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MSN Exam for Acute Renal Failure (PM)
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Question 1
____________ 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.
A
Hemodialysis
B
Continuous Renal Replacement Therapy
C
Continuous cyclic peritoneal dialysis
D
Continuous ambulatory peritoneal dialysis
Question 2
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.
A
End-stage renal disease (ESRD)
B
renal insufficiency
C
acute tubular necrosis
D
dialysis
Question 3
What tests and results prove the presence of dilute urine?
A
Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)
B
Serum Creatinine (1.5 mg/dl)
C
GFR (100 ml/min), and/or Specific Gravity (1.030)
Question 4
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?
A
Oliguria
B
Polydypsia
C
Polyuria
D
Anuria
Question 5
Signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include
A
tachycardia and headache
B
fever and painful transplant site
C
severe hypotension and weight loss
D
recurrent urinary tract infections and oral yeast infections
Question 6
“urine in the blood”
A
urethritis
B
uticaria
C
urethrorrhea
D
uremia
Question 7
Anti-hypertensive therapy in patients with chronic renal disease is for?
A
Both renal and cardiovascular protection
B
Renal protection
C
Cardiovascular protection
D
None of the above
Question 8
Which of these drugs is nephrotoxic?
A
Diuretics
B
Sodium bicarbonate/ Potassium bicarbonate
C
ACE inhibitors
D
NSAIDs
Question 9
________ 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.
A
Acute
B
Chronic
Question 10
During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids.
A
recovery
B
maintenance
C
initiation
Question 11
__________ in BUN/Creatinine ratio indicate fluid volume excess,malnutrition and fluid volume excess or malnutrition ?
A
Increase
B
Decrease
Question 12
How much KCL do normal kidneys excrete each day?
A
6-8 g
B
1 g
C
6-8 mg
D
3 mg
Question 13
Common early manifestation of kidney disease are loss of concentration and dilute urine and loss of ability to concentrate and dilute urine .
A
False
B
True
Question 14
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
A
Hypervolemia, hyperkalemia, and hypernatremia.
B
Hypovolemia, no fluctuation in serum sodium and potassium levels.
C
Hypervolemia, hypokalemia, and hypernatremia.
D
Hypovolemia, wide fluctuations in serum sodium and potassium levels.
Question 14 Explanation:
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.
Question 15
What electrolytes are in urine?
A
Cl
B
HCO3-
C
Na
D
All of the above
E
K
Question 16
A client with acute renal failure is aware that the most serious complication of this condition is:
A
Constipation
B
Platelet dysfunction
C
Anemia
D
Infection
Question 16 Explanation:
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)
Question 17
Agents that damage the kidney tissue are called:
A
antibodies
B
nephrotoxins
C
enterotoxins
D
nephrons
Question 18
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:
A
metabolic acidosis
B
renal failure
C
Hypovolemia
D
hyperkalemia
Question 19
What controls the amount of water absorption?
A
melanin
B
prolactin
C
thyroxine
D
antidiuretic hormone (Vasopressin)
Question 20
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
A
hepatitis C infection
B
coronary artery disease
C
extensive vascular disease
D
refractory hypertension
Question 21
The most serious electrolyte disorder associated with kidney disease is
A
metabolic acidosis
B
hyponatremia
C
hypermagnesemia
D
hyperkalemia
Question 22
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:
A
acute bone pain and confusion.
B
hypotension, tachycardia, and tachypnea.
C
weakness, tingling, and cardiac arrhythmias.
D
confusion, headache, and seizures.
Question 22 Explanation:
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.
Question 23
how many ml/hr of urine output is the normal minimum?
A
40
B
35
C
30
D
45
Question 24
A client in acute renal failure is a candidate for continuous renal placement therapy (CRRT). The most common indication for use of CRRT is
A
fluid overload
B
azotemia
C
hyperkalemia
D
pericarditis
Question 25
What is the #1 cause of death when kidneys fail?
A
hypernatremia
B
hyponatremia
C
hypokalemia
D
hyperkalemia
Question 26
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?
A
initiation phase
B
maintenance phase
C
recovery phase
D
intrarenal phase
Question 27
ESRD occurs when the GFR is less than ___ per minute.
