Medi Surgi Chi 62i Coordinatingi Carei fori Patientsi withi Renali
Disorders,i Brunneri andi Suddarth'si Textbooki ofi Medicali Surgicali
Nursing-i Chapteri 54:i Managementi ofi Patientsi withi Kidneyi
Disorders,i Chapteri 26i Kidneyi Disordersi andi Therapeutici
Management,i NCLEX
Thei nursei monitorsi fori whichi clinicali manifestationi ini Ms.i Flood,i whoi isi
newlyi diagnosedi withi PKD?
A.i Hypotensioni relatedi toi fluidi shifts
B.i Bradycardiai relatedi toi fluidi overload
C.i Hypertensioni relatedi toi decreasedi renali perfusion
D.i Tachycardiai relatedi toi fluidi lossi -i
i i i i i i i i i Answer:i C
Rationale:i Newlyi diagnosedi PKDi typicallyi presentsi withi hypertension.i Fluidi
overloadi andi fluidi shiftsi occuri lateri ini thei diseasei ifi renali failurei occurs.
Thei nursei includesi whichi informationi ini thei teachingi plani abouti managementi
ofi PKD?
A.i "Youri bloodi pressurei willi normalizei wheni wei successfullyi managei youri
PKD."
B.i "Youri UTIi willi noti recuri ifi youi finishi youri antibiotici prescription."
C.i "Stayingi oni youri antihypertensivei medicationi isi necessaryi toi controli youri
bloodi pressure."
D.i "Thisi diseasei isi reversiblei ifi youi closelyi followi youri provider'si orders."i
-i
i i i i i i i i i Answer:i C
Rationale:i BPi andi UTIi arei chronici problemsi withi PKD.i Continuedi BPi
medicationi willi bei necessary.i PKDi isi noti reversible.
Thei nursei providingi carei fori Ms.i Flood,i whoi isi diagnosedi withi PKD,i
shouldi includei whichi activityi intoi thei plani ofi care?
A.i Providingi cranberryi juicei ati mealsi toi reducei thei riski ofi UTIs
B.i Frequenti range-of-motioni exercisesi toi reducei stiffnessi duei toi inactivity
C.i Encouragei fluidsi toi maintaini adequatei volumei andi perfusioni toi thei
kidneys
D.i Restricti fluidsi toi reducei thei riski ofi fluidi overloadi -i
i i i i i i i i i Answer:i D
Rationale:i Fluidi overloadi isi ai chronici problemi duei toi renali failurei requiringi
ai fluidi restriction.
Thei nursei caringi fori Ms.i Floodi incorporatesi whichi priorityi nursingi diagnosisi
intoi thei plani ofi carei relatedi toi heri diagnosisi ofi PKD?
A.i Paini relatedi toi irritationi oni urinationi secondaryi toi UTI
B.i Imbalancedi nutritioni relatedi toi excessivei lossi ofi proteini ini thei urine
C.i Decreasedi cardiaci outputi relatedi toi dysrhythmiasi secondaryi toi electrolytei
imbalance
D.i Impairedi perfusioni relatedi toi decreasedi circulatingi volumei secondaryi toi
diuresisi -i
1i |i P a g e
,i i i i i i i i i Answer:i C
Rationale:i Decreasedi cardiaci outputi isi ai riski duei toi thei potentiali riski
electrolytei imbalancesi thati occuri withi renali failure.
Whichi statementi byi Ms.i Floodi whoi isi diagnosedi withi PKDi indicatesi thati
teachingi hasi beeni effective?
A.i "I'mi gladi wei cani controli thisi diseasei withi medications."
B.i "I'mi gladi wei caughti thisi earlyi soi Ii won'ti needi dialysisi forever."
C.i "Gettingi ai newi kidneyi willi helpi eveni ifi Ii developi thei cystsi again."
D.i "Doi Ii havei ai choicei betweeni hemodialysisi ori peritoneali dialysis."i -i
i i i i i i i i i Answer:i D
Rationale:i Chronici dialysisi isi ai parti ofi treatment
fori thei renali failurei thati accompaniesi PKD.
Thei nursei recognizesi thati genetici counselingi isi appropriatei fori whichi patient?
