions would the nurse avoid in the care of the client after this procedure?

  1. Encourage fluids to at least 3L in the first 24 hours
  2. Administering narcotics as needed
  3. Testing serial samples iwth dipsticks for occult blood
  4. Ambulating the client in the room and hall for short distances

25) A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance?

  1. Hyponatremia
  2. Hyperkalemia
  3. Hyperphosphatemia
  4. Hypercalcemia

26) how many ml/hr of urine output is the normal minimum?

  1. 30
  2. 35
  3. 40
  4. 45

27) Signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include

  1. tachycardia and headache
  2. fever and painful transplant site
  3. severe hypotension and weight loss
  4. recurrent urinary tract infections and oral yeast infections

28) ________ renal failure is a slow, insidious process of kidney destruction. It may go unrecognized for years as nephrons are destroyed and renal mass is reduced.

  1. Chronic
  2. Acute

29) The client with renal failure should be on which type of diet?

  1. high protein, high carbohydrate, low calorie
  2. adequate calorie intake, high carbohydrate, limited protein
  3. Limited protein, low carbohydrate, adequate calorie intake
  4. Low calorie, limited protein, low carbohydrate

30) A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout this phase include observation for signs and symptoms of

  1. Hypervolemia, hypokalemia, and hypernatremia.
  2. Hypervolemia, hyperkalemia, and hypernatremia.
  3. Hypovolemia, wide fluctuations in serum sodium and potassium levels.
  4. Hypovolemia, no fluctuation in serum sodium and potassium levels.

31) _________ is the most frequent complication during hemodialysis.

  1. hypertension
  2. bleeding
  3. Infection
  4. Dialysis dementia

32) After 1 week a client with acute renal failure moves, into the diuretic phase. During this phase the client must be carefully assessed for signs of:

  1. Hypovolemia
  2. Hyperkalemia
  3. Metabolic acidosis
  4. Chronic renal failure

33) What is the #1 cause of death when kidneys fail?

  1. hyperkalemia
  2. hypokalemia
  3. hypernatremia
  4. hyponatremia

34) The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported IMMEDIATELY?

  1. Blood urea nitrogen 50 mg/dl
  2. Hemoglobin of 10.3 mg/dl
  3. Venous blood pH 7.30
  4. Serum potassium 6 mEq/L

35) When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, the client is said to have ____________, the final stage of Chronic Renal Failure.

  1. End-stage renal disease (ESRD)
  2. renal insufficiency
  3. acute tubular necrosis
  4. dialysis

36) _________ renal Failure is a rapid decline in renal function with an abrupt onset

  1. acute
  2. chronic

37) How do kidneys control Na+ levels and K+ levels?

  1. The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+
  2. Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin. Angiotensin controls the levels of Na+ and K+
  3. The kidneys release renin which controls K+. The kidneys release angiotensin which causes Na+ realease.

38) Anti-hypertensive therapy in patients with chronic renal disease is for?

  1. Renal protection
  2. Cardiovascular protection
  3. Both renal and cardiovascular protection
  4. None of the above

39) ____________ is a treatment for renal failure in which blood id continuously circulated (artery to vein or vein to vein) and filtered, allowing excess water and solutes to empty into a collecting device. Fluid may be replaced with a balanced electrolyte solution as needed during treatment.

  1. Hemodialysis
  2. Continuous ambulatory peritoneal dialysis
  3. Continuous cyclic peritoneal dialysis
  4. Continuous Renal Replacement Therapy

40) __________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction by calculi)

  1. prerenal
  2. intrarenal
  3. postrenal
  4. perirenal

41) Agents that damage the kidney tissue are called:

  1. nephrons
  2. nephrotoxins
  3. antibodies
  4. enterotoxins

42) Which phase of Acute Renal Failure results in FVE and edema due to salt and water retention, hypertension, Azotemia, hyperkalemia, muscle weakness, nausea, diarrhea, and high serum creatinine and BUN levels?