A
5 ml
B
10 ml
C
15 ml
D
25 ml
Question 28
The leading cause of ESRD is the client with a history of
A
hypotension
B
anemia
C
prostate cancer
D
diabetes Mellitus
Question 29
_________ is the most frequent complication during hemodialysis.
A
bleeding
B
Infection
C
hypertension
D
Dialysis dementia
Question 30
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:
A
hypercalcemia.
B
hypokalemia.
C
hypernatremia.
D
hyperkalemia.
Question 30 Explanation:
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.
Question 31
For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?
A
Limiting fluid intake
B
Encouraging coughing and deep breathing
C
Providing pain-relief measures
D
Promoting carbohydrate intake
Question 31 Explanation:
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.
Question 32
Which of the following medications does not interfere with either creatinine secretion or the assay used to measure the serum creatinine?
A
Cefoxitin
B
Ibuprofen
C
Flucytosine
D
Trimethoprim
E
Cimetidine
Question 33
_________ renal Failure is a rapid decline in renal function with an abrupt onset
A
chronic
B
acute
Question 34
The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock)
A
Intrarenal
B
Postrenal
C
perirenal
D
prerenal
Question 35
The client with renal failure should be on which type of diet?
A
Low calorie, limited protein, low carbohydrate
B
adequate calorie intake, high carbohydrate, limited protein
The kidneys release renin which controls K+. The kidneys release angiotensin which causes Na+ realease.
B
The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+
C
Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin. Angiotensin controls the levels of Na+ and K+
Question 37
Clients on continuous ambulatory peritoneal dialysis (CAPD) must empty their peritoneal cavity and replace the dialysate every __________ hours.
A
48
B
4-6
C
6-8
D
24
Question 38
Clients with chronic renal failure should notify the physician of any weight:
A
loss of 2 pounds over a 5 day period
B
gain of 5 pounds over a 2 day period
C
gain of 2 pounds over a 2 day period
D
loss of 5 pounds over a 5 day period
Question 39
The risk for __________________ is particularly high when ischemia and exposure to a nephrotoxin occur at the same time.
A
UTI
B
chronic renal failure
C
acute tubular necrosis or tubular necrosis
D
acute glomerulonephritis
Question 40
Which diagnostic test would be monitored to evaluate glomerulat filtration rateand renal function?
A
creatinine clearance
B
Urinalysis
C
Sreum creatinine and BUN
D
Kidney biopsy
Question 41
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…
A
Able to sips clear liquidQ.
B
Hourly urine output
C
Temperature
D
Able to turn side to side
Question 41 Explanation:
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.
Question 42
Which is a normal value of Blood Urea Nitrogen (BUN)?
A
40-70 mg/dL
B
250-500 mg/dL
C
0.5-1.1 mg/dL
D
5-20 mg/dL
Question 43
How acidic is urine compared to blood?
A
2000 times more acidic
B
100 times more acidic
C
200 times less acidic
D
1000 times more acidic
Question 44
__________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction by calculi)
A
prerenal
B
postrenal
C
intrarenal
D
perirenal
Question 45
Which of the following are abnormal to be found in the urine?
A
Amino acids
B
Amino acids and glucose
C
Glucose
D
K
E
all of the above
Question 45 Explanation:
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.
Question 46
true or false? Creatinine, phosphate, sulfates, and uric acid should not be present in urine because they signify renal failure.
A
True
B
False
Question 46 Explanation:
Creatinine, phosphate, sulfates, and uric acid should be found in urine.
Question 47
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 ________.
A
restricted
B
limited
C
encouraged
Question 48
Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________.
A
hematuria
B
nephrotoxins
C
uremia
D
oliguria
Question 49
The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately?
A
Venous blood pH 7.30
B
Serum potassium 6 mEq/L
C
Blood urea nitrogen 50 mg/dl
D
Hemoglobin of 10.3 mg/dl
Question 49 Explanation:
Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.
Question 50
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:
A
Metabolic acidosis
B
Chronic renal failure
C
Hypovolemia
D
Hyperkalemia
Question 51
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?
A
Monitor for indications of dehydration
B
Provide oral care every 3-4 hours
C
Administer 0.45% saline by IV line
D
Assess daily weights for trends
Question 51 Explanation:
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.
Question 52
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?
A
Notify the physician
B
Elevate the head of the bed
C
Monitor the client
D
Medicate the client for nausea
Question 53
A client on peritoneal dialysis notices that the collecting bag of dialysate is cloudy, what is this an indication of?
