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 no symptoms.

C polyuria.

D headache.

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 Wear a mask when performing exchanges.

B Perform deep-breathing exercises vigorously.

C Auscultate the lungs frequently.

D Avoid carrying heavy items.

Question #4

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

A Hematuria

B Uremia

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 increased blood pressure.

B hematuria.

C weight loss.

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 2 lb

C 1.5 lb

D 0.5 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 Hold the medications until after dialysis.

B Ask if the client wants to take the medications.

C Check with the dialysis nurse about the medications.

D Administer the medications as ordered.

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 Continuous arteriovenous hemofiltration (CAVH)

B Continuous venovenous hemofiltration (CVVH)

C Peritoneal dialysis

D Hemodialysis

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 Initiation

B Oliguria

C Recovery

D Diuresis

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

B Donors must be relatives.

C Donors with hypertension may qualify.

D Donors are selected from compatible living donors.

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 ureteral stricture

B anaphylaxis

C polycystic disease

D myoglobinuria secondary to burns

Question #12

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

A Ureteral stricture

B Septic shock

C Prostatic hypertrophy

D Polycystic disease

Question #13

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

A Limiting fluid intake

B Promoting carbohydrate intake

C Encouraging coughing and deep breathing

D Providing pain-relief measures

Question #14

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

A Hematuria

B Proteinuria

C Azotemia

D Uremia

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 This type of dialysis will provide more independence.”

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

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 eating protein liberally.

B limiting iron and folic acid intake.

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 polyuria.

B proteinuria.

C pyuria.

D No option is correct.

Question #18

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

A Initiation

B Diuretic

C Oliguric

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 Oliguria

B Restored glomerular function

C Acute tubular necrosis

D Diuresis

Question #20

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

A Crackles

B Hypertension

C Dehydration

D Hyperkalemia

Question #21

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

A High specific gravity

B Increased BUN

C Decreased creatinine

D Decreased urine sodium

Question #22

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

A Hypotension

B Polycythemia

C Metabolic alkalosis

D Uremia

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 fatigue and weakness.

B thrush and circumoral pallor.

C nausea and vomiting.

D dyspnea and cyanosis.

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 At bedtime with 8 ounces of fluid

B 2 hours before meals

C 2 hours after meals

D With food

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 polystyrene sulfonate [Kayexalate])

B Administration of an insulin drip

C Administration of a loop diuretic

D Administration of sodium bicarbonate

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 Hydrating with saline intravenously before the test

C Administering sodium bicarbonate after the procedure

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 400 mL

B 1.5 L

C Less than 50 mL

D 1.0 L

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 7.31, PaCO2 48, HCO3 24–

C pH 7.50, PaCO2 29, HCO3 22–

D pH 7.20, PaCO2 36, HCO3 14–

Question #29

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

A Fever

B Periorbital edema

C Hypertension

D Flank pain

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 History of hyperparathyroidism

C Recent history of streptococcal infection

D History of osteoporosis

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 Hypotension

B Cola-colored urine

C Peripheral neuropathy

D Hyperalbuminemia

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

B BUN of 18 mg/dL.

C Serum creatinine of 1.2 mg/dL.

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

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 90 mL/min/1.73 m2

B A GFR of 30–59 mL/min/1.73 m2

C A GFR of 120 mL/min/1.73 m2

D A GFR of 85 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 Phosphorus

B Sodium

C Calcium

D Magnesium

Question #35

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

A Decreased urine sodium

B High specific gravity

C Increased BUN

D Decreased creatinine

Question #36

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

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

B Blood tinged drainage in Jackson-Pratt drainage tube

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

D Urine output of 35 to 40 mL/hour

Question #37

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

A Presence of albumin in the urine

B Blurred vision

C Peripheral edema

D Dark smoky colored urine

Question #38

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

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

B No tight clothing.

C Cleanse site b.i.d.

D Check daily for thrill and bruit.

E Avoid compression of the site.

Question #39

A Auscultate the lungs frequently.

B Perform deep-breathing exercises vigorously

C Avoid carrying heavy items.

D Wear a mask when performing exchanges.

Question #40

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

A Acute renal failure

B Chronic renal failure

C Nephrotic syndrome

D Acute glomerulonephritis

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 sodium level of 135 mEq/L

B Temperature of 99.2° F (37.3° C)

C Urine output of 20 ml/hour

D Serum potassium level of 4.9 mEq/L

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 1,500 mL of fluid

B 500 mL of fluid

C 2,000 mL of fluid

D 1,000 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 Abdominal distention owing to reflex cessation of intestinal peristalsis

D Paralytic ileus caused by manipulation of the colon during surgery

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 1,000 mL

B 500 mL

C 750 mL

D 250 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 Sorbitol

C Calcium supplements

D IV dextrose 50%

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

B It is important to use strict aseptic technique.”

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

D The infusion clamp should be open during infusion.”

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

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

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

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 Initiation

B Recovery

C Oliguria

D Diuresis

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 serum levels of potassium, magnesium, and calcium

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

C Increased pH with decreased hydrogen ions

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

Question #51

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

A Multiple spiked P waves

B Prolonged ST segment

C Tall, peaked T waves

D Shortened QRS complex

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 Pericarditis

B Anemia

C Acidosis

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 Palpating the fistula for a “thrill”

B Obtaining blood samples from the left arm

C Obtaining a blood pressure reading from the right arm

D Placing the client’s watch on the left wrist

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 Once on dialysis, the need will be permanent.

B The kidneys can improve over a period of months.

C Kidney function will improve with transplant.

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

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

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

D Immunosuppressive drugs guarantee organ success.”

Question #56

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

A Keeps nails trimmed short

B Pats skin dry after bathing

C Brief, hot daily showers

D Uses moisturizing creams

Question #57

A Acute tubular necrosis

B Diuresis

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 IV dextrose 50%

C Sorbitol

D Calcium supplements

Question #59

What is a hallmark of the diagnosis of nephrotic syndrome?

A Hyponatremia

B Hypoalbuminemia

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 Temperature of 100.2° F (37.8° C)

C Serum creatinine level of 1.2 mg/dl

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 Citrus fruits

C Butter

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 Decrease in blood sugar levels due to alteration in insulin levels

D Anemia from the decrease in maturation of red blood cells

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 limiting iron and folic acid intake.

D allowing liberal use of sodium

Question #64

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

A Weight loss

B Absence of pain

C Fever

D Diuresis

Question #65

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

A Activity intolerance

B Impaired urinary elimination

C Risk for infection

D Toileting self-care deficit

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