  1. initiation phase
  2. maintenance phase
  3. recovery phase
  4. intrarenal phase

43) A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that contraindications to kidney transplantation include

  1. hepatitis C infection
  2. extensive vascular disease
  3. coronary artery disease
  4. refractory hypertension

44) Which of the following medications does not interfere with either creatinine secretion or the assay used to measure the serum creatinine?

  1. Ibuprofen
  2. Cimetidine
  3. Trimethoprim
  4. Cefoxitin
  5. Flucytosine

45) A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:

  1. confusion, headache, and seizures.
  2. acute bone pain and confusion.
  3. weakness, tingling, and cardiac arrhythmias.
  4. hypotension, tachycardia, and tachypnea.

46) Clients with chronic renal failure should notify the physician of any weight:

  1. loss of 2 pounds over a 5 day period
  2. gain of 2 pounds over a 2 day period
  3. loss of 5 pounds over a 5 day period
  4. gain of 5 pounds over a 2 day period

47) Nurse Tristan is caring for a male client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:

  1. hypernatremia.
  2. hypokalemia.
  3. hyperkalemia.
  4. hypercalcemia.

48) The client with ESRD tells the nurse that she hates the thought of being tied to the machine, but is also glad to start dialysis because she will be able to eat and drink what she wants. Based on this information, the nuse identifies the nursing diagnosis of

  1. self-esteem disturbance related to dependence on dialysis
  2. anxiety related to perceived threat to health status and role functioning
  3. ineffective management of therapeutic regimen related to lack of knowledge of treatment plan
  4. risk for imbalanced nutrition: more than body requirements, related to increased dietary intake

49) How acidic is urine compared to blood?

  1. 100 times more acidic
  2. 200 times less acidic
  3. 1000 times more acidic
  4. 2000 times more acidic

50) Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________.

  1. hematuria
  2. oliguria
  3. uremia
  4. nephrotoxins

51) ________ failure is caused by Acute damage to renal tissue and nephrons or acute tubular necrosis: abrupt decline in tubular and glomerular function due to either prolonged ischemia and/or exposure to nephrotoxins. (Acute glomerulonephritis, malignant hypertension, ischemia; nephrotoxic drugs or substances; red blood cell destruction; muscle tissue breakdown due to trauma, heatstroke)

  1. Prerenal
  2. Intrarenal
  3. Postrenal
  4. Perirenal

52) Common early manifestation of kidney disease  are loss of concentration and dilute urine and loss of ability to concentrate and dilute urine .

  1. True
  2. False

53) A client with acute renal failure is aware that the most serious complication of this condition is:

  1. Constipation
  2. Anemia
  3. Infection
  4. Platelet dysfunction

54) 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?

  1. Notify the physician
  2. Monitor the client
  3. Elevate the head of the bed
  4. Medicate the client for nausea

55) How much KCL do normal kidneys excrete each day?

  1. 6-8 g
  2. 1 g
  3. 6-8 mg
  4. 3 mg

56) Clients on continuous ambulatory peritoneal dialysis (CAPD) must empty their peritoneal cavity and replace the dialysate every __________ hours.

  1. 24
  2. 6-8
  3. 4-6
  4. 48

57) Which of these drugs is nephrotoxic?

  1. Diuretics
  2. ACE inhibitors
  3. NSAIDs
  4. Sodium bicarbonate/ Potassium bicarbonate

58) 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?

  1. Polyuria
  2. Polydypsia
  3. Oliguria
  4. Anuria

59) A client on peritoneal dialysis notices that the collecting bag of dialysate is cloudy, what is this an indication of?

  1. The client needs to change their dialysate
  2. The patient needs a kidney transplant
  3. Medication was added to the dialysate
  4. The patient is infected and experiencing peritonitis

60) End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2.

  1. 45
  2. 30
  3. 15
  4. 10
  5. 5

61) During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids.

  1. maintenance
  2. initiation
  3. recovery

62) What tests and results prove the presence of dilute urine?

  1. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)
  2. GFR (100 ml/min), and/or Specific Gravity (1.030)
  3. Serum Creatinine (1.5 mg/dl)

63) Which of the following are abnormal to be found in the urine?