A
The patient is infected and experiencing peritonitis
B
Medication was added to the dialysate
C
The patient needs a kidney transplant
D
The client needs to change their dialysate
Question 54
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
A
self-esteem disturbance related to dependence on dialysis
B
ineffective management of therapeutic regimen related to lack of knowledge of treatment plan
C
risk for imbalanced nutrition: more than body requirements, related to increased dietary intake
D
anxiety related to perceived threat to health status and role functioning
Question 55
How much salt do normal kidneys excrete each day?
A
5 g
B
6-8 g
C
3-4 g
D
1-2 mg
Question 56
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?
A
Administering narcotics as needed
B
Testing serial samples iwth dipsticks for occult blood
C
Ambulating the client in the room and hall for short distances
D
Encourage fluids to at least 3L in the first 24 hours
Question 57
The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported IMMEDIATELY?
A
Hemoglobin of 10.3 mg/dl
B
Venous blood pH 7.30
C
Blood urea nitrogen 50 mg/dl
D
Serum potassium 6 mEq/L
Question 57 Explanation:
Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.
Question 58
What is the # 1 renal function test?
A
Serum Creatinine
B
Renal Clearance/Creatinine Clearance
C
Osmolarity
D
BUN
Question 59
________ 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 tissur breakdown due to trauma, heatstroke)
A
Postrenal
B
Intrarenal
C
Prerenal
D
Perirenal
Question 60
End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2.
A
15
B
30
C
5
D
45
E
10
Question 61
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?
A
Nephrotic syndrome
B
Chronic renal failure
C
Acute glomerulonephritis
D
Acute renal failure
Question 61 Explanation:
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.
Question 62
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.
A
3
B
6
C
2
D
1
E
12
Question 63
How much water do normal kidneys excrete each day?
A
7-8 liters
B
5-6 liters
C
1-2 liters
D
3-4 liters
Question 64
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?
A
Hyperkalemia
B
Hypercalcemia
C
Hyponatremia
D
Hyperphosphatemia
Question 64 Explanation:
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
Question 65
What does urine mostly consist of?
A
KCl
B
NaCl (Salt)
C
Urea
D
H2O (Water)
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MSN Exam for Acute Renal Failure (EM)
Choose the letter of the correct answer. You got 65 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Acute Renal Failure (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
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
A
ineffective management of therapeutic regimen related to lack of knowledge of treatment plan
B
self-esteem disturbance related to dependence on dialysis
C
anxiety related to perceived threat to health status and role functioning
D
risk for imbalanced nutrition: more than body requirements, related to increased dietary intake
Question 2
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
A
Hypovolemia, no fluctuation in serum sodium and potassium levels.
B
Hypervolemia, hypokalemia, and hypernatremia.
C
Hypovolemia, wide fluctuations in serum sodium and potassium levels.
D
Hypervolemia, hyperkalemia, and hypernatremia.
Question 2 Explanation:
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.
Question 3
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:
A
hypokalemia.
B
hyperkalemia.
C
hypercalcemia.
D
hypernatremia.
Question 3 Explanation:
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.
Question 4
How acidic is urine compared to blood?
A
100 times more acidic
B
1000 times more acidic
C
200 times less acidic
D
2000 times more acidic
Question 5
For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?
A
Limiting fluid intake
B
Promoting carbohydrate intake
C
Providing pain-relief measures
D
Encouraging coughing and deep breathing
Question 5 Explanation:
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.
Question 6
The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported IMMEDIATELY?
A
Blood urea nitrogen 50 mg/dl
B
Venous blood pH 7.30
C
Serum potassium 6 mEq/L
D
Hemoglobin of 10.3 mg/dl
Question 6 Explanation:
Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.
Question 7
How much water do normal kidneys excrete each day?
A
3-4 liters
B
7-8 liters
C
5-6 liters
D
1-2 liters
Question 8
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?
A
Elevate the head of the bed
B
Monitor the client
C
Medicate the client for nausea
D
Notify the physician
Question 9
What does urine mostly consist of?
A
Urea
B
NaCl (Salt)
C
KCl
D
H2O (Water)
Question 10
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?
