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MSN Exam for Renal Failure and Dialysis (PM)
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Question 1
The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?
A
Monitor the clients level of consciousness
B
Add heparin to the dialysate solution
C
Maintain strict aseptic technique
D
Change the catheter site dressing daily
Question 1 Explanation:
The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although changing the catheter site dressing daily may assist in preventing infection, this option relates to an external site.
Question 2
The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesium) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:
A
Metamucil is more palatable
B
MOM is high in sodium
C
MOM can cause magnesium toxicity
D
MOM is too harsh on the bowel
Question 2 Explanation:
Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. MOM is harsher than Metamucil, but magnesium toxicity is a more serious problem. A client may find both MOM and Metamucil unpalatable. MOM is not high in sodium.
Question 3
A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include which of the following instructions?
A
Use alcohol on the skin and clean it due to integumentary changes.
B
Follow a high potassium diet
C
There will be a few changes in your lifestyle.
D
Strictly follow the hemodialysis schedule
Question 3 Explanation:
To prevent life-threatening complications, the client must follow the dialysis schedule. Alcohol would further dry the client’s skin more than it already is. The client should follow a low-potassium diet because potassium levels increase in chronic renal failure. The client should know hemodialysis is time-consuming and will definitely cause a change in current lifestyle.
Question 4
A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first?
A
Restrict the client’s fluids
B
Administer oxygen
C
Prepare the client for hemodialysis.
D
Elevate the foot of the bed
Question 4 Explanation:
Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first interventions should be aimed at the immediate treatment of hypoxia. The foot of the bed may be elevated to reduce edema, but this isn’t the priority.
Question 5
The dialysis solution is warmed before use in peritoneal dialysis primarily to:
A
Add extra warmth into the body.
B
Encourage the removal of serum urea.
C
Promote abdominal muscle relaxation.
D
Force potassium back into the cells.
Question 5 Explanation:
The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.
Question 6
The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client spills water on the catheter dressing while bathing. The nurse should immediately:
A
Scrub the catheter with providone-iodine
B
Flush the peritoneal dialysis catheter
C
Reinforce the dressing
D
Change the dressing
Question 6 Explanation:
Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for bacteria for bacteria to reach the catheter insertion site. The nurse assures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnecting of peritoneal dialysis.
Question 7
The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should:
A
Discontinue dialysis and notify the physician
B
Continue the dialysis at a slower rate after checking the lines for air
C
Monitor vital signs every 15 minutes for the next hour
D
Bolus the client with 500 ml of normal saline to break up the air embolism.
Question 7 Explanation:
If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed.
Question 8
Which of the following is the most significant sign of peritoneal infection?
A
Redness at the catheter insertion site
B
Poor drainage of the dialysate fluid
C
Cloudy dialysate fluid
D
Swelling in the legs
Question 8 Explanation:
Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may be indicative of congestive heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.
Question 9
The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations?
A
Warmth, redness, and pain in the left hand.
B
Aching pain, pallor, and edema in the left arm.
C
Edema and reddish discoloration of the left arm
D
Pallor, diminished pulse, and pain in the left hand.
Question 9 Explanation:
Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue ischemia. Warmth, redness, and pain more likely would characterize a problem with infection.
Question 10
The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client’s temperature is 100.2. Which of the following is the most appropriate nursing action?
A
Monitor the site of the shunt for infection
B
Notify the physician
C
Continue to monitor vital signs
D
Encourage fluids
Question 10 Explanation:
The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity purposes.
Question 11
The main indicator of the need for hemodialysis is:
A
Ascites
B
Acidosis
C
Hyperkalemia
D
Hypertension
Question 12
The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of the following as a priority action to prevent this complication from occurring?
A
Observe the site once per shift
B
Check the shunt for the presence of a bruit and thrill
C
Check the results of the PT time as they are ordered.
D
Ensure that small clamps are attached to the AV shunt dressing.
Question 12 Explanation:
An AV shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental connection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site to use if needed. The shunt site should be assessed at least every four hours.
Question 13
When caring for Mr. Roberto’s AV shunt on his right arm, you should:
A
User surgical aseptic technique when giving shunt care
B
Take the blood pressure on the right arm instead
C
Notify the physician if a bruit and thrill are present
D
Cover the entire cannula with an elastic bandage
Question 14
The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:
A
Headache, deteriorating level of consciousness, and twitching.
B
restlessness, irritability, and generalized weakness
C
Hypertension, tachycardia, and fever
D
Hypotension, bradycardia, and hypothermia
Question 14 Explanation:
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
Question 15
The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information given if the client states to record the daily:
A
BUN and creatinine levels
B
Intake, output, and weight
C
Activity log
D
Pulse and respiratory rate
Question 15 Explanation:
The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight per day.
Question 16
The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses are most appropriate for this client? Select all that apply.
A
Activity Intolerance
B
Excess Fluid Volume
C
Impaired Gas Exchange
D
Pain.
E
Imbalanced Nutrition; Less than Body Requirements
Question 16 Explanation:
Appropriate nursing diagnoses for clients with chronic renal failure include excess fluid volume related to fluid and sodium retention; imbalanced nutrition, less than body requirements related to anorexia, nausea, and vomiting; and activity intolerance related to fatigue. The nursing diagnoses of impaired gas exchange and pain are not commonly related to chronic renal failure.
Question 17
The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action?
A
Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration.
B
Encourage increased vegetables in the diet
C
Check the sodium level
D
Place the client on a cardiac monitor
Question 17 Explanation:
The client with hyperkalemia is at risk for developing cardiac dysrhythmias and cardiac arrest. Because of this the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse may also assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action at this time.
