A patient on a medical unit has a potassium level of 6.8 mEq/L. What is
the priority action that the nurse should take?
a. Place the patient on a cardiac monitor.
b. Check the patient's BP.
c. Instruct the patient to avoid high-potassium foods.
d. Call the lab and request a redraw of the lab to verify results. -
ANSWER a. Dysrhythmias may occur with an elevated potassium level
and are potentially lethal. Monitor the rhythm while contacting physician
or calling the rapid response team.
How do you determine that a patient's oliguria is associated with acute
renal failure (ARF)?
A. Specific gravity of urine at 3 different times is 1.010.
B. The serum creatinine level is normal.
C. The blood urea nitrogen (BUN) level is normal or below.
D. Hypokalemia is identified. - ANSWER A. Specific gravity of urine at 3
different times is 1.010.
A urinalysis may show casts, red blood cells (RBCs), white blood cells
(WBCs), a specific gravity fixed at about 1.010, and urine osmolality at
about 300 mOsm/kg.
A patient is admitted to the hospital with CKD. You understand that this
condition is characterized by
A. Progressive irreversible destruction of the kidneys
B. A rapid decrease in urinary output with an elevated BUN level
C. Increasing creatinine clearance with a decrease in urinary output
D. Prostration, somnolence, and confusion with coma and imminent
death - ANSWER A. Progressive irreversible destruction of the kidneys
,CKD involves progressive, irreversible loss of kidney function.
Measures indicated in the conservative therapy of CKD include
A. decreased fluid intake, carbohydrate intake, and protein intake.
B. increased fluid intake; decreased carbohydrate intake and protein
intake.
C. decreased fluid intake and protein intake; increased carbohydrate
intake.
D. decreased fluid intake and carbohydrate intake; increased protein
intake. - ANSWER C. decreased fluid intake and protein intake;
increased carbohydrate intake.
Water and any other fluids are not routinely restricted in the pre-end-
stage renal disease (ESRD) stages. Patients on hemodialysis have a
more restricted diet than patients receiving peritoneal dialysis. For those
receiving hemodialysis, as their urinary output diminishes, fluid
restrictions are enhanced. Intake depends on the daily urine output.
Generally, 600 mL (from insensible loss) plus an amount equal to the
previous day's urine output is allowed for a patient receiving
hemodialysis. Patients are advised to limit fluid intake so that weight
gains are no more than 1 to 3 kg between dialyses (interdialytic weight
gain). For the patient who is undergoing dialysis, protein is not routinely
restricted. The beneficial role of protein restriction in CKD stages 1
through 4 as a means to reduce the decline in kidney function is being
studied. Historically, dietary counseling often encouraged restriction of
protein for CKD patients. Although there is some evidence that protein
restriction has benefits, many patients find these diets difficult to adhere
to. For CKD stages 1 through 4, many clinicians encourage a diet with
normal protein intake. However, you should teach patients to avoid high-
protein diets and supplements because they may overstress the
diseased kidneys.
Nurses need to educate patients at risk for CKD. Which individuals are
considered to be at increased risk (select all that apply)?
A. Older African Americans
,B. Individuals older than 60 years
C. Those with a history of pancreatitis
D. Those with a history of hypertension
E. Those with a history of type 2 diabetes - ANSWER A. Older African
Americans
B. Individuals older than 60 years
D. Those with a history of hypertension
E. Those with a history of type 2 diabetes
Risk factors for CKD include diabetes mellitus, hypertension, age older
than 60 years, cardiovascular disease, family history of CKD, exposure
to nephrotoxic drugs, and ethnic minorities (e.g., African American,
Native American).
A patient with a history of end-stage renal disease (ESRD) resulting from
diabetes mellitus has presented to the outpatient dialysis unit for his
scheduled hemodialysis. Which assessment should you prioritize before,
during, and after his treatment?