A.i Childi withi frequenti urinaryi tracti infections
B.i Adulti withi frequenti urinaryi tracti infection
C.i Adulti withi autosomali dominanti polycystici kidneyi disease
D.i Adulti withi metastatici renali canceri -i
i i i i i i i i i Answer:i C
Rationale:i PKDi isi ai genetici disorder.i Individualsi withi PKDi whoi arei
concernedi abouti passingi thei diseasei toi theiri childreni mayi wanti toi consulti
ai genetici counselori toi helpi themi identifyi risksi fori ai childi developingi PKDi
asi well.
Thei nursei understandsi whichi diagnostici studyi isi mosti specifici ini identifyingi
PKD?
A.i Abdominali x-ray
B.i Serumi creatininei level
C.i Urinalysis
D.i Computedi tomographyi scani -i
i i i i i i i i i Answer:i D
Rationale:i Alli ofi thei testi mayi indicatei renali diseasei buti ai CTi scani willi
providei morei precisei results.
Thei nursei providingi carei fori thei patienti posti motori vehiclei accidenti withi ai
suspectedi injuryi toi thei renali systemi anticipatesi whichi ofi thei followingi
orders?
A.i Performi ani electrocardiogrami (ECG).i
B.i Sendi ai urinalysisi toi thei laboratory.
C.i Administeri diuretics.
D.i Administeri antihypertensives.i -i
i i i i i i i i i Answer:i B
Rationale:i Bloodi ini thei urinei (hematuria)i isi thei besti indicatori ofi blunti
kidneyi injury.i Microscopici hematuriai isi easilyi detectedi byi ai simplei urinalysis.
Priori toi thei patient'si CTi scan,i whichi informationi shouldi bei obtainedi fromi
thei patienti ori familyi member?
A.i Familyi historyi ofi CTi scansi
B.i Timei ofi patient'si lasti meal
2i |i P a g e
,C.i Listi ofi patient'si allergies
D.i Timei ofi lasti paini medicationi -i
i i i i i i i i i Answer:i C
Rationale:i Iti isi noti uncommoni fori patientsi toi bei allergici toi thei IVi
contrasti usedi fori CATi scans.i Iti isi importanti toi rulei outi thei presencei ofi
thisi allergyi toi avoidi seriousi allergici reactionsi suchi asi anaphylaxis.
Whichi isi ai prerenali causei ofi AKI?
A.i Acutei glomerulonephritisi andi neoplasms
B.i Septici shocki andi nephrotoxici injuryi fromi medications
C.i Pyelonephritisi andi calculii formation
D.i Hypovolemiai andi myocardiali infarctioni -i
i i i i i i i i i Answer:i D
Rationale:i Severei bloodi lossi ori hypovolemiai relatedi toi cardiaci eventsi arei
majori causesi ofi prerenali acutei kidneyi injury.
Wheni thei patienti isi ini thei diuretici phasei ofi AKI,i thei nursei musti monitori
whichi serumi electrolytei imbalance?
A.i Hypokalemiai andi hyponatremiai
B.i Hypokalemiai andi hypernatremiai
C.i Hyperkalemiai andi hyponatremiai
D.i Hyperkalemiai andi hypernatremiai -i
i i i i i i i i i Answer:i C
Rationale:i Therei isi ai decreasedi excretioni ofi potassiumi andi ani increasei ini
sodiumi losses.
Thei nursei understandsi thati CKDi isi characterizedi byi whichi ofi thei following?
A.i Rapidi decreasei ini urinei outputi withi ai CKD-elevatedi BUN
B.i Progressivei irreversiblei destructioni toi thei kidneys
C.i Abrupti increasingi creatininei clearancei withi ai decreasei ini urinaryi output
D.i Confusioni andi somnolencei leadingi toi comai andi deathi -i
i i i i i i i i i Answer:i B
Rationale:i Chronici kidneyi diseasei (CKD)i isi progres-i sive,i irreversiblei lossi ofi
kidneyi function.i CKDi isi definedi asi thei presencei ofi kidneyi damagei ori ai
glomerulari filtrationi ratei lessi thani 60i ml/mini fori 3i monthsi ori longer.
Thei nursei understandsi CRRTi isi indicatedi fori whichi ofi thei followingi
patients?
