Examz 5:z Kidneyz Disordersz (NCLEX)
Az patientz isz admittedz toz thez hospitalz withz CKD.z Thez nursez understandsz thatz
thisz conditionz isz characterizedz by
a.z progressivez irreversiblez destructionz ofz thez kidneys
b.z az rapidz decreasez inz urinez outputz withz anz elevatedz BUN
c.z anz increasingz creatininez clearancez withz az decreasez inz urinez output
d.z prostration,z somnolence,z andz confusionz withz comaz andz imminentz deathz -z
z z z z z z z z z z z z A
Patientsz withz CKDz experiencez anz increasez incidencez ofz cardiovascularz diseasez
relatedz toz Selectz allz thatz apply
a.z hypertension
b.z vascularz calcifications
c.z az geneticz predisposition
d.z hyperinsulinemiaz causingz dyslipidemia
e.z increasedz high-densityz lipoproteinz levelsz -z
z z z z z z z z z z z z ABD
Anz ESRDz patientz receivingz HDz isz consideringz askingz az relativez toz donatez az
kidneyz forz transplantation.z Inz assistingz thez patientz toz makez az decisionz aboutz
treatment,z thez nursez informsz thez patientz that
a.z successfulz transplantationz usuallyz providesz az betterz qualityz ofz lifez thanz thatz
offeredz byz dialysis
b.z ifz rejectionz ofz thez transplantedz kidneyz occurs,z noz furtherz treatmentz forz thez
renalz failurez isz available
c.z HDz replacesz thez normalz functionz ofz thez kidneys,z andz patientsz doz notz havez
toz livez withz thez continualz fearz ofz rejection
d.z thez immunosuppressivez therapyz followingz transplantationz makesz thez personz
ineligiblez toz receivez otherz formsz ofz treatmentz ifz thez kidneyz failsz -z
z z z z z z z z z z z z A
Toz assessz thez patencyz ofz az newlyz placedz arteriovenousz graftz forz dialysis,z thez
nursez shouldz Selectz allz thatz apply
a.z monitorz thez BPz inz thez affectedz arm
b.z irrigatez thez graftz dailyz withz low-dosez heparin
c.z palpatez thez areaz ofz thez graftz toz feelz az normalz thrill
d.z listenz withz az stethoscopez overz thez graftz toz detectz az bruit
e.z frequentlyz monitorz thez pulsesz andz neurovascularz statusz distalz toz thez graftz -z
z z z z z z z z z z z z CDE
Az majorz advantagez ofz peritonealz dialysisz is
a.z thez dietz isz lessz restrictedz andz dialysisz canz bez performedz atz home
1z |z P a g e
,b.z thez dialysatez isz biocompatiblez andz causesz noz long-termz consequences
c.z highz glucosez concentrationsz ofz thez dialysatez causesz az reductionz inz appetite,z
promotingz weightz loss
d.z noz medicationsz arez requiredz becausez ofz thez enhancesz efficiencyz ofz thez
peritonealz membranez inz removingz toxinsz -z
z z z z z z z z z z z z A
Az kidneyz transplantz recipientz complainsz ofz havingz fever,z chills,z andz dysuriaz
overz thez pastz 2z weeks.z Whatz isz thez firstz actionz thez nursez shouldz take?
a.z assessz temperaturez andz initiatez workupz toz rulez outz infection
b.z reassurez thez patientz thatz thisz isz commonz afterz transplantation
c.z providez warmz coverz forz thez patientz andz givez 1z gz acetaminophenz orally
d.z notifyz thez nephrologistz thatz thez patientz hasz developedz symptomsz ofz acutez
rejectionz -z
z z z z z z z z z z z z A
Inz replyingz toz az patient'sz questionsz aboutz thez seriousnessz ofz herz CKD,z thez
nursez knowsz thatz thez stagez ofz CKDz isz basedz onz what?