A. Level of consciousness
B. Blood pressure and fluid balance
C. Temperature, heart rate, and blood pressure
D. Assessment for signs and symptoms of infection - ANSWER B. Blood
pressure and fluid balance
Although all of the assessments are relevant to the care of a patient
receiving hemodialysis, the nature of the procedure indicates a particular
need to monitor blood pressure and fluid balance.
Which statement regarding continuous ambulatory peritoneal dialysis
(CAPD) is of highest priority when teaching a patient new to this
procedure?
A. "It is essential that you maintain aseptic technique to prevent
peritonitis."
B. "You will be allowed a more liberal protein diet after you complete
CAPD."
, C. "It is important for you to maintain a daily written record of blood
pressure and weight."
D. "You must continue regular medical and nursing follow-up visits while
performing CAPD." - ANSWER A. "It is essential that you maintain
aseptic technique to prevent peritonitis."
Peritonitis is a potentially fatal complication of peritoneal dialysis, and it
is imperative to teach the patient methods to prevent it from occurring.
Although the other teaching statements are accurate, they do not
address the potential for mortality by peritonitis, making that nursing
action the highest priority.
How should you assess the patency of a newly placed arteriovenous
graft for dialysis?
A. Irrigate the graft daily with low-dose heparin.
B. Monitor for any increase in blood pressure in the affected arm.
C. Listen with a stethoscope over the graft for presence of a bruit.
D. Frequently monitor the pulses and neurovascular status distal to the
graft. - ANSWER C. Listen with a stethoscope over the graft for
presence of a bruit.
A thrill can be felt by palpating the area of anastomosis of the
arteriovenous graft, and a bruit can be heard with a stethoscope. The
bruit and thrill are created by arterial blood rushing into the vein.
What are the main advantages of peritoneal dialysis compared to
hemodialysis?
A. No medications are required because of the enhanced efficiency of
the peritoneal membrane in removing toxins.
B. The diet is less restricted and dialysis can be performed at home.
C. The dialysate is biocompatible and causes no long-term
consequences.
the priority action that the nurse should take?
a. Place the patient on a cardiac monitor.
b. Check the patient's BP.
c. Instruct the patient to avoid high-potassium foods.
d. Call the lab and request a redraw of the lab to verify results. -
ANSWER a. Dysrhythmias may occur with an elevated potassium level
and are potentially lethal. Monitor the rhythm while contacting physician
or calling the rapid response team.
How do you determine that a patient's oliguria is associated with acute
renal failure (ARF)?
A. Specific gravity of urine at 3 different times is 1.010.
B. The serum creatinine level is normal.
C. The blood urea nitrogen (BUN) level is normal or below.
D. Hypokalemia is identified. - ANSWER A. Specific gravity of urine at 3
different times is 1.010.
A urinalysis may show casts, red blood cells (RBCs), white blood cells
(WBCs), a specific gravity fixed at about 1.010, and urine osmolality at
about 300 mOsm/kg.
A patient is admitted to the hospital with CKD. You understand that this
condition is characterized by
A. Progressive irreversible destruction of the kidneys
B. A rapid decrease in urinary output with an elevated BUN level
C. Increasing creatinine clearance with a decrease in urinary output
D. Prostration, somnolence, and confusion with coma and imminent
death - ANSWER A. Progressive irreversible destruction of the kidneys
,CKD involves progressive, irreversible loss of kidney function.
Measures indicated in the conservative therapy of CKD include
A. decreased fluid intake, carbohydrate intake, and protein intake.
B. increased fluid intake; decreased carbohydrate intake and protein
intake.
C. decreased fluid intake and protein intake; increased carbohydrate
intake.
D. decreased fluid intake and carbohydrate intake; increased protein
intake. - ANSWER C. decreased fluid intake and protein intake;
increased carbohydrate intake.
