Chapter 54 Quiz

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Question #1

Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit:

A fever.

B headache.

C polyuria.

D no symptoms.

Question #2

Which of the following occurs late in chronic glomerulonephritis?

A Peripheral neuropathy

B Stroke

C Seizure

D Nosebleed

Question #3

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?

A Avoid carrying heavy items.

B Wear a mask when performing exchanges.

C Perform deep-breathing exercises vigorously.

D Auscultate the lungs frequently.

Question #4

What is the term for a concentration of urea and other nitrogenous wastes in the blood?

A Uremia

B Hematuria

C Proteinuria

D Azotemia

Question #5

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

A hematuria.

B weight loss.

C increased blood pressure.

D increased urine output.

Question #6

At the end of five peritoneal exchanges, a patient’s fluid loss was 500 mL. How much is this loss equal to?

A 1.0 lb

B 0.5 lb

C 2 lb

D 1.5 lb

Question #7

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take?

A Ask if the client wants to take the medications.

B Check with the dialysis nurse about the medications.

C Administer the medications as ordered.

D Hold the medications until after dialysis.

Question #8

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client?

A Hemodialysis

B Continuous venovenous hemofiltration (CVVH)

C Peritoneal dialysis

D Continuous arteriovenous hemofiltration (CAVH)

Question #9

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?

A Oliguria

B Diuresis

C Initiation

D Recovery

Question #10

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate?

A Donors with hypertension may qualify.

B Donors are selected from compatible living donors.

C Donors must be relatives.

D The client is placed on a transplant list at the local hospital.

Question #11

A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is:

A myoglobinuria secondary to burns

B anaphylaxis

C ureteral stricture

D polycystic disease

Question #12

Which of the following would a nurse classify as a prerenal cause of acute renal failure?

A Ureteral stricture

B Prostatic hypertrophy

C Polycystic disease

D Septic shock

Question #13

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

A Promoting carbohydrate intake

B Providing pain-relief measures

C Limiting fluid intake

D Encouraging coughing and deep breathing

Question #14

Which term is used to describe the concentration of urea and other nitrogenous wastes in the blood?

A Uremia

B Proteinuria

C Hematuria

D Azotemia

Question #15

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?

A The risk of peritonitis is greater with this type of dialysis.”

B Peritoneal dialysis will require more work for you.”

C Peritoneal dialysis does not work well for every client.”

D This type of dialysis will provide more independence.”

Question #16

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include:

A limiting iron and folic acid intake.

B eating protein liberally.

C restricting sources of potassium usually found in fresh fruits and vegetables.

D allowing liberal use of sodium.

Question #17

A client has been diagnosed with acute glomerulonephritis. This condition causes:

A pyuria.

B No option is correct.

C polyuria.

D proteinuria.

Question #18

Which phase of acute renal failure signals that glomerular filtration has started to recover?

A Initiation

B Oliguric

C Diuretic

D Recovery

Question #19

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?

A Acute tubular necrosis

B Diuresis

C Restored glomerular function

D Oliguria

Question #20

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?

A Dehydration

B Hyperkalemia

C Crackles

D Hypertension

Question #21

What is a characteristic of the intrarenal category of acute renal failure?

A Decreased creatinine

B High specific gravity

C Increased BUN

D Decreased urine sodium

Question #22

Which clinical finding should a nurse look for in a client with chronic renal failure?

A Hypotension

B Uremia

C Polycythemia

D Metabolic alkalosis

Question #23

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

A nausea and vomiting.

B dyspnea and cyanosis.

C fatigue and weakness.

D thrush and circumoral pallor.

Question #24

The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication?

A 2 hours after meals

B At bedtime with 8 ounces of fluid

C With food

D 2 hours before meals

Question #25

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?

A Administration of sodium bicarbonate

B Administration of sodium polystyrene sulfonate [Kayexalate])

C Administration of an insulin drip

D Administration of a loop diuretic

Question #26

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?

A Administering Garamycin (gentamicin) prophylactically

B Administering sodium bicarbonate after the procedure

C Hydrating with saline intravenously before the test

D Performing the test without contrast

Question #27

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?

A Less than 50 mL

B 1.5 L

C 1.0 L

D Less than 400 mL

Question #28

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid–base imbalance is associated with this disorder?

A pH 7.47, PaCO2 45, HCO3 33

B pH 7.50, PaCO2 29, HCO3 22–

C pH 7.20, PaCO2 36, HCO3 14–

D pH 7.31, PaCO2 48, HCO3 24–

Question #29

A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess?

A Fever

B Flank pain

C Periorbital edema

D Hypertension

Question #30

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

A Previous episode of acute pyelonephritis

B Recent history of streptococcal infection

C History of osteoporosis

D History of hyperparathyroidism

Question #31

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?

A Hyperalbuminemia

B Hypotension

C Cola-colored urine

D Peripheral neuropathy

Question #32

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition?

A BUN of 18 mg/dL.

B Glomerular filtration rate (GFR) of 100 mL/min.

C Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.

D Serum creatinine of 1.2 mg/dL.

Question #33

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient’s glomerular filtration rate (GFR) to be?

A A GFR of 120 mL/min/1.73 m2

B A GFR of 90 mL/min/1.73 m2

C A GFR of 85 mL/min/1.73 m2

D A GFR of 30–59 mL/min/1.73 m2

Question #34

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has?

A Sodium

B Magnesium

C Phosphorus

D Calcium

Question #35

What is a characteristic of the intrarenal category of acute kidney injury (AKI)?