a.z totalz dailyz urinez output
b.z GFR
c.z degreez ofz alteredz mentalz status
d.z serumz creatininez andz ureaz levelsz -z
z z z z z z z z z z z z B
Thez patientz withz CKDz isz receivingz dialysis,z andz thez nursez observesz
excoriationsz onz thez patient'sz skin.z Whatz pathophysiologicz changesz inz CKDz
mostz likelyz occurz thatz canz contributez toz thisz finding?z Selectz allz thatz apply
a.z dryz skin
b.z sensoryz neuropathy
c.z vascularz calcifications
d.z calcium-phosphatez skinz deposits
e.z uremicz crystallizationz fromz highz BUNz -z
z z z z z z z z z z z z ABD
Whatz causesz thez GIz manifestationz ofz stomatitisz inz thez patientz withz CKD?
a.z highz serumz sodiumz levels
b.z irritationz ofz thez GIz tractz fromz creatinine
c.z increasedz ammoniaz fromz bacterialz breakdownz ofz urea
d.z ironz salts,z calcium-containingz phosphatez binders,z andz limitedz fluidz intakez -z
z z z z z z z z z z z z C
Thez patientz withz CKDz isz broughtz toz thez EDz withz Kussmaulz respirations.z
Whatz doesz thez nursez knowz aboutz CKDz thatz couldz causez thisz patient'sz
Kussmaulz respirations?
a.z uremicz pleuritisz isz occurring
2z |z P a g e
,b.z therez isz decreasedz pulmonaryz macrophagez activity
c.z theyz arez causedz byz respiratoryz compensationz forz metabolicz acidosis
d.z pulmonaryz edemaz fromz HFz andz fluidz overloadz isz occurringz -z
z z z z z z z z z z z z C
Whichz serumz laboratoryz valuez indicatesz toz thez nursez thatz thez patient'sz CKDz
isz gettingz worse?
a.z decreasedzBUN
b.z decreasedzsodium
c.z decreasedzcreatinine
d.z decreasedzcalculatedz GFRz -z
z z z z z z z z z z z z D
Whatz isz thez mostz seriousz electrolytez disorderz associatedz withz kidneyz disease?
a.z hypocalcemia
b.z hyperkalemia
c.z hyponatremia
d.z hypermagnesemiaz -z
z z z z z z z z z z z z B
Whatz isz thez mostz appropriatez snackz forz thez nursez toz offerz az patientz withz
stagez 4z CKD?
a.z raisins
b.z icez cream
c.z dillz pickles
d.z hardz candyz -z
z z z z z z z z z z z z D
Whichz complicationz ofz CKDz isz treatedz withz erythropoietin?
a.z anemia
b.z hypertension
c.z hyperkalemia
d.z mineralz andz bonez disorderz -z
z z z z z z z z z z z z A
Thez patientz withz CKDz isz consideringz whetherz toz usez PDz orz HD.z Whatz arez
advantagesz ofz PDz whenz comparedz toz HD?z Selectz allz thatz apply
a.z lessz proteinz loss
b.z rapidz fluidz removal
c.z lessz cardiovascularz stress
d.z decreasedz hyperlipidemia
e.z requiresz fewerz dietaryz restrictionsz -z
z z z z z z z z z z z z CE
3z |z P a g e
, Toz preventz thez mostz commonz seriousz complicationz ofz PD,z whatz isz mostz
importantz forz thez nursez toz do?
a.z infusez thez dialysatez slowly
b.z usez strictz asepticz techniquez inz thez dialysisz procedures
c.z havez thez patientz emptyz thez bowelz beforez thez inflowz phase
d.z repositionz thez patientz frequentlyz andz promotez deepz breathingz -z
z z z z z z z z z z z z B
Az manz withz ESRDz isz scheduledz forz HDz followingz healingz ofz anz
arteriovenousz fistula.z Whatz shouldz thez nursez explainz toz himz thatz willz occurz
duringz dialysis?
