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