Med-Surg Exam 2 (RENAL)
1. The nurse is admitting a client diagnosed with acute renal failure
(ARF). Which
question is most important for the nurse to ask during the admission
1. "Have you recently traveled outside the United
interview?
States?"
2. "Did you recently begin a vigorous exercise
3. "Is there a chance you have been exposed to a
program?"
virus?"
4. "What over-the-counter medications do you take regularly?" correct
Medications such as
answers4.
nonsteroidal
anti-inflammatory drugs (NSAIDs)
some herbal remedies are
and
nephrotoxic;
therefore, asking about
medications is
appropriat
e.
2. The nurse is caring for a client diagnosed with ARF. Which laboratory
values are
mos
tsignificant for diagnosing
ARF?
1. BUN and
2. WBC and
creatinine.
hemoglobin.
3. Potassium and
4. Bilirubin and ammonia level. correct answers1. Blood urea nitrogen
sodium.
(BUN) levels
reflec
the balance between the
productionofand
excretion urea from the
Creatinine is a by-product of the
kidneys.
metabolism
of the muscles and is
excreted
the kidneys.
by Creatinine is the ideal
substance
for determining renal
because it is relatively constant
clearance
in theand is the laboratory value
body
most
significant in diagnosing renal
failure.
3. The nurse is caring for a client diagnosed with rule-out ARF. Which
condition
predisposes the client to developing prerenal
1. Diabetes
failure?
mellitus.
2.
3.
Hypotension.
Aminoglycosides.
4. Benign prostatic hypertrophy. correct answers2. Hypotension, which
causes a
decrease
d
blood supply to the kidney, is one
most
of thecommon causes of prerenal
failure
(before the
kidney).
,4. The client is diagnosed with ARF. Which signs/symptoms indicate to the
nurse is
client thein the recovery period? Select all
that
1. apply. alertness and no seizure
Increased
2. Increase in hemoglobin and
activity.
hematocrit.
3. Denial of nausea and
4. Decreased urine-specific
vomiting.
gravity.
5. Increased serum creatinine level. correct
answers1,2,3
5. The client diagnosed with ARF has a serum potassium level of 6.8
mEq/L. Whichtreatment should the nurse anticipate for
collaborative
theAdminister
1. client? a phosphate
2. Type and crossmatch for whole
binder.
blood.
3. Assess the client for leg
4. Prepare the client for dialysis. correct answers4. Normal potassium
cramps.
levelmEq/L.
5.5 is 3.5 Atolevel of 6.8 mEq/L
threatening
is life and could lead to
cardiac
dysrhythmias. Therefore, the
be dialyzed
client may to decrease the
potassium
level quickly. This requires a
provider order, so it is a
health-care
collaborative
interventio
n.
6. The nurse is developing a plan of care for a client diagnosed with
ARF. Whichis an appropriate outcome for the
statement
client?
1. Monitor intake and output every
2. Decrease of pain by 3 levels on a 1-10
shift.
scale.
3. Electrolytes are within normal
4. Administer enemas to decrease hyperkalemia. correct answers3.
limits.
Renal failure
causes an imbalance
electrolytes (potassium, sodium,
of
calcium,
phosphorus). Therefore, the
client outcome is electrolytes
desired
within
normal
limits.
7. The client diagnosed with ARF is admitted to the intensive care unit and
placed on a diet. Which diet is most appropriate for
therapeutic
the
1. Aclient?
high-potassium and low-calcium
2. A low-fat and low-cholesterol
diet.
diet.
3. A high-carbohydrate and restricted-
4. A regular
protein diet. diet with six (6) small feedings a day. correct answers3.
Carbohydrates
increased to are
provide
for the client's caloric intake and
protein
is restricted to minimize
breakdown and to prevent
protein
accumulation
of toxic waste
products.
,8. The client diagnosed with ARF is placed on bedrest. The client asks the
nurse,
do I have
"Whyto stay in bed? I don't feel bad." Which scientific rationale
supports the
nurse's
1. Bedrest helps increase the blood return to the renal
response?
circulation.