A
Hypercalcemia
B
Hyperkalemia
C
Hyperphosphatemia
D
Hyponatremia
Question 10 Explanation:
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
Question 11
________ 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 tissur breakdown due to trauma, heatstroke)
A
Prerenal
B
Intrarenal
C
Perirenal
D
Postrenal
Question 12
The risk for __________________ is particularly high when ischemia and exposure to a nephrotoxin occur at the same time.
A
chronic renal failure
B
UTI
C
acute tubular necrosis or tubular necrosis
D
acute glomerulonephritis
Question 13
true or false? Creatinine, phosphate, sulfates, and uric acid should not be present in urine because they signify renal failure.
A
False
B
True
Question 13 Explanation:
Creatinine, phosphate, sulfates, and uric acid should be found in urine.
Question 14
The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately?
A
Blood urea nitrogen 50 mg/dl
B
Serum potassium 6 mEq/L
C
Hemoglobin of 10.3 mg/dl
D
Venous blood pH 7.30
Question 14 Explanation:
Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.
Question 15
Anti-hypertensive therapy in patients with chronic renal disease is for?
A
Cardiovascular protection
B
Both renal and cardiovascular protection
C
None of the above
D
Renal protection
Question 16
During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids.
A
recovery
B
maintenance
C
initiation
Question 17
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.
A
6
B
1
C
12
D
3
E
2
Question 18
What tests and results prove the presence of dilute urine?
A
Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)
B
GFR (100 ml/min), and/or Specific Gravity (1.030)
C
Serum Creatinine (1.5 mg/dl)
Question 19
Which is a normal value of Blood Urea Nitrogen (BUN)?
A
0.5-1.1 mg/dL
B
5-20 mg/dL
C
250-500 mg/dL
D
40-70 mg/dL
Question 20
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:
A
weakness, tingling, and cardiac arrhythmias.
B
hypotension, tachycardia, and tachypnea.
C
confusion, headache, and seizures.
D
acute bone pain and confusion.
Question 20 Explanation:
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.
Question 21
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 ________.
A
limited
B
restricted
C
encouraged
Question 22
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
A
coronary artery disease
B
hepatitis C infection
C
refractory hypertension
D
extensive vascular disease
Question 23
Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________.
A
nephrotoxins
B
oliguria
C
hematuria
D
uremia
Question 24
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?
A
Oliguria
B
Polydypsia
C
Polyuria
D
Anuria
Question 25
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?
A
Assess daily weights for trends
B
Monitor for indications of dehydration
C
Provide oral care every 3-4 hours
D
Administer 0.45% saline by IV line
Question 25 Explanation:
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.
Question 26
_________ renal Failure is a rapid decline in renal function with an abrupt onset
A
acute
B
chronic
Question 27
ESRD occurs when the GFR is less than ___ per minute.
A
10 ml
B
5 ml
C
15 ml
D
25 ml
Question 28
__________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction by calculi)
A
intrarenal
B
perirenal
C
postrenal
D
prerenal
Question 29
The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock)
A
perirenal
B
Intrarenal
C
prerenal
D
Postrenal
Question 30
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…
A
Temperature
B
Hourly urine output
C
Able to sips clear liquidQ.
D
Able to turn side to side
Question 30 Explanation:
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.
Question 31
____________ 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.
A
Continuous cyclic peritoneal dialysis
B
Continuous Renal Replacement Therapy
C
Hemodialysis
D
Continuous ambulatory peritoneal dialysis
Question 32
Which of the following are abnormal to be found in the urine?
A
K
B
Amino acids and glucose
C
all of the above
D
Amino acids
E
Glucose
Question 32 Explanation:
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.
Question 33
Which diagnostic test would be monitored to evaluate glomerulat filtration rateand renal function?
A
creatinine clearance
B
Kidney biopsy
C
Urinalysis
D
Sreum creatinine and BUN
Question 34
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:
A
Hyperkalemia
B
Hypovolemia
C
Metabolic acidosis
D
Chronic renal failure
Question 35
Clients on continuous ambulatory peritoneal dialysis (CAPD) must empty their peritoneal cavity and replace the dialysate every __________ hours.
A
24
B
4-6
C
6-8
D
48
Question 36
The most serious electrolyte disorder associated with kidney disease is
A
hypermagnesemia
B
metabolic acidosis
C
hyponatremia
D
hyperkalemia
Question 37
__________ in BUN/Creatinine ratio indicate fluid volume excess,malnutrition and fluid volume excess or malnutrition ?
A
Decrease
B
Increase
Question 38
“urine in the blood”
A
uremia
B
urethritis
C
uticaria
D
urethrorrhea
Question 39
The client with renal failure should be on which type of diet?