A.i Ai hospitalizedi buti hemodynamicallyi stablei patienti B.i Ai hospitalized,i
hemodynamicallyi unstablei patient
C.i Ai hospitalizedi ESRDi patienti beingi dischargedi homei soon
D.i Ai hospitalizedi ESRDi patienti whoi isi stablei buti ini ani intensivei carei
settingi -i
i i i i i i i i i Answer:i B
Rationale:i CRRTi isi indicatedi fori thei unstablei patienti whoi mayi noti toleratei
thei rapidi fluidi shiftsi ofi HD.
Thei nursesi recognizesi thati thei elderlyi patienti mayi havei ai reducedi abilityi
toi concentratei urinei whichi isi attributedi toi whichi ofi thei following?
A.i Ai reductioni ini bladderi receptors
3i |i P a g e
, B.i Thickeningi ofi thei basementi membranei ofi thei Bowman'si capsule
C.i Ai decreasei ini thei numberi ofi functioningi nephrons
D.i Ai thickeningi ofi thei efferenti arteriolei -i
i i i i i i i i i Answer:i C
Rationale:i Thei elderlyi havei ai reducedi spacei ofi functioningi nephronsi whichi
impairsi thei abilityi toi concentratei urine.
Thei nursei shouldi intervenei immediatelyi ifi thei patienti posti renali
transplantationi isi notedi toi havei whichi ofi thei followingi symptoms?
A.i Weighti loss,i hypotension,i reducedi urinei output
B.i Fever,i reducedi urinei output,i elevatedi bloodi pressure
C.i Weighti gain,i hypotension,i increasedi urinei output
D.i Increasedi urinei output,i hypertension,i feveri -i
i i i i i i i i i Answer:i B
Rationale:i Fever,i reducedi urinei output,i andi elevatedi BPi mayi bei indicativei
ofi thei presencei ofi AKIi relatedi toi transplanti rejection.
Thei nursei includesi whichi dietaryi informationi ini thei teachingi plani abouti thei
managementi ofi chronici kidneyi disease?
A.i Decreasei fluidi intakei andi proteini intake,i decreasei carbohydratei intake
B.i Increasei fluidi intake,i decreasei carbohydratei intakei andi proteini intake
C.i Decreasei fluidi intakei andi proteini intake,i increasei carbohydratei intake
D.i Increasei fluidi intake,i increasei carbohydratei intakei andi proteini intakei -i
i i i i i i i i i Answer:i C
Rationale:i Iti isi importanti toi decreasei fluidi intake
becausei peoplei withi CKDi mayi havei ai reductioni in
urinei output,i causingi fluidi toi buildi upi ini thei body;i thisi putsi thei patienti
ati furtheri riski fori volumei overload.i Decreasingi proteini intakei willi limit
thei buildupi ofi wastei productsi ini thei body,i andi increasingi carbohydratesi willi
providei patientsi withi ai goodi sourcei ofi energyi thati isi losti withi thei low-
proteini diet.
Thei nursei shouldi informi thei physiciani if,i wheni assessingi thei patienti withi
ani AVi fistula,i theyi notei whichi ofi thei following?
A.i Ai loud,i turbulenti bruiti B.i Ai quieti swooshingi bruit
C.i Ai low-pitchedi thrilli D.i Ai continuousi thrilli -i
i i i i i i i i i Answer:i A
Rationale:i Ai normali functioningi grafti willi havei ai low-pitchedi bruit.i Ai
turbulenti bruiti isi indicativei ofi ani increasedi force,i mostlyi duei toi stenosis.
Thei nursei isi screeningi patienti fori theiri riski ofi developingi renali celli cancer.i
Thei nursei shouldi consideri whichi patienti ati greatesti risk?
A.i 76-year-oldi Africani Americani femalei
B.i 50-year-oldi Caucasiani male
C.i 24-year-oldi malei Caucasiani malei
D.i 50-year-oldi Africani Americani malei -i
i i i i i i i i i Answer:i D
Rationale:i Africani Americansi andi Americani Indiansi andi Alaskani nativesi havei
slightlyi higheri ratesi ofi RCCi thani whites;i thei exacti reasonsi arei unclear.i
RCCi isi twicei asi commoni ini meni thani women.i Thisi isi attributedi toi meni
4i |i P a g e
Disorders,i Brunneri andi Suddarth'si Textbooki ofi Medicali Surgicali
Nursing-i Chapteri 54:i Managementi ofi Patientsi withi Kidneyi
Disorders,i Chapteri 26i Kidneyi Disordersi andi Therapeutici
Management,i NCLEX
Thei nursei monitorsi fori whichi clinicali manifestationi ini Ms.i Flood,i whoi isi
newlyi diagnosedi withi PKD?