a.z hez willz bez ablez toz visit,z read,z sleep,z orz watchz TVz whilez recliningz inz az
chair
b.z hez willz bez placedz onz az cardiacz monitorz toz detectz anyz adversez effectsz thatz
mayz occur
c.z thez dialyzerz willz removez andz holdz partz ofz hisz bloodz forz 20-30z minutesz toz
removez thez wastez products
d.z az largez catheterz withz twoz lumensz willz bez insertedz intoz thez fistulaz toz sendz
bloodz toz andz returnz itz fromz thez dialyzerz -z
z z z z z z z z z z z z A
Az patientz rapidlyz progressingz towardz ESRDz asksz aboutz thez possibilityz ofz az
kidneyz transplant.z Inz respondingz toz thez patient,z thez nursez knowsz thatz whatz isz
az contraindicationz toz kidneyz transplantation?
a.z hepatitisz Cz infection
b.z coronaryz arteryz disease
c.z refractoryz hypertension
d.z extensivez vascularz diseasez -z
z z z z z z z z z z z z D
Duringz thez immediatez postoperativez carez ofz az recipientz ofz az kidneyz transplant,z
whatz isz az priorityz forz thez nursez toz do?
a.z regulatez fluidz intakez hourlyz basedz onz urinez output
b.z monitorz urine-tingedz drainagez onz abdominalz dressing
c.z medicatez thez patientz frequentlyz forz incisionalz flankz pain
d.z removez thez urinaryz catheterz toz evaluatez thez ureteralz implantz -z
z z z z z z z z z z z z A
Az patientz receivedz az kidneyz transplantz lastz month.z Becausez ofz thez effectsz ofz
immunosuppressivez drugsz andz CKD,z whatz complicationz ofz transplantationz shouldz
thez nursez bez assessingz thez patientz for?
a.z infection
b.z rejection
c.z malignancy
d.z cardiovascularz diseasez -z
4z |z P a g e
Az patientz isz admittedz toz thez hospitalz withz CKD.z Thez nursez understandsz thatz
thisz conditionz isz characterizedz by
a.z progressivez irreversiblez destructionz ofz thez kidneys
b.z az rapidz decreasez inz urinez outputz withz anz elevatedz BUN
c.z anz increasingz creatininez clearancez withz az decreasez inz urinez output
d.z prostration,z somnolence,z andz confusionz withz comaz andz imminentz deathz -z
z z z z z z z z z z z z A
Patientsz withz CKDz experiencez anz increasez incidencez ofz cardiovascularz diseasez
relatedz toz Selectz allz thatz apply
a.z hypertension
b.z vascularz calcifications
c.z az geneticz predisposition
d.z hyperinsulinemiaz causingz dyslipidemia
e.z increasedz high-densityz lipoproteinz levelsz -z
z z z z z z z z z z z z ABD
Anz ESRDz patientz receivingz HDz isz consideringz askingz az relativez toz donatez az
kidneyz forz transplantation.z Inz assistingz thez patientz toz makez az decisionz aboutz
treatment,z thez nursez informsz thez patientz that
a.z successfulz transplantationz usuallyz providesz az betterz qualityz ofz lifez thanz thatz
offeredz byz dialysis
b.z ifz rejectionz ofz thez transplantedz kidneyz occurs,z noz furtherz treatmentz forz thez
renalz failurez isz available
c.z HDz replacesz thez normalz functionz ofz thez kidneys,z andz patientsz doz notz havez
toz livez withz thez continualz fearz ofz rejection
d.z thez immunosuppressivez therapyz followingz transplantationz makesz thez personz
ineligiblez toz receivez otherz formsz ofz treatmentz ifz thez kidneyz failsz -z
z z z z z z z z z z z z A