Question 18
Which of the following factors causes the nausea associated with renal failure?
A
Gastric ulcers
B
Electrolyte imbalances
C
Oliguria
D
Accumulation of waste products
Question 18 Explanation:
Although clients with renal failure can develop stress ulcers, the nausea is usually related to the poisons of metabolic wastes that accumulate when the kidneys are unable to eliminate them. The client has electrolyte imbalances and oliguria, but these don’t directly cause nausea.
Question 19
Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure?
A
To relieve the pain of gastric hyperacidity
B
To bind phosphorus in the intestine
C
To prevent Curling’s stress ulcers
D
To reverse metabolic acidosis.
Question 19 Explanation:
A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body’s calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling’s stress ulcers and do not affect metabolic acidosis.
Question 20
The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the following statements would indicate that the client understands the teaching?
A
“I’ll take it when I have a sour stomach.”
B
“I’ll take it between meals and at bedtime.”
C
“I’ll take it every 4 hours around the clock.”
D
“I’ll take it with meals and bedtime snacks.”
Question 20 Explanation:
Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat hyperacidity in clients with CRF and therefore is not prescribed between meals.
Question 21
The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose:
A
Increases osmotic pressure to produce ultrafiltration.
B
Prevents disequilibrium syndrome
C
Prevents excess glucose from being removed from the client.
D
Decreases risk of peritonitis.
Question 21 Explanation:
Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution, the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.
Question 22
The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication:
A
On return from dialysis
B
The day after dialysis
C
During dialysis
D
Just before dialysis
Question 22 Explanation:
Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting a full day to resume the medication. This would lead to ineffective control of the blood pressure.
Question 23
The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction?
A
Lima beans
B
Cantaloupe
C
Strawberries
D
Spinach
Question 23 Explanation:
Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1 ¼ cups) are high potassium foods and average 7 mEq per serving. Lima beans (1/3 c) averages 3 mEq per serving.
Question 24
A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate?
A
Stop the dialysis
B
Slow the infusion
C
Explain that the pain will subside after the first few exchanges
D
Decrease the amount to be infused
Question 24 Explanation:
Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.
Question 25
In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate?
A
Using videotapes to reinforce the material as needed.
B
Providing all needed teaching in one extended session.
C
Conducting a one-on-one session with the client.
D
Validating frequently the client’s understanding of the material.
Question 25 Explanation:
Uremia can cause decreased alertness, so the nurse needs to validate the client’s comprehension frequently. Because the client’s ability to concentrate is limited, short lesions are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes, because the clients may not be able to maintain alertness during the viewing of the videotape.
Question 26
A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client’s plan of care?
A
Assess the AV fistula for a bruit and thrill
B
Keep the AV fistula site dry.
C
Take the blood pressure in the left arm
D
Keep the AV fistula wrapped in gauze.
Question 26 Explanation:
Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. No blood pressures or venipunctures should be taken in the arm with the AV fistula. When not being dialyzed, the AV fistula site may get wet. Immediately after a dialysis treatment, the access site is covered with adhesive bandages.
Question 27
The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a client’s outflow is less than the inflow. Select actions that the nurse should take.
A
Check the peritoneal dialysis system for kinks
B
Reposition the client to his or her side.
C
Check the level of the drainage bag
D
Place the client in good body alignment
E
Contact the physician
Question 27 Explanation:
If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client’s position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client’s abdomen to enhance gravity drainage. The connecting tubing and the peritoneal dialysis system is also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the physician.
Question 28
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
Anuria
C
Polydipsia
D
Oliguria
Question 28 Explanation:
Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria, and the client loses all normal functions of the kidney. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic renal failure.
Question 29
The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of:
A
Disequilibrium syndrome
B
Infection
C
Hyperglycemia
D
Fluid overload
Question 29 Explanation:
An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.
Question 30
During the client’s dialysis, the nurse observes that the solution draining from the abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct?
A
Bleeding indicates abdominal blood vessel damage
B
Bleeding can indicate kidney damage.
C
Bleeding is expected with a permanent peritoneal catheter
D
Bleeding is caused by too-rapid infusion of the dialysate.
Question 30 Explanation:
Because the client has a permanent catheter in place, blood tinged drainage should not occur. Persistent blood tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too rapid infusion of the dialysate can cause pain.
Question 31
The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents?
A
Amphojel (aluminum hydroxide)
B
Alu-cap (aluminum hydroxide)
C
Tums (calcium carbonate)
D
Basaljel (aluminum hydroxide)
Question 31 Explanation:
Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid the occurrence of dementia related to high intake of aluminum. Phosphate binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.
Question 32
A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first?
A
Call the physician.
B
Check the catheter for kinks or obstruction.
C
Change the client’s position.
D
Clamp the catheter and instill more dialysate at the next exchange time.
Question 32 Explanation:
The first intervention should be to check for kinks and obstructions because that could be preventing drainage. After checking for kinks, have the client change position to promote drainage. Don’t give the next scheduled exchange until the dialysate is drained because abdominal distention will occur, unless the output is within parameters set by the physician. If unable to get more output despite checking for kinks and changing the client’s position, the nurse should then call the physician to determine the proper intervention.
Question 33
Which of the following nursing interventions should be included in the client’s care plan during dialysis therapy?
A
Keep the client NPO.
B
Monitor the client’s blood pressure
C
Limit the client’s visitors
D
Pad the side rails of the bed
Question 33 Explanation:
Because hypotension is a complication of peritoneal dialysis, the nurse records intake and output, monitors VS, and observes the client’s behavior. The nurse also encourages visiting and other diversional activities. A client on PD does not need to be placed in bed with padded side rails or kept NPO.