A.i Hypotensioni relatedi toi fluidi shifts
B.i Bradycardiai relatedi toi fluidi overload
C.i Hypertensioni relatedi toi decreasedi renali perfusion
D.i Tachycardiai relatedi toi fluidi lossi -i
i i i i i i i i i Answer:i C
Rationale:i Newlyi diagnosedi PKDi typicallyi presentsi withi hypertension.i Fluidi
overloadi andi fluidi shiftsi occuri lateri ini thei diseasei ifi renali failurei occurs.
Thei nursei includesi whichi informationi ini thei teachingi plani abouti managementi
ofi PKD?
A.i "Youri bloodi pressurei willi normalizei wheni wei successfullyi managei youri
PKD."
B.i "Youri UTIi willi noti recuri ifi youi finishi youri antibiotici prescription."
C.i "Stayingi oni youri antihypertensivei medicationi isi necessaryi toi controli youri
bloodi pressure."
D.i "Thisi diseasei isi reversiblei ifi youi closelyi followi youri provider'si orders."i
-i
i i i i i i i i i Answer:i C
Rationale:i BPi andi UTIi arei chronici problemsi withi PKD.i Continuedi BPi
medicationi willi bei necessary.i PKDi isi noti reversible.
Thei nursei providingi carei fori Ms.i Flood,i whoi isi diagnosedi withi PKD,i
shouldi includei whichi activityi intoi thei plani ofi care?
A.i Providingi cranberryi juicei ati mealsi toi reducei thei riski ofi UTIs
B.i Frequenti range-of-motioni exercisesi toi reducei stiffnessi duei toi inactivity
C.i Encouragei fluidsi toi maintaini adequatei volumei andi perfusioni toi thei
kidneys
D.i Restricti fluidsi toi reducei thei riski ofi fluidi overloadi -i
i i i i i i i i i Answer:i D
Rationale:i Fluidi overloadi isi ai chronici problemi duei toi renali failurei requiringi
ai fluidi restriction.
Thei nursei caringi fori Ms.i Floodi incorporatesi whichi priorityi nursingi diagnosisi
intoi thei plani ofi carei relatedi toi heri diagnosisi ofi PKD?
A.i Paini relatedi toi irritationi oni urinationi secondaryi toi UTI
B.i Imbalancedi nutritioni relatedi toi excessivei lossi ofi proteini ini thei urine
C.i Decreasedi cardiaci outputi relatedi toi dysrhythmiasi secondaryi toi electrolytei
imbalance
D.i Impairedi perfusioni relatedi toi decreasedi circulatingi volumei secondaryi toi
diuresisi -i
1i |i P a g e
,i i i i i i i i i Answer:i C
Rationale:i Decreasedi cardiaci outputi isi ai riski duei toi thei potentiali riski
electrolytei imbalancesi thati occuri withi renali failure.
Whichi statementi byi Ms.i Floodi whoi isi diagnosedi withi PKDi indicatesi thati
teachingi hasi beeni effective?
A.i "I'mi gladi wei cani controli thisi diseasei withi medications."
B.i "I'mi gladi wei caughti thisi earlyi soi Ii won'ti needi dialysisi forever."
C.i "Gettingi ai newi kidneyi willi helpi eveni ifi Ii developi thei cystsi again."
D.i "Doi Ii havei ai choicei betweeni hemodialysisi ori peritoneali dialysis."i -i
i i i i i i i i i Answer:i D
Rationale:i Chronici dialysisi isi ai parti ofi treatment
fori thei renali failurei thati accompaniesi PKD.
Thei nursei recognizesi thati genetici counselingi isi appropriatei fori whichi patient?
