COMPLEX EXAM 3 AND STUDY GUIDE 170 QUESTIONS AND
CORRECT ANSWERS 2024-2025 LATEST VERSION//ALREADY
GRADED A+
A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What
do you do to prevent complications associated with this device?
1. Insert I.V. lines above the fistula.
2. Avoid taking blood pressures in the arm with the fistula.
3. Palpate pulses above the fistula.
4. Report a bruit or thrill over the fistula to the doctor. - CORRECT ANSWER-2. Avoid taking blood
pressures in the arm with the fistula.
Don't take blood pressure readings in the arm with the fistula because the compression could damage
the fistula.
Option A: IV lines shouldn't be inserted in the arm used for hemodialysis.
Option C: Palpate pulses below the fistula.
Option D: Lack of bruit or thrill should be reported to the doctor.
Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis.
Which complication do you suspect?
1. Infection
2. Disequilibrium syndrome
3. Air embolus
4. Acute hemolysis - CORRECT ANSWER-2. Disequilibrium syndrome
Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the
blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms
include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.
Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is
effective in relieving muscle cramps?
1. Increase the rate of dialysis
2. Infuse normal saline solution
3. Administer a 5% dextrose solution
,4. Encourage active ROM exercises - CORRECT ANSWER-2. Infuse normal saline solution
Treatment includes administering normal saline or hypertonic normal saline solution because muscle
cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate
of dialysis, not increasing it, may alleviate muscle cramps.
Your patient with chronic renal failure reports pruritus. Which instruction should you include in this
patient's teaching plan?
1. Rub the skin vigorously with a towel
2. Take frequent baths
3. Apply alcohol-based emollients to the skin
4. Keep fingernails short and clean - CORRECT ANSWER-4. Keep fingernails short and clean
Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in
the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the
risk of infection.
The most common early sign of kidney disease is:
1. Sodium retention
2. Elevated BUN level
3. Development of metabolic acidosis
4. Inability to dilute or concentrate urine - CORRECT ANSWER-2. Elevated BUN level
Increased BUN is usually an early indicator of decreased renal function.
A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs,
sneezes, or lifts heavy objects?
1. Overflow
2. Reflex
3. Stress
4. Urge - CORRECT ANSWER-3. Stress
Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-
abdominal pressure, such as with coughing or sneezing.
,What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease?
1. Activity intolerance
2. Fluid volume excess
3. Knowledge deficit
4. Pain - CORRECT ANSWER-2. Fluid volume excess
Fluid volume excess because the kidneys aren't removing fluid and wastes. The other diagnoses may
apply, but they don't take priority.
A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do
you include in his plan of care?
1. Apply pressure to the needle site upon discontinuing hemodialysis
2. Keep the head of the bed elevated 45 degrees
3. Place the left arm on an arm board for at least 30 minutes
4. Keep the left arm dry - CORRECT ANSWER-1. Apply pressure to the needle site upon discontinuing
hemodialysis
Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all
the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.
Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is
important for providing care for the patient?
1. The patient shouldn't feel pain during initiation of dialysis
2. The patient feels best immediately after the dialysis treatment
3. Using a stethoscope for auscultating the fistula is contraindicated
4. Taking a blood pressure reading on the affected arm can cause clotting of the fistula - CORRECT
ANSWER-4. Taking a blood pressure reading on the affected arm can cause clotting of the fistula
Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking
blood pressure on the affected arm.
After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness,
mental onfusion, nausea, and vomiting. Which condition is indicated?
1. Disequilibrium syndrome
, 2. Respiratory distress
3. Hypervolemia
4. Peritonitis - CORRECT ANSWER-1. Disequilibrium syndrome
Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can
diffuse from the body's cells into the vascular system.
What is the best way to check for patency of the arteriovenous fistula for hemodialysis?
1. Pinch the fistula and note the speed of filling on release
2. Use a needle and syringe to aspirate blood from the fistula
3. Check for capillary refill of the nail beds on that extremity
4. Palpate the fistula throughout its length to assess for a thrill - CORRECT ANSWER-4. Palpate the fistula
throughout its length to assess for a thrill
The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow.
Pinching the fistula could cause damage. Aspirating blood is a needless invasive procedure.
Polystyrene sulfonate (Kayexalate) is used in renal failure to:
1. Correct acidosis
2. Reduce serum phosphate levels
3. Exchange potassium for sodium
4. Prevent constipation from sorbitol use - CORRECT ANSWER-3. Exchange potassium for sodium
In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine.
Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it
for sodium.
Dialysis allows for the exchange of particles across a semipermeable membrane by which of the
following actions?
1. Osmosis and diffusion
2. Passage of fluid toward a solution with a lower solute concentration
3. Allowing the passage of blood cells and protein molecules through it.
4. Passage of solute particles toward a solution with a higher concentration. - CORRECT ANSWER-1.
Osmosis and diffusion
CORRECT ANSWERS 2024-2025 LATEST VERSION//ALREADY
GRADED A+
A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What
do you do to prevent complications associated with this device?