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
Notify the physician
B
Medicate the client for nausea
C
Monitor the client
D
Elevate the head of the bed
Question 34 Explanation:
Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbituates may be necessary to prevent a life-threatening situation. The physician must be notified.
Question 35
Which of the following clients is at greatest risk for developing acute renal failure?
A
A dialysis client who gets influenza
B
A teenager who has an appendectomy
C
A pregnant woman who has a fractured femur
D
A client with diabetes who has a heart catherization
Question 35 Explanation:
Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catherization must be eliminated by the kidneys, which further stresses them and may produce acute renal failure. A teenager who has an appendectomy and a pregnant woman with a fractured femur isn’t at increased risk for renal failure. A dialysis client already has end-stage renal disease and wouldn’t develop acute renal failure.
Question 36
What is the primary disadvantage of using peritoneal dialysis for long term management of chronic renal failure?
A
It cannot correct severe imbalances.
B
It is a time consuming method of treatment.
C
The danger of hemorrhage is high.
D
The risk of contacting hepatitis is high.
Question 36 Explanation:
The disadvantages of peritoneal dialysis in long-term management of chronic renal failure is that is requires large blocks of time. The risk of hemorrhage or hepatitis is not high with PD. PD is effective in maintaining a client’s fluid and electrolyte balance.
Question 37
The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure?
A
High calcium, high potassium, high protein
B
Low protein, high potassium
C
Low protein, low sodium, low potassium
D
High carbohydrate, high protein
Question 37 Explanation:
Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.
Question 38
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it:
A
Is relatively low in cost
B
Allows the client to be more independent
C
Is faster and more efficient than standard peritoneal dialysis
D
Has fewer potential complications than standard peritoneal dialysis
Question 38 Explanation:
The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, home health care personnel, and machines for life-sustaining treatment. The independence is a valuable outcome for some people. CAPD is costly and must be done daily. Side effects and complications are similar to those of standard peritoneal dialysis.
Question 39
The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following nursing diagnoses is appropriate?
A
Ineffective therapeutic Regimen Management related to lack of knowledge about therapy.
B
Ineffective tissue perfusion related to interrupted arterial blood flow.
C
Increased cardiac output related to fluid overload.
D
Excess fluid volume related to the kidney’s inability to maintain fluid balance.
Question 39 Explanation:
Crackles in the lungs, weight gain, and elevated blood pressure are indicators of excess fluid volume, a common complication in chronic renal failure. The client’s fluid status should be monitored carefully for imbalances on an ongoing basis.
Question 40
To gain access to the vein and artery, an AV shunt was used for Mr. Roberto. The most serious problem with regards to the AV shunt is:
A
Exsanguination
B
Vessel sclerosis
C
Clot formation
D
Septicemia
Question 41
A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client’s status after dialysis?
A
VS and weight.
B
BUN and creatinine levels
C
VS and BUN
D
Potassium level and weight
Question 41 Explanation:
Following dialysis, the client’s vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client’s predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.
Question 42
Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions?
A
Passage of fluid toward a solution with a lower solute concentration
B
Passage of solute particles toward a solution with a higher concentration.
C
Allowing the passage of blood cells and protein molecules through it.
D
Osmosis and diffusion
Question 42 Explanation:
Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and creatinine) from an area of higher concentration to an area of lower concentration. Fluid passes to an area with a higher solute concentration. The pores of a semipermeable membrane are small, thus preventing the flow of blood cells and protein molecules through it.
Question 43
The client asks whether her diet would change on CAPD. Which of the following would be the nurse’s best response?
A
“Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly.”
B
“Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique.”
C
“Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant.”
D
“Diet restrictions are the same for both CAPD and standard peritoneal dialysis.”
Question 43 Explanation:
Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.
Question 44
A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?
A
Palpation of a thrill over the fistula
B
Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.
C
Presence of a radial pulse in the left wrist
D
Absence of bruit on auscultation of the fistula.
Question 44 Explanation:
The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.
Question 45
In a client in renal failure, which assessment finding may indicate hypocalcemia?
A
Increased blood coagulation
B
Serum calcium level of 5 mEq/L
C
Headache
D
Diarrhea
Question 45 Explanation:
In renal failure, calcium absorption from the intestine declines, leading to increased smooth muscle contractions, causing diarrhea. CNS changes in renal failure rarely include headache. A serum calcium level of 5 mEq/L indicates hypercalcemia. As renal failure progresses, bleeding tendencies increase.
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MSN Exam for Renal Failure and Dialysis (EM)
Choose the letter of the correct answer. You have 45 mins to finish this exam. Good luck!
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Question 1
The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?
A
Change the catheter site dressing daily
B
Maintain strict aseptic technique
C
Add heparin to the dialysate solution
D
Monitor the clients level of consciousness
Question 1 Explanation:
The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although changing the catheter site dressing daily may assist in preventing infection, this option relates to an external site.
Question 2
The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesium) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:
A
MOM is high in sodium
B
MOM can cause magnesium toxicity
C
MOM is too harsh on the bowel
D
Metamucil is more palatable
Question 2 Explanation:
Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. MOM is harsher than Metamucil, but magnesium toxicity is a more serious problem. A client may find both MOM and Metamucil unpalatable. MOM is not high in sodium.
Question 3
The dialysis solution is warmed before use in peritoneal dialysis primarily to:
A
Add extra warmth into the body.
B
Promote abdominal muscle relaxation.
C
Force potassium back into the cells.
D
Encourage the removal of serum urea.
Question 3 Explanation:
The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.
