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