NMNC 4510 Concept Synthesis Exam | Questions, Answers and Rationales

NMNC 4510 Concept Synthesis Exam | Questions, Answers and Rationales Which statement explains why metabolic acidosis develops with kidney failure? 1. Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate 2. Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention 3. Inability of the renal tubules to reabsorb water to dilute the acid contents of blood 4. Impaired glomerular filtration, causing retention of sodium and metabolic waste products Rationale: Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis. A client is admitted to the hospital in the oliguric phase of acute kidney injury. The client's urine output for the past 12 hours was 200 mL. The nurse notes a prescription for 900 mL of oral fluids over the next 24 hours. Which interpretation of the amount of prescribed fluid would the nurse make? 1. It equals the expected urinary output for the next 24 hours. 2. It will prevent the development of pneumonia and a high fever. 3. It will compensate for both insensible and expected output over the next 24 hours. 4. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias. Rationale: Insensible losses are 500 mL to 1000 mL in 24 hours, with an average of about 600 mL; the measured output is about 400 mL in 24 hours based on the available history (about 200 mL in 12 hours). Based on the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900 mL. More than 900 mL daily is necessary to help prevent pneumonia and its associated fever. Hyperkalemia in acute kidney injury is caused by inadequate glomerular filtration and is not related to fluid intake. Which complication is the most serious for a client with kidney failure? 1. Anemia 2. Weight loss 3. Uremic frost 4. Hyperkalemia Rationale: Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as cardiac arrest. Anemia may occur but is not the most serious complication and should be treated in relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used. Weight loss alone is not life threatening. Uremic frost, a layer of urea crystals on the skin, causes itching, but it is not the most serious complication. A client with a history of chronic kidney disease is hospitalized. Which assessment findings would alert the nurse to suspect kidney insufficiency? 1. Facial flushing 2. Edema and pruritus 3. Dribbling after voiding 4. Diminished force of urination Rationale: The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease. A client who has chronic kidney failure is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client indicates understanding of the therapy? 1. "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." 2. "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." 3. "It decreases the need for immobility because it clears toxins in short and intermittent periods." 4. "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion." Rationale: Diffusion moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day. Which hormone influences kidney function? 1. Renin 2. Bradykinin 3. Aldosterone 4. Erythropoietin Rationale: Released from the adrenal cortex, aldosterone influences kidney function. Renin, bradykinin, and erythropoietin are kidney hormones. Which process is a function of the kidney hormones? 1. Prostaglandin increases blood flow and vascular permeability. 2. Bradykinin regulates intrarenal blood flow via vasodilation or vasoconstriction. 3. Renin raises blood pressure because of angiotensin and aldosterone secretion. 4. Erythropoietin promotes calcium absorption in the gastrointestinal tract tract. Rationale: Renin is a kidney hormone that raises blood pressure as a result of angiotensin and aldosterone secretion. Prostaglandin is a kidney hormone that regulates intrarenal blood flow via vasodilation or vasoconstriction. Bradykinin is a kidney hormone that increases blood flow and vascular permeability. Erythropoietin is a kidney hormone that stimulates the bone marrow to make red blood cells. Which information would the nurse include in response to a client's questioning a protein-restricted dietary change required for his or her acute kidney injury? 1. "A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses." 2. "Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis." 3. "This diet supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys." 4. "Currently, your body is unable to synthesize amino acids, so the nitrogen for amino acid synthesis must come from the dietary protein." Rationale: The amount of protein permitted in the diet depends on the extent of kidney function; excess protein causes an increase in urea concentration, excess metabolic waste, and added stress on the kidneys. The restricted protein diet prevents overburdening the client's kidneys at this time. When experiencing acute kidney injury, the kidneys are unable to eliminate the waste products of a high-protein diet. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids. A client with acute kidney injury is moved into the diuretic phase after 1 week of therapy. During this phase, which clinical indicators would the nurse assess? Select all that apply. One, some, or all responses may be correct. 1. Skin rash 2. Dehydration 3. Hypovolemia 4. Hyperkalemia 5. Metabolic acidosis Rationale: In the diuretic phase, excretion of fluids retained during the oliguric phase occurs and may reach 3 to 5 L daily; unless fluid replacement occurs, dehydration and hypovolemia is a potential. Skin rash is not associated with the diuretic phase. Hyperkalemia develops in the oliguric phase when glomerular filtration is inadequate. Metabolic acidosis occurs in the oliguric, not diuretic, phase. The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis report. Which urinary finding indicates the need to notify the primary health care provider? 