RENAL FAILURE PRACTICE TEST

Which of the following conditions is a common cause of prerenal acute renal failure?

Atherosclerosis

Decreased cardiac output

Prostatic hypertrophy

Rhabdomyolysis

A client admitted for acute pyelonephritis is about to start antibiotic therapy. Which of the following symptoms would be expected in this client?

Hypertension

Flank pain on the affected side

Pain that radiates toward the unaffected side

No tenderness with deep palpation over the costovertebral angle.

Discharge instructions for a client treated for acute pyelonephritis should include which of the following statements?

Avoid taking any dairy products.

Return for follow-up urine cultures

Stop taking the prescribed antibiotics when the symptoms subside.

Recurrence is unlikely because you’ve been treated with antibiotics.

Proper maintenance of a continuous bladder irrigation system includes which of the following interventions?

Regulate irrigant flow to maintain red urine.

Regulate irrigant flow to maintain a good outflow of pink urine

Maintain a slow rate of irrigant to prevent bladder distention

Stop the irrigation if there is a leakage of large amounts of urine around the catheter.

A client with renal insufficiency is admitted with a diagnosis of pneumonia. He’s being treated with IV antibiotics, which can be nephrotoxic. Which of the following lab results should be monitored closely?

BUN and creatinine levels

ABG levels

Platelet count

Potassium level

A client is admitted with severe nausea, vomiting, and diarrhea and is hypotensive. She’s noted to have severe oliguria with elevated BUN and creatinine levels. The physician will most likely write an order for which of the following treatments?

Force oral fluids

Give furosemide 20 mg IV

Start hemodialysis after a temporary access is obtained.

Start IV fluid of normal saline solution bolus followed by a maintenance dose.

Inflammation, incomplete bladder emptying, and anxiety may cause urinary frequency. Which of the following factors is also associated with urinary frequency?

Dehydration

Imipramine use

Opiate analgesics

Pressure from abdominal masses

A woman who reports painful urination during or after voiding might have a problem in which of the following locations?

Bladder

Kidneys

Ureters

Urethra

Which of the following interventions would be inappropriate to help a client with post-op urinary retention?

Give a diuretic

Pour warm water over the perineum

Consider inserting a bladder catheter

Place the client in a sitting or semi-Fowler position.

Which of the following factors may place a surgical client at risk for urinary retention?

Dehydration

History of smoking

Duration of surgery

Anticholinergic medication before surgery.

Which type of catheter is generally used for the client with urinary retention?

Coudé

Indwelling urinary

Straight

Three-way

An 80-year-old man reports urine retention. Which of the following factors may contribute to this client’s problem?

Benign prostatic hyperplasia (BPH)

Diabetes

Diet

Hypertension

Serum creatinine levels provide the most accurate picture of renal function for which of the following reasons?

Serum creatinine is rapidly reabsorbed by the renal tubules.

A slow urine flow through the kidneys increases creatinine level.

Serum creatinine levels indicate a decrease in glomerular filtration.

Serum creatinine levels are related to the rate of urine flow through the kidneys.

A urologic client undergoes excretory urography to evaluate which of the following areas?

Kidney function

Kidneys, ureters, and bladder

Abnormalities in the lower urinary tract

Abnormalities in the upper urinary tract

An 80-year-old man is admitted for a cystoscopy with biopsy of the bladder. After getting a history, surgery is postponed. Which of the following reasons would not be cause to postpone this surgery?

The client is on an anticoagulant

The client has a urinary tract infection

The client might have carcinoma of the bladder

The client reports chest pain at rest for the last 3 days.

Unless there are post-op complications, a cystoscopy client is discharged to home within 24 hours. Which of the following instructions is given at discharge?

Expect bloody urine for about a week

Drink 8 to 10 glasses of water every 8 hours.

Try to urinate frequently, and measure your output

Check the color, consistency, and amount of urine in the indwelling urinary catheter bag every 4 to 8 hours.

Kegel exercises are used to gain control of bladder function in women and with stress incontinence in some men after prostate surgery. Which of the following instructions would help the client perform these exercises?

Completely empty the bladder

Do the exercise 200 times a day

Sit or stand with your legs together

Drink small amounts of fluid frequently

Which of the following instructions is given to clients with chronic pyelonephritis?

Stay on bedrest for 2 weeks

Use analgesia on a regular basis for up to 6 months

Have a urine culture every 2 weeks for up to 6 months

You may need antibiotic treatment for several weeks or months.

A client presents with a possible urinary tract infection. Which of the following should the nurse assess first?

Urine clarity

Urine specific gravity

Urine acetone

urine odor

When teaching a client how to prevent recurrences of acute glomerulonephritis, which instruction should the nurse include?

“Avoid all physical activity.”

“Strain all urine.”

“Seek early treatment for respiratory infection.”

“Monitor urine specific gravity every day.”

A 25-year-old male is admitted to the medical-surgical unit with a diagnosis of nephritic syndrome. Which of the following is a hallmark of this syndrome?

Osmotic diuresis

Edema

Hypolipidemia

Hyperproteinemia

The nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse should be alert for which of the following? Select all that apply.

