N4 - test - Chronic and Acute Renal Failure

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Chapter 72: Interventions for Clients with Chronic and Acute Renal Failure

1. Which statement regarding the pathophysiology of acute renal failure is true?

A. Acute renal failure is the result of a slow, steady decline in renal function.
B. Rising intratubular pressure causes the BUN and creatinine levels to decrease.
C. Inflammatory changes from drugs result in immune-mediated changes in renal tissue.
D. With acute hypoperfusion, renal compensatory mechanisms work to increase urine output.

2. With which of the following clients should you remain alert for the possible development of acute renal failure?

A. 60-year-old woman with a wound infection treated with penicillin
B. 40-year-old woman with community-acquired pneumonia
C. 75-year-old man with a unilateral bladder obstruction
D. 68-year-old woman with severe heart failure

3. Which of the flowing clients is most at risk for the development of chronic renal failure?

A. 77-year-old female with a history of renal calculi
B. 65-year-old male with diabetes and hypertension
C. 24-year-old female who is taking oral contraceptives
D. 42-year-old male who is taking an H2 receptor antagonist

4. The client has been admitted with renal insufficiency. Which of the following alterations of laboratory values should you expect?

A. A rise in BUN and creatinine only
B. Increasing levels of BUN, creatinine, uric acid, and phosphorus
C. Decreased renal reserve without measurable wastes present in the serum
D. Excessive levels of BUN, creatinine, uric acid, and phosphorus incompatible with sustaining life

5. The family of a client with acute renal failure asks how damage to the kidneys can be avoided in the future. What is your best response?

A. Consult with your health care provider before taking any over-the-counter medications.
B. Take vitamin C whenever you have symptoms of a cold.
C. Consume a diet high in protein, potassium, and sodium.
D. Use ibuprofen instead of acetaminophen for pain.

6. A client admitted with acute renal failure develops an infection and spikes a temperature of 100.8° F. What initial action by the nurse will help preserve renal function?

A. Carefully measuring and recording the intake and output
B. Ensuring adequate hydration
C. Administering diuretics as ordered
D. Monitoring vital signs every four hours

7. Which of the following clinical manifestations is characteristic of stage III: end-stage renal disease (ESRD)?

A. The ability to concentrate urine is decreased.
B. The kidneys are unable to maintain homeostasis.
C. Metabolic wastes are beginning to accumulate in the blood.
D. The healthier kidney compensates for the diseased kidney.

8. In teaching a client who has progressed to ESRD treated with hemodialysis three times weekly about her medications, the client wonders why she is no longer taking diuretics. What is your best response?

A. “Diuretics are no longer appropriate as they can cause harmful side effects now.”
B. “The dialysis treatments will remove all excess fluid, so diuretics are not necessary.”
C. “Your high blood pressure will be controlled with dialysis, so they are no longer needed.”
D. “Your kidney failure is causing you to make a large quantity of dilute urine, so diuretics are no longer needed.”

9. In caring for a client immediately following hemodialysis, what priority nursing intervention should you implement at this time?

A. Insert a Foley catheter.
B. Monitor for signs of hemorrhage.
C. Administer antipyretics for fever.
D. Place the client in a high-Fowler position.

10. You are preparing a client receiving continuous ambulatory peritoneal dialysis (CAPD). What discharge instructions should you include in a teaching plan for this client?

A. “Weigh yourself every day.”
B. “The effluent should be a cloudy, opaque color.”
C. “You need only use a “clean” procedure to care for your catheter at home.”
D. “Clean the catheter insertion site going from the abdomen toward the insertion site.”

11. Which statement made by the client indicates an understanding of permanent vascular access for hemodialysis? “I:

A. will not have my blood pressure measured in the arm with the vascular access.”
B. should have my blood drawn only from the arm with the vascular access.”
C. will not need to take any more medication for my kidney disease.”
D. should avoid ROM exercise in the arm with the vascular access.”

12. The client who is on hemodialysis three times weekly asks why he is receiving more protein than prior to his dialysis treatments. What is your best response?

A. “You must be getting the wrong tray, I’ll have to check on this.”
B. “You need more protein now, as protein is lost during dialysis.”
C. “The increase in protein is due to the improvement in your kidney function from dialysis treatments.”
D. “Dialysis removes wastes from the body, so it does not matter how much protein you eat.”

13. You are preparing to perform a dressing change on a client with a peritoneal catheter for dialysis. Which dressing change technique should you employ?

A. Aseptic technique
B. Clean technique
C. Clean technique, unless peritonitis is present
D. Aseptic technique for the first two weeks, until the catheter site matures

14. Which of the following clients would be a candidate for kidney donation?

A. 50-year-old male with COPD
B. 72-year-old male with peptic ulcer disease
C. 38-year-old female with irritable bowel disease
D. 45-year-old female with advanced cardiac disease

15. Following renal transplantation, the client’s urinary output has decreased suddenly. What is your best course of action?

A. Remove the Foley catheter.
B. Notify the physician.
C. Document the finding.
D. Apply pressure over the area of the bladder to facilitate emptying.