1. Acidic pH 2. Glucose negative 3. Bacteria negative 4. Presence of large proteins Rationale: The glomeruli are not permeable to large proteins such as albumin or red blood cells, and finding them in the urine is abnormal; the nurse would report their presence to the primary health care provider to modify the client's treatment plan. The primary health care provider for a client with chronic kidney disease prescribed immediate hemodialysis for the first time. Which clinical manifestation indicates the need for immediate hemodialysis in this client? 1. Ascites 2. Acidosis 3. Hypertension 4. Hyperkalemia Rationale: Protein breakdown liberates cellular potassium ions, leading to hyperkalemia, which can cause a cardiac dysrhythmia and standstill. The failure of the kidneys to maintain a balance of potassium is one of the main indications for dialysis. The nurse reviews the kidney function blood studies of four clients. Which client's results indicate kidney impairment? Client 1: Serum Creatinine 0.1 mg/dL; BUN 16 mg/dL Client 2: Serum Creatinine 0.8 mg/dL; BUN 18 mg/dL Client 3: Serum Creatinine 1.2 mg/dL; BUN 20 mg/dL Client 4: Serum Creatinine 1.9; BUN 22 mg/dL Rationale: Elevated creatinine level signifies impaired kidney function or kidney disease. As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poor clearance of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys. If the kidneys are not able to remove urea from the blood normally, the blood urea nitrogen (BUN) level rises. The normal range of serum creatinine lies between 0.6 and 1.2 mg/dL (53.04-106.08 mmol/L). The normal range of BUN lies between 10 and 20 mg/dL (3.57-7.14 mmol/L). Client 4's levels indicate kidney impairment. The serum creatinine and BUN are within normal limits for clients 1, 2, and 3. Which organ-specific autoimmune disorder would the nurse associate with a client's kidney? 1. Graves disease 2. Addison disease 3. Goodpasture syndrome 4. Guillain-Barré syndrome Rationale: Goodpasture syndrome is an autoimmune disorder associated with the client's kidney. Graves disease and Addison disease are autoimmune disorders associated with the endocrine system. Guillain-Barré syndrome is an autoimmune disorder associated with the central nervous system. A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed to address which purpose? 1. To correct hyperkalemia 2. To increase urinary output 3. To prevent respiratory acidosis 4. To increase serum calcium levels Rationale: The 50% glucose and regular insulin infusion treats the hyperkalemia associated with kidney failure; it moves potassium from the intravascular compartment into the intracellular compartment. Insulin will not increase urinary output. Insulin is not a treatment for respiratory acidosis. Insulin and glucose do not increase serum calcium levels. During the oliguric phase of acute kidney injury, for which abnormal finding would the nurse monitor in the client? 1. Hypothermia 2. Hyperphosphatemia 3. Hypocalcemia 4. Hypernatremia Rationale: The kidneys retain potassium during the oliguric phase of acute kidney injury; an elevated potassium level is one of the main indicators for placing a client on hemodialysis when he or she is experiencing acute kidney injury. Hypothermia does not occur with acute kidney injury. Serum levels of phosphorus decrease during the oliguric phase of kidney failure. The retained fluids create a hemodilution effect and hyponatremia occurs, not hypernatremia. The nurse teaches a client with chronic kidney disease to avoid all salt substitutes in his or her diet. Which rationale supports the nurse's instruction? 1. A person's body tends to retain fluid when a salt substitute is included in the diet. 2. Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. 3. Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. 4. The salt substitute substances interfere with capillary membrane transfer, resulting in anasarca. Rationale: Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Chronic kidney disease already places the client at a higher risk for hyperkalemia because of poor elimination of fluids and electrolytes. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen and creatinine levels; these are the result of protein metabolism. There is not a substance in the salt substitute that interferes with capillary membrane transfer. Anasarca is extensive fluid in the tissues throughout the body and more extensive than typical edema. A client with acute kidney injury states, "Why am I experiencing twitching and tingling of my fingers and toes?" Which process would the nurse consider when formulating a response to this client? 1. Acidosis 2. Calcium depletion 3. Potassium retention 4. Sodium chloride depletion Rationale: In kidney failure, as the glomerular filtration rate decreases, phosphorus is retained. As hyperphosphatemia occurs, calcium is excreted. Calcium depletion hypocalcemia causes tetany, which causes twitching and tingling of the extremities, among other symptoms. Acidosis, potassium retention, and sodium chloride depletion are not characterized by twitching and tingling of the extremities. For which complications would the nurse monitor a client hospitalized with end-stage kidney disease? Select all that apply. One, some, or all responses may be correct. 