1. Insert I.V. lines above the fistula.
2. Avoid taking blood pressures in the arm with the fistula.
3. Palpate pulses above the fistula.
4. Report a bruit or thrill over the fistula to the doctor. - CORRECT ANSWER-2. Avoid taking blood
pressures in the arm with the fistula.
Don't take blood pressure readings in the arm with the fistula because the compression could damage
the fistula.
Option A: IV lines shouldn't be inserted in the arm used for hemodialysis.
Option C: Palpate pulses below the fistula.
Option D: Lack of bruit or thrill should be reported to the doctor.
Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis.
Which complication do you suspect?
1. Infection
2. Disequilibrium syndrome
3. Air embolus
4. Acute hemolysis - CORRECT ANSWER-2. Disequilibrium syndrome
Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the
blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms
include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.
Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is
effective in relieving muscle cramps?
1. Increase the rate of dialysis
2. Infuse normal saline solution
3. Administer a 5% dextrose solution
,4. Encourage active ROM exercises - CORRECT ANSWER-2. Infuse normal saline solution
Treatment includes administering normal saline or hypertonic normal saline solution because muscle
cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate
of dialysis, not increasing it, may alleviate muscle cramps.
Your patient with chronic renal failure reports pruritus. Which instruction should you include in this
patient's teaching plan?
1. Rub the skin vigorously with a towel
2. Take frequent baths
3. Apply alcohol-based emollients to the skin
4. Keep fingernails short and clean - CORRECT ANSWER-4. Keep fingernails short and clean
Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in
the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the
risk of infection.
The most common early sign of kidney disease is:
1. Sodium retention
2. Elevated BUN level
3. Development of metabolic acidosis
4. Inability to dilute or concentrate urine - CORRECT ANSWER-2. Elevated BUN level
Increased BUN is usually an early indicator of decreased renal function.
A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs,
sneezes, or lifts heavy objects?
1. Overflow
2. Reflex
3. Stress
4. Urge - CORRECT ANSWER-3. Stress
Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-
abdominal pressure, such as with coughing or sneezing.
,What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease?
1. Activity intolerance
2. Fluid volume excess
3. Knowledge deficit
4. Pain - CORRECT ANSWER-2. Fluid volume excess
Fluid volume excess because the kidneys aren't removing fluid and wastes. The other diagnoses may
apply, but they don't take priority.
A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do
you include in his plan of care?
1. Apply pressure to the needle site upon discontinuing hemodialysis
2. Keep the head of the bed elevated 45 degrees
3. Place the left arm on an arm board for at least 30 minutes
4. Keep the left arm dry - CORRECT ANSWER-1. Apply pressure to the needle site upon discontinuing
hemodialysis
Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all
the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.
Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is
important for providing care for the patient?
1. The patient shouldn't feel pain during initiation of dialysis
2. The patient feels best immediately after the dialysis treatment
3. Using a stethoscope for auscultating the fistula is contraindicated
4. Taking a blood pressure reading on the affected arm can cause clotting of the fistula - CORRECT
ANSWER-4. Taking a blood pressure reading on the affected arm can cause clotting of the fistula
Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking
blood pressure on the affected arm.
After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness,
mental onfusion, nausea, and vomiting. Which condition is indicated?
1. Disequilibrium syndrome
, 2. Respiratory distress
3. Hypervolemia
4. Peritonitis - CORRECT ANSWER-1. Disequilibrium syndrome
Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can
diffuse from the body's cells into the vascular system.
What is the best way to check for patency of the arteriovenous fistula for hemodialysis?
1. Pinch the fistula and note the speed of filling on release
2. Use a needle and syringe to aspirate blood from the fistula
3. Check for capillary refill of the nail beds on that extremity
4. Palpate the fistula throughout its length to assess for a thrill - CORRECT ANSWER-4. Palpate the fistula
throughout its length to assess for a thrill
The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow.
Pinching the fistula could cause damage. Aspirating blood is a needless invasive procedure.
Polystyrene sulfonate (Kayexalate) is used in renal failure to:
1. Correct acidosis
2. Reduce serum phosphate levels
3. Exchange potassium for sodium
4. Prevent constipation from sorbitol use - CORRECT ANSWER-3. Exchange potassium for sodium
In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine.
Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it
for sodium.
Dialysis allows for the exchange of particles across a semipermeable membrane by which of the
following actions?
1. Osmosis and diffusion
2. Passage of fluid toward a solution with a lower solute concentration
3. Allowing the passage of blood cells and protein molecules through it.
4. Passage of solute particles toward a solution with a higher concentration. - CORRECT ANSWER-1.
Osmosis and diffusion
