NURS 432 Renal Review Questions With Complete
Solutions
A 100-kg patient gets hemodialysis 3 days a week.
In planning the care for this patient, the
nurse recommends
a. a diet of 2500 to 3500 kcal per day.
b. protein intake of less than 50 grams per day.
c. potassium intake of 10 mEq per day.
d. fluid intake of less than 500 mL per day. Correct
Answers ANS: A
Nutritional recommendations include the following:
caloric intake of 25 to 35 kcal/kg of
ideal body weight per day (2500 to 3500 kcal) and
protein intake of no less than 0.8 g/kg
body weight. Patients who are extremely catabolic
such as those on hemodialysis should
receive protein in the amount of 1.5 to 2 g/kg of
ideal body weight per day, 75% to 80% of
which contains all the required essential amino
acids; sodium intake of 0.5 to 1.0 g/day;
potassium intake of 20 to 50 mEq/day; calcium
intake of 800 to 1200 mg/day; fluid intake
equal to the volume of the patient's urine output
plus an additional 600 to 1000 mL/day.
DIF: Cognitive Level: Apply/Application REF: p. 431
OBJ: Develop a plan of care for the patient with
acute kidney injury.
TOP: Nursing Process Step: Implementation
,MSC: NCLEX Client Needs Category: Physiological
Integrity
A 70-kg adult with chronic renal failure is on a 40-g
protein diet. The client has a reduced glomerular
filtration rate and is not undergoing dialysis. Which
result would give the nurse the most concern?
a. Albumin level of 2.5 g/dL
b. Phosphorus level of 5 mg/dL
c. Sodium level of 135 mmol/L
d. Potassium level of 5.5 mmol/L Correct Answers
A
Protein restriction is necessary with chronic renal
failure due to the buildup of waste products from
protein breakdown. The nurse would be concerned
with the low albumin level since this indicates that
the protein in the diet is not enough for the client's
metabolic needs. The electrolyte values are not
related to the protein-restricted diet.
A client has a long history of hypertension. Which
category of medications would the nurse expect to
be ordered to avoid chronic kidney disease (CKD)?
a. Antibiotic
b. Histamine blocker
c. Bronchodilator
d. Angiotensin-converting enzyme (ACE) inhibitor
Correct Answers D
ACE inhibitors stop the conversion of angiotensin I
to the vasoconstrictor angiotensin II. This category
,of medication also blocks bradykinin and
prostaglandin, increases renin, and decreases
aldosterone, which promotes vasodilation and
perfusion to the kidney. Antibiotics fight infection,
histamine blockers decrease inflammation, and
bronchodilators increase the size of the bronchi;
none of these medications helps slow the
progression of CKD in clients with hypertension.
A client has a serum potassium level of 6.5 mmol/L,
a serum creatinine level of 2 mg/dL, and a urine
output of 350 mL/day. What is the best action by
the nurse?
a. Place the client on a cardiac monitor
immediately.
b. Teach the client to limit high-potassium foods.
c. Continue to monitor the client's intake and
output.
d. Ask to have the laboratory redraw the blood
specimen. Correct Answers A
The priority action by the nurse should be to check
the cardiac status with a monitor. High potassium
levels can lead to dysrhythmias. The other choices
are logical nursing interventions for acute kidney
injury but not the best immediate action.
A client has just had a central line catheter placed
that is specific for hemodialysis. What is the most
appropriate action by the nurse?
, a. Use the catheter for the next laboratory blood
draw.
b. Monitor the central venous pressure through this
line.
c. Access the line for the next intravenous
medication.
d. Place a heparin or heparin/saline dwell after
hemodialysis. Correct Answers D
The central line should have a heparin or
heparin/saline dwell after hemodialysis treatment.
The central line catheter used for dialysis should
not be used for blood sampling, monitoring central
venous pressures, or giving drugs or fluids.
A client in the intensive care unit is started on
continuous venovenous hemofiltration (CVVH).
Which finding is the cause of immediate action by
the nurse?
a. Blood pressure of 76/58 mm Hg
b. Sodium level of 138 mEq/L
c. Potassium level of 5.5 mEq/L
d. Pulse rate of 90 beats/min Correct Answers A
Hypotension can be a problem with CVVH if
replacement fluid does not provide enough volume
to maintain blood pressure. The specially trained
nurse needs to monitor for ongoing fluid and
electrolyte replacement. The sodium level is
normal and the potassium level is slightly elevated,
which could be normal findings for someone with
Solutions
A 100-kg patient gets hemodialysis 3 days a week.