Water and any other fluids are not routinely restricted in the pre-end-
stage renal disease (ESRD) stages. Patients on hemodialysis have a
more restricted diet than patients receiving peritoneal dialysis. For those
receiving hemodialysis, as their urinary output diminishes, fluid
restrictions are enhanced. Intake depends on the daily urine output.
Generally, 600 mL (from insensible loss) plus an amount equal to the
previous day's urine output is allowed for a patient receiving
hemodialysis. Patients are advised to limit fluid intake so that weight
gains are no more than 1 to 3 kg between dialyses (interdialytic weight
gain). For the patient who is undergoing dialysis, protein is not routinely
restricted. The beneficial role of protein restriction in CKD stages 1
through 4 as a means to reduce the decline in kidney function is being
studied. Historically, dietary counseling often encouraged restriction of
protein for CKD patients. Although there is some evidence that protein
restriction has benefits, many patients find these diets difficult to adhere
to. For CKD stages 1 through 4, many clinicians encourage a diet with
normal protein intake. However, you should teach patients to avoid high-
protein diets and supplements because they may overstress the
diseased kidneys.
Nurses need to educate patients at risk for CKD. Which individuals are
considered to be at increased risk (select all that apply)?
A. Older African Americans
,B. Individuals older than 60 years
C. Those with a history of pancreatitis
D. Those with a history of hypertension
E. Those with a history of type 2 diabetes - ANSWER A. Older African
Americans
B. Individuals older than 60 years
D. Those with a history of hypertension
E. Those with a history of type 2 diabetes
Risk factors for CKD include diabetes mellitus, hypertension, age older
than 60 years, cardiovascular disease, family history of CKD, exposure
to nephrotoxic drugs, and ethnic minorities (e.g., African American,
Native American).
A patient with a history of end-stage renal disease (ESRD) resulting from
diabetes mellitus has presented to the outpatient dialysis unit for his
scheduled hemodialysis. Which assessment should you prioritize before,
during, and after his treatment?
A. Level of consciousness
B. Blood pressure and fluid balance
C. Temperature, heart rate, and blood pressure
D. Assessment for signs and symptoms of infection - ANSWER B. Blood
pressure and fluid balance
Although all of the assessments are relevant to the care of a patient
receiving hemodialysis, the nature of the procedure indicates a particular
need to monitor blood pressure and fluid balance.
Which statement regarding continuous ambulatory peritoneal dialysis
(CAPD) is of highest priority when teaching a patient new to this
procedure?
A. "It is essential that you maintain aseptic technique to prevent
peritonitis."
B. "You will be allowed a more liberal protein diet after you complete
CAPD."
, C. "It is important for you to maintain a daily written record of blood
pressure and weight."
D. "You must continue regular medical and nursing follow-up visits while
performing CAPD." - ANSWER A. "It is essential that you maintain
aseptic technique to prevent peritonitis."
Peritonitis is a potentially fatal complication of peritoneal dialysis, and it
is imperative to teach the patient methods to prevent it from occurring.
Although the other teaching statements are accurate, they do not
address the potential for mortality by peritonitis, making that nursing
action the highest priority.
How should you assess the patency of a newly placed arteriovenous
graft for dialysis?
A. Irrigate the graft daily with low-dose heparin.
B. Monitor for any increase in blood pressure in the affected arm.
C. Listen with a stethoscope over the graft for presence of a bruit.
D. Frequently monitor the pulses and neurovascular status distal to the
graft. - ANSWER C. Listen with a stethoscope over the graft for
presence of a bruit.
A thrill can be felt by palpating the area of anastomosis of the
arteriovenous graft, and a bruit can be heard with a stethoscope. The
bruit and thrill are created by arterial blood rushing into the vein.
What are the main advantages of peritoneal dialysis compared to
hemodialysis?
A. No medications are required because of the enhanced efficiency of
the peritoneal membrane in removing toxins.
B. The diet is less restricted and dialysis can be performed at home.
C. The dialysate is biocompatible and causes no long-term
consequences.