2. Bedrest reduces the metabolic rate during the
acute
3. Bedrest
stage. decreases the workload of the left side of
theBedrest
4. heart. aids in reduction of peripheral and sacral edema. correct
answers2.
reduces exertion
Bedrestand
the
metabolic rate, thereby
catabolism and subsequent
reducing
release of and
potassium
accumulationwaste
endogenous of products (urea
and
creatinine
).
9. The nurse and an unlicensed assistive personnel (UAP) are caring for
clients on
medical floor.
a Which nursing task is most appropriate for the nurse to
delegate?
1. Collect a clean voided midstream urine
2. Evaluate the client's 8-hour intake and
specimen.
output.
3. Assist in checking a unit of blood prior to
4. Administer a cation-exchange resin enema. correct answers1. The UAP
hanging.
can collect
specimen
Collecting a midstream urine
s.
specimen
requires the client to clean the
perineal
area, to urinate a little, and then
collect
the rest of the urine output in a
containe
sterile
r.
10. The client is admitted to the emergency department after a gunshot
wound to the
abdomen. Which nursing intervention should the nurse implement first
to prevent
ARF?
1. Administer normal
saline
2. TakeIV.vital
signs.
3. Place client on
4. Assess abdominal dressing. correct answers1. Preventing and treating
telemetry.
shock and
blood withfluid
replacement
prevent acutewill
renal failure
hypoperfusion of the
from
Significant blood loss is
kidneys.
expected
the client in
with a gunshot
wound.
11. The UAP tells the nurse the client with ARF has a white crystal-like
layer
the on top
skin. of intervention should the nurse
Which
implement?
1. Have the assistant apply a moisture barrier cream to
2.
theInstruct
skin. the UAP to bathe the client in cool
water.
3. Tell the UAP not to turn the client in this
condition.
, 4. Explain this is normal and do not do anything for the client. correct
answers2.
crystals areThese
uremic frost
resulting
from irritating toxins deposited
in the tissues. Bathing in cool
client's
water
will remove the crystals, promote
comfort, and decrease the
client
itching
resulting from uremic
frost.
12. The client diagnosed with ARF is experiencing hyperkalemia. Which
should the nurse prepare to administer to help decrease the
medication
potassium level?
1.
2. Calcium
Erythropoietin.
gluconate.
3. Regular
4. Osmotic diuretic. correct answers3. Regular insulin, along with
insulin.
glucose,
will drive potassium into the
thereby lowering serum
cells,
potassium
levels
temporarily.
13. The nurse is caring for the client diagnosed with chronic kidney disease
(CKD)
is experiencing
who metabolic acidosis. Which statement best describes
the scientific
rationale for metabolic acidosis in this
1. There is an increased excretion of phosphates and organic acids, which
client?
leads to an
increase in arterial blood
2. A shortened life span of red blood cells because of damage secondary
pH.
to dialysis in turn leads to metabolic
treatments
3. The kidney cannot excrete increased levels of acid because they
acidosis.
cannot excrete
ammonia or cannot reabsorb sodium
4. An increase in nausea and vomiting causes a loss of hydrochloric
bicarbonate.
acid and thesystem cannot compensate adequately. correct answers3. This is
respiratory
the correct
scientific
rationale
for metabolic acidosis occurring
in the with
client
CKD.
14. The nurse in the dialysis center is initiating the morning dialysis run.
Which client
should the nurse assess
1. The client who has hemoglobin of 9.8 g/dL and hematocrit
first?
2.
of The
30%.client who does not have a palpable thrill or
auscultated
3. The clientbruit.
who is complaining of being exhausted and is
sleeping.
4. The client who did not take antihypertensive medication this
answers2. This client's dialysis
morning. correct
access is
compromised and he or she
should be
assessed
first.
15. The male client diagnosed with CKD has received the initial dose of
erythropoietin,
a biologic response modifier, 1 week ago. Which complaint by the
client
the need
indicates
to notify the health-care
provider?