A.i Childi withi frequenti urinaryi tracti infections
B.i Adulti withi frequenti urinaryi tracti infection
C.i Adulti withi autosomali dominanti polycystici kidneyi disease
D.i Adulti withi metastatici renali canceri -i
i i i i i i i i i Answer:i C
Rationale:i PKDi isi ai genetici disorder.i Individualsi withi PKDi whoi arei
concernedi abouti passingi thei diseasei toi theiri childreni mayi wanti toi consulti
ai genetici counselori toi helpi themi identifyi risksi fori ai childi developingi PKDi
asi well.
Thei nursei understandsi whichi diagnostici studyi isi mosti specifici ini identifyingi
PKD?
A.i Abdominali x-ray
B.i Serumi creatininei level
C.i Urinalysis
D.i Computedi tomographyi scani -i
i i i i i i i i i Answer:i D
Rationale:i Alli ofi thei testi mayi indicatei renali diseasei buti ai CTi scani willi
providei morei precisei results.
Thei nursei providingi carei fori thei patienti posti motori vehiclei accidenti withi ai
suspectedi injuryi toi thei renali systemi anticipatesi whichi ofi thei followingi
orders?
A.i Performi ani electrocardiogrami (ECG).i
B.i Sendi ai urinalysisi toi thei laboratory.
C.i Administeri diuretics.
D.i Administeri antihypertensives.i -i
i i i i i i i i i Answer:i B
Rationale:i Bloodi ini thei urinei (hematuria)i isi thei besti indicatori ofi blunti
kidneyi injury.i Microscopici hematuriai isi easilyi detectedi byi ai simplei urinalysis.
Priori toi thei patient'si CTi scan,i whichi informationi shouldi bei obtainedi fromi
thei patienti ori familyi member?
A.i Familyi historyi ofi CTi scansi
B.i Timei ofi patient'si lasti meal
2i |i P a g e
,C.i Listi ofi patient'si allergies
D.i Timei ofi lasti paini medicationi -i
i i i i i i i i i Answer:i C
Rationale:i Iti isi noti uncommoni fori patientsi toi bei allergici toi thei IVi
contrasti usedi fori CATi scans.i Iti isi importanti toi rulei outi thei presencei ofi
thisi allergyi toi avoidi seriousi allergici reactionsi suchi asi anaphylaxis.
Whichi isi ai prerenali causei ofi AKI?
A.i Acutei glomerulonephritisi andi neoplasms
B.i Septici shocki andi nephrotoxici injuryi fromi medications
C.i Pyelonephritisi andi calculii formation
D.i Hypovolemiai andi myocardiali infarctioni -i
i i i i i i i i i Answer:i D
Rationale:i Severei bloodi lossi ori hypovolemiai relatedi toi cardiaci eventsi arei
majori causesi ofi prerenali acutei kidneyi injury.
Wheni thei patienti isi ini thei diuretici phasei ofi AKI,i thei nursei musti monitori
whichi serumi electrolytei imbalance?
A.i Hypokalemiai andi hyponatremiai
B.i Hypokalemiai andi hypernatremiai
C.i Hyperkalemiai andi hyponatremiai
D.i Hyperkalemiai andi hypernatremiai -i
i i i i i i i i i Answer:i C
Rationale:i Therei isi ai decreasedi excretioni ofi potassiumi andi ani increasei ini
sodiumi losses.
Thei nursei understandsi thati CKDi isi characterizedi byi whichi ofi thei following?
A.i Rapidi decreasei ini urinei outputi withi ai CKD-elevatedi BUN
B.i Progressivei irreversiblei destructioni toi thei kidneys
C.i Abrupti increasingi creatininei clearancei withi ai decreasei ini urinaryi output
D.i Confusioni andi somnolencei leadingi toi comai andi deathi -i
i i i i i i i i i Answer:i B
Rationale:i Chronici kidneyi diseasei (CKD)i isi progres-i sive,i irreversiblei lossi ofi
kidneyi function.i CKDi isi definedi asi thei presencei ofi kidneyi damagei ori ai
glomerulari filtrationi ratei lessi thani 60i ml/mini fori 3i monthsi ori longer.
Thei nursei understandsi CRRTi isi indicatedi fori whichi ofi thei followingi
patients?