Toz assessz thez patencyz ofz az newlyz placedz arteriovenousz graftz forz dialysis,z thez
nursez shouldz Selectz allz thatz apply
a.z monitorz thez BPz inz thez affectedz arm
b.z irrigatez thez graftz dailyz withz low-dosez heparin
c.z palpatez thez areaz ofz thez graftz toz feelz az normalz thrill
d.z listenz withz az stethoscopez overz thez graftz toz detectz az bruit
e.z frequentlyz monitorz thez pulsesz andz neurovascularz statusz distalz toz thez graftz -z
z z z z z z z z z z z z CDE
Az majorz advantagez ofz peritonealz dialysisz is
a.z thez dietz isz lessz restrictedz andz dialysisz canz bez performedz atz home
1z |z P a g e
,b.z thez dialysatez isz biocompatiblez andz causesz noz long-termz consequences
c.z highz glucosez concentrationsz ofz thez dialysatez causesz az reductionz inz appetite,z
promotingz weightz loss
d.z noz medicationsz arez requiredz becausez ofz thez enhancesz efficiencyz ofz thez
peritonealz membranez inz removingz toxinsz -z
z z z z z z z z z z z z A
Az kidneyz transplantz recipientz complainsz ofz havingz fever,z chills,z andz dysuriaz
overz thez pastz 2z weeks.z Whatz isz thez firstz actionz thez nursez shouldz take?
a.z assessz temperaturez andz initiatez workupz toz rulez outz infection
b.z reassurez thez patientz thatz thisz isz commonz afterz transplantation
c.z providez warmz coverz forz thez patientz andz givez 1z gz acetaminophenz orally
d.z notifyz thez nephrologistz thatz thez patientz hasz developedz symptomsz ofz acutez
rejectionz -z
z z z z z z z z z z z z A
Inz replyingz toz az patient'sz questionsz aboutz thez seriousnessz ofz herz CKD,z thez
nursez knowsz thatz thez stagez ofz CKDz isz basedz onz what?
a.z totalz dailyz urinez output
b.z GFR
c.z degreez ofz alteredz mentalz status
d.z serumz creatininez andz ureaz levelsz -z
z z z z z z z z z z z z B
Thez patientz withz CKDz isz receivingz dialysis,z andz thez nursez observesz
excoriationsz onz thez patient'sz skin.z Whatz pathophysiologicz changesz inz CKDz
mostz likelyz occurz thatz canz contributez toz thisz finding?z Selectz allz thatz apply
a.z dryz skin
b.z sensoryz neuropathy
c.z vascularz calcifications
d.z calcium-phosphatez skinz deposits
e.z uremicz crystallizationz fromz highz BUNz -z
z z z z z z z z z z z z ABD
Whatz causesz thez GIz manifestationz ofz stomatitisz inz thez patientz withz CKD?
a.z highz serumz sodiumz levels
b.z irritationz ofz thez GIz tractz fromz creatinine
c.z increasedz ammoniaz fromz bacterialz breakdownz ofz urea
d.z ironz salts,z calcium-containingz phosphatez binders,z andz limitedz fluidz intakez -z
z z z z z z z z z z z z C
Thez patientz withz CKDz isz broughtz toz thez EDz withz Kussmaulz respirations.z
Whatz doesz thez nursez knowz aboutz CKDz thatz couldz causez thisz patient'sz
Kussmaulz respirations?
a.z uremicz pleuritisz isz occurring
2z |z P a g e
,b.z therez isz decreasedz pulmonaryz macrophagez activity
c.z theyz arez causedz byz respiratoryz compensationz forz metabolicz acidosis
d.z pulmonaryz edemaz fromz HFz andz fluidz overloadz isz occurringz -z
z z z z z z z z z z z z C
Whichz serumz laboratoryz valuez indicatesz toz thez nursez thatz thez patient'sz CKDz
isz gettingz worse?