Question 4
The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client spills water on the catheter dressing while bathing. The nurse should immediately:
A
Change the dressing
B
Flush the peritoneal dialysis catheter
C
Reinforce the dressing
D
Scrub the catheter with providone-iodine
Question 4 Explanation:
Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for bacteria for bacteria to reach the catheter insertion site. The nurse assures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnecting of peritoneal dialysis.
Question 5
Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions?
A
Passage of solute particles toward a solution with a higher concentration.
B
Allowing the passage of blood cells and protein molecules through it.
C
Passage of fluid toward a solution with a lower solute concentration
D
Osmosis and diffusion
Question 5 Explanation:
Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and creatinine) from an area of higher concentration to an area of lower concentration. Fluid passes to an area with a higher solute concentration. The pores of a semipermeable membrane are small, thus preventing the flow of blood cells and protein molecules through it.
Question 6
The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should:
A
Monitor vital signs every 15 minutes for the next hour
B
Bolus the client with 500 ml of normal saline to break up the air embolism.
C
Continue the dialysis at a slower rate after checking the lines for air
D
Discontinue dialysis and notify the physician
Question 6 Explanation:
If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed.
Question 7
Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure?
A
To relieve the pain of gastric hyperacidity
B
To prevent Curling’s stress ulcers
C
To reverse metabolic acidosis.
D
To bind phosphorus in the intestine
Question 7 Explanation:
A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body’s calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling’s stress ulcers and do not affect metabolic acidosis.
Question 8
The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following nursing diagnoses is appropriate?
A
Increased cardiac output related to fluid overload.
B
Ineffective therapeutic Regimen Management related to lack of knowledge about therapy.
C
Excess fluid volume related to the kidney’s inability to maintain fluid balance.
D
Ineffective tissue perfusion related to interrupted arterial blood flow.
Question 8 Explanation:
Crackles in the lungs, weight gain, and elevated blood pressure are indicators of excess fluid volume, a common complication in chronic renal failure. The client’s fluid status should be monitored carefully for imbalances on an ongoing basis.
Question 9
The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication:
A
During dialysis
B
On return from dialysis
C
The day after dialysis
D
Just before dialysis
Question 9 Explanation:
Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting a full day to resume the medication. This would lead to ineffective control of the blood pressure.
Question 10
The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:
A
Headache, deteriorating level of consciousness, and twitching.
B
Hypotension, bradycardia, and hypothermia
C
restlessness, irritability, and generalized weakness
D
Hypertension, tachycardia, and fever
Question 10 Explanation:
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
Question 11
Which of the following nursing interventions should be included in the client’s care plan during dialysis therapy?
A
Keep the client NPO.
B
Limit the client’s visitors
C
Pad the side rails of the bed
D
Monitor the client’s blood pressure
Question 11 Explanation:
Because hypotension is a complication of peritoneal dialysis, the nurse records intake and output, monitors VS, and observes the client’s behavior. The nurse also encourages visiting and other diversional activities. A client on PD does not need to be placed in bed with padded side rails or kept NPO.
Question 12
The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose:
A
Prevents excess glucose from being removed from the client.
B
Increases osmotic pressure to produce ultrafiltration.
C
Prevents disequilibrium syndrome
D
Decreases risk of peritonitis.
Question 12 Explanation:
Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution, the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.
Question 13
The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the following statements would indicate that the client understands the teaching?
A
“I’ll take it with meals and bedtime snacks.”
B
“I’ll take it between meals and at bedtime.”
C
“I’ll take it when I have a sour stomach.”
D
“I’ll take it every 4 hours around the clock.”
Question 13 Explanation:
Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat hyperacidity in clients with CRF and therefore is not prescribed between meals.
Question 14
A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client’s plan of care?
A
Assess the AV fistula for a bruit and thrill
B
Keep the AV fistula wrapped in gauze.
C
Keep the AV fistula site dry.
D
Take the blood pressure in the left arm
Question 14 Explanation:
Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. No blood pressures or venipunctures should be taken in the arm with the AV fistula. When not being dialyzed, the AV fistula site may get wet. Immediately after a dialysis treatment, the access site is covered with adhesive bandages.
Question 15
The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information given if the client states to record the daily:
A
BUN and creatinine levels
B
Intake, output, and weight
C
Activity log
D
Pulse and respiratory rate
Question 15 Explanation:
The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight per day.
Question 16
A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?
A
Palpation of a thrill over the fistula
B
Presence of a radial pulse in the left wrist
C
Absence of bruit on auscultation of the fistula.
D
Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.
Question 16 Explanation:
The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.
Question 17
A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client’s status after dialysis?
A
BUN and creatinine levels
B
VS and weight.
C
VS and BUN
D
Potassium level and weight
Question 17 Explanation:
Following dialysis, the client’s vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client’s predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.
Question 18
Which of the following clients is at greatest risk for developing acute renal failure?
A
A pregnant woman who has a fractured femur
B
A teenager who has an appendectomy
C
A dialysis client who gets influenza
D
A client with diabetes who has a heart catherization
Question 18 Explanation:
Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catherization must be eliminated by the kidneys, which further stresses them and may produce acute renal failure. A teenager who has an appendectomy and a pregnant woman with a fractured femur isn’t at increased risk for renal failure. A dialysis client already has end-stage renal disease and wouldn’t develop acute renal failure.
Question 19
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
Elevate the head of the bed
C
Medicate the client for nausea
D
Notify the physician
Question 19 Explanation:
Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbituates may be necessary to prevent a life-threatening situation. The physician must be notified.
Question 20
The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses are most appropriate for this client? Select all that apply.
A
Impaired Gas Exchange
B
Excess Fluid Volume
C
Pain.