A.i Ai hospitalizedi buti hemodynamicallyi stablei patienti B.i Ai hospitalized,i
hemodynamicallyi unstablei patient
C.i Ai hospitalizedi ESRDi patienti beingi dischargedi homei soon
D.i Ai hospitalizedi ESRDi patienti whoi isi stablei buti ini ani intensivei carei
settingi -i
i i i i i i i i i Answer:i B
Rationale:i CRRTi isi indicatedi fori thei unstablei patienti whoi mayi noti toleratei
thei rapidi fluidi shiftsi ofi HD.
Thei nursesi recognizesi thati thei elderlyi patienti mayi havei ai reducedi abilityi
toi concentratei urinei whichi isi attributedi toi whichi ofi thei following?
A.i Ai reductioni ini bladderi receptors
3i |i P a g e
, B.i Thickeningi ofi thei basementi membranei ofi thei Bowman'si capsule
C.i Ai decreasei ini thei numberi ofi functioningi nephrons
D.i Ai thickeningi ofi thei efferenti arteriolei -i
i i i i i i i i i Answer:i C
Rationale:i Thei elderlyi havei ai reducedi spacei ofi functioningi nephronsi whichi
impairsi thei abilityi toi concentratei urine.
Thei nursei shouldi intervenei immediatelyi ifi thei patienti posti renali
transplantationi isi notedi toi havei whichi ofi thei followingi symptoms?
A.i Weighti loss,i hypotension,i reducedi urinei output
B.i Fever,i reducedi urinei output,i elevatedi bloodi pressure
C.i Weighti gain,i hypotension,i increasedi urinei output
D.i Increasedi urinei output,i hypertension,i feveri -i
i i i i i i i i i Answer:i B
Rationale:i Fever,i reducedi urinei output,i andi elevatedi BPi mayi bei indicativei
ofi thei presencei ofi AKIi relatedi toi transplanti rejection.
Thei nursei includesi whichi dietaryi informationi ini thei teachingi plani abouti thei
managementi ofi chronici kidneyi disease?
A.i Decreasei fluidi intakei andi proteini intake,i decreasei carbohydratei intake
B.i Increasei fluidi intake,i decreasei carbohydratei intakei andi proteini intake
C.i Decreasei fluidi intakei andi proteini intake,i increasei carbohydratei intake
D.i Increasei fluidi intake,i increasei carbohydratei intakei andi proteini intakei -i
i i i i i i i i i Answer:i C
Rationale:i Iti isi importanti toi decreasei fluidi intake
becausei peoplei withi CKDi mayi havei ai reductioni in
urinei output,i causingi fluidi toi buildi upi ini thei body;i thisi putsi thei patienti
ati furtheri riski fori volumei overload.i Decreasingi proteini intakei willi limit
thei buildupi ofi wastei productsi ini thei body,i andi increasingi carbohydratesi willi
providei patientsi withi ai goodi sourcei ofi energyi thati isi losti withi thei low-
proteini diet.
Thei nursei shouldi informi thei physiciani if,i wheni assessingi thei patienti withi
ani AVi fistula,i theyi notei whichi ofi thei following?
A.i Ai loud,i turbulenti bruiti B.i Ai quieti swooshingi bruit
C.i Ai low-pitchedi thrilli D.i Ai continuousi thrilli -i
i i i i i i i i i Answer:i A
Rationale:i Ai normali functioningi grafti willi havei ai low-pitchedi bruit.i Ai
turbulenti bruiti isi indicativei ofi ani increasedi force,i mostlyi duei toi stenosis.
Thei nursei isi screeningi patienti fori theiri riski ofi developingi renali celli cancer.i
Thei nursei shouldi consideri whichi patienti ati greatesti risk?
A.i 76-year-oldi Africani Americani femalei
B.i 50-year-oldi Caucasiani male
C.i 24-year-oldi malei Caucasiani malei
D.i 50-year-oldi Africani Americani malei -i
i i i i i i i i i Answer:i D
Rationale:i Africani Americansi andi Americani Indiansi andi Alaskani nativesi havei
slightlyi higheri ratesi ofi RCCi thani whites;i thei exacti reasonsi arei unclear.i
RCCi isi twicei asi commoni ini meni thani women.i Thisi isi attributedi toi meni
4i |i P a g e