In planning the care for this patient, the
nurse recommends
a. a diet of 2500 to 3500 kcal per day.
b. protein intake of less than 50 grams per day.
c. potassium intake of 10 mEq per day.
d. fluid intake of less than 500 mL per day. Correct
Answers ANS: A
Nutritional recommendations include the following:
caloric intake of 25 to 35 kcal/kg of
ideal body weight per day (2500 to 3500 kcal) and
protein intake of no less than 0.8 g/kg
body weight. Patients who are extremely catabolic
such as those on hemodialysis should
receive protein in the amount of 1.5 to 2 g/kg of
ideal body weight per day, 75% to 80% of
which contains all the required essential amino
acids; sodium intake of 0.5 to 1.0 g/day;
potassium intake of 20 to 50 mEq/day; calcium
intake of 800 to 1200 mg/day; fluid intake
equal to the volume of the patient's urine output
plus an additional 600 to 1000 mL/day.
DIF: Cognitive Level: Apply/Application REF: p. 431
OBJ: Develop a plan of care for the patient with
acute kidney injury.
TOP: Nursing Process Step: Implementation
,MSC: NCLEX Client Needs Category: Physiological
Integrity
A 70-kg adult with chronic renal failure is on a 40-g
protein diet. The client has a reduced glomerular
filtration rate and is not undergoing dialysis. Which
result would give the nurse the most concern?
a. Albumin level of 2.5 g/dL
b. Phosphorus level of 5 mg/dL
c. Sodium level of 135 mmol/L
d. Potassium level of 5.5 mmol/L Correct Answers
A
Protein restriction is necessary with chronic renal
failure due to the buildup of waste products from
protein breakdown. The nurse would be concerned
with the low albumin level since this indicates that
the protein in the diet is not enough for the client's
metabolic needs. The electrolyte values are not
related to the protein-restricted diet.
A client has a long history of hypertension. Which
category of medications would the nurse expect to
be ordered to avoid chronic kidney disease (CKD)?
a. Antibiotic
b. Histamine blocker
c. Bronchodilator
d. Angiotensin-converting enzyme (ACE) inhibitor
Correct Answers D
ACE inhibitors stop the conversion of angiotensin I
to the vasoconstrictor angiotensin II. This category
,of medication also blocks bradykinin and
prostaglandin, increases renin, and decreases
aldosterone, which promotes vasodilation and
perfusion to the kidney. Antibiotics fight infection,
histamine blockers decrease inflammation, and
bronchodilators increase the size of the bronchi;
none of these medications helps slow the
progression of CKD in clients with hypertension.
A client has a serum potassium level of 6.5 mmol/L,
a serum creatinine level of 2 mg/dL, and a urine
output of 350 mL/day. What is the best action by
the nurse?
a. Place the client on a cardiac monitor
immediately.
b. Teach the client to limit high-potassium foods.
c. Continue to monitor the client's intake and
output.
d. Ask to have the laboratory redraw the blood
specimen. Correct Answers A
The priority action by the nurse should be to check
the cardiac status with a monitor. High potassium
levels can lead to dysrhythmias. The other choices
are logical nursing interventions for acute kidney
injury but not the best immediate action.
A client has just had a central line catheter placed
that is specific for hemodialysis. What is the most
appropriate action by the nurse?
, a. Use the catheter for the next laboratory blood
draw.
b. Monitor the central venous pressure through this
line.
c. Access the line for the next intravenous
medication.
d. Place a heparin or heparin/saline dwell after
hemodialysis. Correct Answers D
The central line should have a heparin or
heparin/saline dwell after hemodialysis treatment.
The central line catheter used for dialysis should
not be used for blood sampling, monitoring central
venous pressures, or giving drugs or fluids.
A client in the intensive care unit is started on
continuous venovenous hemofiltration (CVVH).
Which finding is the cause of immediate action by
the nurse?
a. Blood pressure of 76/58 mm Hg
b. Sodium level of 138 mEq/L
c. Potassium level of 5.5 mEq/L
d. Pulse rate of 90 beats/min Correct Answers A
Hypotension can be a problem with CVVH if
replacement fluid does not provide enough volume
to maintain blood pressure. The specially trained
nurse needs to monitor for ongoing fluid and
electrolyte replacement. The sodium level is
normal and the potassium level is slightly elevated,
which could be normal findings for someone with