D
Imbalanced Nutrition; Less than Body Requirements
E
Activity Intolerance
Question 20 Explanation:
Appropriate nursing diagnoses for clients with chronic renal failure include excess fluid volume related to fluid and sodium retention; imbalanced nutrition, less than body requirements related to anorexia, nausea, and vomiting; and activity intolerance related to fatigue. The nursing diagnoses of impaired gas exchange and pain are not commonly related to chronic renal failure.
Question 21
The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents?
A
Basaljel (aluminum hydroxide)
B
Amphojel (aluminum hydroxide)
C
Tums (calcium carbonate)
D
Alu-cap (aluminum hydroxide)
Question 21 Explanation:
Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid the occurrence of dementia related to high intake of aluminum. Phosphate binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.
Question 22
The client asks whether her diet would change on CAPD. Which of the following would be the nurse’s best response?
A
“Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique.”
B
“Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant.”
C
“Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly.”
D
“Diet restrictions are the same for both CAPD and standard peritoneal dialysis.”
Question 22 Explanation:
Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.
Question 23
In a client in renal failure, which assessment finding may indicate hypocalcemia?
A
Diarrhea
B
Serum calcium level of 5 mEq/L
C
Headache
D
Increased blood coagulation
Question 23 Explanation:
In renal failure, calcium absorption from the intestine declines, leading to increased smooth muscle contractions, causing diarrhea. CNS changes in renal failure rarely include headache. A serum calcium level of 5 mEq/L indicates hypercalcemia. As renal failure progresses, bleeding tendencies increase.
Question 24
The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of:
A
Disequilibrium syndrome
B
Hyperglycemia
C
Fluid overload
D
Infection
Question 24 Explanation:
An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.
Question 25
The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action?
A
Place the client on a cardiac monitor
B
Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration.
C
Encourage increased vegetables in the diet
D
Check the sodium level
Question 25 Explanation:
The client with hyperkalemia is at risk for developing cardiac dysrhythmias and cardiac arrest. Because of this the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse may also assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action at this time.
Question 26
The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of the following as a priority action to prevent this complication from occurring?
A
Ensure that small clamps are attached to the AV shunt dressing.
B
Check the shunt for the presence of a bruit and thrill
C
Check the results of the PT time as they are ordered.
D
Observe the site once per shift
Question 26 Explanation:
An AV shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental connection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site to use if needed. The shunt site should be assessed at least every four hours.
Question 27
A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include which of the following instructions?
A
There will be a few changes in your lifestyle.
B
Use alcohol on the skin and clean it due to integumentary changes.
C
Strictly follow the hemodialysis schedule
D
Follow a high potassium diet
Question 27 Explanation:
To prevent life-threatening complications, the client must follow the dialysis schedule. Alcohol would further dry the client’s skin more than it already is. The client should follow a low-potassium diet because potassium levels increase in chronic renal failure. The client should know hemodialysis is time-consuming and will definitely cause a change in current lifestyle.
Question 28
The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations?
A
Pallor, diminished pulse, and pain in the left hand.
B
Warmth, redness, and pain in the left hand.
C
Aching pain, pallor, and edema in the left arm.
D
Edema and reddish discoloration of the left arm
Question 28 Explanation:
Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue ischemia. Warmth, redness, and pain more likely would characterize a problem with infection.
Question 29
When caring for Mr. Roberto’s AV shunt on his right arm, you should:
A
Notify the physician if a bruit and thrill are present
B
Cover the entire cannula with an elastic bandage
C
User surgical aseptic technique when giving shunt care
D
Take the blood pressure on the right arm instead
Question 30
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it:
A
Has fewer potential complications than standard peritoneal dialysis
B
Is faster and more efficient than standard peritoneal dialysis
C
Is relatively low in cost
D
Allows the client to be more independent
Question 30 Explanation:
The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, home health care personnel, and machines for life-sustaining treatment. The independence is a valuable outcome for some people. CAPD is costly and must be done daily. Side effects and complications are similar to those of standard peritoneal dialysis.
Question 31
In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate?
A
Providing all needed teaching in one extended session.
B
Validating frequently the client’s understanding of the material.
C
Conducting a one-on-one session with the client.
D
Using videotapes to reinforce the material as needed.
Question 31 Explanation:
Uremia can cause decreased alertness, so the nurse needs to validate the client’s comprehension frequently. Because the client’s ability to concentrate is limited, short lesions are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes, because the clients may not be able to maintain alertness during the viewing of the videotape.
Question 32
Which of the following is the most significant sign of peritoneal infection?
A
Redness at the catheter insertion site
B
Cloudy dialysate fluid
C
Poor drainage of the dialysate fluid
D
Swelling in the legs
Question 32 Explanation:
Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may be indicative of congestive heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.
Question 33
The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction?
A
Lima beans
B
Strawberries
C
Spinach
D
Cantaloupe
Question 33 Explanation:
Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1 ¼ cups) are high potassium foods and average 7 mEq per serving. Lima beans (1/3 c) averages 3 mEq per serving.
Question 34
The main indicator of the need for hemodialysis is:
A
Ascites
B
Acidosis
C
Hypertension
D
Hyperkalemia
Question 35
A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first?
A
Change the client’s position.
B
Check the catheter for kinks or obstruction.
C
Call the physician.
D
Clamp the catheter and instill more dialysate at the next exchange time.
Question 35 Explanation:
The first intervention should be to check for kinks and obstructions because that could be preventing drainage. After checking for kinks, have the client change position to promote drainage. Don’t give the next scheduled exchange until the dialysate is drained because abdominal distention will occur, unless the output is within parameters set by the physician. If unable to get more output despite checking for kinks and changing the client’s position, the nurse should then call the physician to determine the proper intervention.