A
Low calorie, limited protein, low carbohydrate
B
adequate calorie intake, high carbohydrate, limited protein
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?
A
Ambulating the client in the room and hall for short distances
B
Encourage fluids to at least 3L in the first 24 hours
C
Administering narcotics as needed
D
Testing serial samples iwth dipsticks for occult blood
Question 44
Signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include
A
severe hypotension and weight loss
B
tachycardia and headache
C
fever and painful transplant site
D
recurrent urinary tract infections and oral yeast infections
Question 45
What electrolytes are in urine?
A
K
B
Na
C
HCO3-
D
All of the above
E
Cl
Question 46
_________ is the most frequent complication during hemodialysis.
A
Dialysis dementia
B
Infection
C
hypertension
D
bleeding
Question 47
Clients with chronic renal failure should notify the physician of any weight:
A
loss of 5 pounds over a 5 day period
B
gain of 5 pounds over a 2 day period
C
gain of 2 pounds over a 2 day period
D
loss of 2 pounds over a 5 day period
Question 48
The leading cause of ESRD is the client with a history of
A
anemia
B
prostate cancer
C
hypotension
D
diabetes Mellitus
Question 49
How much KCL do normal kidneys excrete each day?
A
6-8 g
B
3 mg
C
6-8 mg
D
1 g
Question 50
A client on peritoneal dialysis notices that the collecting bag of dialysate is cloudy, what is this an indication of?
A
The patient is infected and experiencing peritonitis
B
The patient needs a kidney transplant
C
Medication was added to the dialysate
D
The client needs to change their dialysate
Question 51
Which of the following medications does not interfere with either creatinine secretion or the assay used to measure the serum creatinine?
A
Cimetidine
B
Trimethoprim
C
Flucytosine
D
Ibuprofen
E
Cefoxitin
Question 52
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?
A
recovery phase
B
initiation phase
C
intrarenal phase
D
maintenance phase
Question 53
How do kidneys control Na+ levels and K+ levels?
A
The kidneys release renin which controls K+. The kidneys release angiotensin which causes Na+ realease.
B
The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+
C
Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin. Angiotensin controls the levels of Na+ and K+
Question 54
________ 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.
A
Acute
B
Chronic
Question 55
A client in acute renal failure is a candidate for continuous renal placement therapy (CRRT). The most common indication for use of CRRT is
A
pericarditis
B
azotemia
C
fluid overload
D
hyperkalemia
Question 56
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?
A
Nephrotic syndrome
B
Acute glomerulonephritis
C
Acute renal failure
D
Chronic renal failure
Question 56 Explanation:
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.
Question 57
What is the #1 cause of death when kidneys fail?
A
hyperkalemia
B
hypernatremia
C
hypokalemia
D
hyponatremia
Question 58
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:
A
hyperkalemia
B
renal failure
C
Hypovolemia
D
metabolic acidosis
Question 59
Common early manifestation of kidney disease are loss of concentration and dilute urine and loss of ability to concentrate and dilute urine .
A
True
B
False
Question 60
How much salt do normal kidneys excrete each day?
A
3-4 g
B
5 g
C
1-2 mg
D
6-8 g
Question 61
End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2.
A
10
B
15
C
5
D
45
E
30
Question 62
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.
A
acute tubular necrosis
B
dialysis
C
renal insufficiency
D
End-stage renal disease (ESRD)
Question 63
Which of these drugs is nephrotoxic?
A
Diuretics
B
Sodium bicarbonate/ Potassium bicarbonate
C
ACE inhibitors
D
NSAIDs
Question 64
A client with acute renal failure is aware that the most serious complication of this condition is:
A
Anemia
B
Platelet dysfunction
C
Infection
D
Constipation
Question 64 Explanation:
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)
Question 65
how many ml/hr of urine output is the normal minimum?
A
35
B
30
C
45
D
40
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1) The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock)
prerenal
Intrarenal
Postrenal
perirenal
2) What electrolytes are in urine?
Na
K
Cl
HCO3-
All of the above
3) Which diagnostic test would be monitored to evaluate glomerulat filtration rateand renal function?