a.z decreasedzBUN
b.z decreasedzsodium
c.z decreasedzcreatinine
d.z decreasedzcalculatedz GFRz -z
z z z z z z z z z z z z D
Whatz isz thez mostz seriousz electrolytez disorderz associatedz withz kidneyz disease?
a.z hypocalcemia
b.z hyperkalemia
c.z hyponatremia
d.z hypermagnesemiaz -z
z z z z z z z z z z z z B
Whatz isz thez mostz appropriatez snackz forz thez nursez toz offerz az patientz withz
stagez 4z CKD?
a.z raisins
b.z icez cream
c.z dillz pickles
d.z hardz candyz -z
z z z z z z z z z z z z D
Whichz complicationz ofz CKDz isz treatedz withz erythropoietin?
a.z anemia
b.z hypertension
c.z hyperkalemia
d.z mineralz andz bonez disorderz -z
z z z z z z z z z z z z A
Thez patientz withz CKDz isz consideringz whetherz toz usez PDz orz HD.z Whatz arez
advantagesz ofz PDz whenz comparedz toz HD?z Selectz allz thatz apply
a.z lessz proteinz loss
b.z rapidz fluidz removal
c.z lessz cardiovascularz stress
d.z decreasedz hyperlipidemia
e.z requiresz fewerz dietaryz restrictionsz -z
z z z z z z z z z z z z CE
3z |z P a g e
, Toz preventz thez mostz commonz seriousz complicationz ofz PD,z whatz isz mostz
importantz forz thez nursez toz do?
a.z infusez thez dialysatez slowly
b.z usez strictz asepticz techniquez inz thez dialysisz procedures
c.z havez thez patientz emptyz thez bowelz beforez thez inflowz phase
d.z repositionz thez patientz frequentlyz andz promotez deepz breathingz -z
z z z z z z z z z z z z B
Az manz withz ESRDz isz scheduledz forz HDz followingz healingz ofz anz
arteriovenousz fistula.z Whatz shouldz thez nursez explainz toz himz thatz willz occurz
duringz dialysis?
a.z hez willz bez ablez toz visit,z read,z sleep,z orz watchz TVz whilez recliningz inz az
chair
b.z hez willz bez placedz onz az cardiacz monitorz toz detectz anyz adversez effectsz thatz
mayz occur
c.z thez dialyzerz willz removez andz holdz partz ofz hisz bloodz forz 20-30z minutesz toz
removez thez wastez products
d.z az largez catheterz withz twoz lumensz willz bez insertedz intoz thez fistulaz toz sendz
bloodz toz andz returnz itz fromz thez dialyzerz -z
z z z z z z z z z z z z A
Az patientz rapidlyz progressingz towardz ESRDz asksz aboutz thez possibilityz ofz az
kidneyz transplant.z Inz respondingz toz thez patient,z thez nursez knowsz thatz whatz isz
az contraindicationz toz kidneyz transplantation?
a.z hepatitisz Cz infection
b.z coronaryz arteryz disease
c.z refractoryz hypertension
d.z extensivez vascularz diseasez -z
z z z z z z z z z z z z D
Duringz thez immediatez postoperativez carez ofz az recipientz ofz az kidneyz transplant,z
whatz isz az priorityz forz thez nursez toz do?
a.z regulatez fluidz intakez hourlyz basedz onz urinez output
b.z monitorz urine-tingedz drainagez onz abdominalz dressing
c.z medicatez thez patientz frequentlyz forz incisionalz flankz pain
d.z removez thez urinaryz catheterz toz evaluatez thez ureteralz implantz -z
z z z z z z z z z z z z A
Az patientz receivedz az kidneyz transplantz lastz month.z Becausez ofz thez effectsz ofz
immunosuppressivez drugsz andz CKD,z whatz complicationz ofz transplantationz shouldz
thez nursez bez assessingz thez patientz for?
a.z infection
b.z rejection
c.z malignancy
d.z cardiovascularz diseasez -z
4z |z P a g e