Question 36
A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate?
A
Decrease the amount to be infused
B
Slow the infusion
C
Stop the dialysis
D
Explain that the pain will subside after the first few exchanges
Question 36 Explanation:
Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.
Question 37
To gain access to the vein and artery, an AV shunt was used for Mr. Roberto. The most serious problem with regards to the AV shunt is:
A
Clot formation
B
Exsanguination
C
Vessel sclerosis
D
Septicemia
Question 38
The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a client’s outflow is less than the inflow. Select actions that the nurse should take.
A
Check the peritoneal dialysis system for kinks
B
Place the client in good body alignment
C
Check the level of the drainage bag
D
Reposition the client to his or her side.
E
Contact the physician
Question 38 Explanation:
If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client’s position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client’s abdomen to enhance gravity drainage. The connecting tubing and the peritoneal dialysis system is also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the physician.
Question 39
The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client’s temperature is 100.2. Which of the following is the most appropriate nursing action?
A
Encourage fluids
B
Notify the physician
C
Monitor the site of the shunt for infection
D
Continue to monitor vital signs
Question 39 Explanation:
The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity purposes.
Question 40
Which of the following factors causes the nausea associated with renal failure?
A
Accumulation of waste products
B
Oliguria
C
Gastric ulcers
D
Electrolyte imbalances
Question 40 Explanation:
Although clients with renal failure can develop stress ulcers, the nausea is usually related to the poisons of metabolic wastes that accumulate when the kidneys are unable to eliminate them. The client has electrolyte imbalances and oliguria, but these don’t directly cause nausea.
Question 41
During the client’s dialysis, the nurse observes that the solution draining from the abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct?
A
Bleeding is expected with a permanent peritoneal catheter
B
Bleeding can indicate kidney damage.
C
Bleeding indicates abdominal blood vessel damage
D
Bleeding is caused by too-rapid infusion of the dialysate.
Question 41 Explanation:
Because the client has a permanent catheter in place, blood tinged drainage should not occur. Persistent blood tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too rapid infusion of the dialysate can cause pain.
Question 42
What is the primary disadvantage of using peritoneal dialysis for long term management of chronic renal failure?
A
The danger of hemorrhage is high.
B
It cannot correct severe imbalances.
C
It is a time consuming method of treatment.
D
The risk of contacting hepatitis is high.
Question 42 Explanation:
The disadvantages of peritoneal dialysis in long-term management of chronic renal failure is that is requires large blocks of time. The risk of hemorrhage or hepatitis is not high with PD. PD is effective in maintaining a client’s fluid and electrolyte balance.
Question 43
A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first?
A
Restrict the client’s fluids
B
Prepare the client for hemodialysis.
C
Administer oxygen
D
Elevate the foot of the bed
Question 43 Explanation:
Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first interventions should be aimed at the immediate treatment of hypoxia. The foot of the bed may be elevated to reduce edema, but this isn’t the priority.
Question 44
The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure?
A
High carbohydrate, high protein
B
Low protein, high potassium
C
High calcium, high potassium, high protein
D
Low protein, low sodium, low potassium
Question 44 Explanation:
Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.
Question 45
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
Oliguria
C
Anuria
D
Polydipsia
Question 45 Explanation:
Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria, and the client loses all normal functions of the kidney. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic renal failure.
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1. Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions?
Osmosis and diffusion
Passage of fluid toward a solution with a lower solute concentration
Allowing the passage of blood cells and protein molecules through it.
Passage of solute particles toward a solution with a higher concentration.
2. A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include which of the following instructions?
Follow a high potassium diet
Strictly follow the hemodialysis schedule
There will be a few changes in your lifestyle.
Use alcohol on the skin and clean it due to integumentary changes.
3. A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first?
Change the client’s position.
Call the physician.
Check the catheter for kinks or obstruction.
Clamp the catheter and instill more dialysate at the next exchange time.
4. A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first?
Administer oxygen
Elevate the foot of the bed
Restrict the client’s fluids
Prepare the client for hemodialysis.
5. A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client’s plan of care?
Keep the AV fistula site dry.
Keep the AV fistula wrapped in gauze.
Take the blood pressure in the left arm
Assess the AV fistula for a bruit and thrill
6. Which of the following factors causes the nausea associated with renal failure?
Oliguria
Gastric ulcers
Electrolyte imbalances
Accumulation of waste products
7. Which of the following clients is at greatest risk for developing acute renal failure?
A dialysis client who gets influenza
A teenager who has an appendectomy
A pregnant woman who has a fractured femur
A client with diabetes who has a heart catherization
8. In a client in renal failure, which assessment finding may indicate hypocalcemia?
Headache
Serum calcium level of 5 mEq/L
Increased blood coagulation
Diarrhea
9. A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?
Absence of bruit on auscultation of the fistula.
Palpation of a thrill over the fistula
Presence of a radial pulse in the left wrist
Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.
10. The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents?
Alu-cap (aluminum hydroxide)
Tums (calcium carbonate)
Amphojel (aluminum hydroxide)
Basaljel (aluminum hydroxide)
11. The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:
Hypertension, tachycardia, and fever
Hypotension, bradycardia, and hypothermia
restlessness, irritability, and generalized weakness
Headache, deteriorating level of consciousness, and twitching.
12. A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client’s status after dialysis?
Potassium level and weight
BUN and creatinine levels
VS and BUN
VS and weight.
13. The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations?
Warmth, redness, and pain in the left hand.
Pallor, diminished pulse, and pain in the left hand.