Sreum creatinine and BUN
Urinalysis
Kidney biopsy
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:
Hypovolemia
renal failure
metabolic acidosis
hyperkalemia
5) true or false? Creatinine, phosphate, sulfates, and uric acid should not be present in urine because they signify renal failure.
True
False
6) The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately?
Blood urea nitrogen 50 mg/dl
Hemoglobin of 10.3 mg/dl
Venous blood pH 7.30
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…
Hourly urine output
Temperature
Able to turn side to side
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?
Provide oral care every 3-4 hours
Monitor for indications of dehydration
Administer 0.45% saline by IV line
Assess daily weights for trends
9) __________ in BUN/Creatinine ratio indicate fluid volume excess,malnutrition and fluid volume excess or malnutrition ?
Increase
Decrease
10) The most serious electrolyte disorder associated with kidney disease is
hypermagnesemia
hyponatremia
hyperkalemia
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
azotemia
pericarditis
hyperkalemia
fluid overload
12) A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?
Acute glomerulonephritis
Acute renal failure
Chronic renal failure
Nephrotic syndrome
13) The leading cause of ESRD is the client with a history of
hypotension
anemia
prostate cancer
diabetes Mellitus
14) The risk for __________________ is particularly high when ischemia and exposure to a nephrotoxin occur at the same time.
acute tubular necrosis or tubular necrosis
acute glomerulonephritis
chronic renal failure
UTI
15) What controls the amount of water absorption?
antidiuretic hormone (Vasopressin)
melanin
thyroxine
prolactin
16) What does urine mostly consist of?
H2O (Water)
NaCl (Salt)
Urea
KCl
17) How much water do normal kidneys excrete each day?
3-4 liters
5-6 liters
1-2 liters
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
2
3
6
12
19) What is the # 1 renal function test?
Renal Clearance/Creatinine Clearance
Osmolarity
Serum Creatinine
BUN
20) For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?
Encouraging coughing and deep breathing
Promoting carbohydrate intake
Limiting fluid intake
Providing pain-relief measures
21) How much salt do normal kidneys excrete each day?
1-2 mg
5 g
3-4 g
6-8 g
22) Which is a normal value of Blood Urea Nitrogen (BUN)?
0.5-1.1 mg/dL
5-20 mg/dL
40-70 mg/dL
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 ________.
encouraged
limited
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?
Encourage fluids to at least 3L in the first 24 hours
Administering narcotics as needed
Testing serial samples iwth dipsticks for occult blood
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?
Hyponatremia
Hyperkalemia
Hyperphosphatemia
Hypercalcemia
26) how many ml/hr of urine output is the normal minimum?
30
35
40
45
27) Signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include
tachycardia and headache
fever and painful transplant site
severe hypotension and weight loss
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.
Chronic
Acute
29) The client with renal failure should be on which type of diet?
high protein, high carbohydrate, low calorie
adequate calorie intake, high carbohydrate, limited protein
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
Hypervolemia, hypokalemia, and hypernatremia.
Hypervolemia, hyperkalemia, and hypernatremia.
Hypovolemia, wide fluctuations in serum sodium and potassium levels.
Hypovolemia, no fluctuation in serum sodium and potassium levels.
31) _________ is the most frequent complication during hemodialysis.
hypertension
bleeding
Infection
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:
Hypovolemia
Hyperkalemia
Metabolic acidosis
Chronic renal failure
33) What is the #1 cause of death when kidneys fail?
hyperkalemia
hypokalemia
hypernatremia
hyponatremia
34) The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported IMMEDIATELY?
Blood urea nitrogen 50 mg/dl
Hemoglobin of 10.3 mg/dl
Venous blood pH 7.30
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.
End-stage renal disease (ESRD)
renal insufficiency
acute tubular necrosis
dialysis
36) _________ renal Failure is a rapid decline in renal function with an abrupt onset
acute
chronic
37) How do kidneys control Na+ levels and K+ levels?
The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+
Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin. Angiotensin controls the levels of Na+ and K+
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?
Renal protection
Cardiovascular protection
Both renal and cardiovascular protection
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.
Hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cyclic peritoneal dialysis
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)
prerenal
intrarenal
postrenal
perirenal
41) Agents that damage the kidney tissue are called:
nephrons
nephrotoxins
antibodies
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?
initiation phase
maintenance phase
recovery phase
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
hepatitis C infection
extensive vascular disease
coronary artery disease
refractory hypertension
44) Which of the following medications does not interfere with either creatinine secretion or the assay used to measure the serum creatinine?