1. The nurse is admitting a client diagnosed with acute renal failure
(ARF). Which
question is most important for the nurse to ask during the admission
1. "Have you recently traveled outside the United
interview?
States?"
2. "Did you recently begin a vigorous exercise
3. "Is there a chance you have been exposed to a
program?"
virus?"
4. "What over-the-counter medications do you take regularly?" correct
Medications such as
answers4.
nonsteroidal
anti-inflammatory drugs (NSAIDs)
some herbal remedies are
and
nephrotoxic;
therefore, asking about
medications is
appropriat
e.
2. The nurse is caring for a client diagnosed with ARF. Which laboratory
values are
mos
tsignificant for diagnosing
ARF?
1. BUN and
2. WBC and
creatinine.
hemoglobin.
3. Potassium and
4. Bilirubin and ammonia level. correct answers1. Blood urea nitrogen
sodium.
(BUN) levels
reflec
the balance between the
productionofand
excretion urea from the
Creatinine is a by-product of the
kidneys.
metabolism
of the muscles and is
excreted
the kidneys.
by Creatinine is the ideal
substance
for determining renal
because it is relatively constant
clearance
in theand is the laboratory value
body
most
significant in diagnosing renal
failure.
3. The nurse is caring for a client diagnosed with rule-out ARF. Which
condition
predisposes the client to developing prerenal
1. Diabetes
failure?
mellitus.
2.
3.
Hypotension.
Aminoglycosides.
4. Benign prostatic hypertrophy. correct answers2. Hypotension, which
causes a
decrease
d
blood supply to the kidney, is one
most
of thecommon causes of prerenal
failure
(before the
kidney).
,4. The client is diagnosed with ARF. Which signs/symptoms indicate to the
nurse is
client thein the recovery period? Select all
that
1. apply. alertness and no seizure
Increased
2. Increase in hemoglobin and
activity.
hematocrit.
3. Denial of nausea and
4. Decreased urine-specific
vomiting.
gravity.
5. Increased serum creatinine level. correct
answers1,2,3
5. The client diagnosed with ARF has a serum potassium level of 6.8
mEq/L. Whichtreatment should the nurse anticipate for
collaborative
theAdminister
1. client? a phosphate
2. Type and crossmatch for whole
binder.
blood.
3. Assess the client for leg
4. Prepare the client for dialysis. correct answers4. Normal potassium
cramps.
levelmEq/L.
5.5 is 3.5 Atolevel of 6.8 mEq/L
threatening
is life and could lead to
cardiac
dysrhythmias. Therefore, the
be dialyzed
client may to decrease the
potassium
level quickly. This requires a
provider order, so it is a
health-care
collaborative
interventio
n.
6. The nurse is developing a plan of care for a client diagnosed with
ARF. Whichis an appropriate outcome for the
statement
client?
1. Monitor intake and output every
2. Decrease of pain by 3 levels on a 1-10
shift.
scale.
3. Electrolytes are within normal
4. Administer enemas to decrease hyperkalemia. correct answers3.
limits.
Renal failure
causes an imbalance
electrolytes (potassium, sodium,
of
calcium,
phosphorus). Therefore, the
client outcome is electrolytes
desired
within
normal
limits.
7. The client diagnosed with ARF is admitted to the intensive care unit and
placed on a diet. Which diet is most appropriate for
therapeutic
the
1. Aclient?
high-potassium and low-calcium
2. A low-fat and low-cholesterol
diet.
diet.
3. A high-carbohydrate and restricted-
4. A regular
protein diet. diet with six (6) small feedings a day. correct answers3.
Carbohydrates
increased to are
provide
for the client's caloric intake and
protein
is restricted to minimize
breakdown and to prevent
protein
accumulation
of toxic waste
products.
,8. The client diagnosed with ARF is placed on bedrest. The client asks the
nurse,
do I have
"Whyto stay in bed? I don't feel bad." Which scientific rationale
supports the
nurse's
1. Bedrest helps increase the blood return to the renal
response?
circulation.