  1. K
  2. Amino acids
  3. Glucose
  4. all of the above
  5. Amino acids and glucose

64) ESRD occurs when the GFR is less than ___ per minute.

  1. 5 ml
  2. 10 ml
  3. 15 ml
  4. 25 ml

65) “urine in the blood”

  1. uremia
  2. uticaria
  3. urethritis
  4. urethrorrhea
Answers and Rationales
  1. A. prerenal
  2. E. All of the above 
  3. D. creatinine cleatance
  4. A. Hypovolemia 
  5. B. False . Creatinine, phosphate, sulfates, and uric acid should be found in urine.
  6. D. Serum potassium 6 mEq/L . Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.
  7. A. Hourly urine output . After nephrectomy, it is necessary to measure urine output hourly. This is done to assess the effectiveness of the remaining kidney also to detect renal failure early.
  8. A. Provide oral care every 3-4 hours . Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.
  9. B. Decrease
  10. C. hyperkalemia 
  11. D. fluid overload 
  12. A. Acute glomerulonephritis
    • Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus.
    • Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney.
    • Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications.
    • Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
  13. D. diabetes Mellitus 
  14. A. acute tubular necrosis or tubular necrosis 
  15. A. antidiuretic hormone 
  16. A. H2O (Water) 
  17. C. 1-2 liters 
  18. C. 3 
  19. A. Renal Clearance/Creatinine Clearance
  20. C. Limiting fluid intake . During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn’t take precedence over fluid limitation. Controlling pain isn’t important because ARF rarely causes pain.
  21. D. 6-8 g 
  22. B. 5-20 mg/dL
  23. B. limited
  24. D. Ambulating the client in the room and hall for short distances
  25. A. Hyponatremia . The normal serum sodium level is 135 – 145 mEq/L. The client’s serum sodium is below normal. Hyponatremia also manifests itself with abdominal cramps and nausea and vomiting
  26. A. 30 
  27. B. fever and painful transplant site
  28. A. chronic
  29. B. adequate calorie intake, high carbohydrate, limited protein 
  30. C. Hypovolemia, wide fluctuations in serum sodium and potassium levels. The second phase of ARF is the diuretic phase or high output phase. The diuresis can result in an output of up to 10L/day of dilute urine. Loss of fluids and electrolytes occur.
  31. A. hypertension 
  32. A. Hypovolemia 
  33. A. hyperkalemia
  34. D. Serum potassium 6 mEq/L. Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.
  35. A. End-stage renal disease (ESRD) 
  36. A. acute
  37. A. The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+
  38. C. Both renal and cardiovascular protection
  39. D. Continuous Renal Replacement Therapy
  40. C. postrenal 
  41. B. nephrotoxins 
  42. B. maintenance phase 
  43. B. extensive vascular disease
  44. A. Ibuprofen 
  45. A. confusion, headache, and seizures. Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.
  46. D. gain of 5 pounds over a 2 day period
  47. C. hyperkalemia. Hyperkalemia is a common complication of acute renal failure. It’s life-threatening if immediate action isn’t taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don’t usually occur with acute renal failure and aren’t treated with glucose, insulin, or sodium bicarbonate.
  48. C. ineffective management of therapeutic regimen related to lack of knowledge of treatment plan
  49. C. 1000 times more acidic
  50. C. uremia
  51. B. Intrarenal 
  52. A. True 
  53. C. Infection . Infection is responsible for one third of the traumatic or surgically induced death of clients with renal failure as well as medical induced acute renal failure (ARF)
  54. A. Notify the physician 
  55. A. 6-8 g
  56. C. 4-6
  57. C. NSAIDs
  58. A. Polyuria 
  59. D. The patient is infected and experiencing peritonitis 
  60. C. 15
  61. A. maintenance 
  62. A. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l) 
  63. E. Amino acids and glucose. Amino acids (proteins) found in the urine indicate trauma to the glomeruli. Glucose found in the urine indicate BS levels to be above the renal threshold.
  64. C. 15 ml 
  65. Auremia