Exam 4: Chronic Kidney Disease NCLEX Questions and Answers

a A patient is admitted to the hospital with CKD. The nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys b. a rapid decrease in urine output with an elevated BUN c. an increasing creatinine clearance with a decrease in urine output d. prostration, somnolence, and confusion with coma and imminent death a b d Patients with CKD experience an increase incidence of cardiovascular disease related to Select all that apply a. hypertension b. vascular calcifications c. a genetic predisposition d. hyperinsulinemia causing dyslipidemia e. increased high-density lipoprotein levels 00:31 00:54 a An ESRD patient receiving HD is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that a. successful transplantation usually provides a better quality of life than that offered by dialysis b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available c. HD replaces the normal function of the kidneys, and patients do not have to live with the continual fear of rejection d. the immunosuppressive therapy following transplantation makes the person ineligible to receive other forms of treatment if the kidney fails c d e To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should Select all that apply a. monitor the BP in the affected arm b. irrigate the graft daily with low-dose heparin c. palpate the area of the graft to feel a normal thrill d. listen with a stethoscope over the graft to detect a bruit e. frequently monitor the pulses and neurovascular status distal to the graft a A major advantage of peritoneal dialysis is a. the diet is less restricted and dialysis can be performed at home b. the dialysate is biocompatible and causes no long-term consequences c. high glucose concentrations of the dialysate causes a reduction in appetite, promoting weight loss d. no medications are required because of the enhances efficiency of the peritoneal membrane in removing toxins a A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 weeks. What is the first action the nurse should take? a. assess temperature and initiate workup to rule out infection b. reassure the patient that this is common after transplantation c. provide warm cover for the patient and give 1 g acetaminophen orally d. notify the nephrologist that the patient has developed symptoms of acute rejection b In replying to a patient's questions about the seriousness of her CKD, the nurse knows that the stage of CKD is based on what? a. total daily urine output b. GFR c. degree of altered mental status d. serum creatinine and urea levels a b d The patient with CKD is receiving dialysis, and the nurse observes excoriations on the patient's skin. What pathophysiologic changes in CKD most likely occur that can contribute to this finding? Select all that apply a. dry skin b. sensory neuropathy c. vascular calcifications d. calcium-phosphate skin deposits e. uremic crystallization from high BUN c What causes the GI manifestation of stomatitis in the patient with CKD? a. high serum sodium levels b. irritation of the GI tract from creatinine c. increased ammonia from bacterial breakdown of urea d. iron salts, calcium-containing phosphate binders, and limited fluid intake c The patient with CKD is brought to the ED with Kussmaul respirations. What does the nurse know about CKD that could cause this patient's Kussmaul respirations? a. uremic pleuritis is occurring b. there is decreased pulmonary macrophage activity c. they are caused by respiratory compensation for metabolic acidosis d. pulmonary edema from HF and fluid overload is occurring d Which serum laboratory value indicates to the nurse that the patient's CKD is getting worse? a. decreased BUN b. decreased sodium c. decreased creatinine d. decreased calculated GFR b What is the most serious electrolyte disorder associated with kidney disease? a. hypocalcemia b. hyperkalemia c. hyponatremia d. hypermagnesemia d What is the most appropriate snack for the nurse to offer a patient with stage 4 CKD? a. raisins b. ice cream c. dill pickles d. hard candy a Which complication of CKD is treated with erythropoietin? a. anemia b. hypertension c. hyperkalemia d. mineral and bone disorder c e The patient with CKD is considering whether to use PD or HD. What are advantages of PD when compared to HD? Select all that apply a. less protein loss b. rapid fluid removal c. less cardiovascular stress d. decreased hyperlipidemia e. requires fewer dietary restrictions b To prevent the most common serious complication of PD, what is most important for the nurse to do? a. infuse the dialysate slowly b. use strict aseptic technique in the dialysis procedures c. have the patient empty the bowel before the inflow phase d. reposition the patient frequently and promote deep breathing a A man with ESRD is scheduled for HD following healing of an arteriovenous fistula. What should the nurse explain to him that will occur during dialysis? a. he will be able to visit, read, sleep, or watch TV while reclining in a chair b. he will be placed on a cardiac monitor to detect any adverse effects that may occur c. the dialyzer will remove and hold part of his blood for 20-30 minutes to remove the waste products d. a large catheter with two lumens will be inserted into the fistula to send blood to and return it from the dialyzer d A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that what is a contraindication to kidney transplantation? a. hepatitis C infection b. coronary artery disease c. refractory hypertension d. extensive vascular disease a During the immediate postoperative care of a recipient of a kidney transplant, what is a priority for the nurse to do? a. regulate fluid intake hourly based on urine output b. monitor urine-tinged drainage on abdominal dressing c. medicate the patient frequently for incisional flank pain d. remove the urinary catheter to evaluate the ureteral implant