Edema and reddish discoloration of the left arm
Aching pain, pallor, and edema in the left arm.
14. 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
Polydipsia
Oliguria
Anuria
15. The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client’s temperature is 100.2. Which of the following is the most appropriate nursing action?
Encourage fluids
Notify the physician
Monitor the site of the shunt for infection
Continue to monitor vital signs
16. 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
17. The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction?
Cantaloupe
Spinach
Lima beans
Strawberries
18. The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose:
Prevents excess glucose from being removed from the client.
Decreases risk of peritonitis.
Prevents disequilibrium syndrome
Increases osmotic pressure to produce ultrafiltration.
19. The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?
Monitor the clients level of consciousness
Maintain strict aseptic technique
Add heparin to the dialysate solution
Change the catheter site dressing daily
20. A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate?
Slow the infusion
Decrease the amount to be infused
Explain that the pain will subside after the first few exchanges
Stop the dialysis
21. The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of:
Infection
Hyperglycemia
Fluid overload
Disequilibrium syndrome
22. The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action?
Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration.
Encourage increased vegetables in the diet
Place the client on a cardiac monitor
Check the sodium level
23. The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication:
Just before dialysis
During dialysis
On return from dialysis
The day after dialysis
24. The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client spills water on the catheter dressing while bathing. The nurse should immediately:
Reinforce the dressing
Change the dressing
Flush the peritoneal dialysis catheter
Scrub the catheter with providone-iodine
25. The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should:
Continue the dialysis at a slower rate after checking the lines for air
Discontinue dialysis and notify the physician
Monitor vital signs every 15 minutes for the next hour
Bolus the client with 500 ml of normal saline to break up the air embolism.
26. The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information given if the client states to record the daily:
Pulse and respiratory rate
Intake, output, and weight
BUN and creatinine levels
Activity log
27. The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of the following as a priority action to prevent this complication from occurring?
Check the results of the PT time as they are ordered.
Observe the site once per shift
Check the shunt for the presence of a bruit and thrill
Ensure that small clamps are attached to the AV shunt dressing.
28. The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a client’s outflow is less than the inflow. Select actions that the nurse should take.
Place the client in good body alignment
Check the level of the drainage bag
Contact the physician
Check the peritoneal dialysis system for kinks
Reposition the client to his or her side.
29. The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following nursing diagnoses is appropriate?
Excess fluid volume related to the kidney’s inability to maintain fluid balance.
Increased cardiac output related to fluid overload.
Ineffective tissue perfusion related to interrupted arterial blood flow.
Ineffective therapeutic Regimen Management related to lack of knowledge about therapy.
30. The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses are most appropriate for this client? Select all that apply.
Excess Fluid Volume
Imbalanced Nutrition; Less than Body Requirements
Activity Intolerance
Impaired Gas Exchange
Pain.
31. What is the primary disadvantage of using peritoneal dialysis for long term management of chronic renal failure?
The danger of hemorrhage is high.
It cannot correct severe imbalances.
It is a time consuming method of treatment.
The risk of contacting hepatitis is high.
32. The dialysis solution is warmed before use in peritoneal dialysis primarily to:
Encourage the removal of serum urea.
Force potassium back into the cells.
Add extra warmth into the body.
Promote abdominal muscle relaxation.
33. During the client’s dialysis, the nurse observes that the solution draining from the abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct?
Bleeding is expected with a permanent peritoneal catheter
Bleeding indicates abdominal blood vessel damage
Bleeding can indicate kidney damage.
Bleeding is caused by too-rapid infusion of the dialysate.
34. Which of the following nursing interventions should be included in the client’s care plan during dialysis therapy?
Limit the client’s visitors
Monitor the client’s blood pressure
Pad the side rails of the bed
Keep the client NPO.
35. Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure?
To relieve the pain of gastric hyperacidity
To prevent Curling’s stress ulcers
To bind phosphorus in the intestine
To reverse metabolic acidosis.
36. The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the following statements would indicate that the client understands the teaching?
“I’ll take it every 4 hours around the clock.”
“I’ll take it between meals and at bedtime.”
“I’ll take it when I have a sour stomach.”
“I’ll take it with meals and bedtime snacks.”
37. The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesium) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:
MOM can cause magnesium toxicity
MOM is too harsh on the bowel
Metamucil is more palatable
MOM is high in sodium
38. In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate?
Providing all needed teaching in one extended session.
Validating frequently the client’s understanding of the material.
Conducting a one-on-one session with the client.
Using videotapes to reinforce the material as needed.
39. The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure?
High carbohydrate, high protein
High calcium, high potassium, high protein
Low protein, low sodium, low potassium
Low protein, high potassium
40. A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it:
Is relatively low in cost
Allows the client to be more independent
Is faster and more efficient than standard peritoneal dialysis
Has fewer potential complications than standard peritoneal dialysis
41. The client asks whether her diet would change on CAPD. Which of the following would be the nurse’s best response?
“Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique.”
“Diet restrictions are the same for both CAPD and standard peritoneal dialysis.”
“Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant.”
“Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly.”
42. Which of the following is the most significant sign of peritoneal infection?
Cloudy dialysate fluid
Swelling in the legs
Poor drainage of the dialysate fluid
Redness at the catheter insertion site
43. The main indicator of the need for hemodialysis is:
Ascites
Acidosis
Hypertension
Hyperkalemia
44. To gain access to the vein and artery, an AV shunt was used for Mr. Roberto. The most serious problem with regards to the AV shunt is:
Septicemia
Clot formation
Exsanguination
Vessel sclerosis
45. When caring for Mr. Roberto’s AV shunt on his right arm, you should:
Cover the entire cannula with an elastic bandage
Notify the physician if a bruit and thrill are present
User surgical aseptic technique when giving shunt care
Take the blood pressure on the right arm instead
Answers and Rationales
A. Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and creatinine) from an area of higher concentration to an area of lower concentration. Fluid passes to an area with a higher solute concentration. The pores of a semipermeable membrane are small, thus preventing the flow of blood cells and protein molecules through it.