Ibuprofen
Cimetidine
Trimethoprim
Cefoxitin
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:
confusion, headache, and seizures.
acute bone pain and confusion.
weakness, tingling, and cardiac arrhythmias.
hypotension, tachycardia, and tachypnea.
46) Clients with chronic renal failure should notify the physician of any weight:
loss of 2 pounds over a 5 day period
gain of 2 pounds over a 2 day period
loss of 5 pounds over a 5 day period
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:
hypernatremia.
hypokalemia.
hyperkalemia.
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
self-esteem disturbance related to dependence on dialysis
anxiety related to perceived threat to health status and role functioning
ineffective management of therapeutic regimen related to lack of knowledge of treatment plan
risk for imbalanced nutrition: more than body requirements, related to increased dietary intake
49) How acidic is urine compared to blood?
100 times more acidic
200 times less acidic
1000 times more acidic
2000 times more acidic
50) Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________.
hematuria
oliguria
uremia
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)
Prerenal
Intrarenal
Postrenal
Perirenal
52) Common early manifestation of kidney disease are loss of concentration and dilute urine and loss of ability to concentrate and dilute urine .
True
False
53) A client with acute renal failure is aware that the most serious complication of this condition is:
Constipation
Anemia
Infection
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?
Notify the physician
Monitor the client
Elevate the head of the bed
Medicate the client for nausea
55) How much KCL do normal kidneys excrete each day?
6-8 g
1 g
6-8 mg
3 mg
56) Clients on continuous ambulatory peritoneal dialysis (CAPD) must empty their peritoneal cavity and replace the dialysate every __________ hours.
24
6-8
4-6
48
57) Which of these drugs is nephrotoxic?
Diuretics
ACE inhibitors
NSAIDs
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?
Polyuria
Polydypsia
Oliguria
Anuria
59) A client on peritoneal dialysis notices that the collecting bag of dialysate is cloudy, what is this an indication of?
The client needs to change their dialysate
The patient needs a kidney transplant
Medication was added to the dialysate
The patient is infected and experiencing peritonitis
60) End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2.
45
30
15
10
5
61) During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids.
maintenance
initiation
recovery
62) What tests and results prove the presence of dilute urine?
Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)
GFR (100 ml/min), and/or Specific Gravity (1.030)
Serum Creatinine (1.5 mg/dl)
63) Which of the following are abnormal to be found in the urine?
K
Amino acids
Glucose
all of the above
Amino acids and glucose
64) ESRD occurs when the GFR is less than ___ per minute.
5 ml
10 ml
15 ml
25 ml
65) “urine in the blood”
uremia
uticaria
urethritis
urethrorrhea
Answers and Rationales
A. prerenal
E. All of the above
D. creatinine cleatance
A. Hypovolemia
B. False . Creatinine, phosphate, sulfates, and uric acid should be found in urine.
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.
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.
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.
B. Decrease
C. hyperkalemia
D. fluid overload
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.
D. diabetes Mellitus
A. acute tubular necrosis or tubular necrosis
A. antidiuretic hormone
A. H2O (Water)
C. 1-2 liters
C. 3
A. Renal Clearance/Creatinine Clearance
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.
D. 6-8 g
B. 5-20 mg/dL
B. limited
D. Ambulating the client in the room and hall for short distances
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
A. 30
B. fever and painful transplant site
A. chronic
B. adequate calorie intake, high carbohydrate, limited protein
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.
A. hypertension
A. Hypovolemia
A. hyperkalemia
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.
A. End-stage renal disease (ESRD)
A. acute
A. The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+
C. Both renal and cardiovascular protection
D. Continuous Renal Replacement Therapy
C. postrenal
B. nephrotoxins
B. maintenance phase
B. extensive vascular disease
A. Ibuprofen
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.
D. gain of 5 pounds over a 2 day period
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.
C. ineffective management of therapeutic regimen related to lack of knowledge of treatment plan
C. 1000 times more acidic
C. uremia
B. Intrarenal
A. True
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)
A. Notify the physician
A. 6-8 g
C. 4-6
C. NSAIDs
A. Polyuria
D. The patient is infected and experiencing peritonitis
C. 15
A. maintenance
A. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)
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.