A Decreased creatinine

B High specific gravity

C Decreased urine sodium

D Increased BUN

Question #36

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?

A Urine output of 35 to 40 mL/hour

B Pain of 3 out of 10, 1 hour after analgesic administration

C Blood tinged drainage in Jackson-Pratt drainage tube

D SpO2 at 90% with fine crackles in the lung bases

Question #37

Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis?

A Dark smoky colored urine

B Presence of albumin in the urine

C Peripheral edema

D Blurred vision

Question #38

Patient education regarding a fistulae or graft includes which of the following? Select all that apply.,,

A No tight clothing.

B Cleanse site b.i.d.

C Check daily for thrill and bruit.

D Avoid compression of the site.

E No IV or blood pressure taken on extremity with dialysis access

Question #39

A Perform deep-breathing exercises vigorously

B Wear a mask when performing exchanges.

C Avoid carrying heavy items.

D Auscultate the lungs frequently.

Question #40

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?

A Acute glomerulonephritis

B Nephrotic syndrome

C Acute renal failure

D Chronic renal failure

Question #41

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

A Serum potassium level of 4.9 mEq/L

B Serum sodium level of 135 mEq/L

C Temperature of 99.2° F (37.3° C)

D Urine output of 20 ml/hour

Question #42

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of:

A 1,000 mL of fluid

B 500 mL of fluid

C 2,000 mL of fluid

D 1,500 mL of fluid

Question #43

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

A Pneumonia caused by shallow breathing because of severe incisional pain

B Hypovolemic shock caused by hemorrhage

C Paralytic ileus caused by manipulation of the colon during surgery

D Abdominal distention owing to reflex cessation of intestinal peristalsis

Question #44

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?

A 250 mL

B 750 mL

C 500 mL

D 1,000 mL

Question #45

A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:

A sodium polystyrene sulfonate (Kayexalate)

B IV dextrose 50%

C Sorbitol

D Calcium supplements

Question #46

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?

A The infusion clamp should be open during infusion.”

B The effluent should be allowed to drain by gravity.”

C It is appropriate to warm the dialysate in a microwave.”

D It is important to use strict aseptic technique.”

Question #47

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?

A Eliminate fat intake and increase protein intake.

B Increase protein, carbohydrates, and fat intake.

C Increase fat intake and limit carbohydrates.

D Increase carbohydrates and limit protein intake.

Question #48

The client with polycystic kidney disease asks the nurse, “Will my kidneys ever function normally again?” The best response by the nurse is:

A Genetic testing will determine the best treatment for your condition.”

B Draining of the cysts and antibiotic therapy will cure your disease.”

C As the disease progresses, you will most likely require renal replacement therapy.”

D Dietary changes can reverse the damage that has occurred in your kidneys.”

Question #49

Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?

A Oliguria

B Diuresis

C Recovery

D Initiation

Question #50

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

A Increased pH with decreased hydrogen ions

B Increased serum levels of potassium, magnesium, and calcium

C Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

D Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75%

Question #51

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.

A Prolonged ST segment

B Multiple spiked P waves

C Shortened QRS complex

D Tall, peaked T waves

Question #52

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client?

A Acidosis

B Pericarditis

C Anemia

D Hyperkalemia

Question #53

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated?

A Obtaining a blood pressure reading from the right arm

B Placing the client’s watch on the left wrist

C Palpating the fistula for a “thrill”

D Obtaining blood samples from the left arm

Question #54

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?

A Acute renal failure tends to turn to end-stage failure.

B The kidneys can improve over a period of months.

C Kidney function will improve with transplant.

D Once on dialysis, the need will be permanent.

Question #55

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?

A “Even a perfect match does not guarantee organ success.”

B Immunosuppressive drugs guarantee organ success.”

C Let’s wait until after the surgery to discuss your treatment plan.”

D The doctor may decide to delay the use of immunosuppressant drugs.”

Question #56

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?

A Brief, hot daily showers

B Uses moisturizing creams

C Keeps nails trimmed short

D Pats skin dry after bathing

Question #57

A Diuresis

B Acute tubular necrosis

C Restored glomerular function

D Oliguria

Question #58

What is used to decrease potassium level seen in acute renal failure?

A Sodium polystyrene sulfonate

B Sorbitol

C Calcium supplements

D IV dextrose 50%

Question #59

What is a hallmark of the diagnosis of nephrotic syndrome?

A Hypoalbuminemia

B Hyponatremia

C Proteinuria

D Hypokalemia

Question #60

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

A Blood urea nitrogen (BUN) level of 22 mg/dl

B Serum creatinine level of 1.2 mg/dl

C Temperature of 100.2° F (37.8° C)

D Urine output of 250 ml/24 hours

Question #61

Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.

A White rice

B Butter

C Citrus fruits

D Salad oils

Question #62

A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. What outcome will the decrease in erythropoietin have?

A Development of male sex characteristics

B Increase in blood sugar levels due to alteration in insulin levels

C Anemia from the decrease in maturation of red blood cells

D Decrease in blood sugar levels due to alteration in insulin levels

Question #63

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include:

A restricting sources of potassium usually found in fresh fruits and vegetables.

B eating protein liberally.

C allowing liberal use of sodium

D limiting iron and folic acid intake.

Question #64

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?

A Diuresis

B Absence of pain

C Weight loss

D Fever

Question #65

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

A Impaired urinary elimination

B Activity intolerance

C Risk for infection

D Toileting self-care deficit

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