B. To prevent life-threatening complications, the client must follow the dialysis schedule. Alcohol would further dry the client’s skin more than it already is. The client should follow a low-potassium diet because potassium levels increase in chronic renal failure. The client should know hemodialysis is time-consuming and will definitely cause a change in current lifestyle.
C. The first intervention should be to check for kinks and obstructions because that could be preventing drainage. After checking for kinks, have the client change position to promote drainage. Don’t give the next scheduled exchange until the dialysate is drained because abdominal distention will occur, unless the output is within parameters set by the physician. If unable to get more output despite checking for kinks and changing the client’s position, the nurse should then call the physician to determine the proper intervention.
A. Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first interventions should be aimed at the immediate treatment of hypoxia. The foot of the bed may be elevated to reduce edema, but this isn’t the priority.
D. Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. No blood pressures or venipunctures should be taken in the arm with the AV fistula. When not being dialyzed, the AV fistula site may get wet. Immediately after a dialysis treatment, the access site is covered with adhesive bandages.
D. Although clients with renal failure can develop stress ulcers, the nausea is usually related to the poisons of metabolic wastes that accumulate when the kidneys are unable to eliminate them. The client has electrolyte imbalances and oliguria, but these don’t directly cause nausea.
D. Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catherization must be eliminated by the kidneys, which further stresses them and may produce acute renal failure. A teenager who has an appendectomy and a pregnant woman with a fractured femur isn’t at increased risk for renal failure. A dialysis client already has end-stage renal disease and wouldn’t develop acute renal failure.
D. In renal failure, calcium absorption from the intestine declines, leading to increased smooth muscle contractions, causing diarrhea. CNS changes in renal failure rarely include headache. A serum calcium level of 5 mEq/L indicates hypercalcemia. As renal failure progresses, bleeding tendencies increase.
B. The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.
B. Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid the occurrence of dementia related to high intake of aluminum. Phosphate binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.
D. Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
D. Following dialysis, the client’s vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client’s predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.
B. Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue ischemia. Warmth, redness, and pain more likely would characterize a problem with infection.
A. Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria, and the client loses all normal functions of the kidney. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic renal failure.
D. The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity purposes.
A. Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbituates may be necessary to prevent a life-threatening situation. The physician must be notified.
C. Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1 ¼ cups) are high potassium foods and average 7 mEq per serving. Lima beans (1/3 c) averages 3 mEq per serving.
D. Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution, the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.
B. The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although changing the catheter site dressing daily may assist in preventing infection, this option relates to an external site.
C. Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.
B. An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.
C. The client with hyperkalemia is at risk for developing cardiac dysrhythmias and cardiac arrest. Because of this the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse may also assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action at this time.
C. Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting a full day to resume the medication. This would lead to ineffective control of the blood pressure.
B. Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for bacteria for bacteria to reach the catheter insertion site. The nurse assures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnecting of peritoneal dialysis.
B. If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed.
B. The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight per day.
D. An AV shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental connection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site to use if needed. The shunt site should be assessed at least every four hours.
A, B, D, E. If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client’s position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client’s abdomen to enhance gravity drainage. The connecting tubing and the peritoneal dialysis system is also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the physician.
A. Crackles in the lungs, weight gain, and elevated blood pressure are indicators of excess fluid volume, a common complication in chronic renal failure. The client’s fluid status should be monitored carefully for imbalances on an ongoing basis.
A, B, C. Appropriate nursing diagnoses for clients with chronic renal failure include excess fluid volume related to fluid and sodium retention; imbalanced nutrition, less than body requirements related to anorexia, nausea, and vomiting; and activity intolerance related to fatigue. The nursing diagnoses of impaired gas exchange and pain are not commonly related to chronic renal failure.
C. The disadvantages of peritoneal dialysis in long-term management of chronic renal failure is that is requires large blocks of time. The risk of hemorrhage or hepatitis is not high with PD. PD is effective in maintaining a client’s fluid and electrolyte balance.
A. The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.
B. Because the client has a permanent catheter in place, blood tinged drainage should not occur. Persistent blood tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too rapid infusion of the dialysate can cause pain.
B. Because hypotension is a complication of peritoneal dialysis, the nurse records intake and output, monitors VS, and observes the client’s behavior. The nurse also encourages visiting and other diversional activities. A client on PD does not need to be placed in bed with padded side rails or kept NPO.
C. A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body’s calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling’s stress ulcers and do not affect metabolic acidosis.
D. Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat hyperacidity in clients with CRF and therefore is not prescribed between meals.
A. Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. MOM is harsher than Metamucil, but magnesium toxicity is a more serious problem. A client may find both MOM and Metamucil unpalatable. MOM is not high in sodium.
B. Uremia can cause decreased alertness, so the nurse needs to validate the client’s comprehension frequently. Because the client’s ability to concentrate is limited, short lesions are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes, because the clients may not be able to maintain alertness during the viewing of the videotape.
C. Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.
B. The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, home health care personnel, and machines for life-sustaining treatment. The independence is a valuable outcome for some people. CAPD is costly and must be done daily. Side effects and complications are similar to those of standard peritoneal dialysis.
C. Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.
A. Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may be indicative of congestive heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.