2. Bedrest reduces the metabolic rate during the
acute
3. Bedrest
stage. decreases the workload of the left side of
theBedrest
4. heart. aids in reduction of peripheral and sacral edema. correct
answers2.
reduces exertion
Bedrestand
the
metabolic rate, thereby
catabolism and subsequent
reducing
release of and
potassium
accumulationwaste
endogenous of products (urea
and
creatinine
).
9. The nurse and an unlicensed assistive personnel (UAP) are caring for
clients on
medical floor.
a Which nursing task is most appropriate for the nurse to
delegate?
1. Collect a clean voided midstream urine
2. Evaluate the client's 8-hour intake and
specimen.
output.
3. Assist in checking a unit of blood prior to
4. Administer a cation-exchange resin enema. correct answers1. The UAP
hanging.
can collect
specimen
Collecting a midstream urine
s.
specimen
requires the client to clean the
perineal
area, to urinate a little, and then
collect
the rest of the urine output in a
containe
sterile
r.
10. The client is admitted to the emergency department after a gunshot
wound to the
abdomen. Which nursing intervention should the nurse implement first
to prevent
ARF?
1. Administer normal
saline
2. TakeIV.vital
signs.
3. Place client on
4. Assess abdominal dressing. correct answers1. Preventing and treating
telemetry.
shock and
blood withfluid
replacement
prevent acutewill
renal failure
hypoperfusion of the
from
Significant blood loss is
kidneys.
expected
the client in
with a gunshot
wound.
11. The UAP tells the nurse the client with ARF has a white crystal-like
layer
the on top
skin. of intervention should the nurse
Which
implement?
1. Have the assistant apply a moisture barrier cream to
2.
theInstruct
skin. the UAP to bathe the client in cool
water.
3. Tell the UAP not to turn the client in this
condition.
, 4. Explain this is normal and do not do anything for the client. correct
answers2.
crystals areThese
uremic frost
resulting
from irritating toxins deposited
in the tissues. Bathing in cool
client's
water
will remove the crystals, promote
comfort, and decrease the
client
itching
resulting from uremic
frost.
12. The client diagnosed with ARF is experiencing hyperkalemia. Which
should the nurse prepare to administer to help decrease the
medication
potassium level?
1.
2. Calcium
Erythropoietin.
gluconate.
3. Regular
4. Osmotic diuretic. correct answers3. Regular insulin, along with
insulin.
glucose,
will drive potassium into the
thereby lowering serum
cells,
potassium
levels
temporarily.
13. The nurse is caring for the client diagnosed with chronic kidney disease
(CKD)
is experiencing
who metabolic acidosis. Which statement best describes
the scientific
rationale for metabolic acidosis in this
1. There is an increased excretion of phosphates and organic acids, which
client?
leads to an
increase in arterial blood
2. A shortened life span of red blood cells because of damage secondary
pH.
to dialysis in turn leads to metabolic
treatments
3. The kidney cannot excrete increased levels of acid because they
acidosis.
cannot excrete
ammonia or cannot reabsorb sodium
4. An increase in nausea and vomiting causes a loss of hydrochloric
bicarbonate.
acid and thesystem cannot compensate adequately. correct answers3. This is
respiratory
the correct
scientific
rationale
for metabolic acidosis occurring
in the with
client
CKD.
14. The nurse in the dialysis center is initiating the morning dialysis run.
Which client
should the nurse assess
1. The client who has hemoglobin of 9.8 g/dL and hematocrit
first?
2.
of The
30%.client who does not have a palpable thrill or
auscultated
3. The clientbruit.
who is complaining of being exhausted and is
sleeping.
4. The client who did not take antihypertensive medication this
answers2. This client's dialysis
morning. correct
access is
compromised and he or she
should be
assessed
first.
15. The male client diagnosed with CKD has received the initial dose of
erythropoietin,
a biologic response modifier, 1 week ago. Which complaint by the
client
the need
indicates
to notify the health-care
provider?