Trousseau’s sign

Cardiac arrhythmias

Constipation

Decreased clotting time

Drowsiness and lethargy

Fractures

The nurse is caring for a client who has had a renal biopsy. Which of the following interventions would the nurse avoid in the care of the client after this procedure?

Encouraging fluids to at least 3 L in the first 24 hours.

Administering narcotics as needed

Testing serial samples with dipsticks for occult blood

Ambulating the client in the room and hall for short distances.

The client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of:

Renal cancer in the clients family

Blow or trauma to the bladder or abdomen

Glomerulonephritis

Pyelonephritis

The client is scheduled for an intravenous pyelogram. Before the test the priority nursing action would be to:

Administer an oral preparation of radiopaque dye

Restrict fluids

Determine a history of allergies

Administer a sedative

Following a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. The nurse interprets this complaint and further assesses the client for:

Bleeding

Infection

Renal colic

A normal expected pain

The client with crush injury to the right lower leg develops acute renal failure. The nurse interprets that this type of renal failure is due to:

Prerenal causes

Renal causes (intrarenal)

Postrenal causes

Extrarenal causes

A client is to have a cystoscopy to rule out cancer of the bladder. Which of the following symptoms would indicate that the client has developed a complication after the cystoscopy?

Dizziness

Chills

Pink-tinged urine

Bladder spasms

If the client develops lower abdominal pain after a cystoscopy, the nurse should instruct the client to do which of the following?

Apply an ice pack to pubic area

Massage the abdomen gently

Ambulate as much as possible

Sit in a tub of warm water

A client is scheduled to have a KUB radiograph. Which of the following would be ordered to prepare the client for this radiograph?

Fluid and food will be withheld the morning of the examination

A tranquilizer will be given before the examination

An enema will be given before the examination

No specific preparation is required for the examination

Which of the following urinary symptoms is the most common initial manifestations of acute renal failure?

Dysuria

Anuria

Hematuria

Oliguria

A client developed shock after a severe myocardial infarction and has now developed acute renal failure. The client’s family asks the nurse why the client has developed acute renal failure. The nurse should base the response on knowledge that there was:

A decrease in the blood flow through the kidneys

An obstruction of urine flow from the kidneys

A blood clot formed in the kidneys

A structural damage to the kidney resulting in acute tubular necrosis.

The client’s BUN concentration is elevated in acute renal failure. What is the likely cause of this finding?

Fluid retention

Hemolysis of RBCs

Below-normal metabolic rate

Reduced renal blood flow.

A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The rationale for the high-carbohydrate diet is that carbohydrates will:

Act as a diuretic

Reduce demands on the lover

help maintain urine acidity

Prevent the development of ketosis

The client with acute renal failure asks the nurse for a snack. Because the client’s potassium level is elevated, which of the following snacks would be most appropriate?

A gelatin desert

Yogurt

An orange

Peanuts

In the oliguric phase of acute renal failure, the nurse should anticipate the development of which of the following complications?

Pulmonary edema

Metabolic alkalosis

Hypotension

Hypokalemia

The client with acute renal failure is recovering and asks the nurse, “Will my kidneys ever function normally again?” The nurse’s response is based on the knowledge that the client’s renal status will most likely:

Continue to improve over a period of weeks

Result in the need for permanent hemodialysis

Improve only if the client received a renal transplant

Result in end-stage renal failure.

A 24-year-old female client comes into an urgent care facility in moderate distress with a probable diagnosis of cystitis. Which of the following symptoms would the nurse most likely expect the client to report during the assessment?

Fever and chills

Frequency and burning on urination

Flank pain and nausea

Hematuria

The client asks the nurse, “How did I get this urinary tract infection?” The nurse should explain that in most instances, cystitis is caused by:

Congenital structures in the urethra

An infection elsewhere in the body

Urine stasis in the urinary bladder

An ascending infection from the urethra

The nurse teaches a client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which of the following responses by the client would indicate that she understands the nurse’s instructions?

“I will place ice packs on my perineum.”

“I will take hot tub baths.”

“I will drink a cup of warm tea very hour.”

“I will void every 5 to 6 hours.”

The client with cystitis is also given a prescription for phenazopyridine hydrochloride (Pyridium). The nurse should teach the client that this drug is used to treat urinary tract infections by:

Releasing formaldehyde and proving bacteriostatic action

Potentiating the action of the antibiotic

Providing an analgesic effect on the bladder mucosa.

Preventing the crystallization that can occur with sulfa drugs.

Before the client starts taking phenazopyridine hydrochloride (Pyridium), she should be taught about which of the drugs side effects?

Bright orange-red urine

Incontinence

Constipation

Slight drowsiness

Which of the following symptoms would most likely indicate pyelonephritis?

Ascites

Costovertebral angle (CVA) tenderness

Polyuria

N/V

Which of the following factors would put the client at increased risk for pyelonephritis?

History of hypertension

Intake of large quantities of cranberry juice

Fluid intake of 2,000 mL/day

History of diabetes mellitus

The client with acute pyelonephritis wants to know the possibility of developing chronic pyelonephritis. The nurse’s response is based on knowledge that which of the following disorders most commonly leads to chronic pyelonephritis?

Acute pyelonephritis

Recurrent UTIs

Acute renal failure

Glomerulonephritis

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