1. Anemia 2. Dyspnea 3. Jaundice 4. Hyperexcitability 5. Hypophosphatemia Rationale: Anemia results from decreased production of erythropoietin by the kidneys, which causes decreased erythropoiesis by bone marrow. Dyspnea is a result of fluid overload, which is associated with chronic kidney failure. Jaundice occurs with biliary obstruction or liver disorders, not with kidney failure. Hyperphosphatemia occurs with kidney failure, not hypophosphatemia. Hyperexcitability is not a feature of end-stage kidney disease. A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client reports feeling depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. Which response would the nurse provide? 1. "The staff will provide total care, because the infection causes severe fatigue." 2. "Mood elevators will be prescribed to improve the depression and irritability." 3. "Vitamin B12 will be prescribed for the anemia, and the stools will be dark." 4. "Protein foods will be restricted so the kidneys can clear the waste products." Rationale: One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron and folic acid supplements are used for anemia in chronic kidney disease; Vitamin B12 is used for pernicious anemia and does not make the stools dark; iron makes the stools dark. A client develops a transfusion reaction. Which clinical response will the nurse assess to determine kidney damage? 1. Glycosuria 2. Blood in the urine 3. Decreased urinary output 4. Acute pain over the kidney Rationale: Diminished renal function usually is evidenced by a decrease in urine output to less than 100 to 400 mL/24 h. Glycosuria is unrelated to a transfusion reaction. Although blood in the urine and acute pain over the kidney are related to the renal system and are signs of an acute hemolytic reaction, their presence does not necessarily indicate that kidney damage has occurred. Which landmark is correct for the nurse to use when auscultating the mitral valve? Left fifth intercostal space, midaxillary line Left fifth intercostal space, midclavicular line Left second intercostal space, sternal border Left fifth intercostal space, sternal border Which topics will the nurse include in discharge teaching for a client who has had a mitral valve replacement with a mechanical valve? SATA Need for daily aspirin Symptoms of infection Use of pain medications Wound care for leg incision Purpose of anticoagulant medications When the nurse is obtaining the health history for a client with mitral valve stenosis, which question will be most relevant to ask? "Do you frequently get urinary tract infections?" "Have you had a recent episode of pneumonia?" "Did you ever have strep throat during childhood?" "Do you have a family history of heart attack or angina?" Rationale: Streptococcal infections occurring in childhood may result in damage to heart valves, particularly the mitral valve. When assessing a client who has aortic stenosis and is scheduled for aortic valve replacement, which finding by the nurse is most important to communicate to the health care provider? Loud systolic murmur Multiple dental caries Heartburn when lying down Paroxysmal nocturnal dyspnea Rationale: Multiple dental caries increase the risk for endocarditis in clients with valvular disease and caries should be treated before surgery. A loud systolic murmur is typical for aortic stenosis. Heartburn will be treated with medications such as histamine blockers or protein pump inhibitors, but is not a reason to postpone surgery. Paroxysmal nocturnal dyspnea is a common symptom of severe aortic stenosis. A child being treated with cardiac medications developed vomiting, bradycardia, anorexia, and dysrhythmias. The nurse understands which medication toxicity is responsible for these symptoms? Digoxin Nesiritide Dobutamine Spironolactone Rationale: Digoxin helps improve pumping efficacy of the heart, but an overdose can cause toxicity leading to nausea, vomiting, bradycardia, anorexia, and dysrhythmias. After donning gloves, which action would the nurse take first after discovering a large amount of blood under the buttocks of a client who had a cardiac catheterization through the femoral artery? Apply pressure to the site. Obtain vital signs. Change the client's gown and bed linens. Assess the catheterization site. Rationale: Observing standard precautions is the first priority when dealing with any body fluid, followed by assessment of the catheterization site as the second priority. This action establishes the source of the blood and determines how much blood has been lost. Once the source of the bleeding is determined, the priority goal for this client is to stop the bleeding and ensure stability of the client by monitoring the vital signs. Changing the client's gown and bed linens is not necessary until the bleeding is controlled and the client is stabilized. A child is returned to the pediatric intensive care unit after cardiac surgery. The child has a left chest tube attached to water-seal drainage, an intravenous line running of D5 ½ NS at 4 mL/h, and a double-lumen nasogastric tube connected to continuous suction. A cardiac monitor is in place, as is a dressing on the left side of the chest dressing. Which is the priority nursing intervention? Auscultating breath sounds Testing the level of consciousness Measuring drainage from both tubes Determining the suction pressure of the nasogastric tube Rationale: Assessing the level of consciousness provides the nurse with information about how awake the client is and therefore how able to clear the throat and protect the airway.